Gelelim ikinci kisima:

ABUSE:

SAFE GUARD:
Safety
Afraid??
Family&friends aware?
Emergency plan?
Guns at home?
Alcohol?
Relationships with partner?
Drugs/depression


PSYCHIATRIC

1- How do you feel?
Since when?
Constant? Daytime-night effect?
Is there a specific reason/any recent financial, emotional problems

2- SIG E CAPS
sleep
interest
guilt/worthlessness
energy level/can you make it to work?
Concentration/memory
Appetite/weight loss
Psychomotor/ daily routine effected?/ functions, activities changed?
Suicide/homocide intentions?

3- plans for future/ feelings of hopelessness

4- hallucination/delusion/paranoia
do you hear or see things that others don’t
do you have thoughts that others find unrealistic
do you feel as if other people are trying to harm or control you

5- hows you relationship with friends/family/work

6- Thyroid questioning!!

7- FH: anyone having similar experiences in the family

8- SH: ETOH/drugs!!! (always consider intoxication)


PEDIATRIC

HPI (history of present illness)
PMH
any serious illness, any previous episodes
medication
allergy
hospital, trauma, surgery

FH
any serious illness in family
sick contacts
smokers at home
attending day care/

Prenatal:
Routine check ups, USG
Complications (illness, infection, discharge…)
Smoke-drink-drugs

Natal:
? weeks birth
way of birth (vaginal, forceps assisted, C&S)
complications, hospital stay

Postnatal:
Development= when did the child sit up/crawl/walk/speek
Weight gain (appropriate to charts??)
Feeding/appetite: iron supplements with formula?/breast feeding/pediatric multivitamins/solid foods
Immunizations up to date??
Last routine check up

Fever questioning in pediatric patients:
Vomiting?
Ear-nose discharge?
Cough, wheezing, shortness of breath
Diarrhea
Irratability, sleep increase (lethargic), shaking movements (seizures)
Ill contacts (family, daycare)
Rash


MINI MENTAL STATUS EXAM

Orientation:
What’s the date
Where are we
What’s your president’s name

Registration:
Pencil, door, clock / please repeat (immediate memory)
say the patient that, you’ll ask you these words again later on

Attention and Calculation:
-serial 7’s: please reduce 7 from 100 and keep reducing until I tell you to stop, 100, 93, 86….
-Spell “world” backwards please: d-l-r-o-w

Recall:
Do you remember the 3 objects (short term memory)
Ask for what the patient had for breakfast (recent memory)
Ask anniversary or mother’s birthdate (remote memory)

Language tests:
Name: pencil, watch (show the object and ask the patient to name it)
Repeat: “no ifs, ands, or buts”
3 step command: take the paper with your right hand fold it into 2 and place it on the floor

Read and obey:
-close your eyes
-write a sentence
-copy the design (make them copy a triangle in a square)

Questioning for dementia patients other than MMSE:
DEATH SHAFT
Consider thyroid problems
B12/folate def.
Underlying medical condition (delirium)
Risk factors (HTN, DM, CAD, high Chol..)=multienfarkt demans
Masked depression
Drug intox.


FUNCTIONAL STATUS EXAM:

DEATH SHAFT:
Dressing
Eating
Ambulating
Toiletting (+bowel and bladder control)
Hygeine (can you bathe yourself)
Shopping
House-keeping
Accounting
Food preparation
Transportation
+trouble taking medications on your own?

Ulas Camsari