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What external factors should you control before conducting an interview?
  • ensure privacy (real or psychological)
  • refuse interuptions
How should the physical enviroment be controlled to facillitate the interview?
  • set a comfortable room temp
  • provide sufficient lighting
  • reduce noise
  • remove distracting objects
  • maintain a distance of 4-5 feet
  • arrange equal status seating (eye level, avoid barriers)
  • avoid standing
What are the three phases of the interview?
  • Introduction
  • The working phase
  • closing/termination
What should take place during the introduction?
  • Adress the pt by surname
  • introduce yourself and your role
  • ask what they would like to be called
  • state the reason for the interview
What are some common communication strategies?
  • open-ended questions
  • closed/direct questions
  • facilitation (please continue)
  • silence
  • reflection (repeating part of what was just said)
  • confirmation (If I understand correctly...)
  • clarification (when pt is confusing)
  • empathy (this must be very hard for you, touch)
  • interpretation
  • explanation
  • summary
How should an interview be closed?
  • Ask the pt if they have anything else to mention
  • summarize what you have learned
What should be avoided during an interview?
  • false reassurance
  • giving unwanted advice
  • using authority
  • using avoidance language
  • engaging in distancing
  • using professional hargon
  • using leading or biased questions
  • talking too much
  • interupting
  • using "why" questions
What can you do to empower your pt?
Give them choices
What three things should you begin your history with?
  • biographical data
  • the source of the history
  • the reason for seeking care
What does PQRSTU stand for?
  • Provocative: what brings it on, anything make it better or worse
  • Quality: how intense or severe, describe the pain
  • Region/radiation: where is it, does it spread?
  • severity: rate from 0-10
  • timing: onset, when did it start?
  • understanding: pt's perception of the problem
What are the components of a comprehensive adult health history?
  • chief complaint: the pts own words
  • present illness: duration of the present illness, onset and treatments, PQRSTU
  • Immunizations: last tetanus?
  • Past history: medical, surgical, OB, psych
  • allergies and reactions to allergens
  • family history: parents and siblings
  • personal and social history: ETOH, smoking, spiritual beliefs, diet, alternative health pracatices
Domestic violence: abuse assesment screening
  • "do you feel safe at home?" hesitation needs a followup
  • when you and your partner argue are you ever afraid of him or her?
  • does your partner try and control you? where you go? who you see? how much money you can have?
  • assess the skin for bruising that does not match the injury
  • ask questions wen family members are not present
What occers during the review of systems in a comprehensive adult history?
  • question the pt from head to toe from general to specific
  • skin, head, EENT, neck, breasts, respiratory, CV, GI, urinary, peripheral vascular, musculoskeletal, psych, neurologic, hematologic, endocrine
What are sources of pt data?
  • pt
  • family/significant others
  • pt record
  • other healthcare professionals
  • nursing and other healthcare literature
What is the difference between objective and subject?
  • Objective data is data that can be measured (vomiting, bp, temp, pulse)
  • subjective data is experienced by the pt (pain, nausea, dizziness)
What are the characteristics of well documented data?
  • Good grammer
  • standard medical abbreviations
  • use of pt's own words when possible
  • avoid non specific terms
  • avoid individual interpretation
Tools of assessment
  • BP cuff
  • cotton balls
  • gloves
  • metric ruler
  • visual acuity charts (snellen's charts)
  • opthalmoscope
  • otoscope
  • penlight
  • specular (nasal, vaginal)
  • stethoscope
  • tuning fork
  • wooden tounge blades
What are the most important tools for assessing a pt?
Your eyes and observations
What techniques are used during pysical assessment?
  • inspection: assess size, color, shape, position, and symetry
  • palpation: assess temperature, turgor, texture, moisture, and shape
  • percussion, assess location, size, share, and density of tissue
  • auscultation: assess the four characteristics of sound i.e. pitch, loudness, quality, and duration
Inspection
  • deliberate and purposeful observation in a specific manner
  • uses the observers vision, sense of smell, and hearing
  • Describe: size, shape, position, symmetry
Palpation
  • uses the sense of touch
  • temperature, turgor, mositure, and shape can be described with palpation
  • you should have warm hands and short fingernails
  • palpate areas of tenderness last
  • start with light palpation to moderate to deep
What are the characteristics of masses that can be determined by palpation?
  • shape
  • size
  • consistency
  • surface
  • mobility
  • tenderness
  • pulsatile
Percussion
  • striking an object against another to produce a sound
  • location, shape, size and density of tissues
What are the sounds that can be heard from percussing?
  • Flat: soft, over dense tissue ex, thigh area
  • Dull: medium, thud like, ex. liver
  • Resonance: loud, hollow ex. normal lung
  • Hyperresonance: booming, very loud, ex. emphysematous lung
  • Tympany: over enclosed air, loud, ex puffed out cheek
Auscultation
  • listening with a stethoscope to sounds produced within the body
  • expose the area to be listened to while providing privacy
  • pitch, loudness, quality, and duration are the characteristics and data that are acquired
Characteristics of sound heard when using auscultation
  • Pitch: ranging from high to low
  • Loudness: ranging from soft to loud
  • Quality: gurgling or swishing
  • Duration: short, medium, or long
Integumentary Assessment and techniques
  • inpection
  • palpation
  • generally assessed throughout the entire exam
  • skin, hair (change in patterns), and nails are assessed
Integument health history
  • any history or presence of rashes, lumps, bumps, or leisions, changes in color, bruising, wounds or burns?
  • exposure to sun or chemicals
  • allergic reactions
  • changes in size or shape of a mole
  • degree of mobility
  • example of daily diet
Skin assessment
Assess for
  • color
  • texture
  • turgot
  • edema
  • temperature
  • moisture
  • lesions
Common shapes of skin lesions
  • Annular: circular lesions that begin in a center and spread to the periphery
  • confluent: leisons that run together
  • grouped: clusters of leisons
  • zosteriform: follow a dermatome
Primary skin lesions
  • Macule: color change, often flat (freckles, cafe-au-lait)
  • Papule: palpable, less than 1 cm (wart)
  • Nodule: palpable, larger than 1 cm, (fibroma)
  • Wheal: superficial, raised, can have erythema (red color), (hives)
  • Cyst: encapsulated, fluid filled cavity (wen)
Hair and scalp assessment
Assess hair for
  • color
  • amount
  • texture
  • distribution
Assess scalp for:
  • color & dryness
  • lesions
  • lumps
  • lice
Nail assessment
Assess nails for:
  • shape
  • angle
  • texture
  • color
  • cap refil
Documentation example
Recd pt, skin pink warm dry. mucous membranes are moist, no ecchymosis (bruising), rash, or petechiae noted. Nails without clubbing or cyanosis. hair distribution sparce, male pattern baldness noted
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