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doctor: okay so pain on flexion what about extension when you pick your wrist up patient: yeah i have a hard time doing that actually
D2N077
20
[ "Physical Examination" ]
[ "Objective" ]
okay so pain on flexion what about extension when you pick your wrist up
2,000
doctor: alright what about we're gon na go ahead and hold your arm like straight like flat and then try and move it sideways does radial deviation hurt patient: yeah
D2N077
21
[ "Physical Examination" ]
[ "Objective" ]
alright what about we're gon na go ahead and hold your arm like straight like flat and then try and move it sideways does radial deviation hurt
2,001
doctor: alright and then lateral as well patient: yeah it's really hard to move any direction of this hand for some reason
D2N077
22
[ "Physical Examination" ]
[ "Objective" ]
alright and then lateral as well
2,002
doctor: alright so wrist abduction adduction positive for pain on movement are you able to make a fist patient: hmmm yeah a little bit but i ca n't do it really tight
D2N077
23
[ "Physical Examination" ]
[ "Objective" ]
alright so wrist abduction adduction positive for pain on movement are you able to make a fist
2,003
doctor: okay alright okay so i'm just gon na go ahead and feel on your fingers really quickly alright metacarpals intact noticed some obvious swelling ecchymosis obvious swelling and bruising tenderness on palpation throughout there is evidence of potential fracture feeling some bony crepitus alright so this pain is it like chronic i wanted to ask you patient: yeah i would say it kinda goes away when i take that ibuprofen but for the most part i feel it i feel it there and it it's just really really bad when i move it all
D2N077
24
[ "Physical Examination" ]
[ "Objective" ]
okay alright okay so i'm just gon na go ahead and feel on your fingers really quickly alright metacarpals intact noticed some obvious swelling ecchymosis obvious swelling and bruising tenderness on palpation throughout there is evidence of potential fracture feeling some bony crepitus alright so this pain is it like chronic i wanted to ask you
2,004
doctor: okay so when you like is there a position either hurts less or hurts more like say if your arm is raised and elevated over your head does it hurt more or is it just best to keep it like down patient: it's good if i keep it a little bit above my like a little i guess a little bit like around my like just a regular level like if you're typing or something and then i just put it on a pillow and i just let it stay straight like i feel better
D2N077
25
[ "Physical Examination" ]
[ "Objective" ]
okay so when you like is there a position either hurts less or hurts more like say if your arm is raised and elevated over your head does it hurt more or is it just best to keep it like down
2,005
doctor: okay yeah no i do n't think i understand completely okay so i took a look at your vitals and your blood pressure is a little elevated but honestly that's probably to do with the pain right our body can respond to pain in that way we are looking at like a hundred and forty over over seventy it's not anything crazy but something to mention i see that your heart rate is also a little elevated at like about like eighty beats a minute you are not running a fever so that's great look at ninety ninety seven . two your respiratory rate is pretty normal at like twenty so before we came in i i know that we had you do an x-ray and i'm sure that that was a bit more painful because we had to do so many manipulations but i do wan na note that you are positive for what we call a colles' fracture what that means is that the joints between your wrist like the bones between your wrist that there there is evidence of a a fracture and we are gon na have to treat it a little conservatively at first and then consider some of the options options that are available to us so for your primary diagnosis of a colles' fracture we are going to give you a thumb spica for today and that's going to patient: i'm sorry
D2N077
26
[ "Physical Examination", "Other Treatments", "Radiology Examination", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay yeah no i do n't think i understand completely okay so i took a look at your vitals and your blood pressure is a little elevated but honestly that's probably to do with the pain right our body can respond to pain in that way we are looking at like a hundred and forty over over seventy it's not anything crazy but something to mention i see that your heart rate is also a little elevated at like about like eighty beats a minute you are not running a fever so that's great look at ninety ninety seven . two your respiratory rate is pretty normal at like twenty so before we came in i i know that we had you do an x-ray and i'm sure that that was a bit more painful because we had to do so many manipulations but i do wan na note that you are positive for what we call a colles' fracture what that means is that the joints between your wrist like the bones between your wrist that there there is evidence of a a fracture and we are gon na have to treat it a little conservatively at first and then consider some of the options options that are available to us so for your primary diagnosis of a colles' fracture we are going to give you a thumb spica for today and that's going to
