Health Problem

Question

Stomatitis

When did you start having mouth ulcers?

What was the reason they developed?

  Were they related to poorly fitting dentures or other dental prostheses?

How are the ulcers right now?

Are you using any specific medicine for them? If so,

  What is the name of the medicine?

  How often do you use it?

Do the ulcers cause you much pain? If so,

  What do you do for the pain?

Have you changed your diet because of the ulcers? If so,

  What foods do you avoid?

  What foods are you able to tolerate?

Have you gained/lost weight because of the mouth ulcers?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the mouth ulcers?

GERD

When were you diagnosed with GERD?

What were you told was the reason that it developed?

What symptoms do you experience when the GERD is “acting up”? Such as,

  Burping up food from the stomach?

  Chest pain?

  Sore throat?

  Hoarseness?

  Belching?

  Problems swallowing?

  Pain when eating?

  Chronic cough?

What causes the symptoms? For example,

  Food?

  Alcohol intake?

  Stress?

  Bending over after eating?

  Lying down flat in bed?

Have you been avoiding certain foods because of it? Such as foods that are:

  Acidic?

  Fatty?

  Spicy?

What medicine are you taking for the GERD?

  How long have you been instructed to take it?

  Does it help with the symptoms?

What else have you been instructed to do to help with the GERD, such as:

  Smoking cessation?

  Avoid wearing tight clothing?

  Maintain body weight or lose weight?

  Eat smaller more frequent meals?

  Avoid eating for several hours before going to bed?

  Staying upright for several hours after eating?

  Elevating the head of the bed on blocks?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the GERD?

Gastric/duodenal ulcers

When were you told that you had a gastric/duodenal ulcer?

What were/are your symptoms? Such as:

  Pain (describe the pain; some common terms include gnawing, aching, or extreme hunger)?

      Does eating make the pain go away?

  Heartburn?

  Vomiting coffee-ground appearing material?

Are you taking an antibiotic as treatment for the ulcer? If so,

  What is the name of the antibiotic?

  How long do you have to take it?

  Are you having any ill effects from the antibiotic?

Are you taking any other medicine for the ulcers?

  Do you have to get a vitamin injection every month because of the ulcers?

Have you been told to avoid certain things because of the ulcer, such as:

  Aspirin?

  Other over-the-counter pain medicine?

  Alcohol?

  Smoking?

Have you ever been hospitalized because the ulcers were bleeding?

  If so, when was the last time this happened?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the ulcers?

Small bowel obstruction

When were you told you had an obstruction in your small intestine?

What were you told was the reason the obstruction occurred?

What symptoms did you have/are you having now because of the obstruction such as:

  Abdominal pain?

  Bloating?

  Constipation?

What treatment have you been prescribed for the obstruction?

Are you scheduled for/planning to have surgery for the obstruction? If so,

  When is this going to be done/when was it done?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the ulcers?

Irritable bowel syndrome

When were you told you have irritable bowel syndrome?

What are your symptoms? Such as:

  Abdominal pain?

  Periods of diarrhea and then periods of constipation?

  Hard lumpy stool?

  Bloating?

  Excessive flatus/gas?

What medicine have you been taking for the irritable bowel syndrome?

  Has the medication improved the symptoms?

What other changes have you made because of the irritable bowel syndrome such as:

  Increasing the amount of fiber that you eat?

  Avoiding milk or dairy products?

  Avoiding foods such as beans, cabbage, apples, and nuts?

  Avoiding all caffeine and caffeinated drinks?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the irritable bowel syndrome?

Ulcerative colitis

When were you told that you have this disorder?

What are your symptoms? Such as

  Diarrhea (four to six stools a day)?

  Fever?

  Rectal bleeding?

  Mucus in the stool?

What medicine are you taking for the ulcerative colitis?

  Is the medication helping?

What other things have you changed because of the ulcerative colitis, such as:

  Eliminating dairy products (milk, cheese, yogurt)?

  Increasing roughage by eating fruit and vegetables?

Has your doctor or health care professional said anything about needing surgery for the problem?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the ulcerative colitis?

Crohn’s disease

When were you told that you have this disease?

What symptoms of the disease are you having right now?

  Constant diarrhea?

  Abdominal pain?

  Weight loss?

  Loss of appetite?

  Nausea?

  Vomiting?

What medicine are you taking for the disease? Is it helping?

What other things have you changed because of the disease? Such as:

  Avoiding all foods with roughage or fiber?

  Drinking liquid supplements?

Have you ever had surgery because of the disease? If so, when was this done?

  Was some of your bowel removed?

  Do you have an ostomy (ileostomy, colostomy)?

  Where is the ostomy located?

  What is the consistency of the stool that comes out of the ostomy?

  Are you having any problems with the skin around the ostomy?

  Are you able to change the ostomy appliance yourself?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the Crohn’s disease?

