Assume that you are performing an EKG on an elderly patient with chest pain. What considerations should you take into account when performing the exam and interacting with this patient?
Therapeutic Communication
Chapter 2
1
FIRST IMPRESSIONS
• Physical dress and
appearance
• Have a positive attitude
• Show compassion
• Always smile
• Communicate effectively
2
DIVERSITY AND
COMMUNICATION
•
Types of diversity
• Nationality
• Race
• Culture
• Ethnicity
• Social factors
•
Individual diversity factors
• Language
• Age
• Religion
• Economic status
• Gender
• Appearance
3
NONVERBAL COMMUNICATION
• Body language
• Gestures
• Mannerisms
• Appearance
• Self-esteem and confidence
• Facial expressions
4
NONVERBAL COMMUNICATION
DELIVERY FACTORS
• Rate
• Clarity
• Volume
• Pitch
• Tone
• Pauses
• Intonation
• Vocabulary
• Grammatical structure
• Pronunciation
5
CULTURAL DIFFERENCES
AND SPATIAL DISTANCE
•
•
If you are interacting with person from another
cultural group that you are unfamiliar with:
•
Follow the other person’s lead
•
Use gestures cautiously
•
Refrain from touching a child’s head
Different types of spaces:
•
Intimate or personal space (0-18 inches)
•
Casual person space (18 inches to 4 feet)
•
Social-business space (distance of 4-12 feet)
•
Public space (distance greater than 12 feet)
6
COMMUNICATION CYCLE
• Sender creates the
MESSAGE
• Receiver DECODES the
message
• Receiver creates FEEDBACK
• Sender DECODES feedback
7
WRITTEN COMMUNICATION
• Type of verbal communication
• Includes:
• Written messages (e.g., phone messages)
• Letters and emails
• Online information and media (e.g., informational flyer)
8
ORAL COMMUNICATION
• Type of verbal communication
• Styles
• Passive communicators
• Aggressive communicators
• Passive-aggressive communicators
• Manipulative communicators
• Assertive communicators
9
THERAPEUTIC COMMUNICATION
• Active listening
• Most important therapeutic communication technique
• Fully concentrate on what is being said and how it is being said
• Show interest verbally and nonverbally
• Open and closed questions/statements
• Open: asks for general information; encourages patients to
respond in a manner in which they find comfortable
• Closed: asks for specific information; limits patient’s answer to
one or two words
10
THERAPEUTIC COMMUNICATION
TECHNIQUES
• Reflection
• Restatement or paraphrasing
• Neutral
• Silence
• Clarification
• Summarizing
11
ANGER
• Crucial to know how to handle and diffuse the situation
• Important to make sure the person feels heard
• Demonstrate empathy
• Use active listening
• Follow policies for dealing with angry individuals
12
COMMUNICATION BARRIERS
• Environmental distractions
• Internal distractions
• Visually impaired
• Hearing impaired
• Intellectual disability
• Illiterate
• Non-English speaking
• Emotional distractions
13
AGE
• Understand Erikson’s stages of psychosocial development
• Trust vs. mistrust (0-1.5 years of age)
• Autonomy vs. shame/doubt (1.5-3 years of age)
• Initiative vs. guilt (3-6 years of age)
• Industry vs. inferiority (6-12 years of age)
• Identity vs. role confusion (12-18 years of age)
• Intimacy vs. isolation (18-25 years of age)
• Generativity vs. stagnation (25-60 years of age)
• Ego integrity vs. despair (60+ years of age)
14
DISEASE STATUS
• Understand Kübler-Ross’s Stages of Grief and Dying
• Denial
• Anger
• Bargaining
• Depression
• Acceptance
15
PERSONAL BOUNDARIES WITH
VERBAL COMMUNICATION
• Remember that certain topics are inappropriate in an
office/work setting
• Retain a professional relationship with patients
• Do not discuss religion, politics, or relationships
• Do not gossip with the patient, befriend them on social media,
share personal issues, or engage in a flirty or romantic
conversation
16
MASLOW’S
HIERARCHY OF
NEEDS
•
Physiological needs
•
Safety needs
•
Love and belongingness
needs
•
Esteem needs
•
Cognitive needs
•
Aesthetic needs
•
Self-actualization needs
•
Transcendence needs
17
DEFENSE MECHANISMS
• Unconscious mental processes that protect people from anxiety, loss,
conflict, or shame
• Types:
• Denial
• Repression
• Regression
• Displacement
• Projection
• Suppression
• Splitting
• Reaction formation
• Rationalization
18
COPING MECHANISMS
• Stress: a condition that causes physical and/or emotional
tension
• Two types:
• Adaptive (healthy)
• Exercising, eating healthy, talking with others
• Maladaptive (healthy)
• Hostility, aggression, denial, drugs
19
PATIENT COACHING
• Medical assistant must remember to adapt teaching for patient
• Adapt to special needs
• Write down information for a patient with a hearing impairment
• Use play techniques with kids
20
LEGAL AND ETHICAL ISSUES
• Civil Rights Act
• All providers who accept federal funds for healthcare provided
must ensure equal access to services
• Americans with Disabilities Act (ADA)
• All healthcare providers must provide free effective
communication to patients/companions with disabilities
• Americans with Disabilities Act Amendments Act (ADAAA)
• Expanded definition of disabilities established in ADA
21
PATIENT-CENTERED CARE
• Create a relationship with the patient
• Make the patient feel respected, involved, and knowledgeable
about plan of care
• Use therapeutic communication
• Build a respectful, comfortable, and accepting relationship with
patient
• Give patient self-confidence
22
QUESTIONS?
