H&P Final Study Guide Flashcards
What does CBC stand for?
Complete blood count
What does WBC stand for?
White blood cell count
Includes: neutrophils, lymphocytes
What does RBC stand for? What does it include?
Indices: MHC, MCHC, MCV Hemoglobin
Hematocrit
Platelets
RDW
What does BMP stand for? What are examples?
Basic Metabolic Panel
Renal -> BUN, Creatinine
Electrolytes -> Calcium, CO2, Chloride, Glucose, Potassium, Sodium
What does CMP stand for?
Complete Metabolic Panel
What does BMP with Liver Tests include?
Function Indicators -> PROTEIN
Albumin
Damage Indicators -> ENZYMES
Alkaline Phosphatase, ALT, AST, Bilirubin
What does PO stand for?
Taken orally
What does PR stand for?
Taken rectally
What does IV stand for?
Intravenous
What does IVP stand for?
Intravenous push
What does Q day stand for?
Once a day
What does Bid, tid, qid indicate?
2, 3, 4 times a day
What does Q 6 hrs mean?
Every 6 hours
What does Gtts, dppr stand for?
Drops, dropperfuls
What does Prn stand for?
As needed
What is the importance of open-ended questions?
Open-ended questions require that the physician appears relaxed and ready to listen regardless of the amount of pressure from other patients or other duties
Most useful in the beginning of the interview
Allows patient to tell story spontaneously
What can open ended questions not be answered with?
Yes and no
What do we need to explain the use of the computer for?
EMR
Specific questions require…
Specific answers, and rarely anything more and are of more value in dealing with the verbose or rambling patient
What are examples of open ended questions?
How are you feeling today, what brought you in today, tell me about your pain, etc.
After open-ended Q’s, interviewers move onto…
Direct questions
What are the importance of direct questions?
Clarifies and adds detail.
Leaves little room for explanation.
Can usually be answered in one word or with a brief response.
What are examples of open-ended questions?
Where does it hurt? When do you get the pain? Which side is the pain?
Should an interviewer stand or sit?
Seated at least the same level as patient; patient can be slightly elevated
How far should an interviewer sit?
It is generally preferred that the interviewer sit at a distance of about 3 – 4 feet from the patient.
Distance > 5 feet = impersonal
Distance < 3 feet = interferes with “Private space”.
What does tense indicate?
Erect with a fairly rigid posture
What does moderately relaxed indicate?
Forward 20 or side 10 degrees
What does very relaxed indicate?
Back 20 or side 10 degrees
What will allow for higher patient satisfaction?
Higher patient satisfaction - forward body lean and rotation of the torso toward the patient
What will cause a better response from physician?
Better response to physicians who support their head with hands on their chin versus physicians who elevate their chin without support
What are the goals of a patient encounter?
Establish a relationship with the patient
Gather information
Develop a diagnosis and treatment plan
Relate information to the patient
What is the principle organ of expression?
Eyes
What is best expressed with eyes?
Sincerity
What is the best method for sincerity?
Frequent eye contact
Patient are most comfortable…
when the physician looks at them approximately 50% of the time
When is a patient uncomfortable?
Eye contact is avoided
What is eye contact most accurate for? What is it least accurate for?
Most accurate -> fear
Least accurate -> anger or disgust
What is a micro-expression valuable for?
Indicator of masking or deception
Most facial expressions last…
More than 1 second
What is a micro-expression?
Very brief facial expressions, lasting only a fraction of a second. They occur when a person either deliberately or unconsciously conceals a feeling.
What is a macro-expression?
Normal expressions usually last between 1⁄2-second and 4 seconds. They often repeat, and fit with what is said and the sound of the person’s voice.
When do micro-expressions occur?
Micro-expressions occur when the patient begins to show a true facial expression, senses this and immediately neutralizes or masks the expression (lasting only a fraction of a second)
What must be done before entering the room?
Knock
What do we use to greet the patient?
Last name
How do we introduce ourselves?
“Good morning, Mrs. Smith, I’m student doctor Bob Jones”
“Good morning, Mrs. Todd, I’m Jim Smith, a third-year medical student and how are you today?”
What must be asked early in the interview?
Ask the patient what they would prefer to be called. Studies have shown that 90% plus of patients prefer to be addressed by their first names
When can summarization be done?
While typing soap note
What is the importance of summarization?
Summarization assures that both parties are using the same definitions and minimizes inappropriate assumptions
“Let me see if I have understood you correctly”
“Am I understanding this correctly?”
What are some important points about the conclusion?
30-40%, forget to mention to the physician all of their medical concerns.
In order to avoid leaving gaps in the history or allowing patient concerns to go unattended, conclude each interview with:
“Is there anything else bothering you today that we haven’t discussed?” “Is there anything else you would like to mention?”
“Is there anything else that we have not discussed?”
“Did we touch on everything today?”
What is the importance of the cuff size?
The most common mistake is to use a cuff that is too small, which will result in an overestimation of the pressure
What is the proper positioning of blood pressure?
Is vital in obtaining accurate blood pressure readings
In general, blood pressure should be measured while you are seated comfortably
The arm being used should be relaxed, uncovered, and supported at the level of the heart
What are the importances of technique for BP?
Cuff directly over the skin
Position cuff 2.5 cm (1 inch) above antecubital
Center bladder of cuff over brachial artery
DEFLATE THE CUFF SLOWLY @ a rate of 2-3 mmHg/sec
The first Kartokoff’s sound is…
Systolic pressure
What is the point of which the last sound is heard?
Diastolic pressure
What are the 5 Kartokoff’s sounds?
1st: rhythmic tapping which gradually increases in intensity
2nd: soft, swishing sound (turbulent flow)
3rd: sharp crisper sound
4th: muffled, soft
5th: silence
What is palpated for pulse?
Radial artery
What should we not use for pulse?
Thumb
How do we calculate pulse?
RATE: Count number of pulses for 15 seconds and multiply by 4. Normal: 60-100 bpm
Bradycardia: Slow Heart <60 bpm
Tachycardia: Swift Heart > 100 bpm
When do we find respiration?
After taking pulse
What should we not tell patient during respirations?
That you are taking respirations
What is the technique for respirations?
Respirations: Count the number of breaths for 30 seconds and multiply by 2
Normal - Adults at rest 12 - 20
What are the three questions for BP?
Ask if patient has been seated for 5 minutes
* Inquire about nicotine and caffeine use in the last 30 minutes
* Inquire about restrictions in taking blood pressures in either arm
– NOT preferences
Stethoscope binaurals should be positioned…
Forward
What is eupnea?
Normal breathing
12 to 20 bpm
What is bradypnea?
Slow breathing
< 12 bpm
What is tachypnea?
Rapid breathing
> 20 bpm
What is the most common temperature assessment?
Oral
What are the 4 components of SOAP note?
SUBJECTIVE: Chief Complaint
OBJECTIVE: What health provider observes or
measures.
ASSESSMENT: Possible etiologies of patients
problems (differential diagnosis)
Plan: What will health provider do for patients
problems.
