Procedures/Studies
An assessment that describes a particular patient complaint, usually consisting of quality, intensity, location, and duration factors.
What is a pain assessment?
What is abduction?
An individual with professional training in the fundamentals of pulmonology and respiratory care and management and skills in ventilator technology and respiratory therapies.
Who is a respiratory therapist?
p.o.
What is the abbreviation for "by mouth"?
Maps of best practices protocols and standards of care for particular diagnoses or conditions.
What are care pathways, care paths, or critical paths?
A numerical rating of the vital signs of infants observed at 1 minute and 5 minutes following delivery.
What is an APGAR SCORE?
Indicators of the patient's lack of appreciation of their condition or situation.
What is insight?
A surgeon who specializes in the medical and surgical treatment of ear, nose, and throat diseases.
Who is an otolaryngologist?
ad lib
What is the abbreviation for "as desired"?
An outline of the chief complaint, admitting diagnosis, pertinent medical history, vital signs, and findings of the physical examination of the client.
What is the history and physical examination (H & P)?
A blood test to determine the appearance, specific gravity, and pH of the urine.
What is urinalysis?
Pulse, respiration, temperature, weight, blood pressure.
What are vital signs?
A physician, usually an internist, with specialty training in the diagnosis and treatment of infectious and communicable diseases.
Who is an Infectious Disease Specialist?
t.i.d.
What is the abbreviation for "three times a day"?
Documentation of how the patient was informed of the risks and benefits of any procedure and confirmation that the patient was given the opportunity to refuse the procedure.
What is consent?
A recordingn of the electrical impulses in the brain using 8, 12, 16, or 20 channels.
What is an encephalogram or electroencephalography? (EEG)
Flexion of the great toe when the undersurface of the foot is stroked.
What is the plantar reflex?
An individual who coordinates and oversees the referrals for services and continuity of care for a patient assigned to him or her.
Who is the case manager?
CPT
What is the abbreviation for "current procedural terminology"?
A document specifying the patient's preferences for the use of invasive life-prolonging procedures in the event of an irreversible medical condition or emergency.
What is an advance directive or advance medical directive? (Living Will also acceptable)
An x-ray study of the subarachnoid space of the spinal cord with an injection of contrast dye for the purpose of examining the impingement of nerves.
What is myelography?
Medical conditions that have not yet been revealed to be significant or in need of medical treatment.
What is subclinical illness?
An individual with skilled training in vascular invasive techniques for the treatment of blood and circulatory diseases who works under the supervision of a physician.
Who is a phlebotomist?
LOS
What is the abbreviation for "length of stay"?
What is an eponym?