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16 Cards in this Set
- Front
- Back
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General
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Recent changes in weight, fit of clothing, changes in appetite, weakness, fatigue/lack of energy, fever, chills, night sweats
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Skin
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Rash, lumps, itching, dryness, sores, color changes in hair/nails, changes in size/color of moles
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HEENT
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Head: headache, dizziness, lightheadedness
Eyes: vision change, glasses/contacts, redness/yellow color, double vision, blurred vision Ears: changes in hearing, ringing, earache, discharge Nose: nosebleed, sinus problems, congestion, itching Throat: sore throat, hoarseness, tooth pain, dry mouth, mouth sores |
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Neck
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Pain, stiffness, goiter (enlarged thyroid gland), "swollen glands"
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Breasts
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Lumps, pain, discomfort, nipple discharge, skin changes, self-examination practices
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Respiratory
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SOB, cough, sputum production, hemoptysis (coughing up blood), dyspnea (difficulty breathing), wheezing
*May include: asthma, bronchitis, emphysema, pneumonia, TB |
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Cardiovascular
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Chest pain or discomfort, palpitations, HTN, heart murmors, orthopnea, awakening at night with shortness of breath, lower extremity edema, Rheumatic fever (prior cardiac tests)
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GI
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Abdominal pain, bloating, nausea, vomiting (pattern/color), vomiting blood, appetite, heartburn, difficulty swallowing, heartburn, diarrhea, constipation, belching/gas, blood in stool, black tarry stools, food intolerance
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Peripheral vascular
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Leg cramps (intermittent claudication), varicose veins, past clots in veins, swelling in the calves, legs or feet, color changes in fingertips/toes in cold weather
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Urinary
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Frequency of urination, urgency, burning or pain, urinary infections, Hx of infection/stones, kidney or flank pain, color change (blood), incontinence
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Genital
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Male: lumps, hernias, discharge, sores, painful/swollen testicle, sexual habits, Hx STD's, condom use, interest, function
Female: age at menarche, duration of periods, LMP, vaginal discharge, itching, gravida/para, type of delivery, hot flashes, Hx STD's, contraception |
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Musculoskeletal
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Muscle pain, joint pain, joint swelling, limited motion or activity, joint redness, heat, tenderness, stiffness, weakness or "giving out", Hx of arthritis, gout, trauma
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Psychiatric
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Nervousness, anxiety, tension, depression, trouble with memory, insomnia, hallucinations
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Neurological
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Changes in mood, attention, speech, orientation, insight, judgement; vertigo, seizures, fainting, paralysis, loss of sensation, tingling, tremors or involuntary movements
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Hematological
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Anemia, easy bruising, easy bleeding (gums, cuts, periods), Hx past transfusions
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Endocrine
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Heat or cold intolerance, skin changes, polyuria, polydypsia, changes in sexual drive, salt craving, changes in hat, glove, or shoe size
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