Interview Guide Edit

MISSION
“MABINI COLLEGES provides quality

MABINI COLLEGES INCORPORATED instruction, research and extension service
VISION College of Nursing and Midwifery programs at all educational levels as its
“MABINI COLLEGES shall monumental contribution to national and
cultivate a CULTURE of Governor Panotes Avenue, global growth and development.
EXCELLENCE in Education.” Daet, Camarines Norte Specifically, it transforms students into:
 God – fearing,
Tel. no. (054) 721-1281 local 109  Nation – loving,
 Law abiding
Email: mabinicollege@hotmail.com  Earth caring
 Productive,
 and Locally and Globally
competitive persons
Interview Guide for Older Adults
Basic Components of a Nursing Health History
1. Patient Profile/llingraphic Data
A.) Client's name-

"Magandang araw po pwede pong malaman ang iyong pangalan?"
B.) Address and contact number-

"Ano po bang address ng tirahan nyo? Pwede po bang makuha ang contact
number nyo, cellphone man o landline?"
C.) Date and place of birth-

"Kelan po ang inyong kapanganakan and saang lugar po kayo ipinanganak?"
D.) Age-
Ilang taon na po ngayon?
E.) Gender- (observation)
F.) Race- (observation)
G.) Religion-
"Ano po ang iyong relihiyon?"
H.) Marital status-

"Meron po ba kayong asawa?"
I.) Education (Elementary, High School, College, Doctoral Degree if any)-

"Maari po bang malaman ang iyong tinapusan sa pag-aaral? (If needed follow-
up another question/s)
J.) Name, address and cellphone number of nearest contract person-

"Sinu- sino po ba ang mga malalapit ninyong kamag-anak? Pwedepo bang
malaman ang kanilang address and contact numbers?"
K.) Advance directives-

MISSION
 Law abiding
 Productive,
competitive persons
"Alam nyo po ba ang advance directives or paunang tagubilin? Meron na po ba

kayong nagawang advance directives kung sakaling may mangyari sa inyo na
hindi inaasahan?"
2. Family Profile
A.) Family members' names and addresses-

"Sinu-sino po ba ang inyong kamag-anak at pwede po bang makuha and
kanilang mga address?"
B.) Year and cause of death of deceased spouse and children-

"Kumusta naman po ang iyong asawa? Meron na po bang sumakabilang buhay
sa mga anak mo? Ano pong dahilan?"
3. Occupational Profile
A.) Current work or retirement status (if retired, when?)-

"Sa iyong edad na _______ nag ta-trabaho ka po ba o nag retired ka na po?
B.) Previous jobs (from latest jobs)-

Anu-ano po ang mga naging trabaho nyo noong kayo ay bata-bata pa?"
C.) Sources of income and perceived adequacy for needs-

"Saan po ba nyo kinukuha ang panggastos sa pang araw-araw?"
4. Living Environment Profile
A.) Type of dwelling- (evaluate classify the house according to observation)
B.) Number of rooms, levels and people residing-

"Ilan po ba ang silid ng inyong tirahan? Meron po ba itong second or third floor?
Sinu-sino po ba ang mga kasama nyo ngayon dito sa bahay?
C.) Degree of privacy-

"Sa iyo pong pananaw, may privacy naman po ba ang isa'tisa?"
D. Name, address and contact number of nearest neighbors-
"Maari po bang malaman ang mga pangalan, address and contact numbers ng
mga kapit bahay nyo?
5. Recreation/Leisure Profile
MISSION
 Law abiding
 Productive,
competitive persons
A.) Hobbies or interest-

"Ano naman po ang mga libangan nyo ngayon?
B.) Organization membership-

"May kinaaaniban po ba kayo ngayon na organisasyon? Katulad po sa simbahan
o kumonidad?"
C.)Vacations or travels-
"Nakapag bakasyon na po ba kayo o nakapag travel sa ibang lugar ngayong
taon?"
6. Resources/Support Systems Used
A.) Names of physicians, hospitals, clinics and other community services

used-"Maari po bang malaman kung sinu-sino ang mga doctor na tumitingin
saiyong kalusugan? Saan po kayo nagpa-paconfine kung kayo ay
nagkakasakit? Nagpapacheck-up ka rin po ba sainyong barangay center?"
7. Description of Typical Day
A.) Type and amount of time spent in each activity-

Anu-ano po ang mga kinabibisihan nyo ngaun? Mga ilang minuto o oras naman
po ang ginu gugol nyo sa bawat aktibidad?"
8. Present Health Status
A.) Description of perception of health in past 1 year and 5 years-

"Ano naman po ang pananaw ninyo sainyong kalusugan? Masasabi nyo po ba
na kayo ay malusog sa nakaraang 5 taon?"
B.) Health screenings-

"Nagpapa annual check-up po ba kayo o nagpapa laboratory taun-taon? Meron
po bang nakitang abnormal results sa laboratory nyo? Pwede po bang makita
ang mga resulta?"
C.) Chief complaint and full symptoms analysis-

"Sa ngayon po, meron po ba kayong masamang nararamdaman, anu-ano po
iyon?"
D.) Prescribed and self-prescribed drugs-

MISSION
 Law abiding
 Productive,
competitive persons
"Meron po ba kayo ngayong iniinom na mga gamot o maintenance medications?

