For this Discussion, you will take on the role of a clinician who is building a health history for one

of the
following new patients:

76-year-old Black/African-American male with disabilities living in an urban setting

Adolescent Hispanic/Latino boy living in a middle-class suburb

55-year-old Asian female living in a high-density poverty housing complex

Pre-school aged white female living in a rural community

16-year-old white pregnant teenager living in an inner-city neighborhood

To prepare:

With the information presented in Chapter 1 in mind, consider the following:

How would your communication and interview techniques for building a health history differ with each
patient?

How might you target your questions for building a health history based on the patient’s age, gender,
ethnicity, or environment?

What risk assessment instruments would be appropriate to use with each patient?

What questions would you ask each patient to assess his or her health risks?

Select one patient from the list above on which to focus for this Discussion.

Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or
environmental setting that should be taken into consideration.

Select one of the risk assessment instruments presented in Chapter 1 or Chapter 26 of the course text,
or another tool with which you are familiar, related to your selected patient.

Develop at least five targeted questions you would ask your selected patient to assess his or her health
risks and begin building a health history.

By Day 3

Post a description of the interview and communication techniques you would use with your selected
patient. Explain why you would use these techniques. Identify the risk assessment instrument you
selected, and justify why it would be applicable to the selected patient. Provide at least five targeted
questions you would ask the patient.
Amita Leonard

Main post Week 1

Adolescent Hispanic/Latino boy living in a middle-class suburb

The adolescent patient in this scenario is also Hispanic. I will first find out if he

understands English. If he doesn’t, I will arrange for an interpreter. I also need to be culturally

competent. I can do this by being sensitive to his heritage, sexual orientation, socioeconomic

situation, ethnicity, and cultural background. (Cuellar et al.,2008).

Communication Techniques

An adolescent is the time of life from puberty to maturity. This is the most vulnerable

time of a person’s life. Most of them are usually not easy to open up to any conversation. Getting

information from them can be quite challenging. It is also important to provide them privacy. I

will try to get the chief concern for seeking care from parent/s if present and request them to

step out of the room to investigate further. I will begin the conversation with day to day activities

in the patient’s life. I have to remember to respect him and gain his trust. If I am faced with

silence, I have to respect that as well. I will try to gauge if this silence is out of anger, shame, or

just the unwillingness to share. My primary focus will be to find out the details about his

concerns, and show genuine interest and curiosity. I will use language that is understandable. I

will avoid confrontation. I will listen to what the patient is saying. Once I figure out the chief

concern, I can go on to discuss other sensitive issues such as sex, drug, or alcohol use (Ball,

Dains, Flynn, Solomon, Stewart, 2015).

Risk Assessment Tool

 Knowing the fact that adolescents go for risky behaviors, it will be important to assess him

for the same. I would use the HEEADSSS screening tool for adolescent issues for this. Here I

can find out more about his home environment, education, employment, eating pattern, his

activities, ambitions. I can also find out about any drug use, his sexuality, or if he is having any

suicidal thoughts and if he is safe from injury and violence (Ball, Dains, Flynn, Solomon,

Stewart, 2015).

Some of the questions I would ask him are as follows:

1. How are things at home?

2. How is school going?

3. Tell me about your friends.

4. What types of computer and electronic games do you play?

5. What are you good at doing?

Thus, I will ask such open ended questions which will allow my patient to talk about areas

that are troubling him.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel's guide to

physical examination (8th ed.)(pp. 1-29). St. Louis, MO: Elsevier Mosby.

Cuellar, N. G., Brennan, A. M., Vito, K., & Siantz, M. L. (2008). Cultural Competence in the
 Undergraduate Nursing Curriculum. Journal of Professional Nursing, 24(3), 143-149.

doi:10.1016/j.profnurs.2008.01.004

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected a different patient than
you, using one or more of the following approaches:

Share additional interview and communication techniques that could be effective with your colleague’s
selected patient.

