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Flashcards in ROS Deck (28)
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1
Q

identifier

A

includes name, age, gender, ethnicity if pertinent, source of referral, who’s giving the history, interpreter used, reliability, competence

2
Q

HPI

A
  • 7 attributes for each separate symptom
  • begin with age and gender
  • associated symptoms from ROS
3
Q

7 attributes

A
OLD CARTS
Onset
Location
Duration
Character
Aggravating/Alleviating factors
Radiation
Timing
Severity
4
Q

Social history

A

● Relationships, living situation, support systems
● Occupation
● Diet, exercise, habits
● Hobbies, interests, stress management
● Religious/spiritual, cultural, CAM
● Domestic violence, child and elder abuse (later)

Subheadings (indent):
● Diet
● Exercise
● Habits:
    ○ Tobacco
    ○ Alcohol
    ○ Drug Use
● Patient Concerns
● Sexual History (paragraph form)
    ○ Partner gender, number (in past year), past new partners
    ○ Sexual satisfaction, libido, impotence, any concerns regarding sex
    ○ Safe Sex practices
    ○ Goes in HPI also if relevant to present illness or will be addressed today
5
Q

What is a physician assistant

A

● American Academy of Physician Assistants
○ Physician assistants are healthcare professionals who are authorized by the state to practice medicine as part of a team with physicians.
○ PAs perform physical examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling and make rounds in hospitals and nursing homes. All 50 states and the District of Columbia allow PAs to practice and prescribe medications

● U.S. Department of Labor Bureau of Labor Statistics
○ Physician assistants, also known as PAs, practice medicine under the direction of physicians and surgeons. They
are formally trained to examine patients, diagnose injuries and illnesses, and provide treatment.

6
Q

HEADDSS

A

H: home/family life and relationships/privacy/safety/foster care
E: education/grade/progress, adjustment/conflicts/fighting, bullying/employment/life goals and plans/etc.
A: activities/fun/friends/gang activity/sports/hobbies/weapons
D: diet/body image/exercise
D: drugs-substance use/tobacco/alcohol/steroids/caffeine
S: sexual activity (debut, # partners, orientation, etc.)/sexual assault
S: suicidal (and homicidal) ideation and depression
*Social hx should also include patient and parental concerns.

7
Q

CAGE

A

● Have you ever felt the need to C ut down on drinking?
● Have you ever felt A nnoyed by criticism about drinking?
● Have you ever felt G uilty about drinking?
● Have you ever had to take a drink first thing in the morning ( E ye-opener) to steady your nerves or get rid of a
hangover?

8
Q

SPLATT

A
● S ymptoms - before and after fall
● P revious falls
● L ocation of fall
● A ctivity at time of fall
● T ime of fall
● T rauma - physical and psychological
9
Q

SAFE

A

● Safety/ Stress
● Afraid/ Abused
● Friends/ Family
● Emergency Plan

10
Q

ROS Pediatric

A

● Sx’s basically the same if >10yo
● Sx’s age dependent/appropriate
● Infants/toddlers can’t describe sx’s; only observable
● Omit tests and illnesses in ROS (unless chronic/hospitalized)
● OB/GYN Hx included after menarche
● Breast if >11yo (girls only); SBE older adolescents only
● STE - older adolescents
● Peripheral Vascular - omit category
General: alertness, energy
Skin: neonatal jaundice
Eyes: squinting, crossing
Ears: pulling at, foreign bodies in (6mo+)
Respiratory: rapid or noisy breathing
Cardiovascular: sweating w/ feeding, cyanosis, edema, chest pain GI: stooling
GU: enuresis (diurnal/nocturnal), urine/potty training issues, foreskin issues, diaper rash
Neurologic: febrile seizures, coordination problems
Endocrine: heat/cold intolerance
Psychiatric: mood changes, stressful events, tantrum

11
Q

ROS Geriatric

A

General: weight loss, “not feeling well”, sleep, appetite
Skin: breakdown, sores (extremities)
HEENT: vision changes, hearing loss, eye/dental care, tongue changes
GU: bowel/bladder function, continence
Breast: changes, self exam, mammogram
Genital: sexual concerns/function, vaginal bleeding or dryness, Pap, prostate sx’s
Musculoskeletal: movement, strength
Peripheral Vascular: claudication
Neurologic: sensation/motor disturbance, weakness, tremor Psychiatric: memory, depression, suicide

12
Q

Ethnicity

A

Ethnicity: self-defined identity based on nationality, language, and/or religion
● Refers to country of origin, family heritage or origin, religion
● People define themselves
● Appearance not dominant factor
● Shared values/beliefs common but not universal - watch assumptions

13
Q

Race

A

socially and politically created categories without clear scientific basis

14
Q

Culture

A

collective set of learned beliefs, values and practices that are shared within a group, used to understand the world and how to live in it
● Provides the lens through which all facets of human behavior can be interpreted
● Includes language, thoughts, actions, customs, beliefs, institutions
● Incorporates experiences of the past, influences thought and action in present, and is passed onto future generations
● What determines culture?
○ Primary: gender, ethnicity, sexual orientation, physical characteristics, physical/mental abilities
○ Secondary: religion, level of education, income, location, family status, political, values/perspective, preferences,
experience

15
Q

Acculturation

A

refers to the extent to which an individual or family from another culture is able to:
● Understand rules of the dominant culture
● Successfully navigate/negotiate the rules of the dominant culture
● Does not imply acceptance

16
Q

Assimilation

A

● Adaptation, acceptance, incorporation into dominant culture’s belief system
● Absorption of one culture into another
● May augment or even replace native or ethnic belief system

17
Q

Stereotype

A

● Assumes a person’s characteristics based on conscious or unconscious beliefs about a group(s) to which s/he is presumed to belong
● Based on limited personal experiences or knowledge
● Is ENDING point; no attempt is made to learn if the individual fits the category
● Are held even by people who truly believe that they do not judge others based on social categories
● Are automatically activated
● Guide our expectations and perceptions, creating ‘self-fulfilling prophecies’
● Order of stereotyping: Race > gender > age

18
Q

Generalization

A

● Also a “mental shortcut”
● Based on common trends in beliefs and behaviors of a group(s)
● Can be inaccurate when applied to specific individuals
● Is STARTING point; need further information to learn if the individual fits the category

19
Q

Health Disparities

A

● Defined as racial or ethnic differences in the quality of healthcare
● Differences result in worse clinical outcomes
● The differences persist after adjusting for known factors, including: social determinants, access to care, healthcare

20
Q

Cultural Competence

A

● The attitudes, knowledge, and skills necessary for providing quality care to diverse populations. It is an ongoing process in
which an individual or organization develops along a continuum until diversity is accepted as a norm and the nurse has
acquired greater understanding and capacity in a diverse environment. -AACN, 2009
● The ability to deliver effective patient-centered medical care to all individuals.

21
Q

Culture-bound Syndrome

A

A recurrent, locality-specific pattern of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be “illnesses,” or at least afflictions, and most have local names.

22
Q

Disease

A

Abnormalities of structures and/or function of body organs and systems (including both physical and mental disorders); defined by cultural constructs

23
Q

Illness

A

Patients’ and/or family’s personal definition and experiences of ill health

24
Q

Kleinman’s 8 Questions

A
  1. What do you call this problem?
  2. What do you think caused this illness?
  3. Why did it start when it did?
  4. What do you think the
    sickness does? How does it
    work?
  5. How serious is the illness?
    Will it go on for a long or a
    short time?
  6. What kind of treatment do
    you think you need? What results do you hope for? Can anyone besides me help you get better?
  7. What are the biggest problems this illness has caused for you?
  8. What do you fear most about the illness?
25
Q

LEARN Model

A
● L isten with sympathy and
understanding to the patient’s perceptions.
● E xplain your perceptions.
● A cknowledge and discuss the
differences and
similarities.
● R ecommend
treatment.
● N egotiate
agreement.
26
Q

RESPECT Model

A
● R apport
● E mpathy
● S upport
● P artnership
● E xplanations
● C ultural
Competence
● T rust
27
Q

Strategies for Interview: EEEE

A
● Empathy
○ Listen; acknowledge anger;
frustrations; identify concerns,
beliefs, situations 
● Enlist
○ Frame the problem in a way that makes sense to the patient
○ Recognize pt’s priorities
○ Assign value to addressing the
problem 
● Explain
○ The process, treatment, rationale, consequences
○ Avoid jargon - be concrete, specific 
● Empower
○ Negotiate compromise, decide what’s critical
○ I’ve heard you, I will do what I can do
○ You have a partner to work with you
○ Recognize successes
28
Q

Subjective Chart Components

A
Identifier
Chief Complaint (CC)
History of Present Illness (HPI) Past Medical History (PMH) Medications
Allergies Hospitalizations/Surgeries PCP/Specialists Injuries/Accidents
Health Maintenance
Family History (FH)
Social History (SH)
Review of Symptoms (ROS)