Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

2 PART I Assessment of Respiratory Disease

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

4 Mosby 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 5

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 6

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 7

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 8

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 Facial expressions Eye movement Eye movement Pain grimaces Pain grimaces Restlessness Restlessness Sighing Sighing 9

10 Mosby 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 11

12 Mosby 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?” 13

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?” 14

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” 15

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) 16

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) 18

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) 19

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) 20

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) 21

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) 22

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) 23

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 24

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 25

26 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Nonverbal Skills Professional appearance vs. Unprofessional appearance

27 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Sitting next to the patient vs. Sitting behind a desk Nonverbal Skills (Cont’d)

28 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Proximity to patient vs. Far away from patient Nonverbal Skills (Cont’d)

29 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Turned toward patient vs. Turned away from patient Nonverbal Skills (Cont’d)

30 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Relaxed, open posture vs. Tense, closed posture Nonverbal Skills (Cont’d)

31 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Leaning toward patient vs. Slouched away from patient Nonverbal Skills (Cont’d)

32 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Facilitating gestures (e.g., nodding the head) vs. Nonfacilitating gestures (e.g., looking at watch) Nonverbal Skills (Cont’d)

33 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Positive facial expressions vs. Negative facial expressions Nonverbal Skills (Cont’d)

34 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Good eye contact vs. Poor eye contact Nonverbal Skills (Cont’d)

35 Mosby items and derived items © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Moderate tone of voice vs. Strident, high-pitched voice Nonverbal Skills (Cont’d)

36 Mosby 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)

37 Mosby 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?” 38

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. 39