HEALTH HX/ INTERVIEW TECH/ DATABASE/ CULTURE (4-6Q)Differentiate when to obtain complete vs focuses examoCOMPLETE— collection of subjective and objective data gathered during a step-by-step physical examinationWhere? Hospitals, community, clinics, or homeWho? Any health care providerW...
PHYSICAL EXAM
• Understand 4 components oh Physical Exam (PE)
o INSPECTION
▪ Note symmetry, skin tone, abnormalities (bruising, masses,
lesions, discoloration), shape of chest, facial features, any
deformities
▪ Note general disposition, affect and mood
o PALPATION
▪ Assesses temperature, moisture and masses/nodules
▪ Temperature—use dorsal surface of hand
▪ Light (1cm), moderate (1-2 cm) and deep (2-4cm)
o PERCUSSION
▪ Tapping body parts to produce sounds
▪ Use percussion to:
• Elicit pain = inflammation
• Determine location, size and shape of organs
• Determines density
• Detects abdominal masses
• Elicits reflexes
▪ Types of percussion:
• Direct—direct tapping of body part to elicit tenderness (sinus)
• Blunt—detect tenderness over organs (inflammation)
• Indirect—(most common) as density increases, sound decreases
o AUSCULTATION
▪ Listening to sounds of the heart, lungs, stomach, intestines, and arteries
▪ Most common technique used in HC
▪ NEVER over clothing; always direct contact w/ skin
▪ TOOL—stethoscope, doppler
• When to use bell, when to use diaphragm
o BELL—listening for adventitious sounds, bruits, swooshes, etc
▪ Aorta, renal, iliac, femoral arteries
▪ Carotid
o DIAPHRAGM—lung sounds, heart sounds, bowel sounds
• Normal & expected changes associated with aging
o ADLs decrease functionality and mobility decrease, cognitive ability varies, driving
decreases, it all depends on the pt and their support system and socioeconomics, etc.
o Increased risk for alcohol dependency
o Muscle tone and mass decrease; loss of subcutaneous fats makes bones and muscles
more prominent, fat redistribution
,HEALTH HX/ INTERVIEW TECH/ DATABASE/ CULTURE (4-6Q)
• Differentiate when to obtain complete vs focuses exam
o COMPLETE— collection of subjective and objective data gathered during a step-
by- step physical examination
▪ Where? Hospitals, community, clinics, or home
▪ Who? Any health care provider
▪ What? Must include a total health assessment; is required when pt first enters
health care system to establish baselines; first dx
o FOCUSED—completed when a comprehensive database exists but the pt presents w/
specific health concern
▪ What? Thorough assessment of specific health problem
▪ Hx and exam follow direction of presenting concern
▪ Where? Hospital, primary care, long term
• Differentiate objective vs. subjective questions
o OBJECTIVE—data based, taking someone’s temperature, physical evidence
o SUBJECTIVE—pt responds personally; about the patient; not always measurable
• Culturally competent care
o the ability for healthcare professional to demonstrate cultural concern toward patients
w/ diverse values, beliefs and feelings
o Important for establishing good repour w/ patient
• Interview techniques
o OPEN-ENDED
▪ Advantages
• Questions allow pt to elaborate and relay info that is important to them
• Conveys caring and interest by the nurse
• Results in more thorough and detailed response
▪ Disadvantages
• Requires more time
• Pt may share irrelevant or unnecessary info
• Responses may be more difficult to document
o CLOSE-ENDED
▪ Advantages
• Direct, non-complex questions that require simple answers
• Time saving, less threatening, and easily documented
• Limit ability to discern pts emotional state or feelings
▪ Disadvantages
• Pt may misinterpret these questions as the nurse being cold and/or
disinterested in them as a person
, o TECHNIQUES
▪ P—past med hx to include previous illnesses and state of health
▪ L—last oral intake of liquids and foods
▪ E—events leading to illness or injury
▪ A—allergies and types of rxns
▪ S—symptoms and chief complaint
▪ E—each prescribed medication, OTC meds, herbs
▪ Direct interview technique “cuts out the BS, straight to business”
• What? Highly structured, nurse controls elements of interview w/ list of
essential questions, pt has limited opportunity to discuss Q or concerns,
usually consists of close ended Q
• Why? To gain precise details about reported condition
• Ex: trauma, emergency surgery/situation
▪ Indirect interview technique
• What? Pt controls the pace and the info—seeking routine, usually
contains more open-ended Qs
• Why? Useful for developing rapport w/ patient, useful during clinical
visits when providing pt education or needed lifestyle health change
• Culture aspects of pain
o P—pattern of precipitating factors—what causes the pain?
o Q—quality of pain—is it sharp? Dull? Shooting?
o R—radiates—if yes, where?
o S—severity—"On a scale of 0 to 10?”
o T—time and treatment—when did it start? Are you taking meds?
ABUSE (PHYSICAL, SUBSTANCE & EtOH) (4-6Q)
• Assessing for intimate partner violence (IPV) & Substance/EtOH abuse
o IPV
▪ Individual risk factors: low self-esteem, low income, young age, isolation
▪ Relationship factors: martial conflicts, martial instability, dominance, $$
▪ Community factors: traditional gender norms—women should stay at home,
etc.
o Assessing for IPV
▪ Screen in private, safe setting w/pt alone
▪ Use professional interpreters
▪ Offer that screening is universal and not b/c of suspected IPV
▪ Ensure confidentiality
▪ Resources (safe house)
• Have accessible take home materials, hotlines, etc. in private areas
(bathroom, changing rooms, exam room)
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