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RTH 120 Patient History - Chapter 4 (unit 2)

Terms in this set (61)

What are some factors that may affect a patient interview?
- Patient's emotional and mental state, cognitive function, and any perceptual deficits
- Fear, Stress, Anxiety, and Pain
- Environment, privacy, noise
- General patient comfort
What are some additional factors that may affect communication?
- Choice of words, explanations,and questions (avoid jargon)
- Voice tone and nonverbal communication cues (facial expression and body language)
- Language barriers (use a trained medical interpreter: "marty")
*****What components contribute to a successful patient interview?
- Establish rapport with the patient
- Gather information about the patient's condition, including a chronology of events and the patient's impressions of his or her health
- Obtain feedback from the patient regarding your understanding of the patient's answers to your questions
- Involve the family, especially family caregivers
- Demonstrate to the patient and the family that you understand the patient's problems and will work with them to obtain the appropriate care
- Build on initial rapport to enhance further assessment, evaluations, and treatment plans
- Provide additional assessment, evaluation, and a treatment plan for chronic cardiopulmonary conditions to facilitate disease management
The patient interview should include questions to asses the following:
- Cough, sputum production, hemoptysis (coughing up of blood or blood-stained mucus)
- Wheezing, whistling, or chest tightness, dyspnea
- Past history of chest illness
- Smoking history
- Occupation (where appropriate)
- Current medications: Use of oxygen in the home, use of other respiratory care equipment, history of other episodes requiring intubation or mechanical ventilatory support
- Benefits of any respiratory care the patient may have experienced
What are some key things to remember, as a professional, as you encounter a patient?
- Use appropriate eye contact
- Social space (4 to 12 feet distance from patient)
_ Ask permissions before entering their personal space
What are some ways that help identify and clarify the patient's problem with a patient history?
- *Collection of a patient's demographic data
- Development of a patient profile
- Identification of the patient's chief complaint
What is the demographic data?
Description or overview of patient and condition that includes:
- Patient name, address, age, gender, race/ethnicity, and admitting diagnosis
- Place of birth, education, socioeconomic status, marital status, religion, and languages spoken
- Name(s) of physician(s) caring for patient, sources of referral for care, and a brief description of why the patient sought medical care
What is the patient profile?
An outline or summary of patient's characteristics and problems
What is the chief complaint?
A concise statement by the patient relating his or her reason for seeking medical attention
- Patient's primary symptom described in his or her own words
What are some common chief complaints?
- Breathlessness
- Development of a cough or change in a chronic cough
- Sputum production
What is the "history of the present illness"?
A detailed description of the symptoms, chronology of events, and resultant impact on the patient's health of the current illness or problem
What is "pulmonary history"?
A specialized version of the HPI (History of the Present Illness) that focuses on symptoms related to cardiopulmonary disease
What is included in pulmonary history?
Includes questions regarding the presence or absence of cough, sputum production, or hemoptysis
*****What is the most common symptoms for which medical treatment care is sought?
the cough
What are the classifications of the cough?
- acute (< 3 weeks)
- subacute (3-8 weeks)
- or chronic (> 8 weeks)
*****What may come about from the development of a new cough, what may it signal?
It may signal development of a pulmonary problem and a change in chronic cough may indicate a change in chronic lung disease or condition
What is associated with obstruction such as asthma?
wheezing with a cough
What symptoms are seen with croup?
a hoarse, brassy, or barking cough as seen with upper airway or laryngeal disorders
What is the most common cause of an acute cough?
an acute respiratory tract infection
What is acute bronchitis generally caused by?
a viral infection
What are common causes of subacute and chronic cough?
post nasal drip or also referred as the upper airway cough syndrome, chronic bronchitis, asthma, and GERD
Chronic bronchitis is a form of ________ and is associated with ________.
COPD; cigarette smoke or chronic exposure to inhaled irritants
What is the leading cause of persistent cough?
Asthma
They typical presentation of acute asthma includes wheezing and shortness of breath.
What happens with GERD?
It occurs when the acidic contents of the stomach leak backwards from the stomach into the esophagus.
Excessive sputum production is a common symptom of what?
pulmonary disease
What is excessive sputum production generally associated with?
acute or chronic infection, or inflammation of the respiratory mucosa
The term sputum refers to:
material expelled from the upper or lower airways
The term phlegm refers to:
secretions from the lower airways
How is sputum volume measured?
volume of sputum produce should be estimated using a standard measurement system (teaspoon, tablespoon, or portion of a cup)
Describe the sputum colors:
- colorless or clear is normal.
- cream, white, or clear generally has few bacteria present
- green, yellow green, yellow, or rust in color generally has a much higher concentration of bacteria
Describe the sputum consistency:
thin and mucoidal is normal sputum
Describe sputum odor:
foul-smelling is associated with long-term infections (fetid)
Explain the changes in sputum production:
- increased sputum production may occur with improved hydration and effective bronchial hygiene therapy
- decreased sputum of production is caused by airway obstruction, bronchospasm, dehydration, or inadequate humidification of the inspired gases
What is hemoptysis?
blood-tinged sputum associated with a large number of pulmonary disorders
What are curschmann's spirals?
mucus plugs or casts that have been coughed out and are associated with bronchial asthma
What are the most common causes of blood in the sputum?
bronchitis and pulmonary tuberculosis
What are some other common causes of hemoptysis?
lung cancer, pneumonia, bronchiectasis, lung abscess, pulmonary embolus/infarction, and cystic fibrosis
How may hemoptysis be classified as?
submassive and massive
How is wheezing described as?
a high-pitched, whistling sound during breathing
What is wheezing caused by?
narrowing of the upper or lower airway due to obstruction, bronchospasm, tumor, or asthma
What is a common complaint in the early stages of an asthma attack?
chest tightness which is associated with bronchoconstriction
What are potentially life-threatening causes of chest pain?
myocardial infarction, pulmonary embolism, tension pneumothorax, aortic dissection, and esophageal rupture
What are three basic types of chest pain?
substernal, pleuritic, and musculoskeletal
What is angina pectoris and what is it caused by?
A form of substernal chest pain seen in patients with ischemic heart disease.
Caused by reduced blood flow to myocardium.
What is myocardial infarction?
defined as myocardial cell death, most commonly caused by prolonged ischemia
What is pleuritic chest pain?
described as a sharp, knife like localized pain, often at the periphery of the chest
What are some common causes of pleuritic chest pain?
pleurisy, pneumonia, pulmonary embolus, pleuropericarditis, and pneumothorax
What is musculoskeletal chest pain?
caused by rib fractures, chest trauma or bruising, thoracic or cardiac surgery, and sprain or injury to the muscles of the chest
What is dyspnea?
the conscious sensation of being short of breath
What are some underlying causes of dyspnea?
pulmonary, cardiac, hematologic, neurologic, psychogenic, metabolic, or mechanical
What causes the increase of the respiratory drive with dyspnea?
hypoxemia, hypercapnia, and acidosis
What are the most common clinical causes of dyspnea?
asthma, COPD, interstitial lung disease, heart disease, and obesity with deconditioning
What are some things to consider with dyspnea?
- the pace with which dyspnea began
- the characteristics or qualities of the dyspnea
- their duration and character of the dyspnea
- any maneuvers that relieve or reduce the dyspnea
What is the treatment of dyspnea?
The treatment should be aimed at the underlying cause.
An example would be dyspnea due to hypoxemia with increased respiratory demand may benefit from oxygen therapy.
Sleep-related breathing disorders include:
Obstructive sleep apnea and Central sleep apnea
What are some events noted in the past medical history of an asthmatic patient that places the patient at a much higher risk for death from asthma?
- intubation
- prior admission to intensive care unit
- two or more hospitalizations or three or more emergency department visits in the past year
- use of more than two canisters per month of short-acting bronchodilators
- systemic steroid use
- ER visit or hospitalization due to asthma in the last month
What are some major diseases that should be included in the family history?
hypertension, cancer, heart disease, lung disease, diabetes, stroke, kidney disease, thyroid problems, and Alzheimer disease
*****For tobacco history, how do you figure out someone's cigarette pack year?
For cigarettes: the number of years smoked and the number of packs smoked per day are multiplied to create a measure called "pack-years."

