Study Guide Exam 1: Skills and Techniques, Evidence-based Assessment Jarvis Chapters 1, 3 2024/2025. 50 QUESTIONS WITH CLEAR GUIDELINES. 2024 LATEST UPDATE. GUARANTEED A+ GRADE.

1. Differentiate between subjective and objective data. Subjective data: what the person says about themselves during history taking Then whatever they say is classified as the subjective data. Patients often complain about physical symptoms pertaining to how they feel. This can be pain, discomfort, itching or any type of abnormal sensations. They state problems they are experiencing with their bodies, such as coughing, vomiting or muscle spasms. Objective data: observed through measurement, inspection, palpation, and auscultation Objective data are observable and measurable data (“signs”) obtained through observation, physical examination, and laboratory and diagnostic testing. 2. What techniques can be used to gain information from the patient? Introducin the Interview Address patient by their surname and shake hands if appropriate. Ask how they prefer to be addressed Address kids and adolescents by their first name Ask how to pronounce their name. Introduce yourself and state your role in the agency State the importance and reason for your interview Ask open ended questions to start the narrative information. Limit small talk. Closed questions needed for specific information that may have been left out of the narrative 2.1 Give examples of open-ended and closed (direct) questions. Open-ended questions: Tell me how I can help you. What brings you to the hospital? You mentioned SOB. Tell me more about that. Direct questions: elicit a one or two-word answer: “yes” or “no” Where is your headache located? Avoid asking questions in list. Are you experiencing any double vision? Do you follow a diet? 3. What are should the optimal physical environment look like in the interview? Room temp at a comfortable level Provide sufficient lighting but avoid strong, direct lighting Quiet room, no TV, radios and any unnecessary equipment Remove distracting objects: IE mail, lunch, files (you may leave otoscope/ophthalmoscope, BP manometer) Stay about 4 to 5 feet from person Equal-status seating: comfortably seated at 90 degrees, avoid a desk Standing: communicates hast and assumes superiority If Pt is in a bed, Pt should have eye contact 4. Give an example of the ten traps of interviewing. What are some common interviewing traps or nonproductive verbal messages? How could you prevent errors associated with these techniques? Providing false assurance or reassurance “Don’t worry, I’m sure the baby will be fine” “it’s probably not that bad, I’m sure it will subside after a few days.” Instead ask: “I’m sure you’re really worried about your baby, tell some of your concerns.” Giving unwanted advice “If I were you, I would elect to do the surgery.” “If I were in your shoes, I would do as the doctor suggested.” Instead ask: “what are the pros and cons of doing the surgery?” “what’s holding you back?” Using Authority “Your doctor/nurse knows best.” “As a doctor, I would recommend taking Wellbutrin to help with your depression.” Distancing “there is a tumor growing in the occipital lobe of the brain”--omitting “your” Instead state: “there is a tumor growing in the back of your brain.” Using Professional Jargon “Based on your last VS, it seems that you a slightly prehypertensive.” Instead ask: “It seems as though your BP has gone up a little.” Using Leading of Biased Questions “You don’t smoke, do you? “You exercise on a consistent basis, right?” “You don’t ever have unprotected sex, correct?” Instead ask: “Do you smoke?” “Are you sexually active? Do you use protection?” “Are you on some sort of exercise plan?” Talking too much Listen more than you talk Interrupting Cutting off or finishing the Pt statement Asking “why” questions “Why did you wait so long before coming in to see us?” Instead ask: “What was happening between the time you starting experiencing this pain and when you came to see us?” 5. What are the nonverbal skills and modes of communication? How can nonverbal behaviors interfere or enhance an interview? Physical Appearance: Professional dress (uniform) and grooming. Anything less may communicate in competence to the patient Posture: Calm, relaxed posture conveys interest. Standing and hastily filling out forms while peeking at watch communicates that you are busy with other things. If something can potentially come up, state that at the beginning of the interview Gestures: Nodding head, openly turning out the hand: shows acceptance, attention, or agreement. Don’t pick your nails, bounce legs, click a pen, play with hair, these show that you are anxious and can be very distracting to the PT. Facial Expression: Have an expression that shows you are attentive, sincere and interested. Try not to reflect the Pt and avoid looking board, disgusted, distracted, critical or disbelieving. Eye Contact: Maintain eye contact, but don’t share. Occasional glance away. Lack of eye contact suggest that the person is shy and withdrawn, confused, bored, intimidated, apathetic or depressed. Exception in some cultures Voice Tone, don’t show sarcasm, disbelief, sympathy, r hostility. Soft voice may seem shy. Loud and fast talk makes you seem anxious, too long of pauses makes you seem unsure. Touch Don’t touch the patient Nonverbal messages that show attentiveness and unconditional acceptance are productive and help build rapport. Defeating, nonproductive nonverbal behaviors are those of inattentiveness, authority, and superiority. 6. What are some good techniques to use when closing an interview? An abrupt or awkward closing can destroy rapport. To ease the into the closing, ask: “is there anything else you would like to mention?” “Are there any question you woild like to ask?” “we’ve covered a number of concerns today. What would you most like to accomplish?” End with”: “Our interview is just about over” and then give a summary of what you’ve learned. Thank them and leave 7. Read the section on Culture and Genetics in Chapter 1 as it relates to providing culturally competent care. The minority-majority is on the rise. For the first time in history, the older population will outnumber the young. This means as healthcare professionals that it is important that we are aware of different cultural norms when it comes to health care. Please read the information on developmental competence, interviewing people with special needs and Culture and Genetics for your information - it will not be covered on the exam. Health History Jarvis Chapter 4 1. What is the primary purpose of the health history? The purpose of the health history to collect subjective data. This combined with objective data will create a database to make a judgement or a diagnosis. It is to affirm what the person is doing right and to keep it that way. For the ill, it is a detailed and chronologic record of the health problem. For healthcare providers it is a screening tool for abnormal symptoms, helath problems and concerns 2. What components do you want to include when documenting the reason for seeking care? A spontaneous statement from the patient own words (the title) of why the patient is here. Should have a symptom (subjective data the person feels) and sign (objective abnormality that an examiner can observe). Also a time frame of the symptoms 3. What eight critical characteristics are explored when evaluating a patient’s present health or history of present illness? Location: where is the pain, superficial or deep Character or Quality: descriptive terms ie burning, sharp, dull, aching, gnawing, throbbing, shooting, viselike when describing pain. Similes: blood in the stool = sticky tarm, blood in emesis = coffee grounds You do not need to know the content on culture and genetics, developmental competence, children, adolescents or elderly patients. Review the 'Review of Systems' section for your own information; it will not be on the exam. Quantity or Severity: pain scale, how you responded and how it makes you feel. (doubled over, profuse, lasted for hours) Timing (onset, duration, frequency): when did the symptoms first appear, how long did they last, was is constant or intermittent. Did it come and go after a few days Setting: what was the Pt doing when the pain comes on Aggravating or Relieving Factors: does weather or activity bring it on? Medication? What relieves it, medication, rest, ice? Associated Factors: is this symptoms associatted with others? (urinary frequency and burning or chills or fever) Patient’s Perception: how does it affect the patient's activities PQRSTU