History taking Flashcards
Why can taking a history from older people be challenging (4)?
- Confusion
- Delirium
- Dementia
- Agitation
- Coma - Sensory problems
- Hard of hearing
- Poor vision - Language
- Dysphasia – expressive or receptive (disorder of language)
- Dysarthria (disorder of speech)
- Other speech problems
- Other languages - Environmental
- Time of day
- Noisy wards
What is delirium? How is it characterised?
NICE describes delirium (acute confusional state) as a clinical syndrome characterised by:
- Disturbed consciousness, cognitive function or perception
- which has an acute onset and fluctuating course
- Inattention
How are delirium and dementia similar and different?
Delirium is a treatable condition and may co-exist with dementia. However, it is sometimes difficult to recognise in people with dementia because it has similar symptoms such as confusion and difficulties with thinking and concentration.
Delirium can last for a few days, weeks or even months but it may take longer for people with dementia to recover
How do you quickly check for confusion?
Abbreviated mental test score:
- Year
- DOB
- Age
- Place
Despite confusion, what should you still ask about in a patient?
They may not remember why they came to hospital but should be able to tell you how they feel i.e. chest pain, cough, urinary symptoms
What 6 things do you need to remember when working with an older patient with confusion and agitation?
- Be calm
- Smile and communicate
- Defuse the situation
- Reorientation
- Distraction
- Be safe
What are some things you can do to take a history from someone with sensory problems?
- Hearing (4)
- Vision (2)
Hearing
- Environment
- Hearing aids
- Speak slowly and clearly
- Try writing
Vision
- Environment
- Glasses
What can you do to help when taking a history from someone with language problems?
- Assess speech!
- Speak slowly and clearly
- Seek help from SALT
- Try writing
- Interpreter
Do not diagnosis confusion if they are dysphasic
What is a vital thing to do when taking a history from an older patient?
Take a collateral
Who should you get your collateral history from?
What should you enquire in your collateral history?
From someone who spends time with them and has seen them recently
Get a linear story from them. What could the patient do:
- 2 weeks ago
- 6 months ago
- 1 year ago
When a patient comes in with a fall, what do you need to ask about? (5)
- Ask them describe the exact events
- Where?
- When?
- What did you fall on?
- Recovery - Symptoms
- Syncope, presyncope, SOB, chest pain, palpitations, leg weakness, leg pain, dizziness, trip, slip or pushed! - If they can’t remember the events have a high suspicion that they blacked out
- Witness history
- Seizure and post ictal
- Sweaty, pale with brief LOC and quick recovery
- Balance
- Environment
- Gait - How they felt before, during and after the event
What are the 3 types of dizziness?
- Vertigo
- True sensation of room or patient rotating - Light headedness
- Pre-syncope – funny feeling, sweaty, pale, need to sit down - Unsteady (dysequilibrium)
- Unsteady, off balance
Important to differentiate because different dizziness have different tests and different treatments
If you suspect a UTI, what do you need to ask about?
Ask about symptoms
Positive symptoms include:
- Frequency
- Dysuria
- Urgency
- New incontinence
What symptoms are not associated with UTIs?
Being smelly
Being old
Being a woman
Dark urine
What 3 words should you not use?
- Acopia
- Mechanical fall
- Poor historian
