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Clinical Interviewing and Patient Assessment: A Comprehensive Guide, Exams of Nursing

Staffordshire University Nursing

A detailed guide on conducting clinical interviews and assessing patients. It covers topics such as setting goals, exploring the patient's perspective, identifying and responding to emotional cues, and understanding common symptoms and their diagnoses. It also offers advice on motivational interviewing, understanding the patient's life history, and physical examinations. The guide is essential for medical students, healthcare professionals, and lifelong learners seeking to improve their interviewing and assessment skills.

Typology: Exams

2023/2024

Available from 04/15/2024

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NR509 rMid-Term rStudy rGuide

•

Articular rstructures rinclude rjoint rcapsule rand rarticular rcartilage, rthe rsynovium rand

rsynovial rfluid, rintra-articular rligaments rand rjuxta-articular rbone

o Articular rdisease rinvolves:

▪

Swelling

▪

Tenderness rof rthe rjoint

▪

Crepitus

▪

Instability r“locking”

▪

Deformity

▪

Limits ractive rand rpassive rrange rof rmotion rdue rto rstiffness ror rpain

•

Extra-articular rstructures rinclude rperiarticular rligaments, rtendons, rbursae, rmuscle,

rfascia, rbone, rnerve rand roverlying rskin

o Extra-articular rdisease rinvolves:

▪

“point rof rfocal rtenderness rin rregions radjacent rto rarticular rstructures

▪

Limits ractive rrange rof rmotion

▪

RARELY rcauses rswelling, rinstability, rjoint rdeformity

Know rthe rsources rof rjoint rpain r(pg. r627 ralgorithm)

•

Nonarticular rconditions: rtrauma/fracture, rfibromyalgia, rpolymyalgia rrheumatica,

rbursitis, rtendinitis

•

Intra-articular r(acute, r< r6 rweeks): racute rarthritis

o infectious rarthritis

o gout

o pseudogout

o Reiter rsyndrome

•

Intra-articular r(chronic, r> r6 rweeks): rchronic rinflammatory rarthritis rvs rchronic

rnoninflammatory rarthritis

o Chronic rinflammatory rarthritis rwith r1-3 rjoints rinvolved:

▪

Indolent rinfection

▪

Psoriatic rarthritis

▪

Reiter rsyndrome

▪

Periarticular rJA

o Chronic rinflammatory rarthritis rwith r>3 rjoints rinvolved:

▪

Psoriatic rarthritis ror rReiter rsyndrome r(no rsymmetry)

▪

rheumatoid rarthritis rif rnot rRA rthen r rsystemic rlupus, rscleroderma,

rpolymyositis

*Know rwhat rcauses rsaddle rnumbness rand rurinary rretention r(pg. r678?)

•

CES r(cauda requina rsyndrome) rmost rcommonly rresults rfrom ra rmassive rherniated rdisc rin rthe

rlumbar rregion.

•

A rsingle rexcessive rstrain ror rinjury rmay rcause ra rherniated rdisc.

•

However, rdisc rmaterial rdegenerates rnaturally ras ra rperson rages, rand rthe rligaments rthat rhold rit

rin rplace rbegin rto rweaken. rAs rthis rdegeneration rprogresses, ra rrelatively rminor rstrain ror

twisting rmovement rcan rcause ra rdisc rto rrupture.

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NR509 rMid-Term rStudy rGuide

