NR 509 Shadow Health Focused Exam Abdominal Transcript

Chamberlain College of Nursing – NR 509 Shadow Health Focused Exam Abdominal Transcript Started: Sep 30, 2018 | Patient Exam Time: 264 min All Li nes (303) Inter vi ew Questi ons (170) Statements ( 26) Exam Acti ons ...

Chamberlain College of Nursing – NR 509 Shadow Health Focused Exam Abdominal Transcript Started: Sep 30, 2018 | Patient Exam Time: 264 min All Li nes (303) Inter vi ew Questi ons (170) Statements ( 26) Exam Acti ons (107) Hello, My name is Lucy, an FNP student I will be interviewing you today Greet 09/30/18 7:53 PM CDT Hello. what is your name? Question 09/30/18 7:53 PM CDT Esther Park.what is your birthday? Question 09/30/18 7:53 PM CDT My birthday is January 7th. how old are your? (Clarified to how old are you.) Question 09/30/18 7:53 PM CDT Seventy-eight. (Clarified to what is my age.) what bring you in today? Question 09/30/18 7:54 PM CDTI have pain in my belly. . . and I'm having some difficulty with going to the bathroom. My daughter was concerned. when did your pain start? Question 09/30/18 7:55 PM CDT The pain started as a general discomfort, about five days ago, when I started having the. . . difficulties going to the bathroom. I'm sorry to hear you are having pain and discomfort Empathize 09/30/18 7:56 PM CDT Thank you.where is your pain? Question 09/30/18 7:58 PM CDT The pain and discomfort is down low in my belly. can you point the location? Question 09/30/18 7:58 PM CDT Well my whole belly is uncomfortable to some degree, but it's mostly in the lower part, that's where the pain is. Down in my lower belly. are you in pain right now? Question 09/30/18 7:59 PM CDTYes. . . it hurts now, like it has been. can you describe your pain? Question 09/30/18 7:59 PM CDT I'd say it's crampy and. . . a dull, crampy feeling. what is your pain level 0-10, 10 being worst? Question 09/30/18 8:00 PM CDT Right now. . . 6 out of 10.sorry to hear that you are in pain, Empathize 09/30/18 8:01 PM CDT Thank you. what make your pain relieve? (Clarified to what relieves your pain.) Question 09/30/18 8:01 PM CDT When I rest and try not to move much, I feel better. But the pain is still there. (Clarified to what relieves the pain.) is change of posture relieves your pain? (No matching questions found.) Question 09/30/18 8:02 PM CDT what makes your pain worse? Question 09/30/18 8:02 PM CDTMoving around certainly doesn't help. Neither does eating. how often are your having pain? Question 09/30/18 8:03 PM CDT Oh, it's with me all the time. The bloating, too. But certain things do make it worse. can you specify of certain things? (No matching questions found.) Question 09/30/18 8:03 PM CDT can you specify of certain things make worse? (No matching questions found.) Question 09/30/18 8:04 PM CDT what make your pain worse? Question 09/30/18 8:04 PM CDTMoving around certainly doesn't help. Neither does eating. how long have you had this problem? (Clarified to how long have you been in pain.) Question 09/30/18 8:05 PM CDT The pain started as a general discomfort, about five days ago, when I started having the. . . difficulties going to the bathroom. (Clarified to how long I have been in pain.) have you had any different activities 5 days ago? (No matching questions found.) Question 09/30/18 8:05 PM CDT what were you doing 5 days ago? (Clarified to What were you doing prior to the start of the pain?.) Question 09/30/18 8:06 PM CDTI don't know what caused it. . . about five days ago, I started having difficult going to the bathroom. It came with a general uneasiness and a small amount of discomfort. Then the pain got much worse two--maybe three--days ago. (Clarified to what I was doing when the pain started.) what was the pain level two or three days ago? (No matching questions found.) Question 09/30/18 8:06 PM CDT was the pain started sudden? Question 09/30/18 8:07 PM CDT No, it was gradual. I had some pain and discomfort about. . . five days ago. Then in the past few days it got much worse. how long does your pain last? Question 09/30/18 8:07 PM CDTThe pain is there all the time, but it gets much worse at certain points--when I move around a lot or eat something, especially. I'm sorry to hear that, in order to figure out what cause your pain, I need to gather information and examining you Educate 09/30/18 8:09 PM CDT Thank you for explaining that. what