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Med Term Ch2
| Question | Answer |
|---|---|
| acute | it just started recently or is a sharp, severe symptom |
| chronic | it has been going on for a while now |
| exacerbation | it is getting worse |
| abrupt | all of a sudden |
| febrile | to have a fever |
| afebrile | to not have a fever |
| malaise | not feeling well |
| progressive | more and more each day |
| symptom | something a patient feels |
| noncontributory | not related to this specific problem |
| lethargic | a decrease in level of consciousness; in a medical record, this is generally an indication that the patient is really sick |
| genetic/hereditary | it runs in the family |
| alert | able to answer questions; responsive; interactive |
| oriented | being aware of who he or she is, where he or she is, and the current time; a patient who is aware of all 3 is "oriented 3" |
| marked | it really stands out |
| unremarkable | another way of saying normal |
| auscultation | to listen |
| percussion | to hit something and listen to the resulting sound or feel for the resulting vibration; drums are a percussion instrument |
| palpation | to feel |
| impression | another way of saying assessment |
| diagnosis | what the health care professional thinks the patient has |
| differential diagnosis | a list of conditions the patient may have based on the symptoms exhibited and the results of the exam |
| benign | safe |
| malignant | dangerous; a problem |
| degeneration | to be getting worse |
| remission | to get better or improve; most often used when discussing cancer; remission does not mean cure |
| idiopathic | no known specific cause; it just happens |
| localized | stays in a certain part of body |
| systemics/generalized | all of body (or most of it) |
| prognosis | the chances for things getting better or worse |
| occult | hidden |
| lesion | diseased tissue |
| recurrent | to have again |
| sequela | a problem resulting from a disease or injury |
| pending | waiting for |
| pathogen | the organism that causes the problem |
| morbidity | the risk for being sick |
| mortality | the risk for dying |
| etiology | the cause |
| disposition | what happened to the patient at the end of the visit; often used at the end of ED notes to reference where the patient went after the visit, (home, ICU, hospital bed) |
| discharge | literally, to unload, 1. send home 2. fluid coming out of a part of the body |
| palliative | treating the symptoms, but not actually getting rid of the cause |
| observation | watch, keep an eye on |
| reassurance | to tell the patient that the problem is not serious or dangerous |
| supportive care | to treat the symptoms and make the patient feel better |
| sterile | extremely clean, germ free conditions; especially important during medical procedures and surgery |
| prophylaxis | preventive treatment |
| proximal | closer in to the center |
| distal | farther away from the center |
| lateral | out to the side |
| medial | toward the middle |
| ventral/antral/anterior | the front |
| dorsal/posterior | the back |
| cranial | toward the top |
| caudal | toward the bottom |
| superior | above |
| inferior | below |
| prone | lying down on belly |
| supine | lying down on back |
| contralateral | opposite side |
| ipsilateral | same side |
| unilateral | one side |
| bilateral | both sides |
| dorsum | the top of the hand or foot |
| plantar | the sole of the foot |
| palmar | the palm of the hand |
| sagittal | divides the body along a hypothetical plane from right to left |
| coronal | divides the body along a hypothetical plane from front to back |
| transverse | divides the body from top to bottom |
| physician | a skilled health care provider who attended and graduated medical school. There are two types who practice in America: medical doctor (MD) and doctor of osteopathy (DO) |
| pediatrician | a physician with special training in caring for children |
| surgeon | a physician qualified to treat patients surgically, that is, by means of operation or invasive procedure |
| anesthesiologist | a physician with special training in pain sedation and pain control |
| epidemiologist | a specialist in the study of the causes and distribution of diseases in populations and the use of this data to enhance public health |
| physician assistant (PA) | a midlevel health care provider who works under the license of a supervising physician; requires postgraduate training |
| nurse practitioner (NP) | a nurse with postgraduate training that serves as a midlevel health care provider; works under the license of a supervising physician |
| emergency medical technician (EMT) | specially trained in the emergency care of a patient before and/or during transport to a medical facility |
| speech therapist | specially trained in evaluating and treating problems with speech and/or swallowing |
| occupational therapist | specially trained in evaluating and treating problems with performing daily activities at home, school, or work |
