3.11 Reason for Seeking Health Care
It is helpful to begin the health history by obtaining the reason why the patient is seeking health care in their own words. During a visit to a clinic or emergency department or on admission to a health care agency, the patient’s reasons for seeking care are referred to as the reason for visit. After a patient has been admitted, the term main health needs is used to classify what the patient feels is most important at that time. Whichever term is used, it recognizes that patients are complex beings, with potentially multiple coexisting health needs, but there is often a pressing issue that requires most immediate care. This is not to suggest that other issues should be ignored; rather, it allows health care team members to prioritize care and address more urgent needs first. See Table 3.3 for suggested focused interview questions to use to investigate the reason a patient is seeking care based on the health care setting.
The nurse is always aware of critical assessment findings requiring immediate notification of a health care provider or the initiation of emergency care according to agency policy. For example, if a patient reports chest pain, difficulty breathing, sudden changes in vision or the ability to speak, sudden weakness or paralysis, uncontrolled bleeding, or thoughts of self-harm, the provider should immediately be notified with possible initiation of emergency care.
| Setting | Focused Assessment Questions | Sample Responses (Subjective Data) |
|---|---|---|
| Clinic Visit | Please tell me what brought you in today.
Can you tell me how long this has been going on? How is this affecting you?
|
“I have a headache that will not go away.”
“I have had this headache since yesterday morning when I woke up.” “I am not able to see clearly, and I feel sick to my stomach so I was not able to go to work.” |
| Hospital Admission | Please tell me what brought you in today.
Can you tell me how long this has been going on? Have you taken anything to improve the symptoms you are reporting? |
“I am having chest pain and my arm hurts.”
“The chest pain started after I finished shoveling my driveway about an hour ago.” “I took an aspirin like the commercials always say to do.” |
| Inpatient Follow-Up | Tell me what your main concerns are today since your admission.
Have you noticed any improvements since you were admitted? Do you have any symptoms currently? |
“I am wondering how long I am going to be admitted. I need to get back to work.”
“I feel huge improvements. I do not feel at all like I did yesterday.” “I do not have any chest pain and I do not have any arm pain anymore.” |
Reason for Visit
After identifying the reason the patient is seeking health care, additional focused questions are used to obtain detailed information about this concern. The mnemonic PQRSTU is often used to ask the patient questions in an organized fashion (see Figure 3.5).
The PQRSTU mnemonic is often used to assess pain, but it can also be used to assess many other symptoms. See Table 3.4 for suggested focus questions for pain and other symptoms using the PQRSTU mnemonic.
| PQRSTU | Questions Related to Pain | Questions Related to Other Symptoms |
|---|---|---|
| Provocation/Palliation
|
What makes your pain worse?
What makes your pain feel better? |
What makes your breathing worse?
What makes your nausea better? |
| Quality
|
What does the pain feel like?
Note: You can provide suggestions for pain characteristics such as “aching,” “stabbing,” or “burning.” |
What does the dizziness feel like? Do you feel light-headed, as if you’re going to faint or the room is spinning? |
| Region
|
Where exactly do you feel the pain? Does it move around or radiate elsewhere?
Note: Instruct the patient to point to the pain location. |
Where exactly do you feel the itching? Does it move around? |
| Severity
|
How would you rate your pain on a scale of 0 to 10, with “0” being no pain and “10” being the worst pain you’ve ever experienced? | How would you rate your shortness of breath on a scale of 0 to 10, with “0” being no problem and “10” being the worst breathing issues you’ve ever experienced? |
| Timing/Treatment
|
When did the pain start?
What were you doing when the pain started? Is the pain constant or does it come and go? If the pain is intermittent, when does it occur? How long does the pain last? Have you taken anything to help relieve the pain? |
When did your breathing issues begin?
What were you doing when the itching first started? Is the nausea constant or does it come and go? If the nausea is intermittent, does anything trigger it? How long did the nausea last? Have you taken anything to relieve the itching? |
| Understanding | What do you think is causing the pain? | What do you think is causing the itching? |
While interviewing a patient about their reason for visiting, use open-ended questions to allow the patient to elaborate on information that further improves your understanding of their health concerns. If their answers do not seem to align, continue to ask focused questions to clarify information. For example, if a patient states that “the pain is tolerable” but also rates the pain as a “7” on a 0-10 pain scale, these answers do not align, and the nurse should continue to use follow-up questions using the PQRSTU framework. For example, upon further questioning, the patient explains they rate the pain as a “7” in their knee when participating in physical therapy exercises, but currently feels the pain is tolerable while resting in bed. This additional information will help the nurse customize interventions for effective treatment.
Attribution
This chapter contains material taken from The Complete Subjective Health Assessment by Lapum, St-Amany, Hughes, Petrie, Morrell, and Mistry and is licensed under CC BY-SA 4.0.
