Based on inference or conclusion

"It seems that every time you feel stomach pain, you have a new stressor in your life." 

Encourages the person to say more.

Ex: nodding, "yes, go on," "uh=huh" 

Echoing your patient's words.

Ex: P:"My foot hurts" N:"Your foot hurts?" 

Recognizes a feeling and puts it into words.

Ex:

P:"Oh great, I own a business, have 20 employees, and now... I can't even make it to the bathroom by myself!"

 N:"It must be hard, having so much responsibility, yet feeling so dependent."

When a persons words are ambiguous.

Ex: P:"My blood is tired." N:"Tell me what you mean by 'tired blood'."

Summarize your patients words and simplify.

Your response or feelings toward an observation.

Ex: N:"You say it doesn't hurt, but when I touch you here...you grimace." 

The nurse shares factual or objective information.

Ex" N:"You cannot eat anything after midnight due to your scheduled surgery." 

What are the ten traps of interviewing?

1. Providing false reassurance

2. Giving unwanted advice

3. Using authority

4. Using avoidance language

5. Engaging in distancing

6. Using professional jargon

7. Using leading or biased questions

8. Talking too much

9. Interrupting

10. Using "why" questions

Nonverbal

- Appearance (grooming, clothing style)

- Posture (crossing arms, slumping, clutching arm)
- Gestures (nodding, yawning, looking at watch)

- Facial Expression (alert, relaxed, angry, pain)

- Eye Contact (shy, bored, cultural)

- Voice (tone, rate, pitch)

- Touch (influenced by culture, age, sex, past experience)

You are interviewing Marcy, a 25 year old caucasian female. When you first walk into her room (having never met her before), would it be best to touch her arm, touch her face, touch her leg, or refrain from touching her?

Which of the following questions would be best to ask when assessing a patient?

A. "Do you have a good relationship with your husband?"

B. "Do you and your significant other have a good relationship?"

B. "Do you and your significant other have a good relationship?"

Mrs. Slavayotvka only speaks Russian, but her son, Sasha, has come to the hospital with her and speaks both Russian and English. When interviewing her, would it be appropriate to ask her son to interpret what his mother is saying?

- Vocal cues (moaning, silence)

- Action cues (posture, expression)

- Object cues (clothes, jewelry)

- Eye contact (downcast, eye=rolling, indirect)

- Use of personal & territorial space

Sam & Elizabeth bring their newborn child into the pediatric clinic for a regular checkup. The baby is sooooo cute and you just want to touch it! It would be better to:

A. pat it on the head

B. touch its hand

B. touch its hand

(patting a child on the head is a sign of disrespect or curse in some cultures)

Does health history consist of objective or subjective information?

Reliable

Reliability - based on if the patient gives same answers later in conversation

- Biographical data

- Reason for seeking care

- History of present illness

- Past history

- Family history

- Review of systems

- Functional assessment

- Name

- Phone #

- Address

- Age & birthdate

- Birthplace

- Sex

- Marital status

- Race

- Ethnic origin

- Occupation (now & in past)

- brief description of reason for visit

- one or two signs or symptoms and their duration

- all info is subjective and should be in "quotes"

ex: "chest pain" for over 2 hours

or

"need a physical for work"

the chronological history of the reason the patient is seeking care

(OLDCART or PQRSTU)

- Childhood illness

- Accidents or injuries

- Serious or chronic illness

- Hospitalizations

- Operations

- Obstetric History

- Immunizations

- Last exam date for dental, vision, hearing, EKG, chest x-ray

- Allergies

- Current meds

Asking questions about:

- Age & health/death of parents, grandparents, siblings & close family members

- The history of each system from head to toe

(everything should be recorded as "present," "absent," or "denies")

Measuring a client's self care ability related to:

- ADLs

- Activities needed for independent living

- Personal habits (tobacco, alcohol, drugs) 

1. Inspect

2. Ausculate

3. Percuss

4. Palpate

(IN THIS ORDER!) 

- is concentrated watching

- always comes first

- begins w/ general survey

- yields surprising amount of data

- compares L & R

- direct & tangential lighting

- draping

- use of instruments 

- does not magnify/block extraneous sound (snug fit & quality)

- uses diaphragm (high pitched sounds)

- uses bell (low pitched sounds)

- reduce extraneous noise

- keep room & equipment warm

- avoid friction by wetting hair

- never listen through clothing/gown

Applies touch (texture, temperature, moisture, organ location & size, swelling, etc.)

- using fingertips (tactile discrimination, texture, swelling, pulsation, masses)

- grasping (positon, shape, consistency, attachment to other structures)

- using dorsa or hands & fingers (temperature)

- using ball of hand/base of fingers (vibrations) 

In the general survey it is important to:

A. Look before you touch

B. Touch before you look

C. Palpate before you look

D. Palpate before you ausculate 

- Physical appearance

- Body structure & nutritional status

- Mobility

- Behavior 

- Age

- Gender

- Level of consciousness

- Skin color

- Facial features

- No signs of acute distress

- Stature

- Nutrition

- Symmetry

- Posture

- Position

- Body build & contour 

- Facial expression

- Mood and affect

- Speech

- Dress

- Personal hygiene 

In the general survey, mobility includes: 

- gait (how they move around)

- range of motion 

Ms. Moore was not wearing the same outfit on Wednesday as she was wearing on Tuesday and/or the same scale was not used to weigh Ms. Moore both days.

Make sure your patients wear the same outfit & use the same scale every time you weigh them! 

- Temperature

- Pulse

- Respiration

- Blood Pressure

(usually in this order!) 

1. Respiration

2. Pulse

3. Temperature

Why? If the infant starts to cry it may increase respirations and pulse (least to most invasive)! 

- Diurnal cycle (daily)

- Menstrual cycle (ovulation)

- Exercise

- Age 

96.4-99.1 °F and 35.8-37.3 °C

Low: 96.4 °F (35.8 °C)

High: 99.1 °F (37.3 °C)

(°C x 9/5) + 32 = °F

Celsius times nine-over-five, plus thirty-two equals farenheit.

To get the correct answer on the  computer calculator:

1. Divide 9 by 5 (should be 1.8)

2. Multiply 1.8 by °C

3. Add 32

TRY THIS OUT ON COMPUTER CALCULATOR BEFORE TEST! 

(°F - 32) x 5/9 = °C

Farenheit minus thirty-two, times five-over-nine equals Celsius.

To get the correct answer on the  computer calculator:

1. Subtract 32 from °F

2. Multiply answer by 5/9

TRY THIS OUT ON COMPUTER CALCULATOR BEFORE TEST!

The long bulbed, black tip is the oral thermometer.

(the other is a rectal thermometer) 

Bradycardia 

the first eight years

(50% by age 2, 100% by age 8) 

You have just finished listening to Mr. Brown's lungs. The next thing you should do is:

A. Observe his breathing

B. Percuss his lung area

C. Palpate his back

D. Look for lesions 

B. Percuss his lung area

(remember the order of assessment: inspect, ausculate, percuss, palpate. Since you just ausculated, you would percuss next.)