control the flow of the communication or

conversation.

COMMUNICATION

A process in which people affect one another

through exchange of information, ideas and feelings,
process of generating and transmitting meanings
between two or more individuals.

PRINCIPLES

Communication process
• is one of the foundational
components of the nurse-patient relationship
• The purpose of taking the health history is to
collect subjective data from patients.
• are based on the signs and
symptoms that the patient reports.
• is a complex, ongoing,
interactive process that forms the basis for
building interpersonal relationships.
• It is a system of sending and receiving
messages, forming a connection between
sender and receiver.
WHAT IS INTERVIEW?
• A planned communication or a conversation
with a purpose.
CHARACTERISTICS
FOCUS/PURPOSES
• - is a basic component of
human relationships
• is a more
accurate expression of a person’s feelings
and thoughts.
▪ When assessing nonverbal
behaviors,
• is reciprocal
communication based on trust and aimed at
identifying client needs and developing
mutual goals.
• is the foundation of a positive
relationship
• is a fundamental
component in all phases of the nursing
process
• is a
helping relationship which is growth -
facilitating and provides support, comfort,
and hope.

• Establishing Rapport and testing

relationship. • Use of commonly understood words,
• Gathering information on the client's brevity, and completeness.
developmental, psychological, physiological,
sociocultural and spiritual.
• Saying exactly what is meant;
APPROACHES TO INTERVIEW • speak slowly and enunciate words well;
Directive Interview • repeat message as needed;
• reduce distractions
• Highly structured and elicits specific
information.

Non-directive Interview • Choice of appropriate time and

consideration of the client's interests and
• is an approach to interview concerns;
where in the nurse allows the patient to • Ask one question at a time
 • Wait for an answer before making another
comment
• Adjustment on what the HCP says and how
it is said
• depending on moods and behavior of the
client
• Worthiness of belief
• To become credible, one should have
adequate knowledge about the topic being
discussed
• One should the ability to provide accurate
information, to convey confidence and
certainly in what she says.
• One should be a good role model for what
she teaches
TYPES/FORMS OF COMMUNICATION
VERBAL COMMUNICATION
• Exchange of information using words
including both the spoken and written word
• Depends on language (prescribed way of
using words so that people can share
information effectively)
• Reveals aspects of the client's intellectual
development, educational level, and
geographic and ethnic origin.
• Another way to ask questions is to provide
the client with a choice of to choose from in
describing symptoms, conditions, or feelings
• Rephrasing information the client has
provided is an effective way to communicate
during the interview.
• Client verbalization can be encouraged by
well-placed phrases from the nurse. If the
client is in the middle of explaining a
symptom or feeling and believes that you are
not paying attention, you may fail to get all
the necessary information.
• Inferring information from what the client
tells you and what you observe in the client's
behavior may elicit more data or verify
existing data.
• Another important thing to consider
throughout the interview is to provide the
client with information as questions and
concerns arise. Make sure you answer every
question as well as you can.
NON - VERBAL COMMUNICATION
• Transmission of information without the use
of words - it is What is not said.
• Often as BODY LANGUAGE
• Helps an HCP to understand subtle and
hidden meanings in what is being said
verbally
▪ Touch
▪ Eye contact
▪ Facial Expressions
▪ Posture/Gait
▪ Mode of Dress and grooming
▪ Sounds
▪ Silence
▪ General physical
appearance/Gesture
• Your demeanor should also be professional.
When you enter a room to interview a client,
display poise. Focus on the client and the
upcoming interview and assessment.
• Facial expressions are often an overlooked
aspect of communication. Facial expression
often shows what you are truly thinking
(regardless of what you are saying), keep a
close check on your facial expression.