Diverticulitis/Diverticulosis

When were you told that you have diverticulitis/diverticulosis?

What were your symptoms?

  Pain after eating foods with seeds such as popcorn, nuts, strawberries?

What treatment were you prescribed for the health problem?

  Increase roughage?

  Avoid roughage?

What medicine are you taking for the health problem?

Have you ever been in the hospital for the health problem?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the diverticulitis/diverticulosis?

Appendicitis

When were you told that you had appendicitis?

What were your symptoms?

  Abdominal pain (that got worse with walking or coughing)?

What treatment did you have for the appendicitis?

Did you have surgery to remove the appendix? If so, when was this done?

Did you have any fevers or an infection after the appendix was removed?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the appendix problem? (Keep in mind that the pain of appendicitis can be severe. If the pain suddenly stops or disappears, the appendix could have ruptured. This is an emergency situation requiring surgery to prevent peritonitis.)

Hemorrhoids

When were you told that you have hemorrhoids?

When did you first notice a problem? Was it:

  After having a baby?

  Associated with constipation?

  After a weight gain?

  Sitting too long at work?

  Eating a low-fiber diet?

What symptoms do you have because of the hemorrhoids?

What medicine do you use for the hemorrhoids?

  Does the medicine help?

Have you been told that you need surgery for the hemorrhoids? If so, when was it/will it be done?

Have you had to make any other changes because of the hemorrhoids?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the hemorrhoids?

Liver cirrhosis

When were you told that you have liver cirrhosis?

What were you told was the reason that the condition developed?

What symptoms are you experiencing right now? Such as:

  Abdominal swelling?

  Bleeding (in the stool or in vomit)?

  Bruising?

  Jaundice?

  Loss of appetite?

  Diarrhea?

Have you been in the hospital for the cirrhosis? Was it because of bleeding from your stomach or esophagus?

What medicine are you taking for the cirrhosis, such as:

  Water pill (diuretic)?

  Antibiotics?

  Lactulose?

  Vitamin supplements?

  Antacids?

What other treatment have you been prescribed for the cirrhosis such as:

  Low-salt diet?

  Avoiding all alcohol?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the cirrhosis?

Hepatitis

When were you told that you have/had hepatitis?

What type of hepatitis were you told that you had/have? A, B, or C?

What were you told was the reason you developed hepatitis?

  Ingesting food that was infected with fecal material?

  Exposure to blood?

What symptoms are you currently experiencing?

  Jaundice?

  Fatigue?

  Weakness?

  Loss of appetite?

  Abdominal pain?

What medicine are you taking for the hepatitis?

Were you given vaccinations to prevent any future episodes of hepatitis?

Were you prescribed any other treatment for the hepatitis?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the hepatitis?

Cholelithiasis/Cholecystitis

When were you told that you have a problem with your gallbladder?

What were you told was/is the problem?

  Infection?

  Inflammation?

  Stones in the gallbladder?

  Rapid weight loss?

  Use of medications?

What symptoms are you having right now because of your gallbladder?

  Right shoulder pain?

  Nausea?

  Vomiting?

  Abdominal pain?

  Stool appears clay colored?

What medicine have you been taking for the gallbladder problem? Is it helping with the pain?

What other things are you doing to help with the gall bladder problem:

  Avoiding high-fat foods?

Are you scheduled for/planning to have surgery to remove your gallbladder?

  When was it/when is it going to be done?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of your gallbladder?

Pancreatitis

When were you told that you have a problem with your pancreas?

What were you told was the reason that you have a problem with your pancreas?

What symptoms are you having right now because of your pancreas?

  Abdominal pain that radiates to your back?

  Pain after eating a high-fat meal or drinking alcohol?

  Nausea?

  Vomiting?

  Bloating?

What medicine are you taking for your pancreas?

  Pain medication?

  Enzyme replacements?

Is it helping with the symptoms?

What else have you been directed to do to help with your pancreas problem?

  Low-fat diet?

  Avoiding all alcohol?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of your pancreas?

Eating disorder: anorexia nervosa/bulimia nervosa

The patient/client may not refer to this disorder with the appropriate name. It may be referred to as not eating or avoiding food. For bulimia, it might be referred to as binge eating or vomiting after eating.

When did you realize that you have a problem with eating food?

What happens when you eat food?

  How do you feel when you eat food? (Keep in mind that the assessment does not go in depth into the psychology of anorexia nervosa.)

Do you ever make yourself throw up after eating?

  How does that make you feel?

  How often do you do this?

  Are you having any problems because of throwing up such as:

      Problems with your teeth?

      Sore throat?

Have you ever been hospitalized because you were not eating/throwing up too much?

Have you ever had to have food replacements given to you through your veins or through a tube that goes into the stomach?

How are you feeling right now? When was the last time that you ate something/felt the need to throw up?

For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of your eating problem?