interview/communiciation
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| phases of interview | *introductory (explain, pt at ease)
*working (data collection, longest)
*termination (summarize, restate findings)
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| Health histary starts with with these 4 topics | *biographical datae
*source of referral
*source of history
*reason for seeking care/chief complaint
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| critical characteristics of a symptom | PQRSTU where U is understand pts perception
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| past health laundry list includes | childhood illness, immunizations, allergies, current medications, last exam dates, recent travel, military service...amongst similar
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| family history provides clues to genetically linked or familial diseases | the usual list of heart disease, HTN, diabetes et al
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| family history should include | same subjects on as genogram (extended blood family)
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| two methods for obtaining family history | list and genogram
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| Review of Body systems - review, but you know them | 1-general
2-integumentary
3-head
4-eyes
5-ears
6-nose/sinus
7-mouth/throat
8-neck
9-breast, axilla
10+ resp, CV, PV, GI, UG, sexual, musculoskelatal, neuro, hematlological, endocrine, psychiatric
8
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| functional assessment indicators | self-esteem/concept---health practicies/beliefs---activity/exercise/leisure---sleep/rest---nutrition/tobacco/alcohol/street drugs---physical violence, SES, env hazards, occ health, saffety, rltnshps, coping/stress mgmt
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| when documenting | summarize pertinent findings, don't use normal, record pertinent negatives, date/sign
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| ends with summary | which is a subjective data base from which we bridge into phpysical assessment and helps develop successful plan of care
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Created by:
lorrelaws
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