Articular rstructures rinclude rjoint rcapsule rand rarticular rcartilage, rthe rsynovium rand rsynovial rfluid, rintra-articular rligaments rand rjuxta-articular rbone o Articular rdisease r involves: ▪ Swelling ▪ Tenderness rof rthe rjoint ▪ Crepitus ▪ Instability r“locking” ▪ Deformity ▪ Limits ractive rand rpassive rrange rof rmotion rdue rto rstiffness ror rpain
Extra-articular rstructures r include rperiarticular rligaments, rtendons, rbursae, rmuscle, rfascia, rbone, rnerve rand roverlying rskin o Extra-articular rdisease rinvolves: ▪ “point rof rfocal rtenderness rin rregions radjacent rto rarticular rstructures ▪ Limits ractive rrange rof rmotion ▪ RARELY rcauses rswelling, rinstability, rjoint rdeformity Know rthe rsources rof rjoint rpain r(pg. r 627 ralgorithm)
Nonarticular rconditions : rtrauma/fracture, rfibromyalgia, rpolymyalgia rrheumatica, rbursitis, rtendinitis
Intra-articular r(acute, r< r 6 rweeks) : racute rarthritis o infectious rarthritis o gout o pseudogout o Reiter rsyndrome
Intra-articular r(chronic, r> r 6 rweeks) : rchronic rinflammatory rarthritis rvs rchronic rnoninflammatory rarthritis o Chronic rinflammatory rarthritis rwith r 1 - 3 rjoints rinvolved: ▪ Indolent rinfection ▪ Psoriatic rarthritis ▪ Reiter rsyndrome ▪ Periarticular rJA o Chronic rinflammatory rarthritis rwith r>3 rjoints rinvolved: ▪ Psoriatic rarthritis ror rReiter rsyndrome r(no rsymmetry) ▪ rheumatoid rarthritis rif rnot rRArthen r rsystemic rlupus, rscleroderma, rpolymyositis *Know rwhat rcauses rsaddle rnumbness rand rurinary rretention r(pg. r678?)
CES r(cauda requina rsyndrome) rmost rcommonly rresults rfrom ra rmassive rherniated rdisc rin rthe rlumbar rregion.
A rsingle rexcessive rstrain ror rinjury rmay rcause ra rherniated rdisc.
However, rdisc rmaterial rdegenerates rnaturally ras ra rperson rages, rand rthe rligaments rthat rhold rit rin rplace rbegin rto rweaken. rAs rthis rdegeneration rprogresses, ra rrelatively rminor rstrain ror twisting rmovement rcan rcause ra rdisc rto rrupture.

The rfollowing rare rother rpotential rcauses rof rCES:

Spinal rlesions rand rtumors
Spinal rinfections ror rinflammation
Lumbar rspinal rstenosis
Violent rinjuries rto rthe rlower rback r(gunshots, rfalls, rauto raccidents)
Birth rabnormalities
Spinal rarteriovenous rmalformations r(AVMs)
Spinal rhemorrhages r(subarachnoid, rsubdural, repidural)
Postoperative rlumbar rspine rsurgery rcomplications
Spinal ranesthesia Know rhow rretinal rdetachment rpresents r(p.217)
Sudden, rpainless rvision rloss rthat ris runilateral Know rwhat rthe rword robtunded rmeans r(p. r769)
The robtunded rpatient ropens reyes rand rlooks rat ryou rbut rresponds rslowly rand ris rsomewhat rconfused. rAlertness rand rinterest rin rthe renvironment rare rdecreased. Know rwhat rcranial rnerve ryou’re rassessing rwhen rchecking rlateral rgaze r(p. r237)
Cranial rnerve rVI: rabducens Know rwhat rshould rbe rlisted runder radult rillnesses rin rhealth rhistory r(pg. r10)
Medical rillnesses : rsuch ras rdiabetes, rhypertension, rhepatitis, rasthma, rand rHIV. rAlso rhospitalizations, rnumber rand rgender rof rsexual rpartners, rand rrisk-taking rsexual rpractices
Surgical : rdates, rindications, rand rtypes rof roperations
Obstetric/Gynecologic : robstetric rhistory, rmenstrual rhistory, rmethods rof rcontraception, rand rsexual rfunction
Psychiatric : rillness rand rtimeframe, rdiagnoses, rhospitalizations, rand rtreatments Know rwhat rconditions rdo rnot rhave rred rreflexes r(p. r239)
Absence rof rred rreflex rsuggests ran ropacity rof rthe rlens r(cataract), ror rpossibly rthe rvitreous r(or reven ran rartificial reye).
Less rcommonly, ra rdetached rretina, ror rin rchildren ra rretinoblastoma rmay robscure rthis rreflex. Know rthe rsigns rof rseasonal rallergies r(p. r27)
itching, rwatery reyes, rsneezing, rear rcongestion, rpostnasal rdrainage Know rhow roptic rneuritis rpresents r(p. r217)
Sudden rvisual rloss rthat ris runilateral rand rcan rbe rpainful, rassociated rwith rmultiple rsclerosis Know rhow rpityriasis rrosacea rpresents r(p. r912)
Oval rlesions ron rtrunk, rin rolder rchildren roften rin ra rChristmas rtree rpattern, rsometimes ra rHarold rpatch r(a rlarge rpatch rthat rappears rfirst)

