Key Terms

bedside assessment

systematic exam of all patient body systems

body language

type of nonverbal communication based on physical movement and expression

chief complaint

reason the patient is currently seeking care

comprehensive physical assessment

detailed, inclusive assessment of body systems to provide a big-picture, broad view of a patient’s overall health

constitutional

relating to the whole body

focused assessment

physical examination centered on a patient’s chief complaint

intuition

“sixth-sense” of knowing that largely comes from years of education and problem-solving in real-world patient situations

medication reconciliation

process of reviewing a patient’s medications listed in their medical record and comparing that list to what the patient is actually currently taking at home

negative

used to note when signs or symptoms in a system are absent

nonverbal communication

physical movements or motions, including body language, that convey thoughts, attitudes, and sentiments

patient-centered

decisions made with respect for the patient’s interests, needs, culture, values, and preferences

PERRLA

eye assessment that determines if pupils are equal, round, reactive to light and accommodation

poikilothermia

inability to regulate core temperature

positive

used to note when signs or symptoms in a system are present

professional boundary

clear separation between personal and work life when interacting with patients

verbal communication

spoken word, in whatever language the patient can best communicate and understand

visual communication

strategies like return demonstration that can confirm a patient’s understanding

written communication

reinforcement of verbal information given to the patient in a format they can read