Sex: Femаle. Age: 69 yeаrs-оld. Nurse Nоte: Pаtient presents tоday with wanting to get back on track. Also wants to go back on synthroid, also wants to lose weight, otherwise no other complaints. Subjective CC: Stopped meds, feels tired, gained 20 pounds in a year. HPI: above ROS: Constitution: Reports weight change, but denies chills, fatigue and fever, tired. Eyes: Denies visual disturbance. Cardiovascular: Denies chest pain and palpitations. Respiratory: Denies cough, dyspnea and wheezing. Gastrointestinal: Denies constipation, diarrhea, dyspepsia, dysphagia, hematochezia, melena, nausea and vomiting. Genitourinary: Denies dysuria, frequency, hematuria, incontinence, nocturia and urgency. Musculoskeletal: Denies arthralgia and myalgia. Skin: Denies rashes, no pain or bleed. Neuro: Denies neurologic symptoms. Psych: Denies symptoms other than stated above. Stress caring for others. Current Meds: None. Allergies: NKDA PMH: Mammogram: (5/2008). Pelvic/Pap Exam: (5/2008). Blood Test: (5/2007). Bone Density Test: never within 10 years. Dental: (4/2008). Eye Exam: (2/2007) Reviewed and updated. Family History: Father: Hypertension; MI. Mother: Hypertension. Reviewed and updated. Social History: Highest level of education completed is 12th grade. Marital status: Married. Lives with spouse and grandson. Household pets include fish. Personal Habits: Cigarette Use: None. Alcohol: Rare. Daily Caffeine: Consumes on average three cups of coffee per day. Reviewed and updated. Objective BP: 142/84 P: 68 T: 98.5 RR: 16 HT: 65" 5'5" WT: 2241b BMI: 37.3 LMP: HYSTERECTOMY Exam: Constitution: Appears overweight. No signs of apparent distress present. Neck: Palpation reveals no lymphadenopathy. No masses appreciated. Thyroid exhibits no thyromegaly. No JVD. Respiratory: Respiration rate is normal. No wheezing. Auscultate good airflow. Lungs are clear bilaterally. Cardiovascular: Rate is regular. Rhythm is regular. No heart murmur appreciated. Extremities: No clubbing, cyanosis or edema. Abdomen: Bowel sounds are normoactive. Palpation of the abdomen reveals no CVA tenderness. Muscle guarding, rebound tenderness or tenderness. No abdominal masses. No palpable hepatosplenomegaly. Skin: Skin is warm and dry. Assessment #1: Hypothyroidism Plan for #1: Lab: Comp Metabolic Panel I/P TSH (Ultra-Sensitive) Urinalysis Routine T4 Assessment #2: Obesity Plan for #2: Follow-up: Fasting labs then return one month to review and do annual GYN then. At that visit, will arrange biopsy face/temple lesion, order mammogram and she's considering screen c scope.
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