CLINICAL SKILLS LAB 2

RS-History taking.

Haneen Salahat.

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Clinical Skills Record 1 RS History

Skills:-
What is sign posting?
It is telling the patient what youre going to do.
Eg: Now I would like to ask you some questions
concerning your past medical history.
Negotiation of Agenda:-
A Plan of action within a given time.
Eg:- deciding that a patient needs an X-ray therefore
booking them an X-ray appointment, or deciding that he
only needs rest so you tell them to have some rest and
drink orange juice and soup etc.. btqayyem el 7aleh.
Some patients will tell you I have work so I cant stay in
bed for 5 days, therefore you change the treatment to a
more suitable one.
Non-verbal and verbal cues
- Non-verbal cues:- eg
patient looks in pain with
hands on stomach
- Verbal:- Ahhhh my
stomach hurts.
Respect
Active Listening
Screening:- Make sure that
you didnt miss anything, so
check systematically
Summarizing:- *Dont forget
this in the OSCE, in order to
do this you have to keep up

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 with the patient and not interrupt him, remember the key
words so that youll summarize his condition when hes
done.
Empathy:- Eg if patient tells you both parents died, My
deepest condolences..
Facilitation:- If the patient is thirsty you offer them a
drink, if the patient is limping you offer them a chair, etc..
Clarification ask a question so that you understand them
properly
Using simple language, no medical terms.
Logical order,
Patients perspective:- The patients view, which is
summarized with the word FIFE.
1- F - Feelings and concerns
2- I - Ideas:- Do you have an idea about the
symptoms you have or disease you have?,
some patients might think they have cancer for
example
3- F -Functionality, how does this affect your
daily life?
4- E - Expectations:- Dont ask, What do you
expect me to do for you? The patient will
think you dont know what youre doing, so
instead, ask, We know that you have and
that it affects your life in a certain way.. Do
you think that there is anything we can add to
your treatment that can benefit you more
from your perspective?

History:-

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 1- Patients profile:-
Name, age, gender (if necessary eg. Transgender patients),
address, occupation..
2- Mode of transportation:- How did you come to the
hospital/clinic today? Ambulance, walking, by car..
3- Chief complaint :- What brings you here today? Shu el
moshkeleh elli jabatak hon el youm? What bothers you
the most?
4- SOCRATES :-
S -site Can you point with your finger at where the pain
is?
O -onset How did it start, was it sudden or gradual? Faj2a
wella shway shway?
C -Character Describe the pain, is it burning, stabbing,
etc..?
R -Radiation Does it move? *If the pain goes/shifts from A
to B or *stays at A and goes to B extension, or *Form 3:-
Referred pain. For example:- Patients with appendicitis,
when they lift their leg theyll be in pain.
Determine whether the pain is visceral pain or superficial. Eg
when a patient comes in complaining of stomach ache, your
mind immediately goes to visceral problems, eg constipation or
diarrhea or a bacteria, but then he goes on to specify that hes
in pain when he walks or climbs the stairs or when he laughs
then youll know that the cause of the ache is actually a
problem with the muscles.

A -Associated symptoms, the patient has to tell you

themselves, dont start listing anything infront of him like
Do you have fever, diahrrea, vomiting..? because the
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 patient wants your empathy so he might say yes to all of
these things even though he doesnt have them.
*Be careful not to be too nice to the opposite gender
because youll be misunderstood.

T -Timing:- When does the pain start? At night or in the

morning? Is it episodic (meaning that it comes and goes),
is it throbbing?

E -Exacerbating and relieving factors: Does anything

make the pain worse or better? It goes when I drink
warm water, when I eat the pain becomes worse.
S -Severity On a scale of 1 to 10 where 1 is the lowest
and 10 is the worst pain, can you grade your pain? Note
that this is just an estimation.
5- Patients Perspective.

Respiratory system diseases and symptoms:-

The most frequent diseases that youll encounter:-

Asthma and COPD

o In both asthma and COPD, youll see coughing, although it
is more prominent in COPD patients.
o Wheezes are more accentuated in asthma patients. It
means an abnormal sound coming from the lung tissue
while breathing. If the abnormal sound is coming from the
throat then it is called stridor.
o Sputum is more prominent in COPD patients.

