NU 325 Health Assessment Exam 1

Implementation

-5th step in nursing process •Do it in a safe and timely manner •Use evidence-based interventions •Collaborate with colleagues •Use community resources •Coordinate care delivery •Provide health teaching and health promotion •Document _________________ and any modification

traps of interviewing

-6th part of an interview -1. Providing False Assurance or Reassurance 2. Giving Unwanted Advice 3. Using Authority 4. Using Avoidance Language 5. Distancing 6. Using Professional Jargon 7. Using Leading or Biased Questions 8. Talking Too Much 9. Interrupting 10. Using "Why" Questions

Evaluation

-6th step of the nursing process •Progress toward outcomes •Conduct systematic, ongoing, criterion-based _________________ •Include patient and significant others •Use ongoing assessment to revise diagnonses, outcomes, plan •Disseminate results to patient and family

Negative nonverbal skills

-7th part of an interview -Appearance objectionable to client -Standing -Sitting behind desk, far away, turned away -Tense posture -Slouched in chair -Critical or distracting gestures: pointing finger, clenched fist, finger-tapping, foot-swinging, looking at watch -Bland expression, yawning, tight mouth -Frowning, lip biting -Shifty, avoiding eye contact, focusing on notes -Strident, high-pitched tone -Rate too slow or too fast -Too frequent or inappropriate touch

symptom

-is a subjective sensation that the person feels from the disorder -Examples: •"Chest palpitations" for 2 hours. •"My ear is killing me and I have been up all night" •"Pressure to my face and cannot breathe through my nose for one week"

Introduction

-1st part of an interview -Introduce yourself -Establish expectations

Assessment

-1st step of the nursing process -is the collection of data about the individual's health state •Collect data: -Review of the clinical record -Health history -Physical examination -Functional assessment -Risk assessment -Review of literature •Use evidence-based ____________________ techniques •Document relevant data

Working phase

-2nd part of an interview -is the data-gathering phase. Verbal skills for this phase include your ability to form questions appropriately and your responses to the answers given by the client. You will likely use a combination of open-ended and closed questions during the interview.

Diagnosis

-2nd step in the nursing process •Compare clinical findings with normal and abnormal variation and developmental events •Interpret data -Identify clusters of clues -Make hypotheses -Test hypotheses -Derive ______________________

Open-Ended Questions

-3rd part of an interview -Asks for narrative information. It states the topic to be discussed but only in general terms. Use it to begin the interview, to introduce a new section of questions, and whenever the person introduces a new topic. Is unbiased; it leaves the person free to answer in any way. This question encourages the person to respond in paragraphs and give a spontaneous account in any order chosen. It lets the person express himself or herself fully.

Outcome Identification

-3rd step i the nursing process •Identify expected _________________ •Individualize to the person •Culturally appropriate •Realistic and measurable •Include a timeline

Closed or Direct Questions

-4th part of an interview -Ask for specific information. They elicit a short, one- or two-word answer, a "yes" or "no," or a forced choice. Whereas the open-ended question allows the client to have free rein, the ____________ question limits his or her answer. Help you elicit specific information and are useful to fill in any details that were initially left out after the person's opening narrative. Are also useful when you need specific facts such as past medical history or during the review of systems. You need ___________ questions to speed up the interview. Asking all open-ended questions would be unwieldy and extend the interview for hours, but be careful not to overuse them.

Planning

-4th step in the nursing process •Establish priorities •Develop outcomes •Set timelines for outcomes •Identify interventions •Integrate evidence-based trends and research •Document _________ of care

types of examiner responses that could be used during the interview

-5th part of an interview •Client's Perspective: -Facilitation, general leads, minimal cues -Silence -Reflection -Empathy -Clarification •Examiner's Perspective: -Confrontation -Interpretation -Explanation -Summary

Positive nonverbal skills

-7th part of an interview -Appropriate professional appearance -Equal-status seating -Close proximity to client -Relaxed, open posture -Leaning slightly toward person -Occasional facilitating gestures -Facial animation, interest -Appropriate smiling -Appropriate eye contact -Moderate tone of voice -Moderate rate of speech -Appropriate touch

ways that nonverbal behavior may vary cross-culturally

-7th part of an interview -The meaning of physical touch is influenced by the person's age, gender, cultural background, past experience, and current setting. The meaning of touch is easily misinterpreted. In most Western cultures physical touch is reserved for expressions of love and affection or for rigidly defined acts of greeting. Do not use touch during the interview unless you know the person well and are sure how it will be interpreted.

