Chapter 7 Vocab Flashcards Preview

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Flashcards in Chapter 7 Vocab Deck (24)
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1
Q

Abbreviation

A

Shortened form of word/phrase

2
Q

Anterior (ventral)

A

At/towards front of the body

3
Q

Medical record

Chart/clinical record

A

Legal account of person’s condition and response to treatment/care

4
Q

Communication

A

Exchange if information- correctly interpreted by receiver

5
Q

Distal

A

Farthest from the center/point of attachment

6
Q

Dorsal/Posterior

A

At/toward the back of body

7
Q

Electronic Health Record (EHR)

Elect. Medical record-EMR

A

Electronic version of person’s medical record

8
Q

End-of-shift report

A

Report nurse gives to the on-coming shift durning shift change

9
Q

Kardex

A

Type of card file that summarizes information found in med record

(drugs, treatment, diagnoses, routine care measures, equipment, and special needs)

10
Q

Lateral

A

Away from midline or at side of body

11
Q

Medial

A

Near the middle/mid-line of body

12
Q

Prefix

A

Word/element before the root word (changes meaning)

13
Q

Progress note

A

Describes care given and person’s response/progress

14
Q

Proximal

A

Nearest to center/point of attachment

15
Q

Recording

A

Written account of care/observations - charting, documentation

16
Q

Reporting

A

Oral account of care/observations

17
Q

Root

A

Word/element containing basic meaning of word

18
Q

Suffix

A

Word/element placed after root (changes meaning)

19
Q

Word element

A

A part of a word

20
Q

ADL (abbreviation)

A

Activities of Daily Living

21
Q

EHR (abbreviation)

A

Electronic Health Record

22
Q

EMR (abbreviation)

A

Electronic Medical Record

23
Q

EPHI or ePHI (abbreviation)

A

Electronic Protected Health Information

24
Q

PHI (abbreviation)

A

Protected Health Information