Clinical skills lecture 2.pptx
Transcript
History taking DR. WEAM ARIBI. SKILL LAB INSTRUCTOR. I N T E R N AT I O N A L M A A R E F U N I V E R S I T Y. Analysis of history components The history of the present complaint It involves detailed analysis and recording of the present complaint or complaints. Allow the patient to talk about the...
History taking DR. WEAM ARIBI. SKILL LAB INSTRUCTOR. I N T E R N AT I O N A L M A A R E F U N I V E R S I T Y. Analysis of history components The history of the present complaint It involves detailed analysis and recording of the present complaint or complaints. Allow the patient to talk about the problem for few minutes without interruption. Observe the patient talking and you can form an initial assessment about the patient in terms of: Anxiety. Personality. His or her main concern. Analysis of history components Now start asking the patient about his symptoms. For each symptom you should ask about : The site where the symptom started. Duration of the symptom. Onset , if sudden ,gradual and over how long and if the symptom was present for long time ,ask the patient why he only came now? If the problem is continuous or intermittent ? If intermittent ask about : Number of attacks ,frequency of attacks. Time between attacks. Duration of each attack. What brings the attack and what relieves it. Analysis of symptoms Progression : If symptoms improving. If symptoms getting worse. If the symptoms constant. If there is fluctuation of symptoms. Exaggerating or exacerbating factors. What factors make the symptoms worse. Relieving factors , what makes symptoms better. Any associated symptoms. Analysis of pain Pain is very common symptom. It is the main symptom which brings patients to doctors. Pain has different causes and types depending on the disease process and the tissues or organs involved. Perception of pain is influenced by factors which should taken in consideration. Analysis of pain You should carry thorough analysis of pain which involves asking about : Site. Duration. Onset. Progression. Periodicity and frequency. Character of pain Radiation Referral. Severity. Relieving factors. Aggravating factors Associated symptoms Analysis of pain Site , exact point where the pain started, point of maximum intensity. Sometimes the patient can not localize one point but put his hand on a wide area. Duration of pain, take the duration of last attack if patient has chronic pain with intermittent attacks ,but mention that the patient had pain and for how long. Analysis of pain Onset If sudden onset ( infections ,injuries ,vascular incidents ,inflammatory conditions ) Gradual onset ,chronic diseases. Progression If pain getting worse ,better ,constant or intermittent. Frequency If continuous pain or periodic. If periodic , number of attacks ,duration of each attack and time between attacks. What brings each attack and what relieves it. Analysis of pain Character or nature or type of pain Some pain have a specific character, but some are difficult to describe by patients. The common descriptions of pain are : Colicky pain : It arises from a hollow viscus due to contraction of the smooth muscle like in, intestine ,ureter ,uterus ,gall bladder. It is a severe pain which comes in attacks, it increases in intensity, then decreases or disappears to come in another attack. Analysis of pain Throbbing pain : It is a sensation of increasing tension in a limited area which gets worse with each heartbeat. It occurs mostly with collection of pus (abscess ) ,vascular tumors etc. Burning pain. Stabbing pain It describes a sudden severe short and sharp pain. Analysis of pain Constricting pain and tightness The patient feels tightness and some thing constricting a part of his body like pain of myocardial infarction. Distending or bursting pain Occurs with bladder or bowel distension and encapsulated tumors and facial compartments Aching pain: It is a dull ache and not well localized. Analysis of pain Severity : Pain is a subjective feeling , so perception of severity differs from one person to another ,but some questions can help to get a better idea about the severity of pain. If pain interferes with sleep. If pain interferes with normal activity. If pain causes anorexia ,loss of appetite. Need for analgesia and medical help. Use of pain scales is useful, especially in children. Analysis of pain Radiation and shifting of pain If pain moves to another site. Pain of gall bladder radiates to the angle of right scapula, Pain of pancreas radiates to middle of the back. Pain of ureteric colic goes from loin to groin. Pain of acute appendicitis shifts to right lower abdomen. Analysis of pain Referral of pain it means that the patient feels the pain in another area away from the site of the pain with a gap between the two. Pain of gall bladder goes to right shoulder. Pain from spleen goes to left shoulder. Analysis of pain Aggravating or exacerbating factors: Food and type of food. Activity. Coughing. Position. Bowel habit ,urination. Analysis of pain Relieving factors : Food. Position. Rest. Vomiting. Passing motions. Local applications. Medications. Analysis of pain Associated symptoms : None specific general symptoms : Anorexia. Nausea. Malaise. Sweating. Loss of sleep. Loss of interest in daily activities. Symptoms specific for the system involved : Any questio n?