causes your pain? Question 09/30/18 8:09 PM CDT I'm just not sure. I've been having trouble going to the bathroom, but I don't know what is making all this happen.when was last you had bowel movement? Question 09/30/18 8:09 PM CDT That was a few days ago. When I had a digestive upset. Diarrhea. when was last you had urination? (Clarified to When did you last urinate?.) Question 09/30/18 8:10 PM CDT I urinated before I left the house to come here. About an hour ago. (Clarified to when I last urinated.) are you having any trouble urinate? Question 09/30/18 8:11 PM CDTNo, no trouble. are you having bowel problem? Question 09/30/18 8:11 PM CDT Well, I do remember my father having heartburn on occasion. But I can't think of anyone having anything, other than that. what causes digestive upset a few days ago? Question 09/30/18 8:12 PM CDT I wasn't eating very much, even then. Just a few peach slices that morning, I think. [AUDIO COMING SOON]how's your eating habit? Question 09/30/18 8:13 PM CDT I eat a heart-healthy diet. Low fat, lean meats, low sugar. . . I eat light. very good Ms Park, you are on healthy diet Educate 09/30/18 8:14 PM CDT Thank you for explaining that. what makes it feel better? Question 09/30/18 8:14 PM CDTWhen I rest and try not to move much, I feel better. But the pain is still there. are you feeling nausea? (Clarified to Does nausea occur with the pain?.) Question 09/30/18 8:15 PM CDT No. I haven't vomited or had any nausea. It's more of a problem with pain. . . and difficulty going to the bathroom. (Clarified to if nausea occurs with the pain.) have you had this problem before? Question 09/30/18 8:15 PM CDT No, nothing like this.is your pain sharp? Question 09/30/18 8:16 PM CDT No. I'd say it's crampy and. . . a dull, crampy feeling. is your pain constant? Question 09/30/18 8:16 PM CDT Yes. Certain things can make it a tiny bit better or a tiny bit worse, I suppose. But it's always there. does laying down make pain relieve? Question 09/30/18 8:17 PM CDTWhen I rest and try not to move much, I feel better. But the pain is still there. what makes it feel better? Question 09/30/18 8:17 PM CDT When I rest and try not to move much, I feel better. But the pain is still there. Have you take any medication to relieve the pain? Question 09/30/18 8:18 PM CDT I'm not taking anything for it.what have you done to relieve the pain? Question 09/30/18 8:18 PM CDT I've tried taking small sips of warm water, resting. The warm water does nothing. A friend suggested it, but it's nonsense. I'm sorry to hear that it sounds nothing help your pain (No matching questions found.) Question 09/30/18 8:26 PM CDT I'm sorry to hear that it sounds nothing help your pain Empathize 09/30/18 8:26 PM CDT Thank you. does your pain affected your daily life? (Clarified to Has the pain affected your usual activities?.) Question 09/30/18 8:28 PM CDTWell, I don't feel unnaturally tired or weak. But I have experienced low energy, like I need to rest more often. (Clarified to if my pain has affected my activities.) how's your energy level? Question 09/30/18 8:29 PM CDT Right now? I feel slow, sluggish. I just feel very uncomfortable. what's your usual activities? Question 09/30/18 8:30 PM CDT I enjoy staying busy -- but not too busy. I take classes at the community center--water aerobics, and now Pilates. And I love to walk. My friend and I walk to the botanical gardens, once a week. I garden as well. Those are all nice ways to spend my time.any experience changes of usual activities? (No matching questions found.) Question 09/30/18 8:31 PM CDT any change of usual activities? Question 09/30/18 8:32 PM CDT Yes, it seems like my energy got low when I did simple things around the house, like tidying up. I had to miss my exercise classes this week -- I didn't have the energy for them. That's unusual for me. what have you done last couple days? Question 09/30/18 8:32 PM CDT I've tried taking small sips of warm water, resting. The warm water does nothing. A friend suggested it, but it's nonsense. you seems enjoy your usual activities, we will work together so you can go back to your usual activities as soon as possible (No matching questions found.) Question 09/30/18 8:34 PM CDT you seems enjoy your usual activities, we will work together so you can go back to your usual activities as soon as possible Educate 09/30/18 8:34 PM