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160 Cards in this Set
- Front
- Back
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A
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assessment
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A&W
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alive and well
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CC
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chief complaint
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c/o
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complains of
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Dx
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diagnosis
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FH
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family history
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HEENT
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head, eyes, ears, nose, and throat
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H&P
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history and physical
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HPI, PI
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history of present illness, present illness
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Hx
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history
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IMP
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impression
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L&W
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living and well
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NAD
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no acute distress
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NKA, NKDA
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no known allergies, no known drug allergies
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O
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objective information
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OH
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occupational history
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P
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plan (recommendation, disposition)
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PE, Px
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physical examination
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PERRLA
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pupils equal, round, and reactive to light and accommodation
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PH, PMH
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past history, past medical history
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ROS, SR
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review of systems, system review
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R/O
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rule out
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S
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subjective information
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SH
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social history
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Sx
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symptom
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UCHD
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usual childhood diseases
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WNL
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within normal limits
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acute
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sharp; having intense, often severe symptoms and a short course
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chronic
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a condition that develops slowly and persists over a period of time
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benign
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mild or noncancerous
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malignant
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harmful or cancerous
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degeneration
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gradual deterioration of normal cells and body functions
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degenerative disease
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any disease in which deterioration of the structure or function of tissue occurs
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diagnosis
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determination of the presence of a disease based on an evaluation of symptoms, signs, and test findings (results) (dia = through; gnosis = knowing)
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etiology
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study of the cause of a disease (etio = cause)
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exacerbation
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increase in the severity of a disease, with aggravation of symptoms (ex = out; acerbo = harsh)
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remission
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a period in which symptoms and signs stop or abate
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febrile
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relating to a fever (elevated temperature)
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idiopathic
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a condition occurring without a clearly identified cause (idio = one's own)
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localized
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limited to a definite area or part
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systemic
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relating to the whole body rather than to only a part
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malaise
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a feeling of uneasiness or discomfort; often the first indication of illness
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marked
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significant
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morbidity
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sick; a diseased state
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mortality
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the state of being subject to death
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prognosis
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foreknowledge; prediction of the likely outcome of a disease based on the general health status of the patient along with knowledge of the usual course of the disease; often noted in one word (e.g., "Prognosis: good")
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progressive
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pertaining to the advance of a condition as the signs and symptoms increase in severity
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prophylaxis
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a process or measure that prevents disease (pro = before; phylassein = guard)
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recurrent
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to occur again; describes a return of symptoms and signs after a period of quiescence (rest or inactivity)
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sequela
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a disorder or condition usually resulting from a previous disease or injury
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sign
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a mark; objective evidence of a disease that can be seen or verified by an examiner
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syndrome
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a running together; combination of symptoms and signs that give a distinct clinical picture indicating a particular condition or disease (e.g., menopausal syndrome)
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noncontributory
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not involved in bringing in the condition or result
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unremarkable
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common; not out of the ordinary or significant
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CCU
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coronary (cardiac) care unit
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ECU
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emergency care unit
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ER
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emergency room
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ICU
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intensive care unit
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IP
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inpatient (a registered bed patient)
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OP
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outpatient
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OR
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operating room
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PAR
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postanesthetic recovery
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post-op/postop
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postoperative
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pre-op/preop
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preoperative
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RTC
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return to clinic
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RTO
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return to office
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BRP
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bathroom privileges
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CP
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chest pain
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DC or D/C
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discharge or discontinue
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ETOH
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ethyl alcohol
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(L)
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left
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(R)
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right
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pt
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patient
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RRR
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regular rate and rhythm
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SOB
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shortness of breath
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PACU
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postanesthetic care unit
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Tr
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treatment
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Tx
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treatment or traction
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VS
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vital signs
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T
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temperature
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P
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pulse
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R
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respiration
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BP
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blood pressure
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Ht
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height
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Wt
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weight
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WDWN
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well-developed and well-nourished
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y/o or y.o.
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year old
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cc
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cubic centimeter
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cm
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centimeter
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g or gm
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gram
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kg
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kilogram
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L
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liter
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mg
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milligram
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mL or ml
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milliliter
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mm
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millimeter
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cu mm or mm^3
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cubic millimeter
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fl oz
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fluid ounce
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gr
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grain
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gt
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drop
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gtt
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drops
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dr
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dram
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oz
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ounce
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lb or #
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pound
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qt
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quart
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tablet (tab) / capsule (cap)
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oral [per os (p.o.)] - by mouth
sublingual (SL) - under the tongue buccal - in the cheek |
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suppository (suppos)
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vaginal [per vagina (PV)] - inserted in the vagina
rectal [per rectum (PR)] - inserted in the rectum |
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fluid
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inhalation - inhaled through the nose or mouth
• aerosol - spray • nebulizer - device used to produce a fine spray or mist, often in a metered dose |
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parenteral
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by injection
• intradermal (ID) - within the skin • intramuscular (IM) - within the muscle • intravenous (IV) - within the vein • subcutaneous (SC, SQ, or sub-Q) - under the skin |
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cream, lotion, ointment
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topical - applied to the surface of the skin
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other delivery systems
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transdermal - absorption of drug through unbroken skin
implant - a drug reservoir imbedded in the body to provide continual infusion of a medication (e.g., insulin pump) |
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ā
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before
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a.c.
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before meals
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a.m.
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before noon
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b.i.d.
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twice a day
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d
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day
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h
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hour
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h.s.
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at the hour of sleep (bedtime)
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noc.
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night
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_
p |
after
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p.c.
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after meals
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p.m.
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after noon
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p.r.n.
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as needed
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q
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every
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q.d.
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every day
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qh
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every hour
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q2h
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every two hours
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q.i.d.
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four times a day
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q.o.d.
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every other day
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STAT
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immediately
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t.i.d.
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three times a day
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wk
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week
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yr
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year
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#
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number, pound
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°
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degree; hour
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Ø
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none or negative
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AD
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right ear
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AS
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left ear
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AU
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both ears
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ad lib.
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as desired
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amt
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amount
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aq
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water
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(B)
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bilateral
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C
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Celsius, centigrade
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_
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with
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F
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Fahrenheit
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(m)
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murmur
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NPO
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nothing by mouth
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OD
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right eye
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OS
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left eye
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OU
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both eyes
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per
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by or through
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p.o.
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by mouth
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PR
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through rectum
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PV
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through vagina
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Rx
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recipe; prescription
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Sig
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label; instruction to the patient
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_
s |
without
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__
ss |
one-half
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wa
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while awake
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x
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times or for
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