CLASS

SOAP NOTE

Name: Ciara Rachels	Date: 11/09/2020	Time: 0800
	Age: 28	Sex: F
SUBJECTIVE
CC: “ODORFUL DISCHARGE AND PAINFUL INTERCOURSE”
HPI: She reported to the clinic complaining of a series of symptoms. These included painful coitus, dense vaginal exoneration and severe pelvic pain. The discharge was pinkish and bloody with odor. She explains that all the symptom’s intensity grew steadily within the last month. She however admits that she ignored the signs and thought they were just normal until the discharge, the odor, and the intercourse pain became too much to bear. She articulated that the discharge was somehow watery. Also, her periods became irregular and with heavy and prolonged menstrual flow. She however refuted occurrence of weight loss, fatigue and bone pain. The discomfort began in the pelvis. According to the patient there were no relieving symptoms. Prior to this visitation she had not received any treatment whatsoever. It is however notable that she’s been on heavy contractual use over the past one year. She hasn’t had surgeries but has been on HPV vaccination all through.
Medications: chemotherapy and radiation therapy as her condition was clearly worsening and there was need to kill the growing cancerous cells in and around the pelvis. Cervical and vaginal cytology: She has undergone two Pap smear at the age of 23 and 27 years. Pap smear test is done under high restrictions as its health effects are severe in case of regular conduction. She tested negative in the first test and positive in the second test. History of abnormal pap smears- she has recorded one abnormal tests of pap smears at 27.However, her doctors recommended some therapy and in a few months she was declared normal again.
PMH Intensive contraceptive use. Tested positive Medication Intolerances: She had no medical intolerance Chronic Illnesses/Major traumas She registered no chronic illnesses Surgical history and medical history None, she has not been pregnant yet and has had no history of chronic diseases
Family History Both parents are still alive, living normal healthy lives. Her father,she states has hypertension.
Social History The patient is engaged, having one sexual partner. Her husband is an Electrical Engineer. They live together with her fiancée. Economically she is well off. They regularly go for routine checkups. Her husband is on diet. She is a Statistician. Has worked with several NGO’s. She sometimes smokes.

Obstetric history: gravida2, para 2, arbortus 0, secundigravida gravida 2, G2:. The patient denies having abortions and states that her menstrual health has been superb and regular with no complications whatsoever, Her periods lasted for exactly 4 days with little cramping. Health Maintenance: her diet is supplemented with vitamins. She integrates vegetables and fruits on her diet. The last test on Pap smear recorded positive results, indicating she had minor cervical cancer. However, she was on medication and the cancerous cells were allegedly killed
ROS
General No reported weight change She didn’t feel fatigue or abnormal temperatures.	Cardiovascular No chest pain.
Skin She has Soft and tender skin	Respiratory Normal breathing rate. No respiratory illnesses detected.
Eyes She has Symmetrical eyeballs	Gastrointestinal Abdominal pain registered during menstruation only.
Ears Her ears are normal with no discharge or hearing disorder.No ringing.	Genitourinary/Gynecological Normal color of urine. No sensation recorded. She recodes intensive contraception use over the past one year. A hyperactive sex life with no history of any STD. No menstrual complaint till last month when her menses were delayed, heavy. She also recorded intermenstrual flow in the past month.
Nose/Mouth/Throat Normal	Musculoskeletal She felt no alarming symtoms.
Breast No notable change	Neurological Normal
Heme/Lymph/Endo HIV Negative, no bruising, She has not has a transfusion in the past.	Psychiatric No suicidal attempts

