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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
3Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Section I
Clinical Data Obtained at
the Patient’s Bedside
4Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 1
The Patient Interview
Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Patient History
Biographic data Age, gender, occupation
Chief complaint
Present health
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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Patient History (Cont’d)
Past health
Family history
Review of body systems
Functional assessment
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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Internal Factors
What the practitioner brings to the interview Genuine concern for others
Empathy
The ability to listen
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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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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10Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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?
Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
External Factors
A good physical setting Ensures privacy
Prevents interruptions
Secures a comfortable physical environment
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12Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Techniques of Communication
Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Responses—Assisting the Narrative
Facilitation “Mm-hmm,” “Go on,” “Continue”
“Uh-huh”
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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Silence Effective after an open-ended question
Responses—Assisting the Narrative
(Cont’d)
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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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.”
17
Responses—Assisting the Narrative
(Cont’d)
Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Clarification “Tell me what you mean by bad air.”
Responses—Assisting the Narrative
(Cont’d)
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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Confrontation “You look depressed today.”
Responses—Assisting the Narrative
(Cont’d)
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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Nonproductive Verbal Messages
Providing assurance or reassurance
Giving advice
Using authority
Using avoidance language
Distancing
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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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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26Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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)
36Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Moderate rate of speech
vs.
Speech too fast or too slow
Nonverbal Skills (Cont’d)
37Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Appropriate touch
vs.
Too frequent or inappropriate touch
Nonverbal Skills (Cont’d)
Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
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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Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Closing the Interview (Cont’d)
Finally,
Thank the patient for the time and
cooperation provided during the interview.
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