lOMoARcPSD|3013804
NR 509 Adv Physical Assessment- Midterm
Notes
Advanced Physical Assessment (Chamberlain University)
, lOMoARcPSD|3013804
Chapter 1 Approach to Clinical Encounter
Clinician-centered approach: the clinician takes charge of the interaction to meet his own need
to acquire the symptoms, details and other data that will help him ID the disease.
Patient-centered approach recognizes the importance of patients’ expression of personal
concerns, feelings and emotions and evokes the personal context of the patient’s symptoms
and disease.
▪ Following the pts lead without adding any additional information from the
clinician’s perspective
Disease: explanation that the clinician uses to organize symptoms that lead to a clinical diagnosis
Illness: is a construct that explains how the pt exp. the disease
- Effects relationship, function and sense of well-being
**the clinical interview needs to incorporate both the clinician’s and the pts views of reality,
disease and illness.
Feelings (fears or concerns about the problem)
Ideas (about the nature of the cause of the problem)
Function (effects)
Expectations (of the disease, clinician, healthcare- could be based on past experience)
Structure and Sequence of the Clinical Encounter
1. Initiating the session
2. Information gathering
3. Physical Examination
4. Explaining and Planning
5. Closing the Session
Social Determinants of Health
***See Table 1-1 Example of a Comprehensive Clinical Record: The Case of Pt MN
, lOMoARcPSD|3013804
Chapter 2 Interviewing, Communication, and Interpersonal Skills
Empathy has been described as “the capacity to identify with the patient and feel the patient’s
pain as your own, then respond in a supportive manner.
- Requires a wiliness to suffer some of the pts pain
**Use people first language
Disclosing Serious News
- The SPIKES Protocol
o Setting up the interview
o Assessing the pts Perception
o Obtaining the pts Invitation
o Giving Knowledge and info to the pt
o Addressing the pts Emotions with empathetic responses
o Strategy and Summary
Some patients present a confusing array of multiple symptoms. They seem to have every
symptom that you ask about, or “a positive review of systems.
Chapter 3 Health History
Comprehensive Assessment vs. Episodic Visit
Comprehensive: includes all the elements of the health history and the complete phys exam
- Pts may not present with a “cc” so the history and examination will need to be
detailed focusing on primary care.
o Initial information
o “CC”
o HPI
o PMH
o Fam Hx
o Personal and Social Hx
o ROS
Episodic: pt will have a chief complaint such as: cough, abdominal pain, sore throat etc- the
clinician’s history will focus on the “cc” as they begin Dx and management
Basic interviewing techniques include:
Active listening
Empathic responses
Guided questioning
Nonverbal communication
Validation
Reassurance
NR 509 Adv Physical Assessment- Midterm
Notes
Advanced Physical Assessment (Chamberlain University)
, lOMoARcPSD|3013804
Chapter 1 Approach to Clinical Encounter
Clinician-centered approach: the clinician takes charge of the interaction to meet his own need
to acquire the symptoms, details and other data that will help him ID the disease.
Patient-centered approach recognizes the importance of patients’ expression of personal
concerns, feelings and emotions and evokes the personal context of the patient’s symptoms
and disease.
▪ Following the pts lead without adding any additional information from the
clinician’s perspective
Disease: explanation that the clinician uses to organize symptoms that lead to a clinical diagnosis
Illness: is a construct that explains how the pt exp. the disease
- Effects relationship, function and sense of well-being
**the clinical interview needs to incorporate both the clinician’s and the pts views of reality,
disease and illness.
Feelings (fears or concerns about the problem)
Ideas (about the nature of the cause of the problem)
Function (effects)
Expectations (of the disease, clinician, healthcare- could be based on past experience)
Structure and Sequence of the Clinical Encounter
1. Initiating the session
2. Information gathering
3. Physical Examination
4. Explaining and Planning
5. Closing the Session
Social Determinants of Health
***See Table 1-1 Example of a Comprehensive Clinical Record: The Case of Pt MN
, lOMoARcPSD|3013804
Chapter 2 Interviewing, Communication, and Interpersonal Skills
Empathy has been described as “the capacity to identify with the patient and feel the patient’s
pain as your own, then respond in a supportive manner.
- Requires a wiliness to suffer some of the pts pain
**Use people first language
Disclosing Serious News
- The SPIKES Protocol
o Setting up the interview
o Assessing the pts Perception
o Obtaining the pts Invitation
o Giving Knowledge and info to the pt
o Addressing the pts Emotions with empathetic responses
o Strategy and Summary
Some patients present a confusing array of multiple symptoms. They seem to have every
symptom that you ask about, or “a positive review of systems.
Chapter 3 Health History
Comprehensive Assessment vs. Episodic Visit
Comprehensive: includes all the elements of the health history and the complete phys exam
- Pts may not present with a “cc” so the history and examination will need to be
detailed focusing on primary care.
o Initial information
o “CC”
o HPI
o PMH
o Fam Hx
o Personal and Social Hx
o ROS
Episodic: pt will have a chief complaint such as: cough, abdominal pain, sore throat etc- the
clinician’s history will focus on the “cc” as they begin Dx and management
Basic interviewing techniques include:
Active listening
Empathic responses
Guided questioning
Nonverbal communication
Validation
Reassurance