CDTThank you for explaining that. have you constipate? (Clarified to Are you feeling constipated?.) Question 09/30/18 8:35 PM CDT Well, yes. . . other than my. . . digestive upset. . . I haven't moved my bowels for several days. (Clarified to if I am constipated.) how often do you have diarrhea? Question 09/30/18 8:35 PM CDT I don't have diarrhea often at all. . . the bout a few days ago was the first time in a long while.do you have history of constipation? Question 09/30/18 8:36 PM CDT I don't usually have problems going to the bathroom. . . but this has been going on for. . . about five days now. Other than the digestive upset I had a few days ago. what have you done for your constipation? Question 09/30/18 8:36 PM CDT Well, I haven't experienced constipation before, so I haven't done anything for it. have you dining out recently? (No matching questions found.) Question 09/30/18 8:38 PM CDT how many time have you had diarrhea a few days ago? (Clarified to How much diarrhea did you have?.) Question 09/30/18 8:39 PM CDTA few times, just for that one day. Three or four times. Something like that. (Clarified to how much diarrhea I had.) can you describe the diarrhea? Question 09/30/18 8:39 PM CDT It was very loose. Watery. what color was the diarrhea? Question 09/30/18 8:40 PM CDT It was brown, but thinned out. It was liquidy. Oof! I do not enjoy discussing this.sorry about you might not comfortable taking about this, but in order to figure something out, your information is very important Educate 09/30/18 8:42 PM CDT Thank you for explaining that. do you noticed any blood? (Clarified to Has there been blood in your stool?.) Question 09/30/18 8:43 PM CDT No. I've never experienced that. (Clarified to if there has been blood in my stool.) has there been any mucus in the stool? (Clarified to have you had mucus in your stool.) Question 09/30/18 8:44 PM CDTNo, I haven't noticed anything like that. (Clarified to if there has been mucus in my stool.) how are your bowel movement? Question 09/30/18 8:45 PM CDT My bowel movements are usually. . . what I assume one would call normal. Not too soft, a normal brown color. Fairly regular. how often are your bowel movement? Question 09/30/18 8:45 PM CDT Before this? Every day. Well, I miss a day now and then, but usually every day.although sounds little gross, your bowel can tell your health, so it's important to look shape, color, Educate 09/30/18 8:49 PM CDT Thank you for explaining that. when was last your bowel movement? Question 09/30/18 8:49 PM CDT That was a few days ago. When I had a digestive upset. Diarrhea. any discomfort with your last bowel movement? Question 09/30/18 8:50 PM CDTYes, I have been very uncomfortable in my belly-- my lower belly. It's been going on for almost a week. any changes the frequency of your urination? Question 09/30/18 8:51 PM CDT I've been going slightly less often because. . . well, I've been little less thirsty than usual. sorry to hear that Empathize 09/30/18 8:52 PM CDT Thank you.how much of water are you drink a day? Question 09/30/18 8:52 PM CDT Usually I drink, oh, six glasses of water a day. But it's been difficult to drink much in the last few days. it's important to drink water even though you don't feel like drink Educate 09/30/18 8:53 PM CDT Thank you for explaining that. what color of your urin? (Clarified to What is the color of your urine?.) Question 09/30/18 8:54 PM CDTYellow and. . . maybe a bit darker than usual. (Clarified to what color my urine is.) any smell of urine? Question 09/30/18 8:54 PM CDT No, it seems normal enough to me. Maybe a little darker than usual. any blood in the urine? Question 09/30/18 8:54 PM CDT No, it seems normal enough to me. Maybe a little darker than usual.have you had colonoscopy? Question 09/30/18 8:55 PM CDT I've had two colonoscopies. The last one was ten years ago. what was the result? Question 09/30/18 8:56 PM CDT It was years ago, so I don't remember anything about it. I'm sure it was fine. when is next your colonoscopy? (No matching questions found.) Question 09/30/18 8:56 PM CDT do you have any history of gastrointestinal problem? Educate 09/30/18 8:57 PM CDTThank you for explaining that. do you have any history of gastrointestinal problem? Question 09/30/18 8:57 PM CDT No, I have a good stomach. I've never had this kind of trouble before. And I'm usually fairly regular. what