This document provides templates for gathering histories on common symptoms. It includes sections to define the symptom, related signs and symptoms, and relevant historical elements to inquire about. Templates are provided for chest pain, dyspnea, diarrhea, headache, depression, leg edema, abdominal pain, dysuria, polyuria and other symptoms. The templates guide the clinician to systematically evaluate symptoms and consider potential underlying conditions.
This document provides templates for gathering histories on common symptoms. It includes sections to define the symptom, related signs and symptoms, and relevant historical elements to inquire about. Templates are provided for chest pain, dyspnea, diarrhea, headache, depression, leg edema, abdominal pain, dysuria, polyuria and other symptoms. The templates guide the clinician to systematically evaluate symptoms and consider potential underlying conditions.
This document provides templates for gathering histories on common symptoms. It includes sections to define the symptom, related signs and symptoms, and relevant historical elements to inquire about. Templates are provided for chest pain, dyspnea, diarrhea, headache, depression, leg edema, abdominal pain, dysuria, polyuria and other symptoms. The templates guide the clinician to systematically evaluate symptoms and consider potential underlying conditions.
1) Define: 1) Define: 1) Define: a) Location a) Resting vs exertional vs paroxysmal a) Character: watery vs bloody? b) Character noctunal b) Frequency/Pattern: c) Radiation b) Frequency/Pattern c) Precipitants d) Frequency/Pattern c) Precipitants d) Alleviators e) Precipitants d) Alleviators 2) Related Symptoms/Signs: f) Alleviators 2) Related Symptoms/Signs: a) N/V 2) Related Symptoms/Signs: a) Cough b) Weight Loss a) Diaphoresis b) Sputum Production: character? c) Anorexia b) N/V c) Hemoptysis d) Night Sweats c) Jaw Pain d) Chest Pain e) Melena d) Left Arm Pain e) Fever/Chills f) Hematochezia e) Dizziness f) Weight Loss g) Hematemesis f) Loss of Consciousness g) Night Sweats 3) History Elements g) Fainting (syncope) h) Wheezing a) Hx of Colon Cancer 3) History Elements i) N/V/D b) Hx of Inflamm Bowel Dis a) Hx of CAD or MI j) LE Edema c) Hx of Irritable Bowel Syndr (IBS) b) Hx of HTN k) Paroxysmal Nocturnal Dyspnea d) Recent travel c) Hx of Hyperlipidemia 3) History Elements e) Sick contacts d) Hx of DM a) Hx of Lung Disease e) Family Hx of CAD b) Hx of Asthma c) Bronchodilator Use Abdominal Pain d) Hx of Frequent Resp Infections 1) Define: Headache e) Hx of Pneumothorax a) Character 1) Define: f) Family Hx of Lung Disease b) Frequency/Pattern a) Location g) Sick contacts c) Precipitants b) Frequency/Pattern d) Alleviators c) Precipitants 2) Related Symptoms/Signs: d) Alleviators Depression a) N/V/D 2) Related Symptoms/Signs: 1) Define: b) Weight Loss a) Dizziness a) Frequency/Pattern c) Melena b) Loss of Consciousness b) Precipitants d) Hematochezia c) Fainting c) Alleviators e) Hematemesis d) Numbness/Tingling 2) Related Symptoms/Signs: f) ETOH or NSAID Use e) Focal Weakness a) Anorexia g) Last BM 3) History Elements b) Weight Loss h) Fever/Chills a) Hx of Headaches c) Overeating 3) History Elements b) Hx of Seizures d) Sleep Disturbance a) Hx of Colon Cancer e) Crying Spells b) Hx of Inflamm Bowel Dis f) Loss of Interest in Activities c) Hx of Irritable Bowel Syndr (IBS) g) Loss of Social Network d) Hx of Prior Abdominal Pain LE Edema h) ETOH/Substance Abuse 1) Define: i) Suicidal Ideation or Intent a) Frequency/Pattern 3) History Elements 2) Related Symptoms/Signs: Dysuria a) Recent Life Losses (Job, etc.) a) Orthopnea 1) Define: b) Hx of Depression b) Paroxysmal Nocturnal Dyspnea a) Character c) Hx of Antidepressant Use c) Chest Pain b) Urinary Frequency/Pattern d) Family Hx of Depression d) Resting/Exertional Dyspnea c) Precipitants e) Cough d) Alleviators f) Sputum Production e) Sensation of Incomplete Bladder g) Hemoptysis Emptying 3) History Elements 2) Related Symptoms/Signs: a) Hx of CHF a) N/V/D b) Hx of Pulmonary HTN b) Hematuria c) Hx of Lung Disease c) Urine Odor d) Urine Discoloration/Cloudiness e) Fever/Chills f) Abdominal Pain g) Flank Pain Polyuria h) Pneumaturia 1) Define: 3) History Elements a) Frequency/Pattern a) Hx of UTI 2) Related Symptoms/Signs: b) Hx of Kidney Stones a) Weight Loss/Gain b) Polydipsia c) Hyperphagia/Anorexia d) N/V e) Abdominal Pain f) Visual Changes 3) History Elements a) Hx of DM b) Family Hx of DM