N504 Ch 3, 4, and 11. Questions and answers, 2022 update, Graded A+ Document Content and Description Below

N504 Ch 3, 4, and 11. Questions and answers, 2022 update, Graded A+ Document Content and Description Below N504 Ch 3, 4, and 11. Questions and answers, 2022 update, Graded A+ Subjective data collection Patient perception of health First step in the therapeutic relationship - ☑☑The interview Identify health strengths and problems as bridge to physical examination -First and most important part of data collection -Collects subjective data: what person says about his or her perceived health state -Individual knows everything about his or her own health state, and nurse knows nothing - ☑☑Interview goal identification What are some successful interview characteristics? - ☑☑-Gather complete and accurate data about person's health state -Establish rapport and trust -Teach person about health state -Build rapport to continue therapeutic relationship and to facilitate future diagnoses, planning, and treatment -Begin teaching for health promotion and disease prevention _____ consists of spoken and unspoken rules for behavior What person needs and expects from health care and what health professional has to offer Mutual goal is optimal health for patient - ☑☑The interview contract Below describes Time and place of interview and physical examination Introduction of and explanation of health care provider's role Purpose of interview How long it will take Expectation of participation for each person Presence of others (family, etc.) Confidentiality and to what extent it may be limited Any costs that the patient must pay - ☑☑The interview contract terms Communication is behavior, conscious and unconscious, verbal and nonverbal All behavior has meaning Body language: posture, gestures, facial expression, eye contact, foot tapping, touch, even where you place your chair - ☑☑process of communication: sending Communication is a tool, as basic to quality health care as tools of inspection or palpation Receiver attaches meaning determined by his or her past experiences, culture, self-concept, and current physical and emotional state Successful communication requires mutual understanding by sender and receiver Patients' health problems intensify communication because patients depend on you to get better - ☑☑process of communication: recieveing -Awareness of internal and external factors and their influence allows you to maximize communicating skill -Internal factors Liking others Empathy Ability to listen - ☑☑Process of communication: internal factors Ensure privacy Refuse interruptions Physical environment Dress Note-taking may be unavoidable Cannot rely completely on memory for details of previous illnesses or review of body systems Tape and video recording - ☑☑Process of communication: external factors Which of the following would be the best way to refer to an adult patient when initiating the interview? 1. Hello Mr. Jones, what brought you to the emergency department today? 2. Hello James, what brought you to the emergency department today? 3. Hi, I'm nurse John, what brought you into the hospital today Jim? 4. Hi Mr. J., what's up? Why are you here today? - ☑☑3 Breaks eye contact too often Shifts attention away from person, diminishing his or her sense of importance Interrupts patient's narrative flow Impedes observation of patient's nonverbal behavior May be threatening to patient's discussion of sensitive issues - ☑☑Challenges of note taking Introducing the interview -Working phase -Data-gathering phase -Verbal skills include questions to patient and your - responses to what is said Two types of questions -Open-ended -Closed -Each has a different place and function in interview - ☑☑Techniques of communication Ask for narrative responses State topic only in general terms Use them in the following situations: To begin interview To introduce a new section of questions Whenever the patient introduces a new topic - ☑☑open ended questions Ask for specific information Elicit short one- or two-word answers, a yes or no answer, or a forced choice Use them in the following situations: After opening narrative to fill in details person may have left out When you need many specific facts about past health problems or during review of systems To move the interview along - ☑☑Closed or direct questions Which of the following questions would likely warrant the best response? 1. Why did you come in today? 2. Where does it hurt? 3. Have you been checking your blood pressure? 4. When was the last time you were seen by a doctor? - ☑☑1 _______ encourages patients to say more and shows you are interested and will listen further - ☑☑Facilitation Gives patient time to think and organize what to say without interruption from you Gives you a chance to observe person unobtrusively and note nonverbal cues - ☑☑silent attentiveness Echoes patient's words, repeating what person has just said, focuses further attention on a specific phrase, and helps person continue in his or her own way - ☑☑reflection Recognizes a feeling and puts it into words Names the feeling and allows expression of it - ☑☑Empathy Use when person's words are ambiguous or confusing You are asking for agreement, and the person can then confirm or deny your understanding - ☑☑clarification Frame of reference shifts from patient's perspective to yours May focus on discrepancy or inconsistency in person's narrative You have observed a certain action, feeling, or statement and now focus person's attention on it You give honest feedback about what you see or feel - ☑☑confrontation Based on your inference or conclusion It links events, makes associations, implies cause, ascribes feelings Helps person understand his or her own feelings in relation to the verbal message If your inference is incorrect, the patient may correct it and thus prompt further discussion of topic - ☑☑interpretation These statements inform the person; you share factual and objective information, offering reasons for requirements or actions - ☑☑explanation Final review of what person has said; it condenses facts and presents your view of health problem Is a type of validation