1 pack/day x 1 year = 1 pack year
What may cause patients to under-report current tobacco use?
Embarrassment or the desire to please their healthcare provider
*****What kind of levels can be measured via co-oximetry to help identify "hidden" smokers?
Measurement of blood carboxyhemoglobin levels
*****Review of Symptoms
After taking a complete patient history, clinician develops a problem list based on a review of the symptoms noted.
- General symptoms: Problems which may be related to pulmonary or cardiac/ cardiovascular disease
- Skin and nails: color, temperature, and appearance of the skin and nails
Head, eyes, ears, nose, and throat problems (HEENT)
- Endocrine: problems such as thyroid enlargement or tenderness, diabetes, or pregnancy
- Respiratory: cough; sputum production; hemoptysis; dyspnea; orthopnea; wheezing, whistling or chest tightness; chest pain; exposure to infection; night sweats; or use of accessory muscles
- Cardiac/cardiovascular: chest pain or discomfort, palpitations, dyspnea, orthopnea, exercise tolerance, and past tests done (ECG, other cardiac tests)
- Hematologic: anemia, bleeding, and blood loss
Lymph nodes: tender, swollen, or enlarged
- Gastrointestinal (GI): problems with diet, appetite, digestion, food problems or restrictions, and any food allergies
- Genitourinary: problems with urination or urine output
- Muscloskeletal: joint stiffness or pain, swelling, fractures, or trauma or restrictions to motion
- Neurologic and mental status: headache, disorientation, excitement, fainting, dizziness, confusion, and somnolence, loss of consciousness, or coma
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