NR509midtermstudyguide LATEST 2022-2023
NR 509 Midterm Study Guide Week 3
Ch. 1
● Basic and Advanced Interviewing Techniques
Basic Interviewing Techniques
● Active listening: Active listening means closely attending to what the
patient is communicating, connecting to the patient's emotional state,
and using verbal and nonverbal skills to encourage the patient to expand
on his or her feelings and concerns.
● Empathic responses: 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.
● Guided questioning: Guided questions show your sustained interest in
the patient's feelings and deepest disclosures and allows the
interviewer to facilitate full communication, in the patient's own words,
without interruption.
● Nonverbal communication: Nonverbal communication includes eye
contact, facial expression, posture, head position and movement such as
shaking or nodding, interpersonal distance, and placement of the arms
or legs—crossed, neutral, or open.
● Validation: Validation helps to affirm the legitimacy of the
patient's emotional experience.
● Reassurance: Reassurance is an appropriate way to help the patient
feel that problems have been fully understood and are being addressed.
● Partnering: When building rapport with patients, express
your commitment to an ongoing relationship.
● Summarization: Giving a capsule summary of the patient's story during
the course of the interview to communicate that you have been
listening carefully.
● Transitions: Inform your patient when you are changing directions
during the interview.
● Empowering the patient: Empower patients to ask questions, express
their concerns, and probe your recommendations in order to encourage
them to adopt your advice, make lifestyle changes, or take medications
as prescribed.
Advanced Interview Techniques
, 2
𝖮 Determine scope of assessment: Focused vs. Comprehensive:
■ Comprehensive: Used patients you are seeing for the first
time in the office or hospital. Includes all the elements of
the health history and complete physical examination.
● Is appropriate for new patients in the office or
hospital
● Provides fundamental and personalized
knowledge about the patient
● Strengthens the clinician–patient relationship
● Helps identify or rule out physical causes related
to patient concerns
● Provides a baseline for future assessments
● Creates a platform for health promotion through
education and counseling
● Develops proficiency in the essential skills of physical
examination
■ Focused: For patients you know well returning for routine
care, or those with specific “urgent care” concerns like
sore throat or knee pain. You will adjust the scope of your
history and physical examination to the situation at hand,
keeping several factors in mind: the magnitude and
severity of the patient’s prob- lems; the need for
thoroughness; the clinical setting—inpatient or
outpatient, primary or subspecialty care; and the time
available.
● Is appropriate for established patients, especially
during routine or urgent care visits
● Addresses focused concerns or symptoms
● Assesses symptoms restricted to a specific body
system
● Applies examination methods relevant to assessing
the concern or problem as thoroughly and carefully
as possible
𝖮 Being aware of your reactions helps develop your clinical skills.
𝖮 Your success in eliciting the history from different types of patients
grows with experience, but take into account your own stressors,
such as fatigue, mood, and overwork.
𝖮 Self-care is also important in caring for others. Even if a patient is
challenging, always remember the importance of listening to the
patient and clarifying his or her concerns.
● Components of the Health History
● Initial information
■ Date and time of history-time is especially important in emergent
, 3
situations
■ Identifying data-age, gender, marital status, occupation-
identify source of history ie: family member, friend etc.
■ Reliability-usually documented at end of interview ie: “patient
is vague when describing symptoms”.
𝖮 Chief Complaint(s)
■ Try to quote the patients words
𝖮 Present Illness
■ Complete, clear and chronological description of the
problem prompting the patient visit
■ Onset, setting in which it occurred, manifestations and any treatments
■ Should include 7 attributes of a symptom:
● Location
● Quality
● Quantity or severity
● Timing, onset, duration, frequency
● Setting in which it occurs
● Aggravating or relieving factors
● Associated manifestations
Differential diagnosis is derived from the “pertinent positives” and “pertinent negatives”
when doing Review of Systems that are relevant to the chief complaint.
Present illness should reveal patient’s responses to his or her symptoms and what effect this
has on their life.
Each symptom needs its own paragraph and a full description.
