Pertinent Positives And Negatives
Diagnosed with type 2 diabetes 6 years ago but did to follow up with recommendations for care. Pertinent positives and negatives i e.
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It s a term used when documenting a medical exam that basically states that you checked for something and didn t find it.
Pertinent positives and negatives. Now complaining of weakness in her right foot and itching rash in her groin area. This could be from history physical exam labs other tests or chart review. Pertinent negatives which require more analytical and creative thinking are gleaned from the differential diagnosis and function to rule out other diagnostic possibilities.
A pertinent negative isn t actually a diagnosis. Learn vocabulary terms and more with flashcards games and other study tools. Chest pain pertinent negatives sob ha fever chills cough n v d diaphoresis jaw pain back pain lower extremity pain swelling recent travel recent surgery recent prolonged immobilization.
This includes both positive and negative findings pertinent positives and negatives. Initial history 52 year old black female. Most pertinent positives easily fit into a well organized narrative and do not need to be listed separately.
Taken together the pertinent positives and negatives help to put the case in focus and make an argument for the most likely diagnosis. Knock the wind out of asthma with tips from dr denitza blagev a pulmonologist and intensivist who currently serves as director for the schmidt chest clinic at intermountain medical center in murray utah. An element of a patient s history that aids diagnosis because the patient affirms that it is present.
Start studying pertinent positives and negatives. Pt denies experiencing any rippin or tearing sensation in the chest back abdomen or pelvis. Symptoms relevant to your differential diagnosis can be included in a separate paragraph after the description and elaboration of the symptoms.
Case study type 2 diabetes. This is an exercise to reinforce recognizing and using pertinent findings in thinking critically about your cases. Create a problem representation.
Distill the data into pertinent positive and negative findings. In medical documentation the rule is generally if you didn t write it you. Pertinent positives and negatives instructions.
What are the pertinent positives and negatives on the physical examination. Both pertinent positives and pertinent negatives are included within the hpi and physical exam not a separate section of the chart by their very presence it indicates. We simplify the approach to diagnosis spirometry patient counseling choice of agent stepwise therapy and de escalation plus a little myth busting.
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