M1: Pediatric History Flashcards
Important principles in Partnership with the Patient
Beneficence, Autonomy, Nonmaleficence, Deontological imperatives, Utilitarianism and Fair & Justice. “BANDUF”
Elements of an Interview
Sharing, Union, Negotiation, Discovery & Support “SUNDS”
Must be informative. Encourages patient participation. Includes questions about social and emotional issues.
Communicating with Patient
Communication: Non verbal attitude complements _________.
Words
Communication: Utilizes _________ skills.
Active Listening
Communication: Constantly maintains _________.
Eye contact
Important Elements when Communicating with Patients
Flexibility, Empathy, Clarity, Specificity and Subtlety “FECSS”
Wants attention. Do not want to be patronized. Who love it when you get down on the floor to talk to and play with them. Who have anxieties and fears that must be anticipated and eased.
Pediatric Patient
Pediatric Patient: Requires ________. May prefer to be _______ with physician.
Sensitivity. Alone.
Pediatric Patient: Look for _____ regarding family interaction that may suggest a _______ with the family, significant others and friends.
Clues. Problems.
Pediatric Patient: The interviewer must give a clear evidence of _________ and for their impending adulthood.
Respect for Confidentiality
Pediatric Patient: Do not force _________.
Conversation
Issues for Adolescence
Home environment, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/Depression and Safety from injury & violence “HEEADSSS”
Approach to Interview: Take time for _________. A continual part of professional development. Brings a deepening personal awareness to our work with patients and is one of the most rewarding aspects of providing patient care.
Self-reflection
Approach to Interview: Review the _______. To gather information and partly develop ideas about what to explore with patient.
Chart
Approach to Interview: Set _______ for the interview.
Goals
Approach to Interview: Review Clinician ________ & ________. Patient observes you from time to time.
Behavior & Appearance
Approach to Interview: Improve the ________. Make it private and comfortable thus it improved communication.
Environment
Approach to Interview: __________. Jot down important data.m
Take notes
Interview process: Greet the patient and establish rapport. Maintain ________. Be attuned to the patient’s _________. ________ the room.m
Confidentiality. Comfort. Arrange.
Interview process: Invite the patient’s story. Begin with ____________. Follow the patient’s _________.
Open ended questions. Lead.
Interview process: Establish the agenda for the interview. Identify all the ________.
Issues
Interview process: Expand and clarify the health history. Guide them in ________ significant matters.
Expressing
Understand the full range of what every good interview needs to cover
Disease Illness Distinction Model
How clinician brings to the symptom
Disease
How the patient experience the symptom
Illness
7 Attributes of a Symptom
Associated manifestations, Location, Quality, Quantity, Remitting/exacerbating factors, Timing & Setting “ALQQRST”
Process of Interviewing: Generate and Test _______.
Hypotheses
Process of Interviewing: Create a shared _________ of the problem.
Understanding
Process of Interviewing: ________ a plan.
Negotiate
Process of Interviewing: Plan for _______ & _______.
Follow up and closing
Process of fully attending to what the patient is communicating, being aware of the patient’s emotional state and using verbal & nonverbal skills to encourage the speaker continue and expand.
Active Listening
There are several ways you can ask questions that add detail to the patient’s story yet facilitate the flow of the interview. Learn to adapt your questioning to the patient’s verbal and nonverbal cues.
Adaptive Questioning
Useful for drawing the patient’s attention to specific areas of the history. It should follow several principles to be effective. Directed questioning should proceed from the general to the specific.
Directed Questioning
If necessary, ask questions that require a _________ rather than a single answer. “What physical activity do you do that makes you short of breath?” is better than “How many steps can you climb before you get short of breath?”
Graded response
Sometimes patients seem quite unable to describe their symptoms without help. To minimize bias, offer __________ answers. “Is your pain aching, sharp, pressing, burning, shooting, or what?”
Multiple choices
Asking a serious question, ___________. Pause and establish eye contact.
One at a time
At times patients use words that are ambiguous or have unclear associations. To understand their meaning, you need to ______________, as in “Tell me exactly what you meant by ‘the flu’” or “You said you were behaving just like your mother. What did you mean?”
Request Clarification
Provide important clues to feeling and emotions. Read the patient.
Nonverbal communication
By posture, actions, or words, you encourage the patient to say more but do not specify the topic.
Facilitation
Simple repetition of the patient’s words encourages the patient to express both factual details and feelings.
Echoing
Part of establishing and strengthening rapport
Empathic response
To make patient feel accepted is to legitimize or validate his/her emotional experience
Validation
The first step to the effectivity of this is to identify and accept the patient’s feelings without offering reassurance at that moment
Reassurance
Indicates that you’ve been listening carefully. Allows to organize clinical reasoning and to convey your thinking to the patient which makes tye relationship more collaborative.
Summarization
Tell them when you are changing directions
Highlighting Transitions
Interviewing Children: Children are usually accompanied by a
Parent/Caregiver
Interviewing Children: You need to consider the _______ and ______ of both the child and the caregivers.
Needs. Perspective.
Interviewing Children: Age when a child can already talk
3 y/o
Interviewing Children: Ask simple _________ questions follow with more ________ questions.
Open-ended. Specific.
Interviewing Children: Ask parents to _______ the information, to ____ details and to identify other issues.
Verify. Add.
Interviewing Children: Provide rich opportunity to ______ how they interact with the child.
Observe
Interviewing Adolescent: They respond positively to anyone who demonstrates a _________ in them.
Genuine interest
Interviewing Adolescent: They are more likely to open up when the interview is _______ on them rather than on their ________.
Focused. Problem.
Interviewing Adolescent: Start with ___________ to build trust and rapport and start the conversation.m
Specific directed questions
Interviewing Adolescent: Use ________ & _________.
Summarizations. Transitional statements.
Interviewing Adolescent: _______ to both parents and adolescents that the best health care allows adolescents some degree of _______ and ________.
Explain. Independence & Confidentiality.
Interviewing Adolescent: Before patient leaves, get relevant _________ to clarify patient’s agenda upon visit.
Medical history
Interviewing Adolescent: Your goal is to help the adolescents bring their _________ or ________ to their parents and to promote more _________.
Concerns or Questions. Open Dialogue.
Presenting problem. Reason for seeking care. State the information verbatim in quotation marks and include the duration of the problem.
Chief complaint
Includes the seven attributes of a symptom
HPI
When the problem started. Chronologic order of events. Setting and circumstances.
Onset
General health and strength. Reserve detailed questioning for those aspects most pertinent to the age of the child.
Past medical history
Includes dates and complications. Illnesses, surgeries, injuries, durg reactions and hospitalizations.m
Past Illnesses
Mother’s health during her pregnancy. Attitude towards pregnancy, specific diseases or conditions and general health.
Maternal History
Pregnancy, Condition of infant at birth, Labor and Delivery
Birth History
Breastfeeding or Bottle feeding. Present diet and appetite.
Feeding History
Age when able to perform certain tasks. Time when able to walk, toilet trained, sexual development and etc.
Growth and Development
Vaccines that were given including dates and any given reactions
Immunizations
Important diseases in the Family. Health status of parents and children.
Family History
Personal status, home conditions and utilizes HEEADSSS for adolescents.
Personal and Social History
Includes review of general body, skin, head, eyes, ears, nose, mouth, neck, lungs, heart, breast, GI, GUT, extremities and neurologic/psychiatric.
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