Mosby items and derived items 2011, 2006 by Mosby, Inc ... items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Section I Clinical Data Obtained at the

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  • 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 I

    Assessment of

    Respiratory Disease

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    Section I

    Clinical Data Obtained at

    the Patients 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 (Contd)

    Past health

    Family history

    Review of body systems

    Functional assessment

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    Patient Interview

    Patients impression of his or her health

    Establish rapport and trust

    Understanding of patients 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 (Contd)

    During the interview the examiner should: Observe the patients body language

    For example, note Facial expressions Eye movement Pain grimaces Restlessness Sighing

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    Internal Factors (Contd)

    The examiner should listen to the way things

    are said

    For example: Is the tone of the patients voice?

    Does the patients voice quiver?

    Are there pitch breaks in the patients 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 informationa 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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    ResponsesAssisting the Narrative

    Facilitation Mm-hmm, Go on, Continue

    Uh-huh

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    Silence Effective after an open-ended question

    ResponsesAssisting the Narrative

    (Contd)

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    Reflection Patient: My breathing is blocked.

    Examiner: Its 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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    ResponsesAssisting the Narrative

    (Contd)

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

    day, and now I dont have enough breath to walk

    up the stairs!

    Examiner: It must be hardyou used to exercise

    every day, and now you cant do a fraction of what

    you used to do.

    ResponsesAssisting the Narrative

    (Contd)

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    Clarification Tell me what you mean by bad air.

    ResponsesAssisting the Narrative

    (Contd)

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    Confrontation You look depressed today.

    ResponsesAssisting the Narrative

    (Contd)

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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.

    ResponsesAssisting the Narrative

    (Contd)

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

    bit after a bronchodilator treatment.

    ResponsesAssisting the Narrative

    (Contd)

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    Summary The final overview of the examiners

    understanding of the patients statements.

    It condenses the facts and presents an outline of

    the way the examiner perceives the patients

    statements.

    The patient can agree or disagree with the

    examiners summary.

    ResponsesAssisting the Narrative

    (Contd)

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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

    (Contd)

    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 (Contd)

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    Proximity to patient

    vs.

    Far away from patient

    Nonverbal Skills (Contd)

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    Turned toward patient

    vs.

    Turned away from patient

    Nonverbal Skills (Contd)

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    Relaxed, open posture

    vs.

    Tense, closed posture

    Nonverbal Skills (Contd)

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    Leaning toward patient

    vs.

    Slouched away from patient

    Nonverbal Skills (Contd)

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    Facilitating gestures

    (e.g., nodding the head)

    vs.

    Nonfacilitating gestures

    (e.g., looking at watch)

    Nonverbal Skills (Contd)

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    Positive facial expressions

    vs.

    Negative facial expressions

    Nonverbal Skills (Contd)

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    Good eye contact

    vs.

    Poor eye contact

    Nonverbal Skills (Contd)

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    Moderate tone of voice

    vs.

    Strident, high-pitched voice

    Nonverbal Skills (Contd)

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    Moderate rate of speech

    vs.

    Speech too fast or too slow

    Nonverbal Skills (Contd)

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    Appropriate touch

    vs.

    Too frequent or inappropriate touch

    Nonverbal Skills (Contd)

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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 (Contd)

    Finally,

    Thank the patient for the time and

    cooperation provided during the interview.

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