Medication should be documented, name, dose, route, and frequency. Home remedies, non-
prescriptions drugs, vitamins, mineral or herbal supplements, oral contraceptives, or
borrowed medications.
Allergies-foods, insects, or environmental, including specific reaction
Tobacco use, including the type. If someone has quit, note for how
long
Alcohol and drug use should always be investigated and is often pertinent to the Presenting
Illness.
𝖮 Past history
■ Childhood Illness: measles, rubella, mumps, whooping cough,
, 4
chickenpox, rheumatic fever, scarlet fever, and polio. Also include
any chronic childhood illness
■ Adult illnesses: Provide information in each of the 4 areas:
● Medical: diabetes, hypertension, hepatitis, asthma and
HIV; hospitaliations; number and gender of sexual
partners; and risk taking sexual practices.
● Surgical: dates, indications, and types of operations
● Obstetric/gynecologic: Obstetric history, menstrual
history, methods of contraception, and sexual function.
● Psychiatric: Illness and time frame, diagnoses,
hospitalizations, and treatments.
Health Maintenance: Find out if they are up to date on
immunizations and screening tests.
𝖮 Family history
■ Outlines or diagrams age and health, or age and cause
of death, of siblings, parents, and grandparents
■ Documents presence or absence of specific illnesses in
family, such as hypertension, coronary artery disease,
elevated cholesterol levels, stroke, diabetes, thyroid or
renal disease, arthritis, tuberculosis, asthma or lung
disease, headache, seizure disorder, mental illness,
suicide, substance abuse, and allergies, and symtoms
reported by patient.
■ Ask about history of breast, ovarian, colon, or
prostate cancer
■ Ask about Genetically transmitted diseases
Personal or social history
■ Describes educational level, occupation, family of
origin, current household, personal interests, and
lifestyle
■ Capture the patients personality and interests, sources
of support, coping style, strengths, and concerns
■ Includes lifestyle habits that promote health or create risk,
such as exercise and diet, safety measures, sexual
practices, and use of alcohol, drugs, and tobacco
■ Expanded personal and social history personalizes your
relationship with the patient and builds a rapport
𝖮 Review of systems
NR 509 Midterm Study Guide Week 3
Ch. 1
● Basic and Advanced Interviewing Techniques
Basic Interviewing Techniques
● Active listening: Active listening means closely attending to what the
patient is communicating, connecting to the patient's emotional state,
and using verbal and nonverbal skills to encourage the patient to expand
on his or her feelings and concerns.
● Empathic responses: 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.
● Guided questioning: Guided questions show your sustained interest in
the patient's feelings and deepest disclosures and allows the
interviewer to facilitate full communication, in the patient's own words,
without interruption.
● Nonverbal communication: Nonverbal communication includes eye
contact, facial expression, posture, head position and movement such as
shaking or nodding, interpersonal distance, and placement of the arms
or legs—crossed, neutral, or open.
● Validation: Validation helps to affirm the legitimacy of the
patient's emotional experience.
● Reassurance: Reassurance is an appropriate way to help the patient
feel that problems have been fully understood and are being addressed.
● Partnering: When building rapport with patients, express
your commitment to an ongoing relationship.
● Summarization: Giving a capsule summary of the patient's story during
the course of the interview to communicate that you have been
listening carefully.
● Transitions: Inform your patient when you are changing directions
during the interview.
● Empowering the patient: Empower patients to ask questions, express
their concerns, and probe your recommendations in order to encourage
them to adopt your advice, make lifestyle changes, or take medications
as prescribed.
Advanced Interview Techniques
, 2
𝖮 Determine scope of assessment: Focused vs. Comprehensive:
■ Comprehensive: Used patients you are seeing for the first
time in the office or hospital. Includes all the elements of
the health history and complete physical examination.
● Is appropriate for new patients in the office or
hospital
● Provides fundamental and personalized
knowledge about the patient
● Strengthens the clinician–patient relationship
● Helps identify or rule out physical causes related
to patient concerns
● Provides a baseline for future assessments
● Creates a platform for health promotion through
education and counseling
● Develops proficiency in the essential skills of physical
examination
■ Focused: For patients you know well returning for routine
care, or those with specific “urgent care” concerns like
sore throat or knee pain. You will adjust the scope of your
history and physical examination to the situation at hand,
keeping several factors in mind: the magnitude and
severity of the patient’s prob- lems; the need for
thoroughness; the clinical setting—inpatient or
outpatient, primary or subspecialty care; and the time
available.