2,006
doctor: pardon what patient: a what
D2N077
27
[ "Chitchat" ]
[ "Null" ]
pardon what
2,007
doctor: we're gon na brace you we're gon na give you a brace patient: okay thank you
D2N077
28
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
we're gon na brace you we're gon na give you a brace
2,008
doctor: sorry no problem sorry yeah not a thumb spica we're gon na brace your arm and you're gon na have that we we have a couple of options but i think the best course of action is gon na be for surgery we will in the meantime give you pain medication i wan na put you on fifty milligrams of ultram every six hours and then i also wan na get you on get you into physical therapy a few weeks after surgery this is gon na be just a normal procedure you will be in for an overnight stay but after that once we assess and make sure that everything is good you'll be able to go home okay patient: when do i have to have the surgery
D2N077
29
[ "Discussion", "Medication", "Other Treatments" ]
[ "Plan" ]
sorry no problem sorry yeah not a thumb spica we're gon na brace your arm and you're gon na have that we we have a couple of options but i think the best course of action is gon na be for surgery we will in the meantime give you pain medication i wan na put you on fifty milligrams of ultram every six hours and then i also wan na get you on get you into physical therapy a few weeks after surgery this is gon na be just a normal procedure you will be in for an overnight stay but after that once we assess and make sure that everything is good you'll be able to go home okay
2,009
doctor: we would like it to happen as quickly as possible you know your body is a wonderful miracle and it's going to start trying to heal on it's own what we need to do is get your wrist straight and then like put screws in to make sure that we hold it in place or else it could like heal and malform patient: okay
D2N077
30
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
we would like it to happen as quickly as possible you know your body is a wonderful miracle and it's going to start trying to heal on it's own what we need to do is get your wrist straight and then like put screws in to make sure that we hold it in place or else it could like heal and malform
2,010
doctor: alright so what patient: how how long do i have to wear that brace
D2N077
31
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
alright so what
2,011
doctor: you're gon na be wearing the brace for about six weeks patient: six weeks
D2N077
32
[ "Discussion", "Other Treatments" ]
[ "Plan" ]
you're gon na be wearing the brace for about six weeks
2,012
doctor: yeah so you're gon na you're gon na come in for your surgery we're gon na perform it you're gon na stay overnight and then you'll be bracing it for six weeks in the meantime you'll also then go to physical therapy i want you there like we're gon na they're gon na do an assessment and determine how much but i'm thinking probably three times a week just to make sure that you can get your wrist as strong as possible to prevent like future injury now the cool thing about getting any kind of a bone break is that your your body comes out even stronger so this should n't happen again but unfortunately like it's these situations that oof that just kind of patient: oof
D2N077
33
[ "Referral", "Other Treatments" ]
[ "Plan" ]
yeah so you're gon na you're gon na come in for your surgery we're gon na perform it you're gon na stay overnight and then you'll be bracing it for six weeks in the meantime you'll also then go to physical therapy i want you there like we're gon na they're gon na do an assessment and determine how much but i'm thinking probably three times a week just to make sure that you can get your wrist as strong as possible to prevent like future injury now the cool thing about getting any kind of a bone break is that your your body comes out even stronger so this should n't happen again but unfortunately like it's these situations that oof that just kind of
2,013
doctor: these these deform these deformities that really that really kind of hurt is the short version alright no problem any other questions patient: no well i am going on vacation do i need to cancel it like can i still go even with the i mean after the surgery
D2N077
34
[ "Discussion" ]
[ "Plan" ]
these these deform these deformities that really that really kind of hurt is the short version alright no problem any other questions
2,014
doctor: okay how long is the vacation patient: it's only for like a couple weeks
