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NUR 3065 Exam #1 Study Guide (Critical thinking, Interviewing, Health History).
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NUR 3065 Exam #1 Study Guide (Critical thinking, Interviewing, Health History).
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NUR 3065 Exam #1 Study Guide (Criticalthinking, Interviewing, Health History)
What is subjective data?
what the patient tells you
Where can subjective data come from?
History, from the Chief Complaint through the Review of Systems
What is objective data?
what you detect during the examination
Where can objective data come from?
all physical examination findings
What are the 7 attributes of the chief complaint?
1. Location
2. Quality
3. Quantity or Severity
4. Timing
5. Setting in which it occurs
6. Remitting or exacerbating factors
7. Associated Manifestations
What are questions that can be asked for location?
Where is it? Does it radiate?
What are questions that can be asked for quality?
What is it like?
What are questions that can be asked for quantity or severity?
, How bad is it? For pain, ask for a rating on a scale from 1-10
What are questions that can be asked for timing?
When did it start? How long does it last? How often does it come?
What are questions that can be asked for setting?
Include environmental factors, personal activities, emotional reactions, or
other circumstances that may have contributed to the illness.
What are questions that can be asked for remitting/exacerbating factors?
Is there anything that makes it better or worse?
What are questions that can be asked for associated manifestations?
Have you noticed anything else that accompanies it?
What are the 7 components of the comprehensive health history?
1. Identifying data and source of the history
2. Chief Complaint(s) (CC)
3. History of Present Illness (HPI)
4. Past Medical History (PMH)
5. Family History (FH)
6. Personal & Social History, including Health Patterns (SH)
7. Review of Systems (ROS)
What is involved when identifying data?
1. Date and time of history
2. Data which identifies the patient (ex. age, gender)
3. Source of the history (ex. patient or family member)
4. Source of referral
5. Reliability
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