Interviewing as a screening tool Flashcards

1
Q

Do’s of interviewing

A

Extend small courtesies

Use a sequence of questions that begins with open-ended questions

Leave close-ended questions for the end of interviewing to clarify

Select a private location for confidentiality

Undivided attention; re-assuring comments; eye contact

Ask one question at a time, allow time for patient to respond

Encourage patient to ask questions

Listen with attention of assessing patient’s current level of understanding and knowledge of his/her condition

Eliminate unnecessary info and speak at patient’s level of understanding

Correlate signs and symptoms with medical history and objective findings to rule-out systemic disease

Provide several choices/selections to questions that require descriptive response

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2
Q

Don’ts of interviewing

A

Jump to pre-mature conclusions based on answers to one or two questions

Interrupt or take over conversation when client speaking

Destroy helpful open-ended questions with closed-ended follow-up questions before patient has chance to respond

Use professional or medical jargon when it is possible to use common language

Overreact to info presented by the patient (including facial expressions)

Use leading questions
- Where is your pain?
(Do you have pain associated with your injury, if so tell me about it)
- Does it hurt when you first get out of bed?
(When does your back hurt?)
- Does the pain radiate down your leg?
(Do you have this pain anywhere else)
- Do you have pain in your lower back?
(Point to the exact location of your pain)

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3
Q

What are different racial or ethnic designations?

A

American Indian/Alaska Native

Asian

Black/African American

Hispanic or Latino (of any race)

Native Hawaiian/Pacific Islander

White/Caucasian

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4
Q

What are important aspects of cultural competency while interviewing?

A

Wait until patient is finished speaking before interrupting or asking questions

Allow “wait time” for some cultures (English could be 2nd language)

Be aware that eye-contact, body-space boundaries, even handshaking may differ from culture to culture

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5
Q

Keys to successful interactions via interpreter

A

Choose a competent medical interpreter

Interpreter who is older than the patient important in some cultures

Info about client’s diagnosis and condition is relayed to head of household in some cultures who makes decisions for members of family (Muslim)

Listen to interpreter, but direct gaze at patient

Watch body language while speaking for cues

Head nodding and smiling does not necessarily mean that the patient understands you

Keep remarks simple and short

Avoid using medical jargon

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6
Q

What are the topics of data that can be gleaned from a client history?

A

General demographics

Medical/Surgical history

Current conditions/Chief complaints

Functional status and activity level

Medications

Other clinical tests

Family history

Social/Health habits (past and current)

General health status (self-report, family report, caregiver report)

Living environment

Growth and development

Employment/work (job/school/play)

Social history

FIGURE 2.1

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7
Q

What age and sex is related to Guillain Barre syndrome?

A

Any age (hx of infection/alcoholism)

Men > Women

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8
Q

What age and sex is related to Multiple sclerosis?

A

15-35 y.o.

Women > Men

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9
Q

What age and sex is related to Rotator cuff degeneration?

A

30+ y.o.

No difference between sexes

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10
Q

What age and sex is related to spinal stenosis?

A

60+ y.o.

Men > Women

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11
Q

What age and sex is related to Tietze’s syndrome?

A

Before 40 y.o., including children

No differences between sexes

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12
Q

What age and sex is related to Costochondritis?

A

40+ y.o.

Women > Men

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13
Q

What age and sex is related to Neurogenic claudication?

A

40-60 y.o.

No difference between sexes

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14
Q

What age and sex is related to AIDS/HIV?

A

20-49 y.o.

Men > Women

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15
Q

What age and sex is related to Ankylosing spondylitis?

A

15-30 y.o.

Men > Women

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16
Q

What age and sex is related to abdominal aortic aneurism?

A

40-70 y.o.

(Hypertensive) Men > Women

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17
Q

What age and sex is related to Buerger’s disease?

A

20-40 y.o. (smokers)

Men > Women

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18
Q

What age and sex is related to cancer?

A

Any age; incidence rises over age of 50 y.o.

Men > Women

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19
Q

What age and sex is related to Breast cancer?

A

45-70 y.o.

Women > Men

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20
Q

What age and sex is related to Hodgkin’s disease?

A

20-40, 50-60 y.o

Men > Women

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21
Q

What age and sex is related to Osteoid osteoma?

A

10-20 y.o.

Men > Women

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22
Q

What age and sex is related to Pancreatic carcinoma?

A

50-70 y.o.

Men > Women

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23
Q

What age and sex is related to RA?

A

20-50 y.o.

Women > Men

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24
Q

What age and sex is related to skin cancer?