D2N077
36
[ "Discussion" ]
[ "Plan" ]
okay how long is the vacation
2,015
doctor: okay well so you might have to postpone it just because depending on what physical therapy says right if they feel that you can sustain if you can like sustain the exercises while you're gone that if there's something that you can do by yourself then you should be fine but we do wan na give it you said that it's gon na happen in a couple of weeks patient: no vacation in a month
D2N077
37
[ "Discussion" ]
[ "Plan" ]
okay well so you might have to postpone it just because depending on what physical therapy says right if they feel that you can sustain if you can like sustain the exercises while you're gone that if there's something that you can do by yourself then you should be fine but we do wan na give it you said that it's gon na happen in a couple of weeks
2,016
doctor: okay okay yeah so how about in a month we come you come back let's do a checkup again see where we are at and then we can assess whether or not this is something that i would recommend you do patient: that sounds good thank you
D2N077
38
[ "Discussion", "Follow-up" ]
[ "Plan" ]
okay okay yeah so how about in a month we come you come back let's do a checkup again see where we are at and then we can assess whether or not this is something that i would recommend you do
2,017
doctor: no problem bye patient: bye
D2N077
39
[ "Chitchat" ]
[ "Null" ]
no problem bye
2,018
doctor: the fracture appears extra-articular and usually proximal to the radial ulnar joint dorsal angulation of the distal fracture fragment is present to a variable degree if dorsal angulation is severe presenting with a dinner fork deformity ulnar styloid fracture is present
D2N077
40
[ "Radiology Examination", "Acute Assessment" ]
[ "Objective", "Assessment" ]
doctor: the fracture appears extra-articular and usually proximal to the radial ulnar joint dorsal angulation of the distal fracture fragment is present to a variable degree if dorsal angulation is severe presenting with a dinner fork deformity ulnar styloid fracture is present
2,019
doctor: hey philip good to see you today so take a look here at my notes i see you're coming in for some right knee pain and you have a past medical history of hypertension and we will take a look at that so can you tell me what happened to your knee patient: yeah i was you know i was just doing some work on my property and i i accidentally slipped and fell down and i just still having some knee issues
D2N078
0
[ "Acute Symptoms", "Personal History", "Greetings" ]
[ "Subjective" ]
hey philip good to see you today so take a look here at my notes i see you're coming in for some right knee pain and you have a past medical history of hypertension and we will take a look at that so can you tell me what happened to your knee
2,020
doctor: okay well that that's not good do you patient: no
D2N078
1
[ "Chitchat" ]
[ "Null" ]
okay well that that's not good do you
2,021
doctor: what part of your knee would you say hurts patient: i would just say you know the it it you know it basically when i when i'm flexing my knee when i'm moving it up and down and i put pressure on it
D2N078
2
[ "Acute Symptoms" ]
[ "Subjective" ]
what part of your knee would you say hurts
2,022
doctor: alright did you hear a pop or anything like that patient: i did feel something pop yes
D2N078
3
[ "Acute Symptoms" ]
[ "Subjective" ]
alright did you hear a pop or anything like that
2,023
doctor: okay and did it was it swollen afterwards or is it looks a little bit swollen right now patient: yeah little bit swollen yeah
D2N078
4
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and did it was it swollen afterwards or is it looks a little bit swollen right now
2,024
doctor: okay so so far have you taken anything for the pain patient: just taking some ibuprofen just for some swelling
D2N078
5
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay so so far have you taken anything for the pain
2,025
doctor: okay that's it what would you say your pain score is a out of ten with ten being the worst pain you ever felt patient: i would say that when i'm stationary i do n't really feel a lot of pain but if i start doing some mobility i would say probably a four five
D2N078
6
[ "Acute Symptoms" ]
[ "Subjective" ]
okay that's it what would you say your pain score is a out of ten with ten being the worst pain you ever felt
2,026
doctor: about a four okay and how long ago did you say this was is this happened this injury patient: it's been a week now
D2N078
7
[ "Acute Symptoms" ]
[ "Subjective" ]
about a four okay and how long ago did you say this was is this happened this injury
2,027
doctor: a week okay alright alright so we will take a look i'll do a physical exam of your knee in a second but i do want to check up you do have a past medical history of hypertension i'm seeing here you're on twenty milligrams of lisinopril when you came in today your blood pressure was a little bit high it was one fifty over seventy so have you been taking your medications regularly patient: yes i have