Note rthe rdirection rof rthe rgaze rin rwhich rit rappears, rthe rplane rof rthe rnystagmus r(horizontal, rvertical, rrotary, ror rmixed), rand rthe rdirection rof rthe rquick rand rslow rcomponents.
Nystagmus ris rnamed rfor rthe rdirection rof rthe rquick rcomponent.
Ask rthe rpatient rto rfix rhis ror rher rvision ron ra rdistant robject rand robserve rif rthe rnystagmus rincreases ror rdecreases. Know rwhat ryellow rsclera rindicates r(p. r234)
A ryellow rsclera rindicates rjaundice Pg. r 72 r- rKnow rhow rto rget ra rpatient rto ropen rup rwhen rhe rseems rupset
The rfirst rstep rto reffective rreassurance ris rsimply ridentifying rand racknowledging rthe rpatient’srfeelings. r For rexample, ryou rmight rsimply rsay, r“You rseem rupset rtoday.” rThis rpromotes ra rfeeling rof rconnection. r Meaningful rreassurance r comes rlater, rafter ryou rhave rcompleted rthe rinterview, rthe rphysical rexamination, rand rperhaps rsome rlaboratory rtests. rAt rthat rpoint, ryou rcan rexplain rwhat ryou rthink ris rhappening rand rdeal ropenly rwith rany rconcerns. rReassurance risrmore rappropriate rwhen rthe rpatient rfeels rthat rproblems rhave rbeen rfully runderstood rand rare rbeing raddressed.
Another rway rto raffirm rthe rpatient ris rto rvalidate rthe rlegitimacy rof rhis ror rher remotional rexperience. rSaying rsomething rlike, r“Your raccident rmust rhave rbeen rvery rscary. rCar raccidents rare ralways runsettling rbecause rthey rremind rus rhow rvulnerable rwe rare. rPerhapsrthat rexplains rwhy ryou rstill rfeel rupset,” rvalidates rthe rpatient’s rresponse ras rlegitimate randrunderstandable
Moving rcloser ror rmaking rphysical rcontact rlike rplacing ryour rhand ron rthe rpatient’s rshoulder rconveys rempathy rand rcan rhelp rthe rpatient rgain rcontrol rof rupsetting rfeelings. rThe rfirst rstep rto rusing rthis rimportant rtechnique ris rto rnotice rnonverbal rbehaviors rand rbring rthem rto rconscious rlevel. Pg. r 27 r- rKnow rthe rsigns rof rdegenerative rpain Page r 696 Pg. r 289 r- rKnow rhow rotosclerosis rpresents rwith rWeber rand rRinne rtest rOtosclerosis rcondition rthat raffects rthe rtiny rmiddle rear rbone rknown ras rthe rstapes.
Stapes rcan rbecome rstuck, rlimiting rits rability rto rvibrate r(vibrations rare rcrucial rfor rhearing)
Conductive rhearing rloss
Weber rtest o Tuning rfork rat rvertex o Sound ris rheard rin rthe rimpaired rear o Room rnoise rnot rwell rheard, rso rdetection rof rvibrations rimproves
Rinne rtest o Tuning rfork rat rexternal rauditory rmeatus; rthen ron rmastoid rbone o BC rlonger rthan ror requal rto rAC r(BC r> rAC ror rBC r= rAC) o While rair rconduction rthrough rthe rexternal ror rmiddle rear ris rimpaired, rvibrations rthrough rbone rbypass rthe rproblem rto rreach rthe rcochlea o The rsound ris rheard rlonger rthrough rbone rthan rair

