Endocrine focus soap FH: (+) DM in

Endocrine focus soap FH: (+) DM in maternal aunt, no primary relatives; bladder CA in mother (died in 2008); medullary thyroid CA in father and two brothers; denies family history of CAD. S H: Lives at home with his wife, works as a mortgage broker. He smokes tobacco, ½ 1 pack per day ( starts when he first wakes up, and after eating), denies alcohol and illicit drug use. He currently has prescription insurance trough a commercial provider. Immunizations: Influenza (inactivated) October 2015 Meds: Insulin glargine U-300 35 units SQ at bedtime Losartan 50mg PO daily Chlorthalidone 12.5 mg PO daily Levothyroxine 88 mcg PO daily Pravastatin 40mg PO daily at bedtime Allergies: No known drug allergies Past surgical History: Total thyroidectomy ( age 6) ROS: Complains of polyuria, especially at night, as well as paresthesias as described above ( denies pain). Denies nausea, constipation, polydipsia. She states that he has noticed a slight weight gain ( 5 pounds) since starting insulin. No other complains are noted at this time. Physical Examination: Obese, Caucasian male who is in no apparent distress. Heart, lung and abdominal exams were unremarkable. Pedal pulses were reduced, but his feet were warm and without ulcers; he was unable to detect a monofilament on the soles of either feet. VS: BP= 131/72, P- 75, RR 18, T 38.7 height =5’9″, weight = 273Ibs Labs: Na = 139 mEq/L K= 4.1 Cl= 98 CO2= 22 BUN= 28g/dL Scr= 1.55 mg/dL ALT =15 units/L Glucose = 230 mg/dL Ca = 9.1 mg/dl Albumin = 4g/dL Phosphorus = 4.2 mg/dL Urine alb creat = 275g/g Cr TSH = 1.54 mlU/L Alk Phos = 41 units/L HbA1c = 8.1% Total chol = 188 mg/dL TG = 216 mg/dL HDL= 51 mg/dL LDL=122mg/dL AST = 20 units/L Prioritized Problem List Problem list: Medical Problem Drug Therapy Problem Supporting Evidence Status Intervention 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) *You may subtract or add more boxes if needed Calculated objective data (must include units and show calculations to receive credit) IBW: ______ CrCl: ______ BMI: ______ BMI classification (circle one of the following): underweight normal overweight obesity class ____ Other: Any other calculation that may be pertinent to the specific case (Example: LDL-C, corrected calcium, anion gap, etc.) S: (All pertinent subjective findings for all problems) O: (All pertinent objective findings for all problems) A: (Assessment statements for each problem) 1) 2) 3) 4) P: (Complete plan for each assessment statement) Recommendation(s): Efficacy Monitoring: Safety Monitoring: Patient Education/Counseling: Follow-up: Recommendation(s): Efficacy Monitoring: Safety Monitoring: Patient Education/Counseling: Follow-up: Recommendation(s): Efficacy Monitoring: Safety Monitoring: Patient Education/Counseling: Follow-up: Recommendation(s): Efficacy Monitoring: Safety Monitoring: Patient Education/Counseling: Follow-up: SCIENCE HEALTH SCIENCE NURSING NURSING 641

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