I Need two Responses Per Each Discussion(soap note) Total 6 Responses. Attached Are The Discussions(soap Note) .One Reference Per Each Discussion

Patient Demographic:

Name: Mrs.: L.D

Age: 49 y/o.

Encounter date: 10/05/2020.

Soap number: 1527-20201005-001. Sex: Female.

Race: Hispanic.

Insurance: Medicaid.

Subjective data:

Subjective:

CC: “I’m having Irregular period and hot all time”.

HPI: 49-year-old female patient, of the white race of Hispanic origin, who comes to us office because she thinks she has menopause, refers to having: Irregular periods, Vaginal dryness, Hot all times, Night sweats, Sleep problems, Mood swings, Weight gain and dry skin, all these symptoms have been more agreed during the last 2 months. And now she has anxiety and think has sexual problem in the future. Denies fever, nauseas, chill, urinary problems, or vaginal problems. No pain, no SOB.

PMH: none.

Sexual/Reproductive Hx: Last pap: 2019/ march negative, Breast, mammogram: none.

Menstrual periods: LMP: august/2019.

G4P2T0L2A2. Menarche: at 11 years old. Use of contraception: Condon occasional. She is sexually active.

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FPMHx: Father: Cardiomyopathy and Mother: Breast cancer. Meds: None.

Allergy: Sulfas.

Immunizations: TT 2016, Flu 2019. Diet: Regular

Exercise: Use Gym 3-4 times per week. Hospitalization: None.

ROS:

General: denies fever, change in appetite or headaches. She has no chills. Refers Hot flashes, Night sweats, Sleep problems, Mood swings, and Weight gain

HEENT: Eyes - Denies pain, redness, loss of vision, double or blurred vision, Ears, nose, mouth, and throat. Denies ringing in the ears, loss of hearing, nosebleeds, loss of sense of smell, dry sinuses, sinusitis, post nasal drip, sore tongue, bleeding gums, sores in the mouth, loss of sense of taste, dry mouth, frequent sore throats, hoarseness, waking up with acid or bitter fluid in the mouth or throat, food sticking in throat when swallows or painful swallowing.

CARDIOVASCULAR: Denies chest pain, irregular heartbeats, sudden changes in heartbeat or palpitation, shortness of breath, difficulty breathing at night, swollen legs or feet, heart murmurs, high blood pressure, cramps in his legs with walking, pain in his feet or toes at night or varicose veins.

RESPIRATORY: Denies chronic dry cough, coughing up blood, coughing up mucus, waking at night coughing or choking, repeated pneumonias, wheezing or night sweats.

GASTROINTESTINAL: Denies decreased appetite, nausea, vomiting, vomiting blood or coffee ground material, heartburn, regurgitation, frequent belching, stomach pain relieved by

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food, yellow jaundice, diarrhea, constipation, gas, blood in the stools, black tarry stools or hemorrhoids. Has excessive salivation.

GENITOURINARY: Denies difficult urination, pain or burning with urination, blood in

the urine, cloudy or smoky urine, frequent need to urinate, urgency, needing to urinate frequently at night, denies vaginal discharge, Refers irregular menstrual cycles. Ones more abundant them others.

Breast: Skin normal color, pink, no lesions, no swelling, no tenderness. Denies breast lump, breast pain or nipple discharge.

MUSCULOSKELETAL: Denies arm, buttock, thigh, or calf cramps. No joint or muscle pain. No muscle weakness or tenderness. No joint swelling, neck pain, back pain, or major orthopedic injuries.

SKIN: Denies easy bruising, skin redness, skin rash, hives, sensitivity to sun exposure, tightness, nodules or bumps, hair loss, color changes in the hands or feet with cold.

NEUROLOGIC: Denies headache, dizziness, fainting, muscle spasm, loss of consciousness, sensitivity or pain in the hands and feet or memory loss.

Objective

General survey: in no acute distress, well-nourished. Cooperative, normal speech, no distress noted.

Vital Signs:

BP: 130/80 mmhg HR: 86 x min, RR: 18 x min

T: 37.2 C.

SpO2: 99 %.

Wt: 168 pns (Initial W), BMI: 27.0

Pain scale: 0/10.

HEENT: Normocephalic. There is no evidence of eyes or ear problems. Neck: Full ROM.

No JVD, no bruits, no masses, thyroid gland no visible, no palpable. negative lymphadenopathy

Resp: Normal appearance, symmetric. Lungs: Clear to auscultation, No rales, no cough, no shortness of breath

Breasts and Axillae: Breasts- no dimpling, no masses, axillae- no masses observed, no lymphadenopathy

Cardio: Regular rate and rhythm, no gallop, no murmur, no edema, peripheral pulses present, no cyanosis, no tachycardia.

GI: abdomen soft, non-tender, non-distended, +BSx4, no masses M/S: Full ROM, muscle strength 5/5

Neuro: Awake, alert, and oriented x 3, responsive to verbal and tactile stimuli. No focalization

Genitourinary and gynecological: No pain in CVA, no lesions, no vaginal discharge. The bladder is non-distended; Vaginal exam: Normal external genitalia. Bi-manual examination display uterus smooth, no pelvic tenderness, Ovaries nonpalpable.

Speculum: Vagina and Cervix healthy.

Breasts: Areola and nipple well contoured, skin with good pigmentation, no masses or lifoadenopathy are palpated, no pain on palpation or referred, no sequestration, nipple without pathological alterations.

Assessment

ICD 10: E28.310; Menopause is the time that marks the end of your menstrual cycles. It's diagnosed after you've gone 12 months without a menstrual period. Menopause can happen in your 40s or 50s, but the average age is 51 in the United States. Menopause is a natural biological process. But the physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt your sleep, lower your energy, or affect emotional health. There are many effective

treatments available, from lifestyle adjustments to hormone therapy.

DDx:

ICD 10: D53.9; Nutritional anemia, unspecified.

ICD 10: F32.0; Major depressive disorder, single episode, mild Dysthymic Disorder ICD 10: E03.9; Hypothyroidism

Plan

Medications: No currently. Education:

Nutrition and vitamins in the first trimester:

Nutrition guidelines: Eat small, frequent meals. Do not try to lose weight and stick to a diet. It’s not good for your health at this point. Eat heat-treated foods, giving preference to boiled and stewed dishes. Do not eat raw foods, particularly eggs, shellfish, fish, and meat to prevent

infectious diseases and parasites. Consume more fruits, vegetables, thoroughly washing

them before eating. Cut down on caffeine. it's important to get regular exercise, eat a healthy diet

and maintain a normal weight. Ask your doctor for advice on how to protect your heart, such as how to reduce your cholesterol or blood pressure if it's too high.

Sexual function. Vaginal dryness from decreased moisture production and loss of

elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity (libido).

Water-based vaginal moisturizers and lubricants may help. If a vaginal lubricant isn't enough, many women benefit from the use of local vaginal estrogen treatment, available as a vaginal cream, tablet, or ring.

Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows. You may need to eat less and exercise more, just to maintain your current weight.

Follow up in 1 months. Referral: no.

References:

Chen H, Li J, Cui T, Hu L. Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women.

Cochrane Database Syst Rev. 2017;(11):CD00801

North American Menopause Society. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017 Jul;24(7):728-53.

Panzer C, Guay A. Testosterone replacement therapy in naturally and surgically menopausal women. J Sex Med. 2016 Jan;6(1):8-18.