Chapter 4 - The Complete Health History Flashcards
What is the health history sequence
Biographical data (Patient indentifiers)
Source of history (From patient or family member)
Reason for seeking care
Present health or history of present illness
Past health
Family history
Review of systems
Functional assessment including activities of daily living (ADLs)
What is the purpose of health history
Collect subjective data to combine with objective data
CC = ____
Chief Complaint
1-2 words or patient quote
A ____ is a subjective sensation that a person feels from disorder
symptom
A ____ is an objective abnormality that can be detected on physical examination or in laboratory reports
sign
When assessing pain, what question do you want to ask
Onset
Location
Duration
Characteristics
Aggravating factors
Reliefs
Treatment/time
Nurses do ____
medication reconciliation
If a person answered yes to ____ or more CAGE test questions, you should susspect alchol abuse
two
What does the CAGE test stand for
Have you ever thought you should Cut down your drinking?
Have you ever been Annoyed by criticism of your drinking?
Have you ever felt Guilty about your drinking?
Do you drink in the morning (an Eye opener?)
In the Review of Systems, do not include ____ data
objective
The psychosocial interview focuses on assessment of ____
Home Envrionment
Education and employment
Eating
peer-related Activities
Drugs
Sexuality
Suicide and depression
Safery from injury anf violence
The older adult: Past health history includes:
1) ______
2) ______
3) ______
4) ______
The Older Adult: Functional Assessment includes _____
ADLs or Active Daily Living
Self-concept, self-esteem
Occupation
Activity and exercise
Sleep and rest
Nutrition and elimination
Interpersonal relationships and resources
Coping and stress management
Environment and home safety hazards