Cherry angioma is a mole-like skin growth made up of small blood vessels or capillaries.
Most common type of angioma
Benign tumors that result from an overgrowth of capillaries
Rare for children to develop these noncancerous lesions Pg. r 183 r– Know rthat rcherry rangiomas rare rbenign Pg. r 231 r- rKnow rhow rto rinterpret rvisual racuity rresults
Visual racuity ris rexpressed ras rtwo rnumbers r(e.g., r20/30): o First rindicates rthe rdistance rof rthe rpatient rfrom rthe rchart r(20 rfeet), o Second, rthe rdistance rat rwhich ra rnormal reye rcan rread rthe rline rof rletters ▪ Vision rof r20/200 rmeans rthat rat r 20 rfeet rthe rpatient rcan rread rprint rthat ra rperson rwith rnormal rvision rcould rread rat r 200 rfeet.
The rlarger rthe rsecond rnumber, rthe rworse rthe rvision.
“20/40 rcorrected” rmeans rthe rpatient rcould rread rthe r20/40 rline rwith rglasses r(a rcorrection).
A rpatient rwho rcannot rread rthe rlargest rletter rshould rbe rpositioned rcloser rto rthe rchart; rnote rthe rintervening rdistance. Pg. r 73 r- rKnow rthe rorder rof rmeeting ra rpatient rand rconducting ran rinterviewrPreparation
Reviewing rthe rClinical rRecord o Provides rimportant rbackground rinformation rand rsuggests rareas ryou rneed rto rexplore
Setting rgoals o Before ryou rtalk rwith rthe rpatient, rclarify ryour rgoals rfor rthe rinterview o The rclinician rmust rbalance rthese rprovider-centered rgoals rwith rpatient-centered rgoals, r weighing rmultiple ragendas rarising rfrom rthe rneeds rof rthe rpatient, rthe rpatient’s rfamily, rand rhealth rcare ragencies rand rfacilities.
Reviewing ryour rclinical rbehavior rand rappearance o Posture, rgestures, reye rcontact, rand rtone rof rvoice rall rconvey rthe rextent rof ryour rinterest, rattention, racceptance, rand runderstanding. o Adjusting rthe renvironment o Private rand rcomfortable Sequence rof rInterview
Greeting rthe rpatient rand restablishing rrapport

Direct rstatement(s) rby rthe rpatient rof rexplanations, remotions, rexpectations, rand reffects rof rthe rillness
Expression rof rfeelings rabout rthe rillness rwithout rnaming rthe rillness
Attempts rto rexplain ror runderstand rsymptoms
Speech rclues r(e.g., rrepetition, rprolonged rreflective rpauses)
Sharing ra rpersonal rstory
Behavioral rclues rindicative rof runidentified rconcerns, rdissatisfaction, ror runmet rneeds rsuch ras rreluctance rto raccept rrecommendations, rseeking ra rsecond ropinion, ror rearly rreturn rappointment o Learn rto rrespond rattentively rto remotional rcues rusing rtechniques rlike rreflection, rfeedback, rand r“continuers” rthat rconvey rsupport.
A rmnemonic rfor rresponding rto remotional rcues ris r NURSE :
N ame—“That rsounds rlike ra rscary rexperience”
U nder- rstand ror rlegitimize—“It’s runderstandable rthat ryou rfeel rthat rway”
R espect— r“You’ve rdone rbetter rthan rmost rpeople rwould rwith rthis”
S upport—“I rwill rcontinue rto rwork rwith ryou ron rthis”
E xplore—“How relse rwere ryou rfeeling rabout rit?
Expanding rand rclarifying rthe rpatient’s rstory
You rmust rdiligently rclarify rthe rattributes rof reach rsymptom, rincluding rcontext, rassociations, rand rchronology.
For rpain rand rmany rother rsymptoms, runderstanding rthese ressential rcharacteristics, rsummarized ras rthe r seven rattributes rof ra rsymptom, r is rcritical.
OLD rCARTS, r or r O nset, r L ocation, r D uration, r C haracter, r A ggravating/ r A lleviating rFactors, r R adiation, rand r T iming, r or
OPQRST, r or r O nset, r P alliating/ P rovoking rFactors, r Q uality, r R adiation, r S ite, rand r T iming
Whenever rpossible, rrepeat rback rthe rpatient’s rwords rand rexpressions
Generating rand rtesting rdiagnostic rhypotheses
You rwill rgenerate rand rtest rdiagnostic rhypotheses rabout rwhich rdisease rprocess rmight rbe rpresent.
Identifying rall rthe rfeatures rof reach rsymptom ris rfundamental rto rrecognizing rpatterns rof rdisease rand rto rgenerating rthe r differential rdiagnosis.
It is rimportant rto rfully flesh rout rthe rpatient’s rstory. rThis ravoids rthe rcommon rtrap rof r premature rclosure, r or rshutting rdown rthe rpatient’s rstory rtoo rquickly
Each rsymptom rhas its rown r“cone”

