Chapter 1
What are the different facets of patient health?
There are 7 facets 1. physical health, emotional health, social well-being, cultural influences, spiritual
influences, environmental influences, and developmental level.
What is the role of the nurse when conducting a health assessment?
The nurse assesses the patient’s needs, develops interventions, & educates and counsels. The nurse asks
the patient about their goals and views, offers holistic care. The nurse collects patient data using the 7 b
b facets of health, and looks for teaching opportunities.
What are the steps in the nursing process and how might the nurse utilize these steps when
conducting a health assessment?
ADPIE-
Assessment-Head to Toe assessment going over the entire patient’s body functions to determine issues or
abnormalities.
Diagnosis - Active and changes. Rather than giving a concrete problem, it diagnoses problems that a
person is at “risk for”, and seeks ways to change or fix those issues.
Planning: Creating a care plan for a patient is personal and very accustomed to the patient’s needs,
education level, etc. A strong plan will have SMART Goals normally.
Implementation: Strong communication and effective teaching in this phase will impact the level of
activity the patient is willing to join in on. The implementation of the plan is vital, and should be as
smooth and comfortable for the patient as possible.
Evaluation: How did the plan work out? Did it work/not work? What were the patient’s concerns or
shortcomings? Discover issues, re-assess, and reconstruct a new plan, if the previous failed.
Ch. 2
What types of problems must have highest priority for patient care?
When prioritizing cares or nursing diagnoses:
1. Safety - the stuff that is life threatening (Fire, Smoke, Electricity, train tracks…)
2. ABCs – For example, altered tissue perfusion is probably a circulation issue. If one of
the other options is impaired gas exchange (an airway or breathing issue), then you
probably need to address it first. - Airway, breathing, circulation always come first if there
is no safety issue.
3. Safety - the non-life-threatening (I try to make this plain in the questions.)
4. Pain after that – if your patient in pain is falling out of bed, you have the falling first.
(typically 4 or greater on pain scale) - If your patient is safe, and has no airway, breathing,
circulation problems than you need to assess the patient's pain level first, especially if 4 or
greater.
5. Other problems - Any problems that may result from the reason the patient came in today
(diarrhea, obesity, diabetes complications, etc)
6. “Risk for” concerns – since these are concerns that not yet problems, they will
generally fall at the end of the priority list (I’m sure there are exceptions to this
somewhere, but generally speaking, that will be the case.) - “risk for diagnosis.”
What is the OLDCART mnemonic used for? What does each part mean?
OLDCART is generally used for a symptom/ pain. Onset, Location, Duration, Characteristic symptoms,
Associated manifestations, relieving factors, Treatment, Severity
What is the difference between subjective and objective data?
Subjective data- What the patient is telling the nurse, symptoms. Objective- Things that can be seen and
,measured such as pallor, blood pressure, lab tests, signs.
What is the purpose of evaluating a patient’s care plan?
Determining if the interventions are useful & are improving patient’s condition. Are the goals of care
being met.
Ch. 3 & 4
Interviewing & Communication
1. Compare different therapeutic communication techniques which are used during the patient
interview.
a. Active listening: SOLER
b. Guided questioning: facilitate the patient’s fullest communication
i. Move from open-ended to focused questions
ii. Using questions that elicit a graded response: e.g. how many steps can you climb
before you are short of breath?
iii. Asking a series of questions, one at a time: have you ever had any of the
following problems? Then ask them one at a time.
iv. Offering multiple choices for answers: which of the following best describes
your pain: dull, sharp, shooting, etc.
v. Clarifying what the patient means: tell me exactly what you meant by …
vi. Encouraging with continuers: go on, I’m listening, Mm hmmm…
vii. Using reflection: echoing back the patient’s last words
c. Nonverbal communication:
i. Nodding, eyes focused on patient, and good posture show attentiveness and
caring.
ii. Pay close attention to eye contact, facial expression, posture, head position,
movement, interpersonal distance, placement of arms and legs
iii. Match your position with the pt
iv. Be sensitive to the pt culture
d. Empathic responses:
i. Identify pt feelings
ii. Once identified, respond with understanding and acceptance
iii. Provide comfort for the patient that someone understands them and wishes to
help.
e. Validation: Showing the patient that what they feel/think is valid and important to their
overall health.
f. Reassurance: Showing reassurance provides comfort to the patient, allowing their
anxieties or concerns to be resolved safely.
