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56 LAYING THE FOUNDATION

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CHAPTER RESOURCES

REVIEW QUESTIONS

UNIT 1

For answers to these questions, see Answer section at the end of the book.

1. During which stage of the consumer interview process does

the nurse collect the majority of the consumer’s data?

a. Joining stage b. Working stage c. Termination stage d. Summary stage

2. A consumer at a women’s health clinic is telling you about the

death of her nephew. She becomes silent and starts to cry. You touch her hand, nod to her, and say ‘uh-huh’. You have used the communication technique of:

a. Making observations b. Clarifying c. Facilitating d. Interpreting

3. The nurse should use listening responses when interviewing

a consumer. Which of the following are examples? (Select all that apply.)

a. Restating b. Reecting c. Focusing d. Exploring e. Interpreting f. Encouraging comparisons

4. The nurse tells the consumer, ‘Let’s look at the environment

you are located in when you have an asthma attack and see if we can identify your triggers.’ This statement exemplies the communication technique of:

a. Confronting b. Informing c. Collaborating d. Presenting reality

5. With which of the following consumers should the nurse use

mostly closed questions?

a. Consumer with impaired hearing b. Consumer with impaired vision c. Non-English-speaking consumer d. Aphasic consumer

6. A patient wants to attach his rosary beads to the IV pole near

his bed. What would be the best action for the nurse?

a. Call the hospital chaplain b. Inform the patient that this is not in their job description c. Inform the patient that you cannot attach things to the

equipment

d. Tape the beads to the IV pole near his bed.

7. The nurse tells the consumer who was just diagnosed with

prostate cancer, ‘It’s OK to cry. Most people who are given that diagnosis react in a similar fashion.’ The nurse used the communication technique of:

a. Presenting reality b. Normalising c. Offering false reassurance d. Advising

8. A major development task of early middle age is to: a. Evolve one’s own value system and integrate it with those

of family and society

b. Form a meaningful philosophy of life and implement it in

one’s own household

c. Develop a personal style of living and manage one’s own

household

d. Work on a life review consistent with one’s philosophy

9. One of the principal developmental tasks of adolescents is to: a. Manage life stress accompanying change b. Be independent of parental care and home c. Form an intimate afliation with another d. Develop self-identity and appreciate own achievement

and worth

10. When assessing an 18-month-old toddler, the nurse would

expect to see:

a. Building a tower of four blocks, drawing a circle and

kicking a ball

b. Pouring liquids, drawing circles and throwing a ball

overhead

c. Dressing and undressing self, running, jumping, and

kicking a ball

d. Walking up and down stairs, pushing and pulling toys, and

skipping rope

FURTHER RESOURCES

> AuslanServices (Interpreters): http://www.auslanservices.com > Australian Commission on Safety and Quality in Health

Care – Australian Charter of Healthcare Rights: https://www. safetyandquality.gov.au/consumers/working-your-healthcareprovider/australian-charter-healthcare-rights

> Australian Commission on Safety and Quality in Health Care:

https://www.safetyandquality.gov.au/standards/nsqhsstandards

> Australian Government. Children’s health and immunisation:

https://www.australia.gov.au/information-and-services/health/ childrens-health-and-immunisation

> Australian Human Rights Commission: https://www.

humanrights.gov.au/education/face-facts/face-facts-lesbiangay-bisexual-trans-and-intersex-people

> NZ Human Rights: https://www.hrc.co.nz/ > Interpreting New Zealand: https://interpret.org.nz/ > KidsHealth: https://kidshealth.org.nz/ > Ministry of Health. Child health: https://www.health.govt.nz/

our-work/life-stages/child-health

> New South Wales Government, HealthyKids: http://www.

healthykids.nsw.gov.au

> Nursing and Midwifery Board of Australia – Code of ethics

THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 57

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for nurses & Code of ethics for midwives: http://www. nursingmidwiferyboard.gov.au/News/2018-03-01-new-codesof-ethics-in-effect.aspx

> Nursing Council of New Zealand – Code of Conduct: https://

www.nursingcouncil.org.nz/Public/Nursing/Code_of_Conduct/ NCNZ/nursing-section/Code_of_Conduct.aspx

> The Paediatric Society of New Zealand: http://www.

paediatrics.org.nz/

REFERENCES

American Academy of Pediatrics. (2020). Newborn and infant nutrition:

a clinical decision support chart. American Academy of Pediatrics.