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 COPD patients:- their disease can manifest in two
presentations.
1- Patients with Emphysema can develop COPD.
In Emphysema there is destruction of the septa
between the alveoli forming bullae.
2- COPD
can also
be seen in
patients
with
chronic

bronchitis.
Pneumonia
- Is the inflammation of the lung.
- we expect to see:- fever, cough, sweating, dyspnea
difficulty breathing, hemoptysis coughing blood,
sputum, chest pain, nausea, vomiting, diarrhea,
fatigue.

Pulmonary Embolism:-
- Pulmonary embolism is the sudden blockage of a major
blood vessel (artery) in the lung, usually by a blood clot
- We expect to see:- chest pain, dyspnea, palpitations,
sweating, hemoptysis, fainting and anxiety, fainting.
o What is the difference between stress and anxiety?

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 Stress is a very general term, it may be mechanical,
physical, psychological, Anxiety is more nervous, not
angry, but there are emotions, hes worried. If there is
continuous chronic stress, this turns to anxiety.
Pneumothorax:-
- The presence of air in the pleural cavity
- Low blood pressure, anxiety, dyspnea, palpitations,
chest pain, breathlessness.

Pulmonary edema:-
- Accumulation of fluids in the lung tissue
- Dyspnea, orthopnea When patient lays down, the fluid
covers a larger area so the patient will be very
uncomfortable and cant breathe than compared to
standing because while standing the fluid is present only
down.,

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 -Paroxysmal Nocturnal Dyspnea:- Paroxysmal;- comes and
goes Nocturnal:- At night Dyspnea:- difficulty breathing.

- Wheezing:- Gasping for breath, feeling of suffocation and

drowning, anxiety, cough with frothy sputum air and water
and pressure, froth like espresso, weight gain and lower
limb edema because of Long-term (chronic) pulmonary
edema symptoms. ... Rapid weight gain when pulmonary
edema develops as a result of congestive heart failure, a
condition in which your heart pumps too little blood to meet
your body's needs. The weight gain is from buildup of fluid
in your body, especially in your legs.

Patients with cancer in Respiratory System:- Cough,

sputum, stridor.
Laryngeal tumors compress the vocal cords, resulting in a
change in your voice, such as sounding hoarse,

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 smokers, endotracheal tube, dyspnea due to tumor in
lung,
metastasis is when the tumor spreads from one site to
another, it might reach the lymph nodes, or the liver
resulting in jaundice the patient looks yellow because
the bile goes with the blood,
bone pain, headaches, numbness because the cancer
eats away at the nerves, seizures, muscle weakness,
dyspnea
*If a patient does not move his neck a lot, eg if he
works in marketing and stays in front of the monitor
all of the time, with time the there will be lack of
vascularity leading to tissue degeneration and
cartilages and this might affect a nerve, lets say in
on the left side and its muscles will undergo
hypotrophy so the muscles of his left arm will be
smaller than the muscles in the right arm.

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 Dyspnea:- the difficulty in breathing is graded
from:- Grade 1 til 5 and 5b
Grade 1:- The lightest form of dyspnea and
grade 5b is the most severe

Grade 1:- Breathless when hurrying up a slight

hill or walking on a level.
Grade 2:- breathlessness when walking with
people of the same age on flat ground.
Grade 3:- walks slower than peers or stops
when walking on a flat surface at own pace.
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 Grade 4: stops after a walking distance 100
meters or a few minutes on a flat level ground,
normal pace.
Grade 5:- too breathless to leave the house, eg
cant go to the market to buy something
outside the house
Grade 5b:- Cant do simple physical activity
inside the house.

Managing patients who are crying: -

- When we cry it is the result of hormones in our
body and these chemicals need some time to
dissolve. When a person is sad we normally tell
them to change their place or go outside and take a
breath of fresh air etc this is in order for the
stimulus to change and to give time for the
chemicals to dissolve.
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 1- Give them their time and space
2- You can ask them whats the problem after some
time, let them speak and actively listen to your
patients
3- Offer immediate practical support like tissues or
a drink of water.
4- Consider the use of physical touch if appropriate.
5- Active listening
6- Facilitate patients to verbalize problems and
emotions. Eg:- some patients need help when
telling you the story so you can give
them key words to help them go on
7- Express some empathy and give them moral
support.
8- Offer solutions
9- Offer support

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