Intro to PA Final Review PDF

1\) What are the "4 orgs" of the profession? What is each responsible for? (previous) - AAPA -- professional society - NCCPA -- certifying agent - ARC-PA -- accrediting PA programs - PAEA -- supports PA education 2\) How is "supervision" defined? (previous) - Supervision - PA...

1\) What are the "4 orgs" of the profession? What is each responsible for? (previous) - AAPA -- professional society - NCCPA -- certifying agent - ARC-PA -- accrediting PA programs - PAEA -- supports PA education 2\) How is "supervision" defined? (previous) - Supervision - PA is legally bound to his/her supervision physician - ***This does NOT mean that a physician must always be present!*** - Usually regulated by individual state licensing boards as to what level is needed -- In Kentucky they cant prescribe meds - Typically seen as "counter productive" in that physicians must stop what they're doing to supervise a PA (cosign chart, sign prescription, check a lab, etc) - In reality, supervision is typically a positive (more emphasis on the healthcare team in 2018) - Most studies show that decreasing the physicians work load and filling in the gaps with a PA actually INCREASES productivity 3\) What is the patient's hierarchy of systems? (week 3) The Hierarchy of Natural systems breaks the patient into culture and community which denote social, the persons experience and behavior which denotes psycho, and the nervous system, tissue, cells, and organelles which denotes bio 4\) What does "full prescriptive authority?" (previous) 5\) Types of responses to injury, illness, stress? (week 5) A diagram of a model of stress and physical injuries Description automatically generated **Cognitive** **Emotional** ------------------- ------------------------ Low concentration Overwhelmed Confusion Depressed Disorientation Numb Inattention Volatile Indecision Fearful Memory loss Anxious Unwanted memory Uncertain Physical Behavioral Nausea Irritability Dizziness Withdrawal GI problems Argumentative Tachycardia Inappropriate humor Tremors Appetite change Headache Sexual desire/function Fatigue Substance use Insomnia Suspicious Pain Teeth grinding 6\) Biomedical vs biopsychosocial (week 3) The Biomedical model focuses on defeating the disease, disease is like an equation, ignored the other reasons someone comes in like anxiety about the disease The Biopsychosocial model explains how patients with the same disease can act different, individualized treatment plans, provider-patient relationship is important, separates the disease from illness 7\) Patient centered interviewing techniques (including barriers to communication) (week 3) The **transition to the Middle Interview is** , Summarize the interview so far, Check for accuracy, Alert the patient that the style of the interview is about to change, Make sure the patient is ready All of these are Common Interview Challenges Special-needs Patients Personality Challenges Culture Competency, Different Types of Patient Visits 8\) Calculation of pack years (week 5) Cigarettes divided by 20 and them times by the number of years 9\) Parts of the medical history- what are they, and what is included in each? (week 4) - Chief Complaint (CC) - History of Present Illness (HPI) -- Locates, - Past Medical History (PMH - Social History (SH) - Family History (FH) - Surgical History (SxH) - Medications (Med) - Review of Systems (ROS) - Allergies (Ax) 10\) How many problems do most patients wish to discuss in a visit? (week 3) 3 to 4 11\) Which parts of a visit are clinician centered? (Week 3) Middle and end 12\) Open ended interviewing (week 3) What is the goal of open ended interviewing? Goal: encourage the patient to speak freely, provide information, and express emotions 13\) Health professions discussed in class (previous) I don't know 14\) Intimate partner violence warning signs (week 4) - Statistics - Does not discriminate in effects ^--^ Higher risks do involve: ^»^ Females, ages 18-24, and relationship status of separated (vs divorced or married) - History - Who? - ALL adolescent and adult women brought to the ED - ALL mothers of children brought to the ED - Previous history of IPV - Delay in seeking care or illogical explanation of injury - How? - Screening questions - Open posture - Private setting. Chaperone or translator as needed Warning signs - Isolation. Many abusers begin to exert control by systematically isolating their victims from friends and family. \...  - Financial Control. \...  - Unexplained Injuries. \...  - Anxiety, Depression or PTSD. \...  - Low Self-Esteem. \...  - Substance Abuse. \...  - Self-Harm, Suicidal Ideation or Suicide Attempts. 15\) How to approach an emergent visit (week 4) Don't have to ask the social history 16\) Disease vs sign vs symptoms (week 3) Sign is something that can be seen or recorded, vitals, rash, fever, symptoms are subjective, the patient is the only one that feels them, pain dizziness. Disease is both of these combined 17\) Personality types (schizoid, obsessive compulsive, histrionic, etc.) (week 3) - Dependent Personality - Basic Need - Fear of abandonment - Presentation - Spectrum - Need detailed instruction and attention but claim "super-independence" - Adult living in parent's home (when not necessary) - "We" statements. "We took the medicine" "We had a headache" - Dysfunction - Demand "urgent" special attention. Any type of loss is extremely stressful - Simplest instructions require extensive detail (Where's the bathroom?) How to respond - Provide detailed instructions, but set a limit - Arrange for more frequent follow ups - Avoid becoming over-involved - Obsessive-Compulsive Personality - Basic Need - CONTROL, CONTROL, CONTROL - Presentation - Spectrum - Orderly, punctual, a bit judgmental - Tidy and conservative (overly concerned with right/wrong) - Dysfunction - Obsession: Germs everywhere! - Compulsion: excessive hand washing that takes up so much time that cannot sustain relationships or function properly - Usually angry and anxious simultaneously - Obsessive-Compulsive Personality - How to Respond - Give as much control to the patient as you can ^--^ Choose from a list of options - Compliment patient preparedness - Give detailed information when appropriate, caution with overly detailed information - Histrionic Personality - Basic Need - Emotional connection with others (even when it's not there) - Presentation - Spectrum - Charming, attractive, romantic, and appealing (usually at inappropriate times) - Dysfunction - Impulsive and overly dramatic - Pervasive superficially: use sexual proclivity to connect with others - Women: vain but overly vulnerable - Men: Macho OR very effeminate (both versions very vulnerable) - Get angry when advances are shunned - Histrionic Personality - How to Respond - Calmly and firmly deny seductive behaviors - Short, small compliments but NEVER suggestive - Show interest in the health of the person, not attraction or objectification at the the appearance - Narcissistic Personality - Basic Need - Overcome low self-esteem - Presentation - Spectrum - Overopinionated and self-confident - Dysfunction - Exaggerated self-confidence, posses mysterious knowledge, have superior intellect - Patronize and minimize medical provider's knowledge - Big reactions (even violently) whenever challenged - Narcissistic Personality - How to Respond - Acknowledge the patient as a person of unique accomplishment - Carefully show expertise by discussing journals, texts, or other informatics with the patient (like talking to a colleague) - Develop patience: don't feel threatened - Paranoid Personality - Basic Need - Fear of own faults; suspicious of others - Presentation - Spectrum - Suspicious of newcomers and VERY aware when things are out of the ordinary - Dysfunction - Hypervigilant. Overly guarded. Blame everyone else for their problems - "I'll SUE!!" patients - The slightest inconvenience is a personal attack (waiting 5 minutes to be seen) - Paranoid Personality - How to Respond - Try to avoid inadvertent slights - Be friendly and courteous but avoid getting too close - Often praise the patient for research, alertness - Schizoid Personality - Basic Need - Protect against disappointment from others - Presentation - Spectrum - Aloof. Alone - Dysfunction - Very solitary. Unsociable - Avoid any places where interaction is needed - Typically, very low socioeconomic status (stay at home instead of work) - Flat responses to bad news - Schizoid Personality - How to Respond - Building a relationship with them can be threatening to them - Maintain interest in them a people, but don't demand reciprocation - Remain calm and professional - ^--^ The majority of these patients typically are deprived of loving or meaningful relationship - Schizoid Personality - How to Respond - Building a relationship with them can be threatening to them - Maintain interest in them a people, but don't demand reciprocation - Remain calm and professional - ^--^ The majority