Australian Bureau of Statistics. (2021). Religious afliation in Australia.

Exploration of the changes in reported religion in the 2021 Census. Retrieved 18 April 2022 from https://www.abs.gov.au/articles/ religious-afliation-australia#:~:text=Religious%20afliation%20 in%202021,-In%202021%2C%20more&text=In%202021%2C%20the%20 number%20of,No%20religion%20(38.9%25)

Australian Commission on Safety and Quality in Health Care. (2017).

National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC.

Australian Government Department of Health. (2022). Australian national

breastfeeding strategy collection. Retrieved 19 May 2022 from https:// www.health.gov.au/resources/collections/australian-nationalbreastfeeding-strategy-collection?utm_source=health.gov.au&utm_ medium=callout-auto-custom&utm_campaign=digital_transformation

Australian Institute of Health and Welfare (AIHW). (2020). Australia’s

health 2020. Alcohol risk and harm. https://www.aihw.gov.au/reports/ australias-health/alcohol-risk-and-harm

Carnevali, M., & Patrick, M. (Eds.). (1993). Nursing management for the

elderly (3rd ed.). Philadelphia: JB Lippincott.

Commonwealth of Australia. (2019). National Alcohol Strategy 2019–2028.

Canberra: Commonwealth of Australia.

Dubowitz, L. M. S., Dubowitz, V., & Goldberg, C. (1970). Clinical assessment

of gestational age in the newborn infant. Journal of Pediatrics, 77, 1–10.

Einspieler, C., & Prechtl, H. (2005). Prechtl’s assessment of general

movements: a diagnostic tool for the functional assessment of the young nervous system. Mental Retardation and Developmental

Disabilities Research Reviews 11(1), 61–7. doi: 10.1002/mrdd.20051. Erikson, E. (1974). Dimensions of a new identity. New York: W. W. Norton. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). ‘Mini-mental state’.

A practical method for grading the cognitive state of patients for the

clinician. Journal of Psychiatric Research, 12, 189–98. Freud, S. (1946). The ego and the mechanism of defense. New York:

International Universities Press. Gallagher, D. (1986). The Beck Depression Inventory and older adults:

Review of its development and utility. In T. L. Brink (Ed.), Clinical

gerontology: A guide to assessment and intervention (pp. 149–63).

New York: Haworth Press. Glascoe, F. P., Foster, E. M., & Wolraich, M. L. (1997). An economic analysis

of developmental detection methods. Pediatrics, 99, 830–7. Hayes, K. (2020). (Ed.). Infant, toddler and child health sourcebook. (1st ed.).

Detroit: Omnigraphics.

> Sign Language Interpreters Association of New Zealand:

http://www.slianz.org.nz

> SMART Recovery Australia: https://smartrecoveryaustralia.

com.au/

> Triple P Positive Parenting Program: https://www.triplep.net/

glo-en/home/

> Child and Family Health Service: https://www.cafhs.sa.gov.au/

Knight, E., & Lappalainen, L. (2017). Clinical Institute Withdrawal Assessment for

Alcohol–Revised might be an unreliable tool in the management of alcohol withdrawal. Alcohol and Family Physician, 63(9), 691–5.

Kohlberg, L. (1981). The philosophy of moral development: Moral stages

and the idea of justice. New York: Harper & Row.

Kozlowska, K., Scher, S., & Helgeland, H. (2020). Functional somatic

symptoms in children and adolescents: a stress-system approach to assessment and treatment. (1st ed.). Springer International Publishing.

Lissauer, T., & Carroll, W. (2022). Illustrated textbook of paediatrics.

