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What is the importance of the interview?
Information gathering
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"CC"
Chief Complaint (i.e. patient states "..."; said "...")
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"O"
Onset (i.e. How it started? When it started? What started it? Where it started? Better over time? Worse over time?
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"P"
Palliative & Provocative (i.e. What makes it better? What makes it worse?)
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"Q"
Quality (i.e. "Describe your pain.")
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"R"
Referral (i.e. "Does the pain travel?")
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"S"
Severity (i.e. On a scale of 0-10, 0 being no pain and 10 being most pain, What do you feel right now? When is it better? When is it worse?)
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"T"
Temporal (i.e. Does weather / climate affect your pain? What time of day is it best / worst?)
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Medical History
- Did you have a similar problem in the past?
- If "yes" then When was it treated? How was it treated? Where did you treat it? Results of treatment? How often treated? When were you diagnosies with condition?
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Family History
- Does anyone in your family have this condition?
- Any other conditions in the the family I need to know about?
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Social History
- Is your work life stressful?
- Is you non-work life stressful?
- Do you smoke? drink? do drugs? exercise? diet?
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What does SOAP stand for?
- Subjective (what they feel - Patient States "...")
- Objective (What practitioner observes)
- Assessment (Subjective + Objective)
- Plan (Advise patient to ...)
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What are the key words that need to be said it a new patient asks "What is Acupuncture?"
- Show them on type of Needle (the smaller the better)
- Q: "Will it hurt?"
- A: You may feel a slight prick.
- Balance
- Energy
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Before you start treatment, what is the first thing you ask?
Do you need to go to the bathroom?
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After you insert needles, what is the first thing you tell them?
Try not to move.
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When asking about sleep, what other questions are important to ask that are not found on "10 Question"?
- Quality of Sleep?
- Do you feel rested?
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When asking about appetite, what other questions are important to ask that are not found on "10 Questions"?
- What do you eat?
- When do you eat?
- How much do you eat?
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When asking about urination, what other questions are important to ask that are not found on "10 Question"?
- How much are you drinking? How oftern do you go?
- Any strage odor?
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When asking about Menses, what atre other questions to ask that are not found on "10 Questions"?
- Last Menses?
- Would this be your first pregnancy?
- Any problems with previous pregnancies?
- Could you be pregnant?
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What is a good general question when facing any condition?
How long has it been like this?
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What is the difference between Denial and Repression?
- Denial - intentional / conscious blocking out of memories
- Repression - unintentional blocking out of memories
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Patients who are sick usually become less effective in the world. It compromises their ability to work. Loss of self-esteem and a loss sense of value in the world.
Threat of Efficacy
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Illness or hospitalization generates the fear of separation from people who are loved and are perceived as needed for comfort and support.
Threat of Separation
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Fear that illness will make them unattractive or unlovable.
Threat of Loss of Love
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Illness often leads to urinary or fecal incontinence. This is usually embarrassing and terrifying. It makes one feel like a baby, a sense of helplessness.
Threat of Loss of Bodily function
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Illness often compromises mental and cognitive functioning. Fear of going crazy is a terrifying experience and patients may not realize that this cognitive loss is commonly associated with many physical illnesses and treatments.
Threat of Loss of Rationality
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Patients are in general afraid of pain and do not want to suffer
Threat of Pain
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Become more child-like and has increase physical and emotional dependency during illness. Good in that the patient will do what the doctor says without question.
Regression
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When a patient pushes the idea of the illness out of their mind, and manages to not think about it
Denial
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When the thoughts are still on the borders of consciousness, but the patient is able to divert his or her attention from the problem for a short periods of time
Suppression
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The unintentional movement of a thought from consciousness to unconsciousness
Repression
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The subjective experience of dread and fear. it can be experienced by patients as a state of fearfulness, but it can also have somatic manifestations and influence the course of the primary physical illness itself (i.e palpitations, GI hyper motility, sweating, sleeplessness)
Anxiety
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Patients wonder "Why me?". Many patients fell a generalized anger that cannot be focused on any one particular idea or person. When this occurs, they often lash out unexpectedly and seemingly without good reason at all or at any person around them.
Anger
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Chronic illness usually lead to many losses; work function, leisure pleasures, physical pleasures, relationships, etc. The most common and expected emotional reaction to loss. It is not a the same as persistent major depression.
Sadness
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Emotions that interfere with a patient's quality of life or overall functioning
Maladaptive reactions
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It can become serious when it is so persistent and offensive that the patient alienates the people he or she needs most for physical and emotional support. The patient can be so unpleasant that nurses and doctors stay away. In addition, the anger may actually cover up underlying fear. The patient may be in need of reassurance and emotional support, but his or her anger could lead to withdrawal of support when it is most needed.
Persistent anger
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Emotional response to a stressful life event that is stronger and more persistent than the reaction that would be expected in most individuals.
Depressed Mood
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A syndromal set of signs and symptoms including at least 2 weeks of persistent unhappiness or pervasive loss of interest or pleasure
Major Depression
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6 months of significant autonomic arousal and fearful behavior toward the environment. Interferes with the coping process as well as with physical recovery.
Anxiety Disorders
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Patient that finds it difficult to go through life without assistance. Needs steady emotional support. When this support is not delivered, the patients may feel deserted, hurt, and angry and demand even more assistance.
Dependent Patients
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