Closing

-8th part of an interview -The session should end gracefully. An abrupt or awkward closing can destroy rapport and leave the person with a negative impression of the interaction. To ease into the closing, ask the person: "Is there anything else you would like to mention?" "Are there any questions you would like to ask?" "We've covered a number of concerns today. What would you most like to accomplish?" This gives the person the final opportunity for self-expression. Once this opportunity has been offered, you will need to make a _________________ statement that indicates that the end of the interview is imminent, such as, "Our interview is just about over." At this point no new topics should be introduced, and no unexpected questions should be asked. This is a good time to give your summary or a recapitulation of what you have learned during the interview. The summary is a final statement of what you and the client agree the health state to be. It should include positive health aspects, any health problems that have been identified, any plans for action, and an explanation of the following physical examination. As you part from clients, thank them for the time spent and for their cooperation.

Physical Assessment

-A common mistake made by beginning practitioners is to record some physical finding or objective data here such as "skin warm and dry." Remember that the history should be limited to patient statements or subjective data. -Is objective, objective data is collected through assessment, data is documented in medical terms

Spiritual resources/religion

-A concern for a patient related to culture -Assess whether certain procedures, such as administering blood to a Jehovah's Witness or drawing large amounts of blood from a Chinese patient, are prohibited.

Health perception

-A concern for a patient related to culture -How does the person describe health and illness, and what does he or she see as the problem that he or she is now experiencing?

Biographical data

-A concern for a patient related to culture -When did the person enter the United States and from what country. If a refugee, under which conditions did he or she come? Was there harassment or torture? The older adult may have come to this country after World War II and may be a Holocaust survivor—Questions regarding family and past history may evoke painful memories and must be asked carefully.

Nutritional

-A concern for a patient related to culture -Which foods and food combinations are taboo?

Past health

-A concern for a patient related to culture -Which immunizations were given in the homeland (e.g., was the person given Bacillus Calmette-Guérin [BCG])? This vaccine is used in many countries to prevent TB; it is not administered in the United States. If the person has had BCG, he or she will have a positive tuberculin test; further diagnostic procedures must be done, including a sputum test and chest x-ray film.

Cultural taboos

-Administration of blood; medications containing caffeine, pork, or other prohibited substances and selected procedures may be perceived as ___________________________ (i.e., practices to be avoided by both children and adults). -Forbidden

Palpation

-Applies your sense of touch to assess these factors: texture; temperature; moisture; organ location and size; and any swelling, vibration or pulsation, rigidity or spasticity, crepitation, presence of lumps or masses, and presence of tenderness or pain. -Instruments: Different parts of the hands are best suited for assessing different factors: •Fingertips—Best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps •A grasping action of the fingers and thumb—To detect the position, shape, and consistency of an organ or mass •The dorsa (backs) of hands and fingers—Best for determining temperature because the skin here is thinner than on the palms •Base of fingers (metacarpophalangeal joints) or ulnar surface of the hand—Best for vibration instruments

Collaborative problems

-Are those in which the approach to treatment involves multiple disciplines. Are certain physiologic conditions in which nurses have the primary responsibility to diagnose the onset and monitor the changes in status. For example, C.D.'s data regarding diabetes represent one. With this problem the sudden imbalance of insulin and blood sugar has profound implications on the central nervous and gastrointestinal (GI) systems. Her care will be monitored by nurses, doctors, dietitians, and case managers. Or another patient with an alcohol-use disorder presents to the hospital for unrelated surgery and experiences sudden alcohol withdrawal symptoms. This causes rebound effects on the central nervous and cardiovascular systems that must be managed by a team of clinicians. -When every one works to get you well

considerations when using an interpreter

-Before locating an one, identify the language the person speaks at home. Be aware that it may differ from the language spoken publicly (e.g., French is sometimes spoken by well-educated and upper-class members of certain Asian, African, or Middle Eastern cultures, but it is not the language spoken in the home). -Whenever possible, use a trained one, preferably one who knows medical terminology. -Avoid ones from a rival tribe, state, region, or nation (e.g., a Palestinian who knows Hebrew may not be the best interpreter for a Jewish person). -Be aware of gender differences between one and a client. In general the same gender is preferred. -Be aware of age differences between one and a client. In general an older, more mature ones are preferred to a younger, less experienced ones. -Be aware of socioeconomic differences between one and a client.

Best approach to intimate partner violence

-Begin with open-ended questions: "How are things at home?" and "Do you feel safe?" These are valuable initial screening questions because some people may not recognize that they are in abusive situations or may be reluctant to admit it because of guilt, fear, shame, or denial. If the person responds to feeling unsafe, follow up with closed-ended questions: "Have you ever been emotionally or physically abused by your partner or someone important to you? Within the past year, have you been hit, slapped, kicked, pushed, or shoved or otherwise physically hurt by your partner or ex-partner?" If yes, ask: "By whom? How many times? Does your partner ever force you into having sex? Are you afraid of your partner or ex-partner?"