(6th ed.). Elsevier Limited.

McDowell, I., & Newell, C. (1996). Functional disability and handicap.

Measuring health: A guide to rating scales and questionnaires.

(2nd ed.). New York: Oxford University Press.

Neinstein, L. S., Gordon, C. M., Katzman, D. K., Rosen, D. S., & Woods, E. R.

(Eds.) (2007). Adolescent health care: A practical guide (5th ed.). New York: Lippincott Williams & Wilkins.

Piaget, J. (1952). The origins of intelligence in children. New York:

International Universities Press.

Quigley, A., Connolly, C., Palmer, B., & Helfgott, S. (2015). A brief guide to

the assessment and treatment of alcohol dependence (2nd ed.). Perth, Western Australia: Drug and Alcohol Ofce. Retrieved 15 May 2022 from https://www.mhc.wa.gov.au/media/1171/dependence-brochure2014v8web.pdf

Resnick, N. M. (1994). Geriatric medicine and the elderly patient. In L. M.

Tierney, Jr., S. J. McPhee, & M. A. Papadakis (Eds.), Current medical diagnosis & treatment (33rd ed.), pp. 41–60. Norwalk, CT: Appleton & Lange.

Sarason, J. G., Johnson, J. H., & Siegal, J. M. (1978). Assessing the impact

of life changes: Development of life experiences survey. Journal of Consulting Clinical Psychology, 46, 932–46.

Saxon, S. V., Etten, M. J., & Perkins, E. A. (2015). Physical change & aging:

A guide for the helping professions. (6th ed.). New York: Springer Publishing Company.

Skye, L. M. (2006). Australian Aboriginal Catholic women seek wholeness:

Hearts are still burning. Pacica 19(3), 283–307.

Statistics New Zealand. (2020). 2018 Census. Retrieved 19 May 2022 from

https://www.stats.govt.nz/2018-census/

Stein-Parbury, J. (2021). Patient & person interpersonal skills in nursing.

(7th ed.). Chatswood: Elsevier Australia.

United States of America and InterRAI. (2011). Minimum Data Sets

MDS 3.0. Retrieved 15 May 2022 from https://www.cms.gov/ Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ NursinHomeQuaityInits/Downloads/Archive-Draft-of-the-MDS-30Nursing-Home-Comprehensive-NC-Version-1140.pdf

CHAPTER 2

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CHAPTER

THE COMPLETE HEALTH HISTORY INCLUDING DOCUMENTATION

LEARNING OUTCOMES

By the end of this chapter you should be able to:

1 identify three different types of health history and the context each type of health history may be used in 2 identify the components of the complete health history 3 describe how to assess the 10 characteristics of a chief complaint when examining present health

status and history of the presenting illness

4 demonstrate sensitivity to consumers of different race, religion, cultural background, sexual orientation

and socioeconomic status when conducting a health history

5 conduct a complete health history on well and ill consumers, and document appropriately according

tocontext.

BACKGROUND

The health history is usually the rst step of consumer assessment. It is the collection of subjective information on the consumer’s health status from them and other sources. The health history can provide information on a consumer’s health status as well as social, emotional, physical, cultural, developmental and spiritual identities. Consumer strengths and areas of improvement should also be identied. Combined with the physical examination ndings, this information should guide the nurse in identifying consumer concerns, which serve as the foundation for their plan of care.

PUTTING IT IN CONTEXT

Problems encountered during history taking

You are taking a health history from Jessica, a 15-year-old female who has presented with abdominal pain. Her mother is not present but waiting outside for you to nish the assessment. You ask Jessica details about her sexual activity and she states, ‘That’s a bit personal! Why are you asking me this?’ You explain that abdominal pain can be caused by many different issues, so you are trying to narrow down the possible area that needs further testing and investigation. Jessica seems to answer your questions fully after this and you feel like you have built rapport with her; she discloses that she had a termination about 6weeks ago. After you have completed the health history, as Jessica is preparing to leave the room she states, ‘You can’t tell my mother about the termination I had. I know these sessions are supposed to be condential.’

