The "First 21"

Question 1

Step 1

Answer 1

Ensure the exam room is set up with standard clinic tools and supplies. Check all equipment to ensure it is operational. Verify th scale’s batteries are charged.

Question 2

Step 2

Answer 2

Introduce yourself and confirm the patient’s identity, i.e. “ Hello, I’m HS3 Hastings. Can you please tell me your name, DOB, and last four of your social.

Question 3

Step 3

Answer 3

Offer same sex chaperone i.e “would you like a chaperon present during the exam?”

If pt is not familiar reference policy located in exam room

Question 4

Step 4

Answer 4

Obtain an initial impression of the patient. Ask the following:
* Does the pt appear to be in distress?
* If yes, is the distress mild, moderate, or severe?
* Could this be an emergency situation?

Question 5

Step 5

Answer 5

Obtian Pt’s height and weight

Attempt to obtain this prior to the Pt sitting down

Question 6

Step 6

Answer 6

Document Pt’s age, race, rank, gender born with, gender identity as and job within the Coast Guard.

Document all findings on the SF-600 or MHS genesis

Question 7

Step 7

Answer 7

Obtain Pt’s pregnancy status and LMP. Ask “When was your last menstrual period? Was it normal?” If not ask, “ what was different?”

If the Pt is male defer this question

Question 8

Step 8

Answer 8

Ask Pt’s chief complaint

Use plain language when addressing and speaking with Pts. Avoid the use of any medical terms or Jargon

Question 9

Step 9

Answer 9

Determine major signs and symptoms of Pt’s chief complaint.

If the Pt already declared why they are being seen, ask amplifying questions

Question 10

Step 10

Answer 10

Obtain the Pt’s OPQRSTTT

This is a mere tool, not a set in stone method to determine a diagnosis

Question 11

Step 11

Answer 11

Determine wether or not the Pt has had any contact with people possessing similiar symptoms
Ask,” have you been in close contact with anyone who has had similar symptoms such as roommates, partners, or co-workers?”

If the Pt has been in contact ask if they were diagnosed and had seen a Doctor

Question 12

Step 12

Answer 12

Ask 3 System Specific Questions

i.e. Circulatory, respiratory, GI, Nervous, Endocrine, Lymphatic etc…

Question 13

Step 13

Answer 13

Determine any pertinent symptoms in related systems. Ask, “Do you have any nausea, vomiting, or Diarrhea? Any fever or chills? Headaches? A general feeling of tiredness or lack of energy?
(Malaise)

Question 14

Step 14

Answer 14

Obtain Pt’s Medical History (PMH) i.e.
Have you ever felt this way before? if yes ask, “Did you see a doctor and was there a diagnosis?”
or
Do you have any history of significant injuries or past medical history such as: asthma, high blood pressure, high cholestrol, diabetes, cancer, or heart disease? If yes ask,” When were you diagnosed and how was it treated?”

Question 15

Step 15

Answer 15

Obtain Pt’s Surg Hx. i.e.
Have you ever had surgery?
if yes ask,
“What for, at what age, and were there any complications?”

Question 16

Step 16

Answer 16

Obtain Pt’s Family Hx. i.e.
Has anyone in your family had similar symptoms?
If yes ask:
Who?
When?
What was the result?

Also, “Do you have family Hx of asthma, high blood pressure, high cholesterol, diabetes, cancer, or heart disease?
If yes ask:
Who?
When?
How old they were?
What is their current condition?

Question 17

Step 17

Answer 17

Determine if Pt has any allergies i.e.
“ Do you have any allergies to food, medication, or the environment?
if yes ask
When was your last reaction?
What kind of reaction do you experience?

Question 17

Step 18

Answer 17

Determine if the Pt takes any MEDS either prescription or OTCs. i.e.

Do you take any prescribed MEDS/OTCs/dietary supplements/herbal remedies/ or vitamins?
If yes ask
What do you take?
What for?
What dosage and frequency?
How long have you been taking them?

Question 18

Step 19

Answer 18

Obtain information on Pt’s Social Hx. i.e.
“Do you smoke, vape, dip or use any type of tobacco products? if yes, ask how much and for how long? also ask
,” Would you like to quit? if yes refer the Pt to the tobacco cessation counselor.

Do you drink any alcoholic beverages like beer or wine? if yes,
“What do you drink?”
“How much and how often?”

Do you exercise? if yes.
“ what kind of exercise, for how long, and how many times per week?”

“What is your daily water intake?”

“What is your daily intake of caffeine?
Does that include energy drinks?”
Follow up with
“What do you drink?”
“How much and how often?”

Question 19

Step 20

Answer 19

Utilize A&Ox3 (Alert and oriented x1 alert to self, x2 alert to place, x3 alert to time) Document Pt’s mental status and general appearance. i.e Pt is WNWD 24 yr old female in mild distress, /guarding lower left quadrant, A&Ox3

Question 20

Step 21

Answer 20

Obtain Pt’s vitals: temp, pulse, blood pressure, respirations, SpO2