do you mean by fairly regular? (No matching questions found.) Question 09/30/18 8:58 PM CDT any history of GERD? Question 09/30/18 8:58 PM CDTNo. I don't get indigestion, heartburn, nothing like that. any history of ulcer? Question 09/30/18 8:59 PM CDT No, I've never had one. any family history of gastrointestinal problem? Question 09/30/18 8:59 PM CDT None that I know of.any family history of liver disease? Question 09/30/18 9:00 PM CDT No, not that I know of. do you have history of liver disease? Question 09/30/18 9:00 PM CDT I've never had any problems with my liver. do you have history of pancreas disease? Question 09/30/18 9:00 PM CDTNo, not that I know of. do you have history of gallbladder disease? Question 09/30/18 9:01 PM CDT I had gallstones--many, many years ago. I had my gallbladder removed. do you have history of appendicitis? Question 09/30/18 9:01 PM CDT No.do you any spleen problem? (No matching questions found.) Question 09/30/18 9:03 PM CDT any spleen problem? Question 09/30/18 9:03 PM CDT No, not that I know of. any problem after your gallbladder removed? Question 09/30/18 9:04 PM CDT No, no complications. any other surgeries you had? (No matching questions found.) Question 09/30/18 9:04 PM CDT any surgeries you had? Question 09/30/18 9:05 PM CDTI've had two operations, both many years ago. what were two operations ? (Clarified to what surgeries have you had.) Question 09/30/18 9:06 PM CDT I've had two. I had my gallbladder out, and I had a C-section. Both in my early 40s. (Clarified to what surgeries I have had.) what do you typically eat a day? Question 09/30/18 9:07 PM CDT Hm. Fruit for breakfast. For lunch. . . usually soup, maybe a salad. But I don't always have lunch. And for dinner I eat fish, or sometimes chicken, and a vegetable.skipping a meal is not ideal (No matching questions found.) Question 09/30/18 9:08 PM CDT skipping a meal is not ideal Educate 09/30/18 9:08 PM CDT Thank you for explaining that. do you eat fruit for breakfast only? (Clarified to What's your usual breakfast?.) Question 09/30/18 9:09 PM CDT For breakfast? I eat fruit, usually a banana. (Clarified to what I usually eat for breakfast.) it's important to have balance meal Educate 09/30/18 9:11 PM CDTThank you for explaining that. when was your last meal? Question 09/30/18 9:11 PM CDT I haven't been eating much at all lately. . . the last time I ate was this morning, a little toast. do you take any fiber? Question 09/30/18 9:12 PM CDT No, I don't take any extra fiber. My diet is very healthy.who prepare your foods? Question 09/30/18 9:12 PM CDT My daughter has many wonderful talents, but... I prefer that I do the cooking. how many banana do you eat for breakfast? (No matching questions found.) Question 09/30/18 9:14 PM CDT do you drink caffeine? Question 09/30/18 9:15 PM CDT No. I avoid caffeinated drinks altogether. do you drink soda? Question 09/30/18 9:15 PM CDTNo, I never do. do you drink tea? Question 09/30/18 9:15 PM CDT I mostly just drink water. Sometimes chamomile tea. how often drink chamomile tea? (Clarified to how often do you drink alcohol.) Question 09/30/18 9:16 PM CDT Very little. (Clarified to how often I drink alcohol.)how much of alcohol? Question 09/30/18 9:16 PM CDT Very little. how many of days are you drink alcohol? Question 09/30/18 9:17 PM CDT Oh, I certainly don't drink alcohol every day. I drink once a week - on Sunday evening. what kind of alcoholic beverage do you drink? Question 09/30/18 9:17 PM CDTI always have one glass of wine. A dry white wine. do you smoke/ Question 09/30/18 9:19 PM CDT I've never smoked a cigarette in my life. What a sad habit. are you exposed to smoked cigarette in the house? Question 09/30/18 9:20 PM CDT No.any recent weight changes? Question 09/30/18 9:21 PM CDT No, not that I've noticed. have you lost of appetite? Question 09/30/18 9:21 PM CDT I haven't been hungry. Eating only makes me feel worse. how long have you had decrease in appetite? Question 09/30/18 9:23 PM CDTIt's been hard to eat since the belly pain got much worse, about two or three days ago. When I do eat--my daughter Jennifer makes sure I have a little something--it only makes me feel worse. sorry to hear that Question 09/30/18 9:23 PM CDT Well, my hearing is not as good as a younger person's. But I hear well enough that I don't notice problems. sorry to hear that Empathize 