• One of the most important nonverbal skills to
develop as a health care professional is a
nonjudgmental attitude. All clients should be
accepted, regardless of beliefs, ethnicity,
lifestyle, and health care
• Another nonverbal technique to use during
the interview process is silence.
• Listening is the most important skill to learn
and develop fully in order to collect complete
and valid data from your client.
• maintain good eye contact,
• smile or display an open, appropriate facial
expression,
• maintain an open body position
LEVEL OF COMMUNICATION
• SELF-TALK
• Communication that happens within the
individual
• Occurs between two or more people with a
goal to exchange message
FACTORS INFLUENCING COMMUNICATION
EX. a 10 y/o child has
limited understanding of what infection is
men and women possess differing
communication styles and might give different
interpretations to the same conversation.
culture influences a
person’s world view/philosophy in life and
relationships with the surrounding environment,
religion, time, and others
assume that patients
who are health care professionals know everything
about their condition and need little assistance,
teaching and counselling.
Special Considerations during the Interview
CULTURE
• common lifestyles, languages, behavior
patterns, traditions, and beliefs that are
learned and passed from generation to the
next
• Ethnic/cultural variations in communication
and self -disclosure styles may significantly
affect the Information obtained. Be aware of
possible variations in the communication
styles of yourself and the client.
• Age affects and commonly slows all body
systems to varying degrees. Speak clearly and
use straight forward language during the
interview with the elderly client. Ask
questions in simple terms. Avoid medical
jargon and modern slang.
Frequently noted variations in communication
styles
• Reluctance to reveal personal information to
strangers for various culturally-based
reasons
• Variation in willingness to openly express
emotional distress or pain
• Variation m ability to receive information
(listen)
• Variation in meaning conveyed by language.
• Variation in disease/illness perception
• Variation in the family's role in the decision-
making process.
• Clients' emotions vary for a number of
reasons.

Some helpful ways to deal with various
clients WITH VARIOUS EMOTIONS
When Interacting with an Anxious Client
• Provide the client with simple, organized
information in a structured format.
• Explain who you are and your role and
purpose
When Interacting with an Angry Client
• Approach this client in a calm, reassuring, in-
control manner.
• Allow him to ventilate feelings. However, if
the client is out of control, do not argue with
or touch the client.
When Interacting with a Depressed Client
• Express interest in and understanding of the
client and respond in a neutral manner.
When Interacting with a Manipulative Client
• Provide structure and set limits.
• Differentiate between manipulation and a
reasonable request.
When Interacting with a Seductive Client
• Set firm limits on overt sexual client behavior
and avoid responding to subtle seductive
behaviors.
When Discussing Sensitive Issues
• First be aware of your own thoughts and
feelings.
• Ask simple questions in a nonjudgmental
manner.
• Allow time for ventilation of client's feelings
as needed.
• If you do not feel comfortable or competent
discussing personal, sensitive topics, you may
make referrals as appropriate
Guidelines or tips to improve an interview:
• Use language the patient understands
• Listen attentively
• Plan questions to follow a logical
sequence
• Ask only one question at a time
• Allow the client complete self-expression
even if it disagrees with your values and
morals.
• Use and accept silence avoid injecting
your own thoughts during periods of
silence
• Acknowledge the client's right to look at
things the way they appear to him or her
and not the way they appear to the nurse
or someone else.
• Do not impose your values on the client.
• Avoid using personal examples, such as
saying "If I were you..."
• Nonverbally convey respect, concern,
Interest, and acceptance.
Open — Ended Questions
• Used to elicit the clients feeling.
• Typically begins with "how" or "what".
• Associated with non-directive interview,
invite clients to discover and explore,
elaborate, clarify or illustrates their thoughts
or feelings.
• This type of questions are important because
they require more than a one-word response
from the client and therefore, encourage
description.
 5. Focusing
• helping the client expand on and develop a
topic of importance.
TECHNIQUES FOR THERAPEUTIC
• Example:
COMMUNICATION; ▪ Client: " My wife says she will look
after me, but I don't think she can.
1. Attentive listening
what will the children to take care
• is listening actively as
of, and they're always after her
opposed to listening passively with just the
about something - clothes,
ear.
homework, what's for dinner that
• it is probably the most important technique
night."
in nursing and is basic to all other
Nurse: " Sounds like you are
techniques.
worried about how well she can
• it involves attention to the total message,
manage.
both verbal and non-verbal, and noting
whether these communications are
6. Being specific and tentative
congruent.
• Making statements that are specific rather
• it means absorbing both the content and the
than general, and tentative rather than
feeling the person is conveying, without
absolute
selectivity
• Example:
▪ “Rate your pain on a scale of 0 – 10.”
2. Paraphrasing or Restating
• Actively listening for the client's basic
▪ “Are you in pain?”
message and then repeating those thoughts
and/or feelings in similar words.
• Example:
▪ Client: “I couldn't manage to eat 7. Using touch and silence
any dinner last night - not even the • providing appropriate forms of touch to
dessert." Nurse: "You had difficulty reinforce caring feelings.
eating yesterday." • Example:
▪ Putting an arm over the client's
3. Clarifying shoulder. Placing your hand
• A method of making the client's broad overall
over the client's hand.
meaning of the message more
▪ Sitting quietly or walking with
understandable.
the client and waiting
• Example:
attentively until the client is
▪ " I'm puzzled."
able to put thoughts and
▪ " Would you please say that again."
feelings into words.
▪ "Would you tell me more?" 8. Offering self
4. Using open-ended questions • suggesting one's presence, interest, or wish
• asking broad questions that lead or invite the
to understand the client without making any
client to explore (elaborate, clarify, describe,
demands or attaching conditions that the
compare, or illustrate) thoughts or feelings.
client must comply with to receive the
• Example:
nurse's attention.
▪ "I'd like to hear more about that."
• Example: "I'll stay with you until your
▪ "Tell me about...."
daughter arrives."
▪ "What brought you to the hospital."

