Interview Basics Flashcards
OLD CAAARTS
Onset Location Duration Characterize Associated symptoms Alleviating factors Aggravating factors Radiating Timing Scale
NURS
NAME the patient’s expressed emotions
Make and UNDERSTANDING statement
RESPECT the patient (praise them, acknowledge plight)
Offer SUPPORT
Paralanguage
Speech rate Pauses Pause to speech ratio Tone or voice quality Pitch Volume Articulation
Functions of Pauses
Absolute recall time Language formation time Censorship of material Creating and effect (timing) Preparing to lie
Word Choice
Professional
An atomic terms
Clear
Avoid medicalese
Doctor-Centered Skills
Medications (Rx, OTC, herbals, vitamins)
Allergies (to medications) (and effect)
PMH: other active problems (identified by doctor or the patient) problems in the past that have resolved
PSH: operations or invasive procedures in the past
Social History
Demographics and occupational history Nutrition and diet Daily activities and exercise Alcohol, tobacco, and recreational drug use Spirituality and beliefs Relationships Sexual history (sometimes)
Demographics
Age Gender Race or ethnic background Religion/spirituality Residence
Occupational History
Do you work outside your home?
What kind of work do you do?
Tell me what your job is like for you?
What other jobs have you held in the past?
Have you ever had exposure to fumes, chemicals, dust, loud noises, or radiation?
Do you think anything at work or home is affecting your symptoms now?
Nutrition and Diet
How would you describe your every day diet?
Patients often give “best case scenarios”
Patients respond differently to different physicians regarding these questions
Food habits are EXTREMELY SENSITIVE topics for many patients
Daily Activities and Exercise
CDC recommends adults get 150 min/week of moderate activity (brink walking) and strength training 2 days/week that focuses on all major muscle groups
Tobacco Use
Smoking linked to cardiovascular events, cancer, lung disease
Most smokers know they should quit
Most ex-smokers tried to quit 7-8 times before success
Pack years = number of packs smoked per day x number of years smoked
Alcohol Use
CAGE questions
Screen patient’s who drink more than one drink daily or who drink a lot on the weekends
If a patient is a daily drinker, can’t say “just quit” - could go through DTs (seizure activity) - need medical support
NIAAA Safe Drinking Limits
Men: 14 or fewer drinks/week, no more than 4 drinks/day
Women & those over 65: 7 drinks/week, nor more than 3 drinks/day
CAGE Questions
Has anyone ever suggested you CUT BACK?
Are you ever ANNOYED when people talk to you about your drinking?
Do you ever feel GUILTY about your drinking?
Do you ever need a drink in the morning to steady your nerves (an EYE OPENER)?
Recreational Drug Use
Truth-telling is an issue
May be tolerate of and/or addicted to prescription pain/anxiety meds
Establishing confidentiality is important
Important to know resources in your communities
Drugs can exacerbate certain health issues
Ask if they have used any prescription or nonprescription or street drug to “get high” in the past 12 months
Spirituality and Religion
Spirituality does not always mean religion
Spirituality - where do you go to get your strength
Spirituality does not require belief in a higher power
Do you feel supported by any specific faith community?
Is spirituality important to you?
Relationships
Living environment
Support system
Domestic violence
Partnering
Living Environment
Who do you share a home with? Friends Children Spouse or romantic partner Extended family
Support System
Who can you count on to help you if your have a problem? May be people they share a home with Co-workers Church family Neighbors Friends For some, sadly, "nobody"
Domestic Violence
Be careful when screening for domestic violence
Remember there is emotional warfare, too: words can hurt
SAFE
SAFE
Stress/Safety
Afraid/Abused
Friends/Family
Emergency Plan
Partnering
Life patterns can be husbands, wives, girlfriends, boyfriends, or friends
Marriage is not a requirement for people to spend their lives together
Living together is not a requirement for people to spend their lives together
Sexual intercourse is not a requirement for people to spend their lives together
Sexual History
Open ended first, then get more specific
Remain non-judgmental in choice of words, tone, facial expression, body language
Five P’s
Partners Prevention of Pregnancy Protection from STDs Practices Past History of STDs
Partners
Do you have sex with men, women, or both?
In the past 2 months, how many partners have you had sex with?
In the past 12 months, how many partners have you had sex with?
Is it possible that any of your sex partners in the past 12 months had sex with someone else while they were still in a sexual relationship with you?
Prevention of Pregnancy
What are you doing to prevent pregnancy?
Protection from STDs
What do you do to protect yourself from STDs and HIV?
Practices
To understand your risk for STDs, I need to understand the kind of sex you have had recently.
Have you had vaginal sex, meaning ‘penis in vagina sex’?
Do you use condoms: never, sometimes, or always?
Have you had anal sex, meaning ‘penis in rectum/anus’ sex?
Do you use condoms: never, sometimes, or always?
Have you had oral sex, meaning ‘mouth on penis/vagina’?
If never: why don’t you use condoms?
If sometimes: in what situations (or with whom) do you not use condoms?
Past History of STDs
Have you ever had an STD?
Have any of your partners had an STD?
Additional questions to identify HIV and viral hepatitis risk:
Have you or any of your partners ever injected drugs?
Review of Systems (ROS)
14 body systems
Sort of like “associated symptoms” but questions are more important for ruling in or out other important disease processes (other than the chief complaint)
Associated Symptoms vs ROS
Associated symptoms are symptoms that may be related to the chief complaint
ROS is about making sure the clinician ins’t missing something ELSE that might do a patient harm
Delivering Bad News
The warning shot No euphemisms No timelines Non-anxious presence Use silence effectively
“I want to make sure you understood, tell me what you heard”
Patient-Centered Skills
Set the stage for the interview
Obtain the patient’s agenda
Obtain the HPI
Obtain more about the HPI
