Interview of the cardiopulmonary patient: What questions do you ask?

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Interview of the cardiopulmonary patient What
questions do you ask?

• By Elizabeth Kelley Buzbee AAS RRT-NPS, RCP
• Kingwood College Respiratory Care Program
• RSPT 1429

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Why are you here?

• What are the signs symptoms s /s that brought
  you into the institution?
• Is this a chronic problem with an acute
  manifestation exacerbation?

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Who are you?

• Basic demographics
• Age/sex/race/national origin/religion
• Marital status?
• Occupation/hobbies?

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Discuss the history of the recent illness

• When did you get first signs symptoms s/s?
• How fast did you get sick?
• What events triggered this illness?
• What did you do for this?

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Describe cough/sputum

• Amount? How often? triggers?
• Do you cough a lot at night or in the morning.
• Do you have a dry cough?
• Is there blood if so, bright red, bubbles
• old dark blood?
• How much blood? Teaspoon, streaks in the sputum,
  clots.

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More on cough

• Is the cough recurrent keeps coming back?
• Is the cough effective or is the patient too weak
  to bring up anything?
• Is the cough associated with eating or drinking?
• Is there a history of choking, reflux, heartburn
  sour stomach
• Is there a history of post nasal drip, nasal
  congestion?

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More on sputum

• Sputum is mucous from deep in the lungs. It
  should not be confused with nasal secretions or
  spit from the mouth.
• Normal sputum is watery, clear, looks like raw
  egg white. Small amount.
• Black or brown sputum is associated with smoke or
  inhaled coal dust
• Frothy, pink is associated with pulmonary edema
• Thick, colored sputum is associated with various
  infections
• Blood streaked, bloody or frank blood is
  associated with pulmonary bleeding that could be
  due to TB or cancer

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Get the details of this patients symptoms

• If pain
• when, how long does it last and where on the
  body?
• Rate pain from 10 most extreme to 1 mildest.
• What triggered the pain what makes it go away?
• If shortness of breath
• When, how long does it last and what triggered
  SOB.
• Is it associated with cough? Body position? Chest
  pain?
• Rate SOB from 10 to 1
• Is SOB associated with blue or grey lips or nail
  beds
• How many stairs can you climb before getting SOB
• How many steps can you take before getting SOB

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Get the details of this patients symptoms

• If swelling
• Is swelling worse at night or during the day.
• Is it associated with SOB or chest tightness?
• Is swelling in the feet or legs?
• Is the abdomen swollen?

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Get the details of this patients symptoms

• Do you get chest palpations feelings like your
  heart is turning over in your chest
• Do you feel like your heart is beating too hard
  or too fast?
• Is it associated with swelling or SOB?
• Do you have hypertension high blood pressure
• Do you take medicine for hypertension?

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Get the details of this patients symptoms

• How about sleep
• Do symtoms interfere with sleep?
• Does spouse complain about sudden arousals or
  snoring?
• Night sweats?
• Wake up with headaches?
• Extra-sleepiness during the daytime
• How about appetite
• Do you get SOB with meals
• Have you unexplained weight loss?
• Do you have reflux
• Do you choke easily

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Past medical history

• Have you been diagnosed with any type of
  pulmonary lung disease?
• Did you have allergies or asthma as a child?
• Have you been diagnosed with any type of cardiac
  heart disease?
• Have you been diagnosed with any type of
  neurological or neuromuscular disease?
• Do you have hypertension high blood pressure
• Do you have allergies?
• Up-to-date on immunizations?

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Recent exposures

• Have you traveled out of the country?
• Have you recently traveled to san Joaquin valley
  or to Mississippi River area?
• Have you been exposed to chemicals or smokehouse
  fire, toxic spill?
• Has your house flooded? Located near freeway or
  factories?
• have you been outside in the weather, mold, mowed
  the grass recently, BBQ smoke

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Family medical history

• From what diseases did parents/grandparents/siblin
  gs/uncles/aunts/cousins die?
• At what age did they die?
• Is there a family history of heart disease, or
  lung disease.
• Is there a family history of neurological or
  neuromuscular disorders?

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History of surgeries

• Ask approximate dates and types of any surgical
  procedures this patient has had in the past.
• Ask about complications
• Ask about earlier hospitalizations.
• Admission to the ICU.
• Been on a mechanical ventilator?

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Drug history

• What OTC or prescription drugs is this patient
• taking and for what?
• If patient is taking drugs for pulmonary problems
  
• ask about compliance with treatment.
• Ask about drinking, recreational drug use.
  Needles? Snorting? Pills?
• Discuss your smoking history. How many packs of
  cigarettes for how many years. Pack/years
• If patient says he quit ask when?
• Does patient take inhalers at home discuss
  technique
• Does patient take nebulized medication at home
  discuss technique of cleaning equipment
• Does patient have home oxygen?

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Psychosocial

• Is the disease affecting mood?
• Would this patient describe himself as
• happy, content, unhappy, depressed?
• Is disease affecting patients ability to
• leave the house? go to store? go to church?
• Is there a good support system at
  home/church/support groups for disease?
• Does this patient live alone?