9. Clarifying reality, time or sequence
• helping the client clarify an event, situation,
or happening in relations to time.
• Example:
▪ Client: "I vomited this morning."
Nurse: "Was that after breakfast?"
10. Acknowledging
• giving recognition, in a nonjudgmental way,
of a change in behavior, an effort the client
has made, or a contribution to a
communication.
• Example:
▪ “You trimmed your beard and
mustache and washed your hai "
"You walked twice as far today with
your walker."
11. Providing general leads
• using statements or questions that encourage
the client to verbalize, choose a topic of
conversation, and facilitate continued
verbalization.
• Example:
▪ "Could you tell me how it is for
you?"
▪ Where would you like to begin?
▪ "And then what?"
12. Giving Information
• providing, in a simple and direct manner,
specific factual information the client may or
may not request. When information is not
known, the nurse states this and indicates
who has it or when the nurse will obtain it.
• Example:
▪ " Your surgery is scheduled for 11
am tomorrow"
▪ "I don't know' the answer to that,
but I will find out from Mrs. King,
the nurse in charge"
13. Summarizing
• stating the main points of a discussion to
clarify the relevant points discussed.
• this technique is useful at the end of an
interview or to review a health teaching
session.
Techniques that block communication:
• Unwarranted reassurance
• Agreeing/disagreeing
• Giving common advice
• Stereotyping
• Being defensive
• Posing judgment
• Challenging
• Probing
• Testing
• Rejecting
• Changing topics/subjects
STAGES OF INTERVIEWS
(Pre-orientation phase/stage)
( : compiling existing data;
preparing for patient interview from existing medical
records)
• Introduce one-self to the client.
• Explain the purpose of the interview,
• Discuss the types of questions that will be
asked, explains the reason for taking notes
and assures the client that confidentiality is
remain
• RATIONALE: Establish Rapport
• Nurse elicits the client's comments about
major biographic data, reasons for seeking
care, history of present health concern, past
health history, family history, review of body
systems for current health problems, lifestyle
and health practices and developmental level.
• Nurse listens, observe cues and uses critical ▪ In some cases when the client
thinking skills to interpret and validate terminates it:
information received from the client. ▪ The client is unable to
• specific provide information
information ▪ The client is fatigue
• broad answers in
patient's own words; avoid "why" questions Techniques commonly used to close an
• The client communicates what he/she feels, interview
thinks, knows and perceives m response to ▪ Allow to answer questions
the question given by the interviewer. ▪ Conclude by saying
• ▪ "well, that's all the questions for
▪ Use of communication techniques now"
that make the client and interviewer ▪ or "well. that's all I need to know for
feel comfortable. now"
▪ Thank the client
▪ Express concerns for person's welfare and
• These are used to elicit the client's feelings time
and perceptions ▪ Plan the next meeting. if there is to be one.
• Typically starts with the word "how" or ▪ Provide a summary to verify accuracy and
"what". agreement
• Associated with non-directive Interview,
invite client to discover and explore, What is Health History?
elaborate, clarify or illustrate their thoughts
An excellent way to begin the assess process
or feelings.
because it lays the ground for identifying nursing
• Example: "How have you been feeling
problems provides a focus for the physical
lately?"
examination.