Your response will depend on the legal requirements relating to her age, as well as privacy and condentiality requirements, if the presenting health concern is related to the termination, and if her mother asks for information.

What would the legal requirements be in your environment, if you found yourself presented with this issue?

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The health history interview provides the mutual opportunity for the nurse and consumer to become more comfortable with each other and build rapport. The consumer usually feels more at ease with the collection of health history data than with the physical contact necessary for the examination. For this reason, the health history is usually performed prior to the physical examination. Additionally, the health history can help the clinician focus in on specic areas of examination or decide if more comprehensive diagnostic testing may be needed. The health history can be broadly or narrowly focused, depending on the consumer’s needs and physical condition. Analysis of the information from the consumer in the health history provides the basis for planning the healthcare education needed by the consumer. The written health history also serves as part of the legal documentation of the consumer’s health status. It is a means of communicating information to other healthcare team members, and in this way is an important factor in continuity of care.

Refer to Chapter 2 for communication techniques and strategies for dealing with consumers who have special needs.

TYPES OF HEALTH HISTORY

There are three types of health history: complete, focused and emergency. The choice of which type of health history to use may depend on the healthcare context norms and local requirements, and the clinician’s judgement based on the consumer situation and acuity (the care needs of the consumer) (Dalton, Harrison, Malin & Leavey, 2018). The comprehensive history of the consumer’s past and present health status, and covers many facets of a consumer’s life. It is usually gathered during a consumer’s initial visit to a healthcare facility on a non-emergency basis and for nursing admission when a consumer is admitted to the hospital.

The

focused history is shorter and is specic to the consumer’s current reason

for seeking health care. For example, the consumer who seeks care for a sore throat and fever would have a focused health history taken. This type of history is also used for follow-up care. It documents the consumer’s recovery from illness, or progress from a prior visit. However, remember that you may need to switch to a comprehensive or emergency health history if new information surfaces or red ags are evident in the focused health history.

Finally, the other sources in an emergency. At times, lifesaving interventions will interrupt the emergency health history as well. Only information that is required immediately to treat the emergent need of the consumer is gathered; once the life-threatening condition is no longer present, the clinician may elicit a more comprehensive history from the consumer.

emergency health history is elicited from the consumer and

complete health history, described in this text, is a

CHAPTER 3

PREPARING FOR THE HEALTH HISTORY

Taking a complete health history with a consumer may require 30 to 60 minutes. Inform the consumer before the interview starts of the amount of time that will be required. If the health history is not completed within the allotted time, you may need to continue it later to avoid tiring the consumer, depending on their state of health, and willingness to be involved. If the consumer will be spending some time in the healthcare facility, then additional information can be obtained during routine nursing tasks such as bathing or assessing vital signs. Some healthcare agencies request that the literate consumer complete detailed health history forms on admission; in this instance, the nurse can validate the responses during the health history and save valuable time. In addition, information can often be obtained from prior medical records, and then checked and updated during the interview.

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PUTTING IT IN CONTEXT

UNIT 1

It is essential that health professionals ask the consumer whether he or she has a living will, an advance healthcare directive, and an enduring power of attorney for health care. These documents should be obtained from the consumer at the outset and incorporated into the healthcare record in a prominent place so they can be quickly referred to and immediately seen by other healthcare professionals. Many organisations have policies and processes around the use of advance health directives, which will need to be the basis for how staff interact with and use these documents (Figure 3.1).

For example, consider this for these two consumers:

> A 52-year-old man presenting with shortness of breath tells you he does not want to be

‘brought back to life’ if his breathing stops. He has had no medical history except major depression. No family members are present.

> An admitted consumer on the ward, a 91-year-old man with multiple life-limiting illnesses,

has stated to staff that he does not want resuscitation measures if his cardiac issues escalate. He goes into cardiac arrest the day after being admitted, and family members who are present tell you they want you to ‘do everything you can’ to resuscitate him.

