How To Sign Kansas Banking Medical History

How to industry sign banking kansas medical history

[Music] hey guys what's up this is stephanie welcome back to my channel so in the video today i wanted to show you guys real quick on how to get a history from a patient something that they teach you in pa school specifically your didactic care and it's a really really important tool to use as a pa once you graduate and then also during your clinical rotation so it's really important that you know how to master these and how to ask the appropriate questions because one thing that pas are known for we're known for is getting good histories from patients okay so you want to make sure you get a good history from a patient because it can tell you so much about the diagnosis so it's really important that you get that so i wanted to discuss that for those of you that are interested you've probably seen my previous videos of when i started to learn how to get a history you probably saw those videos of when i was practicing with my classmates and now i do it so often that i feel like i've memorized it now and most of our oscars were required to get a history of course from a patient and make sure that we do it in the correct way so i feel like i have a little proficient in it not amazing but i feel like i am good at it definitely have to work on it and hopefully with years of experience that comes so hopefully this video is helpful for you guys for those of you who are wanting to pursue medicine wanting to pursue the pa career or currently in your didactic year or about to start your clinical rotations one thing i do have to say though is that you learn how to get a history in school right but you definitely do not use it sometimes or you don't ask all the questions when you are in your clinical rotations i notice this a lot especially if the physician or the preceptor that you're with has a lot of patients they don't go through all the questions that you were taught in school and that's okay you just want to make sure that you ask the pertinent questions and you're not rushing your history and you miss something from the patient so let's start with your hbis your history of present illness so a mnemonic that we learned in pa school is old cards o l c o-l-d-c-a-r-t-s and it's something that stuck with me and it's what i use basically what it means that you're gonna ask your o which is your onset you're gonna ask the patient when did the pain pain start so the patient presents with a chief complaint of abdominal pain you're gonna ask him when did it start where is it located because they can see abdominal pain but maybe it can be in the pelvic area for females you want to make sure that you rule out things like ovarian torsion okay or any of the emergencies like ectopic pregnancies so you want to ask them to afford location for males for example for abdominal pain it can even be something like testicular torsion so that's why it's really important that you ask him where you can even ask him can you point to the pain sometimes they tell you it's just like generalized so it's all over or sometimes they'll say it's here etc so you make sure you want to ask them the location d is for duration so how long has it been going on when did it start did this start yesterday has been going on for weeks for months so the duration's really important c is going to be further the character so what is the character of the pain is it throbbing is it stabbing is it burning does it radiate anywhere else does it just stay in that location like if the pain is in the right lower quadrant area does it radiate to the left lower quadrant area does it radiate to the back does it radiate to the shoulder there's a lot of things that you can diagnose when you ask them what is um the character a is for anything that aggravates it is there anything that makes it worse does it get worse when you eat fatty foods for example does the abdominal pain get worse when you're laying to pine so when you're laying down when you're laying on your side when you're doing certain things what aggravates what makes the pain worse r is going to be for relieves is there anything that relieves the pain okay is the pain relieved like when you're laying down is it relieved when you stop breathing okay is it relieved with any type of medication that you tried have you tried anything for it like over-the-counter maybe nsaids acetaminophen aspirin etc and then you have your treatment so this is a treatment have you taken anything for the pain and if you have has it worked how much did you take and when was the last time you took it okay and then symptoms s so what other symptoms is the patient complaining of is the patient also having nausea are you having nausea are you having vomiting okay are you having trouble going to the restroom any diarrhea any constipation have you noticed any blood etc so ask them what other symptoms are associated with their abdominal pain so this is your old cards this is your history present illness o-l-d-c-a-r-t-s this is a mnemonic so feel free to use it i know there's multiple mnemonics and if you have any feel free to comment below and let us know what other mnemonics you can use but old karts is the one i use okay so once we've gotten the hpi then you're gonna move on to your past medical history a mnemonic i memorized for this was your a history okay a-h-i-s-t-o-r-y it's what i use you're gonna ask him for a allergies do you have any allergies to no medications maybe the abdominal pain is because they just started a new mitigation okay h history i mean hospitalizations have they ever