Sharing rthe rtreatment rplan
- Shared rdecision-making rhas rbeen rcalled rthe rpinnacle rof rpatient-centered rcare
- Experts rrecommend ra rthree-step rprocess: rintroducing rchoices rand rdescribing roptions rusing rpatient rdecision rsupport rtools rwhen ravailable; rexploring rpatient rpreferences; rand rmoving rto ra rdecision, rchecking rthat rtherpatient ris rready rto rmake ra rdecision rand roffering rmore rtime, rif rneeded.
- Motivational rinterviewing rhelps rpatients r“to rsay rwhy rand rhow rthey rmight rchange, rand ris rbased ron rthe ruse rof ra rguiding rstyle” rof rinter- rviewing, rrather rthan rdirect radvice.
“Ask” ropen-ended rquestions—invite rthe rpatient rto rconsider rhow rand rwhy rthey rmight rchange.
“Listen” rto runderstand ryour rpatient’s rexperience—“capture” rtheir raccount rwith rbrief rsummaries ror rreflective rlistening rstatements rsuch rasr“quitting rsmoking rfeels rbeyond ryou rat rthe rmoment”; rthese rexpress rempathy, rencourage rthe rpatient rto relaborate, rand rare roften rthe rbest rway rto rrespond rto rresistance.
“Inform”—by rasking rpermission rto rprovide rinformation, rand rthen rasking rwhat rthe rimplications rmight rbe rfor rthe rpatient.
Closing rthe rinterview rand rthe rvisit
- Let rthe rpatient rknow rthat rthe rend rof rthe rinterview ror rthe rvisit ris rapproaching rto rallow rtime rfor rany rfinal rquestions.
- Make rsure rthe rpatient runderstands rthe rmutual rplans ryou rhave rdeveloped.
- As ryou rclose, rsummarizing rplans rfor rfuture revaluation, rtreatments, rand rfollow-up ris rhelpful.
- A ruseful rtechnique rto rassess rthe rpatient’s runderstanding ris rto r“teach rback,” rwhereby ryou rinvite rthe rpatient rto rtell ryou, rin rhis ror rher rown rwords, rthe rplanrof rcare. rAn rexample rwould rbe: r“Could ryou rplease rtell rme rwhat ryou runderstand ris rour rplan rof rcare?
- The rpatient rshould rhave ra rchance rto rask rany rfinal rquestions, rbut rthe rlast rfew rminutes rare rnot ra rgood rtime rto rbring rup rnew rtopics. rIf rthis rhappens rand rthe rconcern ris rnot rlife rthreatening, rsimply rassure rthe rpatient rof ryour rinterest randrmake rplans rto raddress rthe rproblem rat ra rfuture rtime
Taking rthe rtime rfor rself-reflection
- “purposefully rand rnonjudgmentally rattentive rto r[one’s] rown rexperience, rthoughts, rand rfeelings.
- Because rwe rbring rour rown rvalues, rassumptions, rand rbiases rto revery rencounter, rwe rmust rlook rinward rto rsee rhow rour rown rexpectations rand rreactions raffect rwhat rwe rhear rand rhow rwe rbehave