● Is appropriate for established patients, especially
during routine or urgent care visits
● Addresses focused concerns or symptoms
● Assesses symptoms restricted to a specific body
system
● Applies examination methods relevant to assessing
the concern or problem as thoroughly and carefully
as possible
𝖮 Being aware of your reactions helps develop your clinical skills.
𝖮 Your success in eliciting the history from different types of patients
grows with experience, but take into account your own stressors,
such as fatigue, mood, and overwork.
𝖮 Self-care is also important in caring for others. Even if a patient is
challenging, always remember the importance of listening to the
patient and clarifying his or her concerns.
● Components of the Health History
● Initial information
■ Date and time of history-time is especially important in emergent
, 3
situations
■ Identifying data-age, gender, marital status, occupation-
identify source of history ie: family member, friend etc.
■ Reliability-usually documented at end of interview ie: “patient
is vague when describing symptoms”.
𝖮 Chief Complaint(s)
■ Try to quote the patients words
𝖮 Present Illness
■ Complete, clear and chronological description of the
problem prompting the patient visit
■ Onset, setting in which it occurred, manifestations and any treatments
■ Should include 7 attributes of a symptom:
● Location
● Quality
● Quantity or severity
● Timing, onset, duration, frequency
● Setting in which it occurs
● Aggravating or relieving factors
● Associated manifestations
Differential diagnosis is derived from the “pertinent positives” and “pertinent negatives”
when doing Review of Systems that are relevant to the chief complaint.
Present illness should reveal patient’s responses to his or her symptoms and what effect this
has on their life.
Each symptom needs its own paragraph and a full description.
Medication should be documented, name, dose, route, and frequency. Home remedies, non-
prescriptions drugs, vitamins, mineral or herbal supplements, oral contraceptives, or
borrowed medications.
Allergies-foods, insects, or environmental, including specific reaction
Tobacco use, including the type. If someone has quit, note for how
long
Alcohol and drug use should always be investigated and is often pertinent to the Presenting
Illness.
𝖮 Past history
■ Childhood Illness: measles, rubella, mumps, whooping cough,
, 4
chickenpox, rheumatic fever, scarlet fever, and polio. Also include
any chronic childhood illness
■ Adult illnesses: Provide information in each of the 4 areas:
● Medical: diabetes, hypertension, hepatitis, asthma and
HIV; hospitaliations; number and gender of sexual
partners; and risk taking sexual practices.
● Surgical: dates, indications, and types of operations
● Obstetric/gynecologic: Obstetric history, menstrual
history, methods of contraception, and sexual function.
● Psychiatric: Illness and time frame, diagnoses,
hospitalizations, and treatments.
Health Maintenance: Find out if they are up to date on
immunizations and screening tests.
𝖮 Family history
■ Outlines or diagrams age and health, or age and cause
of death, of siblings, parents, and grandparents
■ Documents presence or absence of specific illnesses in
family, such as hypertension, coronary artery disease,
elevated cholesterol levels, stroke, diabetes, thyroid or
renal disease, arthritis, tuberculosis, asthma or lung
disease, headache, seizure disorder, mental illness,
suicide, substance abuse, and allergies, and symtoms
reported by patient.
■ Ask about history of breast, ovarian, colon, or
prostate cancer
■ Ask about Genetically transmitted diseases
Personal or social history
■ Describes educational level, occupation, family of
origin, current household, personal interests, and
lifestyle
■ Capture the patients personality and interests, sources
of support, coping style, strengths, and concerns
■ Includes lifestyle habits that promote health or create risk,
such as exercise and diet, safety measures, sexual
practices, and use of alcohol, drugs, and tobacco
■ Expanded personal and social history personalizes your
relationship with the patient and builds a rapport
𝖮 Review of systems
