L1: Foundations of Health Assessment 1 Flashcards
What is the best type of question type to start off with when meeting your pt?
- Open ended, followed by closed if needed.
What is the screening acronyn for partner violence/domestic violence?
- HITS o H: hurt o I: insult o T: threaten o S: scream
What skills are on the listening skills checklist?
- Non-verbal cues - Watch for and respond to clues - Collaborate - Avoid repeating questions - Legitimize concerns
When assessing for illicit drug use/abuse, what are the acronyms to keep in mind?
- CAGE: o C: concern o A: annoyed o G: guilty o E: eye opener - CRAFFT: o C: car (been in car driven by someone under influence?) o R: relax (used to relax?) o A: alone (use alone?) o F: forget (while using?) o F: family/friend (ever asked you to cut down?) o T: trouble (gotten into?)
When is an inventory history used?
related to complete history, but not as detailed
Explain the ‘4 Cs’ method of assessing pt-clinician communication.
- Call: What does the pt call their problem? - Cause: What does the pt think caused/contributed to their problem? - Concern: What concerns the pt the most that needs to be addressed? - Cope: What is the pt currently doing to cope with their problem?
What are the various history types that can be obtained?
- Comprehensive (complete, expanded, new patient) - Focused (aka problem oriented, basic) - Inventory - Interim
Explain the ‘Ask Me 3’ method of assessing pt-clinician communication.
- Encourages pt to understand: - What their main problem is - What they need to do - Why it is important for them to do that
Characteristics of Leading question
- risky for of questions (can loose out / limit on information returned by pt) - to be avoided
Different questionnaires:
- Challenging pt - Sexual history - Mental health history - Alcohol, rx and illicit drugs - Partner violence / domestic violence - Death and dying
When is a focused history used?
- used with established pt (previously comprehensive exam done) - urgent/sick care - focused concerns or symptoms - restricted to a specific body system - exam methods relevant to assessing the concern/problem
Types of interview questions:
- Open-ended - Direct or closed - Graded response - Leading - Multiple
When is a complete history used?
- used with new pt - for getting to know the pt - to develop provider/pt relationship - identifying / ruling out physical causes related to chief complaint - baseline for future assessment - platform for health promotion - proficiency in essential skills of PEX
When assessing for alcohol abuse, what are the acronyms to keep in mind?
- CAGE: o C: concern o A: annoyed o G: guilty o E: eye opener - TACE: o T: take (how many drinks to feel buzzed?) o A: annoyed (by other ppls criticism) o C: cut o E: eye opener
What are the various interview techniques that can be used during history taking?
- Facilitation: verbal, non verbal, encourages pt to say more (nodding, mmm) - Reflection: repeat what pt said - Clarification: what do you mean? - Reassurance: without false hope - Empathy: verbal or non-verbal - Confrontation: if pt exhibits disturbing behavior - Interpretation: restate and confirm - Validation: acknowledge and legitimize - Summarization - Transitions
Explain the Alcohol, rx and illicit drugs questionnaire
- understanding if pt has addiction, physical dependence or tolerance to etoh, rx and / or illicit drugs - use acronyms: CAGE, TACE, MAST, ACEDIT, CRAFFT - CAGE: o C: concern o A: annoyed o G: guilty o E: eye opener - TACE: o T: take (how many drinks to feel buzzed?) o A: annoyed (by other ppls criticism) o C: cut o E: eye opener - CRAFFT: (used to determine abuse by adolescents) o C: car (been in car driven by someone under influence?) o R: relax (used to relax?) o A: alone (use alone?) o F: forget (while using?) o F: family/friend (ever asked you to cut down?) o T: trouble (gotten into?)
What skills are on the verbal skills checklist?
- Clear and appropriate volume (lower voice for pts with hearing loss) - Avoid medical jargon - Start with open-ended questions, closed if needed - Redirect as needed
What is a medical history?