Cultural competency

-Includes the attitudes, knowledge, and skills necessary for providing quality care to diverse populations. You must climb several steps on the journey to it. The integration of this knowledge into day-to-day practice takes time because many practitioners in the health care system hesitate to adopt new ideas. It does not come after reading a chapter or several chapters or books on this highly specialized area. It is complex and multifaceted, and many facets change over time. The areas of knowledge include sociology, psychology, theology, cultural anthropology, demography, folklore, and immigration history and policies. One must also have an understanding of poverty and environmental health. Also involves soul searching about your own culture and health. -What you believe in may be different than someone else, but you still have to respect their beliefs -It is ok to ask if you don't know something -Patient should let soemone know about their cultural/religious preferences -Eye contact -Death and cancer

Inspection

-Is concentrated watching. It is close, careful, scrutiny, first of the individual as a whole and then of each body system. -Instruments: otoscope, ophthalmoscope, penlight, nasal and vaginal specula

Auscultation

-Is listening to sounds produced by the body, such as the heart and blood vessels and the lungs and abdomen. -Instruments: stethoscope and your ears

Percussion

-Is tapping the person's skin with short, sharp strokes to assess underlying structures. The strokes yield a palpable vibration and a characteristic sound that depicts the location, size, and density of the underlying organ. -Instruments: stationary hand, striking hand, and reflex hammer

Functional Assessment

-Measures a person's self-care ability in the areas of general physical health or absence of illness; ADLs such as bathing, dressing, toileting, eating, walking; instrumental ADLs (IADLs) or those needed for independent living such as housekeeping, shopping, cooking, doing laundry, using the telephone, managing finances; nutrition; social relationships and resources; self-concept and coping; and home environment. -Assisted-encourge them to do the things they can

Tympany

-One of the sounds that can be heard durring percussion -Amplitude: Loud -Pitch: High -Quality: Musical and drumlike (like a kettledrum) -Duration: Sustained longest -Sample Location: Over air-filled viscus (e.g., the stomach, the intestine)

Hyperresonant

-One of the sounds that can be heard durring percussion -Amplitude: Louder -Pitch: Lower -Quality: Booming -Duration: Longer -Sample Location: •Normal over child's lung •Abnormal in the adult, over lungs with increased amount of air as in emphysema

Resonant

-One of the sounds that can be heard durring percussion -Amplitude: Medium-loud -Pitch: Low -Quality: Clear, hollow -Duration: Moderate -Sample Location: Over normal lung tissue

Dull

-One of the sounds that can be heard durring percussion -Amplitude: Soft -Pitch: High -Quality: Muffled thud -Duration: Short -Sample Location: Relatively dense organ as liver or spleen

Flat

-One of the sounds that can be heard durring percussion -Amplitude: Very soft -Pitch: High -Quality: A dead stop of sound, absolute dullness -Duration: Very short -Sample Location: When no air is present, over thigh muscles or bone or over tumor

First-level priority

-Problems are those that are emergent, life threatening, and immediate, such as establishing an airway or supporting breathing. -Examples: •An unresponsive patient •Child choking on a piece of candy •ER patient clutching chest c/o chest pain •Potassium level of 8.5 meq •Laceration to the forehead that is bleeding profusely

Third-level priority

-Problems are those that are important to the patient's health but can be addressed after more urgent health problems are addressed. Interventions to treat these problems are more long term, and the response to treatment is expected to take more time (e.g., problems with lack of knowledge, activity, rest, family coping). -Examples: •Knowledge deficient regarding smoking cessation

Second-level priority

-Problems are those that are next in urgency—those requiring your prompt intervention to forestall further deterioration (e.g., mental status change, acute pain [pain is all that matters to a patient, it is a sign something is wrong but it won't kill you], acute urinary elimination problems, untreated medical problems, abnormal laboratory values, risks of infection, or risk to safety or security). -Examples: •Patient in pain due to fractured ulna •Potassium level of 2.9meq •Laceration to forehead with bleeding

Clarification

-Reasons for use :•Useful when person's word choice is ambiguous or confusing •Summarize person's words, simplify the statement, and ensure that you are on the right track -Types of examiner responses that could be used during the interview -Client's Perspective -Example: •Response: "The heaviness in your chest occurs with walking up 1 flight of stairs or more than 1 block, but it stops when you rest. Is that correct?" •Client: "Yes, that's it."