Suggest additional health-related risks that might be considered.

Validate an idea with your own experience and additional research.

Reply1

Hi Jill,

Very nice post on interacting with a pregnant teenager! It is also important to find out her

feelings about this pregnancy and how she views this situation. Factors like her relation with her own

mother, previous experiences with any previous child bearing can affect this. I will also try to get her

past history, assess her for potential risk factors as well. I will try to use the history and physical

assessment findings to identify conditions that threaten the mother and / or fetus. Some of these

conditions could include preterm labor, preeclampsia/eclampsia, maternal malnutrition and vitamin

deficiency etc.

Reference

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel's guide to

physical examination (8th ed.)(pp. 1-29). St. Louis, MO: Elsevier Mosby.
Reply 2

Hi Tejia,

Lovely post! I agree with the assessment risk tool you chose for the 55 year old Asian lady.

Since she is Asian, it calls for a cultural assessment. These would include questions to assess her

health belief and practices, fluency in English, role of family, sources of support beyond the

family, and dietary practices as well. It is not possible as healthcare providers to learn all the

native languages of all of our patients, we should use our resources and effectively use

interpreters (Seeleman et al, 2009). Though the use of medical interpreters has had a positive

impact on health care quality, these services have not been used regularly (Flores, 2005; Kuo,

2007).

References

Flores, G. (2005). The Impact of Medical Interpreter Services on the Quality of Health Care: A

Systematic Review. Medical Care Research and Review, 62(3), 255-299.

doi:10.1177/1077558705275416

Kuo, D. Z., O'connor, K. G., Flores, G., & Minkovitz, C. S. (2007). Pediatricians' Use of

Language Services for Families With Limited English Proficiency. Pediatrics, 119(4).

doi:10.1542/peds.2006-1508

Seeleman, C., Suurmond, J., & Stronks, K. (2009). Cultural competence: A conceptual

framework for teaching and learning. Medical Education, 43(3), 229-237.

doi:10.1111/j.1365-2923.2008.03269.x
https://quizlet.com/75061479/pd-chapter-01-partnership-with-patients-building-a-history-flash-cards/

https://www.coursehero.com/file/13631659/quiz1docx/

http://www.studystack.com/flashcard-675063

need to do good for the patient.

In issues surrounding ethical decision making, beneficence refers to the:

nonmaleficence.

The term denoting the caregiver's need to do no harm to the patient is:

deontologic imperatives.

The duties of care providers established by tradition, and within the context of culture, are known as:

Inform the patient of treatment options and possible results.

Which of the following is initially appropriate in the management of a patient's diagnosed problem?

"You don't get headaches often do you?"

Which question would be considered a "leading question?"

avoid extremes in dress.

To prevent personal appearance from becoming an obstacle in patient care, the health professional
should:

Ask a person unfamiliar with the patient to translate.

Which action would best promote accurate translations as well as confidentiality when the caregiver
does not speak the patient's language?

acupuncture

An example of a complementary care modality is:

During the initial part of the interview

When are open-ended questions generally most useful?

providing forthright answers to questions.

Behaviors that diffuse anxiety during the interview include:

providing time for reflection.

Periods of silence during the interview can serve important purposes, such as:

Use the patient's own terms if possible

Which technique is most likely to result in the patient's understanding of questions?

acknowledge his anger and proceed with the history and examination.

A patient becomes restless during the history and says, "I don't have time for all of this conversation.
I've got to get back to work." Your most appropriate response would be to:

"What amount and what kind of alcohol do you drink in a week?"

When questioning a patient regarding alcohol intake, she tells you that she is "only a social drinker."
Which initial response is appropriate?

"Why do you think that your mother's tumor is cancerous?"

Ms. T. is crying and states that her mother couldn't possibly have a tumor. "No one else in the family,"
exclaims the daughter, "has ever had cancer!" The most appropriate response to Ms. T. would be:
"Can you describe the pain?"

