Before We Start
Why health history comes before everything else
Before you touch a patient, before you give a medication, before you perform any assessment — you need to know who you're caring for. The health history tells you the context that makes every other piece of data meaningful.
A blood pressure of 90/60 means something very different in a 25-year-old athlete than in a 70-year-old with heart failure. A heart rate of 110 is expected in a patient with a fever but alarming in someone who just had a cardiac catheterization.
SAMPLE ensures you capture the six most critical categories of health information — quickly, systematically, and in a way that can be communicated to the entire care team.
💡 SAMPLE vs AMPLE
You may notice SAMPLE and AMPLE cover similar ground. The difference:
AMPLE = rapid pre-surgical or trauma history (Allergies, Medications, Past history, Last meal, Events)
SAMPLE = comprehensive admission health history (adds Symptoms as the first priority)
SAMPLE is broader and starts with the patient's chief complaint. AMPLE is faster and used in emergencies.
The Six Components
SAMPLE — what to ask and what to listen for
S — Symptoms
What is the patient experiencing right now?
Symptoms are what brings the patient in — their chief complaint. Use open-ended questions and let the patient describe their experience in their own words.
Key questions:
• "What brings you in today?" or "What's been bothering you?"
• "When did it start?"
• "Has this happened before?"
Use OLDCART to dig deeper:
Onset · Location · Duration · Character · Aggravating factors · Relieving factors · Treatment tried
Subjective vs objective: Symptoms are subjective — only the patient can report them. Pain, nausea, dizziness, shortness of breath. Document in the patient's own words using quotation marks when possible.
💊 "Tell me what's been going on" opens better than "Do you have chest pain?" Open-ended questions reveal what the patient thinks is important — closed questions only get yes/no.
A — Allergies
What is the patient allergic to — and what is the reaction?
Every patient must be asked about allergies before any medication is given. This is non-negotiable and is a patient safety standard.
Always document:
• What they're allergic to (drug name, food, environmental)
• The specific reaction (hives, anaphylaxis, GI upset, difficulty breathing)
• Severity — mild intolerance vs. life-threatening anaphylaxis require very different management
Important distinction: An allergy is an immune response. A side effect is a known pharmacological response (nausea from codeine). These are different — a side effect does NOT get documented as an allergy.
Check:** Medication allergies, food allergies (shellfish before contrast), latex allergy (critical in surgical patients), environmental allergies.
💊 "Any allergies?" is not enough. Ask: "What happens when you take [medication]?" A patient who says "penicillin — I get a rash and my throat swells" needs to be flagged as anaphylactic risk — very different from "it upsets my stomach."
M — Medications
What is the patient currently taking?
A complete medication reconciliation is required on every admission. This includes ALL medications — not just prescriptions.
Ask specifically about:
• Prescription medications
• Over-the-counter drugs (aspirin, ibuprofen, antacids, cold medications)
• Vitamins and supplements
• Herbal remedies (St. John's Wort, garlic, ginkgo — many have drug interactions)
• Birth control pills and hormones
• Any medications "borrowed" from family members
High-alert medications to always flag: Anticoagulants, insulin, digoxin, lithium, chemotherapy, immunosuppressants, opioids.
💊 Bring the medication bottles from home — patients often can't remember drug names. The best medication reconciliation happens with the actual bottles in hand.
P — Past Medical History
What conditions and surgeries has the patient had?
Past history provides the background that contextualizes the current problem.
Cover all of these:
• Chronic medical conditions (diabetes, HTN, heart disease, COPD, kidney disease, cancer)
• Previous hospitalizations and their reasons
• Previous surgeries — especially complications or reactions to anesthesia
• Psychiatric history
• Obstetric history for female patients (pregnancies, deliveries, current pregnancy status)
• Family history of relevant conditions (heart disease, cancer, diabetes, genetic disorders)
• Immunization status
• Social history — smoking, alcohol, recreational drug use, living situation, support system
💊 "Have you ever been hospitalized before? When and why?" — This often reveals conditions the patient doesn't think to mention because they consider them "old news."
L — Last Oral Intake
When did the patient last eat or drink? What did they consume?
