Interview of the cardiopulmonary patient: What questions do you ask? By Elizabeth Kelley Buzbee AAS RRT-NPS, RCP Kingwood College Respiratory Care Program RSPT 1429

Why are you here? What are the signs & symptoms [s /s] that brought you into the institution? What are the signs & symptoms [s /s] that brought you into the institution? Is this a chronic problem with an acute manifestation [exacerbation?] Is this a chronic problem with an acute manifestation [exacerbation?]

Who are you? Basic demographics: Basic demographics: Age/sex/race/national origin/religion Age/sex/race/national origin/religion Marital status? Marital status? Occupation/hobbies? Occupation/hobbies?

Discuss the history of the recent illness When did you get first signs & symptoms [s/s?] When did you get first signs & symptoms [s/s?] How fast did you get sick? How fast did you get sick? What events triggered this illness? What events triggered this illness? What did you do for this? What did you do for this?

Describe cough/sputum Amount? How often? triggers? Amount? How often? triggers? Do you cough a lot at night or in the morning. Do you cough a lot at night or in the morning. Do you have a dry cough? Do you have a dry cough? Is there blood; if so, bright red, bubbles Is there blood; if so, bright red, bubbles old dark blood? old dark blood? How much blood? Teaspoon, streaks in the sputum, clots.

More on cough Is the cough recurrent [keeps coming back?] Is the cough recurrent [keeps coming back?] Is the cough effective or is the patient too weak to bring up anything? Is the cough effective or is the patient too weak to bring up anything? Is the cough associated with eating or drinking? Is the cough associated with eating or drinking? Is there a history of choking, reflux, heartburn [sour stomach] Is there a history of choking, reflux, heartburn [sour stomach] Is there a history of post nasal drip, nasal congestion? Is there a history of post nasal drip, nasal congestion?

More on sputum Sputum is mucous from deep in the lungs. It should not be confused with nasal secretions or spit from the mouth. Sputum is mucous from deep in the lungs. It should not be confused with nasal secretions or spit from the mouth. Normal sputum is watery, clear, looks like raw egg white. Small amount. Normal sputum is watery, clear, looks like raw egg white. Small amount. Black or brown sputum is associated with smoke or inhaled coal dust Black or brown sputum is associated with smoke or inhaled coal dust Frothy, pink is associated with pulmonary edema Frothy, pink is associated with pulmonary edema Thick, colored sputum is associated with various infections Thick, colored sputum is associated with various infections Blood streaked, bloody or frank blood is associated with pulmonary bleeding that could be due to TB or cancer Blood streaked, bloody or frank blood is associated with pulmonary bleeding that could be due to TB or cancer

Get the details of this patient’s symptoms If pain: If pain: when, how long does it last and where on the body? when, how long does it last and where on the body? Rate pain from 10 most extreme to 1 mildest. Rate pain from 10 most extreme to 1 mildest. What triggered the pain; what makes it go away? What triggered the pain; what makes it go away? If shortness of breath: If shortness of breath: When, how long does it last and what triggered SOB. When, how long does it last and what triggered SOB. Is it associated with cough? Body position? Chest pain? Is it associated with cough? Body position? Chest pain? Rate SOB from 10 to 1 Rate SOB from 10 to 1 Is SOB associated with blue or grey lips or nail beds Is SOB associated with blue or grey lips or nail beds How many stairs can you climb before getting SOB How many stairs can you climb before getting SOB How many steps can you take before getting SOB How many steps can you take before getting SOB

Get the details of this patient’s symptoms If swelling: If swelling: Is swelling worse at night or during the day. Is swelling worse at night or during the day. Is it associated with SOB or chest tightness? Is it associated with SOB or chest tightness? Is swelling in the feet or legs? Is swelling in the feet or legs? Is the abdomen swollen? Is the abdomen swollen?

Get the details of this patient’s symptoms Do you get chest palpations [feelings like your heart is turning over in your chest Do you feel like your heart is beating too hard or too fast? Is it associated with swelling or SOB? Do you have hypertension [high blood pressure] Do you take medicine for hypertension?

