Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Transcription

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2 PART I Assessment of Respiratory Disease 2

3 Section I Clinical Data Obtained at the Patient s Bedside 3

4 Chapter 1 The Patient Interview 4

5 Patient History Biographic data Age, gender, occupation Chief complaint Present health 5

6 Patient History (Cont d) Past health Family history Review of body systems Functional assessment 6

7 Patient Interview Patient s impression of his or her health Establish rapport and trust Understanding of patient s health Facilitates future assessments 7

8 Internal Factors What the practitioner brings to the interview Genuine concern for others Empathy The ability to listen 8

9 Internal Factors (Cont d) During the interview the examiner should: Observe the patient s body language For example, note Facial expressions Eye movement Pain grimaces Restlessness Sighing 9

10 Internal Factors (Cont d) The examiner should listen to the way things are said For example: Is the tone of the patient s voice? Does the patient s voice quiver? Are there pitch breaks in the patient s voice? Does the patient say only a few words and then take a breath? 10

11 External Factors A good physical setting Ensures privacy Prevents interruptions Secures a comfortable physical environment 11

12 Techniques of Communication 12

13 Open-Ended Questions This type of question asks the patient to provide narrative information. For example: What brings you to the hospital today? How has your breathing been getting along? 13

14 Closed or Direct Questions This type of question asks the patient for specific information a short one- or twoword answer, a yes or no, or a forced choice. For example: Have you ever had this chest pain before? 14

15 Responses Assisting the Narrative Facilitation Mm-hmm, Go on, Continue Uh-huh 15

16 Responses Assisting the Narrative (Cont d) Silence Effective after an open-ended question 16

17 Responses Assisting the Narrative (Cont d) Reflection Patient: My breathing is blocked. Examiner: It s blocked? Patient: Yes, every time I try to exhale, something blocks my breath and prevents me from getting all my air out. 17

18 Responses Assisting the Narrative (Cont d) Empathy Patient: This is just great! I used to work out every day, and now I don t have enough breath to walk up the stairs! Examiner: It must be hard you used to exercise every day, and now you can t do a fraction of what you used to do. 18

19 Responses Assisting the Narrative (Cont d) Clarification Tell me what you mean by bad air. 19

20 Responses Assisting the Narrative (Cont d) Confrontation You look depressed today. 20

21 Responses Assisting the Narrative (Cont d) Interpretation It seems that every time you have a serious asthma attack, you have had some kind of stress in your life. 21

22 Responses Assisting the Narrative (Cont d) Explanation It is very common for your heart rate to increase a bit after a bronchodilator treatment. 22

23 Responses Assisting the Narrative (Cont d) Summary The final overview of the examiner s understanding of the patient s statements. It condenses the facts and presents an outline of the way the examiner perceives the patient s statements. The patient can agree or disagree with the examiner s summary. 23

24 Nonproductive Verbal Messages Providing assurance or reassurance Giving advice Using authority Using avoidance language Distancing 24

25 Nonproductive Verbal Messages (Cont d) Professional jargon Asking leading or biased questions Talking too much Interrupting and anticipating Using why questions 25

26 Nonverbal Skills Professional appearance vs. Unprofessional appearance 26

27 Nonverbal Skills (Cont d) Sitting next to the patient vs. Sitting behind a desk 27

28 Nonverbal Skills (Cont d) Proximity to patient vs. Far away from patient 28

29 Nonverbal Skills (Cont d) Turned toward patient vs. Turned away from patient 29

30 Nonverbal Skills (Cont d) Relaxed, open posture vs. Tense, closed posture 30

31 Nonverbal Skills (Cont d) Leaning toward patient vs. Slouched away from patient 31

32 Nonverbal Skills (Cont d) Facilitating gestures (e.g., nodding the head) vs. Nonfacilitating gestures (e.g., looking at watch) 32

33 Nonverbal Skills (Cont d) Positive facial expressions vs. Negative facial expressions 33

34 Nonverbal Skills (Cont d) Good eye contact vs. Poor eye contact 34

35 Nonverbal Skills (Cont d) Moderate tone of voice vs. Strident, high-pitched voice 35

36 Nonverbal Skills (Cont d) Moderate rate of speech vs. Speech too fast or too slow 36

37 Nonverbal Skills (Cont d) Appropriate touch vs. Too frequent or inappropriate touch 37

38 Closing the Interview The interview should end gracefully. Is there anything else that you would like to talk about? Do you have any questions you would like to ask me? Are there any other problems that I should have asked you about? 38

39 Closing the Interview (Cont d) Finally, Thank the patient for the time and cooperation provided during the interview. 39