Last oral intake matters in several clinical situations:
Pre-surgery/procedures: Aspiration risk under anesthesia. Must know exact time and content of last meal.
Hypoglycemia assessment: A diabetic patient who hasn't eaten in 12 hours needs glucose monitoring.
Dehydration/nutrition status: A patient who "hasn't been able to eat for three days" needs nutritional assessment and fluid management.
Medication timing: Some medications must be taken with food; others on an empty stomach.
Always document: the TIME and the CONTENT (solid food vs. liquids, what specifically they consumed).
💊 "When did you last eat or drink anything — including water, coffee, or juice?" Patients often forget that coffee or a morning sip of water counts as intake.
E — Events Surrounding Illness
What was happening when symptoms started? What led to this admission?
The events surrounding the current illness provide crucial context for diagnosis and treatment.
Key questions:
• "What were you doing when the symptoms started?"
• "Has anything like this happened before?"
• "What have you tried to make it better?"
• "Did anything happen recently that might be related?" (new medication, dietary change, travel, exposure to sick contacts)
For trauma: Mechanism of injury, loss of consciousness, events immediately before injury
Hidden connections: A patient with new chest pain who started a new medication last week. A patient with diarrhea who was traveling internationally last month. The events reveal the cause.
💊 "What were you doing right before this started?" — A patient who had chest pain while shoveling snow has a very different picture than one whose chest pain woke them from sleep.
🏥 Clinical Scenario — SAMPLE on Admission
Mr. Patel, 66 years old, arrives at the ED with complaints of chest tightness and shortness of breath that started 2 hours ago. You conduct the SAMPLE history.
S
Symptoms: "Pressure in my chest — like something is sitting on it. Started about 2 hours ago while I was raking leaves. Radiates to my left arm. Also short of breath. I rate it 8/10." Diaphoretic, pale, anxious.
A
Allergies: "Sulfa drugs — I get a rash all over." No medication allergies beyond sulfa. No latex allergy. Documented as sulfa allergy with rash reaction.
M
Medications: Metoprolol 25mg daily (beta blocker), atorvastatin 40mg nightly, aspirin 81mg daily, lisinopril 10mg daily. Patient took all medications this morning. → Cardiac medication profile consistent with known heart disease risk factors.
P
Past history: HTN × 15 years, hyperlipidemia × 10 years, Type 2 DM × 8 years, father died of MI at 62. No previous hospitalizations. Never had cardiac catheterization. Non-smoker, occasional alcohol. Lives with wife.
L
Last intake: Lunch at noon — sandwich and coffee. It is now 4pm. Last solid food 4 hours ago. → Relevant if cardiac catheterization is needed. Reported to physician.
E
Events: Raking leaves — moderate exertion. Pain came on suddenly. No similar episodes before. No recent illness or medication changes. No recent travel. → Exertional onset of chest pain with radiation in a patient with multiple cardiac risk factors = high suspicion for ACS. 12-lead ECG ordered immediately.
📌 NCLEX Application
SAMPLE is foundational — it appears in almost every NCLEX patient scenario. The question may not name SAMPLE explicitly, but the information gathered through SAMPLE is what the questions are testing.
Key NCLEX applications:
• Medication reconciliation on admission — always required, nurses do it
• Allergy documentation — two identifiers + allergy check before every medication
• Last intake documentation before procedures
• Past surgical history — anesthesia reactions, previous difficult airways
Priority NCLEX rule: A patient cannot receive any medication until allergies are documented. This is both a safety standard and an NCLEX answer.
⚠️ The Trap — Documenting Side Effects as Allergies
One of the most common nursing errors is documenting a medication side effect as an allergy.
Allergy: An immune-mediated reaction — rash, urticaria, angioedema, anaphylaxis. This is a true allergy. The medication should not be given again.
Side effect: A known pharmacological response — nausea from codeine, constipation from opioids, dry cough from ACE inhibitors. These are expected reactions, not immune responses.
Why does this matter? If a patient with a documented "allergy" to penicillin actually just had GI upset (a side effect), they may be incorrectly denied the most effective antibiotic for a serious infection and given a more expensive, less effective, or more toxic alternative.
Always document: what exactly happened and what type of reaction it was.