A 50-year-old man comes to the primary care clinic. He tells you he is worried because he has had
severe chest pains for the past 2 weeks. Which initial history interview question is most appropriate?

Give a brief, undetailed answer

After you ask a patient about her family history, she says, "Tell me about your family now." Which
response is generally most appropriate?

continue to collect information regarding the chief complaint in an unhurried manner.

A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She seems
nervous as she speaks to you. An appropriate response is to:

"What in life is causing you such pain?"

Ms. A. states, "My life is just too painful. It isn't worth it." She appears depressed. Which one of the
following statements is the most appropriate caregiver response?

offer a tissue and let him know it is all right to cry.

During an interview, tears appear in the patient's eyes and his voice becomes shaky. Initially, you should:

Ask whether the patient has considered self-harm.

During an interview, you have the impression that a patient may be considering suicide. Which action is
essential?

Make a note to pursue sensitive issues later in the interview.

During a history-taking session, Mr. B. appears to be avoiding certain questions. He keeps looking out
the window. What should the caregiver do?

given the opportunity to be interviewed without the parent at some point during the interview.

You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination
room. When collecting history from older children or adolescents, they should be:
the gender that the woman hopes the baby will be.

Information that is needed during the initial interview of a pregnant woman includes all of the following
except:

typical reluctance to talk.

When communicating with older children and teenagers, you should be sensitive to their:

position himself face-to-face with the patient.

When interviewing older adults, the examiner should:

validate the concern with his family or caregivers.

When you suspect that your 81-year-old patient has short-term memory loss because he cannot
remember what he had for breakfast, you should:

The patient should be fully involved to the limit of his or her ability.

To what extent should the patient with a physical disability or emotional disorder be involved in
providing health history information to the health professional?

chief complaint.

A brief statement of the reason the patient is seeking health care is called the:

the patient's stimulus to seek care.

The iatropic stimulus refers to:

use a chronologic and sequential framework.

When taking a history, you should:

"Do you have any worries or concerns regarding your sexual life?"

When questioning the patient regarding his or her sexual history, which question should be asked
initially?
make notes sparingly so that patients can be observed during the history taking.

A guideline for history taking is for caregivers to:

personal and social history.

Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This
information would most likely belong in the:

a routine component of history taking with female patients.

Direct questioning about domestic violence in the home should be:

CAGE questionnaire.

Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem
drinking, you would use the:

CRAFFT

A tool used to screen adolescents for alcoholism is the:

leave the child sitting in the father's lap while you talk to the father.

When you enter the examination room of a 3-year-old girl, you find her sitting on her father's lap. She
turns away from you when you greet her. Initially, your best response is to:

Propensity for risk taking

Tom is a 16-year-old diabetic who does not follow his diet. He enjoys his dirt bike and seems
unconcerned about any consequences of his activities. Which factor is typical of adolescence and
pertinent to Tom's health?

sharp pain may be felt as a dull ache.

Pain is difficult to assess in older adults because

functional assessment.

A survey of mobility and activities of daily living (ADLs) is part of a(n):

fever, chills, fatigue, malaise.

Constitutional symptoms in the ROS refer to:

problem or focused

J.M. has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute
sinusitis. The type of history that is warranted is a(n) _____ history.

"Have you made plans to harm yourself?"

Mary Jane has brought in her 16-year-old son, Kyle. She states that he has been sleeping more, doesn't
hang around his friends, and recently his girlfriend broke up with him. Your most immediate question is
to ask Kyle:

Paying bills

Which of the following is considered an IADL but not an ADL?

genetic and familial health problems.

