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

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

2Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

PART IPART I

Assessment of Assessment of Respiratory DiseaseRespiratory Disease


Section ISection I

Clinical Data Obtained at Clinical Data Obtained at the Patient’s Bedsidethe Patient’s Bedside


Chapter 1Chapter 1

The Patient InterviewThe Patient Interview


Patient HistoryPatient History

Biographic data Biographic data Age, gender, occupationAge, gender, occupation

Chief complaintChief complaint Present healthPresent health

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Patient History (Cont’d)Patient History (Cont’d)

Past healthPast health Family historyFamily history Review of body systemsReview of body systems Functional assessmentFunctional assessment

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Patient InterviewPatient Interview

Patient’s impression of his or her healthPatient’s impression of his or her health Establish rapport and trustEstablish rapport and trust Understanding of patient’s healthUnderstanding of patient’s health Facilitates future assessmentsFacilitates future assessments

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Internal FactorsInternal Factors

What the practitioner brings to the interviewWhat the practitioner brings to the interview Genuine concern for othersGenuine concern for others EmpathyEmpathy The ability to listenThe ability to listen

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Internal Factors (Cont’d)Internal Factors (Cont’d)

During the interview the examiner should:During the interview the examiner should: Observe the patient’s body languageObserve the patient’s body language For example, note For example, note

• Facial expressionsFacial expressions• Eye movementEye movement• Pain grimacesPain grimaces• RestlessnessRestlessness• SighingSighing

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Internal Factors (Cont’d)Internal Factors (Cont’d)

The examiner should listen to the way things The examiner should listen to the way things are saidare said

For example:For example: Is the tone of the patient’s voice?Is the tone of the patient’s voice? Does the patient’s voice quiver?Does the patient’s voice quiver? Are there pitch breaks in the patient’s voice?Are there pitch breaks in the patient’s voice? Does the patient say only a few words and then Does the patient say only a few words and then

take a breath?take a breath?


External FactorsExternal Factors

A good physical settingA good physical setting Ensures privacyEnsures privacy Prevents interruptionsPrevents interruptions Secures a comfortable physical environmentSecures a comfortable physical environment

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Techniques of CommunicationTechniques of Communication


Open-Ended QuestionsOpen-Ended Questions

This type of question asks the patient to This type of question asks the patient to provide narrative information.provide narrative information.

For example:For example: ““What brings you to the hospital today?”What brings you to the hospital today?” ““How has your breathing been getting along?”How has your breathing been getting along?”

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Closed or Direct QuestionsClosed or Direct Questions

This type of question asks the patient for This type of question asks the patient for specific information—a short one- or two-specific information—a short one- or two-word answer, a yes or no, or a forced choice.word answer, a yes or no, or a forced choice.

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

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Responses—Assisting the NarrativeResponses—Assisting the Narrative

FacilitationFacilitation ““Mm-hmm,” “Go on,” “Continue” Mm-hmm,” “Go on,” “Continue” ““Uh-huh”Uh-huh”

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SilenceSilence Effective after an open-ended questionEffective after an open-ended question

Responses—Assisting the Narrative Responses—Assisting the Narrative (Cont’d)(Cont’d)

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ReflectionReflection Patient:Patient: “My breathing is blocked.” “My breathing is blocked.” Examiner:Examiner: “It’s blocked?” “It’s blocked?” Patient:Patient: “Yes, every time I try to exhale, something “Yes, every time I try to exhale, something

blocks my breath and prevents me from getting all blocks my breath and prevents me from getting all my air out.”my air out.”

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

every day, and now I don’t have enough breath to every day, and now I don’t have enough breath to walk up the stairs!”walk up the stairs!”

Examiner:Examiner: “It must be hard—you used to exercise “It must be hard—you used to exercise every day, and now you can’t do a fraction of what every day, and now you can’t do a fraction of what you used to do.”you used to do.”


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


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ConfrontationConfrontation ““You look depressed today.”You look depressed today.”


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InterpretationInterpretation ““It seems that every time you have a serious It seems that every time you have a serious

asthma attack, you have had some kind of stress asthma attack, you have had some kind of stress in your life.”in your life.”


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

bit after a bronchodilator treatment.”bit after a bronchodilator treatment.”


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SummarySummary The final overview of the examiner’s The final overview of the examiner’s

understanding of the patient’s statements.understanding of the patient’s statements. It condenses the facts and presents an outline of It condenses the facts and presents an outline of

the way the examiner perceives the patient’s the way the examiner perceives the patient’s statements. statements.

The patient can agree or disagree with the The patient can agree or disagree with the examiner’s summary.examiner’s summary.


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Nonproductive Verbal MessagesNonproductive Verbal Messages

Providing assurance or reassuranceProviding assurance or reassurance Giving adviceGiving advice Using authorityUsing authority Using avoidance languageUsing avoidance language DistancingDistancing

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Nonproductive Verbal Messages Nonproductive Verbal Messages (Cont’d)(Cont’d)

Professional jargonProfessional jargon Asking leading or biased questionsAsking leading or biased questions Talking too muchTalking too much Interrupting and anticipatingInterrupting and anticipating Using “why” questionsUsing “why” questions

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Nonverbal SkillsNonverbal Skills

Professional appearanceProfessional appearancevs.vs.

Unprofessional appearanceUnprofessional appearance


Sitting next to the patientSitting next to the patientvs.vs.

Sitting behind a deskSitting behind a desk

Nonverbal Skills (Cont’d)Nonverbal Skills (Cont’d)


Proximity to patientProximity to patientvs.vs.

Far away from patientFar away from patient



Turned toward patientTurned toward patientvs.vs.

Turned away from patientTurned away from patient



Relaxed, open postureRelaxed, open posturevs.vs.

Tense, closed postureTense, closed posture



Leaning toward patientLeaning toward patientvs.vs.

Slouched away from patientSlouched away from patient



Facilitating gesturesFacilitating gestures(e.g., nodding the head) (e.g., nodding the head)

vs.vs.Nonfacilitating gesturesNonfacilitating gestures(e.g., looking at watch)(e.g., looking at watch)



Positive facial expressionsPositive facial expressionsvs.vs.

Negative facial expressionsNegative facial expressions



Good eye contactGood eye contactvs.vs.

Poor eye contactPoor eye contact



Moderate tone of voiceModerate tone of voicevs.vs.

Strident, high-pitched voiceStrident, high-pitched voice



Moderate rate of speechModerate rate of speechvs.vs.

Speech too fast or too slowSpeech too fast or too slow



Appropriate touchAppropriate touchvs.vs.

Too frequent or inappropriate touchToo frequent or inappropriate touch



Closing the InterviewClosing the Interview

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

about?”about?” ““Do you have any questions you would like to ask Do you have any questions you would like to ask

me?”me?” ““Are there any other problems that I should have Are there any other problems that I should have

asked you about?”asked you about?”

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Closing the Interview (Cont’d)Closing the Interview (Cont’d)

Finally, Finally,

Thank the patient for the time and Thank the patient for the time and cooperation provided during the interview.cooperation provided during the interview.

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