Includes rhealth rmaintenance rpractices rsuch ras rimmunizations, rscreening rtests, rlifestyle rissues, rand rhome rsafety
Family rhistory
Outlines ror rdiagrams rage rand rhealth, ror rage rand rcause rof rdeath, rof rsiblings, rparents, rgrandparents, rchildren, rand rgrandchildren
Documents rpresent ror rabsence rof rspecific rillnesses rin rfamily, r Review reach rof rthe rfollowing rconditions rand rrecord rwhether rthey rare rpresent ror rabsent rin rthe rfamily: r hypertension, rcoronary rartery rdisease, relevated rcholesterol rlevels, rstroke, rdiabetes, rthyroid ror rrenal rdisease, rarthritis, rtuberculosis, rasthma ror rlung rdisease, rheadache, rseizure rdisorder, rmental rillness, rsuicide, rsubstance rabuse, rallergies, ror rtype rof rcancer
Personal rand rsocial rhistory
Describes reducational rlevel, rfamily rof rorigin, rcurrent rhousehold, rpersonal rinterests, rand rlifestyle
Review rof rsystems
Documents rpresence ror rabsence rof rcommon rsymptoms rrelated rto reach rof rthe rmajor rbody rsystems

Pg. r649, r655, r 700 r- rKnow rhow ra rrotatorrcuff rtear rpresents

Patients rcomplain rof rchronic rshoulder rpain, rnight rpain, ror rcatching rand rgrating rwhen rraising rthe rarm roverhead
Weakness ror rtears rof rthe rtendons rusually rstart rin rthe rsupraspinatus rtendon rand rprogress rposterior rand ranterior
Look rfor ratrophy rof rthe rdeltoid, rsupraspinatus, ror rinfraspinatus rmuscles.

Pg. r 37 r- rKnow rhow rto rprioritize rpatient rcomplaints

List rthe rmost ractive rand rserious rproblems rfirst rand rtheir rdate rof ronset
Problems rcan rbe rsymptoms, rsigns, rpast rhealth revents rsuch ras ra rhospital radmission ror rsurgery, ror rdiagnoses. Pg. r 629 r- rKnow rwhat rjoints rare rcondylar - Articulating rsurfaces rthat rare rconvex ror rconcave - These rjoins rallow rflexion, rextension, rrotation rand rmotion rin rthe rcoronal rplane - Movement rof rtwo rarticulating rsurfaces rnot rdissociable o Knee o Temporo-mandibular rjoint Pg. r 703 r- rKnow rhow rRA rpresentsrAcute
Tender, rpainful, rstiff rjoints rin r RA, r usually rwith r symmetric r involvement ron rboth rsides rof rthe rbody.
The rdistal rinterphalangeal r(DIP), rmetacarpophalangeal r(MCP)
wrist rjoints rare rthe rmost rfrequently raffected
Note rthe rfusiform ror rspindle-shaped rswelling rof rthe rPIP rjoints rin racute rdisease Chronic
In rchronic rdisease, rnote rthe rswelling rand rthickening rof rthe rMCP rand rPIP rjoints.
Range rof rmotion rbecomes rlimited, rand rfingers rmay rdeviate rtoward rthe rulnar rside.
The rinterosseous rmuscles ratrophy.
The rfingers rmay rshow r “swan rneck” rdeformities r (hyperextension rof rthe rPIP rjoints rwith rfixed rflexion rof rthe rdistal rinterphalangeal r[DIP] rjoints).
Less rcommon ris ra r boutonnière rdeformity r (persistent rflexion rof rthe rPIP rjoint rwith rhyperextension rof rthe rDIP rjoint).

Rheumatoid rnodules rare rseen rin rthe racute ror rthe rchronic rstage.

Subcutaneous rnodules rmay rdevelop rat rpressure rpoints ralong rthe rextensor rsurface rof rthe rulna rin rpatient rwith rRA ror racute rrheumatic rfever.
Firm rand rnontender
Not rattached rto roverlying rskin rbut rmay rbe rattached rto rthe runderlying rperiosteum Pg. r 9 r- rBe rable rto rfigure rout rwhat ris rmissing rin ran rHPI r(scenario, rOLDCART rmethod)
Onset
Location
Duration
Characteristics
Aggravating rfactors
Relieving rfactors
Treatment Pg. r 6 r- rKnow rwhat rsubjective rinformation ris
What rthe rpatient rtells ryou
The r symptoms r and rhistory, rfrom rchief rcomplaint rthrough rreview rof rsystems Ex: rMrs. rG ris ra r 54 ryear rold rhairdresser rwho rreports rpressure rover rher rleft rchest r“like ran relephant rsitting rthere,” rwhich rgoes rinto rher rleft Know rrisk rfactors rof rmelanoma r(pg. r177)

