Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. ©...

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Paramedic Care:Principles & Practice

Volume 2 Patient Assessment

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Chapter 1 The History

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Topics

Establishing Patient RapportThe Comprehensive Patient HistorySpecial Challenges

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

The Interview

In the majority of medical interviews, field diagnosis is based on history.It is conducted simultaneously with the physical exam.It is a structured, flexible, tool with several components.Patient condition dictates length and completeness.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Establishing Patient Rapport

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Establishing Patient Rapport

Situation, the patient, and conditions will determine ability to establish rapport.Respond to the patient with empathy to gain trust.Patient’s response to questions will guide the exam.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Establishing Patient Rapport

Setting the Stage – In a healthcare facility, if a patient’s chart is

available, review it before interviewing the patient.

– Gather information from the first responder personnel.

– Reconfirm information.Maintain an open mind!

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

If the patient cannot provide useful information, gather it from family or

bystanders.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Establishing Patient Rapport The First Impression – Your appearance should suggest neatness,

cleanliness, pride, and professionalism. – Present yourself as a caring, competent, and

confident health care professional.– Your voice, body language, gestures, and

especially eye contact should communicate that you care about your patient’s problems.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Establishing Patient RapportIntroductions – Make eye contact with your patient and maintain

it as you conduct the interview. – Use your patient’s name frequently during the

interview. Avoid slang terms such as “honey,” “chief,” “pops,” or “sweetie.”

– Be aware of other forms of nonverbal communication.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Establishing Patient RapportAsking Questions – Ask questions in a way that elicits accurate

information from your patient.– Use a combination of open-ended and closed-

ended questions.Open-ended questions allow patient to explain how he/she feels.Closed-ended questions elicit short answers.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Establishing Patient Rapport Language and Communication – Effective communication means connecting with

your patient. – Barriers to communication include:

Cultural differencesLanguage differencesDeafnessSpeech impedimentsBlindness

– When encountering communication barriers, try to enlist someone to help.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Establishing Patient Rapport

FacilitationReflectionClarificationEmpathy

ConfrontationInterpretationAsking about feelings

Active listening techniques:

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Establishing Patient Rapport

Sensitive Topics – A paramedic must learn to become comfortable

dealing with sensitive topics.– Sensitive topics may include sexual activities,

death and dying, physical deformities, bodily functions, and domestic violence.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Establishing Patient Rapport

Sensitive Topics – Familiarize yourself with and practice some

opening questions on sensitive topics. – It is critical that you remain calm, objective, and

nonjudgmental.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

The Comprehensive Patient History

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Preliminary DataAlways record the date and time of the physical exam. Determine your patient’s age, sex, race, birthplace, and occupation. – These questions provide a starting point for the

interview. After you have gathered the information, you should establish its reliability.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

The Chief ComplaintBegin with an open-ended question about your patient’s chief complaint. The chief complaint is the pain, discomfort, or dysfunction that caused the patient to request help.When possible, report and record the chief complaint in the patient’s own words.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

The Present Illness OPQRST-ASPN

Onset of the problemProvocative/ Palliative factorsQualityRegion/Radiation

SeverityTime Associated SymptomsPertinent Negatives

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Past HistoryAsk questions about the patient’s general state of health, childhood and adult diseases, psychiatric illnesses, accidents or injuries, surgeries, and hospitalizations. The patient’s condition, the situation, and time constraints will determine how much information you can and should gather on the scene.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Current Health Status

Current medicationsAllergiesTobaccoAlcohol, drugs, and related substancesDietScreening testsImmunizations

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Current Health Status

Sleep patternsExercise and leisure activitiesEnvironmental hazardsUse of safety measuresFamily historyHome situation and significant othersDaily life

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Current Health Status

Important exercisesReligious beliefsThe patient’s outlook

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

You should take your patient’s medications with you to the hospital, when practical.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Review of SystemsA system-by-system series of questions designed to identify problems your patient has not already identified:

– Skin– Head– Eyes– Ears– Nose– Mouth/Throat– Respiratory– Cardiovascular

– Gastrointestinal– Genitourinary– Musculoskeletal– Neurologic– Psychologic– Endocrine– Hematologic

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Special Challenges

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Special Challenges

SilenceOverly talkative patientsMultiple symptomsAnxiety

DepressionSexually attractive or seductive patientsConfusing behaviors or symptoms

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Special Challenges

Patients needing reassuranceAnger and hostilityIntoxicationCrying

Limited intelligenceLanguage barriersHearing problemsBlindnessTalking with families or friends

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Summary

Establishing Patient RapportThe Comprehensive Patient HistorySpecial Challenges