# Anyone know what "looks well NAD" means in a medical context?



## Magpie

I'm hoping this is the right board for this question!

My son chopped the tip of his thumb off yesterday.  I stuck it in a baggie, we went to the ER, and a plastic surgery resident sewed it back on.  On my son's chart he wrote, "Piece looks well NAD" on his chart.  Does anyone here know what that means?

I'm also a bit puzzled by two things that happened...  outside the examining room I heard the plastic surgery resident say something to the doctor in charge and she said, "No, he's 13.  He'd have to go to the Children's Hospital for that."  And then she said something I didn't quite catch about "...and then there'd be billing...".  Issues, perhaps?  She'd been saying earlier my son's thumb should be just left to heal over on its own (something about "I know we used to graft anything over a centimeter, but..."), and she didn't look happy when the plastic surgery guy asked me if I wanted him to try and sew it back on.

Secondly, instead of sending my son's chart directly to his family physician, the nurse gave it to me instead and went on some sort of confusing rant about "patients need to be their own advocates these days" as she was cleaning up the room.

Now that I've had some time to think about things, I'm kind of wondering what was going on there.  All in all, I'm VERY happy with the treatment we got.  They stopped the bleeding, bandaged up the wound and we were in and out of the ER in less than three hours.  Plus, the residents were all very nice to my son and seemed competent (other than the plastic surgery guy accidentally throwing my son's thumb piece away... but it was still wrapped in its baggie, so no harm done).  He did make very neat little stitches, and he was quick and careful.


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## queendisney

I am not medically trained but do work in a hospital and I think it means 'nothing abnormal detected'


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## Magpie

queendisney said:


> I am not medically trained but do work in a hospital and I think it means 'nothing abnormal detected'



Oh... like saying it's a nice clean slice and doesn't look funny or anything?  I guess that'd bode well for it grafting back on.  (Got my fingers crossed!)


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## kristenrice

As a paramedic, I use "NAD" to refer to a patient who appears in "no apparent distress", however I don't think that applies in your situation.  There are a lot of different abbreviations that mean different things, depending on their context.  For example, "LOC" can mean "level of consciousness" (i.e. "his LOC is normal") or "loss of consciousness" ("she had a positive LOC after being hit in the head").  If you have questions about the chart, the best thing you can do is ask the person who wrote it to answer them for you.  Good luck and I hope your son's thumb heals quickly.


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## SueM in MN

My guess is that the word "piece" doesn't belong with "looks well NAD". 
I think "looks well" is referring to your son in general. In that case NAD = "no acute distress". 
In other words, he was doing quite well, despite having his finger tip cut off. NAD is kind of shorthand for the things like heart rate, blood pressure are OK and the person was doing well for their situation. 

NAD doesn't really fit with the thumb piece unless there is a word missing between "well" and NAD. 

I don't know what the "that" in the phrase about Children's Hospital would be - could be for admission or if he needed to be put under anesthetic. The reason him being only 13 is significant is that some hospitals no longer have a pediatric department. At 16, they can use adult doses for medication, at 13, they would be using pediatric dosing, so that is a dividing line for which patients would go to a children's hospital. 
Not sure why they sent the record with you to take to the primary physician, other than it probably saved a few steps in the process. 

Good luck on the thumb and hope he doesn't have too much pain. 

Edited to add: my browser crashed before I finished and kristenrice posted between my first post and now. 
I agree with her that if you have questions, it's best to go back to the people involved ( in fact, in hospitals, nurses fairly often have to go back to the doctor to figure out just what was written).


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## Magpie

SueM in MN said:


> My guess is that the word "piece" doesn't belong with "looks well NAD".
> In that case NAD = "no acute distress".
> In other words, he was doing quite well, despite having his finger tip cut off. NAD is kind of shorthand for the things like heart rate, blood pressure are OK and the person was doing well for their situation.
> 
> I don't know what the "that" in the phrase about Children's Hospital would be - could be for admission or if he needed to be put under anesthetic. The reason him being only 13 is significant is that some hospitals no longer have a pediatric department. At 16, they can use adult doses for medication, at 13, they would be using pediatric dosing, so that is a dividing line for which patients would go to a children's hospital.
> Not sure why they sent the record with you to take to the primary physician, other than it probably saved a few steps in the process.
> 
> Edited to add: my browser crashed before I finished and kristenrice posted between my first post and now.
> I agree with her that if you have questions, it's best to go back to the people involved ( in fact, in hospitals, nurses fairly often have to go back to the doctor to figure out just what was written).



