A.

INITIATION

Greets patient by name, Introduces self, Explain purpose of interview

- Good afternoon, Ms. Alejan! I am Sofia Atienza, a student nurse from Feu Manila. So for

today. I’ll be conducting a health interview to gather some information for your baseline

data.

Nature of interview, Information needed, Confidentiality of data collected

- In this interview, I will be asking you some open and close ended questions, starting

from your demographic data, followed by your medical history and health patterns. Also

you don't have to worry since all of the information you will share will remain strictly

confidential.

Time frame, Expectation from the patient, Note taking

- This interview will take about 15 to 20 mins of your time and I encourage you to answer

honestly and for your full cooperation. I will also be taking notes during the interview to

ensure accuracy.

B. ENVIRONMENT

1. Room should be well lighted and ventilated

2. Provide privacys

3. Provide room free from noise and distraction

- Is the light okay with you ma'am?

- Privacy (action)

- Okay, I already made the room free from noise and distractions so are you comfortable

ms.
 C. BODY

1. Has organized sequence of questions

2. Ask clear questions at a time

3. Uses appropriate transitional statement

4. Uses probing

Biographic Data

a. Name
b. Address
c. Contact Number
d. Age
e. Birthdate
f. Birthplace
g. Marital Status
h. Nationality
i. Ethnicity
j. Religion
k. Language Preference
l. Educational Level
m. Occupation
n. Name of Medical Insurance

Reason for Seeking Health Care

- So what brings you here today ma'am?
- I've been experiencing headaches
- When did the headache start?
- It started about one week ago
- Can you describe where you feel the headache?
- Its only on one side of my head, mostly on the right side
- On a scale of 0-10, how painful is it?
- Around 6 out of 10

Present Health History

- What symptoms do you experience along with the headache?
- I feel throbbing pain and sometimes i feel sensitive to light
 - Has the headache changed since it started?
- At first it was mild, but after a few days it became stronger and happens almost every
day.
- What seems to trigger or worsen the headache?
- It gets worse when I lack sleep or look at my phone for too long
- What helps relieve it?
- Resting in a dark room and sleeping helps lessen the pain
- Does the headache affect your daily activities?
- Yes, I find it hard to focus on studying, and sometimes I just want to lie down.
- Have you taken any medication or treatment?
- Yes, paracetamol
- Did the medication help?
- It helped a little, but the headache comes back after a few hours.

Past Health History

- Do you have any vaccinations?
- Yes. Flu, tdap, hepa b
- Are your vaccinations up to date?
- Yes, as far as i know
- Did you have any significant illnesses during childhood?
- I had chickenpox when i was young
- Do you have any previous medical conditions like hypertension, heart disease or
diabetes?
- No, none.
- Have you experienced any serious accidents or head injuries?
- No, I haven’t.
- Have you ever been hospitalized before?
- No
- Have you undergone any surgery?
- No surgeries.
- Have you traveled recently, locally or abroad?
- No recent travel

Family Health History

- Now, let’s talk about your family health history. Are your grandparents on your mother
and father’s side still alive?
- How about your parents, are they still alive?
- Do you have any siblings? If yes, how many?
- So between you and your sibling, are you the older one or the younger one?
- Are there any illnesses that run in your family?
1. Health Perception & Management
"To start off, how would you describe your overall health lately? What do you usually do to stay
healthy, and do you have any trouble following your current treatments or medications?"

2. Nutritional-Metabolic
"Can you tell me a bit about what you typically eat and drink in a day? Have you noticed any
recent changes in your appetite, weight, or how your skin and wounds heal?"

3. Elimination
"Do you have any issues or regular patterns with your bowel movements or urination that I
should know about? Any discomfort or changes you've noticed?"

4. Activity-Exercise
"What does a typical day of physical activity look like for you? Do you feel you have enough
energy for your daily chores or hobbies, or do you find yourself getting short of breath or tired
easily?"

5. Sleep-Rest
"How have you been sleeping lately? Do you feel rested when you wake up, or do you find it
hard to fall asleep or stay asleep?"

6. Cognitive-Perceptual
"Have you had any trouble with your memory, or any changes in your vision or hearing? Also,
are you experiencing any pain or discomfort right now?"

7. Self-Perception-Self-Concept
"How have you been feeling about yourself lately? Has your current health situation changed the
way you see yourself or your abilities?"

8. Role-Relationship
"Who are the most important people in your life right now? Does your health ever get in the way
of your responsibilities at home, work, or with your family?"

9. Sexuality-Reproductive
"Are you satisfied with your reproductive health and your personal relationships? Have you
noticed any changes or concerns in this area since your symptoms started?"

10. Coping-Stress Tolerance

"When things get stressful, how do you usually handle it? Who do you turn to for support when
you're feeling overwhelmed?"

11. Value-Belief
"Is there anything particularly important to you—like your faith, culture, or personal
values—that we should keep in mind while planning your care?"

D. CLOSING

1. Use concluding words, Provide summary

2. Offer to answer question

3. Plan for the next meeting

4. Express appreciation and concern for the patient

5. Thank the patient

- So to wrap everything up you’ve been having headaches for a week is that correct?

- Yes

- Do you have any questions or clarifications?

- None

- Okay so we will meet again March 7 and 8 am. If that's all, thank you so much for your

cooperation. See you next Saturday .