Adolescents: be respectful, be honest, stay in character, show an interest, explain the process of the interview and exam, keep questions short and simple, avoid reflection, tackle tougher questions later on, reassure everything is confidential, use positive reinforcement
Older Adults
Use proper surname, i.e. "Mrs. Johnson"
Avoid "elderspeak"
Allow for ample time; older adults may take longer to form answers, and also have much more to tell!
Do not shout: demeaning and actually distorts sound thru hearing aids
Touch can be a great nonverbal skill to use
Different cultures/cultural competence:
Know your own culture first
Consider patient's culture, ethnicity, heritage, immigration status, language barriers, religious status, beliefs as related to health and healing, sexual orientation, gender identity
NEVER ASSUME
Be respectful of cultural views on personal space, eye contact, use proper names and titles
Seek help of professional interpreter
Be sure to address patient, not the interpreter
If a family member must be used as an interpreter, refrain from using medical jargon and note that more personal questions may be harder for them to address
When interpreter is not available: Vocal cues (and silence), action cues (posture, facial expression, gestures),object cues (clothing, jewelry, hairstyle),use of personal and territorial space (belongings),touch (personal space)
Special needs: hearing-imparied, cognitive/developmentally-delayed acutely ill, under influence of street drugs or alcohol (use simple, direct questions), sexually aggressive people (ZERO tolerance), anger (don't personalize this), crying (be supportive), threats of violence (ALWAYS have easy access to the door) ESTABLISH RAPPORT
Be pleasant, empathetic, listen, be self-aware, ensure privacy, ensure confidentiality, refuse interruptions
Physical environment: inviting, clean, good temperature, remove distractions, appropriate distancing, equal-status seating, FACE PATIENT (especially when having to document on computer or WOW)
Start with an introduction
Open-ended vs close-ended questions: know when these are appropriate, know when to assist the narrative
Pick up on non-verbal communication
Physical appearance, posture, gestures, facial expressions, eye contact, voice, touch to examine by touch
Using hands to touch and assess the patient
Texture, temperature, moisture, organ location, size, any swelling, vibration or pulsation, rigidity/spasticity, crepitus, lumps or masses, tenderness or pain
Ex: crepitus is like a "rice krispie" sound
Should be slow, calm, gentle; start with light palpation then deep
Uses for particular parts of hand
Fingertips → for fine motor, tactile discrimination, swelling
Ex: assess skin texture, pulsation, any lumps
Grasping of fingers and thumb →
Detect position, shape, and consistency of organ or mass
Dorsa (backs) of hands and fingers → determining temperature
Base of fingers (MCP joints) or ulnar surface → for vibration
Percussion → Overall pain assessment tool
Chronic pain conditions or particularly problematic acute pain problems
Initial Pain Assessment
Ask the patient to answer 8 questions regarding location, duration, quality, intensity, and aggravating/relieving factors
Brief Pain Inventory
Ask the patient to rate the pain within the past 24 hours using graduated scales (0-10) → mood, walking ability, sleep
McGill Pain Questionnaire
Rank a list of descriptors in terms of their intensity and to give an overall intensity rating to his or her pain
Wong-Baker Faces
6 drawings of faces that show pain intensity from "no pain" to "very much pain"
Used for children
Avoids smiles or tears so that children will not associate pain with happiness or sadness
Beyer Oucher pain scale
Developed for children to help them communicate how much pain they feel
Uses faces on a scale from 0-100 with 6 photographs of children in pain
FLACC scale (0-2)
0 = normal, 2= pain
Nonverbal assessment for infant and toddlers (under 3)
Assesses: facial expression, leg movement, activity level, cry, and consolability
COMFORT scale (1-5)
Used to assess pain in critically ill pediatric patients
Relies on 6 behavioral and two physiologic factors
Alertness, calmness, respiratory distress, crying, physical movement, muscle tone, facial tension, blood pressure baseline, heart rate baseline
CRIES pain scale (0-2)
0=normal, 2= irregular behavior
Assess postoperative pain in preterm and term neonates by measuring physiologic and behavioral indicators on a 3 point scale
Assess: crying, sleepless, expression, vital signs, requires O2 for sat >95% mental status functioning is inferred through assessment of an individual's behaviors.
It can NOT be assessed directly like characteristics of the skin or heart sounds.
Consciousness: Being aware of one's own existence, feelings, and thoughts and of the environment. This is the most elementary of mental status functions.
Language: Using the voice to communicate one's thoughts and feelings. This is a basic tool of humans, and its loss has a heavy social impact on the individual.
Mood and affect: Both of these elements deal with the prevailing feelings. Affect is a temporary expression of feelings or state of mind, and mood is more durable, a prolonged display of feelings that color the whole emotional life.
Orientation: The awareness of the objective world in relation to the self, including person, place, and time.
Attention: The power of concentration, the ability to focus on one specific thing without being distracted by many environmental stimuli.
Memory: The ability to lay down and store experiences and perceptions for later recall. Recent memory evokes day-to-day events; remote memory brings up years' worth of experiences.
Abstract reasoning: Pondering a deeper meaning beyond the concrete and literal.
Thought process: The way a person thinks; the logical train of thought.
Thought content: What the person thinks—specific ideas, beliefs, the use of words.
Perceptions: An awareness of objects through the five senses. Color: graying
Texture: fine, thick, straight, curly, kinky, shiny or dull
Distribution:
Alopecia (traction, areata, traumatic)
Distinguish normal male pattern hair loss
Telogen effluvium: hair loss due to sudden onset of stress
absence or sparse genital hair suggests endocrine abnormalities
Hirsutism: abnormal hair growth on a person's face or body, particularly a woman
Lesions: psoriasis plaques, pilar cysts, seborrheic dermatitis (severe dandruff/flaking- aka "cradle cap" in infants) 7th Edition•ISBN: 9780323402118Gary A. Thibodeau, Kevin T. Patton1,505 solutions
7th Edition•ISBN: 9780323527361Julie S Snyder, Mariann M Harding2,512 solutions
4th Edition•ISBN: 9781492501626G Haff, N Triplett121 solutions
1st Edition•ISBN: 9781111782450Joel Helms1,674 solutions
