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What is the process of clinical reasoning?
Assessment & plan
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What is the record of Mrs. N & the challenges of clinical data?
Recording your findings
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What is the checklist for a clear & accurate record?
Recording your findings
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What is the integration of clinical reasoning, assessment, and analysis of clinical evidence?
Lifelong learning
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What is the information gathered in the health history from the patient or family termed?
Subjective data
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What is the information gathered in the health history from the physical examination & lab tests termed?
Objective data
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What are the appropriate steps in identifying problems & making your diagnoses?
- Identify abnormal findings
- Localize findings anatomically
- Interpret findings
- Make hypotheses
- Test hypotheses
- Develop plan that patient agrees
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When generating the problem list, how do you make the list?
List most active & serious problems first while recording their date of onset
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What are the challenges that you will face when dealing with clinical data?
- Clustering data into single vs multiple problems
- Sifting through an extensive array of data
- Assessing the quality of data
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What is one of the most important adjuncts to patient care?
Clear, well-organized clinical record
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What should your goal be as a clinician when recording your findings?
To report a clear, concise but comprehensive report that documents key findings of patient assessment & communicates patients problems in a succint & legible format
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What are some tips for ensuring the quality of patient data?
- Open-ended questions
- Systematic sequence
- Open mind to patient
- Worst-case scenario
- Analyze data
- Confer w/colleagues
- Apply principles of data analysis
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Describe the acronym "SnNout"
Sensitivity of sympton is high, Negative response rules out target disorder
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Describe the acronym "SpPin"
Specificity is high, positive test result rules in target disorder
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What are the interviewing milestones that you as a clinician need to know?
- Approach
- Sequence
- Building Relationship
- Adapting to specific situations
- Sensitive topics
- Societal Aspects
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Why is self-reflection important for professional development in clinical work?
It brings a deepening personal awareness to our work w/patients
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How should the clinician get ready for the interview or approach be?
- Self-reflection
- Review record
- Setting goals
- Review their clinical behavior/appearance
- Adjusting environment
- Take notes
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How should the sequence for the interview be carried out?
- Greet & establish rapport w/patient
- Establish agenda
- Inviting to patient's story
- Notice emotional cues
- Expand/clarify story
- Hypotheses testing
- Shared understanding of problem
- Plan
- Follow-up/closing
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What is an appropriate response technique for responding to emotional cues?
- NURS
- Naming-sounds like a scary exp
- Understand-its understandable that you feel that way
- Respecting-you've done better than most people would with this
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What are the 7 attributes of a sympton?
- Location
- Quality
- Quantitiy/severity
- Timing
- Setting in which it occurs
- Remitting or exacerbating factors
- Associated maifestations
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When asking the patient about the location of sympton what do you want to know?
- Where is it?
- Does it radiate?
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When asking the patient about the quality of sympton what do you want to know?
What is it like?
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When asking the patient about the quantity or serverity of a sympton what do you want to know?
How bad is it using a scale of 0-10
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When asking the patient about the timing of a symptom it is important to note what?
- When did it start?
- How long it lasts?
- How often does it come?
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When asking the patient about setting in which symptoms occurs note what?
- Environmental
- Personal activities
- Emotional reactions
- Circumstances that may contribute
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When asking the patient about exacerbating factors what is important to note?
What makes it feel better or worse?
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When asking the patient about associated manifestations of a symptom note what?
If anything else accompanies it
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What is important to note when exploring the patients perspective?
- Feelings
- Ideas
- Function
- Expectations
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What are the techniques of skilled interviewing?
- Active listening
- Guided questioning
- Nonverbal communication
- Empathic responses
- Validation
- Reassurance
- Partnering
- Summarization
- Transitions
- Empowering patient
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Guided questioning: options for expanding & clarifying patient's story is done how?
- Open-ended to focused questions
- Questions that elicit graded resp
- Series of questions-1 at time
- Multiple choices for answers
- Clarifying
- Encourage
- Echoing
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How can you empower the patient that shows principles of sharing power?
- Patient's perspective
- Show interest in person
- Follow their lead
- Emotional content
- Share information at transition points
- Clinical reasoning transparent
- Reveal limits of your knowledge
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What are the general guidelines for broaching sensitive topics?
- Nonjudgmental
- Explain why you need certain info
- Opening questions
- Consciously acknowledge whatever discomforts you are feeling
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When asking about sexual hx what general questions should you ask?
- Last time you had intimate contact
- Sex w/men, women, or both
- Number of partners in last 6 mo's
- Concerns about HIV or AIDS
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The CAGE questionnaire is helpful when dealing with what types of questions?
Alcohol & Drugs
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Cage represents what?
- Cut down
- Annoyed by criticsm
- Guilty
- Eye opener
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A good question for opening the lines of communication concerning illicit drugs?
Have you ever used any drugs other than those required for medical reasons
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What are some possible clues to possible physical abuse?
- Unexplained injuries
- Delayed treatment
- Repeated injuries or accidents
- Alcohol or drug abuse
- Partner dominates interview
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What are the 3 dimensions of cultural humility?
- Self-awareness
- Respectful communication
- Collaborative partnerships
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What are the 4 building blocks of professional ethics in patient care?
- Nonmaleficence
- Beneficence
- Automonomy
- Confidentiallity
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What are the tavistock principles?
- Rights
- Balance
- Comprehensiveness
- Cooperation
- Improvement
- Safety
- Openness
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