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NR 509 MIDTERM STUDY GUIDE WEEK 3 WITH 100%verified QUESTIONS AND ANSWERS
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NR 509 MIDTERM STUDY GUIDE WEEK 3 WITH 100%verified QUESTIONS AND ANSWERS 2023-2024
NR 509 Midterm Study Guide Week 3
Ch. 1
● Basic and Advanced Interviewing Techniques
Basic Interviewing Techniques
● Active listening: Active listening means closely attending to what the patient is
communicating, connecting to the patient's emotional state, and using verbal and
nonverbal skills to encourage the patient to expand on his or her feelings and
concerns.
● Empathic responses: Empathy has been described as the capacity to identify with the
patient and feel the patient's pain as your own, then respond in a supportive manner.
● Guided questioning: Guided questions show your sustained interest in the patient's
feelings and deepest disclosures and allows the interviewer to facilitate full
communication, in the patient's own words, without interruption.
● Nonverbal communication: Nonverbal communication includes eye contact, facial
expression, posture, head position and movement such as shaking or nodding,
interpersonal distance, and placement of the arms or legs—crossed, neutral, or open.
● Validation: Validation helps to affirm the legitimacy of the patient's emotional
experience.
● Reassurance: Reassurance is an appropriate way to help the patient feel that
problems have been fully understood and are being addressed.
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● Partnering: When building rapport with patients, express your commitment to an
ongoing relationship.
● Summarization: Giving a capsule summary of the patient's story during the course of
the interview to communicate that you have been listening carefully.
● Transitions: Inform your patient when you are changing directions during the
interview.
● Empowering the patient: Empower patients to ask questions, express their concerns,
and probe your recommendations in order to encourage them to adopt your advice,
make lifestyle changes, or take medications as prescribed.
Advanced Interview Techniques
○ Determine scope of assessment: Focused vs. Comprehensive:
■ Comprehensive: Used patients you are seeing for the first
time in the office or hospital. Includes all the elements of the health history and
complete physical examination.
● Is appropriate for new patients in the office or hospital
● Provides fundamental and personalized knowledge about the patient
● Strengthens the clinician–patient relationship
● Helps identify or rule out physical causes related to patient concerns
● Provides a baseline for future assessments
● Creates a platform for health promotion through education and
counseling
● Develops proficiency in the essential skills of physical examination
■ Focused: For patients you know well returning for routine
care, or those with specific “urgent care” concerns like sore throat or knee pain.
You will adjust the scope of your history and physical examination to the situation
at hand, keeping several factors in mind: the magnitude and severity of the
patient’s prob- lems; the need for thoroughness; the clinical setting—inpatient or
outpatient, primary or subspecialty care; and the time available.
● Is appropriate for established patients, especially during routine or urgent
care visits
● Addresses focused concerns or symptoms
● Assesses symptoms restricted to a specific body system
● Applies examination methods relevant to assessing the concern or
problem as thoroughly and carefully as possible
○ Being aware of your reactions helps develop your clinical skills.
○ Your success in eliciting the history from different types of patients grows with
experience, but take into account your own stressors, such as fatigue, mood,
and overwork.
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○ Self-care is also important in caring for others. Even if a patient is challenging,
always remember the importance of listening to the patient and clarifying his
or her concerns.
● Components of the Health History
● Initial information
■ Date and time of history-time is especially important in emergent
situations
■ Identifying data-age, gender, marital status, occupation-identify source of
history ie: family member, friend etc.
■ Reliability-usually documented at end of interview ie: “patient is vague
when describing symptoms”.
○ Chief Complaint(s)
■ Try to quote the patients words
○ Present Illness
■ Complete, clear and chronological description of the problem prompting
the patient visit
■ Onset, setting in which it occurred, manifestations and any treatments ■
Should include 7 attributes of a symptom:
● Location
● Quality
● Quantity or severity
● Timing, onset, duration, frequency
● Setting in which it occurs
● Aggravating or relieving factors
● Associated manifestations
Differential diagnosis is derived from the “pertinent positives” and “pertinent negatives”
when doing Review of Systems that are relevant to the chief complaint.
Present illness should reveal patient’s responses to his or her symptoms and what effect this
has on their life.
Each symptom needs its own paragraph and a full description.
Medication should be documented, name, dose, route, and frequency. Home remedies,
nonprescriptions drugs, vitamins, mineral or herbal supplements, oral contraceptives, or
borrowed medications.
Allergies-foods, insects, or environmental, including specific reaction
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Tobacco use, including the type. If someone has quit, note for how long
Alcohol and drug use should always be investigated and is often pertinent to the Presenting
Illness.
○ Past history
■ Childhood Illness: measles, rubella, mumps, whooping cough,
chickenpox, rheumatic fever, scarlet fever, and polio. Also include any
chronic childhood illness
■ Adult illnesses: Provide information in each of the 4 areas:
● Medical: diabetes, hypertension, hepatitis, asthma and HIV;
hospitaliations; number and gender of sexual partners; and risk
taking sexual practices.
● Surgical: dates, indications, and types of operations
● Obstetric/gynecologic: Obstetric history, menstrual history,
methods of contraception, and sexual function.
● Psychiatric: Illness and time frame, diagnoses, hospitalizations,
and treatments.
Health Maintenance: Find out if they are up to date on immunizations
and screening tests.
○ Family history
■ Outlines or diagrams age and health, or age and cause of death, of siblings, parents,
and grandparents
■ Documents presence or absence of specific illnesses in family, such as hypertension,
coronary artery disease, elevated cholesterol levels, stroke, diabetes, thyroid or
renal disease, arthritis, tuberculosis, asthma or lung disease, headache, seizure
disorder, mental illness, suicide, substance abuse, and allergies, and symtoms
reported by patient.
■ Ask about history of breast, ovarian, colon, or prostate cancer
■ Ask about Genetically transmitted diseases
Personal or social history
■ Describes educational level, occupation, family of origin, current household,
personal interests, and lifestyle
■ Capture the patients personality and interests, sources of support, coping style,
strengths, and concerns
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