1 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 1 Preparing for the Patient Encounter

2 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives After reading this chapter you will be able to:  Describe the role of the respiratory therapist (RT) in patient assessment  Recognize the purpose(s) of the preinteraction, introductory, initial assessment, treatment and monitoring, and follow-up stages of patient-clinician interaction

3 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.  Recognize the approximate distances and appropriate activities for proper conduct within social, personal, and intimate spaces  Recognize the value of the RT’s being aware of territoriality  Describe techniques that convey genuine concern during patient-clinician interaction Learning Objectives (cont’d)

4 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.  Describe universal precautions and methods by which they are practiced  Define the following terms as they pertain to interpreting diagnostic test results:  True positive  True negative  False positive  False negative  Sensitivity Learning Objectives (cont’d)

5 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Role of the RT in Patient Assessment  Role has changed dramatically over the past several decades  Today RTs are called to assist physician in the process of diagnostic reasoning  This requires that RTs be skilled at critical thinking while evaluating very sick patients

6 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Stages of Patient-Clinician Interaction  Preinteraction stage  Most patient encounters begin with RT reviewing patient’s chart to identify name, age, chief complaints, and history of present illness  Clarify in your mind what your role will be with this patient

7 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Stages of Patient-Clinician Interaction  Introductory stage  Purpose is to introduce yourself to the patient and begin to establish a rapport  Use patient’s formal name initially until he/she gives you permission to use a first name  Verify patient identification

8 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Stages of Patient-Clinician Interaction  Initial assessment stage  Overlaps with the introductory stage  Observe patient’s general appearance and response to questions  Identify patient’s baseline condition and need for treatment the physician has ordered

9 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Stages of Patient-Clinician Interaction  Treatment and monitoring stage  After the initial assessment you are ready to administer the treatment  Monitoring patient’s response to the treatment is important  If patient has side effects, the treatment should be stopped

10 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Stages of Patient-Clinician Interaction  Follow-up stage  After treatment is over, take a minute to communicate with the patient  Let him/her know when you will return and how to contact you if needed  Mare sure the patient is comfortable before you leave

11 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Use of Space  Social space: 4 to 12 feet from the patient; useful for the initial introduction  Personal space: 2 to 4 feet from the patient; useful for the interview  Intimate space: 0 to 2 feet from the patient; useful only for the physical examination

12 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Confidentiality  All information about the patient is confidential  RTs must not share patient information with others who do not need to know about the patient  Violations of confidentiality are unethical and may be subject to legal recourse

13 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Health Insurance Portability and Accountability Act  Passed by Congress in 1996 to increase one’s ability to transfer health care information from one provider to another  Title II of this law took effect in 2003 and established rules for disclosure of Protected Health Information (PHI)  Only approved health care providers can have access to PHI

14 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Expressing Genuine Concern: Techniques  Face the patient squarely  Use eye contact appropriately  Maintain an open posture  Consider appropriate use of touch  Difficult to use when patient is a different gender or from another culture  Be an active listener

15 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Interpreting Diagnostic Tests  Results that are normal are said to be “negative”  Results that are abnormal are said to be “positive”  Results are said to represent a “true negative” if the patient truly lacks disease  Results are said to represent a “true positive” if they are the result of disease

16 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Interpreting Diagnostic Tests  Some negative test results may represent a “false negative” when for some reason the test result does not detect underlying disease  False positives suggest a disease is present even when it is not  False negatives and false positives are not uncommon for TB skin tests

17 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Interpreting Diagnostic Tests  Tests that are “sensitive” are able to detect a certain disease when it is present most of the time  Tests that are “specific” are only positive when the suspected disease is present  The sensitivity and specificity for any given test will vary with the illness under investigation