History Taking

History Taking One of the most valuable opportunities to acquire clinical information that can contribute to the diagnostic process

Data Collection Process Objective data Signs that can be seen, heard or felt Includes laboratory reports Subjective data Perceived by the affected individual only Pain and its severity

Questioning Skills Open ended questions Facilitation Silence Probing Let the patient tell the story Facilitation Nod or say yes Okay, go on Silence Gives the patient time to remember Probing Provides more detail Repetition Clarifies information Summarization Verifies accuracy

Seven elements for a complete history Localization Exactly where does it hurt? Chronology How long ago did the injury happen? Quality Acute/chronic Crushing injury Severity Intensity of pain Onset When did it start? Aggravating factors What or when is the symptom aggravated Associated manifestations Do other symptoms accompany the chief complaint

1. Practice taking histories on our patient 2. Classwork

Safe Patient Movement

Base of support The feet and the space between the feet Standing w/ feet farther apart improves stability

Center of Gravity Gravitation forces appear to act from this point Moving heavy objects hold the object close to the center of gravity Center of gravity should be over base of support

Mobility muscles Stability muscles Found in limbs Have tendons and cross two or more joints Biceps hamstrings Stability muscles Found in the torso Provide postural support Abdomen/back muscles Use mobility muscles for lifting, postural muscles for support Lifting should be done by bending and straightening knees while keeping the back straight

Principles of Lifting Ask patient if they can move first Check chart for any restrictions Explain the transfer and execute it slowly enough for pt to feel secure Stand with feet apart Align pts center of gravity with yours Keep back stationary and let legs do lifting Avoid twisting

Be aware of orthostatic hypotension When blood pressure drops once a person stands from a recumbent position Dizziness, fainting, blurred vision, slurred speech Move slowly and ask how they are feeling throughout

Wheelchair Transfers Standby assist (let’s practice!) Pts transfer to table on their own Position wheelchair to 45°angle to table

Standby assist cont. Move footrests Lock wheelchair Tell pt to Sit on edge and push down on arms of chair Stand up slowly Reach out and hold onto table Give footstool if needed Turn slowly until you feel table behind you Hold onto table w both hands Sit down

Wheelchair Transfers Assisted standing pivot transfer (let’s practice!) Can bear weight on their legs Position wheelchair at 45° to table w/ pts stronger side closest to table Pt Sit on edge and push down on arms of chair Stand up slowly Technologist

Assisted standing pivot transfer Bend at your knees Keep back straight Grasp transfer belt or waist Place one foot outside the patients foot Place knee at the medial surface of pts knee

Assisted standing pivot transfer As pt rises, you rise also by straightening your knees

Assisted standing pivot transfer Both of you pivot toward table until pt can feel the table against the back of the thighs

Wheelchair Transfers Two-person lift Pt can not bear weight on lower extremities Stronger technologists lifts the patients torso while other person lifts the patients feet Technologist lifting torso gives directions

Two person lift Lock wheelchair Move armrests and leg rests Ask pt to cross his arms over chest Stronger technologist Stands behind pt, reaches under axillae, grasps pts crossed forearms Second technologist Squats in front of pt and cradles pts thighs and calves

Wheelchair Transfers Hydraulic Lift Techniques Patient is too heavy to lift

Hydraulic lift Pts sling attaches to the spreader bar by hoooks Hook the chain to the sling from inside out

Hydraulic lift Begin to raise the patient When the pt has cleared the seat, the wheelchair can be remove and pt can be positioned on table

Cart Transfers Roll pt onto his side away from direction of the transfer Place device in midpoint of back Roll the pt supine

Cart Transfers The draw sheet is gently pulled to move the patient onto the table. If necessary, the patient may be rolled again to remove the moving device.

Cart Transfers Cart-to-table transfer without a moving device. A, Begin by rolling up the draw sheet on both sides of the patient. B, The person directing the transfer supports the patient’s head and upper body from the far side of the radiographic table. An assistant supports the patient’s pelvic girdle from the cart side. A second assistant supports the patient’s legs from the tableside. The patient’s arms can be crossed over the chest to avoid injury or getting in the way.