Bates Guide to Physical Examination - Health History
What is a Comprehensive Health History (CHH) and when is it best used? - ANS A comprehensive interview to gather all aspects of the patient's history
For use with a new patient
What is a Focused History and when is it best used? - ANS ...
Bates
Guide
to
Physical
Examination
-
Health
History
What
is
a
Comprehensive
Health
History
(CHH)
and
when
is
it
best
used?
-
ANS
A
comprehensive
interview
to
gather
all
aspects
of
the
patient's
history
For
use
with
a
new
patient
What
is
a
Focused
History
and
when
is
it
best
used?
-
ANS
A
problem-orientated
history
that
is
more
limited
and
tailored
to
a
specific
problem
For
use
with
an
established
patient
What
are
the
five
steps
of
the
nursing
process?
-
ANS
1.
Assessment
2.
Outcome
Identification
3.
Planning
4.
Implementation
5.
Evaluation
In
a
successful
interview
you...
-
ANS
1.
generate
the
patient's
story
and
gather
complete
and
accurate
data
about
the
patient
2.
Establish
rapport
and
trust
3.
Build
a
continuing
therapeutic
relationship
4.
Teach
about
the
health
state,
health
promotion
and
disease
prevention.
What
is
patient
centered
care?
(Institute
of
Medicine
definition)
-
ANS
Respecting
and
responding
to
patients'
wants,
needs,
and
preferences,
so
they
can
make
choices
in
their
care
that
best
fit
their
individual
circumstances.
Setting
the
Environment
for
a
patient
interview
-
what
is
important?
-
ANS
Courtesy
and
Comfort
1.
Privacy
-
Knock
on
the
door,
use
privacy
curtains,
be
aware
of
room-mates
(inquire
about
confidentiality
wishes)
2.
Attention/lack
of
interruptions
-
ask
for
coverage
help
to
ensure
you
give
the
patient
your
full
attention
3.
Comfortable
room
-
make
sure
room
is
clean
and
at
adequate
temperature
4.
Seating
-
provide
comfortable
seating
for
the
patient,
sit
at
equal
level
with
the
patient,
do
not
place
furniture
between
you
and
the
patient.
5.
Dress
-
Understand
and
be
empathetic
to
patient
vulnerability
in
gowns.
Wear
proper
uniform
(provides
patient
with
professional
image
and
establishes
non-verbal
recognition
of
care). 6.
Note
taking/use
of
computer
during
the
interview
at
minimum
-
explain
why
you
are
taking
notes
or
using
a
computer,
involve
patient
if
possible.
What
is
involved
in
effective
communication
for
skilled
interviewing?
-
ANS
1.
Active
Listening
2.
Empathetic
responses
-
non-verbal
and
verbal,
be
open
and
genuine,
pay
attention
to
patient
body
language
and
cues
3.
Guided
questioning
-
ask
open-ended
questions,
pause
between
questions,
give
multiple
choices
if
needed
4.
Non-verbal
communication
-
maintain
professionalism
in
all
patient
answers
5.
Validation
&
Reassurance
-
do
not
say
"you
will
be
ok"
and
avoid
false
reassurance
6.
Partnering
-
let
the
patient
know
we
are
not
going
to
abandon
them
7.
Summarize
-
gives
clarity
to
the
interaction,
allows
patient
to
provide
input
if
anything
is
inaccurate
or
missing.
8.
Use
transitions
9.
Empowering
the
patient
-
ask
what
the
patient
wants,
goals
What
does
OLDCARTS
stand
for?
-
ANS
O
-
onset
L
-
Location
D
-
Duration
C
-
Character
A
-
Aggrivating/Alleviating
Factors
R
-
Radiation
T
-
Timing
S
-
summary
What
does
OPQRST
stand
for?
-
ANS
O
-
Onset
P
-
Palliating/Provoking
Factors
Q
-
Quality
R
-
Radiating
S
-
Site
T
-
Timing
What
are
the
seven
attributes
of
a
symptom
-
ANS
1.
Location
-
where
is
it?
does
it
radiate?
2.
Quality
-
what
is
it
like?
3.
Quantity
or
severity
-
how
bad
is
it?
(for
pain,
1-10
raiting)
4.
Timing
-
when
did
(does)
it
start?
How
long
does
it
last?
How
often
does
it
come?
5.
Setting
in
which
it
occurs
-
include
environmental
factors,
personal
activities,
emotional
reactions,
or
other
circumstances
that
may
have
contributed
to
the
illness
6.
Remitting
or
exacerbating
factors
-
is
there
anything
that
makes
it
better
or
worse?
7.
Associated
manifestations
-
have
you
noticed
anything
else
that
accompanies
it?
Exploring
the
patients
perspective
-
understand
what
are
the
patients...
-
ANS
1.
Feelings
about
the
problem
2.
Ideas
about
the
nature
and
cause
of
the
problem
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