Legal documents status

FIGURE 3.1 Advance Health Care Directive paperwork

General approach to the health history

1. Present with a professional appearance and demeanour.

2. Ensure an appropriate environment: for example, good lighting, comfortable

temperature, if possible, lack of noise and distractions, and most importantly adequate privacy. Refer to Chapter 2 for additional information.

3. Sit facing the consumer at eye level, with the consumer in a chair or on

a bed. Ensure that the consumer is as comfortable as possible because obtaining the health history can be a lengthy process.

4. Ask the consumer whether there are any questions about the interview before

it is started.

5. Avoid the use of medical jargon. Use terms the consumer can understand.

6. Reserve asking intimate and personal questions for when rapport is established,

and explain why you are collecting this information and how it will be stored.

7. Remain exible in obtaining the health history. It does not have to be obtained

in the exact order it is presented in this chapter or on organisational forms.

8. Remind the consumer that all information will be treated condentially

(keeping in mind the need for mandatory reporting requirements).

ALAMY STOCK PHOTO/PICTURELA KE

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IDENTIFYING INFORMATION

The consumer usually completes the identifying information prior to the actual physical examination.

Today’s date

Record the date and time that the health history is recorded. If the health history is not written immediately, document the time that the health history was taken and the time when it is recorded. In contexts where documentation is electronic, ensure you clearly identify when the health history was undertaken.

Demographic data

The following demographic data are usually requested for the consumer record:

1. Name

2. Address

3. Phone number

4. Date of birth

5. Birthplace

6. Occupation

7. Work address

8. Work phone number

9. Health insurance/Medicare number/Veteran Affairs/Community Services Card

10. Usual source of health care/Primary healthcare practitioner

11. Source of referral

12. Emergency contact.

THE COMPLETE HEALTH HISTORY ASSESSMENT TOOL

All elements of a complete health history are outlined in the following pages.

Figure3.2 provides an outline of the information needed for a complete health

history, which will be explained in more detail in this section.

CHAPTER 3

Source and reliability of information

Consumer proﬁle

Reason for seeking health care and chief complaint

Present health and history of the present illness

Past health history

Family health history

Social history

Health maintenance/promotion activities

Review of systems

FIGURE 3.2 The complete health history assessment tool

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UNIT 1

The consumer assessment may be recorded in handwriting. The format of recording may be dictated by your local context rules. In contexts where electronic or digital systems are used to record consumer information, tools or formats may already be embedded to collect this information. An example is the Queensland Health integrated electronic medical record (ieMR), which uses an SBAR (situation, background, assessment, recommendation) format (see

Figure 3.3). Additionally, in

Chapter 11 you can see a free-form medical record entered into an electronic medical record such as Medical Director, which is often found in primary care contexts.

FIGURE 3.3 A digital tool for collecting consumer health assessment information

Source and reliability of information

Usually the adult consumer is the historian (Figure 3.4). However, in some instances, such as trauma, the historian may be someone other than the consumer. Note the name of the historian as well as the relationship between the historian and the consumer.

FIGURE 3.4 The nurse needs to note the source of the consumer health history. When working with adult

consumers, the consumer is usually the historian.

ISTOCK.COM/FATCAMERA

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In addition, assess the reliability of the historian. Consider the mental state of the historian, because emotions and certain medical conditions can inuence the retelling of events. For example, the information provided by a consumer with severe Alzheimer’s disease may not be accurate. Note if an interpreter is used. (Pleaseensure you have considered if the consumer requires an interpreter and organise one where required.)

Consumer prole

The consumer prole provides demographics that may be linked to health status. Note the consumer’s age, gender and linked to these characteristics. Also note the consumer’s marital status, as this may provide clues to support systems. In some organisations national key performance indicators (KPIs) are linked to identifying Indigenous communities. For example, in Queensland (Australia), one KPI is linked to identifying consumers who are Australian Aboriginal, Torres Strait Islander and Pasika.

race, because many diseases are

Reason for seeking health care and chief complaint

The reason for seeking health care is the reason for the consumer’s visit and is usually focused on the specic problem. However, the experienced clinician will always assess opportunities for health promotion. Improving a person’s ability for self-care should always be a goal the clinician works towards with the consumer. The consumer may present with multiple

chief complaints for a single visit.

