Introduction to Therapeutic Services

1. Introduction to Therapeutic Services

2. What is Therapeutic Services? • treatment of a clinical nature deliberately performed to regulate or stop disease and sustain healthy tissues.

3. What are some of the professions in Therapeutic Services? • Physician Nurse Practitioner • Nurse Nurse Anesthetist • Physical Therapist Physician Assistant • Pharmacist • Nutritionist • Occupational Therapist

4. Healthcare Providers • Care for patients to have the optimal quality of life (Whatever it is)

5. History & Physical • End of the year, each person will perform a H & P on a patient. • What is a History & Physical??

6. History & Physical • Purpose—obtain subjective patient • information • – Combined with physical exam findings and • lab data • • Allows for current health status evaluation

7. Components of a H & P • • Chief Complaint (CC) • • History of present illness (HPI) • • Past medical history (PMH) • • Family history (FH) • • Social history (SH) • • Review of systems (ROS) • • Medication history

8. Chief Complaint • Why is the patient seeking medical care?

9. Past Medical History • Listing of the patient’s past (& ongoing) • medical problems (conditions) • • Surgeries and procedures • • Descriptors when possible • – Date • – Duration

10. Health History • Family History • • Presence/absence of • illness 1st degree • relatives • • Typical interest • – Cardiac, HTN, diabetes, • cholesterol, cancer, • osteoporosis, mental • illness • • F↓58(MI) M↓70(CVA) • B↑64(HTN,DM) • Social History • • Education • • Employment • • Marital status • • Living condition • • Exercise • • Nutrition • • Substance use • – Caffeine, ETOH, • Tobacco, Illicit/Rx

11. Review of Systems • Generalized or medication specific • • Patient symptoms per body system • • Purpose: identify symptoms or • conditions missed by CC, HPI and PMH

12. Medication History • EVERY medication that the patient takes • Prescription • OTC • • Instruct patients to bring everything • – Give examples • • OTCs, herbal/home, eye drops, inhaled • medicines, creams/ointments, etc. • – List is good, but actual meds better • – If pillbox used (see both)

13. Medications • – Name • – Dose • – Directions • • Label • • Actual • – Duration • – Perceived Efficacy • – Perceived Side • Effects • – Value/necessity • History • – Allergies vs. intolerances • – Therapeutic failures • – Recent changes • • Dose or directions • – Recent additions • – Recent • discontinuations • Signed consent • – Refill records • – Medical/lab information

14. Important Terminology for Healthcare Providers • Co-morbidity - coexistence of two or more disease processes (medicinenet.com) • What are some co-morbidity diseases? • Co-morbidities are listed in the H & P

15. Patient Interview • Patient Interview Setting • • Comfortable • – Temperature • • Lighting • • Quiet • • Clean & organized • • Privacy • • Good • communication • techniques

16. QUESTIONING • Most often used by clinical interviewers • patient is asked direct questions in areas determined by interviewer • questioning may be open or closed ended • Direct questions usually begin with now, what, and why • Closed-short answers, become "regressive" • Open-"how does it make you feel" • newer clinicians use direct questioning

17. Reflection • requires interviewer to skillfully restate the patients cognitive or emotional material demonstrate to the patient that their feelings

18. Restatement (paraphrasing) • rephrase what client said in clearer or more articulate terms lets the patient know you are paying attention differs from reflection - to facilitate understanding or for clarification (reflection is type of intervention)

19. Clarification • usually done by using one of the other techniques (questioning, paraphrasing, restating) • purpose is to provide understanding of the client in the interview rarely evokes defensiveness

20. Skills to be learned • Patient Transfers • Patient interviewing skills • Making a bed

21. Project • Healthcare profession exhibit/Board

22. References • http://www.eduers.com/resume/Clinical_Interview_Techniques.htm • www.historyandphysicals.com