Anu-ano po at para saan daw po iyon?"
E.) Immunizations and allergies-
"Ayon po sainyong magulang, kumpleto naman po ba ang inyong bakuna noong
bata pa kayo? How about po yong bakunasa COVID-19? May allergy po ba
kayo sapagkain o sa mga gamot?"
F.) Eating and nutritional patterns-

"Pwede po bang malaman kung anu-ano ang mga pagkain o kinain nyo
ngayong lingo?" (Give pen and paper for weekly nutrition or food intake of client.
Let the client write his/her nutritional patterns.)
9. Past Health Status
A.) Previous illnesses throughout life, traumatic injuries, hospitalizations,

operations, obstetrics history-
"Sa mga nakaraang pangkalusugan naman po, anong mga sakit ang naranasan
nyo po sa buong buhay nyo? Nagkaroon po ba kayo ng high blood o diabetes?
Meron po bang pagkakataon na kayo ay naaksidente, naoperahan at naconfine
sa hospital? Sa obstetrics history naman po, ilan po ang mga anak nyo? May
history po ba kayong naagasan o nakunan?"
10. Family History
A.) Health status of immediate and living relatives-

"Sa iyo pong magulang at mga kapatid, nagkaroon po ba sila ng malubhang
sakit?"
B.) Causes of death of immediate relatives -

"Doon po sa mga yumao nyong kamag-anak, ano po ang dahilan ng kanilang
kamatayan?"
C.) Survey for risk of specific diseases and disorders-

"Anu-ano po bang sakit o karamdaman ang dumadaloy sainyong pamilya?"
11. Review of Systems
A.) Head-to-toe review of all body systems- (Do the head-to-toe health
assessment)
B.) Review of health promotion habits-

MISSION
 Law abiding
 Productive,
competitive persons
"Anu-ano naman po ang ginagawa nyo para hindi kayo dapuan ng sakit?
Maraming salamat po sa tamang pagtugon sa aking mga katanungan. Asahan
nyo po na walang makakaalam nito maliban saating dalawa. God bless you po."
Name of Student:
_____________________________________________________
Schedule of Clinical Exposure:

_________________________________________
Name &Signature of Clinical Instructor: ________________________________

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MISSION

“MABINI COLLEGES provides quality

Interview Guide for Older Adults

Basic Components of a Nursing Health History

1. Patient Profile/llingraphic Data

A.) Client's name-

B.) Address and contact number-

C.) Date and place of birth-

E.) Gender- (observation)

F.) Race- (observation)

H.) Marital status-

I.) Education (Elementary, High School, College, Doctoral Degree if any)-

J.) Name, address and cellphone number of nearest contract person-

K.) Advance directives-

"Alam nyo po ba ang advance directives or paunang tagubilin? Meron na po ba

A.) Family members' names and addresses-

B.) Year and cause of death of deceased spouse and children-

A.) Current work or retirement status (if retired, when?)-

B.) Previous jobs (from latest jobs)-

C.) Sources of income and perceived adequacy for needs-

4. Living Environment Profile

A.) Type of dwelling- (evaluate classify the house according to observation)

B.) Number of rooms, levels and people residing-

C.) Degree of privacy-

A.) Hobbies or interest-

B.) Organization membership-

6. Resources/Support Systems Used

A.) Names of physicians, hospitals, clinics and other community services

7. Description of Typical Day

A.) Type and amount of time spent in each activity-

8. Present Health Status

A.) Description of perception of health in past 1 year and 5 years-

B.) Health screenings-

C.) Chief complaint and full symptoms analysis-

D.) Prescribed and self-prescribed drugs-

"Meron po ba kayo ngayong iniinom na mga gamot o maintenance medications?

F.) Eating and nutritional patterns-

9. Past Health Status

A.) Previous illnesses throughout life, traumatic injuries, hospitalizations,

10. Family History

A.) Health status of immediate and living relatives-

B.) Causes of death of immediate relatives -

C.) Survey for risk of specific diseases and disorders-

11. Review of Systems

B.) Review of health promotion habits-

Schedule of Clinical Exposure:

Name &Signature of Clinical Instructor: ________________________________

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