Tachypnea: rgreater rthan ror requal rto r 25 rbreaths/min r rpneumonia rand rcardiac rdisease
Cyanosis ror rpallor r(signals rhypoxia)
Audible rsounds rof rbreathing: raudible rwhistling rduring rinspiration rover rthe rneck ror rlungs o stridor r signals rupper rairway robstruction rin rthe rlarynx ror rtrachea
Contraction rof rthe raccessory rmuscles rof rthe rneck ror rsupraclavicular rretraction, rcontraction rof rthe rintercostal ror rabdominal roblique rmuscles o Is rthe rtrachea rmidline? Know rwhat robjective rinformation ris r(pg. r6)
What ryou rdetect rduring rthe rexamination, rlaboratory rinformation, r& rtest rdata. rAll rphysical rexam rfindings, ror rsigns. Know rwhat rcan rcause repistaxis r(p. r220)
Trauma r(especially rnose rpicking), rinflammation, rdrying rand rcrusting rof rthe rnasal rmucosa, rtumors, rand rforeign rbodies Know rthe rsigns rof rotitis rexterna r(swimmer’s rear) r(pg. r245)
Painful rmovement rof rthe rauricle rand rtragus r(tug rtest) Movement rof rthe rauricle rand rtragus r(the r“tug rtest”) ris rpainful rin racute rotitis rexterna r(inflammation rof rthe rear rcanal), rbut rnot rin rotitis rmedia r(inflammation rof rthe rmiddle rear). rTenderness rbehind rthe rear roccurs rin rotitis rmedia. in racute rotitis rexterna r(Fig. r 7 - 43), rthe rcanal ris roften rswollen, rnarrowed, rmoist, rpale, rand rtender. rIt rmay rbe rreddened. Know rthe rsigns rof rpneumonia r(pg. r 322 - 340)
Dullness rreplaces rresonance, rcrackles rcan rarise rfrom rabnormalities rof rthe rlung rparenchyma, rpleural rrubs, rlocalized rbronchophony rand regophony r(in rpatients rwith rfever rand rcough rthe rpresence rof rbronchial rbreath rsounds rand regophony rmore rthan rtriples rthe rlikelihood rof pneumonia.
Pleuritic rpain: rsharp, rknifelike, raggravated rby rdeep rinspiration, rcoughing, rmovements rof rthe rtrunk. rOften rpersistent rand rsevere.
Pg r333: rdyspnea, rpleuritic rpain, rcough, rsputum, rfever. rPg. r 339 rgoes rover rphysical rfindings rin rlobar rpneumonia Dullness rreplaces rresonance rwhen rfluid ror rsolid rtissue rreplaces rair-containing rlung ror roccupies rthe rpleural rspace rbeneath ryour rpercussing rfingers. rExamples rinclude: rlobar rpneumonia, rin rwhich rthe ralveoli rare rfilled rwith rfluid rand rblood rcells; rand rpleural raccumulations rof rserous rfluid r(pleural reffusion), rblood r(hemothorax), rpus r(empyema), rfibrous rtissue, ror rtumor. rDullness rmakes rpneumonic rand rpleural reffusion rthree rto rfour rtimes rmore rlikely, rrespectively. Dullness rreplaces rresonance rwhen rfluid ror rsolid rtissue rreplaces rair-containing rlung ror roccupies rthe rpleural rspace rbeneath ryour rpercussing rfingers. rExamples rinclude: rlobar rpneumonia, rin rwhich rthe ralveoli rare rfilled rwith rfluid rand rblood rcells; rand rpleural raccumulations rof rserous rfluid r(pleural

effusion), rblood r(hemothorax), rpus r(empyema), rfibrous rtissue, ror rtumor. rDullness rmakes rpneumonic rand rpleural reffusion rthree rto rfour rtimes rmore rlikely, rrespectively. Know rthe rphysical rsigns rof rmeningitis r(pg. r765)