A pedigree diagram is drafted for the purpose of obtaining:

Subjective data, as well as symptomatic data, should be placed in

history section
the _________ section

The quality of a symptom, such as pain is ____information that

subjective data, history
should be described in the _________ section

Which is an effective adjunct to document location of findings

relationship to anatomic landmarks
during the recording of the physical exam

The position on a clock, topographic notations and anatomic

recording locations of findings
landmarks are methods for ______
regardless of origin, discharge is described by noting oolor and consistency

drawing of stick figures is most useful to compare findings in extremities

findings of an unknown origin should be recorded on the patients

problem list
_______

a problem may be defined as anything that will require: evaluation

differential diagnoses belong in the ______ assessment

When recording assessments during the construction of the create an assessment for each
problem-oriented medical record, the examiner should: problem on the problem list.

Your patient returns for a blood pressure check 2 weeks after a

visit during which you performed a complete history and physical. PROGRESS NOTE
This visit would be documented by creating a(n):

detailed description of the symptoms related to the chief

history of present illness
complaint is presented in the:

The effect of the chief complaint on the patient’s lifestyle is

history of present ilness
recorded in which section of the medical record?

The patient’s perceived disabilities and functional limitations are

past medical history
recorded in the:

The review of systems is a component of the: health history

Allergies to drugs and foods are generally listed in which section

past medical history
of the medical record?

Information such as education and economic condition is part of personal and social

Information recorded about an infant differs from that recorded

developmental status
about an adult, mainly because of the infant’s:

In which section of the newborn history would you find details of

present problem
gestational assessment and extrauterine adjustment data?

Data relevant to the social history of older adults include

family support systems
information on:
A SOAP note is used in which type of recording system? problem oriented

The examiner’s evaluation of a patient’s mental status belongs in

physical examination
the:

follow-up visits for problems identified in the POMR are recorded

progress notes
in the_________

Documentation of the _________ should always be done by using

chief complaint
the patient’s own words in quotation marks.

When using the mnemonic OLDCARTS, the A stands for

aggravating an associated factors
____________________.

The duties of care providers established by tradition, and within

deontological imperatives
the context of culture, are known as:

during the initial part of the

When are open-ended questions generally most useful?
interview

providing forthright answers to

Behaviors that diffuse anxiety during the interview include:
questions

Periods of silence during the interview can serve important

providing times for reflextion
purposes, such as:

a woman complains that she has had crushing chest pain for the continue to collect information
past 2 days. She seems nervous as she speaks to you. An regarding the chief complaint in an
appropriate response is to: unhurried manner.

When interviewing older adults, the examiner should: position himself facing the patient

The iatrotropic stimulus refers to the: the patients stimulus to seek care

A pt complains of a headache. During the history, he mentions his

use of alcohol and illicit drugs. This information would most likely personal and social history.
belong in the:

A pt. reports an increase in her alcohol intake over the past 5

CAGE questionnaire
years. To screen her for problem drinking, you would use the:

A tool used to screen adolescents for alcoholism is the: CRAFFT

Mr. Mills is a 55-year-old patient who presents to the office for an
initial visit for health promotion. A survey of mobility and functional assessment
activities of daily living (ADLs) is part of a(an):

If the patient is well known or if you have been seeing the patient
focused history
for the same problem over time, a __________ is appropriate

A fixed image of any group that rejects its potential for originality
sterotype
or individuality is known as a(n):

Which group is traditionally considered to be past oriented? eastern asians

Which group is characterized as emphasizing accomplishments

dominant americans
that are measured by external standards?

Mr. Jones is a 45-year-old patient who presents to the office. A

enculturation
person’s definition of illness is likely to be most influenced by:

As the health care provider, you are informing a patient that he

or she has a terminal illness. This discussion is most likely to be Navajo Native Americans
discouraged in which cultural group?

Tuberculosis is an example of a "___" condition cold

The duties of care providers established by tradition, and within

deontological imperatives
the context of culture, are known as:

The iatrotropic stimulus refers to the: patient’s stimulus to seek care.

________ is used to screen adolescents for important issues in

PACES
their life

the process by which an individual assumes the traits and

enculturation
behaviors of a given culture

Penicillin is an example of a ____ medicine. “hot”

The ____________ position places the left ventricle closer to the

chest wall and is recommended for auscultating low-pitched left lateral recumbent
sounds, such as the third and fourth heart sounds.