IMPORTANCE OF HEALTH HISTORY

• This is to obtain facts and to focus on specific
• Lies in its ability to provide information that
information
will assist the examiner in identifying areas
• The client can respond with one or two
of strength and limitation in the individual's
words
lifestyle and current health status.
• The question usually begins with the words
• Provide the examiner with specific cues to
"when" or "did"
health problems that are most apparent to
•
the client.
• Close-ended questions useful in keeping the
Interview on course COMPONENTS OF HEALTH HISTORY

• Biographic data
• Reasons for seeking health care
• summarizing, stating most important to
• History of present health concern
three problems of patterns
• Past health hist01Y
▪ Report any information that is • Family Health
required by law • Review of body systems (ROS) for current
▪ The interviewers terminate the health problems
interview when the needed • Lifestyle and Health practices profile
information has been obtained • developmental level
PERSONAL PROFILE (BIOGRAPHIC DATA) • The answer to the questions: "What is
troubling you?" or "Can you tell me the
• reason you came to the hospital today?" and
▪ Usually requested for the patient record
"How do you feel having to seek health
▪ Name
care?"
▪ Address and phone number
• NOTE: First question assists the client to
▪ Age and date of birth
focus on his most significant health concern.
▪ Gender
Second Question encourages the client to
▪ Marital status
discuss fears or other feelings about having
▪ Race, ethnic origin
to see a health care provider
▪ Occupation, religion
• NOTE: "Chief complaints should be written
❖ Social security number
in client's own word".
❖ Identifying number
• ASK: Reason for seeking health care and
❖ Insurance
Feelings about seeking health care.
❖ Usual source of health care
❖ Emergency contact History of Present Health Concerns

IMPORTANT CONCEPTS ABOUT BIOGRAPHICAL DATA • For the , this is a short statement
about general state of health
• NOTE: Client should be the primary source.
• NOTE: In ELDERLY and CHILD, the client's
immediate family or caregiver may be a more
• For the , this is a chronological record
accurate source of information than the
of the reason for seeking care, from the time
client.
the symptom first started until now.
• NOTE: The client's culture, Ethnicity,
• Example: "Describe the condition that you
subculture, nationality, place of birth
are experiencing from the earliest time that it
together with religious and martial health
occurred to the present."
practices are also gathered to identify special
needs or beliefs that can affect the patient
condition.
• NOTE: Language and dialect spoken,
educational level, occupation, work status
assist the nurse to tailor questions to the
client's level of understanding.

Chief Complaint

Reason for seeking care

• This is a brief spontaneous statement in the

patient's own words that describes the
reason for visit
• The chief complaint is the (objective
finding) or (subjective finding) that
causes the patient to seek health care
• The reason for seeking health care and the
chief complaint should be recorded as

•
 COMPONENTS:

✓ Problems at Birth
✓ Child Illnesses
✓ Child Immunization
✓ Chronic diseases
✓ Allergies
✓ Hospitalization
✓ Accidents and Injuries
✓ Medications

• "Can you tell me how your mother described

your birth?"
CHARACTER PATTERN
• "Were there any problems?"
ONSET ASSOCIATED FACTOR • "As far as you know, did you progress
normally as you grew to adulthood?" "Were
LOCATION
there any problems that your family told you
DURATION about or that you experienced?"

SECURITY
• "What diseases did you have as a child?"
• Chicken pox, mumps, measles, rubella,
rubeola, streptococcal infections, and other
significant illnesses

• "What immunization did you get and are

you up to date?"

• "Do you have any chronic diseases?"

• To drugs, animals, insects, or other

environmental agents, the type of
reaction that occurs, and how the
reaction is treated
Past health history/ChildhooD Illness

• Provides information on the patient's health

status from birth to the present
• Past health events may have residual effects
on the current state of health