CHAPTER 3

EXAMPLES OF QUESTIONS TO ELICIT CONSUMER INFORMATION

> ‘What concern(s) bring you here today?’ or ‘What can I help you with today?’ > ‘How long has this condition been concerning you?’

Present health and history of the present illness

The history of the present illness is a chronological account of the consumer’s primary complaint and the events surrounding it. The chronology can be taken in one of two ways: from the current state of the problem back to its origin (reverse chronology), or from the origin of the symptom leading to the current status (forward chronology). Either approach is acceptable as long as it is consistent with subsequent documentation of chronological events. Usually, the consumer describes one or two signs or symptoms that are abnormal and their progression. Allow the consumer to give the detailed history without interruption where possible, and then ask questions if information is incomplete.

> ‘Describe the condition that you are experiencing from the earliest time that it

occurred to the present.’ (forward chronology)

Ten characteristics of each primary complaint can be ascertained for a completehistory:

1. Location

2. Radiation

3. Quality

4. Quantity

5. Associated signs and symptoms

6. Aggravating factors

7. Alleviating factors

8. Setting

9. Timing

10. Impact on quality of life.

Note that some primary complaints may not have all 10 qualiers; hoarseness, for example, may not be characterised by quantity. The primary complaint of abdominal pain will be used to demonstrate the use of these 10 characteristics.

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UNIT 1

Location

Location refers to the primary area where the symptom occurs or originates. You will want to take note of any changes to this description (if it does change) once you start the physical examination.

EXAMPLES OF QUESTIONS ASSESSING LOCATION

> ‘Where does your abdomen hurt? Can you point to the location of the pain?’ > ‘Is it in one location or is it spread out (diffuse or localised)?’ > ‘Have you ever experienced this type of abdominal pain before? When?’ > ‘Does this current pain differ from times you have had it in the past?’

Radiation

Radiation is the spreading of the symptom or other primary complaint from its original location to another part of the body. The areas of radiation can be diagnostic for specic pathologies.

EXAMPLES OF QUESTIONS ASSESSING RADIATION

> ‘Does the pain move to another part of your body? If so, where?’ > ‘Is the pain presently travelling to any other area?’ > ‘Describe how the pain feels in the area to which it radiated.’

Quality

The quality of the primary complaint describes the way it feels to the consumer. Use the consumer’s own terms to describe the quality of the primary complaint. For example, if the consumer is having difculty describing pain, suggest some quality terms such as gnawing, pounding, burning, stabbing, pinching, aching, throbbing and crushing.

EXAMPLES OF QUESTIONS ASSESSING QUALITY

> ‘What does the pain feel like?’ > ‘What word would you use to describe it?’ > ‘Is the pain deep or closer to the skin/surface?’

Quantity

Quantity depicts the severity, volume, number or extent of the primary complaint. The consumer may refer to the primary complaint with such terms as minor, moderate or severe, and small, medium or large. Although this terminology is important to the history, this information is subjective and is, therefore, difcult to quantify. If the consumer consistently uses the same terms, then a relative scale can be used to assess whether the primary complaint is improving or becoming worse as reported by the consumer.

Another mechanism that can be used to assess the quantity of pain is a numerical

scale, known as the Visual Analog Scale, which rates pain from 0 (no pain) to 10(worst pain possible). Refer to Chapter 6 for additional pain intensity scales.

EXAMPLES OF QUESTIONS ASSESSING QUANTITY OF PAIN

> ‘Using a scale of 0 to 10, where 0 is no pain and 10 is the worst pain that you can imagine, rate the

pain that you are having now.’

> ‘When was the last time that your pain was at this level?’ > ‘Has the severity of the pain changed? In what way?’ > ‘Has the pain interfered with your normal daily activities? How?’