Factual
Mass 72 Kg BMI	Warmth 36 degrees	BP 111/73 mmHg
Stature 6’’	Heart Beat 79
General Appearance She is in fine fettle but has a long and gloomy face due to pain. She has no normal gait due to the pain in the vulva and swelling. She is well-groomed. There is Adour due to vaginal discharge. She appears troubled and deep in thought. Answers questions without attitude.
Skin Skin is bright, smooth and intact.
HEENT Has a normal atraumatic head without lesion, well distributed hair. Teeth are well arranged an in order, very complete. Her lungs were functioning properly with a steady breath rate. Her breast were soft and tender raising little concern. The vagina is clean and normal off pubic hair. The peripheral vascular, neck abdomen and bladder are working perfectly.
Cardiovascular S1, S2 with unvarying frequency. Sounds cannot be heard
Respirational Diagnosis No notable abnormalities. The lungs are working well, normal breath rate
Gastrointestinal Abdomen obese; Active BS in all quadrants.soft and non-tender abdomen. No hepatosplenomegaly.
Breast The breast is normal and Breast soft, no discharge, no dimpling, no pimping and tenderness or stretching of the skin.
Genitourinary She has a non-descended bladder with no CVA tenderness. Her genitalia has coarse well distributed, but shaved, distribution. Her skin color is consistent and she has a general pigmentation. She has a pink and nulliparous cervix. Her drainage is in a range between cloudy and almost clear.. The cervix is firm on bimanual exam. No CMT. Uterus is ant evert and positioned behind a slightly distended bladder.
Musculoskeletal The full rom in 4 extremities are visible upon motion by the patient within the room.
Neurological She speaks clearly and audibly .She maintains an erect posture throughout the examination. Posture Balance stable; gait without abnormalities noted.
Psychiatric She is vigilant, properly dressed in the latest fashion. She speaks calmly and answers questions just as asked and sometimes asks questions concerning her. .
Lab Tests Bimanual pelvic examination Pap smear test- Positive Urine culture – pending Wet prep - pending HPV typing test-positive Xray-n/a
Special Tests (done or ordered during the OV) Pep smear test Biopsy colposcopy Lipoid disorder screening
Diagnosis
Primary Diagnosis	Malignant neoplasm of Cervix Uteri,uspecified.C53.9 ICD-10-CM
	After thorough research and examination, I diagnosed the patient with cervical cancer. Further examination made me realize that the cancer is still its initial stages, increasing the possibility of cure. And chances of survival. Painful intercourse and intermenstrual flows distinct cancer in its earlier stage. In addition to that The pink discharge .The main cause of the Cervical cancer to the patient could be early sexual exposure, contraception smoking of tobacco. Differential Diagnoses (these must be different from the Primary Diagnosis) 1. Bacterial vaginosis (BV) : The Couse is from the lactobacilli bacteria from within the birth canal. It transpires in the event that lactobacilli level gets low in the body. Generally it comes as an It’s an overgrowth in the vagina. It’s characterized by thick or whitish discharge or one that is slippery and clear. It causes itching and burning sensation. Fishy odor may be noticed during intercourse. 2. Trichomonas’s: it’ also called as trichomonas’s and is transmitted sexually. It’s caused by single-celled trichomonas vaginalis and transmitted through coitus. Its symptoms are a burning sensation, irritation ,swelling of the vulva and a greenish vaginal discharge 3. Gonorrhea: it’s a highly contagious sexually transmitted infection. The symptoms include; vaginal discharge, discomfort when urinating and a painful intercourse.
Plan/Therapeutics (explain fully) The doctor did a laser surgery in order to destroy the pre-cancerous cells. This was done carefully in order not to kill the surrounding healthy cells. A follow up examination was recommended for a period of 6 months with Pap smear after laser ablation to ensure all the cancerous cells are gone. She should have foods with enough calories and proteins. She should also have minor physical practices and quit smoking and alcohol intake. A consistent pelvic examination and pap smears as she has been diagnosed with cervical cancer. To prevent the disease, the patient should avoid exposure to HPV by abstaining from sex or having protected sex with a barrier, like Condom).In addition to that quitting smoking would reduce possibility of exposure. She is recommended to have a weekly routine checkups with the gynecologist and to take care and not her progress.
Evaluation of patient encounter – Heavy Contraceptive use is hazardous and should be reduced as much as possible.

References

1. Schiffman, M., Castle, P. E., Jeronimo, J., Rodriguez, A. C., & Wacholder, S. (2007). Human papillomavirus and cervical cancer. The Lancet, 370(9590), 890-907.

1. Waggoner, S. E. (2003). Cervical cancer. The Lancet, 361(9376), 2217-2225.

1. Dasari, S., Wudayagiri, R., & Valluru, L. (2015). Cervical cancer: Biomarkers for diagnosis and treatment. Clinica chimica acta, 445, 7-11.

1. Glick, S. B., Clarke, A. R., Blanchard, A., & Whitaker, A. K. (2012). Cervical cancer screening, diagnosis and treatment interventions for racial and ethnic minorities: a systematic review. Journal of general internal medicine, 27(8), 1016-1032.

SOAP NOTE

Name: Ciara Rachels Date: 11/09/2020 Time: 0800

Age: 28 Sex: F

SUBJECTIVE

CC:

“ODORFUL DISCHARGE AND PAINFUL INTERCOURSE”

HPI:

She reported to the clinic complaining of a series of symptoms. These included painful coitus, dense vaginal exoneration and severe pelvic pain. The discharge was pinkish and bloody with odor. She explains that all the symptom’s intensity grew steadily within the last month. She however admits that she ignored the signs and thought they were just normal until the discharge, the odor, and the intercourse pain became too much to bear. She articulated that the discharge was somehow watery. Also, her periods became irregular and with heavy and prolonged menstrual flow. She however refuted occurrence of weight loss, fatigue and bone pain. The discomfort began in the pelvis. According to the patient there were no relieving symptoms. Prior to this visitation she had not received any treatment whatsoever. It is however notable that she’s been on heavy contractual use over the past one year. She hasn’t had surgeries but has been on HPV vaccination all through.

