Nursing care
OLDCARTS in nursing: what the letters mean and how it compares with PQRST
Written and reviewed by Nicole Ramirez, BSN, RN, CMSRN · 4 min read · Updated November 2026
Short answer
OLDCARTS is a symptom history checklist: onset, location, duration, character, aggravating factors, radiation, timing or treatment, and severity. Nurses use it to question a client about pain or any new symptom. Published versions disagree on what A, R and T mean, so learn the questions behind the letters rather than one fixed spelling.
What OLDCARTS stands for, and its competing versions
O is onset: when it started and whether suddenly or gradually. L is location: where it is felt. D is duration: how long it has gone on and how long each episode lasts. C is character: sharp, dull, crushing, burning or aching. S at the end is severity, usually rated on a 0 to 10 scale.
The middle letters vary. The Open RN Nursing Fundamentals text uses A for aggravating factors, R for radiating and T for treatment already tried. A University of Maryland nursing course uses A for alleviating or aggravating, R for radiation and T for timing, such as day, night or constant. Other study guides read R as relieving. All versions aim at the same questions.
When nurses use OLDCARTS
OLDCARTS is used whenever a client reports a symptom that needs more detail than a yes or no: new pain, shortness of breath, nausea, dizziness or itching. Open RN notes that its sister mnemonic, PQRSTU, works for many symptoms, not only pain, and the same holds for OLDCARTS.
Questions should be open-ended so the client can describe the problem in their own words. When answers do not fit together, the nurse asks follow-up questions. Open RN gives the example of a client who calls pain tolerable yet rates it a 7; further questions show the 7 is during physical therapy, while rest is bearable.
Worked scenario: when to stop asking questions
Hypothetical scenario, not a real exam item: a 62-year-old client reports chest pressure that began 20 minutes ago while walking to the bathroom. He is pale and sweating. The nurse could finish every OLDCARTS question, ask about what makes it better, check vital signs and get a rapid assessment underway per protocol, or offer a heat pack.
Starting the rapid assessment and escalating per protocol is the best answer. Onset, location, character and the sweating already describe a possible cardiac emergency, and completing a full symptom history first delays care. The heat pack is a distractor that treats the pain as musculoskeletal. The remaining OLDCARTS questions can be asked once the client is being monitored.
What OLDCARTS leaves out
The letters do not include associated symptoms, which the University of Maryland course lists as a separate step: symptoms that occur alongside the chief complaint, such as nausea with abdominal pain or fever with a headache. They are often the finding that changes priority, so ask about them even though no letter prompts you.
OLDCARTS also skips the client's own explanation and goal. PQRSTU ends with understanding, asking what the client thinks is causing the problem, and Open RN advises setting a comfort and function goal that guides treatment. A severity number alone does not tell the nurse whether the client can walk, sleep or take part in therapy.
Related exam trap: treating the letters as a ranking
Exam questions sometimes ask which assessment the nurse should make first. A student who recites the mnemonic may choose onset because it comes first. The order of letters is a memory aid, not a priority order. Severity, character and red flag findings such as sweating, new weakness or breathing difficulty decide what happens next.
A second trap is accepting a number without context. Self-report is the main pain measure, yet a rating that clashes with what the client says or shows calls for clarifying questions, not a judgment that the client is exaggerating. Write down the exact words the client used along with the score.
Sources and further reading
Open RN Nursing Fundamentals: 11.3 Pain Assessment Methods. OLDCARTS with R as radiating and T as treatment, PQRSTU and COLDSPA expansions, comfort-function goals, and the tolerable-but-7 follow-up example.
Open RN Nursing Skills: 2.5 Reason for Seeking Health Care. PQRSTU used for pain and for other symptoms such as breathing difficulty, nausea and itching, and open-ended questioning.
University of Maryland School of Nursing NDNP819: Symptom analysis. OLDCARTS version with A as alleviating or aggravating, R as radiation and T as timing, and associated symptoms as a separate step.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our fundamentals practice questions are the closest set to what this page covers.
Common questions
What does OLDCARTS stand for?
Onset, location, duration, character, aggravating factors, radiation, timing (or treatment), and severity. Some sources read A as alleviating or aggravating and R as relieving, so check which version your program teaches.
Is OLDCARTS the same as PQRST?
They cover the same ground in a different order. PQRSTU stands for provocative or palliative, quality or quantity, region or radiation, severity, timing or treatment, and understanding. PQRSTU asks what the client thinks is causing the symptom; OLDCARTS does not.
Can OLDCARTS be used for symptoms other than pain?
Yes. It suits any symptom that needs a structured history, such as shortness of breath, nausea, dizziness or itching. Add questions about associated symptoms, since none of the letters prompts them.
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