A

Rarely before puberty; increased incidence with age

Men = women

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25
What age and sex is related to Gallstones?
40+ y.o. Women > Men
26
What age and sex is related to Gout?
40-59 y.o. Men > Women
27
What age and sex is related to Gynecologic conditions?
20-45 y.o. Women
28
What age and sex is related to Paget's disease of the bone?
60+ y.o. Men > Women
29
What age and sex is related to Prostatitis?
40+ y.o. Men
30
What age and sex is related to Primary biliary cirrhosis?
40-60 y.o. Women > Men
31
What age and sex is related to Reiter's syndrome?
20-40 y.o. Men > Women
32
What age and sex is related to Renal tuberculosis?
20-40 y.o. Men > Women
33
What age and sex is related to Rheumatic fever?
4-9; 18-30 y.o. Girls > Boys
34
What age and sex is related to Shingles?
60+ y.o.; increasing incidence with age No difference between sexes
35
What age and sex is related to Spontaneous pneumothorax?
20-40 y.o. Men > Women
36
What age and sex is related to Systemic backache?
45+ y.o. No difference between sexes
37
What age and sex is related to Thyroiditis?
30-50 y.o. Women > Men
38
What age and sex is related to Vascular claudication?
40-60+ y.o. No difference between sexes
39
What are the life cycles of a woman?
Premenes (before start of monthly menstrual cycle; may include early puberty) Reproductive years (including birth, delivery, miscarriage, and/or abortion history; the time period may include puberty) Perimenopause (usually begins with obvious symptoms in the mid-30s and continues until symptoms of menopause occur) Menopausal (may be a natural or surgical menopause) Postmenopausal (cessation of blood flow associated with menstrual cycle)
40
What are the clinical signs and symptoms of MENOPAUSE?
Fatigue and malaise Depression, mood swings Difficulty concentrating: "brain fog" Headache Altered sleep pattern (insomnia/sleep disturbance) Hot flashes Irregular menes, cessation of menes Vaginal dryness, pain during intercourse Atrophy of breasts and vaginal tissue Pelvic floor relaxation (Cystosele/rectocele) Urge incontinence
41
What are the PHYSICAL clinical signs and symptoms of EATING DISORDERS?
Weight loss or gain Skeletal myopathy and weakness Chronic fatigue Dehydration or rebound water retention; pitting edema Discoloration or staining of the teeth from contact with stomach acid Broken blood vessels in the eyes from induced vomiting Enlarged parotid glands from repeated contact with vomit Tooth marks, scratches, scars, or calluses on back of hands from induced vomiting (Russell's sign) Irregular or absent menstrual periods; delay of menes onset in young adolescent girls Inability to tolerate cold Dry skin and hair; brittle nails, hair loss and growth of downy hair all over the body, including face Reports of heartburn, abdominal bloating or gas, constipation, or diarrhea Vital signs: slow HR, low BP In women/girls: irregular or absent menstrual cycles
42
What are the BEHAVIORAL clinical signs and symptoms of EATING DISORDERS?
Preoccupation with weight, food, calories, fat grams, dieting, clothing size, body shape Mood swings, irritability Binging and purging (bulimia) or food restriction (anorexia); frequent visits to the bathroom after eating Frequent comments about being fat or overweight despite looking very thin Excessive exercise to burn off calories Use of diuretics, laxatives, enemas, or other drugs to induce urination, bowel movements, and vomiting
43
What are the physiologic effects/adverse reactions to CAFFEINE (Coffee, expresso, chocolate, OTC "alert aids," black tea, red bull, etc)?
Vasoconstriction Irritability Enhanced pain perception Intestinal disorders Headaches Muscle tension Fatigue Sleep disturbances Urinary frequency Tachypenia Sensory disturbances Agitation Nervousness Heart palpitation
44
What are the physiologic effects/adverse reactions to CANNABIS (Marijuana, hashish)?
Short-term memory loss Sedation Tachycardia Euphoria Increased appetite Relaxed inhibitions Fatigue Paranoia Psychosis Ataxia, tremor
45
What are the physiologic effects/adverse reactions to DEPRESSANTS (Alcohol, sedatives/sleeping pills, barbiturates, tranquilizers)?
Agitation, mood swings, anxiety, depression Vasodilation; red eyes Fatigue Altered pain perception Excessive sleepiness/insomnia Coma (over-dose) Altered behavior Slow, shallow breathing Clammy skin Slurred speech
46
What are the physiologic effects/adverse reactions to NARCOTICS (Heroine, opium, morphine, codeine)?
Euphoria Drowsiness Respiratory depression
47