Confrontation

-Reasons for use: •Clarifying inconsistent information •Focusing client's attention on an observed behavior, action, or feeling -Types of examiner responses that could be used during the interview -Examiner's Perspective -Example: •"You look sad, or You sound angry." •"Earlier you said that you didn't drink, but just now you said you go out every night after work for 1-2 beers." •"When I press here you grimace, but you said it doesn't hurt."

Silence

-Reasons for use: •Communicates that client has time to think •Can be uncomfortable for novice examiner, but interruption can make client lose his or her train of thought •Provides you with chance to observe client and note nonverbal cues -Types of examiner responses that could be used during the interview -Client's Perspective -Examples: •Waiting for response without interruption •Sitting quietly; don't fidget •Counting silently 1 to 10

Summary

-Reasons for use: •Condenses facts and validates what was discussed during the interview •Signals that termination of interview is imminent •Both client and examiner should be active participants -Types of examiner responses that could be used during the interview -Examiner's Perspective -Example: •Review pertinent facts •Allow client time to make corrections

Reflection

-Reasons for use: •Echoes client's words by repeating part of what person has just said •Can help express feelings behind words •Mirroring client's words can help person elaborate on problem -Types of examiner responses that could be used during the interview -Client's Perspective -Example: •Client: "It's so hard having to stay in bed during my pregnancy. I have kids at home I'm worried about." •Response: "You feel worried and anxious about your children?"

Facilitation, general leads, minimal cues

-Reasons for use: •Encourages client to say more •Shows person you are interested -Types of examiner responses that could be used during the interview -Client's Perspective -Examples: •"mm-hmmm, go on, uh-huh" •Maintaining eye contact, shifting forward •Nodding yes

Explanation

-Reasons for use: •Informing person •Sharing factual and objective information -Types of examiner responses that could be used during the interview -Examiner's Perspective -Example: •"You order your dinner from the menu provided, and it takes approximately 30 minutes to arrive." •"You may not eat or drink for 12 hours before your blood test because the food may change the results."

Interpretation

-Reasons for use: •Links events, makes associations, and implies cause •Not based on direct observations but instead on inference or conclusion •Your's may be incorrect but helps prompt further discussion -Types of examiner responses that could be used during the interview -Examiner's Perspective -Example: •"It seems that every time you feel the stomach pain, you have some type of stress in your life." •Client: "I don't want any more treatment, but I can't seem to tell the doctor I'm ready to stop." •Response: "Could it be that you're afraid of her reaction?"

Empathy

-Reasons for use: •Names a feeling and allows its expression •Allows person to feel accepted and strengthens rapport •Useful in instances when client hasn't identified the feeling or isn't ready to discuss it -Types of examiner responses that could be used during the interview -Client's Perspective -Example: •Client (sarcastically): "This is just great! I own a business, direct my employees; now I can't even go to the bathroom without help." •Response: "It must be hard—one day having so much control and now feeling dependent on someone else." •Other responses include: "This must be very hard for you" or just placing hand on person's arm.

Sexually aggressive patients

-Set boundaries -Responses: "I am uncomfortable when you talk to me that way; please don't." A further response that would open communication is, "I wonder if the way you're feeling now relates to your illness or to being in the hospital?" If the behavior continues, you may need to remove yourself from the situation. -Let instructor know

Review of Systems

-The purposes of this section are (1) to evaluate the past and present health state of each body system, (2) to double-check in case any significant data were omitted in the Present Illness section, and (3) to evaluate health promotion practices. -Is subjective, reviews each body system, recorded using medical terminology, promotes health practices

Subjective data

-an element of a database -what the person says about himself or herself during history taking -Examples: •Headache •She tells you she's lost weight over the last 6 months •Denies color change •Nausea •Heart is racing •States she just started having anxiety attacks •Palpitations •Chest pain

Objective data

-an element of a database -what you as the health professional observe by inspecting, percussing, palpating, and auscultating during the physical examination

sentinel events

-events that should not happen to a patient -pore communication is the main cause

sign

-is an objective abnormality that you as the examiner could detect on physical examination or in laboratory reports. -Examples: •Tachycardia - Heart rate 105 bpm •Acute otitis media with effusion to right ear •Tenderness noted upon palpation to frontal and maxillary sinuses - nasal mucosa swollen with thick, green-yellow discharge

Setting priorities

1. Airway (nothing else matters until a patent airway is established) 2. Breathing 3. Circulation (is patient's heart beating) 4. Perfusion (is the rest of the patienr's body getting blood) •Chain of command goes by what will kill you first