g. Summarization:
i. Give a capsule summary of the patient’s story
ii. Give the patient a chance to clarify any misunderstandings
h. Transition:
i. Tell patient when changing directions during the interview
ii. Orient the patient with brief transitional phrases
i. Empowering the patient:
i. Evoke the patient’s perspective
ii. Convey interest in the person, not just the problem
iii. Follow the patient’s lead
iv. Elicit and validate emotional content
v. Share information with the patient
, vi. Make your clinical reasoning transparent to the pt
vii. Reveal the limits of your knowledge
2. Organize the phases of the nurse-patient interview
a. Phase 1: Pre Interview: gather supplies, review pt charts, collect thoughts
b. Phase 2: Interview/Introduction: AIDET
c. Phase 3: Working
d. Phase 4: Termination: summarize, and let pt know interview is coming to an end
3. Discuss strategies for handling difficult patients.
a. Silent patient:
i. Silence has many meaning and purposes
ii. Pt. may be collecting thoughts, remembering details, deciding whether to trust
you
iii. Nurse should appear attentive and give brief encouragement
iv. Watch pt for nonverbal cues
v. Pt. culture
vi. Depression or dementia
b. Confusing patient:
i. Confusing array of multiple symptoms
ii. Guide interview into psychosocial assessment
iii. If you suspect a psychiatric or neurologic disorder, shift to a mental status
examination
iv. Check responses against chart or seek permission to speak with family members
c. Altered capacity:
i. Determine “decision making capacity.”
ii. Obtain pt permission to talk to family member
iii. May need to find surrogate informant or decision maker to assist with history
iv. Check for durable power of attorney for health care or a health care proxy
v. Apply same principles of interviewing
vi. Always seek best-informed source
d. Talkative patient:
i. Allow the patient to talk, without interruptions. Then summarize what they said
afterwards.
e. Crying patient: Allow the patient to cry, and comfort them if needed. Say things like “it’s
okay to be upset and I’m glad you can share those feelings with me.”
f. Angry or disruptive: Try to calm them down and assure them in their concerns. Tell them
they have a right to be upset, and to acknowledge their emotions. Try to deescalate the
situation. If not, security may have to be involved.
i. Allow the patient to express themselves.
g. Language barriers: use professional translator, always talk toward the patient
h. Low literacy: use of infographics and simple language to help them understand will work.
i. Impaired hearing: Quiet environment, face patient, simple sentences
j. Impaired eyesight: Good lighting, give environment cues
k. Cognitive disabilities: Simple and clear to understand informatics.
l. Personal problems: Let them express them, ask them what they think they should do.
Don’t give advice. Don’t express your own.
m. Sexuality: No hanky panky (Acknowledge that it is normal and healthy to be sexually
attracted to patients, and vice versa. Handle the situation maturely, acknowledge the
patient-provider relationship importance and focus on that).
, What is the difference between open and closed ended questioning and what is the role of each in
the patient interview? Open ended questions elicits information. Closed ended questions are for more
specific information (Symptoms, etc.)
What are the different therapeutic communication techniques?
-Active Listening -Reassurance
-Guided Questioning -Summarizing
-Nonverbal communication -Transitions
-Empathic responses -Empowering the patient
-Validation
a. Phase 1: Pre-interview- set the stage for a smooth interview
a.i. self reflection
a.ii. review patient record
a.iii. set interview goals
a.iv. review own clinical behavior and appearance
b. Phase 2:Introduction- put the patient at ease and establish trust
b.i. greet the patient and establish rapport
b.ii. establish the agenda for the interview
c. Phase 3:Working- obtain patient information
c.i. invite the patient's story
c.ii. identify and respond to emotional cues
c.iii. expand and clarify the patient's story
c.iv. generate and test diagnostic hypotheses
c.v. Negotiate a plan, including further evaluation, treatment, education, and self-management
support and prevention
d. Phase 4: Termination
d.i. summarize important points
d.ii. discuss plan of care
*How do you focus an interview for a specific condition?
- You would conduct a Focused or Problem-oriented assessment
- Open ended questions, then work to close ended questions
-
Health History
1. Apply the four types of histories to appropriate settings.
a. Comprehensive health history -New admit patient
b. Focused or problem-oriented assessment: Old patient coming for a problem with a
specific body system.
c. Follow up history:
d. Emergency history: Emergency situation in the ED.
Identify the components of a comprehensive health history & examples of data that would go in each:
1. Identifying data and source of the history: Name, date, age, gender, marital status, race,
ethnicity, culture, occupation, insurance, source of information/reliability, date of last
visit.
2. Chief complaints: reason for seeking healthcare, focused symptoms analysis of the
current problem.