| physical therapist | specially trained in evaluating and treating physical impairments including disabilities or recovery from an injury |
| respiratory therapist | specially trained in treating patient's respiratory issues under the guidance of a health care provider |
| dietician | specially trained in evaluating the nutritional status of a patient and developing an appropriate diet plan |
| licensed practical nurse (LPN) | trained and certified to provide basic care to a patient |
| licensed vocational nurse (LVN) | trained and certified to provide basic care to a patient |
| registered nurse (RN) | an advanced level nurse who has completed an associate's or bachelor's degree; often assists with patient care planning and patient education |
| medical assistant | trained to carry out basic administrative and clinical tasks under the guidance of a health care provider |
| pathologist | a physician with special training in both evaluating the causes and effects of disease and in laboratory medicine |
| medical laboratory technician | trained in performing laboratory testing on bodily fluids |
| phlebotomist | trained in the removal of blood from the body for diagnostic or therapeutic purposes |
| radiologist | a physician specially trained in evaluating images of the body to diagnose illness or injury |
| radiology technician | trained to perform radiologic testing or administer radiation therapy under the direction of a health care provider |
| ultrasonographer | trained in performing ultrasound imaging on a patient |
| pharmacist | trained and licensed in preparing and dispensing medicine |
| pharmacy technician | trained to assist a pharmacist with pharmacy-related tasks |
| patient service coordinator | handles administrative tasks and coordinates patient care |
| medical transcriptionist | trained in converting the voice-recorded dictations of health care providers into text format |
| chief complaint | the main reason for the patients visit |
| history of present illness | the story of the patients problem |
| review of systems | description of individual body systems in order to discover any symptoms not directly related to the main problem |
| past medical history | other significant past illnesses, like high blood pressure, asthma, diabetes |
| past surgical history | any of the patients past surgeries |
| family history | any significant illnesses that run in the patients family |
| social history | a record of habits like smoking drinking, drug abuse, and sexual practices that can impact health |
| CCU | coronary care unit |
| ECU | emergency care unit |
| ER | emergency room |
| ED | emergency department |
| ICU | intensive care unit |
| PICU | pediatric intensive care unit |
| NICU | neonatal intensive care unit |
| SICU | surgical intensive care unit |
| PACU | post-anesthesia care unit |
| L&D | labor and delivery |
| OR | operating room |
| post-op | after surgery |
| pre-op | before surgery |
| VS | vital signs |
| T | temperature |
| BP | blood pressure |
| HR | heart rate |
| RR | respiratory rate |
| Ht | height |
| Wt | weight |
| BMI | body mass index |
| I/O | intake/output: the amount of fluids a patient has taken in (by IV or mouth) and produced (usually just urine output) |
| Dx | diagnosis |
| DDx | differential diagnosis |
| Tx | treatment |
| Rx | prescription |
| H&P | history and physical |
| Hx | history |
| CC | chief complaint |
| HPI | history of present illness |
| ROS | review of systems |
| PMHx | past medical history |
| FHx | family history |
| NKDA | no known drug allergies |
| PE | physical exam |
| Pt | patient |
| y/o | years old |
| h/o | history of |
| PCP | primary care provider |
| f/u | follow up |
| SOB (SOA) | shortness of breath (shortness of air) |
| HEENT | head, eyes, ears, nose. throat |
| PERRLA | pupils are equal, round, reactive to light and accommodation |
| NAD | no acute distress (the patient does not display any intense symptoms) |
| CV | cardiovascular |
| RRR | regular rate and rhythm |
| CTA | clear to auscultation (description of normal-sounding lungs) |
| WDWN | well developed, well nourished (the patient is growing or has grown appropriately and does not appear to be malnourished) |
| A&O | alert and oriented |
| WNL | within normal limits |
| NOS | not otherwise specified |
| NEC | not elsewhere classified |
| PO | per os (by mouth) |
| NPO | nil per os (nothing by mouth) |
| PR | per rectum |
| IM | intramuscular |
| SC | subcutaneous |
| IV | intravenous |
| CVL | central venous line |
| PICC | peripherally inserted central catheter |
| Sig | instructions short for signa, from Latin, for "label" |
| BID | twice daily (bis in die) |
| TID | three times daily (ter in die) |
| Q | every x |
| QD* | daily (quaque die) |
| QID* | four times daily (quater in die) |
| QHS | at night (quaque hora somni) |
| AC | before meals (ante cibum) |
| PC | after meals (post cibum) |
| prn | as needed (per re nata) |
| ad lib | as desired |
Created by:
lchandler24
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