1. List pertinent positive & negatives. 2.

1. List pertinent positive & negatives. 2. What additional information should be asked? 3. Name three possible differential diagnoses 4. What would the plan of care be according to guidelines? CC “I keep having accidents.” HPI: AW is 65-year-old female who reports urinary incontinence normally with physical activity since the birth of her children but over the last several days has been having incontinence without activity. Denies hematuria or dysuria. Has been more tired recently but denies fever, chills, lightheadedness or dizziness. Denies abdominal or flank plan. Patient had history of hysterectomy due to irregular period, menorrhagia. PMH: Constipation, Hypocalcemia, Hypothyroidism, Urinary tract infection, Vitamin D deficiency, Fibrocystic breast disease GTPAL: G=3, T=0, P=0, A=0, L=3 (Normal vaginal deliveries without complication) Menstrual Hx: Menarche at age 12. Normal PAP results previously. Hysterectomy (2012) Past Surgical history: hysterectomy (2012 Medications: Armor Thyroid 30mg oral tablet: take 2 tablets on Monday, Wednesday, and Friday and 3 tablets other days Allergies: Penicillin (rash), No known environmental, latex, or food allergies, Family History: Her mother died when she was 46-year-old. Her father is 91-year-old, still alive, with a history of hypertension. Social History: Patient is divorced, lives alone. She is a non-smoker, drinks alcohol occasionally, but no use of illicit drug. Sexual/Contraceptive History: She has not been sexually active for five years. Immunizations: Reports she is up to date with childhood vaccinations and adult vaccination. ROS: General. She denies chills, or fatigue or fever. Skin, hair, nails: Denies rashes, change in pigmentation or texture, or excessive sweating except. Denies changes in skin, hair, and nails. HEENT: Denies headaches or vertigo. No complaints of eye discharge, redness, tearing, or vision loss. No complaints of ear drainage, swallowing difficulty, hearing loss. Denies nasal congestion or rhinorrhea. No bleeding in gums. Neck: Denies lumps, pain, or swollen glands. Denies neck discomfort. Respiratory: Denies cough, wheezing, or shortness of breath. Cardiovascular: Denies chest pain, palpitations, dyspnea, or orthopnea. No previous EKG. Gastrointestinal: Appetite normal; no nausea, vomiting, reflux, indigestion, or diarrhea. No abdominal pain. Bowel movement normal, regularly once daily. Genitourinary: Denies vaginal discomfort, irritation, itchiness, discharge. Denies dysuria, hematuria, flank or suprapubic pain, burning with urination. Having urinary incontinence with and without activity. Has had issues with urinary continence after the birth of her children but now it is even when sitting down. Musculoskeletal: Denies pain on bones, muscles, and joint. Denies joint swelling, stiffness, weakness, restriction to range of motion in all Extremities: No redness, heat, or bony deformity on the joints. Neuro/Psychiatric: Denies any behavioral changes or difficulty of concentrating. Denies fainting, seizures or motor sensory loss. Denies suicidal ideation, depression, mood swings, or hallucinations. Gait has been steady. Hematologic: Denies easy bruising or bleeding. Endocrine: Denies increase thirst or urination or polyuria. Objective Weight: 129 lbs., Ht: 63 in Temp: 97.9 F BP: 118/84 Pulse:70 Resp 16 Constitutional: Well-groomed patient appears her stated age. She appears well nourished, hydrated and does not appear to be acutely ill. She is alert, oriented and in mild distress. Skin: Warm, color normal for ethnicity. No clubbing noted. Same pigmentation throughout the body. Good skin turgor. Nail beds pink; good capillary refill < 2 seconds. Mucus membranes moist and pink in mouth. Hair of average texture. Scalp without lesions. No rashes, or nevi noted. HEENT: Normocephalic, facial features symmetric. Neck supple, trachea midline; no lymphadenopathy Cardiovascular: No general edema or cyanosis. S1 and S2 heart sounds audible with no murmurs, rubs, or gallops. No visible JVD or cyanosis. No thrills, lifts or heaves felt on palpation. Respiratory: Respirations non labored, equal bilateral, regular rate and rhythm. No excessive depth, effort of breathing, or unilateral lag. Lungs are clear bilaterally. No abnormalities of chest wall. GI: Abdomen is soft. Non-distended. Mild suprapubic pain with palpation. Bowel sounds positive upon auscultation in all 4 quadrants. No hepatomegaly or splenomegaly. Genitourinary: No CVA tenderness. GYN: No lesions, discharge noted (only external exam completed) Musculoskeletal: Good muscle bulk and tone. Strength 5/5 throughout. Gait steady. Psychiatric: Behavior appropriate for the age. Neurological: Awake, alert, oriented, cooperative. Speech is clear. Oriented to person, place, and time.

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