09/30/18 9:23 PM CDT Thank you.do you feel bloating? Question 09/30/18 9:24 PM CDT Yes. Quite a bit. any gas? Question 09/30/18 9:24 PM CDT Hm. I have been experiencing some of that. possible food poisoning? (Clarified to Could you have had food poisoning?.) Question 09/30/18 9:25 PM CDTNo, I didn't eat anything unusual. (Clarified to if I could have had food poisoning.) any difficulty swallowing? Question 09/30/18 9:26 PM CDT No. I am able to swallow without any problems. have you ever had illegal drugs? Question 09/30/18 9:26 PM CDT I have never used drugs of any kind.Thank you for information Educate 09/30/18 9:28 PM CDT Thank you for explaining that. Measured vitals Exam Action 09/30/18 9:28 PM CDT Inspected general face: Slight flushing of cheeks Exam Action 09/30/18 9:30 PM CDT Inspected forehead and scalp Exam Action 09/30/18 9:30 PM CDT Inspected nose and mouth Exam Action 09/30/18 9:30 PM CDT Inspected left side of face Exam Action 09/30/18 9:30 PM CDT Inspected back of head Exam Action 09/30/18 9:31 PM CDTInspected right side of face Exam Action 09/30/18 9:32 PM CDT Inspected general face: Slight flushing of cheeks Exam Action 09/30/18 9:32 PM CDT Inspected nose and mouth Exam Action 09/30/18 9:32 PM CDT Inspected forehead and scalp Exam Action 09/30/18 9:32 PM CDT Inspected left side of face Exam Action 09/30/18 9:32 PM CDT Inspected general face: Slight flushing of cheeks Exam Action 09/30/18 9:32 PM CDT Inspected right side of face Exam Action 09/30/18 9:32 PM CDT Inspected general face: Slight flushing of cheeks Exam Action 09/30/18 9:32 PM CDT Performed otoscopic examination of right naris Exam Action 09/30/18 9:33 PM CDTPerformed otoscopic examination of left naris Exam Action 09/30/18 9:33 PM CDT Inspected mouth and throat Exam Action 09/30/18 9:34 PM CDT Inspected left side of abdomen Exam Action 09/30/18 9:35 PM CDT Inspected front of abdomen Exam Action 09/30/18 9:36 PM CDT Inspected right side of abdomen Exam Action 09/30/18 9:36 PM CDT Inspected front of abdomen Exam Action 09/30/18 9:36 PM CDT Inspected left side of abdomen Exam Action 09/30/18 9:36 PM CDT Inspected front of abdomen Exam Action 09/30/18 9:37 PM CDT Inspected front of legs for edema: No edema Exam Action 09/30/18 9:39 PM CDTInspected right leg for edema: No edema Exam Action 09/30/18 9:39 PM CDT Inspected front of legs for edema: No edema Exam Action 09/30/18 9:39 PM CDT Inspected left leg for edema: No edema Exam Action 09/30/18 9:40 PM CDT Auscultated aortic area with the bell Exam Action 09/30/18 9:40 PM CDT Auscultated aortic area with the diaphragm Exam Action 09/30/18 9:40 PM CDT Auscultated pulmonic area with the diaphragm Exam Action 09/30/18 9:40 PM CDT Auscultated Erb's point with the diaphragm Exam Action 09/30/18 9:40 PM CDT Auscultated Erb's point with the bell Exam Action 09/30/18 9:41 PM CDT Auscultated tricuspid area with the bell Exam Action 09/30/18 9:41 PM CDTAuscultated mitral area with the bell Exam Action 09/30/18 9:41 PM CDT Auscultated breath sounds in anterior right upper lobe Exam Action 09/30/18 9:41 PM CDT Auscultated breath sounds in anterior left upper lobe Exam Action 09/30/18 9:41 PM CDT Auscultated breath sounds in anterior right middle lobe Exam Action 09/30/18 9:42 PM CDT Auscultated breath sounds in anterior left midchest (upper lobe) Exam Action 09/30/18 9:42 PM CDT Auscultated breath sounds in anterior right lower lobe Exam Action 09/30/18 9:42 PM CDT Auscultated breath sounds in anterior left lower lobe Exam Action 09/30/18 9:42 PM CDT Auscultated breath sounds in posterior left upper lobe Exam Action 09/30/18 9:42 PM CDT Auscultated breath sounds in posterior right upper lobe Exam Action 09/30/18 9:42 PM CDTAuscultated breath sounds in posterior left midback (lower lobe) Exam Action 09/30/18 9:42 PM CDT Auscultated breath sounds in posterior right midback (lower lobe) Exam Action 09/30/18 9:42 PM CDT Auscultated breath sounds in posterior left lower lobe on side Exam Action 09/30/18 9:42 PM CDT Auscultated breath sounds in posterior left lower lobe Exam Action 09/30/18 9:42 PM CDT Auscultated breath sounds in posterior right lower lobe Exam Action 09/30/18 9:42 PM CDT Auscultated breath sounds in posterior left lower lobe near spine Exam Action 09/30/18 9:43 PM CDT Auscultated breath sounds in posterior right lower lobe near spine Exam Action 09/30/18 9:43 PM CDT