that person can agree with or correct; both you and patient should participate Occurring at the end of the interview, it signals that termination of the interview is near - ☑☑Summary Providing false assurance or reassurance Giving unwanted advice Using authority Using avoidance language Engaging in distancing Using professional jargon Using leading or biased questions Talking too much Interrupting Using "why" questions - ☑☑ten traps of interviewing Nonverbal skills Physical appearance Posture Gestures Facial expression Eye contact Voice Touch Closing the interview - ☑☑elements of the interview process Hearing impaired Acutely ill Under influence of street drugs or alcohol Those who must be asked personal questions Sexually aggressive Crying Angry and threatening violence Anxious - ☑☑Interviewing people with special needs Being aware of maintaining cultural norms during interview and examination process Maintaining privacy and modesty - ☑☑gender Maintaining neutrality related to patient's presentation by being mindful of communication patterns Being aware of your own personal bias and baggage - ☑☑sexual orientation Probability of miscommunication increases when two people are from different cultural backgrounds Cultural backgrounds of both health care professional and patient influence verbal and nonverbal communications Cultural perspectives on professional interactions Etiquette Space and distance - ☑☑cross cultural care Working with and without interpreters Nonverbal cross-cultural communication Touch Touching patients is a necessary component of comprehensive assessment Physical contact with patients conveys various meanings cross-culturally Patient's significant others may exert pressure on nurses by enforcing culturally meaningful norms in health care setting - ☑☑overcoming communication barriers Five types of nonverbal behaviors convey information about person - ☑☑vocal cues action cues object cues personal space touch pitch, tone, and quality of voice, including moaning, crying, and groaning - ☑☑vocal cues posture, facial expression, and gestures - ☑☑action cues clothing, jewelry, and hairstyles - ☑☑object cues interpersonal transactions and care of belongings - ☑☑personal space involves use of personal space and action - ☑☑touch This is more than just the ability to read but rather includes understanding and following directions that lead to effective communication between the patient and the health care provider A patient may be literate but not have health literacy Involves the use of quantitative measurement and memory aspects Tools for determining literacy Test of Functional Health Literacy (TOFHLA) Rapid Estimate of Adult Literacy in Medicine (REALM) Newest Vital Sign (NVS) - ☑☑health literacy Oral teaching Use of written materials based on standard educational levels Teach back or use of return demonstration - ☑☑techniques to improve health literacy Biographical data Source of history Reason for seeking care Present health or history of present illness Past health Family history Review of systems Functional assessment including activities of daily living (ADLs) - ☑☑health history sequence Name Address and phone number Age and birth date Birthplace Sex Marital status Race Ethnic origin Occupation: usual and present - ☑☑biographical data Record who furnishes information, usually the person, although source may be relative or friend Judge reliability of informant and how willing he or she is to communicate A reliable person always gives same answers when questions are rephrased or are repeated later in interview Note any special circumstances, such as use of interpreter - ☑☑source of history Brief spontaneous statement in person's own words describing reason for visit - ☑☑reason for speaking care subjective sensation person feels from disorder What person says is reason for seeking care is recorded and enclosed in quotation marks to indicate person's exact words - ☑☑symptom objective abnormality that can be detected on physical examination or in laboratory reports - ☑☑sign Location Character or quality Quantity or severity Timing Setting Aggravating or relieving factors Associated factors Patient's perception - ☑☑Present Health or History of Present Illness (HPI) PQRSTU mnemonic - ☑☑P = Provocative or palliative Q = Quality or quantity R = Region or radiation S = Severity scale: 1 to 10 T = Timing or onset U = Understand patient's perception of problem Which of the following is a good example of a well-written chief complaint? 1. Patient complaining of chest pain for about 3 days that is worse with activity and relieved with rest. 2. Pain is a 10/10. 3. Patient complaining of chest pain. R/O MI. 4. Patient states "I don't know what this pain is. This is the worst I have ever felt." - ☑☑1 Childhood illnesses Accidents or injuries Serious or chronic illnesses Hospitalizations OperationsObstetric history Immunizations Last examination date Allergies Current medications - ☑☑past medical history Age and health or cause of death of relatives Health of close family members Family history of various conditions such as heart disease, high blood pressure, stroke, diabetes, blood disorders, cancer, sickle-cell anemia, arthritis, allergies, obesity, alcoholism, mental illness, seizure disorder, kidney disease, and tuberculosis Family tree (genogram) to show this information clearly and concisely - ☑☑family history genogram - ☑☑family tree Additional questions for new immigrants Biographical data Spiritual resource and religion: assess if certain procedures cannot be done Past health: what immunizations, if any Health perception How does person describe health and illness How does person see problems he or she is now experiencing Nutrition: taboo foods or food combinations - ☑☑cross cultural care implications General overall health state Skin Hair Head Eyes Ears Nose and sinuses Mouth and throatNeck Breast Axilla Respiratory system Cardiovascular Peripheral vascular Gastrointestinal Urinary systemMale genital system Female genital system Sexual health Musculoskeletal system Neurologic system Hematologic system Endocrine system - ☑☑review of symptoms Self-esteem, self-con