Transcript V2ch01 - SchultzMedic

Paramedic Care:
Principles & Practice
Volume 2
Patient Assessment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 1
The History
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Establishing Patient Rapport
The Comprehensive Patient History
Special Challenges
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Interview
In the majority of medical interviews, field
diagnosis is based on history.
It is conducted simultaneously with the
physical exam.
It is a structured, flexible, tool with several
components.
Patient condition dictates length and
completeness.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient
Rapport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Situation, the patient, and conditions will
determine ability to establish rapport.
Respond to the patient with empathy to gain
trust.
Patient’s response to questions will guide
the exam.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Setting the Stage
– In a healthcare facility, if a patient’s chart is
available, review it before interviewing the
patient.
– Gather information from the first responder
personnel.
– Reconfirm information.
Maintain an open mind!
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
If the patient cannot provide useful
information, gather it from family or
bystanders.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
The First Impression
– Your appearance should suggest neatness,
cleanliness, pride, and professionalism.
– Present yourself as a caring, competent, and
confident health care professional.
– Your voice, body language, gestures, and
especially eye contact should communicate that
you care about your patient’s problems.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Introductions
– Make eye contact with your patient and maintain
it as you conduct the interview.
– Use your patient’s name frequently during the
interview.
Avoid slang terms such as “honey,” “chief,” “pops,” or
“sweetie.”
– Be aware of other forms of nonverbal
communication.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Asking Questions
– Ask questions in a way that elicits accurate
information from your patient.
– Use a combination of open-ended and closedended questions.
Open-ended questions allow patient to explain how
he/she feels.
Closed-ended questions elicit short answers.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Language and Communication
– Effective communication means connecting with
your patient.
– Barriers to communication include:
Cultural differences
Language differences
Deafness
Speech impediments
Blindness
– When encountering communication barriers, try
to enlist someone to help.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Active listening techniques:
Facilitation
Reflection
Clarification
Empathy
Confrontation
Interpretation
Asking about
feelings
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Sensitive Topics
– A paramedic must learn to become comfortable
dealing with sensitive topics.
– Sensitive topics may include sexual activities,
death and dying, physical deformities, bodily
functions, and domestic violence.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Sensitive Topics
– Familiarize yourself with and practice some
opening questions on sensitive topics.
– It is critical that you remain calm, objective, and
nonjudgmental.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Comprehensive
Patient History
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Preliminary Data
Always record the date and time of the
physical exam.
Determine your patient’s age, sex, race,
birthplace, and occupation.
– These questions provide a starting point for the
interview.
After you have gathered the information, you
should establish its reliability.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Chief Complaint
Begin with an open-ended question about
your patient’s chief complaint.
The chief complaint is the pain, discomfort,
or dysfunction that caused the patient to
request help.
When possible, report and record the chief
complaint in the patient’s own words.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Present Illness
OPQRST-ASPN
Onset of the
problem
Provocative/
Palliative factors
Quality
Region/Radiation
Severity
Time
Associated
Symptoms
Pertinent Negatives
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Past History
Ask questions about the patient’s general
state of health, childhood and adult
diseases, psychiatric illnesses, accidents or
injuries, surgeries, and hospitalizations.
The patient’s condition, the situation, and
time constraints will determine how much
information you can and should gather on
the scene.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Current Health Status
Current medications
Allergies
Tobacco
Alcohol, drugs, and related substances
Diet
Screening tests
Immunizations
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Current Health Status
Sleep patterns
Exercise and leisure activities
Environmental hazards
Use of safety measures
Family history
Home situation and significant others
Daily life
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Current Health Status
Important exercises
Religious beliefs
The patient’s outlook
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
You should take your patient’s
medications with you to the
hospital, when practical.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Review of Systems
A system-by-system series of questions
designed to identify problems your patient
has not already identified:
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Skin
Head
Eyes
Ears
Nose
Mouth/Throat
Respiratory
Cardiovascular
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Gastrointestinal
Genitourinary
Musculoskeletal
Neurologic
Psychologic
Endocrine
Hematologic
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Challenges
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Challenges
Silence
Overly talkative
patients
Multiple symptoms
Anxiety
Depression
Sexually attractive
or seductive
patients
Confusing
behaviors or
symptoms
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Challenges
Patients needing
reassurance
Anger and hostility
Intoxication
Crying
Limited intelligence
Language barriers
Hearing problems
Blindness
Talking with families
or friends
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Establishing Patient Rapport
The Comprehensive Patient History
Special Challenges
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