Examples of health promotion

1. Amount of sun exposure; method of self-care for skin and hair. 2. Wear glasses or contacts; last vision check or glaucoma test; how coping with loss of vision if any. 3. Hearing loss, hearing aid use, how loss affects daily life, any exposure to environmental noise, and method of cleaning ears. 4. Sunglasses 5. Earplugs 6. Do you swim 7. Listen to loud music 8. Do you go to the dentist 9. Do you brush your teeth 10. Self breast exams 11. Mamogram 12. Smoking 13. Asthma 14. Do you exercise 15. Diet 16. Regular bowels movements 17. Diahrea 18. Colonoscopy 19. Sexual activites 20. STI screening/ pap smear 21. Prostate exam

elements of a database

1. Subjective data 2. Objective 3. Patient's record and laboratory studies

Items to be communicated to the patient concerning the expectations of the interview

1. Time and place of the interview and succeeding physical examination. 2. Introduction of yourself and a brief explanation of your role. 3. The purpose of the interview. 4. How long it will take. 5. Expectation of participation for each person. 6. Presence of any other people (e.g., family, other health professionals, students). 7. Confidentiality and to what extent it may be limited. 8. Any costs to the client.

Health care-associated (nosocomial) infection

A hazard because hospitals have sites that are reservoirs for virulent microorganisms. Some of these microorganisms are resistant to antibiotics such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), or multidrug-resistant tuberculosis or are microorganisms for which there is currently no known cure such as human immunodeficiency virus (HIV).

Standard precautions

Are based on the principle that all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes may contain transmissible infectious agents. Precautions apply to all patients, regardless of suspected or confirmed infection status, and in any setting in which health care is delivered. Components are: •Hand hygiene. •Use of gloves, gown, mask, eye protection, or face shield. •Respiratory hygiene/cough etiquette

The dorsa (backs) of hands and fingers

Best for determining temperature because the skin here is thinner than on the palms

Fingertips

Best for fine tactile discrimination, as of skin texture, swelling, pulsation, and determining presence of lumps

Base of fingers (metacarpophalangeal joints) or ulnar surface of the hand

Best for vibration instruments

concerns for patient's related to culture

Biographical data, Spiritual resources/religion, Past health, Health perception, and Nutritional

types of databases

Complete (Total Health), Focused or Problem-Centered, Follow-Up, and Emergency

Responsibilities of an examiner doing an assessment

Consider your emotional state and that of the person being examined. The patient may be anxious about being examined by a stranger and the unknown outcome of the examination. Try to reduce any anxiety so the data will more closely describe the person's natural state. Anxiety can be reduced by an examiner who is confident and self-assured, considerate, and unhurried.

Holistic health

Consideration of the whole person is the essence of it. It views the mind, body, and spirit as interdependent and functioning as a whole within the environment. Health depends on all these factors working together. The basis of disease is multifaceted, originating from both within the person and from the external environment. Nursing includes many aspects of the ______________ model (i.e., the interaction of the mind and body, the oneness and unity of the individual). Both the individual human and the external environment are open systems, dynamic and continually changing and adapting to one another. Each person is responsible for his or her own personal health state and is an active participant in health care. Health promotion and disease prevention form the core of nursing practice. In a _________________ model assessment factors are expanded to include such things as lifestyle behaviors, culture and values, family and social roles, self-care behaviors, job-related stress, developmental tasks, and failures and frustrations of life. All are significant to health.

Home Education Eating Activities Drugs Sexuality Suicide Safety

HEEADSSS -best way to interview a teen is one on one -let them know it is cofidential

Bell of stethoscope

Has a deep, hollow, cuplike shape. It is best for soft, low-pitched sounds such as extra heart sounds, murmurs, or brewets

Circulation (2), Knowledge deficit (6), Airway (1), Sleep (5), Pain (4), Perfusion (3)

How would you prioritize these problems?Circulation, Knowledge deficit, Airway, Sleep, Pain, Perfusion

types of nonverbal behaviors that an interviewer could make

Physical appearance, posture, gestures, facial expression, eye contact, voice, and touch

Assessment skills

Inspection, Palpation, Percussion, and Auscultation

1. Introduction 2. Working phase 3. Open-ended questions 4. Closed or direct questions 5. Verbal responses 6. Ten traps of interviewing 7. Nonverbal skills 8. Closing

Parts of an interview

Hand hygiene

Standard precautions for use with all patients: (1) Avoid unnecessary touching of surfaces in close proximity to the patient. (2) When hands are visibly dirty, contaminated with proteinaceous material, or visibly soiled with blood or body fluids, wash them with soap and water. (3) If not visibly soiled, decontaminate hands with an alcohol-based hand rub. Perform hand hygiene: (a) before having direct contact with patients; (b) after contact with blood, body fluids or excretions, mucous membranes, nonintact skin, or wound dressings; (c) after contact with a patient's intact skin (e.g., taking a pulse or blood pressure or lifting a patient); (d) after contact with medical equipment in the immediate vicinity of the patient; (e) after removing gloves.

