HEALTH HISTORY INTERVIEW

PRE INTERVIEW:

Hello Ma’am, I am (Name), a nursing student and I will be assisting you for today. May I
know your birth date po maam? Alright po may I see lang po your name tag. Okay po thank you
po. May I sit with you here for about 10-15 minutes and ask questions about you and your
care po?

Okay po. I will get some information about your (Gordon’s category) for your monthly
check up po noh. I will be taking down notes while we talk and this will be shared with other
staff po. Rest assured this interview is strictly confidential and only will be shared with those
with the legal right to know, will that be okay with you po?

Alright po, if there is anything that you are not comfortable with or have any concerns
throughout the interview please feel free to say so. Do you feel comfortable naman po with the
lighting and ventilation of the room? Okay po, I will close the curtains lang po.

(room is well lighted and ventilated, room is free from noise and distraction, patient has
been provided with privacy)

Before we proceed po ma'am I will be asking a few basic information po. How old are you na po
maam? Gender po? Marital status po? Nationality? And Religion po?

INTERVIEW:

Okay po ma’am I will start asking question na po

(At least 5 questions. If nagstart ng close ended question, i follow up ng open ended)

Health Perception and Health Management:

1. Do you consider yourself healthy?
- What is “healthy” for you?
2. What prescription and non-prescription medications do you take?
3. Do you visit the doctor on a regular basis or have annual check-ups?
4. When was the last time you visited the doctor for a check-up?
5. When there is something wrong with your body or whenever you feel sick, what do you first
do?
- Who and where do you seek help?
Nutrition and Metabolic
1. What is your diet? (Omnivore, Keto, Vegan, Vegetarian, etc.)
2. How often do you drink water in a day?
- How much water do you drink?
3. Do you take any vitamins or food supplements?
4. How often do you eat junk food or eat in a fast food chain?
5. Can you tell me about the time interval of your meals? Including snacks

Elimination Pattern:
1. How often do you urinate in a day?
- How about defecate po?
2. Do you experience pain or discomfort during excretion/pooping?
- How about urinating po, is there any pain po ba?
3. Do you notice if your urine has any strong odor? Foul odor perhaps?
4. Do you have any issues toward controlling urges to urinate po?
5. Do you have an issue towards sweating?
- It is not too excessive naman po?

Activity and Exercise:

1. Do you exercise regularly?
2. What type of exercises do you do?
- Do you follow any exercise plan?
3. Every time you exercise, do you experience any body pain?
4. Are you having any problems in exerting energy for certain activities?
5. What activities do you engage in during your leisure and recreation time?

Sleep and Rest:

1. What time do you usually sleep?
- What time do you usually wake up?
2. On a daily basis, how many hours of sleep do you get?
3. If you were to assess yourself, how long do you think you usually sleep and rest in a day?
4. Do you find it hard to go back to sleep if you are suddenly awoken?
5. Do you have a routine before sleeping?

Cognitive and Perceptual:

1. Do you easily get distracted?
2. How often do you find it difficult to memorize a certain thing?
3. Do you wear eyeglasses?
- Are they prescribed or not?
4. Is there an easiest way for you to learn things?
- If so, in what ways do you tend
5. Do you find it easy/difficult to make an important decision in life?

Self-perception:
1. Do you constantly feel angry or sad?
2. How do you feel and think about yourself lately?
- Do you feel good about your whole being?
 3. Are you aware of your self-worth?
- How would you describe it?
4. Do you ever feel like you lose hope in things
5. Do you do selfcare? If so, how?

Role and Relationship:

1. Do you live alone or are you living with anybody? (With partner and/or family
member/s)
- What is your role in the household?
2. Can you describe your relationship with your family?
3. Do you have friends/peers?
- Can you describe your relationship with them?
4. Can you describe your experience in school or workplace?
5. Is there anyone we can contact in case of an emergency?

Sexuality and Reproductive:

1. Do you visit the OB-GYN po ba?
- How often in a year?
2. When was your last period?
- Regular po ba?
- How many days po typically katagal yung menstruation niyo po?
- Do you track your period po ba?
3. Do you engage po ba in any sexual interaction?
4. Are you using birth control?
5. How do you identify your sexual orientation?

Coping-Stress
1. Have you been under stress recently?
2. What stresses you?
- How do you recognize stress in daily life?
3. How do you cope with stress?
4. Who are the people you can talk to about your stress?
5. Do you have any sort of activities that keep you relaxed?

Values and beliefs:

1. Do you think that herbal or alternative medicines work on your body when you take it?
- When and where did you know about these herbal/alternative medicines?
2. Are you subject to any medical aid restrictions? Bawal po ba mag pa blood transfusion
due to religion mga ganun po?
3. Are you experiencing spiritual distress?

4. Have your beliefs had an impact on how you care for yourself?
5. Do you believe that your life has purpose or meaning?
CLOSING:

Well, those are all the questions I have for today.

To summarize (summarize yung notes). Is that correct po?

Alright po. Do you have any questions pa po ba regarding your care? Okay po. I will be
following up for another check up next month. Will April 14, Friday, 5:00 pm will be alright
with you po?

Okay po ma’am, that is all. Thank you for your time and help (shake hands). These answers will
be helpful for your care and plan. I’ll leave you be na po.