23
1
▪ Four vital signs:
▪ Temperature
▪ Pulse
▪ Respiration
▪ Blood pressure
▪ Anthropometric measurements
▪ Usually measured at the same time as vital signs
2
Influenced by physical and emotional
factors
➢ Patient may have had a hot or cold beverage
➢ Patient could be anxious
➢ Patient could be nervous
➢ Patient could have elevated heart rate because
of racing to get to the appointment
➢ Patient could be in pain
Medical assistant must help the patient relax
before taking any readings
3
▪ Factors affecting body temperature
▪ Age
▪ Stress and physical activity
▪ Gender
▪ External factors
▪ Fever
▪ Continuous
▪ Intermittent
▪ Remittent
4
▪ Axillary
▪ Oral
▪ Tympanic
▪ Rectal
▪ Temporal artery
5
▪ Use either Fahrenheit or Celsius scale
▪ Tympanic, digital, or temporal artery (TA) scanner
thermometers used
▪ TA scanner most accurate for infants
▪ Oral temperatures are not accurate for children
▪ Children are unable to hold thermometer under the tongue
6
▪ º C = (º F − 32) × 5/9
▪ º F = (º C × 9/5) + 32
7
▪ Digital thermometers
▪ Blue probe: axillary
▪ Red probe: rectal
▪ Tympanic thermometers
▪ Temporal artery scanner
8
▪ Temporal
▪ Carotid
▪ Brachial
▪ Radial
▪ Femoral
▪ Popliteal
▪ Dorsalis pedis
9
▪ Rate
▪ Heartbeats felt as blood moves through the artery (1 min)
▪ Lost body heat means increased circulation
▪ Rhythm
▪ Time between pulse beats
▪ Arrhythmia
▪ Intermittent pulse
▪ Volume
▪ Strength of heart as it contracts
10
▪ 3+: Full, bounding pulse
▪ Pulsation is very strong and does not disappear with moderate
pressure
▪ 2+: Normal pulse
▪ Pulsation is easily felt but disappears with moderate pressure
▪ 1+: Weak, thready pulse
▪ Pulsation is not easily felt and disappears with slight pressure
11
▪ Newborn Range: 120-160 beats/min
▪ Average: 140
▪ 1-2 Years Range: 80-140 beats/min
▪ Average: 120
▪ 3-6 Years Range: 75-120 beats/min
▪ Average: 100
▪ 7-11 Years Range: 75-110 beats/min
▪ Average: 95
▪ Adolescence to adulthood: 60-100 beats/min
▪ Average: 80
12
▪ Radial and apical
▪ Have patient in a relaxing position
▪ Use the correct pressure
▪ Femoral, popliteal, pedal
▪ Difficult to find and hear
13
▪ Physiology
▪ Inspiration and expiration
▪ Internal and external
▪ Characteristics of respiration
▪ Counting respirations
14
▪ Rate
▪ Normal, rapid, slow
▪ Breathing alternations
▪ Respond to exercise,
emotional upsets
15
▪ Rhythm
▪ Breathing patterns
▪ Depth
▪ Amount of air
inhaled/exhaled
16
▪ Don’t mention you’re counting them
▪ Patients self-consciously may alter breathing
▪ Count for 30 seconds; multiply by 2
▪ Record variations on the patient chart
17
▪ Newborn Range: 30-50
▪ Average: 40
▪ 1-3 Year Range: 20-30
▪ Average: 25
▪ 4-6 Year Range: 18-26
▪ Average: 22
▪ 7-11 Year Range: 16-22
▪ Average: 19
▪ Adolescence to Adulthood Range: 12-20
▪ Average: 16
18
▪ Factors affecting blood pressure
▪ Evaluating the blood pressure
▪ Measuring blood pressure
▪ Systolic and diastolic measurements
19
▪ Blood volume
▪ Increased or decreased
▪ Peripheral resistance (blood viscosity)
▪ Blood flow through the lumen
▪ Vessel elasticity
▪ Artery ability to expand and contract
▪ Condition of heart muscle and arterial walls
▪ Myocardium is primary determinant
20
▪ Newborn
▪ Systolic Range, 60-96; Diastolic Range, 30-62