Neck rstiffness rwith rresistance rto rflexion ris rpresent rin rapprox. r84% rof rpatients rwith racute rbacterial rmeningitis r(won’t rbe rable rto rtouch rchin rto rchest) Inflammation rin rthe rsubarachnoid rspace rcauses rresistance rto rmovement rthat rstretches rthe rspinal rnerves r(neck rflexion), rthe rfemoral rnerve r(Brudzinski rsign), rand rthe rsciatic rnerve r(Kernig rsign). Neck rstiffness rwith rresistance rto rflexion ris rfound rin r∼84% rof rpatients rwith racute rbacterial rmeningitis rand r21% rto r86% rof rpatients rwith rsubarachnoid rhemorrhage. rIt ris rmost rreliably rpresent rin rsevere rmeningeal rinflammation rbut rits roverall rdiagnostic raccuracy ris rlow.

Progressively rfrequent ror rsevere rover ra r 3 - month rperiod
Sudden ronset rlike ra r“thunderclap” ror r“the rworst rheadache rof rmy rlife”
New ronset rafter rage r 50
Aggravated ror rrelieved rby rchange rin rposition
Precipitated rbyrValsalva rmaneuver ror rexertion
Associated rsymptoms rof rfever, rnight rsweats, ror rweight rloss
Presence rof rcancer, rHIV rinfection, ror rpregnancy
Recent rhead rtrauma
Change rin rpattern rfrom rpast rheadaches
Lack rof rsimilar rheadache rin rthe rpast
Associated rpapilledema, rneck rstiffness, ror rfocal rneurologic rdeficits The rthree rmost rimportant rattributes rof rheadache rare rits rseverity, rits rchronologic rpattern, rand rits rassociated rsymptoms Know rlabs rto rcheck rwith rvitiligo r(pg. r191)
Thyroid rpanel: rTSH, rfree rT3 rand rfree rT4, rCBC C-section r(pg. r10)
Know rthat rit rshould rbe rlisted runder rsurgeries, rmake rsure ryou rinclude rdate rindication rand rtype rof rsurgery Subjective rinfo r(p. r12)
Goes runder rthe rreview rof rsystems, rincludes ritems rthat rthe rpatient rreports rto ryou Where rto rsit rwhen rinterpreter rin rthe rroom r(p. r90)
Arrange rsitting rso rthat ryou rhave reasy reye rcontact rwith rpt r, rhave rthe rinterpreter rsit rclose ror rbehind ryou r r(keeps ryou rfrom rturning ryour rhead rback rand rforth) Know rwhat ris rincluded rin rconstitutional rsymptoms r(pg. r112)
Concerning rs/s rfatigue, rweakness, rfever, rchills, rnight rsweats, rweight rchange rand rpain. (pg. r192) rknow rhow rpsoriasis rpresents
If ryou rrun rur rfingers rover ra rlesion rand rits rpalpable rabove rthe rskin r– rits rraised, rover rone rcm rits rPLAGUE runder rone rcm rits rPAPULE (pg. r231)know rwhat rvisual racuity rmeans, r20/
Means rthat rat r 20 rfeet rthe rpatient rcan rread ra rprint rthat ra rperson rwith rnormal rvision rcould rread rat r 100 rft, rthe rlarger rthe rsecond rnumber rthe rworse rthe rvision rFirst r# rindicates rthe rdistance rfrom rthe rchart (pg. r241) rsee rthe rpicture rand rknow rwhat rcotton rwhool rpatches rlook rlike,

Its rirregular rpatches rseen rat rdiabetic rand rhypertensive rretinopathy (pg. r270) rKnow rhow ra rsubconjunctival rhemorrhage rpresents
Benign, rno rtreatment rrequired, rresolves rin r 2 rweeks r, rLeakage rof rblood routside rthe rvessel rproducing rhomogenous r red rarea. r, rno rocular rdischarge, rvision rnot raffected, rUsually rresultingrfrom rtrauma, ror rsudden rincrease rin rvenous rpressure (pg. r310) rKnow rto rconsider rAngina rPectoris ras ra rdifferentia rwith rCP.
It rcan rbe ra rcause rfor rpain rin rthe rmyocardium. rArclenched rfist rover rthe rsternum rsuggest rangina rpectoris

Clinical Interviewing and Patient Assessment: A Comprehensive Guide, Exams of Nursing

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