Reasons for hospitalization, dates, surgery performed,
course of recovery, and any complications.
"Have you ever been hospitalized for or had surgery?"
If so, when? What were you hospitalized for or what
type of surgery did you have? Were there any
complications?"
• How, when, and where the incident occurred,
Type of injury, treatment received, and any
complications.
• "Have you experienced any accidents or
injuries? Please describe them."
• All currently used prescription and over-the-
counter medications, such as aspirin, nasal
spray, vitamins or laxatives
Family history Genogram
• Records the health status of the
patient, as well as that of immediate
blood relatives
• At a minimum, the history needs to
contain the age and health status of the
patient, spouse, children, siblings, and
the patient's parents
• A second component of the family
health history is the report of
occurrences of familial or genetic
diseases
Lifestyle and Health Practices
- Amount, frequency, and duration of
substance use (tobacco, alcohol, coffee, cola, tea, and
illicit or recreational drugs
- Description of typical diet on a normal day or
any special diet, number of meals and snacks per day,
who cooks and shops for food, ethnically distinct
patterns, and allergies.
- usual daily sleep/wake
times, difficulties sleeping and remedies used for
difficulties.
– any difficulties experienced in the basic
activities of eating, grooming, dressing, elimination,
and locomotion.
– Any difficulties experienced in food
preparation, shopping transportation, housekeeping,
laundry, and ability to use the telephone, handle
finances and manage medications.
- Exercise activity and tolerance,
hobbies and other interest and Vacations
Psychosocial Status
- Clients support the
system in times of stress (who helps the client in
times of needs?), what affects the client's illness
has on the family, and whether any family
problems are affecting the client.
Health customs and beliefs,
Cultural practices that may affect health care
and recovery.
– Data about the client's
highest level of education attained and any past
difficulties with learning.
- Current employment status, the
number of days missed from work because of illness,
any history of accidents on the job, any occupational
hazards with potential for future disease or accident,
the client's needs to change jobs because of past
illness, the employment status of spouses or partners
and the way child care is handled, and the client's
overall satisfaction with work.
- Information on how the client is
paying for medical care and whether the client's
illness presents financial concerns.
– Home safety
measures and adjustments in physical facilities that
may be required to help the client manage a physical
Disability, activity intolerance and activities of daily
living, the availability of neighborhood and
community services to meet the client's needs.
experienced and the client's
perception of them.
- with a serious problem or a high
level of stress.
○ Ability to verbalize appropriate
emotions; non-verbal communication-such as eye
movements, gestures, use of touch, and posture,
interactions with support persons, and the congruence
of non-verbal behavior to verbal expressions.
CULTURALCONSIDERATIONS (ASSESSMENTS)
• Commonly ask the questions:
• What do you believe causes illness? What do
you believe is the correct way to treat minor
or serious illnesses?
• Whom do you go to when you need to treat a
minor illness or diagnoses or treat a more
serious illness?
• What barriers do you run into when you seek
care?
• "Knowing how to assess what is normal
or abnormal for all persons who seek
care."
PROCESSOFCULTURAL COMPETENCE
• Cultural Desire
• Cultural Awareness
• Cultural Knowledge
• Cultural Skill
• Cultural Encounter
• "Is the "deliberate". Cognitive process in
which the health care provider becomes
appreciative and sensitive to the values,
beliefs, life ways, practices and problem-
solving strategies."
• STAGES:
▪ Unconscious incompetence
▪ Conscious incompetence
▪ Conscious competence
▪ Unconscious competence
• "The process of seeking and obtaining a
sound educational foundation concerning
the various worldviews of different cultures."
• "The ability to collect relevant cultural data
regarding the client's health history and
presenting problems as well as accurately
performing a physical assessment."
• "Learning how to complete cultural
assessment."
"The process that allows the healthcare provider to
engage directly in face-to-face interactions with clients
from culturally diverse backgrounds."
• "Assessing these beliefs would help the nurse
to understand the client's approach to the
health care providers and to illness and
healing."
• Beliefs of Human nature.
• Beliefs about relationship with nature
• Beliefs about purpose of life.
• Beliefs about health, illness and healing.
• Beliefs about what causes disease
• Beliefs about health
• Beliefs about who serves in the role of healer
or what practices bring about healing.
FACTORS AFFECTING APPROACH TO PROVIDERS
• Ethnicity
• Generational Status: Age
• Educational Level
• Religion
• Previous experience of care by PHCS
• Occupation and income level
• Time dimensions (focused on Past, Present or
Future)
• Space (personal space distance)
• Communication
OTHERCULTURALFACTORS
• Time perception
• Space perception
• Eye contact and Face positioning
• Body language and hand gestures
• Silence
• Touch
Autonomy Diet and Nutrition Spirituality
• Death Rituals
• Pregnancy and Child Bearing
• Culture-based treatments
• Culture-bound syndrome
• Healthcare practices
• Biological Variations
• Geographical and Ethnic Variations
CONCEPT OF BALANCE