▪ 1-3 Years
▪ Systolic Range, 78-112; Diastolic Range, 48-78
▪ 4-6 Years
▪ Systolic Range, 78-112; Diastolic Range, 50-79
▪ 7-11 Years
▪ Systolic Range, 86-114; Diastolic Range, 52-79
▪ Adolescent
▪ Systolic Range, 94-119; Diastolic Range, 58-79
▪ Adult
▪ Systolic Range, 100-119; Diastolic Range, 60-79
21
▪ Secondary hypertension
▪ Caused by an underlying pathologic condition
▪ Essential hypertension
▪ No single identified cause
▪ Systolic pressure is 140-159 or higher; diastolic pressure is 90-99 or
higher
22
▪ Normal: Less than 120-80 mm Hg
▪ Elevated: Systolic between 120-129 and diastolic less than 80
mm Hg
▪ Stage 1: Systolic between 130-139 or diastolic between 80-89
mm Hg
▪ Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg
▪ Hypertensive crisis: Systolic over 180 and/or diastolic over 120
23
▪ Three stages
▪ Prehypertension
▪ Stage I hypertension
▪ Stage II hypertension
▪ Guidelines
▪ Lifestyle changes before medical treatment
▪ Over age 50, treated for systolic >140
▪ Blood pressure medications
▪ Patient-centered treatment
24
▪ Measured with a sphygmomanometer
▪ Regularly recalibrated
▪ Checked for accuracy
▪ Correct when no more than 3 mm Hg
▪ Must be used with a stethoscope
▪ Blood pressure cuffs
25
▪ Small adult cuff (22-26 cm arm circumference)
▪ 9 inches
▪ Adult cuff (27-34 cm arm circumference)
▪ Up to 13 inches
▪ Large adult cuff (35-44 cm arm circumference)
▪ 14-17 inches
▪ Adult thigh cuff (45-52 cm circumference)
▪ 18-20 inches
26
▪ Blood pressure usually taken with patient in either sitting or
supine position
▪ Diastolic pressure can be as much as 5 mm Hg higher when patients
are sitting than when they are supine
▪ Patients should not cross their legs during reading
▪ Make sure position of arm is correct
▪ At level of heart; resting
27
▪ Limb used for measurement is above the level of heart
▪ Bladder in cuff is not completely deflated before a reading is
started/retaken
▪ Pressure of cuff is released too rapidly
▪ Patient is nervous or anxious
▪ Patient drank coffee or smoked cigarettes within 30 minutes of
measurement
▪ Cuff was applied improperly
▪ Cuff is too large or not placed around arm smoothly
28
▪ Phase I
▪ Sound heard as cuff deflates
▪ Phase II
▪ Produces swishing sound if heard
▪ Phase III
▪ Sharp, rhythmic tapping
▪ Phase IV
▪ Soft, muffled tapping
▪ Phase IV
▪ All sounds disappear
29
▪ Palpate radial pulse
▪ Inflate until pulse disappears; add 30 mm Hg
▪ Don’t remove fingers during this process
30
▪ Noninvasive method of evaluating both pulse rate and oxygen
saturation of blood
▪ May also be referred to as saturation of peripheral oxygen
▪ Medical assisting clips a probe on patient’s earlobe or finger
▪ Normal pulse oximetry reading is 95% or higher
31
▪ Measuring weight and height
▪ Obtain with accuracy and empathy
▪ BMI is used to ascertain disease risk
▪ Keep the scale where privacy is ensured
32
▪ 1 kg = 2.2 lb
▪ Multiply the number of kilograms by 2.2
▪ 1 lb = 0.45 kg
▪ Multiply the number of pounds by 0.45, or divide the number of
pounds by 2.2 kg
33
▪ Accurate and safe thermometer use
▪ Obtaining pulse
▪ Tracking respirations
▪ Measuring blood pressure
▪ Weight management
34
35
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