Use of gloves, gown, mask, eye protection, or face shield

Standard precautions for use with all patients: (1) Wear gloves when you anticipate that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin (e.g., patient incontinent of stool or urine) could occur. (2) Wear a gown to protect skin and clothing when you anticipate contact with blood, body fluids, secretions, or excretions. (3) Use mouth, nose, and eye protection to protect the mucous membranes during procedures that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions.

Respiratory hygiene/cough etiquette

Standard precautions for use with all patients: Is targeted at patients and accompanying persons with undiagnosed transmissible respiratory infections. Elements include: (1) education of staff, patients, and visitors; (2) posted signs in language(s) appropriate to the population; (3) source control measures (e.g., covering the mouth/nose with a tissue when coughing and promptly disposing of used tissues, using surgical masks on the coughing person); (4) hand hygiene after contact with respiratory secretions; and (5) spatial separation of >3 feet from people with respiratory infections in common waiting areas.

1. Assessment 2. Diagnosis 3. Outcome Identification 4. Planning 5. Implementation 6. Evaluation

Steps of the nursing process

Preventing health care-associated (nosocomial) infection

The single most important step to decrease risk of microorganism transmission is to wash your hands promptly and thoroughly: (1) before and after every physical patient encounter; (2) after contact with blood, body fluids, secretions, and excretions; (3) after contact with any equipment contaminated with body fluids; and (4) after removing gloves. Using alcohol-based hand rubs takes less time than soap-and-water handwashing; it also kills more organisms more quickly and is less damaging to the skin because of emollients added to the product. Alcohol is highly effective against both gram-positive and gram-negative bacteria; Mycobacterium tuberculosis; and most viruses, including hepatitis B and C viruses, HIV, and enteroviruses.1 Rub all hand surfaces with 3 to 5 mL of alcohol for 20 to 30 seconds. Use the mechanical action of soap-and-water handwashing when hands are visibly soiled and when patients are infected with spore-forming organisms (e.g., Clostridium difficile and noroviruses). Rub all hand surfaces for 40 to 60 seconds.

Follow-Up Database

The status of any identified problems should be evaluated at regular and appropriate intervals. What change has occurred? Is the problem getting better or worse? Which coping strategies are used? This type of database is used in all settings to _____________________ both short-term and chronic health problems.

Complete (Total Health) Database

This includes a _________________ health history and a full physical examination. It describes the current and past health state and forms a baseline against which all future changes can be measured. It yields the first diagnoses. Often is collected in a primary care setting such as a pediatric or family practice clinic, independent or group private practice, college health service, women's health care agency, visiting nurse agency, or community health agency. Collecting the it is an opportunity to build and strengthen your relationship with the patient. For the well person this database must describe the person's health state; perception of health; strengths or assets such as health maintenance behaviors, individual coping patterns, support systems, and current developmental tasks; and any risk factors or lifestyle changes. For the ill person the database also includes a description of the person's health problems, perception of illness, and response to the problems. For well and ill people, the it must screen for pathology and determine the ways people respond to that pathology or to any health problem. This database also notes the human responses to health problems. In acute hospital care it is gathered on admission to the hospital. In the hospital, data related specifically to pathology may be collected by the admitting physician. You collect additional information on the patient's perception of illness, functional ability or patterns of living, activities of daily living, health maintenance behaviors, response to health problems, coping patterns, interaction patterns, and health goals.

Emergency Database

This is an urgent, rapid collection of crucial information and often is compiled concurrently with lifesaving measures. Diagnosis must be swift and sure. For example, a person is brought into a hospital ED with suspected substance overdose. The first history questions are, "What did you take?" "How much did you take?" and "When?" The person is questioned simultaneously while his or her airway, breathing, circulation, level of consciousness, and disability are being assessed. Clearly it requires more rapid collection of data than the episodic database. Once the person has been stabilized, a complete database can be compiled.

Focused or Problem-Centered Database

This is for a limited or short-term problem. Here you collect a "mini" database, smaller in scope and more targeted than the complete database. It concerns mainly one problem, one cue complex, or one body system. It is used in all settings—hospital, primary care, or long-term care. For example, 2 days after surgery a hospitalized person suddenly has a congested cough, shortness of breath, and fatigue. The history and examination focus primarily on the respiratory and cardiovascular systems. Or in an outpatient clinic a person presents with a rash. The history follows the direction of this presenting concern such as whether the rash had an acute or chronic onset; was associated with a fever, new food, pet, or medicine; and was localized or generalized. Physical examination must include a clear description of the rash.

