Exam 1 / Week 2 Health Assessment Flashcards
List the 7 dimensions of symptom analysis.
If you like the OLDCART order, look in parenthesis.
- Location (L)
- Quality (C)
- Quantitative Aspects (C)
- Chronology (O, D, T)
- Setting
- Aggravating & Alleviating Factors (A, R)
- Related Symptoms or Manifestations
* **What does this problem mean to you?
Which questions should you ask when prompted by “location,” a dimension of symptom analysis?
Where is the symptom located?
Can the patient point to a region of body? Is discomfort close to the surface or is it “inches inside?” Superficial or deep? Does it spread? Is the area large or small? Does it go anywhere/ radiate?
Which questions should you ask when prompted by “quality,” a dimension of symptom analysis?
What is/was it like?
Was it like something you ever felt before? Is it “like” something else that may be familiar, e.g. whirling on carousel? If vague description, “What do you mean by __________?”
Which questions should you ask when prompted by “quantitative aspects,” a dimension of symptom analysis?
A-F
A. Intensity»_space;> “How intense is it on a scale of 1 - 10?” “How severe (was) is it?”
C. Frequency»_space;> “How often?”
B. Degree of impairment»_space;> “How many stairs can you climb?” “Describe a typical day.” “How did your problem limit you or interfere with your life?”
D. Volume»_space;> “How much blood did you spit up?” “What do you mean by a lot, a cup or teaspoon?”
F. Size or extent»_space;> “How large?”
E. Number»_space;> “How many?”
Which questions should you ask when prompted by “chronology,” a dimension of symptom analysis?
When did the symptom begin and what course has it followed? (Ask for calendar dates and check times)
***It is very important to establish chronology and may require persistent focusing later in the interview. Always investigate associations that patient uses in remembering data.
A. Time of onset (When did it start? How did it start?)
B. Duration (How long did it last?)
C. Periodicity and frequency (Did it get better or worse with time?)
D. Course of symptoms
Which questions should you ask when prompted by “setting,” a dimension of symptom analysis?
Under what circumstances does it take place? Relate to events, “Where are you?” “What were you doing?” The patient must be a) Somewhere, b) Doing something, and c) Relating or wishing to relate to someone. You may later expand in investigation of family history, personal and social history.
Which questions should you ask when prompted by “aggravating and alleviating factors,” a dimension of symptom analysis?
“What makes it worse/or better?” “What did you do to try to help it?” “Anything else tried?”
More specifically, what activities or influencing factors can be stated? (e.g. physical exertion, eating, avoiding food, like “What effect does walking have?”)
Which questions should you ask when prompted by “related symptoms or manifestations,” a dimension of symptom analysis?
What other symptoms or phenomena are associated with the presenting problem? Can a symptom complex be formulated? What other symptoms occur?
In addition to the seven dimensions of symptom analysis, what other questions might you ask your patient?
WHAT DOES THIS PROBLEM MEAN TO YOU? Permits patient to verbalize an emotional response. What is the impact of severity?
TIPS FOR INTERVIEWING. What information should you include when introducing yourself to your patient?
Introduce yourself (first and last name and title: MUSC student nurse) and your role/ purpose of the interview. *Remember the MUSC "AIDET" mnemonic? Acknowledge, Introduce, Duration, Explaination, & Thank You (be professional!)
TIPS FOR INTERVIEWING. After introducing yourself, what must you do next?
Attend to the patient’s comfort.
TIPS FOR INTERVIEWING. Once the patient is made comfortable, how should you compose yourself?
It is oftentimes appropriate to be at the same level as your patient (sit down in a chair). Maintain an open posture. Use eye contact to enhance client comfort. Be aware of cultural and gender variations.
TIPS FOR INTERVIEWING. How should questions be formatted – usually.
Always begin with open-ended questions and allow the client adequate time to answer. Questions are primarily directed to the areas relevant to the concern. Avoid asking more than one question at a time or using leading or why questions.
TIPS FOR INTERVIEWING. How should you respond to a patient who is talking fast/giving A LOT of information?
When dealing with a large amount of information, ask some direct or forced choice questions to narrow in on the cues that require further elaboration. Avoid repetition of questions resulting in duplication of information, except for purposes of clarification or summarization. Use segment summaries – restate the content / feeling and check for accuracy. This allows you to verify or clarify the information and ensure that no pertinent information was omitted.
TIPS FOR INTERVIEWING. How should you respond if your patient is relatively quiet/not particularly forthcoming with information?
Be attentive to client and avoid interrupting the client. Use a head nod, “mm-hm”. Use intermittent positive social reinforcement, e.g. occasional appropriate smile. Use silence to facilitate client’s expression of thoughts and feelings. Ask “what else” to ascertain all major concerns. Convey empathy using these skills: reflection, legitimating, respect, support, and partnership.
