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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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PART I

Assessment of

Respiratory Disease

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Section I

Clinical Data Obtained at

the Patient’s Bedside

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Chapter 1

The Patient Interview

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Patient History

Biographic data Age, gender, occupation

Chief complaint

Present health

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Patient History (Cont’d)

Past health

Family history

Review of body systems

Functional assessment

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Patient Interview

Patient’s impression of his or her health

Establish rapport and trust

Understanding of patient’s health

Facilitates future assessments

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Internal Factors

What the practitioner brings to the interview Genuine concern for others

Empathy

The ability to listen

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Internal Factors (Cont’d)

During the interview the examiner should: Observe the patient’s body language

For example, note • Facial expressions

• Eye movement

• Pain grimaces

• Restlessness

• Sighing

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Internal Factors (Cont’d)

The examiner should listen to the way things

are said

For example: Is the tone of the patient’s voice?

Does the patient’s voice quiver?

Are there pitch breaks in the patient’s voice?

Does the patient say only a few words and then

take a breath?

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External Factors

A good physical setting Ensures privacy

Prevents interruptions

Secures a comfortable physical environment

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Techniques of Communication

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Open-Ended Questions

This type of question asks the patient to

provide narrative information.

For example: “What brings you to the hospital today?”

“How has your breathing been getting along?”

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Closed or Direct Questions

This type of question asks the patient for

specific information—a short one- or two-

word answer, a yes or no, or a forced choice.

For example: “Have you ever had this chest pain before?”

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Responses—Assisting the Narrative

Facilitation “Mm-hmm,” “Go on,” “Continue”

“Uh-huh”

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Silence Effective after an open-ended question

Responses—Assisting the Narrative

(Cont’d)

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Reflection Patient: “My breathing is blocked.”

Examiner: “It’s blocked?”

Patient: “Yes, every time I try to exhale, something

blocks my breath and prevents me from getting all

my air out.”

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Responses—Assisting the Narrative

(Cont’d)

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Empathy Patient: “This is just great! I used to work out every

day, and now I don’t have enough breath to walk

up the stairs!”

Examiner: “It must be hard—you used to exercise

every day, and now you can’t do a fraction of what

you used to do.”

Responses—Assisting the Narrative

(Cont’d)

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Clarification “Tell me what you mean by bad air.”

Responses—Assisting the Narrative

(Cont’d)

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Confrontation “You look depressed today.”

Responses—Assisting the Narrative

(Cont’d)

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Interpretation “It seems that every time you have a serious

asthma attack, you have had some kind of stress

in your life.”

Responses—Assisting the Narrative

(Cont’d)

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Explanation “It is very common for your heart rate to increase a

bit after a bronchodilator treatment.”

Responses—Assisting the Narrative

(Cont’d)

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Summary The final overview of the examiner’s

understanding of the patient’s statements.

It condenses the facts and presents an outline of

the way the examiner perceives the patient’s

statements.

The patient can agree or disagree with the

examiner’s summary.

Responses—Assisting the Narrative

(Cont’d)

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Nonproductive Verbal Messages

Providing assurance or reassurance

Giving advice

Using authority

Using avoidance language

Distancing

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Nonproductive Verbal Messages

(Cont’d)

Professional jargon

Asking leading or biased questions

Talking too much

Interrupting and anticipating

Using “why” questions

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Nonverbal Skills

Professional appearance

vs.

Unprofessional appearance

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Sitting next to the patient

vs.

Sitting behind a desk

Nonverbal Skills (Cont’d)

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Proximity to patient

vs.

Far away from patient

Nonverbal Skills (Cont’d)

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Turned toward patient

vs.

Turned away from patient

Nonverbal Skills (Cont’d)

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Relaxed, open posture

vs.

Tense, closed posture

Nonverbal Skills (Cont’d)

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Leaning toward patient

vs.

Slouched away from patient

Nonverbal Skills (Cont’d)

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Facilitating gestures

(e.g., nodding the head)

vs.

Nonfacilitating gestures

(e.g., looking at watch)

Nonverbal Skills (Cont’d)

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Positive facial expressions

vs.

Negative facial expressions

Nonverbal Skills (Cont’d)

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Good eye contact

vs.

Poor eye contact

Nonverbal Skills (Cont’d)

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Moderate tone of voice

vs.

Strident, high-pitched voice

Nonverbal Skills (Cont’d)

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Moderate rate of speech

vs.

Speech too fast or too slow

Nonverbal Skills (Cont’d)

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Appropriate touch

vs.

Too frequent or inappropriate touch

Nonverbal Skills (Cont’d)

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Closing the Interview

The interview should end gracefully. “Is there anything else that you would like to talk

about?”

“Do you have any questions you would like to ask

me?”

“Are there any other problems that I should have

asked you about?”

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Closing the Interview (Cont’d)

Finally,

Thank the patient for the time and

cooperation provided during the interview.

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