Medications: chemotherapy and radiation therapy as her condition was clearly worsening and there was need to kill the growing cancerous cells in and around the pelvis.

Cervical and vaginal cytology:

She has undergone two Pap smear at the age of 23 and 27 years. Pap smear test is done under high restrictions as its health effects are severe in case of regular conduction. She tested negative in the first test and positive in the second test.

History of abnormal pap smears- she has recorded one abnormal tests of pap smears at 27.However, her doctors recommended some therapy and in a few months she was declared normal again.

PMH

Intensive contraceptive use. Tested positive

Medication Intolerances:

She had no medical intolerance

Chronic Illnesses/Major traumas

She registered no chronic illnesses

Surgical history and medical history

None, she has not been pregnant yet and has had no history of chronic diseases

Family History

Both parents are still alive, living normal healthy lives. Her father,she states has hypertension.

Social History

The patient is engaged, having one sexual partner. Her husband is an Electrical Engineer. They live together with her fiancée. Economically she is well off. They regularly go for routine checkups. Her husband is on diet. She is a Statistician. Has worked with several NGO’s. She sometimes smokes.

Obstetric history: gravida2, para 2, arbortus 0, secundigravida gravida 2, G2:.

The patient denies having abortions and states that her menstrual health has been superb and regular with no complications whatsoever, Her periods lasted for exactly 4 days with little cramping.

Health Maintenance: her diet is supplemented with vitamins. She integrates vegetables and fruits on her diet. The last test on Pap smear recorded positive results, indicating she had minor cervical cancer. However, she was on medication and the cancerous cells were allegedly killed

ROS

General

No reported weight change

She didn’t feel fatigue or abnormal temperatures.

Cardiovascular

No chest pain.

Skin

She has Soft and tender skin

Respiratory

Normal breathing rate. No respiratory illnesses detected.

Eyes

She has Symmetrical eyeballs Gastrointestinal

Abdominal pain registered during menstruation only.

Ears

Her ears are normal with no discharge or hearing disorder.No ringing.

Genitourinary/Gynecological

Normal color of urine. No sensation recorded. She recodes intensive contraception use over the past one year. A hyperactive sex life with no history of any STD.

No menstrual complaint till last month when her menses were delayed, heavy. She also recorded intermenstrual flow in the past month.

Nose/Mouth/Throat

Normal

Musculoskeletal

She felt no alarming symtoms.

Breast

No notable change Neurological

Normal

Heme/Lymph/Endo

HIV Negative, no bruising, She has not has a transfusion in the past. Psychiatric

No suicidal attempts

Factual

Mass 72 Kg BMI Warmth 36 degrees BP 111/73 mmHg

Stature 6’’ Heart Beat 79

General Appearance She is in fine fettle but has a long and gloomy face due to pain. She has no normal gait due to the pain in the vulva and swelling. She is well-groomed. There is Adour due to vaginal discharge. She appears troubled and deep in thought. Answers questions without attitude.

Skin

Skin is bright, smooth and intact.

HEENT

Has a normal atraumatic head without lesion, well distributed hair. Teeth are well arranged an in order, very complete. Her lungs were functioning properly with a steady breath rate. Her breast were soft and tender raising little concern. The vagina is clean and normal off pubic hair. The peripheral vascular, neck abdomen and bladder are working perfectly.

Cardiovascular S1, S2 with unvarying frequency. Sounds cannot be heard

Respirational Diagnosis

No notable abnormalities. The lungs are working well, normal breath rate

Gastrointestinal

Abdomen obese; Active BS in all quadrants.soft and non-tender abdomen. No hepatosplenomegaly.

Breast

The breast is normal and Breast soft, no discharge, no dimpling, no pimping and tenderness or stretching of the skin.

Genitourinary

She has a non-descended bladder with no CVA tenderness. Her genitalia has coarse well distributed, but shaved, distribution. Her skin color is consistent and she has a general pigmentation. She has a pink and nulliparous cervix. Her drainage is in a range between cloudy and almost clear.. The cervix is firm on bimanual exam. No CMT.

Uterus is ant evert and positioned behind a slightly distended bladder.

Musculoskeletal

The full rom in 4 extremities are visible upon motion by the patient within the room.

Neurological

She speaks clearly and audibly .She maintains an erect posture throughout the examination. Posture Balance stable; gait without abnormalities noted.

