N595 AdvancedPhysical Assessment and Diagnostic Reasoning SOAP Note Assignment #2

N595 AdvancedPhysical Assessment and Diagnostic Reasoning SOAP Note Assignment #2 SOAP Note: Date 09/21/17 Pt Identity J.G., 56 y/o male, seemsreliable. Prior medical records reviewed. Chief Concern “I’ve had diarrheafor about a week or so.” History of Present Illness Having 5-10 soft unformed light-brown stools per day (including overnight), which started suddenly 7 days ago. He has not had diarrhea this bad before. Has not identified a relationship between diarrhea and food or fluid intake. Some relief from Imodium and Pepto-Bismol. Also reports 3-day historyof increased hemorrhoidal bleeding during defecation w/ perianal burning and itching for about 20 minutes after each BM. Denies direct contact with anyone experiencing similar symptoms, recent travel, and dietary changes. Started taking metformin 500 mg BID 2 weeks ago. Has h/o irritable bowel syndrome, previously well-controlled on Bentyl. Past Medical History Adult Illnesses HTN for “around 15 years” – controlled on lisinopril/HCTZ Irritable bowel syndrome”since I was a teenager”- Bentyl T2DM, diagnosed 2 weeks ago – BG stable on metformin Sinus tachycardia for “abouta year” – controlled on metoprolol Denies CA, CAD, CVA, and HLD. Health Maintenance Colonoscopy orderedlast year, not done d/t fear of bowel prep causing incontinence. Vaccines “up to date” per patient. Has not had hepatitis B vaccine. Childhood Illnesses IBS, as notedabove. Surgical History None reported. Family History Uncle died age 47, colon cancer.Otherwise noncontributory. Accidents/Injuries Denies. Hospitalizations Denies. Psychosocial History Married, 3 grown children. Worksas a high school scienceteacher w/ intermittently high stress, but has not noticed an increase recently. Denies h/o military service. Denies smoking, alcohol, and recreational drug use. Monogamous sexualpartner, denies currentor prior receptiveanal intercourse or rectal-oral sexual practices. Denies recent domestic or international travel,camping/hiking, and fishing/hunting. Denies owning pets. Allergies NKDA. Denies environmental and food allergies. Current Medications Lisinopril/HCTZ 20/12.5 daily. Last dose this morning. Dicyclomine (Bentyl) 40 mg q6h. Last dose this morning. Metformin 500 mg BID. Last dose this morning. Metoprolol 50 mg BID. Last dose this morning. Acetaminophen 1000 mgPRN for “aches and pains”.Last dose 2 daysago. Review of Systems General: Denies weight change, fever,chills, night sweats,fatigue, weakness, and changes in appetite. Skin: Deniesrashes, ulcerations, dryness,flaking, and excessive sweating. Pulmonary: Denies cough, dyspnea, increasedsputum production, hemoptysis, snoring, and wheezing. Cardiovascular: Denies chest pain, palpitations, orthopnea, PND, known heart murmurs, edema, intermittent claudication, leg cramps, and varicose veins. GI: Reports diarrhea, perianal burning and itching, and bright-red blood on toilet paper, as described above. Reports history of hemorrhoids. Denies N/V, indigestion, abdominal pain or cramping, excessive flatulence, bloating, fecal incontinence, constipation, anal trauma, and dark tarry stools.Last BM was 15 minutesbefore appointment, lightbrown, soft and unformed. Psych: Denies feeling depressed, nervous, or anxious. PHYSICAL EXAM Constitutional: Appears well-groomed, well-nourished, and well-developed. Sitting comfortably in exam room chair. T 98.1F (oral), HR 114, RR 16, BP 118/99 (right). BMI 28.4. Skin: Exposed skin is smooth,free of lesions,bruising, tattoos, and piercings. Lungs/Thorax: Rate regularand unlabored. No accessory muscleuse. Lung soundsclear and equal bilat. Resonant in all lung fields. Nail beds pink w/o clubbing. Cardiovascular: Regular rate/rhythm w/o clicks, gallops,rubs, S3, S4, or murmurs.Pedal pulses 2+ bilat. Skin warm, dry. No edema. Abdomen: Round, soft, symmetrical, w/o masses, lesions,or hernia. Bowelsounds hyperactive x4 quadrants. Resonant w/ gastric tympany. No tenderness or rigidity on light and deep palpation. No renal/aortic/iliac bruits. Psych: Affect brightand appropriate. Based on the documented health history, identify2 “provoking factors”for diarrhea that we can rule out (e.g., sick contacts). Identify 2 “provoking factors” that for diarrhea that should still be considered for J.G. His medication list is incomplete. Which 2 medications are missing, and what information (besides their names) is important to document about them? Based on his history and physical exam, create your patient’s problem list. For this assignment, you shouldinclude at least5 problems. Rememberthis should includeanything “abnormal” about your patient – not just a list of medical diagnoses. There is at least 1 system missingfrom the PhysicalExam that is relevant for this acute visit. Which system is missing, and what problem(s) are you specifically looking for? What do you think is causing his acute diarrhea? Explain your answer.Include at least 1 peer-reviewed source.

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."