A grasping action of the fingers and thumb

To detect the position, shape, and consistency of an organ or mass

Diaphragm of the stethoscope

Will use most often because its flat edge is best for high-pitched sounds—breath, bowel, and normal heart sounds

Position, Preparation, and Sequence

developmental competencies when assessing an infant, toddler, preschool child, school-age child, adolescent, aging adult, and/or ill person

Spirituality

is borne out of each person's unique life experience and his or her personal effort to find purpose and meaning in life.

Health

is defined as the balance of the person, both within one's being (physical, mental, or spiritual) and in the outside world (natural, communal, or metaphysical). It is a complex, interrelated phenomenon.

Acculturation

is the process of social and psychological exchanges that take place when there are ongoing encounters between individuals of different cultures, with subsequent changes in either or both groups.

Religion

refers to an organized system of beliefs concerning the cause, nature, and purpose of the universe, especially belief in a divine or superhuman power to be obeyed and worshipped as the creator(s) and ruler(s) of the universe (called by names such as Allah, God, Yahweh, and Jehovah). Is a shared experience of spirituality or the values, beliefs, and practices into which people either are born or which they may adopt to meet their personal spiritual needs through communal actions such as ___________ affiliation; attendance and participation in a ________________ institution, prayer, or meditation; and _________________ practices.

goal of communication

optimal health

Ethnicity

refers to a social group that may possess shared traits such as a common geographic origin, migratory status, religion, language, values, traditions or symbols, and food preferences. The _____________ group may have a loose group identity with few or no cultural traditions in common or a coherent subculture with a shared language and body of tradition.

resonant, hyperresonant tympany, dull, and flat

sounds that can be heard during percussion

Using Authority

•A trap of interviewing •"Your doctor/nurse knows best" is a response that promotes dependency and inferiority. You effectively diminish the client's concerns with one short sentence, and you cut off communication. It should be avoided. Although you may have more professional knowledge than the client, you both have equally important roles since the client must make the final decision about his or her health.

Providing False Assurance or Reassurance

•A trap of interviewing •A pregnant woman says, "I've been spotting on and off all day, and I haven't felt the baby kick. I just know I'm going to miscarry." Your automatic response may be to _____________________________, "Don't worry. I'm sure you and the baby will be fine." Although this helps relieve your anxiety and gives you the sense that you have provided comfort, it actually trivializes the woman's anxiety and closes off communication. You have also just promised something that may not be true, which can diminish rapport. Consider these responses: "You're really worried about your baby, aren't you?" "It must be hard to wait for the doctor. Is there anything I can get you or anything that you'd like to talk about?" These responses acknowledge the feeling and open the door for more communication. A genuine, valid form of reassurance does exist. You can reassure clients that you are listening to them, that you understand them, that you have hope for them, and that you will take good care of them. Client: "I feel so lost here since they transferred me to the medical center. My family lives too far away to visit, and no one here knows me or cares." Response: "I care what happens to you. I will be here all day today and for the next 3 days. Please call if you need anything." This type of reassurance makes a commitment to the client, and it can have a powerful impact.

Using Leading or Biased Questions

•A trap of interviewing •Asking a client, "You don't smoke, do you?" or "You don't ever have unprotected sex, correct?" implies that one answer is "better" than another. If the client wants to please you, he or she will either answer in a way corresponding to your values or feel guilty when he or she must admit the other answer. The client feels that he or she risks your disapproval by not answering the question "correctly." If the client feels dependent on you for care, he or she won't want to alienate you and may not answer truthfully. Make sure that your questions are _________________ and do not _______ clients to a certain "correct" answer. Better questions are: "Do you smoke?" or "When you have sexual intercourse, do you use any type of protection?"

Using "Why" Questions

•A trap of interviewing •Children ask this type questions constantly. Their motive is an innocent search for information. The adult's use of said questions usually implies blame and condemnation; it puts the person on the defensive. Consider your use of these questions in the health care setting. "______ did you take so much medication?" Or "_______ did you wait so long before coming to the hospital if you were having chest pain?" The only possible answer to a _____ question is "because ..." and the person may not know the answer. The use of a _______ question makes the interviewer sound accusatory and judgmental. By using a _____ question, the client must produce an excuse to rationalize his or her behavior. To avoid this trap, say, "I see you started to have chest pains early in the day. What was happening between the time the pains started and the time you came to the emergency department?"