been hospitalized before did they ever have some type of abdominal surgery in the past this can help you rule out so many things maybe the patient might be having some type of bowel obstruction right and what is the number one cause of bowel obstructions adhesions from a previous surgery so that's why you want to make sure that you ask them if they've ever had if they ever had if they've ever been hospitalized in the past for anything maybe pancreatitis maybe even maybe the patient was hospitalized in the past pancreatitis i is you're gonna ask him for any major medical illnesses that may have they may have so maybe if they have diabetes and history of pancreatitis like i mentioned if they have hypertension okay uh cancers etc s it's going to be your surgeries i know much mentioned in hospitalization sometimes when you ask hospitalization patients will tell you about their surgeries but s is going to be for surgery so make sure you ask if they've had any type of surgeries in the past t is going to be for trauma have they ever had any trauma in the past like a motor vehicle accident a major fall that required hospitalization and then you're gonna ask oh okay are they currently taking any prescribed medications by their doctors if they're diabetic are they taking any medications like metformin insulin hypertensive are they taking any medications for their hypertension some of these medications may have side effects of abdominal pain specifically antibiotics right antibiotics deplete all your good abdominal flora and we want to watch out for things like c difficile right clostridium difficile which is really really bad diarrhea and this is something that needs to be treated quickly because the patient can die so i'm going to make sure you ask them if they're taking any antibiotics so we are a a h ist okay oh it's over the counter medications or prescribed medications and then we have r so r i usually ask them if they have any problems uh reproductively for example um if they've tried having children in the past and they haven't been able to do so this is important like i said for a woman because it might the abdominal pain might be related to their ovaries maybe the woman has ovarian cysts a history of fibroids etc for the male maybe they have problems with their testicles etc and then why is a yearly exams are they up to due date with their yearly exams for example for the woman do they have their breast exams regularly when was the last time that they had their breast exams what was the last time they had a wellness example an entire physical and then i'm sorry guys one thing i forgot for i aside for major illnesses you want to ask them if they're up to date with their immunizations okay so if they're older like if say if they're older than 60 or 65 ask them if they've had maybe like their varicella their zoster virus i shot if they've had their pneumococcal shot etc so this is their past medical history and then you can move on to your their family medical history family medical history is basically a history asking them about their family and when you ask the patient about their family medical history you want to make sure that you ask them specifically about members that are close to them so not their diaz or theos or uncles you want to ask them for their parents their grandparents their siblings and their children and that's it are there any illnesses that run in your family any major medical illnesses like diabetes any certain cancers like colon cancer breast cancer ovarian cancer also are there any genetic abnormalities that run in your family like downstream syndrome you also want to ask if there's any history of alcohol abuse in the family or smoking or drug abuse and then you also want to ask them if for example the mother or the grandmother did have a certain cancer you want to ask them what age were they diagnosed at um have they passed away from the disease are they currently alive or not also other questions that you can ask him is definitely ask him if there's any psychiatric illnesses that run in the family since a lot of psychiatric illnesses do have genetic correlations like for example bipolar disease schizophrenia so make sure that you ask these questions also and then after that you can go on to their social history so basically social history is learning a little bit more about the patient you want to ask them who they live with are they currently employed and if they and if they do live where do they live with do they have any children are they married are they currently sexually active if they are sexually active who are they sexually active with is it just a single partner is it multiple partner is it with a male or a female you also want to ask them if they use protection and if they say they don't use protection you can ask them why they don't use protection sometimes on the younger patients you can educate them on the importance of using protection right you can prevent a lot of stds and unwanted pregnancies you can also ask the patients if they smoke ask them if they drink if they do drink ask them how often they drink and ask them how much do they drink and what they drink if you do feel like it's a problem then definitely you can ask them the cage questions right and then you can also ask them if they do any illicit drug use i would also include asking them do you smoke marijuana because sometimes they won't tell you that they smoke marijuana if you only say illicit drug use also you want to ask them what's their occupation like what do they do are they stay-at-home moms do are they teachers do they work for example in