Auscultated breath sounds in posterior right lower lobe on side Exam Action 09/30/18 9:43 PM CDT Auscultated aorta in abdomen Exam Action 09/30/18 9:43 PM CDTAuscultated right lower quadrant Exam Action 09/30/18 9:44 PM CDT Auscultated right upper quadrant Exam Action 09/30/18 9:44 PM CDT Auscultated left upper quadrant Exam Action 09/30/18 9:44 PM CDT Auscultated left lower quadrant Exam Action 09/30/18 9:44 PM CDT Auscultated right renal artery Exam Action 09/30/18 9:45 PM CDT Auscultated right iliac artery Exam Action 09/30/18 9:45 PM CDT Auscultated right femoral artery Exam Action 09/30/18 9:45 PM CDT Auscultated left renal artery Exam Action 09/30/18 9:45 PM CDT Auscultated left iliac artery Exam Action 09/30/18 9:45 PM CDTAuscultated left femoral artery Exam Action 09/30/18 9:46 PM CDT Auscultated over liver Exam Action 09/30/18 9:46 PM CDT Auscultated over spleen Exam Action 09/30/18 9:46 PM CDT Percussed right lower quadrant Exam Action 09/30/18 9:47 PM CDT Percussed right upper quadrant Exam Action 09/30/18 9:47 PM CDT Percussed left upper quadrant Exam Action 09/30/18 9:47 PM CDT Percussed left lower quadrant Exam Action 09/30/18 9:47 PM CDT Percussed left upper quadrant Exam Action 09/30/18 9:47 PM CDT Percussed left lower quadrant Exam Action 09/30/18 9:47 PM CDTPercussed right lower quadrant Exam Action 09/30/18 9:47 PM CDT Percussed left lower quadrant Exam Action 09/30/18 9:47 PM CDT Percussed right upper quadrant Exam Action 09/30/18 9:47 PM CDT Percussed right lower quadrant Exam Action 09/30/18 9:47 PM CDT Percussed left upper quadrant Exam Action 09/30/18 9:47 PM CDT Percussed left lower quadrant Exam Action 09/30/18 9:48 PM CDT Percussed left lower quadrant Exam Action 09/30/18 9:48 PM CDT Percussed left upper quadrant Exam Action 09/30/18 9:48 PM CDT Percussed for spleen Exam Action 09/30/18 9:48 PM CDTPercussed for liver span: 7 cm in the midclavicular line Exam Action 09/30/18 9:48 PM CDT Percussed left flank for CVA tenderness Exam Action 09/30/18 9:49 PM CDT Percussed left flank for CVA tenderness Exam Action 09/30/18 9:49 PM CDT Percussed right flank for CVA tenderness Exam Action 09/30/18 9:49 PM CDT Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action 09/30/18 9:49 PM CDT That feels alright. Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action 09/30/18 9:51 PM CDTThat feels alright. Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension Exam Action 09/30/18 9:51 PM CDT That feels alright. Palpated left lower quadrant with light pressure: Tenderness reported; palpable guarding and distension, no masses Exam Action 09/30/18 9:51 PM CDT Mmm, it feels sore there.Percussed left upper quadrant Exam Action 09/30/18 9:52 PM CDT Percussed left lower quadrant Exam Action 09/30/18 9:52 PM CDT Palpated right lower quadrant: with deep pressure: No masses Exam Action 09/30/18 9:52 PM CDT That feels alright. Palpated right upper quadrant with deep pressure: No masses Exam Action 09/30/18 9:52 PM CDT That feels alright. Palpated left upper quadrant with deep pressure: No masses Exam Action 09/30/18 9:52 PM CDTThat feels alright. Palpated left lower quadrant with deep pressure: Firm, oblong mass (2x4 cm) Exam Action 09/30/18 9:53 PM CDT Ooo, that--that's sore right there. Aortic width is 2 cm: No lateral pulsation Exam Action 09/30/18 9:53 PM CDT Palpated for liver: Palpable 1 cm below right costal margin Exam Action 09/30/18 9:54 PM CDT Palpated for spleen: Not palpable Exam Action 09/30/18 9:54 PM CDT Palpated bladder: Not palpable; no distention or tenderness Exam Action 09/30/18 9:54 PM CDTPalpated for right kidney: Not palpable Exam Action 09/30/18 9:54 PM CDT Palpated for left kidney: Not palpable Exam Action 09/30/18 9:55 PM CDT Tested skin turgor Exam Action 09/30/18 9:55 PM CDT Performed pelvic exam Exam Action 09/30/18 9:55 PM CDT Performed digital rectal exam Exam Action 09/30/18 9:56 PM CDT Checked urinalysis Exam Action 09/30/18 9:56 PM CDT do you take any medication? Question 09/30/18 10:04 PM CDT Just the medication for my blood pressure.what's the name of it? (Clarified to What are the names of your medications?.) Question 09/30/18 10:04 PM CDT It's called Accupril. (Clarified to what the names of my medications are.) how much accupril do you take? Question 09/30/18 10:05 PM CDT 10 milligrams. a day? (No matching questions found.) Question 09/30/18 10:05 PM CDT how often do you take accupril? Question 09/30/18 10:05 PM CDT10 milligrams. are you take a medication everyday? Question 09/30/18 10:06 PM CDT I take pills for my blood pressure. do you take accupril everyday? (Clarified to How long have you been taking Accupril?.) Question 09/30/18 10:06 PM CDT I've been taking it since I was diagnosed. I was. . . 