Interviewing Through a Professional Interpreter: History of Present Illness and Review of Systems for a 54-Year-Old Vietnamese-Speaking Woman With Three Months of Fatigue
[Student Name]
University of Phoenix
NSG/523: Advanced Health Assessment
Week 1 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. No real patient, interpreter or practice is described.
Fatigue is one of the most common complaints in primary care and one of the hardest to interview well. It has many causes, from anemia and thyroid disease to depression, sleep disorders and cancer, and the history, more than any test, decides which of them deserves attention. This paper documents a health interview with a composite 54-year-old woman who has had fatigue for three months. She speaks Vietnamese and limited English, and the interview was conducted through a professional medical interpreter. A history taken through a patient's grandson in the waiting room would have been faster, but it would have missed the one detail that changed the differential: the heavy menstrual bleeding she would not discuss in front of him.
Interview Method
The interview took place in a private room with a professional in-person Vietnamese interpreter. The patient's adult grandson, who drove her to the visit, offered to interpret, but the nurse practitioner thanked him and explained that the clinic uses trained interpreters so that he could simply support his grandmother. Across the studies Karliner et al. (2007) reviewed, trained interpreters produced clearer communication, fewer mistakes, better outcomes and more satisfied patients than untrained ones, and ad hoc interpreters such as family members were more likely to make errors with clinical consequences. Federal rules on nondiscrimination in health programs also require covered practices to offer qualified interpreters to patients with limited English proficiency rather than relying on family members, except in narrow circumstances (Nondiscrimination in Health Programs and Activities, 2024).
The nurse practitioner sat facing the patient, spoke directly to her in the first person, used short sentences and paused for interpretation. She began with an open question, how have you been feeling, and listened without interrupting before moving to focused questions. Near the end she asked the patient what she thought was causing the fatigue and what worried her most, questions drawn from the explanatory model approach described by Kleinman et al. (1978), which invites patients to describe illness in their own terms.
Chief Complaint
"I have been tired all the time for three months, and I cannot do my work."
History of Present Illness
The HPI below records each of the seven attributes of a symptom that standard assessment texts describe, from location and quality through setting, aggravating and relieving factors and associated manifestations (Bickley et al., 2021).
The patient is a 54-year-old woman who reports gradually increasing fatigue over about three months, with no clear starting event. She describes the fatigue as a heavy, drained feeling in her body rather than sleepiness, present from waking and worse by mid-afternoon. It is constant rather than episodic and has worsened slowly. She rates it 7 out of 10 on most days. It is aggravated by physical work; she works six days a week at a nail salon, standing for most of the day, and now has to sit down after climbing one flight of stairs at home because she feels short of breath and her heart beats fast. Rest helps a little but does not restore her energy, and a night's sleep does not make her feel refreshed. She has tried a Vietnamese herbal tonic from a local shop for one month without improvement and takes no other medicine for it.
Associated symptoms emerged only when she was asked directly and privately. She reports that her menstrual periods, which had been irregular for a year, have become very heavy over the past four months, lasting eight to nine days and requiring her to change pads every one to two hours on the heaviest days, with clots. She also reports feeling cold, dizziness when standing quickly and a craving to chew ice. She denies fever, night sweats, weight loss, change in appetite, cough and bleeding from anywhere else.
Asked what she thought was causing the fatigue, she said she believed it was weakness of the blood from working too hard, and she worried most that she might lose her job if she had to take time off.
Past Health History, Medications and Social History
Past history includes gestational diabetes in her second pregnancy and no other chronic illness. She has had no surgeries or hospitalizations and no blood transfusions. She takes no prescription medicines, only the herbal tonic, and has no known drug allergies. She was born in Vietnam and moved to the United States 14 years ago. She is widowed, lives with her son's family, does not smoke or drink alcohol, and eats rice, vegetables and fish daily with little red meat. She has not seen a clinician in four years and has never had a mammogram or colorectal screening.
Review of Systems
General: fatigue as above, cold intolerance; no fever, chills, night sweats or weight change.
Skin, hair and nails: paler than usual according to her family; no rash, no easy bruising; brittle nails, no hair loss.