construction this can tell you a lot specifically for example if a patient comes in complaining of like lung problems and they tell you that they're the construction worker or they work in the mines then they can tell you a lot and maybe help you through a differential diagnosis you can also ask them about the nutrition so what is this what do you eat can you tell me what you eat daily how often do you eat do you drink a lot of water what do you eat is it fast food is it do you have your portions of nutrition etc you also can ask them if they exercise and then how often they exercise and then what do they do to exercise also and then finally you want to do your review of some system so basically your review systems is that you ask them questions pertaining to the cheap complaint right so if a patient comes in with abdominal pains you're not gonna ask them a question about psychological right you're gonna you're not gonna ask them if they've felt like they're angry or or if they had for example suicide or homicidal thoughts for abdominal pain that's something you wouldn't ask that do and a patient has abdominal pain you definitely are going to ask questions for their gi so you would ask them questions like do you have any nausea vomiting have you noticed any blood in your stool do you have diarrhea do you have constipation um do you have tenesmus so basically like an urgency to go to the restroom and you're not going to the restroom other questions that you can ask them is have they noticed that they have trouble swallowing or painful swallowing do they have floating so these are questions that are so associated with your gi right so make sure that you're always asking your general questions review symptoms systems so your general questions is uh do you have any fever do you have any chills have you noticed any night sweats any change in your appetite whether it's increase or decrease have you noticed a weight change have you noticed any weight loss or weight gain any weakness fatigue malaise so these are general questions that are usually common in a lot of complaints that the patient's going to come in and usually your exam starts from the moment that the patient comes into the door so if you have a patient that's complaining of abdominal pain and you see them on their phone then you know it's probably not something extremely severe or emergent that requires an emergency so if a patient comes in they're complaining abdominal pain they're on their phone they have a huge coke and they're drinking i mean it must not be that severe versus you another patient that comes in you see them and they're like profusely sweating they look pale uh you look at their conjunctiva and it's yellow you you see them and they have like they're extremely bloated then you're like that's something more severe right so that's why your exam starts from the minute that you walk in through the door you can also do other questions for example review systems that you can do is if a patient comes in complaining of an eric right you're going to do your h-e-e-n-t exam review systems you're going to ask them well do you have an earache have you noticed any hearing losses any vertigo or dizziness have you noticed any nasal drainage okay any itchy eyes any sore throats like trouble swallowing you can also notice ask them if they've had any hoarseness for their eyes any red eyes any discharge from their eyes any hair loss signs problems and then for respiratory if a patient comes in with shortness of breath then you can ask them are they experiencing any cough and if they do have a cough are they having any sputum so is there productive cough and if it is a productive cough what is the color of the surger is it red does it have blood is it green is it yellow is it clear and if it's not productive cough then not productive is usually not going to have anything right and then other questions that you can ask them is if they have any difficulty breathing okay and if they have any wheezing uh dyspnea so painful breathing also and if it's a patient that's coming in with anything that's cardiac related if they're having chest pain ask them if they're having any palpitations also if a patient comes in that's anything vascular say that they have pain in their calves you want to roll out things like a dvt so you want to ask them if they notice any edema so has the cap been inflamed have they noticed any claudication so basically they have pain whenever they're walking and then if a patient comes in and you might suspect like a uti then you would ask them some gu questions right you ask them frequency so how often do they go the restroom do they feel like they have to go all the time do they have any painful urination have they noticed any blood in their urine have they noticed an increased smell of the urine like it's more foul it's more uh it's more smellier than it usually is okay you also want to ask them about the color of their urine is it a dark color is it a clear color ask them if they are urinating a lot at night so nocturia and then for the general track if it's anything related to the genita like a cds for males and females you're to ask different questions right if it's a male you're going to ask them if they have any penile discharge any genital lesions if they have any testicular swelling or pain for females any vaginal discharge any vaginal bleeding and then if they do have discharge what is the color of the discharge is it thick what's the consistency and if they have any pelvic pain any pelvic masses if they have any changes in the libido so in their if they feel like they're less