NAD (No Acute Distress)
Formal Definition
No Acute Distress: a standard physical exam notation indicating the patient appears comfortable, without visible signs of pain, labored breathing, pallor, diaphoresis, or obvious distress at the time of examination.
How It's Used on the Ward
"NAD" — appears in every physical exam note under general appearance. Often written reflexively without actual observation.
Example
""Attending reviewing the student's note: 'You wrote NAD, but when I went in the room she was grimacing with every breath and guarding her abdomen. What does NAD mean to you?'""
Clinical Context
NAD is one of the most reflexively written phrases in medicine. It should be an active observation, not a default. What you're actually documenting: Is the patient in pain? Struggling to breathe? Diaphoretic? Anxious? Writhing? Use NAD when you genuinely see a calm, comfortable patient — not because you haven't noted otherwise.
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