HISTORY AND PHYSICAL EXAMINATION
Patient
is a 78-year-old female who has had problems with urinary leakage with stress,
especially with lifting. Her bladder is
felt to be dropped, and she notes at that time that she lifted something heavy
and tore loose her bladder attachments and started leaking after that, but it
has been getting worse. She gets up
twice at night to urinate. Had loss of
urine with coughing, sneezing, straining, and changes in position. Patient has had a urinary tract infection in
the past as well. Cystoscopy was done
which showed a slight cystocele, no rectocele.
The patient had a positive Marshall test, at which time the leakage
stopped after elevation of the vesical neck on either side.
Bladder
suspension is planned. The procedure was
discussed with the patient and her daughter, and the risks, complications, and
alternatives were gone over, and the patient agrees with this form of therapy
and wishes to have this done.
ALLERGIES
ALLERGIES TO SULFA; HER MOUTH BREAKS OUT FROM THIS.
MEDICATIONS
Minipress
1 mg once a day, hydrochlorothiazide 25 mg 1 q.a.m.
REVIEW OF SYSTEMS
Sputum
production for years, worse in the past month.
SOCIAL HISTORY
Widowed,
2 children. Smokes 1 pack of cigarettes
per day.
PHYSICAL EXAMINATION
HEENT: Pupils are equal, round, react to light. Ears, nose, and throat are clear.
NECK: Neck is supple. No JV distention or bruit.
LUNGS: Lungs are clear to P&A.
HEART: Regular rhythm, no murmur, gallop, or rub.
ABDOMEN: Soft, nontender. No mass or organomegaly.
BACK: No CVA masses or tenderness.
EXTREMITIES: No cyanosis, clubbing, or edema.
NEUROLOGICAL: Neurologically oriented to time, place, and
person, with no gross deficit.
VAGINAL
EXAMINATION: Absent cervix and no adnexa
or masses palpable.
RECTAL: No masses palpable. Stool guaiac negative.
IMPRESSION
Urinary
stress incontinence.
RECOMMENDATION
Endoscopic
needle suspension of the bladder.
FOOTNOTE
Line
29 (Page 1). The physician dictated
Medications twice. The medications were
merged into 1 heading on line 29 (Page 1).
Other alternatives for merging this information are acceptable if all
pertinent information is included.
Lines
38-50 (Page 1). Headings and subheadings
were added for clarity in the Physical Examination.
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