Which part of the examiner's hand is best for palpating vibration Ulnar surface
Which part of the examiners hand is best for assessing
dorsal surgace
temperature?

which part would the examiner use to feel vibratory sensations Ulnar surface of the hand and
such as thrills and fremitus? bases of the fingers

which part of the hand is best for palpating pulses? finger pads and fingertips

the _____ surface is best for assessing crepitus palmer surface

the _____ surface is best for assessing texture palmer

the _____ surfaces of the hand and fingers are best for assessing
ulnar surface
vibrations

. Less dense tissue (such as that over normal lungs) produces a

loud
____ tone

More dense tissue such as a muscle produces a ____ tone softer

The more dense the medium, the _____ is the percussion tone softer

The more hollow the area, the _____ is the percussion tone louder

Percussion tones over muscle are ___ and ___ soft and flat

an expected normal percussion tone includes ______ over an

tympany
empty stomach

A normal lung produces _________ percussion tones resonance

_______ indicates atelectasis of the lung dullness

______ occurs over muscle flatness

Place the palmar surface of the nondominant hand on the body

surface with the fingers slightly spread apart when using mediate, indirect
________ or ________ percussion

During percussion, the downward snap of the striking fingers

wrist
should originate from the:
Fist percussion is a ______ percussion technique used to elicit
direct
tenderness over organs such as the liver, gallbladder, or kidneys.

When sounds are not clear, and you are having difficulty
isolate each cycle segment
distinguishing between respirations and heartbeats you can:

Underestimation of blood pressure will occur if the cuff’s width more than two thirds of the upper
covers: arm

cover 75% to 80% of the arm

A blood pressure cuff bladder should be long enough to:
circumference

Rotating the lens selector compensates for______ or ______ in

myopia or hyperopia
both the examiner and the patient

The _________ permits recognition of hemorrhages. red-free filter

the _____ estimates the size of lesions grid

The _______ examines the anterior eye and assesses the

slit lamp
elevation of lesions

the _______ is used with small pupils. small aperture

Tuning forks with a frequency of 500 to 1000 Hz are most

hearing range of normal speech
commonly used to measure:

briskly tap the tendon with the

To perform a deep tendon reflex measurement, you should:
rubber end of the hammer.

A variant of a percussion hammer is a ____ hammer neurologic

a neurologic hammer is equipped with a _____ and ______ brush and needle

mark the borders of the tape at

The most effective procedure to ensure correct serial
several intervals on the skin with a
measurements is to:
pen.

___________ functions to differentiate between various media in

Transillumination
a cavity. It can distinguish between air, fluid, and tissue.
if the patient is experiencing symptoms of autonomic
remove the source of the
hyperreflexia, then the first reaction should be for the examiner
stimulation.
to:

Reactions to a cold, hard examination table or cold stirrups;

insertion of a speculum; and pressure during pelvic examinations autonomic hyperreflexia
can cause ___________.

The stethoscope’s diaphragm is most useful in the assessment of

high-pitched
__________ sounds.

When recording assessments during the construction of the create an assessment for each
problem-oriented medical record, the examiner should: problem on the problem list

A differential diagnosis is part of the __________ phase. assessment

A second visit with the clinician is always recorded on a

progress note
________, noting any updates to the condition.

The effect of the chief complaint on the patient’s lifestyle is

History of present illness
recorded in which section of the medical record?

The patient’s perceived disabilities and functional limitations are

past medical history.
recorded in the:

The review of systems is a component of the: health history

to drugs and foods are generally listed in which section of the

past medical history
medical record?

A SOAP note is used in which type of recording system? problem oriented

Mental status assessment, including cognitive and emotional

physical examination
stability and speech and language, is part of the __________.

Follow-up visits for problems identified in the ____ are recorded

POMR
in the progress notes.