What are the physiologic effects/adverse reactions to STIMULANTS (Cocaine and its derivatives, amphetimines, methamphetimine, ecstasy)?
Increased alertness Excitation Euphoria Loss of appetite Increase in BP Insomnia Increase in pulse Agitation, increase in body temperature, hallucinations, convulsions, death
48
What are the physiologic effects/adverse reactions to TOBACCO (Cigarettes, cigars, pipe smoking, smokeless tobacco products)?
Increase in HR Vasoconstriction Decreased oxygen to heart Increase in risk of thrombosis Loss of appetite Poor wound healing Poor bone grafting Increased risk of pneumonia Increased risk of cataracts Disk degeneration
49
What are the clinical signs and symptoms of alcohol use disorders in older adults?
Memory loss or cognitive impairment (new onset or worsening of previous condition) Depression or anxiety Neglect of hygiene and appearance Poor appetite and nutritional deficits Sleep disruption Refractory (resistant) hypertension Blood glucose control problems Refractory seizures Impaired gait, balance, and falls Recurrent gastritis and esophagitis Difficulty managing warfarin dosing
50
What are the clinical signs and symptoms of alcohol withdrawal?
Agitation Headache Insomnia Hallucinations Anorexia, nausea, vomiting, diarrhea Loss of balance, incoordination (apraxia) Seizures (occurs 12-48 hrs after the last drink) Delirium tremens (occurs 2-3 days after last drink) Motor hyperactivity, tachycardia Elevated BP
51
Risk factors for falls secondary to AGE CHANGES
Muscle weakness; loss of joint motion (especially LEs) Abnormal gait Impaired or abnormal balance Impaired proprioception or sensation Delayed muscle response/increased reaction time Decreased systolic BP Stooped or forward bent posture
52
Risk factors for falls secondary to ENVIRONMENTAL/LIVING CONDITIONS
Poor lighting Throw rugs, loose carpet, complex carpet designs Cluster of electric wires or cords Stairs without handrails Bathroom without grab bars Slippery floors Restraints Use of alcohol or other drugs Footwear, especially slippers
53
Risk factors for falls secondary to PATHOLOGIC CONDITIONS
Vestibular disorders; episodes of dizziness or vertigo from any cause Orthostatic hypotension (especially before breakfast) Chronic pain condition Neuropathies Cervical myelopathy Osteoarthritis; RA Visual or hearing impairment; multifocal eyeglasses; change in perception of color; loss of depth perception; decreased contrast sensitivity Cardiovascular disease Urinary incontinence Central nervous system disorders (stroke, PD, MS) Motor disturbance Osteopenia, osteoporosis Pathologic fractures Any mobility impairments Cognitive impairment; dementia; depression
54
Risk factors for falls secondary to MEDICATIONS
Antianxiety; benzodiazepines Anticonvulsants Antidepressants Antihypertensives Antipsychotics Diuretics Narcotics Sedative-hypnotics Phenothiazines Use of more than four medications (polypharmacy/hyperpharmacology)
55
Risk factors for falls secondary to OTHER
History of falls Female sex; postmenopausal status Living alone Elder abuse/assault Nonambulatory status (requires transfers) Gait changes (decreased stride length or speed) Postural instability; reduced postural control Fear of falling; history of falls Dehydration from any cause Recent surgery (general anesthesia, epidural) Sleep disorder/disturbance; sleep deprivation; daytime drowsiness; brief disorientation after waking up from a nap
56
What is INTRINSIC trauma?
Unguarded movement that can occur during normal motion Ex: patient who reaches to the back of a cupboard while turning his or her head away from the extended arm to reach the last inch or two--a sudden pop or twinge experienced with subsequent pain
57
What is EXTRINSIC trauma?
Force or load external to the body is exerted against the body Trauma we typically think of
58
What is ASSAULT trauma?
Domestic abuse-type trauma Any physical, sexual, or psychologic attack (verbal, emotional, economic) Violence against women Must be able to identify the signs of abuse
59
What is ABUSE?
Infliction of physical or mental injury, or the depravation of food, shelter, clothing, or services needed to maintain physical or mental health
60
What is SEXUAL ABUSE?
Sexual assault, sexual intercourse without consent, indecent exposure, deviate sexual conduct, or incest; adult using a child for sexual gratification without physical contact is considered sexual abuse
61
What is NEGLECT?
Failure to provide food, shelter, clothing, or help with daily activities needed to maintain physical of mental well-being; client often displays signs of poor hygiene, hunger, or inappropriate clothing
62
What is MATERIAL EXPLOITATION?
