Symptoms and Signs

The clinician must be able to elicit descriptions of, and recognize, a wide variety of symptoms and signs. Symptom refers to what the patient feels. Symptoms are described by the patient to clarify the nature of the illness. Shortness of breath, chest pain, nausea, diarrhea, and double vision are all symptoms. These labels help the patient describe the discomfort or distress that he or she is experiencing. Symptoms are not absolute; they are influenced by culture, intelligence, and socioeconomic background. As an example, consider the symptom of pain. Patients have different thresholds of pain. This is discussed further in Chapter 3, Caring for Patients in a Culturally Diverse Society.

Constitutional symptoms are symptoms that commonly occur with problems in any of the body systems, such as fever, chills, weight loss, or excessive sweating.

A sign is what the examiner finds. Signs can be observed and quantified. Certain signs are also symptoms. For example, a patient may describe episodes of wheezing; this is a symptom. In addition, an examiner may hear wheezing during a patient's physical examination; this is a sign.

The major task of the interviewer is to sort out the symptoms and signs associated with a specific illness. A major advantage that the seasoned interviewer has over the novice is a better understanding of the pathophysiologic processes of disease states. The novice operates under the limitation of not knowing all the signs and symptoms of the associated diseases. With experience and education, the novice will recognize the combination of symptoms and signs as they relate to the underlying illness. For any given disease, certain symptoms and signs tend to occur together. When there is only an isolated symptom, the interviewer must be careful in making a definitive assessment.

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