• "This concept is central to Filipino self-care
practices and is applied to all social
relationships and encounters."
• "According to this principle, health is thought
to be a result of balance, while illness due to
humoral pathology and stress is usually the
result of some imbalance"
• Rapid shifts from "hot" to "cold" lead to
illness
• "Warm" environment is essential for
maintaining optimal health
• An overheated body is vulnerable to
disease; a heated body can get
"shocked"
• When cooled quickly, it can cause illness
• Cold drinks or cooling foods should be
avoided in the morning
THEORIES OF ILLNESS
• Physical and mental health and illness are
viewed holistically as an equilibrium model
THREE TYPES:
• Mystical causes are often attributed to
experiences or behaviors such as ancestral
retribution for unfinished tasks or
obligations.
• Some believe that the soul goes out from the
body and wanders, a phenomenon known as
Bangungot, or that having nightmares after
a heavy meal may result in death.
• are associated with social
punishment or retribution from supernatural
forces such as evil spirits, witch (Manga ga
mud) or sorcerers (mangkukulam).
• The forces cast these spells on people if they
are jealous or feel disliked.
• are asked
to counteract and cast out these evil forces
through the use of prayers, incantations,
medicinal herbs and plants.
• Naturalistic causes include a host of factors
ranging from natural forces (thunder,
lightning, drafts, etc.) to excessive stress,
food and drug incompatibility, infection, or
familial susceptibility.
Basic Logic of Health and Illness
• The basic logic of health and illness consists
of prevention (avoiding inappropriate
behavior that leads to imbalance) and curing
(restoring balance); it is a system oriented to
moderation.
• Parallel to this holistic belief system is the
understanding of modem medicine with its
 basic logic and principles for treating certain
types of diseases.
• These two systems co-exist, and Filipino
older adults use a dual system of healthcare
Health Promotion/Treatment Concepts
- The body is thought to be a vessel or
container that collects and eliminates impurities
through physiological processes such as
sweating, vomiting, expelling gas, or having an
appropriate volume of menstrual bleeding:
- Adapts the concept of balance
between "hot" and "cold" to prevent
occurrence of illness and disorders.
- Safeguards the body's boundaries
from outside influences such as supernatural
and natural forces.
Health Behaviors
• Response to Illness
• Filipino older adults tend to cope with illness
with the help of family and friends and by
faith in God.
• A complete cure or even the slightest
improvement in a malady or illness is viewed
as a miracle.
• Filipino families greatly influence patients'
decisions about health care.
• Patients subjugate personal needs and tend
to go along with the demands of a more
authoritative family figure in order to
maintain group harmony.
• Before seeking professional help, Filipino
older adults tend to manage their illnesses by
self-monitoring symptoms, ascertaining
possible causes, determining the severity and
threat to functional capacity, and considering
the financial and emotional burden to the
family.
• "Seeking medical advice from family
members or friends who are health
professionals is also a common practice
among Filipino older adults and their family
members, especially if severe somatic
symptoms arise."
Coping Styles
• Coping styles common among elderly
Filipino Americans in times of illness or crisis
include:
• the ability to
tolerate uncertain situations
• ): being respectful
and honest with oneself
• the capacity
to laugh at oneself in times of adversity
• the view
that illness and suffering are the unavoidable
and predestined will of God, in which the
patient, family members and even the
physician should not interfere
•
to maintain group harmony
Responses to Mental Illness
• Indigenous traits common among
elderly Filipino Americans when faced
with illness related to mental
conditions:
• Devastating shame (Hiya)
• Sensitivity to criticism (Amor Propio)
Common Perceptions of Filipinos about Mental
Illness
• Unwillingness to accept having mental
illness, which leads to the avoidance of
needed mental health services due to fear of
being ridiculed
• Involvement of other coping resources such
as reliance on family and friends or
indigenous healers, and dependence on
religion which can diminish the need for
mental health services
• Prioritizing of financial and environmental
needs which preclude the need for mental
health services
• Limited awareness of mental health services
resulting in limiting access
• Difficulty in utilizing mental health services
during usual hours because of the
 unavailability of working adult family
members
• Mental illness connotes a weak spirit, and
may be attributed to divine retribution as a
consequence of personal and ancestral
transgression
• Lack of culturally oriented mental health
services

Review of systems

• General health state- wt. gain or loss, fatigue,

weakness, malaise, pain, usual activity, fever,
and chills
• Nutrition, hydration- malnutrition and
obesity, nausea and vomiting, normal daily
intake, wt. and wt. change, dehydration, dry
skin, fluid excess with shortness of breath,
edema in the feet and legs, diet practices to
promote health.
• Skin, hair, and nails
• Head and neck
• Eyes; ears; nose, mouth, and throat
• Thorax, lungs
• Heart, neck vessels; peripheral vascular
• Breasts Abdominal-gastrointestinal
• Abdominal-urinary
• Musculoskeletal
• Neurological
• Genitalia
• Anus, rectum, prostate
• Endocrine, hematologic system