54. (Clarified to how long I have been taking Accupril.)it's good you take as prescribed Educate 09/30/18 10:07 PM CDT Thank you for explaining that. when do you take your medication? Question 09/30/18 10:08 PM CDT I take it every morning at about 8 a.m., after breakfast. when was last time you took your medication? Question 09/30/18 10:08 PM CDTI took my Accupril this morning, at around 8. it's very important to take your medication as prescribed Educate 09/30/18 10:09 PM CDT Thank you for explaining that. do you take any over the counter medication? Question 09/30/18 10:09 PM CDT No. Those over-the-counter medicines. . . Tylenol-- they say it's very bad for the stomach.do you take any health food? (Clarified to do you take herbals.) Question 09/30/18 10:10 PM CDT I don't take any herbs. Well, nothing beyond a little chamomile tea, sometimes before bed. (Clarified to if I take herbal supplements.) do you have any allergies ? Question 09/30/18 10:11 PM CDT I have an allergy to latex. what were the reaction to latex? (Clarified to What are the symptoms of your latex allergy?.) Question 09/30/18 10:12 PM CDTI get an itchy skin rash. (Clarified to what the symptoms of my latex allergy are.) any family history of gastrointestinal problem? Question 09/30/18 10:13 PM CDT None that I know of. any family history of liver disease? Question 09/30/18 10:13 PM CDT No, not that I know of.any family history of pancreas disease? Question 09/30/18 10:13 PM CDT No, not that I know of. any family history of cancer? Question 09/30/18 10:13 PM CDT Neither of my parents ever had cancer, but one of my grandmother's did. My brother, Walter... he has prostate cancer, but he's doing just fine. what kind of cancer your grandmother had? Question 09/30/18 10:14 PM CDTShe died of lung cancer. sorry to hear that Empathize 09/30/18 10:15 PM CDT Thank you. do your family had any health problems ? Question 09/30/18 10:16 PM CDT Let's see. . . high cholesterol and diabetes. My father was an overweight man. My two older brothers, they live in California. One of them has high cholesterol and now prostate cancer, but he's not having the surgery. His doctor says his cancer is very slow growing. Both. . . Yes, both have high blood pressure. Both my parents had high blood pressure, and so do I, so you might say that runs in my family.have you ever diagnosed with diabetes? Question 09/30/18 10:18 PM CDT No. I have managed to avoid diabetes. that's good Educate 09/30/18 10:18 PM CDT Thank you for explaining that. how do you managed to avoid diabetes? (Clarified to how do you manage your diet.) Question 09/30/18 10:19 PM CDTI eat a heart-healthy diet. Low fat, lean meats, low sugar. . . I eat light. (Clarified to how I manage my diet.) do you eat fiber? Question 09/30/18 10:19 PM CDT I think I get enough fiber. I try to eat at least one vegetable every day. have you noticed thirsty? Question 09/30/18 10:20 PM CDT I haven't felt noticeably thirsty. I suppose I've been drinking a little less water than usual, just in these last few days.drinking 6-8 glass of water a day is one of way to maintain healthy way of living Educate 09/30/18 10:21 PM CDT Thank you for explaining that. when was your last pap smear? Question 09/30/18 10:22 PM CDT A pap smear? I haven't had one in years. Ten years, at least. do you have sexual activity? (Clarified to are you sexually active.) Question 09/30/18 10:22 PM CDTI have a gentleman friend and, yes... We are intimate. (Clarified to if I am sexually active.) do you use any protection? Question 09/30/18 10:23 PM CDT No. That isn't necessary. have you had test for STI? Question 09/30/18 10:23 PM CDT No, that hasn't been necessary.have your gentleman friend had test for STI? Question 09/30/18 10:24 PM CDT I don't know, but I have no reason to think that is something we should be concerned about. do you have intercourse? Question 09/30/18 10:25 PM CDT I have a gentleman friend and, yes... We are intimate. it's important to have a protection to prevent STI Educate 09/30/18 