Get the details of this patient’s symptoms How about sleep: How about sleep: Do symtoms interfere with sleep? Do symtoms interfere with sleep? Does spouse complain about sudden arousals or snoring? Does spouse complain about sudden arousals or snoring? Night sweats? Night sweats? Wake up with headaches? Wake up with headaches? Extra-sleepiness during the daytime Extra-sleepiness during the daytime How about appetite: How about appetite: Do you get SOB with meals Do you get SOB with meals Have you unexplained weight loss? Have you unexplained weight loss? Do you have reflux Do you have reflux Do you choke easily Do you choke easily

Past medical history Have you been diagnosed with any type of pulmonary [lung] disease? Have you been diagnosed with any type of pulmonary [lung] disease? Did you have allergies or asthma as a child? Did you have allergies or asthma as a child? Have you been diagnosed with any type of cardiac [heart] disease? Have you been diagnosed with any type of cardiac [heart] disease? Have you been diagnosed with any type of neurological or neuromuscular disease? Have you been diagnosed with any type of neurological or neuromuscular disease? Do you have hypertension [high blood pressure] Do you have hypertension [high blood pressure] Do you have allergies? Do you have allergies? Up-to-date on immunizations? Up-to-date on immunizations?

Recent exposures Have you traveled out of the country? Have you traveled out of the country? Have you recently traveled to san Joaquin valley or to Mississippi River area? Have you recently traveled to san Joaquin valley or to Mississippi River area? Have you been exposed to chemicals or smoke— house fire, toxic spill? Have you been exposed to chemicals or smoke— house fire, toxic spill? Has your house flooded? Located near freeway or factories? Has your house flooded? Located near freeway or factories? have you been outside in the weather, mold, mowed the grass recently, BBQ smoke have you been outside in the weather, mold, mowed the grass recently, BBQ smoke

Family medical history From what diseases did parents/grandparents/siblings/uncles/aunt s/cousins die? From what diseases did parents/grandparents/siblings/uncles/aunt s/cousins die? At what age did they die? At what age did they die? Is there a family history of heart disease, or lung disease. Is there a family history of heart disease, or lung disease. Is there a family history of neurological or neuromuscular disorders? Is there a family history of neurological or neuromuscular disorders?

History of surgeries Ask approximate dates and types of any surgical procedures this patient has had in the past. Ask approximate dates and types of any surgical procedures this patient has had in the past. Ask about complications Ask about complications Ask about earlier hospitalizations. Ask about earlier hospitalizations. Admission to the ICU. Admission to the ICU. Been on a mechanical ventilator? Been on a mechanical ventilator?

Drug history What OTC or prescription drugs is this patient What OTC or prescription drugs is this patient taking and for what? If patient is taking drugs for pulmonary problems If patient is taking drugs for pulmonary problems ask about compliance with treatment. Ask about drinking, & recreational drug use. Needles? Snorting? Pills? Ask about drinking, & recreational drug use. Needles? Snorting? Pills? Discuss your smoking history. How many packs of cigarettes for how many years. Pack/years Discuss your smoking history. How many packs of cigarettes for how many years. Pack/years If patient says he quit ask: when? If patient says he quit ask: when? Does patient take inhalers at home; discuss technique Does patient take inhalers at home; discuss technique Does patient take nebulized medication at home; discuss technique of cleaning equipment Does patient take nebulized medication at home; discuss technique of cleaning equipment Does patient have home oxygen? Does patient have home oxygen?

Psychosocial Is the disease affecting mood? Is the disease affecting mood? Would this patient describe himself as Would this patient describe himself as happy, content, unhappy, depressed? Is disease affecting patient’s ability to Is disease affecting patient’s ability to leave the house? go to store? go to church? Is there a good support system at home/church/support groups for disease? Is there a good support system at home/church/support groups for disease? Does this patient live alone? Does this patient live alone?