Activity C INTERVIEWING AND RECORDING ASSESSMENT FINDINGS
Instructions: Use the following Nursing Interview Guide to Interview and record
your subjective findings for a health history of a lab partner, peer, or client. Your
instructor may ask you to turn this in to be evaluated.
Nursing Interview Completely Done Satisfactory Done Incompletely Done
Guide (5 pts) (3pts) (1 pt)
Biographical Data
Name
Gender
Address, phone number
Date and place of birth
Nationality or ethnicity
Marital status
Religious or spiritual
practices
Primary and secondary
languages spoken,
written, and read; birth
language
Educational level
Occupation and working
status
Who lives with the
client? Identify
significant others
Caregivers and support
people to the client
Reasons for Seeking
Health Care
What is major health
care or concern?
Are you comfortable with
seeking care from this
organization? Past
experiences good or
not?
History of Present
Health Concern (use
COLDSPA when
appropriate)
Character of symptom or
condition
Onset (when did it begin;
better? worse? Same?)
Location (where and
does it radiate?)
Severity (on scale of 1 –
10?)
Pattern (what makes it
better? worse?)
Associated factors (other
associated symptoms?
Effect on leisure or
exercise?)
Past Health History
Problems at birth?
Childhood illnesses?
Immunizations to date?
Acute or chronic adult
illnesses (physical,
emotional, mental)?
Surgeries?
Pregnancies? Births?
Miscarriages?
Abortions?
Accidents? Injuries?
Prolonged pain or pain
patterns?
Medications?
Allergies?
Family Health History
Recall as many genetic
relatives as possible
(parents, grandparents,
siblings) with age,
longevity, chronic
illnesses (i.e., heart
disease, stroke,
diabetes, cancer,
arthritis, Alzheimer’s).
Lifestyle and Health
Practices Profile
Description of Typical
Day
“Please tell me what an
average or typical day is
for you. Start with
awakening in the
morning and continue
until bedtime.”
Nutrition and Weight
Management
“What do you
usually eat during
a typical day?
Please tell me the
kinds of foods you
prefer, how often
you eat
throughout the
day, and how
much you eat?”
“ Do you eat out
at restaurants
frequently?”
“Do you eat only
when hungry? Do
you eat because
of boredom, habit,
anxiety,
depression?”
“Who buys and
prepares the food
you eat?”
“Where do you
eat your meals?”
“How much and what
type of fluids do you
drink?”
Activity Level and
Exercise
“What is your
daily pattern of
activity?
“Do you follow a
regular exercise
plan? What type
of exercise do
you do?”
“Are there any
reasons why you
cannot follow a
moderately
strenuous
exercise
program?”
“What do you do
for leisure and
recreation?”
“Do your leisure and
recreational activities
include exercise?”
Sleep and Rest
“Tell me about
your sleeping
patterns.”
“Do you have
trouble falling
asleep or staying
asleep?”
“How much sleep
do you get each
night?”
“Do you feel
rested when you
awaken?”
“Do you nap
during the day?
How often and for
how long?”
“What do you do to help
you fall asleep?”
Substance Use
“How much beer,
wine, or other
alcohol do you
drink on the
average?”
“Do you drink
coffee or other
beverages
containing
caffeine (e.g.,
cola)? If so, how
much and how
often?”
“Do you now or
have you ever
smoked
cigarettes or used
any other form of
nicotine? How
long have you
been smoking/did
you smoke? How
many packs per
week? Tell me
about any efforts
to quit.”
“Have you ever
taken any
medication not
prescribed by
your health care
provider? If so,
what type, how
much, and why?”
“Have you ever
used, or do you
now use,
recreational
drugs? Describe
any usage.”
“Do you take vitamins or
herbal supplements? If
so, what?”
Self-Concept and Self-
Care Responsibilities
“What do you see
as your talents or
special abilities?”
“How do you feel
about yourself?
About your
appearance?”
“Can you tell me
what activities
you do to keep
yourself safe,
healthy, or to
prevent disease?”
“Do you practice
safe sex?”
“How do you keep
your home safe?”
“Do you drive
safely?”
“How often do
you have medical
checkups or
screenings?”
“How often do you see
the dentist or have your
eyes (vision)
examined?”
Social Activities
“What do you do for fun
and relaxation?”
“With whom do
you socialize
most frequently?”
“Are you involved
in any community
activities?”
“How do you feel
about your
community?”
“Do you think that
you have enough
time to socialize?”
“What do you see as
your contribution to
society?”
Relationship
“Who is (are) the most
important person(s) in
your life? Describe your
relationship with that
person.”
“Wht was it like
growing up in
your family?”
“What is your
relationship like
with your
spouse?”
“What is your
relationship like
with your
children?”
“Describe any
realtionships you
have with
significant
others.”
“Do you get along
with your in-
laws?”
“Are close to your
extended family?”
“Do you have any
pets?”
“What is your role
in your family? Is
it an important
role?”
“Are you satisfied with
your current sexual
relationships? Have
there been any recent
changes?”
Values and Belief
System
“What is most important
to you in life?”
“What do you
hope to
accomplish in
your life?”
“Do you have a
religious
affiliation? Is this
important to you?”
“Is a relationship
with God (or
another higher
power) an
important part of
your life?”
“What gives you strength
and hope?”
Education and Work
“Tell me about
your experiences
in school or about
your education.”
“Are you satisfied
with the level of
education you
have? Do you
have future
educational
plans?”
“What can you tell
me about your
work? What are
your
responsibilities at
work?”
“Do you enjoy
your work?”
“How do you feel
about your co-
workers?”
“What kind of
stress do you
have that is work
related? Any
major problems?”
“Who is the main
provider of
financial support
in your family?”
“Does your current
income meet your
needs?”
Stress Levels and
Coping Styles
“What types of
things make you
angry?”
“How would you
describe the
stress level?”
“How do you
manage anger or
stress?”
“What do you see
as the greatest
stressors in your
life?”
“Where do you usually
turn for help in a time of
crisis?”
Environment
“What risks are
you aware of in
your environment
such as in your
home,
neighborhood, on
the job, or any
other activities in
which you
participate?”
“What types of
precautions do
you take, if any,
when playing
contact sports,
using harsh
chemicals or
paint, or operating
machinery?”
“Do you believe you are
ever in danger of
becoming a victim of
violence? Explain.”
