Name: R. M | Pt. Encounter Number: cannot remember | |
Date: 18/03/2022 | Age: 78 years | Sex: Female |
SUBJECTIVE | ||
CC: “I have had chronic diarrhea for 10 months, I think it started in May last year but has gotten worse since January” | ||
HPI: The patient taken into consideration is a 78-year-old female who has complained of having diarrhea for almost 10 months but her condition worsened in the last two months. The patient points out that she ends up having diarrhea once or twice a week since May last year but from January she had an increase in the episodes to about 2 to 3 times a day. The diarrhea is described to be thin and watery. The patient points out that in October she saw a GI and had a colonoscopy that gave negative results for any abnormal findings. She had an endoscopy in January and had negative results as well. She indicates that taking Pepto Bismol prn and had minimal relief. The patient as well indicates that she has had issues of being dizzy. She has denied having abdominal pain or loss of appetite. | ||
Medications: Diovan 160mg PO QD Chlorthalidone 25mg PO QD Metoprolol Succinate 50mg PO QD Diovan 160mg PO QD Chlorthalidone 25mg PO QD Metoprolol Succinate 50mg PO QD Zantac 150 mg PO prn Diovan Metroprolol succinate 50 mg PO 4 times a day | ||
PMH Allergies: The patient has denied having any known allergic reactions and she denies having any food allergies Medication Intolerances: Denies any known intolerance to medication Chronic Illnesses/Major traumas: She has denied any traumas Hospitalizations/Surgeries: No past hospitalization was reported | ||
Family History The patient has reported that the mother died at the age of 46 years as a result of colon cancer. Her father died at the age of 76 years of esophagus cancer. There are no other members of the family other than her sister who passed on a year ago at the age of 74 years due to esophagus cancer. |
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