click below
click below
Normal Size Small Size show me how
HLHS101 Chap 2 Mod 3
HLHS101 Module 3/Chapter 2 Flashcards
Term | Definition |
---|---|
SOAP meaning | Subjective, Objective, Assessment, and Plan (Smartbook page 54) |
S in SOAP definition | Subjective - what the patient describes, including histories, duration of aliment, intensity, and other necessary facts (Smartbook page 54) |
O in SOAP definition | Objective - Labs, images, and physical exams at MDO (Smartbook page 54) |
A in SOAP definition | Assessment - Using the labs, images, and notes from exams, MD diagnoses or gives a list of possible explanations (Smartbook page 54) |
P in SOAP definition | Plan - MDO uses assessment to devise a course of treatment (Smartbook page 54) |
EHR | Electronic Health Records - includes all notes, records, lab results, and x-rays (Smartbook page 53) |
Exacerbation | Getting worse (Subjective term, Smartbook page 75) |
Malaise | Not feeling well (Subjective term, Smartbook page 75) |
Auscultation | Listen (Objective term, Smartbook page 77) |
Palpation | Feel (Objective term, Smartbook page 77) |
Differential Diagnosis | a list of conditions the patient may have based on the symptoms exhibited and the results of the exam (Assessment Term, Smartbook page 79) |