Unreasonable use of a person, power of attorney, guardianship, or personal trust to obtain, control of the ownership, use, benefit, or possession of the person's money, assets, or property by means of deception, duress, menace, fraud, undue influence, or intimidation
63
What is MENTAL ABUSE?
Impairment of a person's intellectual or psychologic functioning or well-being
64
What is EMOTIONAL ABUSE?
Anguish inflicted through threats, intimidation, humiliation, and/or isolation; belittling, embarrassing, blaming, rejecting behaviors from adult toward child; withholding love, affection, approval
65
What is PHYSICAL ABUSE?
Physical injury resulting in pain, impairment, or bodily injury of any bodily organ or function, permanent or temporary disfigurement, or death
66
What is SELF-NEGLECT?
Individual is not physically or mentally able to obtain and perform the daily activities of life to avoid physical or mental injury
67
What are the risk factors and red flags for domestic violence?
Women with disabilities Cognitively impaired adult Chronically ill and dependent adult (especially over 75 y.o.) Chronic pain clients Physical and/or sexual abuse history (men and women) Daily headache Previous history of many injuries and accidents (including multiple MVAs) Somatic disorders - Injury seems inconsistent with client's explanation; injury in a child that is not consistent with the child's developmental level - Injury takes much longer to heal than expected Pelvic floor problems - Incontinence - Infertility - Pain Recurrent unwanted pregnancies History of alcohol abuse in a male partner
68
What are warning signs of elder abuse?
Multiple trips to the emergency department Depression "Falls"/Fractures Bruising/suspicious sores Malnutrition/weight loss Pressure ulcers Changing physicians/therapists often Confusion attributed to dementia
69
What are the clinical signs and symptoms of domestic violence: PHYSICAL CUES
Bruises, black eyes, malnutrition Sprains, dislocations, foot injuries, fractures in various stages of healing Skin problems Chronic or migraine headaches Diffuse pain, vague or non-specific symptoms Chronic or multiple injuries in various stages of healing Vision and hearing loss Chronic low back, sacral, or pelvic pain Temporomandibular joint pain (TMJ) Dysphagia and easy gagging Gastrointestinal disorders Patchy hair loss, redness, or swelling over the scalp from violent hair pulling Easily startled, flinching when approached
70
What are the clinical signs and symptoms of domestic violence: SOCIAL CUES
Continually missing appointments; won't return phone calls, unable to talk on phone Bringing all of the children to the clinic Spouse, companion, or partner always accompanying patient Changes physicians often Multiple visits to the ER Multiple car accidents
71
What are the clinical signs and symptoms of domestic violence: PSYCHOLOGIC CUES
Anorexia/bulimia Panic attacks, nightmares, phobias Hypervigilance, tendency to startle easily or be very guarded Substance abuse Depression, anxiety, insomnia Self-mutilation or suicide attempts Multiple personality disorders Mistrust of authority figures Demanding, angry, distrustful of healthcare provider
72
What are the risk factors for adverse drug reactions?
Age (over 65 y.o., especially over 75 y.o.) Small physical size of stature Sex (men and women respond differently) Polypharmacy/hyperpharmacotherapy Prescribing cascade (failure to recognize signs and symptoms of an ADE and treating it as the onset of a new illness) Taking meds prescribed to someone else Organ impairment and dysfunction Concomitant alcohol consumption Concomitant use of certain nutraceuticals Previous history of ADEs Mental deterioration or dementia Difficulty opening medication bottles, difficulty swallowing, unable to read or understand directions Racial/ethnic variations
73
Clinical signs and symptoms of NSAID Complications: GI
May be asymptomatic May cause confusion and memory loss in older adults Indigestion, heartburn, epigastric or abdominal pain Esophagitis, dysphagia, odynophagia Nausea Unexplained fatigue lasting more than 1-2 weeks Ulcers (gastric, duodenal), perforations, bleeding Melena
74
Clinical signs and symptoms of NSAID Complications: RENAL
Polyuria, nocturia Nausea, pallor Edema, dehydration Muscle weakness, restless leg syndrome
75
Clinical signs and symptoms of NSAID Complications: INTEGUMENTARY
Pruritis (symptom of renal impairment) Delayed wound healing Skin reaction to light (photodermatitis)
76
Clinical signs and symptoms of NSAID Complications: CARDIOVASCULAR