Associated signs and symptoms

Rarely does a primary complaint occur without affecting other components of the involved system or another body system. Positive ndings are those associated manifestations that the consumer has experienced along with the

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primary complaint. Negative ndings, also called pertinent negatives, are those manifestations expected in the consumer with a suspected pathology but which are denied by the consumer. If the consumer does not mention specic signs or symptoms that might be present with a given illness, ask whether they are present. Document both positive ndings and pertinent negatives, because both give clues to the consumer’s condition. For example, a consumer with headaches may have nausea, vomiting and diaphoresis as positive associated manifestations. Photophobia and phonophobia are pertinent negatives because they might be present in a consumer with headaches but are absent in this consumer at this time; lack of these associated manifestations may lead to a different diagnosis.

EXAMPLES OF QUESTIONS ASSESSING ASSOCIATED SIGNS AND SYMPTOMS

> ‘Besides your abdominal pain, are you experiencing any additional symptoms? What are they?’ > ‘Have these symptoms occurred before? Do they always occur when you have this type of

abdominalpain?’

REFLECTION IN PRACTICE

Variety of alleviating factors

Remember that alleviating factors encompass more than pharmacological interventions. Youneed to keep in mind the multitude of treatments that consumers implement or seek out to relieve their discomfort. These include, but are not limited to, ice, heat, herbal supplements, exercise, animal-assisted therapy, magnet therapy, meridian therapy, yoga, massage, homeopathy, heat wraps, and other alternative and complementary medicine interventions. It is important to ask about these without judgement or advice when collecting the history. Ensure you collect information and assess the consumer before starting any education interventions, otherwise this may interfere with building rapport and fully exploring the consumer’s condition.

> What alleviating factors do you and your friends and family use?

> How effective are they?

> Do you use multiple factors together in certain circumstances to make them more effective?

CHAPTER 3

Aggravating factors

Those factors that worsen the severity of the primary complaint are the

aggravating factors.

EXAMPLE OF QUESTIONS ASSESSING AGGRAVATING FACTORS

> ‘Does anything make your pain worse? How long does this increase in pain last for?’

Alleviating factors

Alleviating factors are events that decrease the severity of the primary complaint.

EXAMPLES OF QUESTIONS ASSESSING ALLEVIATING FACTORS

> ‘Does anything decrease the severity of or relieve the pain?’ > ‘Has this worked in the past?’ > ‘How long did this improvement last for?’

Setting

The setting in which the primary complaint occurs can provide valuable information about the course of the history. The setting can be the actual physical environmentin which the consumer is located, the mental state of the consumer, or some activity inwhich the consumer was involved. The consumer may or may not be aware of anylink between the setting and the occurrence of the primary complaint. For instance, the odour of some chemicals can induce headaches in some individuals.

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30.08.202648 Мб0Книга_2652_Библиотеки_им_академика_М_И_Перельмана.pdf
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30.08.202647 Мб0Книга_2653_Библиотеки_им_академика_М_И_Перельмана.pdf
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30.08.202647 Мб0Книга_2654_Библиотеки_им_академика_М_И_Перельмана.pdf
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30.08.202647 Мб0Книга_2655_Библиотеки_им_академика_М_И_Перельмана.pdf
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30.08.202647 Мб0Книга_2656_Библиотеки_им_академика_М_И_Перельмана.pdf
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30.08.202646 Мб0Книга_2657_Библиотеки_им_академика_М_И_Перельмана.pdf
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30.08.202646 Мб0Книга_2658_Библиотеки_им_академика_М_И_Перельмана.pdf
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30.08.202645 Мб0Книга_2660_Библиотеки_им_академика_М_И_Перельмана.pdf
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30.08.202644 Мб0Книга_2662_Библиотеки_им_академика_М_И_Перельмана.pdf
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30.08.202643 Мб0Книга_2664_Библиотеки_им_академика_М_И_Перельмана.pdf