In the primary care setting, a thorough history of present illness (HPI) is key to understanding the reason or issues that prompted the patient’s visit. The first and most important component of the HPI is the chief complaint (CC). As you explore the CC it is important to ask about symptom characteristics such as location, timing (onset, duration, frequency), quality or severity, factors that worsen or alleviate the symptoms, and associated signs that accompany the primary symptom.

Symptom Characteristics

• Location: Where is the symptom or problem on the body?
• Quality: Describe how the symptom (i.e., pain, shortness of breath, nausea, etc.) feels.
• Quantity or Severity: Can you rate your pain on a scale of 1-10, with 10 being the worst pain? Can you quantify your shortness of breath as mild, moderate, or severe?
• Timing:
  • Onset: When did the nausea start? What actions or circumstances cause the nausea, make it worse or ease it?
  • Duration: How long have the headaches been present and how long do they last?
  • Frequency: How often dose the symptom occur?
• Modifying Factors: What activities improve the symptom or make it worse?
• Associated Signs: What other problems or issues occur with the primary symptom?

To remember these symptom characteristics during the patient interview, use one of the following two mnemonics.

Nursing Mnemonic: OPQRST

• Onset
• Precipitating and Palliating factors
• Quality
• Region or Radiation
• Severity
• Timing or Temporal characteristics

Nursing Mnemonic: OLD CARTS

• Onset
• Location
• Duration
• Character
• Aggravating or Alleviating factors
• Radiation
• Timing
• Severity

For more helpful nursing mnemonics, check out these Nursing Tips. 

References:
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.

 

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