Psychiatric

She is vigilant, properly dressed in the latest fashion. She speaks calmly and answers questions just as asked and sometimes asks questions concerning her.

.

Lab Tests

Bimanual pelvic examination

Pap smear test- Positive

Urine culture – pending

Wet prep - pending

HPV typing test-positive

Xray-n/a

Special Tests (done or ordered during the OV)

Pep smear test

Biopsy

colposcopy

Lipoid disorder screening

Diagnosis

Primary Diagnosis Malignant neoplasm of Cervix Uteri,uspecified.C53.9 ICD-10-CM

After thorough research and examination, I diagnosed the patient with cervical cancer. Further examination made me realize that the cancer is still its initial stages, increasing the possibility of cure. And chances of survival. Painful intercourse and intermenstrual flows distinct cancer in its earlier stage. In addition to that The pink discharge .The main cause of the Cervical cancer to the patient could be early sexual exposure, contraception smoking of tobacco.

Differential Diagnoses (these must be different from the Primary Diagnosis)

1. Bacterial vaginosis (BV): The Couse is from the lactobacilli bacteria from within the birth canal. It transpires in the event that lactobacilli level gets low in the body. Generally it comes as an It’s an overgrowth in the vagina. It’s characterized by thick or whitish discharge or one that is slippery and clear. It causes itching and burning sensation. Fishy odor may be noticed during intercourse.

2. Trichomonas’s: it’ also called as trichomonas’s and is transmitted sexually. It’s caused by single-celled trichomonas vaginalis and transmitted through coitus. Its symptoms are a burning sensation, irritation ,swelling of the vulva and a greenish vaginal discharge

3. Gonorrhea: it’s a highly contagious sexually transmitted infection. The symptoms include; vaginal discharge, discomfort when urinating and a painful intercourse.

Plan/Therapeutics (explain fully)

The doctor did a laser surgery in order to destroy the pre-cancerous cells. This was done carefully in order not to kill the surrounding healthy cells. A follow up examination was recommended for a period of 6 months with Pap smear after laser ablation to ensure all the cancerous cells are gone.

She should have foods with enough calories and proteins. She should also have minor physical practices and quit smoking and alcohol intake.

A consistent pelvic examination and pap smears as she has been diagnosed with cervical cancer.

To prevent the disease, the patient should avoid exposure to HPV by abstaining from sex or having protected sex with a barrier, like Condom).In addition to that quitting smoking would reduce possibility of exposure.

She is recommended to have a weekly routine checkups with the gynecologist and to take care and not her progress.

Evaluation of patient encounter – Heavy Contraceptive use is hazardous and should be reduced as much as possible.

References

1. Schiffman, M., Castle, P. E., Jeronimo, J., Rodriguez, A. C., & Wacholder, S. (2007). Human papillomavirus and cervical cancer. The Lancet, 370(9590), 890-907.

2. Waggoner, S. E. (2003). Cervical cancer. The Lancet, 361(9376), 2217-2225.

3. Dasari, S., Wudayagiri, R., & Valluru, L. (2015). Cervical cancer: Biomarkers for diagnosis and treatment. Clinica chimica acta, 445, 7-11.

4. Glick, S. B., Clarke, A. R., Blanchard, A., & Whitaker, A. K. (2012). Cervical cancer screening, diagnosis and treatment interventions for racial and ethnic minorities: a systematic review. Journal of general internal medicine, 27(8), 1016-1032.

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https://www.verywellmind.com/provisional-diagnosis-vs-differential-diagnosis-1067284Learn what these mean and the steps required for a mental health diagnosis. ... Difference Between Provisional and Differential Diagnoses ... the specifier "provisional" in parentheses next to the name of the diagnosis.1 For example, ... Clinicians must differentiate major depressive disorder from related mood disorders and ...

· 27% similarIn addition to that The pink discharge .The main cause of the Cervical cancer to the patient could be early sexual exposure, contraception smoking of tobacco.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140050/Jul 14, 2011 - Additional article information ... Cervical cancer (CC) is the third most common cancer in women ... use of oral contraceptives (OCs), tobacco smoking, diet, cervical trauma, ... the first to put the hypothesis that smoking is a risk factor for cervical ... The in vivo effects of long-term nicotine exposure could affect ...

· 26% similarPap smear test is done under high restrictions as its health effects are severe in case of regular conduction.

https://www.acog.org/patient-resources/faqs/special-procedures/cervical-cancer-screeningScreening includes cervical cytology (also called the Pap test or Pap smear) and, for ... Most cases of cervical cancer are caused by infection with HPV. ... lasts for a long time, it can cause more severe (“high-grade”) changes in cervical cells. ... will need to get regular cervical cancer screening after the follow-up is complete.

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