- An organized method of data collection using the presenting concern and past history to help develop a differential diagnosis
Characteristics of Graded response question
answer has multiple defined responses that are typically quantitative
Characteristics of Multiple questions
used by novice, avoid as pt typically only remembers the last thing asked (run risk of limiting information returned by pt)
Explain the Death and dying questionnaire
- questions to ask pt about EOL, advanced directives, living wills, POA, DNR, health proxy
How do you show empathy during an interview/pt encounter?
- Be compassionate and sympathetic - Make eye contact - Listen - Show interest - Be concerned - Consider pts current life situation and impact on what is being discussed on their life
Explain the ‘Teach Back’ method of assessing pt-clinician communication.
- Involves having the pt what was explained to them in their own words - Checks for understanding with pt through their own verbalization - Promotes adherence, quality and safety
Explain the Mental health history questionnaire
- asking pt if they have had problem with emotional mental illness(es), if they have been seen by counselor or therapist, if they or anyone if their family has been treated / hospitalized for emotional or mental health problem, if pt has depression / thought disorders then a careful history should be taken – used acronym SIGECAPS: - S: sleep change, I: interest loss, G: guilt feeling, E: energy loss, C: cognition/concentration change, A: appetite decline leading to weight loss typically, P: psychomotor ie. Anxiety, lethargy, S: suicidal thoughts
What are 3 methods to assess pt-clinician communication?
- Ask me 3 - Teach back - 4 Cs
What are things to consider about regarding professionalism to a pt encounter?
- Dress/appearance - Concern for pt - Compassion, kindness - Confidence, not arrogance - Confidentiality (HIPAA) - Ethics - Practice what you preach
Characteristics of open-ended question
- used when seeking general information - beginner interviewer uses this style
Explain the need for partner violence/domestic violence questionnaire
- if there are clues to phys/sexual abuse seen, such as: unexplained injuries, delayed treatment, history of repeated accidents, etoh/drug use in pt or partner, dominates visits, pregnancy at young age/multiple partners, infections/STIs, trouble walking/sitting indicative of possible genital / anal pain, vaginal lacerations/bruises, fear of pelvic exam/physical contact, fear of leaving exam room - use HITS acronym to screen o H: hurt o I: insult o T: threaten o S: scream
Explain the Challenging patient questionnaire
- pt is: silent, confusing, altered, talkative, is crying, is angry/disruptive, language barrier, lower literacy (including health literacy), hearing loss, impaired vision, limited intelligence, personal problems, is seductive
When is an interim history used?
- means to chronicle events bw visits - pt hasn’t seen provider in a while, used as fill-in
Explain the sexual history questionnaire
- asking pt about when they were last physically intimate, if contact included intercourse, if they have sex with men, women or both, number of sexual partners in the past x timeframe, if they use protection, if they have concerns about HIV/AIDs and other STDs?
Characteristics of Direct or closed question
- used when seeking specific facts - outlines chief complaint and past history for basis of question
What are the four Cs of communication?
- courtesy - comfort - connection - confirmation
What is the best acronym to assess illicit drug abuse in adolescents?
- CRAFFT: o C: car (been in car driven by someone under influence?) o R: relax (used to relax?) o A: alone (use alone?) o F: forget (while using?) o F: family/friend (ever asked you to cut down?) o T: trouble (gotten into?)
What are things to pay attention to during the interview to show respect?
- Unbiased encounter with pt - Politeness - Introduce self, title and role - Greet pt - Address pt appropriately - Shake hands - Be kind - Ask permission - Respect pt’s rights - Respect differences (cultural and background)
Goals of interview/history: Why perform a history?
- Collect info about pt and their illnesses - Establish contract of care with pt - Understand pt’s environment - Develop a problem list - Develop a problem-solving plan
What skills are on the humanistic skills checklist?
- Verbal - Listening - Respect - Empathy - Professionalism - Handling sensitive topics appropriately