I don't want to bother the folks at the Emergency Department just for a question about an abbreviation.  And I doubt they'd answer my other questions.    I took a second look at the chart, and actually I think what I read as "piece" is actually "patient" (his writing is a little sloppy).  So that makes sense now!  Thanks!  

The boy was incredibly calm about he whole thing.  He only flinched a little before voluntarily holding his hand out for the ER resident to start sticking a little needle into the wound to try and stop the bleeding.  It didn't seem to work, so he kept poking at it for quite some time before giving up.

And then when the Plastic Surgery resident asked him to hold his hand out so he could sew the bit back on, my son said, "Give me a second."  Then he pulled his hand in, looked up at the ceiling and made a face, and then calmly said, "Okay, go ahead!" and put his hand down on the table.

Perhaps because he's thirteen, they thought he'd be a lot more upset about the whole thing.  Or the medication issue could be part of it, too...  Other than a couple shots to numb his hand, they didn't give him any meds at all.  They just told me to give him some Tylenol and Advil when we got home.


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## jmartinez1895

It is so funny how "NAD" in the medical field could mean so many different things. In the office that I worked for when a chart had " NAD" on it, the doctor was saying " needs additional diagnostics". I know you don;t want to bother the people in the ER, but they get calls all the time and you will really not be bothering them. You could also call the hospital medical records department and they may know ( but I'd call the ER first).


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## SueM in MN

jmartinez1895 said:


> It is so funny how "NAD" in the medical field could mean so many different things. In the office that I worked for when a chart had " NAD" on it, the doctor was saying " needs additional diagnostics". I know you don;t want to bother the people in the ER, but they get calls all the time and you will really not be bothering them. You could also call the hospital medical records department and they may know ( but I'd call the ER first).


That is why many hospitals have banned using definitions other than a specific list where everyone has agreed what exactly it means.


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## Mrs.Malone

Your poor brave boy!  I hope he's not in too much pain.

I can't answer your question, but I was interested in your post because recently my friend's son's fingertip got accidentally sliced off.  The first doctor said to let it heal over, that it couldn't successfully be sewn back on.  The parents demanded another opinion and finally found someone who agreed to sew the fingertip on.  Sure enough, it has healed very nicely with no problems at all.


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## SoonerSarah

In our situation we actually have to explain what different abbreviations mean.

Such as IPH means Intraparenchymal Hemorrhage. I also had to spell it for some nurses (that I can understand).  I wonder if it means anything else as well. 

Anyway, I actually prefer to be given whatever charts. I have a binder that I keep with us with all of the business cards for my daughter's specialists, various reports from them, photos of her vocal cords and throat damage and CD's with her x-rays, MRIs and MRV's.  That way, any notes that any other doctors need to see, I have it and they can copy it.  If something happens, I have documentation that the doctors can see that might better help in an emergency situation.  And, that way I guarentee that it gets to the doctor.  I can't tell you how many times something has been lost in a fax.


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## Magpie

Mrs.Malone said:


> Your poor brave boy!  I hope he's not in too much pain.
> 
> I can't answer your question, but I was interested in your post because recently my friend's son's fingertip got accidentally sliced off.  The first doctor said to let it heal over, that it couldn't successfully be sewn back on.  The parents demanded another opinion and finally found someone who agreed to sew the fingertip on.  Sure enough, it has healed very nicely with no problems at all.



Oh, thank you for telling me that!  It's good to hear that it (at least sometimes!) works.  The doctor told me to keep my finger's crossed.  

My son's pain isn't bad - he's taking Tylenol and Advil every four hours.  I'm just waiting to hear from the principal to find out if he can take painkillers to school.  Actually, I think I'll call again since school let out awhile ago...


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## pugdog

SueM in MN said:


> That is why many hospitals have banned using definitions other than a specific list where everyone has agreed what exactly it means.



That is why the Joint Commission Has banned the use of abbreviations, there were to many meanings to each one. If the Joint sees a hospital using abbreviations when they come through for accreditation they will receive a type 1 recommendation and will need to fix it immediately.


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