10:25 PM CDTThank you for explaining that. how often do you have intercourse? Question 09/30/18 10:26 PM CDT Well, I don't have intercourse. But I have... My gentleman friend and I do other things. Thank you for explaining Empathize 09/30/18 10:27 PM CDT Thank you.what other things do you have with gentleman friend? (No matching questions found.) Question 09/30/18 10:28 PM CDT what kind of intercourse do you have? Question 09/30/18 10:29 PM CDT Max and I. . . this is not what I'd expected to be discussing here. We kiss, touch, you know. . . we don't have intercourse, but there is oral sex. I hope that answers your question. it's very important part of relationship thank your for answering Educate 09/30/18 10:31 PM CDT Thank you for explaining that. any fever lately? Question 09/30/18 10:31 PM CDTNo, I don't believe so. any chills lately? Question 09/30/18 10:31 PM CDT No. But I did feel a bit clammy when I had my digestive upset a few days ago. any night sweats? Question 09/30/18 10:32 PM CDT No. That is not a problem for me.Postmenopause? (No matching questions found.) Question 09/30/18 10:32 PM CDT are you Postmenopause? Question 09/30/18 10:33 PM CDT Yes. I was 54 when I went through the change. any urinary incontinence? Question 09/30/18 10:33 PM CDT I've never had problems with. . . controlling myself. any history UTI? Question 09/30/18 10:34 PM CDTI don't remember ever having one, no. any painful when urination? (Clarified to Is urinating painful?.) Question 09/30/18 10:34 PM CDT No. It feels just the same as always. (Clarified to if it hurts when I urinate.) any burning with urination? Question 09/30/18 10:35 PM CDT No, my urination has felt normal.any gynecological problems? Question 09/30/18 10:35 PM CDT No. I don't have problems with that area. have you had any vaginal bleeding? Question 09/30/18 10:35 PM CDT No. have you noticed vaginal discharge? Question 09/30/18 10:36 PM CDTI think I have the normal amount of vaginal discharge. . . it all seems fine. any history of bladder disease? Question 09/30/18 10:36 PM CDT No. have you had any kidney problem? Question 09/30/18 10:36 PM CDT No, I've never had any kidney trouble.have you had any sore throat? Question 09/30/18 10:37 PM CDT No. My throat is fine. any cough? Question 09/30/18 10:37 PM CDT No, I haven't been coughing at all. have you had any difficulty breathing? Question 09/30/18 10:37 PM CDTNo. I can breathe well. My lungs feel very healthy. have you had any chest pain? Question 09/30/18 10:37 PM CDT No, I don't ever experience chest pain. have you had any chest tightness? Question 09/30/18 10:38 PM CDT No.do you have any health concern? Question 09/30/18 10:38 PM CDT Aside from this--these problems I'm having now-- I'm very lucky. No major illnesses. Just a little high blood pressure. how many children you have? Question 09/30/18 10:38 PM CDT Two wonderful grown-up children. Jennifer and Timothy. that sounds blessing Empathize 09/30/18 10:40 PM CDTThank you. do you live alone? Question 09/30/18 10:40 PM CDT No. I live with my daughter, Jennifer. do you have family support? Question 09/30/18 10:41 PM CDT I am fortunate that I have a daughter who takes care of me the way she does. And my gentleman friend Max is also very supportive.it's good to hear that you have strong family and friend support Empathize 09/30/18 10:42 PM CDT Thank you. do you exercise? Question 09/30/18 10:42 PM CDT Yes, I usually love exercise--water aerobics, Pilates . . . I take classes at the community center. But with this pain and feeling so uncomfortable this week, I've skipped my classes. very good that you are exercise and keep busy Educate 09/30/18 10:43 PM CDTThank you for explaining that. have you travel recently? Question 09/30/18 10:43 PM CDT No, I haven't gone on any trips in several years. any changes of taste? Question 09/30/18 10:44 PM CDT My sense of taste has not changed.do you have any concern? Question 09/30/18 10:44 PM CDT No. all right (No matching questions found.) Question 09/30/18 10:44 PM CDT Inspected mouth and throat Exam Action 09/30/18 11:51 PM CDT Inspected left side of abdomen Exam Action 09/30/18 11:52 PM CDT Inspected front of abdomen Exam Action 09/30/18 11:52 PM CDT Performed otoscopic examination of right naris Exam Action 09/30/18 11:56 PM CDT Performed otoscopic examination of left naris Exam Action 09/30/18 11:56 PM CDT