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Quiz 5 Nov 5

SOAP Note Abbreviations

TermDefinition
A & P auscultation and percussion
AAOX 3 alert, awake and oriented to person, place and time
ADL activities of daily living
BM bowel movement
CTA clear to auscultation
DTR deep tendon reflex
EOMI extraocular muscles intact
HEENT head, ears, eyes, nose and throat
LMP last menstrual period
NAD no apparent distress; no apparent disease
NSR normal sinus rhythm
PERRLA pupils equal, round, reactive to light and accommodation
ROM range of motion
RRR regular rate and rhythm (heart)
WDWN well developed, well nourished
DNR do not resuscitate
stat immediately
DC OR D/C discharge, discontinue
I/O intake and output
MRx1 may repeat one time
n.p.o. or NPO nothing by mouth
PICC percutaneous indwelling central catheter
NGT nasogastric tube
TKO to keep (vein) open
HA headache
HTN hypertension
MI myocardial infarction
N/V/D OR NVD nausea, vomiting, and diarrhea
SOB shortness of breath
CP chest pain
 

 



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