RCP370: WK#1 Chapter 1 & 2

Explain is the purpose of a patient interview

➤ Purpose is to gather pertinent historical subjective and objective date

What are some examples of biographic data?

-Age

-gender

-occupation

Explain what the patient history forms contain

Forms contain

➤ Chief complaint

➤ Present health or history of present illness

➤ Current medications

➤ Past health

➤ Family history

➤ Review of body systems

➤ Functional assessment

Why is it important to document the chief complaint seperately?

- Chief complaint -> primary reason 4 visit - never in medical terms

- present illness (hx)-> provides more context

Explain the internal factors that should the practitioner have during an interview

➤ Personal Qualities

◈ Genuine concern for others

◈ Empathy

◈ Understanding

◈ The ability to actively listen

How can a computer or clipboard interfere with patient communication?

Physical barrier casues pt to shut down

Practitioner focus may shift to computer/clipboard missing important verbal/nonverbal gestures from pt

Define cultural sensitivity

Respecting pt suctoms (communication norms) by refraining from using offensive lang

How does cultural sensitivity affect communication

Avoids misunderstanding

builds trust + compliance

What is the difference between cultural sensitivity and cultural awareness?

Sensitiviy = Behavior based ( offensive lang)

Awareness = understand person hx & traditions ( beliefs, diet, celebrations/rituals)

Examples of how pt culture of religion might influence their health behaviors or decisions

- dietary restrictions

- belief around treatment methods

- religious practice ( prayer time, certain day cant have procedures)

Explain health literacy and what it includes

➤ pt ability to obtain, process and understand basic health info

➤to understand and act on health information and instructions

What are key elements of the plain language approach?

- section presentation

- importance of patient care 1st

- lamens terms

-short sentences

-follow up questions

Why is it important to avoid technical medical terms when speaking with patients?

causes confusion

ensures pt understands

avoids vagueness

open-ended questions

provide narrative info

gather further info when pt introduces new topic

Examples:

What brings you in today ?

closed direct questions

Specific info

short one words ans

Examples:

Have you ever had this chest pain before?

When would it be appropriate to use a closed question during an interview?

fill in any info pt left out

emergency situation - unable to speak full sentences

Why are follow up q's important after initial response?

Pt will usually add important info when encouraged to expand w/ more detail

Facilitation

➤ Encourages patient to say more

Silence

Silence

➤ Time for patient to think

➤ Effective after an open-ended question

Reflection

Allows pt time to think + organize what they wish to say w/out interruptions

effective after open ended q's

example of empathy during pt interview

"it must be difficult for you"

Clarification

Ensure understanding + compassion towards pt feelings

helps pt focus on specific area and continue in their own words

5 types of nonproductive verbal messages

1. providing false reassurance

2. giving advice

3. using authority (cornering them to say what you want)

4. guiding language

5. distancing (dont be too far or close)

Why should leading/biased questions be avoided?

pt may feel obligated to answer in favor of examiner

feel guilty or judged

dishonest answers

Why is providing false reassurance nonproductive?

- minimizes pt concern

- prevent pt from expressing true feelings

- halts further communication

Examples of effective nonverbal communication

Basically anything the pt observes from examiner - make a comfortable environment

ex: facial expressions, Eye contact, touch

how can nonverbal cues like posture or eye contact affect pt trust

posture - closed arms(defensive, uninterested)

Eye contact - paying attention

A pt says they have "bad air" how would you respond

- clarification: What do you mean by "bad air"

pt seems nervous but says "im fine" what communication strategy would you use?

confrontation and empathy

Primary vital signs

Body temp

pulse

RR

BP

**think of everything we look @ on the monitor

Norm core body temp

37C

98.6 F

How does the body respond to an increase or decrease in temperature?

Inc = vasodilation

decrease = vasoconstriction

Causes of hypothermia

excessive heat loss

inadequate heat production to counter loss

impaired hypothalamic thermoregulation

clinical signs of hypothermia (other reasons other than typical)

pale bluish, cool waxy skin

drowziness/ unconsciousness

disorientation

coma

Why is therapeutic hypothermia

reduce brain metabolism rate

core temperature sites

rectal

tympanic (ear cannal)

esophagus

pulm. artery

aspects of pulse evaluated during assessment

Rate

rhythm

strength

how does temp and oxygenation influence RR rate ?

temp UP = INC RR

Oxygenation DOWN = INC RR

Eupnea

normal rate +rhythm

Biots

Fast, deep respirations with abrupt pauses

conditions associated with Cheyne stokes

Heart failure (CHF)

stroke/ brain injury

Pulsus paradoxus

Decrease of ystolic BP >10mmHg on inspiration

BP increases on expiration

What does a significant drop in BP during inspiration indicate?

Pulsus paradoxus (respiratory distress)

Asthma!

COPD SPO2 norm

88-92%

EARLY stages of oxygenation

respiratory

-tachypnea

- Dyspnea or exertion

LATE stages of oxygenation

respiratory

-use of accessory muscles

- intercostal retractions

-takes breath in bet. each word/sentence

EARLY stages of oxygenation

cardiovascular

- tachycardia

- mild hypertension

-arrythmias

LATE stages of oxygenation

cardiovascular

- hypotension

- cyanosis

- skin cool/clammy

why is pulse oximetry considered the 5th vital sign?

tells us immediate oxygenation

4 techniques during physical chest exam

-inspection

-palpation

-percussion ( checking underlying skin - ex: fluid?)

- auscultation

What are you assessing during palpations?

Symmetry

lumps

tenderness

How is chest excursion evaluated?

hands on T8-T10 on chest

thumbs midline

observe movement (symmetry of chest movement )

What is normal chest movement during exam?

3-5cm from midline

check on inhale

Decreased tactile fremitus

Obstructions: decrease in vibrations - lungs cant expand well

COPD

pleural effusion

pneumothorax

Increased tactile fremitus

Alveolar consolidation

atelectasis

pulm edema

PF (pulm fibrosis)

diseases associated with Dull percussion

INC density in lung of pleural space

- pleural thickening

- pleural effusion

- atelectasis

- consolidation (liquid instead of air)

diseases associated with Hyperresonant percussion

Decreased density - INC air

COPD

Pneumothorax

Asthma

Normal breath sounds

vesicular breath sounds

Fine crackles

Heart failure

pneumonia

Course crackles

pulm edema

chronic bronchitis

bronchial (alveoli)

lung consolidation

pleural friction rub

pleura surrounding lung becomes inflamed and rub together (insp/exp)

Diminished breath sounds

Atelectasis

pleural effusion

How should you document adventitious breath sounds

Note intensity or loudness

- faint, soft, moderate, loud

Which part of respiratory cycle?

-inspiration or expiration

How does pursed lip breathing help?

- stabalizes air way

-offsets airtrapping

- better gas mixing breathing patterns

how do you distinguish abnormal vs absent breath sounds?

ABNORMAL - there's a sounds thats not typical

ABSENT - no sound = restriction of airflow