of these patients typically are deprived of loving or meaningful relationship - 18\) Problem focused vs comprehensive medical history (week 4) Comprehensive ~--~ New patient; non-urgent; high complexity or multiple problems - Problem Focused - Established patient, specific follow up 19\) Transtheoretical Model of Decision Making (week 5) - Assessing your patient for change - Prochaska (psychologist) early 2000s - "*Transtheoretical Model of Decision Making*" - Background - How to assess when a patient is ready to make a change - Stages of change - Precontemplation - Contemplation - Preparation - Action - Maintenance - Termination 20\) 5 A's of Behavior Change (week 5) - A1. ASK - Asking permission to discuss a subject with a patient - Ask if a patient is ready to change - (What Prochaska Stage is the patient in?) - If a patient is unwilling or reluctant to discuss a topic, then change may not be successful at this particular time - A2. ASSESS - 1\. Assess the patient's confidence in reaching target behavior - 2\. Assess any barriers the patient may encounter - Physical, social, economic - Real or perceived - 3\. Assess the patient's knowledge about current behaviors - A3. ADVISE - Offer a clinical management plan to address the patient's assessment - Advice should be personally relevant and specific to the patient - Advise the patient that behavior change is just as important as taking medication - A4. AGREE - Obtain obvious and explicit agreement with the patient about the treatment plan - Make sure you are both on the same page - Provide choices if available - Set collaborative goals - A5. ASSIST - Assist the patient in identifying facilitators and barriers to change - Develop strategies to utilize facilitators - Develop strategies to overcome barriers - Refer the patient to other providers or additional resources - Schedule regular follow ups to review progress towards the goal and address concerns - Revise the action plan as needed **5 As** **Stages of Change** ---------------------------------- ----------------------------------------------------- Ask about a behavior Precontemplation: I'm not ready Assess readiness to change Contemplation: I'm thinking about it Advise the patient on changing Preparation: I'm ready to change Agree on the plan of action Action: I'm changing! Assist the patient with the plan Maintenance: I've been changed for a while Termination: I'm so changed it's not change anymore 21\) SPIKES delivering bad news (week 5) - **[S]**et up the interview - Assess **[P]**erception - **[I]**nvite the patient to speak freely - Give **[K]**nowledge - Address **[E]**motions with **[E]**mpathy - **[S]**et goals 22\) Tips on taking a sexual history (week 4) - 1\. Private Space - 2\. Fully clothed patient - 3\. No barriers between and patient at same height - 4\. Open and nonjudgmental - "These questions may make you feel uncomfortable or may be embarrassing. That is NORMAL. I promise everything you tell me will stay in this room." - 5\. Special Circumstances - Pediatric Patients: Talk to the patient. Ask the parent/guardian to step out unless the patient requests otherwise. Chaperones are needed anytime you have a child without a parent. - Sexual Practices - ALWAYS nonjudgmental; NEVER make assumptions - Ask directly: "Do you have sex with men, women, or both?" - Don't assume monogamy or otherwise if married or single - Don't assume practices if the patient openly identifies as lesbian, gay, bisexual, transgender, or questioning - Sexual Timing - How many partners in the last 6 months (the higher the number, the higher the likelihood of STDs) - How many partners in the last 2 months (maximum incubation period for gonorrhea and chlamydia) - Sexual Behavior - Types of sexual activity (be clear, direct, and use lay terms) - Vaginal, oral, or anal sex - Use of sexual devices or toys - ^»^ Scrotum dermatitis from contact with latex device may be hard to diagnose if you don't ask and the patient doesn't think to share - Hazardous Sexual Activity - Sex while using drugs/alcohol - Associated with higher risk of STD, HIV/AIDS, and violence 23\) LOCATES history (week 4) - L: Location - O: Onset - C: Characteristic - A: Alleviate/Aggrivate - T: Time (duration and frequency) - E: Environment/ Extra - S: Severity 24\) Focusing vs non-focusing skills (open-ended skills) (week 3) - Non-Focusing Skills - Silence, non-verbal communication, neutral utterances - Focusing Skills - Echoing, open-ended questions, summarizing