COMMUNITY HEALTH

MODULE 6: RURAL HEALTH LESSON 6.9 OPQRST Symptom Assessment

Obj. 6.9: Obtain subjective information from a using the OPQRST mnemonic

Heart Disease in the U.S. DO NOW Use the map below to answer quesons 1-3.

Note: Myocardial infarcon = heart aack; angina = heart pain

1. What was the self-reported prevalence of history of heart aack or heart disease in your state?

2. What geographical trends do you noce in the prevalence of heart aack/heart disease?

3. What factors do you think may account for these trends?

DISCUSS Identifying Heart Attacks

Why do you think many heart aacks are difficult to predict and diagnose early?

1 MODULE 6: RURAL HEALTH LESSON 6.9

NEW INFO Acute Illnesses & OPQRST Review: VOCABULARY:

The SOAP note (Subjecve, Objecve, Assessment, Plan) is a method Acute illness: a disease with a of documentaon used by providers to write out notes in a paent rapid onset and/or a short chart. The Subjecve poron of the SOAP consists of all the quesons course asked to gather informaon. The SAMPLE history (Signs/symptoms, , Medicaons, Past history, Last oral intake, & Events leading mnemonic: a learning device to illness/injury) is an important part of the Subjecve data gathering. that helps one remember OPQRST-AAA: informaon Another crical poron of the Subjecve secon for an acute illness provocaon: creang a is the specific set of quesons about the symptoms and history of negave response (in this case, present illness which may help in diagnosis and treatment. One the symptom in queson) mnemonic for this set of quesons is OPQRST. This parcular set of quesons is oen used methodically when a heart aack is palliaon: to relieve the suspected, but can also be used for a range of other illnesses such as symptoms of a disease , stomach pain, and more. The table below summarizes the quesons included in OPQRST.

Letter Meaning Questions

What were you doing when it started (acve, inacve, stressed)? Did it start suddenly, O Onset gradually, or is it part of an ongoing chronic problem?

Does any movement, pressure, or other external factor make the problem beer or worse? Provocaon or Are the symptoms relieved with rest? P Palliaon

Can you describe the pain? Is it is sharp, dull, crushing, burning, tearing, or some other Q Quality of the pain feeling? Is there a paern, such as intermient, constant, or throbbing?

Where is the pain located on the body? Does it radiate (extend) or moves to any other Region and area? (Heart aacks can radiate through the jaw and arms. Other referred pains can R provide clues to underlying medical causes.) Radiaon

How would you rate your pain on a scale of 0 to 10? (0 is no pain and 10 is the worst possible pain.) Either "... compared to the worst pain you have ever experienced") or "... S Severity compared to having your arm ripped off by a bear".

How long has the condion been going on? How has it changed since onset (beer, worse, T Time (history) different symptoms)? Has it ever happened before?

Note: The quesons do not have to be asked in the exact order listed. The paent interview should be conversaonal and have a smooth flow, so somemes the order should be adjusted.

2 MODULE 6: RURAL HEALTH LESSON 6.9

READ

Source: CDC Heart Aack Fact Sheet

DISCUSS One study showed that women are two mes as likely than men to call 911 if they are showing signs of a heart aack. What might explain this finding?

3 MODULE 6: RURAL HEALTH LESSON 6.9

THINK Role Play: OPQRST Interview

Goal: Pracce the OPQRST interview from both angles, the paent and the health care provider Direcons: 1. Choose your starng roles. One person will be an emergency room triage nurse. The other will be a paent who has driven to the hospital, worried about chest pain. 2. Paent uses the first column in the table to record brief details about the chest pain, so they are prepared to act convincingly and answer all quesons. 3. Healthcare provider begins the paent interview by asking quesons and use the first column in the table below to record the OPQRST informaon. 4. Switch roles and repeat, using the second column.

Patient #1 Patient #2

O

P

Q

R

S

T

DISCUSS What was most challenging about the OPQRST interview? (Consider both the healthcare provider and the paent perspecves)

4 MODULE 6: RURAL HEALTH LESSON 6.9

Identifying OPQRST ASSESS

Idenfy the correct poron of the OPQRST interview for each paent statement below.

______1. The pain in my head is a 9.5. It’s the worst pain I’ve ever felt.

______2. My head throbs all over, as if someone is squeezing my brain.

______3. When I turn off all the lights my head feels beer.

______4. It started last night around 11:30pm.

______5. My has started to move into my neck.

______6. It stopped hurng about an hour ago.

HOME WORK Write An OPQRST Interview Script

Goal: Pracce the OPQRST interview for an acute illness

Direcons: 1. Choose any acute illness. 2. Research the illness so you understand how a paent may respond when interviewed. 3. Write out the dialogue between the healthcare provider and paent for an OPQRST interview. 4. Find a partner who will agree to help you act out your script in case you are called on to present your interview next class.

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