3. History of present illness:
What are the different facets of patient health?
There are 7 facets 1. physical health, emotional health, social well-being, cultural influences, spiritual
influences, environmental influences, and developmental level.
What is the role of the nurse when conducting a health assessment?
The nurse assesses the patient’s needs, develops interventions, & educates and counsels. The nurse asks
the patient about their goals and views, offers holistic care. The nurse collects patient data using the 7 b
b facets of health, and looks for teaching opportunities.
What are the steps in the nursing process and how might the nurse utilize these steps when
conducting a health assessment?
ADPIE-
Assessment-Head to Toe assessment going over the entire patient’s body functions to determine issues or
abnormalities.
Diagnosis - Active and changes. Rather than giving a concrete problem, it diagnoses problems that a
person is at “risk for”, and seeks ways to change or fix those issues.
Planning: Creating a care plan for a patient is personal and very accustomed to the patient’s needs,
education level, etc. A strong plan will have SMART Goals normally.
Implementation: Strong communication and effective teaching in this phase will impact the level of
activity the patient is willing to join in on. The implementation of the plan is vital, and should be as
smooth and comfortable for the patient as possible.
Evaluation: How did the plan work out? Did it work/not work? What were the patient’s concerns or
shortcomings? Discover issues, re-assess, and reconstruct a new plan, if the previous failed.
Ch. 2
What types of problems must have highest priority for patient care?
When prioritizing cares or nursing diagnoses:
1. Safety - the stuff that is life threatening (Fire, Smoke, Electricity, train tracks…)
2. ABCs – For example, altered tissue perfusion is probably a circulation issue. If one of
the other options is impaired gas exchange (an airway or breathing issue), then you
probably need to address it first. - Airway, breathing, circulation always come first if there
is no safety issue.
3. Safety - the non-life-threatening (I try to make this plain in the questions.)
4. Pain after that – if your patient in pain is falling out of bed, you have the falling first.
(typically 4 or greater on pain scale) - If your patient is safe, and has no airway, breathing,
circulation problems than you need to assess the patient's pain level first, especially if 4 or
greater.
5. Other problems - Any problems that may result from the reason the patient came in today
(diarrhea, obesity, diabetes complications, etc)
6. “Risk for” concerns – since these are concerns that not yet problems, they will
generally fall at the end of the priority list (I’m sure there are exceptions to this
somewhere, but generally speaking, that will be the case.) - “risk for diagnosis.”
What is the OLDCART mnemonic used for? What does each part mean?
OLDCART is generally used for a symptom/ pain. Onset, Location, Duration, Characteristic symptoms,
Associated manifestations, relieving factors, Treatment, Severity
What is the difference between subjective and objective data?
Subjective data- What the patient is telling the nurse, symptoms. Objective- Things that can be seen and
,measured such as pallor, blood pressure, lab tests, signs.
What is the purpose of evaluating a patient’s care plan?
Determining if the interventions are useful & are improving patient’s condition. Are the goals of care
being met.
Ch. 3 & 4
Interviewing & Communication
1. Compare different therapeutic communication techniques which are used during the patient
interview.
a. Active listening: SOLER
b. Guided questioning: facilitate the patient’s fullest communication
i. Move from open-ended to focused questions
ii. Using questions that elicit a graded response: e.g. how many steps can you climb
before you are short of breath?
iii. Asking a series of questions, one at a time: have you ever had any of the
following problems? Then ask them one at a time.
iv. Offering multiple choices for answers: which of the following best describes
your pain: dull, sharp, shooting, etc.
v. Clarifying what the patient means: tell me exactly what you meant by …
vi. Encouraging with continuers: go on, I’m listening, Mm hmmm…
vii. Using reflection: echoing back the patient’s last words
c. Nonverbal communication:
i. Nodding, eyes focused on patient, and good posture show attentiveness and
caring.
ii. Pay close attention to eye contact, facial expression, posture, head position,
movement, interpersonal distance, placement of arms and legs
iii. Match your position with the pt
iv. Be sensitive to the pt culture
d. Empathic responses:
i. Identify pt feelings
ii. Once identified, respond with understanding and acceptance
iii. Provide comfort for the patient that someone understands them and wishes to
help.
e. Validation: Showing the patient that what they feel/think is valid and important to their
overall health.
f. Reassurance: Showing reassurance provides comfort to the patient, allowing their
anxieties or concerns to be resolved safely.