Head, eyes, ears, nose and throat: no headaches, vision changes, hearing change, nosebleeds or sore throat; she reports a sore tongue.
Neck: no swelling or lumps noticed.
Cardiovascular: rapid heartbeat on exertion; no chest pain, no leg swelling, no episodes of fainting.
Respiratory: shortness of breath on one flight of stairs; no cough, wheeze or hemoptysis.
Gastrointestinal: no abdominal pain, nausea, vomiting, black or bloody stools, diarrhea or constipation; no difficulty swallowing.
Genitourinary: heavy, prolonged menses as above; no bleeding between periods or after intercourse; no urinary symptoms.
Musculoskeletal: aching legs at the end of the workday; no joint swelling.
Neurologic: dizziness on standing; no numbness, tingling, weakness or restless legs.
Psychiatric: feels discouraged about her energy but denies loss of interest in activities; sleeps seven hours; the depression screen answered through the interpreter was negative.
Endocrine: cold intolerance; no heat intolerance, excess thirst or urination.
Hematologic: no known anemia in the past, no bleeding disorders in the family.
Synthesis: What the History Tells the Examination
The history points strongly toward iron deficiency anemia from heavy menstrual bleeding: progressive fatigue with exertional dyspnea and palpitations, orthostatic dizziness, pica for ice, brittle nails, a sore tongue and four months of heavy, prolonged menses with clots in a woman who is likely perimenopausal. It also raises the question of why her bleeding changed, since abnormal uterine bleeding in a woman in her fifties requires evaluation for structural causes, including endometrial disease. Hypothyroidism remains possible given cold intolerance and fatigue, and depression was screened but not excluded entirely.
The examination in later weeks will therefore look for pallor of the conjunctivae and palms, tachycardia and orthostatic vital sign changes, a flow murmur, glossitis and koilonychia, thyroid enlargement, and pelvic findings, and the history suggests laboratory tests that include a complete blood count, iron studies and thyroid-stimulating hormone. The history has done its job when it tells the examiner what to look for.
Conclusion
A health interview conducted through a professional interpreter, in private, with open questions first and the patient's own explanation invited, produced a history that a rushed interview through a family member would likely have missed. The fully characterized HPI and a systematic review of systems turned a vague complaint of fatigue into a focused set of hypotheses, led by iron deficiency anemia from abnormal uterine bleeding, and set the direction for the physical examination and testing that follow.
References
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727-754. https://doi.org/10.1111/j.1475-6773.2006.00629.x
Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88(2), 251-258. https://doi.org/10.7326/0003-4819-88-2-251
Nondiscrimination in Health Programs and Activities, 45 C.F.R. ยง 92.201 (2024). https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-92
How this NSG 523 Week 1 example is structured
The University of Phoenix library guide for NSG/523 lists Week 1 as Interviewing, HPI, and ROS. The paper describes the interview method first, including how the interpreter was used, because in this week the technique is graded as much as the data. The HPI is written with every attribute of the symptom, the review of systems is organized by body system with pertinent positives and negatives, and the short synthesis at the end shows why the history is the foundation for the examination in later weeks. Students search this week as NSG 523 Week 1, NSG523 Wk 1 or NSG/523 Wk 1; all three are the same assignment.
NSG/523 Week 1 questions, answered
What does NSG/523 Week 1 usually ask for?
The University of Phoenix library guide for NSG/523 lists Week 1 as interviewing, the history of present illness and the review of systems. Many sections ask for a written health history or interview write-up that demonstrates technique and a complete HPI and ROS. Your instructions decide whether a full comprehensive history is required.
How detailed should the HPI be?
Detailed enough that another clinician could picture the symptom without asking again: onset, location where relevant, duration, character, aggravating and relieving factors, timing, severity and associated symptoms, plus what the patient thinks is causing it. Mnemonics such as OLDCARTS help make sure nothing is missed.
Why include a section on using an interpreter?
Because interviewing technique is part of what Week 1 assesses, and working with an interpreter is a core advanced practice skill. The evidence shows that professional interpreters improve communication and care compared with ad hoc interpreters, such as family members.
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