Distancing

•A trap of interviewing •Is the use of impersonal speech to put space between a threat and the self: "There is a lump in the left breast." By using "the" instead of "your," you are allowing the woman to deny any association with her diseased breast and protect herself from it. Health professionals use it to soften reality, but in actuality it may communicate that you are afraid of the procedure or disease. Clients use it to avoid admitting that they have a problem: "My doctor told me that the prostate was enlarged." Using blunt specific terms is actually preferable to defuse anxiety. Using specific language and blunt terms indicates that you are not fearful of the disease or procedure and may help the person cope with the reality of the situation.

Giving Unwanted Advice

•A trap of interviewing •It is important as a health care provider to recognize when giving ______________ is warranted and when it should be avoided. People often seek health care because they want professional ____________. A parent may ask how to care for a child with chickenpox, or an older man may ask if it is appropriate to receive a pneumonia vaccine. These are straightforward requests for information, and you respond by providing the appropriate information. But if _________ is based on a hunch or feeling or is your personal opinion, then it is likely inappropriate. Consider a young woman who has just met with her physician about her infertility issues: "Dr. Compton just told me I have to have surgery and that, if I don't, I won't be able to get pregnant. I'm just not sure. What would you do?" If you provide an answer, especially if the answer begins with "If I were you ..." you would be falling into a trap. You are not your client and therefore cannot make decisions for her. Providing an answer shifts accountability to you instead of the client. The woman must work out her own decision. So what do you do?Response: What are your concerns about the recommendation? Woman: I'm terrified of being put to sleep. What if I don't wake up? Now you know her real concern and can help her deal with it. She will have grown in the process and may be better equipped to make her decision. When asked for advice, other preferred responses are: "What are the pros and cons of ________ [this choice] for you?" "What is holding you back?" Although it is quicker just to give __________, take the time to involve the patient in a problem-solving process. When a person participates, he or she is more likely to learn and to change behavior.

Using Avoidance Language

•A trap of interviewing •People use euphemisms instead of discussing unpleasant topics. For example, people use "passed on" or "has gone to a better place" to avoid the reality of dying. Using euphemisms promotes avoidance of reality and allows people to hide their feelings. Not talking about uncomfortable topics doesn't make them go away but instead makes them even more frightening. The best way to deal with frightening or uncomfortable topics is by using direct language.

Talking Too Much

•A trap of interviewing •Some examiners positively associate helpfulness with verbal productivity. If the air has been thick with their oratory and advice, these examiners leave thinking that they have met the client's needs. Just the opposite is true. Eager to please the examiner, the client lets the professional talk at the expense of his or her need to express himself or herself. A good rule for every interviewer is to listen more than you talk.

Using Professional Jargon

•A trap of interviewing •The medical profession is fraught with terminology that sounds exclusionary and paternalistic. It is important that you can adjust your vocabulary to ensure understanding without sounding condescending. Just because your client uses medical terms, don't assume that he or she understands the correct meaning. Some people think "hypertensive" means tense. This misunderstanding may cause them to take their medication only when they are feeling tense and stressed instead of taking it all the time. Misinformation must be corrected immediately to ensure compliance. However, mispronunciations do not need to be corrected every time (e.g., when a client says "prostrate" for prostate gland).

Interrupting

•A trap of interviewing •When you think you know what the client is going to say next, it is easy to cut him or her off and finish the statement. Unfortunately you are not proving that you are clever, but you are signaling impatience or boredom. Related to it is preoccupation with yourself. As the client speaks, you may be thinking about what to say next. If you are focused on your next statement instead of his or her statements, you are unable to fully understand what the person is saying. You become so preoccupied with being a good interviewer that you forget to be a good listener. The goal of the interview is to include two people listening and two people speaking. Leave at least a second of space between the end of the client speaking and your next statement. This ensures that the person is finished.

How can a healthcare provider protect a patient from the spread of infection?

•Keep equipment clean. •Wash your hands or use alcohol-based hand rubs •Use gloves, gowns, masks, eye protection, or a face shield •Practice respiratory hygiene/cough etiquette

Reasons for the patient's visit

•This is a brief, spontaneous statement in the person's own words that describes the reason for the visit. Think of it as the "title" for the story to follow. It states one (possibly two) symptoms or signs and their duration. Try to record whatever the person says is the reason for seeking care, enclose it in quotation marks to indicate the person's exact words, and record a time frame. •Sample Statements: -"Chest pain for 2 hours" -"Sore throat for 3 days now and just getting worse" -"Earache and fussy all night" -"Need annual physical for work" -"Want to start jogging and need checkup"