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Nursing
History Physical and progress
| Question | Answer |
|---|---|
| CC | CHEIF COMPLAINT |
| C/0 | COMPLAINS OF |
| Dx | DIAGNOSIS |
| FH | FAMILY HISTORY |
| HEENT | HEAD, EAR, EYES, NOSE THROAT |
| H AND P | HISTORY AND PHYSICAL |
| HPI, PI | HISTORY OF PRESENT ILLNESS, PRESENT ILLNESS |
| Hx | HISTORY |
| IMP | IMPRESSION |
| L AND W | LIVING AND WELL |
| NAD | NO ACUTE DISTRESS |
| NKA, NKDA | NO KNOWN ALLERGIES, NO KNOWN DRUG ALLERGIES |
| O | OBJECTIVE INFORMATION |
| OH | OCCUPATIONAL HISTORY |
| P | PLAN (RECOMMENDATION, DISPOSITION |
| PE OR Px | PHYSICAL EXAMINATION |
| PERRLA | PUPILS EQUAL, ROUND & REACTIVE TO LIGHT AND ACCOMMODATION |
| PH, PMH | PAST HISTORY, PAST MEDICAL HISTORY |
| R/O | RULE OUT |
| ROS, SR | REVIEW OF SYSTEMS, SYSTEMS REVIEW |
| S | SUBJECTIVE INFORMATION |
| SH | SOCIAL HISTORY |
| Sx | SYMPTOM |
| UCHD | USUAL CHILDHOOD DISEASES |
| WNL | WITHIN NORMAL LIMITS |
| ACUTE | SHARP, HAVING INTENSE, SEVERE SYMPTOMS & A SHORT COURSE |
| CHRONIC | CONDITION THAT DEVELOPS SLOWLY & PERSIST OVER A PERIOD OF TIME |
| BENIGN | MILD OR NONCANCEROUS |
| MALIGNANT | HARMFUL OR CANCEROUS |
| DEGENERATION | GRADUAL DETERIORATION OF NORMAL CELLS AND BODY FUNCTIONS |
| DEGENERATIVE DISEASE | ANY DISEASE IN WHICH DETERIORATION OF THE STRUCTURE OR FUNCTION OF THE TISSUE OCCURS |
| DIAGNOSIS | DETERMINATION OF THE PRESENCE OF A DISEASE BASED ON AN EVALUATION OF SYMPTOMS, SIGNS AND TEST FINDINGS |
| ETIOLOGY | STUDY OF THE CAUSE OF A DISEASE |
| EXACERBATION | INCREASE IN SEVERITY OF DISEASE WITH AGGRAVATION OF SYMPTOMS |
| REMISSION | A PERIOD IN WHICH SYMPTOMS AND SIGNS STOP OR ABATE |
| FEBRILE | RELATING TO A FEVER (ELEVATED TEMPERATURE |
| IDIOPATHIC | A CONDITION OCCURRING WITHOUT A CLEARLY IDENTIFIED CAUSE |
| LOCALIZED | LIMITED TO A DEFINITE AREA OR PART |
| SYSTEMIC | RELATING TO THE WHOLE BODY, RATHER THAN A PART |
| MALAISE | FEELING OF UNEASINESS OR DISCOMFORT, OFTEN FIRST INDICATION OF ILLNESS |
| MARKED | SIGNIFICANT |
| MORBIDITY | SICK, A DISEASED STATE |
| MORTALITY | BEING SUBJECT TO DEATH |
| PROGNOSIS | PREDICTION OF THE LIKELY OUTCOME OF A DISEASE, BASED ON THE GENERAL HEALTH STATUS OF THE PATIENT (PROGNOSIS "GOOD") |
| PROGRESSIVE | THE ADVANCE OF A CONDITION AS SIGNS & SYMPTOMS INCREASE IN SEVERITY |
| PROPHYLAXIS | A PROCESS OR MEASURE THAT PREVENTS DISEASE |
| RECURRENT | TO OCCUR AGAIN; A RETURN OF SYMPTOMS AND SIGNS AFTER A PERIOD OF INACTIVITY |
| SEQUELA | A DISORDER OR CONDITION USUALLY RESULTING FROM A PREVIOUS DISEASE OR INJURY |
| SIGN | AM MARK; OBJECTIVE EVIDENCE OF DISEASE THAT CAN BE SEEN OR VERIFIED BY AN EXAMINER |
| SYMPTOM | EVIDENCE OF DISEASE THAT IS PERCEIVED BY THE PATIENT, OFTEN NOTED IN THEIR OWN WORDS |
| SYNDROME | COMBINATION OF SYMPTOMS THAT GIVE A DISTINCT CLINICAL PICTURE INDICATING A CONDITION OR DISEASE |
| NONCONTRIBUTORY | NOT INVOLVED IN BRINGING ON THE CONDITION OR RESULT |
| UNREMARKABLE | COMMON, NOT OF THE ORDINARY OR SIGNIFICANT |
| A | ASSESSMENT |
| A AND W | ALIVE AND WELL |
Created by:
gillygun
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