Difference between revisions of "Symptom Assessment"
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'''During the <u>past 4 weeks</u>, how much have you been bothered by any of the problems?''' <br> | '''During the <u>past 4 weeks</u>, how much have you been bothered by any of the problems?''' <br> | ||
| − | S1. '''Stomach pain'''?<br> | + | [[S1|S1.]] '''Stomach pain'''?<br> |
□ Bothered a lot <br> | □ Bothered a lot <br> | ||
□ Bothered a little <br> | □ Bothered a little <br> | ||
□ Not bothered at all <br> | □ Not bothered at all <br> | ||
| − | S2. '''Back pain'''?<br> | + | [[S2|S2.]] '''Back pain'''?<br> |
□ Bothered a lot<br> | □ Bothered a lot<br> | ||
□ Bothered a little<br> | □ Bothered a little<br> | ||
□ Not bothered at all<br> | □ Not bothered at all<br> | ||
| − | S3. '''Pain in your arms, legs, or joints (knees, hips, etc.)'''?<br> | + | [[S3|S3.]] '''Pain in your arms, legs, or joints (knees, hips, etc.)'''?<br> |
□ Bothered a lot<br> | □ Bothered a lot<br> | ||
□ Bothered a little<br> | □ Bothered a little<br> | ||
□ Not bothered at all<br> | □ Not bothered at all<br> | ||
| − | S4. '''Menstrual cramps of other problems with your periods - WOMEN ONLY'''?<br> | + | [[S4|S4.]] '''Menstrual cramps of other problems with your periods - WOMEN ONLY'''?<br> |
□ Bothered a lot <br> | □ Bothered a lot <br> | ||
□ Bothered a little <br> | □ Bothered a little <br> | ||
□ Not bothered at all <br> | □ Not bothered at all <br> | ||
| − | S5. '''Headaches'''?<br> | + | [[S5|S5.]] '''Headaches'''?<br> |
□ Bothered a lot<br> | □ Bothered a lot<br> | ||
□ Bothered a little<br> | □ Bothered a little<br> | ||
□ Not bothered at all<br> | □ Not bothered at all<br> | ||
| − | S6. '''Chest pain'''?<br> | + | [[S6|S6.]] '''Chest pain'''?<br> |
□ Bothered a lot<br> | □ Bothered a lot<br> | ||
□ Bothered a little<br> | □ Bothered a little<br> | ||
□ Not bothered at all<br> | □ Not bothered at all<br> | ||
| − | S7. '''Dizziness'''?<br> | + | [[S7|S7.]] '''Dizziness'''?<br> |
□ Bothered a lot <br> | □ Bothered a lot <br> | ||
□ Bothered a little <br> | □ Bothered a little <br> | ||
□ Not bothered at all <br> | □ Not bothered at all <br> | ||
| − | S8. '''Fainting spells'''?<br> | + | [[S8|S8.]] '''Fainting spells'''?<br> |
□ Bothered a lot<br> | □ Bothered a lot<br> | ||
□ Bothered a little<br> | □ Bothered a little<br> | ||
□ Not bothered at all<br> | □ Not bothered at all<br> | ||
| − | S9. '''Feeling your heart pound or race'''?<br> | + | [[S9|S9.]] '''Feeling your heart pound or race'''?<br> |
□ Bothered a lot<br> | □ Bothered a lot<br> | ||
□ Bothered a little<br> | □ Bothered a little<br> | ||
□ Not bothered at all<br> | □ Not bothered at all<br> | ||
| − | S10. '''Shortness of breath'''?<br> | + | [[S10|S10.]] '''Shortness of breath'''?<br> |
□ Bothered a lot <br> | □ Bothered a lot <br> | ||
□ Bothered a little <br> | □ Bothered a little <br> | ||
□ Not bothered at all <br> | □ Not bothered at all <br> | ||
| − | S11. '''Pain or problems during sexual intercourse'''?<br> | + | [[S11|S11.]] '''Pain or problems during sexual intercourse'''?<br> |
□ Bothered a lot<br> | □ Bothered a lot<br> | ||
□ Bothered a little<br> | □ Bothered a little<br> | ||
□ Not bothered at all<br> | □ Not bothered at all<br> | ||
| − | S12. '''Constipation, loose bowels, or diarrhea'''?<br> | + | [[S12|S12.]] '''Constipation, loose bowels, or diarrhea'''?<br> |
□ Bothered a lot<br> | □ Bothered a lot<br> | ||
□ Bothered a little<br> | □ Bothered a little<br> | ||
□ Not bothered at all<br> | □ Not bothered at all<br> | ||
| − | S13. '''Nausea, gas, or indigestion'''?<br> | + | [[S13|S13.]] '''Nausea, gas, or indigestion'''?<br> |
□ Bothered a lot <br> | □ Bothered a lot <br> | ||
□ Bothered a little <br> | □ Bothered a little <br> | ||
Latest revision as of 09:48, 9 June 2015
Symptoms can be reported by the patient with the Symptom Assessment, which is a component of the Well-Being Assessment. There is a capability being developed tat will enable symptoms to be updated regularly via the well-being status. Symptoms are typically addressed by assigning Care Goals and interventions and activities in the Care Plan.
GENERAL SYMPTOMS ASSESSMENT
This is based on the Physical Symptoms (PHQ-15)
During the past 4 weeks, how much have you been bothered by any of the problems?
S1. Stomach pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S2. Back pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S3. Pain in your arms, legs, or joints (knees, hips, etc.)?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S4. Menstrual cramps of other problems with your periods - WOMEN ONLY?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S5. Headaches?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S6. Chest pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S7. Dizziness?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S8. Fainting spells?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S9. Feeling your heart pound or race?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S10. Shortness of breath?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S11. Pain or problems during sexual intercourse?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S12. Constipation, loose bowels, or diarrhea?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
S13. Nausea, gas, or indigestion?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
PHQ-4. Feeling tired or having low energy?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
PHQ-3. Trouble failing or staying asleep, or sleeping too much?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all