sexually active or more sexually active and if a patient comes in for something that you might think it might be endocrine related like hypo or hyperthyroidism then you're gonna ask them questions like do you have any hot or cold intolerance have you noticed any hair loss have you noticed any abnormal menstrual bleeding you're eating more you're bleeding less have you noticed that you're very thirsty or you're very hungry you've noticed any weight loss or weight gain okay any palpitations and anything that's related with the blood so hematologic you can ask questions like have you noticed any unexplained bruising since this can tell you whether there's something wrong with the platelets maybe have they have you noticed any pica symptoms so basically are you having cravings for dirt okay tingling sensations numbness paritis so itchiness any power that you've noticed that you're very very pale or other people tell you that you're pale if the patient's coming in for anything that's related to the skin you can ask them when they notice the skin lesion have they noticed that it's been increasing or decreasing in size have they started any new products like any lotions any shampoos any new makeups for example have you noticed also if the patient is complaining of a mole has them all changed has an increase in size decrease in size for the rash ask them if they've noticed any new rashes if it's itchy okay for the bites ask them when they noticed it where were they definitely ask them for a rash you want to ask them where were they when they notice a rash so this is something i want to keep in mind i know when i was working with a doctor she was telling me that she used to live in an area where there was no ticks and she kept getting the diagnosis is wrong because she kept forgetting about the tick related diseases right so you have your rocky mountain spotted fever and then you have your lyme disease and this presents with a rash so that's why you want to make sure that you ask the patient what were they doing were they outside were they maybe hiking or were they hiking etc so musculoskeletal symptoms so if a patient comes in with a sprained ankle you're going to ask them if it's painful if they notice any stiffness a decreased range of motion any swelling if the patient comes in with anything that's neurological and maybe like a patient's having a stroke you want to ask them if they had for example a headache um you can ask them things like if they have a history of seizures any numbness or tingling weakness any visual changes or disturbances if they have any asymmetrical symptoms cranial nerve abnormalities and psychological okay so for psychological for psychiatry it's a completely different type of questions that you ask you're going to ask in regards to your hpi and your past medical history it's completely different and i'll probably make a video on that later and some of the questions you're going to ask for anything that's psychological you're going to ask them whether they've noticed that they're hyper vigilant hyper-emotional whether they've noticed that they're having hallucinations are they seeing things that aren't there are they hearing voices okay are they feeling things that aren't there like do they feel like they have spiders you gonna ask them if they feel angry do they have any mood swings have they felt like they're extremely depressed anxious had they had trouble sleeping how do they sleep more do they sleep less do they have any thoughts wanting to harm themselves or any thoughts of going to harm someone else and yeah these are basically how you do a medical interview so hopefully this video was helpful for you guys and of course when you start with the patient you want to make sure that you knock on the door you introduce yourself hi my name is for example stephanie in my case i'm a physician assistant student i will be seeing you today and i just want to ask for your permission to see you today if that's okay say yes most patients will be okay with you seeing them uh during your clinical year but sometimes i want to see the doctor and the student but most of the i don't think i've had that ever yet happened to me and then you want to verify their cheap complaint there's been cases where i talked to patients and they were coming in for abdominal pain and it was something related to an std so you would go in hi my name is stephanie i'm a physician assistant student i will be seeing you today i just want to ask you a permission is that okay okay i just want to verify this is your name and your date of birth okay hi miss etc miss chavez for example i see that you're coming in for abdominal pain can you tell me a little bit more about that and sometimes they'll be like well i'm not coming in for abdominal pain i'm coming for something else so that's why you want to make sure that you always verify that you complain all right guys i hope this video was helpful for you for those of you who are about to start clinical rotations about to start your didactic year in ps4 or just want to know how to do a medical examination with patient like i said it's really important that you take your time and you ask your patients what's going on you don't want to rush it because there's so many things like i discussed that they can tell you in just a medical examination with just getting a history with them talking to them asking them and just digging you're basically like a detective right you're wanting to know and find more clues to the reason why the patient is coming in alright guys i hope this video was helpful for you guys and i'll talk to you later bye