g. Summarization:
i. Give a capsule summary of the patient’s story
ii. Give the patient a chance to clarify any misunderstandings
h. Transition:
i. Tell patient when changing directions during the interview
ii. Orient the patient with brief transitional phrases
i. Empowering the patient:
i. Evoke the patient’s perspective
ii. Convey interest in the person, not just the problem
iii. Follow the patient’s lead
iv. Elicit and validate emotional content
v. Share information with the patient
, vi. Make your clinical reasoning transparent to the pt
vii. Reveal the limits of your knowledge
2. Organize the phases of the nurse-patient interview
a. Phase 1: Pre Interview: gather supplies, review pt charts, collect thoughts
b. Phase 2: Interview/Introduction: AIDET
c. Phase 3: Working
d. Phase 4: Termination: summarize, and let pt know interview is coming to an end
3. Discuss strategies for handling difficult patients.
a. Silent patient:
i. Silence has many meaning and purposes
ii. Pt. may be collecting thoughts, remembering details, deciding whether to trust
you
iii. Nurse should appear attentive and give brief encouragement
iv. Watch pt for nonverbal cues
v. Pt. culture
vi. Depression or dementia
b. Confusing patient:
i. Confusing array of multiple symptoms
ii. Guide interview into psychosocial assessment
iii. If you suspect a psychiatric or neurologic disorder, shift to a mental status
examination
iv. Check responses against chart or seek permission to speak with family members
c. Altered capacity:
i. Determine “decision making capacity.”
ii. Obtain pt permission to talk to family member
iii. May need to find surrogate informant or decision maker to assist with history
iv. Check for durable power of attorney for health care or a health care proxy
v. Apply same principles of interviewing
vi. Always seek best-informed source
d. Talkative patient:
i. Allow the patient to talk, without interruptions. Then summarize what they said
afterwards.
e. Crying patient: Allow the patient to cry, and comfort them if needed. Say things like “it’s
okay to be upset and I’m glad you can share those feelings with me.”
f. Angry or disruptive: Try to calm them down and assure them in their concerns. Tell them
they have a right to be upset, and to acknowledge their emotions. Try to deescalate the
situation. If not, security may have to be involved.
i. Allow the patient to express themselves.
g. Language barriers: use professional translator, always talk toward the patient
h. Low literacy: use of infographics and simple language to help them understand will work.
i. Impaired hearing: Quiet environment, face patient, simple sentences
j. Impaired eyesight: Good lighting, give environment cues
k. Cognitive disabilities: Simple and clear to understand informatics.
l. Personal problems: Let them express them, ask them what they think they should do.
Don’t give advice. Don’t express your own.
m. Sexuality: No hanky panky (Acknowledge that it is normal and healthy to be sexually
attracted to patients, and vice versa. Handle the situation maturely, acknowledge the
patient-provider relationship importance and focus on that).
, What is the difference between open and closed ended questioning and what is the role of each in
the patient interview? Open ended questions elicits information. Closed ended questions are for more
specific information (Symptoms, etc.)
What are the different therapeutic communication techniques?
-Active Listening -Reassurance
-Guided Questioning -Summarizing
-Nonverbal communication -Transitions
-Empathic responses -Empowering the patient
-Validation
a. Phase 1: Pre-interview- set the stage for a smooth interview
a.i. self reflection
a.ii. review patient record
a.iii. set interview goals
a.iv. review own clinical behavior and appearance
b. Phase 2:Introduction- put the patient at ease and establish trust
b.i. greet the patient and establish rapport
b.ii. establish the agenda for the interview
c. Phase 3:Working- obtain patient information
c.i. invite the patient's story
c.ii. identify and respond to emotional cues
c.iii. expand and clarify the patient's story
c.iv. generate and test diagnostic hypotheses
c.v. Negotiate a plan, including further evaluation, treatment, education, and self-management
support and prevention
d. Phase 4: Termination
d.i. summarize important points
d.ii. discuss plan of care
*How do you focus an interview for a specific condition?
- You would conduct a Focused or Problem-oriented assessment
- Open ended questions, then work to close ended questions
-
Health History
1. Apply the four types of histories to appropriate settings.
a. Comprehensive health history -New admit patient
b. Focused or problem-oriented assessment: Old patient coming for a problem with a
specific body system.
c. Follow up history:
d. Emergency history: Emergency situation in the ED.
Identify the components of a comprehensive health history & examples of data that would go in each:
1. Identifying data and source of the history: Name, date, age, gender, marital status, race,
ethnicity, culture, occupation, insurance, source of information/reliability, date of last
visit.
2. Chief complaints: reason for seeking healthcare, focused symptoms analysis of the
current problem.
3. History of present illness:
