Principles of Patient Interviewing

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Questions and Answers

What is a key principle of building rapport with patients during an interview?

Using technical jargon to demonstrate expertise

Avoiding direct eye contact for comfort

Rushing through questions to save time

Communicating concern and empathy (correct)

Which type of question is best for encouraging a patient to elaborate on their symptoms?

Closed questions

Open-ended questions (correct)

Leading questions

Yes or no questions

What should the interviewer always ask for before involving themselves in a patient's care?

The patient's permission (correct)

The patient's medical records

The patient's family history

The patient's insurance details

Which of the following is NOT a recommended way to create a conducive interview environment?

Making aggressive eye contact Signup and view all the answers

Why should leading questions be avoided in patient interviews?

They may elicit false information. Signup and view all the answers

In a patient interview, what is an example of a direct question?

When did your cough start? Signup and view all the answers

What is an effective way to handle sensitive patient beliefs during an interview?

Respect and acknowledge the beliefs without judgment Signup and view all the answers

What is the role of smiling and making eye contact during patient interviews?

To build rapport and show sincerity Signup and view all the answers

What are some symptoms that may coincide with hyperventilation?

Chest pain and anxiety Signup and view all the answers

What should be the first priority when approaching a situation involving hyperventilation?

Measuring vital signs Signup and view all the answers

Which of the following is NOT a factor that affects the effectiveness of a cough?

Age of the patient Signup and view all the answers

When should a psychogenic source be considered in cases of hyperventilation?

Only after ruling out a pathogenic source Signup and view all the answers

What type of cough is typically associated with restrictive lung diseases?

A dry, nonproductive cough Signup and view all the answers

What condition is commonly associated with an ineffective cough?

Neuromuscular diseases Signup and view all the answers

Which type of cough is often linked to inflammatory obstructive diseases?

Loose, productive cough Signup and view all the answers

What is considered the most common cause of an acute, self-limited cough?

Viral infection of the upper airway Signup and view all the answers

What is the primary purpose of asking about the occurrence of symptoms during an interview?

To identify the underlying cause of symptoms Signup and view all the answers

How is smoking history quantified?

In pack-years Signup and view all the answers

What would a smoking history of 30 pack-years indicate?

Smoking one and a half packs per day for 20 years Signup and view all the answers

Which of the following is typically used to express a patient's wishes regarding resuscitative efforts?

Advance Directive Signup and view all the answers

If a patient has smoked 15 cigarettes a day for 20 years, what is their smoking history in pack-years?

15 pack years Signup and view all the answers

What is the correct formula for calculating pack-years of smoking history?

Number of packs smoked per day multiplied by the number of years smoked Signup and view all the answers

Which characteristic is NOT typically relevant when assessing new symptoms in a patient?

Past medical treatment efficacy Signup and view all the answers

What does the acronym DNR stand for in medical contexts?

Do Not Resuscitate Signup and view all the answers

What condition primarily causes pedal edema in patients with chronic hypoxemic lung disease?

Right-sided heart failure Signup and view all the answers

How does pitting edema differ from weeping edema?

Pitting edema leaves an indentation, while weeping edema causes fluid leakage. Signup and view all the answers

What does the extent of pitting edema indicate in heart failure patients?

The severity of heart failure Signup and view all the answers

What does a pitting edema rating of '4' signify?

Severe pitting with refill time over 2 minutes Signup and view all the answers

What physiological response does chronic hypoxia trigger in the lungs?

Pulmonary vasoconstriction Signup and view all the answers

What is a significant risk factor associated with ineffective coughing?

Atelectasis Signup and view all the answers

Which of the following describes non-massive hemoptysis?

Blood coughed up from the lungs in small amounts Signup and view all the answers

How is pleuritic chest pain different from non-pleuritic chest pain?

Pleuritic chest pain worsens with deep breaths, while non-pleuritic does not Signup and view all the answers

What are common infectious causes of fever?

Bacterial, viral, or fungal infections Signup and view all the answers

Which condition is most likely associated with massive hemoptysis?

Bronchiectasis Signup and view all the answers

Which of the following describes the common cause of pleuritic chest pain?

Inflammation of the pleural lining Signup and view all the answers

Which of the following is a non-infectious cause of fever?

Burns Signup and view all the answers

What characterizes the pain of angina compared to non-pleuritic chest pain?

It feels like pressure and is often related to exertion Signup and view all the answers

Study Notes

Interviewing Principles

Interviewing involves gathering a patient's medical history.
Building rapport involves demonstrating concern, empathy, and warmth.

Interview Structure

Introduce yourself professionally.
Respect the patient's beliefs, attitudes, and rights.
Cover the patient appropriately.,
Ask permission to be involved in the patient's care.
Dress professionally.
Smile, and make eye contact.
Call the patient by name.
Never guess at an answer or information you do not know.
Never argue.
Ask if there is anything else.

Factors Affecting Communication

Use open-ended questions and statements to encourage the patient to provide information.
Example open-ended question: "What prompted you to come to the hospital?"
Use direct questions to gain specific information.
Example direct question: "Why?"
Employ neutral questions to gather information without leading the patient.
Example neutral question: "Tell me more about..."
Use indirect questions to clarify information.
Example indirect question: “If I understood you correctly, it is harder for you to breathe now than it was yesterday."
Avoid asking leading questions that steer the patient toward a desired response.
Avoid asking these questions:
- What seems to make it better or worse?
- Has it occurred before? (If so, how long did it last?)

Smoking History

The smoking history is recorded in pack-years.
Pack years = # number of packs smoked per day × number of years smoked.

Advance Directives

The patient or a legally authorized representative can formalize wishes for resuscitative efforts.
This is typically referred to as DNR (do not resuscitate) or DNI (do not intubate).

Hyperventilation

Hyperventilation can coincide with chest pain, anxiety, palpitations, and paresthesia (tingling and numbness).
Always approach hyperventilation or dyspnea as if it had a pathogenic basis.
The first priority is to measure vital signs, including SaO2, potentially a 12-lead electrocardiogram, and arterial blood gases.
A psychogenic source is considered only after a pathogenic source is ruled out.

Coughing

The effectiveness of a cough depends on the ability to take a deep breath, lung elastic recoil, expiratory muscle strength, and airway resistance.
Expiratory flow can be limited by bronchospasm, reduced lung elastic recoil, and muscle weakness.
Inadequate coughing can lead to atelectasis, retained secretions, pneumonia, and hypoxemia.

Cough Types

A dry, nonproductive cough is typical for restrictive lung diseases such as CHF or pulmonary fibrosis.
A loose, productive cough is more often associated with inflammatory obstructive diseases like bronchitis and asthma.
The most common cause of an acute, self-limited cough is a viral infection of the upper airway.
Ineffective (non-productive) coughing is common in patients with cardiopulmonary, neurologic, or neuromuscular diseases, as well as in the early postoperative period after thoracic and upper abdominal surgery or trauma.

Sputum Production

Ineffective coughing increases the risk of developing atelectasis, retained secretions, pneumonia, and hypoxemia.

Hemoptysis

Coughing up blood or blood-streaked sputum from the lungs is common in patients with pulmonary disease.
Massive hemoptysis (over 300 ml of blood expectorated in 24 hours) is a medical emergency.
Causes of massive hemoptysis include bronchiectasis, lung abscess, and acute or chronic tuberculosis.
Non-massive hemoptysis can occur in many conditions, such as airway infections, pneumonia, lung cancer, tuberculosis, blunt or penetrating chest trauma, and pulmonary embolism.

Chest Pain

Pleuritic chest pain:
- Location: Laterally or posteriorly
- Description: Sharp, stabbing pain
- Effect of breathing: Worsens with deep breaths
- Common causes: Diseases that cause the pleural lining of the lung to become inflamed (e.g., pneumonia, empyema, pleural effusion), pulmonary embolism.
Non-pleuritic chest pain:
- Location: In the center of the anterior chest
- Description: Dull ache or pressure type of pain
- Effect of breathing: Not affected by breathing
- Common causes: Angina (pressure sensation with exertion or stress), gastroesophageal reflux, esophageal spasm, gallbladder disease.

Fever

An elevated body temperature greater than 38.3°C (101°F).
The most common sources are bacterial, viral, or fungal infections.
Non-infectious causes of fever include drug reactions, malignancies, head trauma, burns, thromboembolic disorders, and non-infectious inflammatory diseases.

Pedal Edema

Swelling of the lower extremities.
Occurs commonly with heart failure.
Increased hydrostatic pressure from blood pooling in the lower extremities causes fluid to leak into the interstitial spaces.
The degree of pedal edema depends on the severity of heart failure.
Patients with chronic hypoxemic lung disease are prone to right-sided heart failure (cor pulmonale), which also causes pedal edema.

Pitting/Weeping Edema

Pitting edema: Indentation mark on the skin after finger pressure is applied.
- The height at which pitting edema occurs can indicate the severity of heart failure.
- Pitting edema extending to the knee signifies a more significant problem than edema limited to the ankles.
- A standard scale (1-4) can be used to quantify the severity of pitting edema.
Weeping edema: Fluid leak when finger pressure is applied.

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Description

This quiz covers the fundamental principles of patient interviewing, including techniques for gathering medical history and building rapport. Learn how to communicate effectively with patients using various questioning strategies while respecting their beliefs and rights.