Elevated BP Peripheral edema Asthma attacks in individuals with asthma
77
Clinical signs and symptoms of NSAID Complications: MSK
Increase symptoms after taking medication Symptoms linked with ingestion of food (increased or decreased depending on ulcer location) Midthoracic back, shoulder, or scapular pain Neuromuscular Muscle weakness (sign of renal impairment) Restless leg syndrome (sign of renal impairment) Paresthesias (sign of renal impairment)
78
What are the risk factors for NSAID Gastropathy?
Back, shoulder, neck, or scapular pain in any client taking NSAIDs in the presence of the following risk factors for NSAID-induced gastropathy raises a red flag of suspicion: - Age ( > 65 y.o.) - History of peptic ulcer disease, GI disease, or RA - Tobacco or alcohol use - NSAIDs combined with oral corticosteroid use - NSAIDs combined with anticoagulants - NSAIDs combined with selective serotonin re-uptake inhibitors - Chronic use of NSAIDs ( > 3 months) - Higher doses of NSAIDs, including the use of more than one NSAID - Concomitant infection with Heliobactor pylori - Use of acid suppressants; these agents may mask the warning symptoms of more serious GI complications, leaving the patient unaware of ongoing damage
79
What are the clinical signs and symptoms of anabolic steroid use?
Rapid weight gain Elevated BP Peripheral edema associated with increased BP Acne on face and upper body Muscular hypertrophy Stretch marks around the trunk Abdominal pain, diarrhea Needle marks in large muscle groups Personality changes (aggression, mood swings, "roid" rages) Bladder irritation, urinary frequency, UTIs Sleep apnea, insomnia Altered ejection fraction (lower end of normal: under 55%)
80
WHAT IS ON PAGES 50-51???
GENERAL HEALTH INFO, | READ IT!!
81
What is the effect of NSAIDs (Naprosyn, Motrin, Anaprox, ibuprofen) on BP?
INCREASE IN BP NSAIDs can be renal vasoconstrictors causing and increase in BP; resultant LE edema as sodium and water are conserved by body
82
Most of the information needed to determine the cause of symptoms is contained in what?
SUBJECTIVE EXAM It is well documented that 80% or more of info needed to determine cause of symptoms is gathered during interview with patient
83
With what final question should you always end an interview?
"Is there anything else you think I should know?"
84
A risk factor for NSAID-related gastropathy is the use of what?
ANTIDEPRESSANTS
85
After interviewing a new client, you summarize what she has told you by saying, "You told me you are here because of right neck and shoulder pain that began 5 years ago as a result of a car accident. You also have a 'pins and needles' sensation in your third and fourth fingers but no other symptoms at this time. You have noticed a considerable decrease in grip strength, and you would like to be able to pick up a pot of coffee without fear of spilling it." WHAT IS THIS SCENARIO AN EXAMPLE OF?
PARAPHRASING TECHNIQUE
86
True of false? Screening for alcohol use would be appropriate when the client reports a history of accidents.
True
87
What is the significance of "sweats?"
SIGN OF SYSTEMIC DISEASE SIDE EFFECT OF CHEMOTHERAPY OR OTHER MEDS POOR VENTILATION WHILE SLEEPING
88
True or false? Spontaneous uterine bleeding after 12 consecutive months w/o menstrual bleeding requires medical referral
TRUE Includes women who have experienced surgical menopause (oophorectomy for ovarian cancer) or postmenopausal women not taking hormone replacements
89
What are red flags to consider when screening for systemic or viscerogenic causes of neuromuscular and musculoskeletal S&S?
FEVER, (NIGHT) SWEATS, DIZZINESS SYMPTOMS OUT OF PROPORTION TO INJURY INSIDIOUS ONSET NO POSITION OF COMFORT
90
A 52 year-old man with LBP and sciatica on the left side has been referred to you by his family physician. He has had a disectomy and laminectomy on two separate occasions about 5-7 years ago. No imaging studies have been performed since that time. What follow-up questions would you want to ask to screen for medical disease?
"Did you actually see your physician?" "Are you having any other symptoms of any kind that you have not mentioned yet" (checking for constitutional symptoms)
91
What physiologic effect associated with risk of HTN should be assessed for patients receiving NSAIDs?
WATER RETENTION Look for sacral and pedal edema
92
How should you proceed with patients with a history of HTN and arthritis?
INFORM THEIR PRIMARY CARE PROVIDER OF BOTH CONDITIONS Also screen for potential adverse effects of NSAIDs and can monitor BP
93
Alcohol screening tools should be...?
Brief, easy to administer, and non-threatening