D2N078
8
[ "Personal History", "Therapeutic History" ]
[ "Subjective" ]
a week okay alright alright so we will take a look i'll do a physical exam of your knee in a second but i do want to check up you do have a past medical history of hypertension i'm seeing here you're on twenty milligrams of lisinopril when you came in today your blood pressure was a little bit high it was one fifty over seventy so have you been taking your medications regularly
2,028
doctor: okay so you might have a little white coat syndrome i know some of my patients definitely do have that so what about your diet i know we talked a little bit before about you reducing your sodium intake to about twenty three hundred milligrams per per day i know you were during the pandemic your diet got out of little bit out of control so how have you been doing how have you been doing with that patient: i definitely need some help there i have not have not made some some changes
D2N078
9
[ "Personal History" ]
[ "Subjective" ]
okay so you might have a little white coat syndrome i know some of my patients definitely do have that so what about your diet i know we talked a little bit before about you reducing your sodium intake to about twenty three hundred milligrams per per day i know you were during the pandemic your diet got out of little bit out of control so how have you been doing how have you been doing with that
2,029
doctor: okay yeah we definitely need to get you to lower that salt intake get your diet a little bit better because the hope is to get you off that medication and get your blood pressure to a manageable level okay so we yeah we definitely can talk about that alright so lem me take a look at your knee i'll do a quick physical exam on you and before i do just want to make sure you're not having any chest pain today patient: no
D2N078
10
[ "Physical Examination", "Other Treatments" ]
[ "Objective", "Plan" ]
okay yeah we definitely need to get you to lower that salt intake get your diet a little bit better because the hope is to get you off that medication and get your blood pressure to a manageable level okay so we yeah we definitely can talk about that alright so lem me take a look at your knee i'll do a quick physical exam on you and before i do just want to make sure you're not having any chest pain today
2,030
doctor: are you any belly pain patient: no
D2N078
11
[ "Physical Examination" ]
[ "Objective" ]
are you any belly pain
2,031
doctor: no shortness of breath just wan na make sure patient: no
D2N078
12
[ "Vegetative History" ]
[ "Subjective" ]
no shortness of breath just wan na make sure
2,032
doctor: okay so i'm just gon na listen to your lungs here your lungs are clear bilaterally i do n't hear any wheezes or crackles listen to your heart so on your heart exam i do still hear that grade two out of six systolic ejection murmur and you already had that and so we we knew about that already so lem me look at your knee here so when i press here on the inside of your knee does that hurt patient: a little bit
D2N078
13
[ "Physical Examination" ]
[ "Objective" ]
okay so i'm just gon na listen to your lungs here your lungs are clear bilaterally i do n't hear any wheezes or crackles listen to your heart so on your heart exam i do still hear that grade two out of six systolic ejection murmur and you already had that and so we we knew about that already so lem me look at your knee here so when i press here on the inside of your knee does that hurt
2,033
doctor: little bit how about when i press on the outs the outside gon na press on the outside is that painful patient: no
D2N078
14
[ "Physical Examination" ]
[ "Objective" ]
little bit how about when i press on the outs the outside gon na press on the outside is that painful
2,034
doctor: no alright so i'm gon na have you flex your knee is that painful patient: yeah that's uncomfortable
D2N078
15
[ "Physical Examination" ]
[ "Objective" ]
no alright so i'm gon na have you flex your knee is that painful
2,035
doctor: that's uncomfortable and extend it so that's painful patient: yeah yes
D2N078
16
[ "Physical Examination" ]
[ "Objective" ]
that's uncomfortable and extend it so that's painful
2,036
doctor: okay so on your knee exam i i see that you do have pain to palpation of the medial aspect of your right knee you have some pain with flexion extension i also identify some edema around the knee and some effusion you have a little bit of fluid in there as well so prior to coming in we did do an x-ray of that right knee and luckily you did n't break anything so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you have what we call a mcl strain so a medial collateral ligament strain so when you fell i think you twisted a little bit and so it irritated you strained that that ligament there so for that what we can do for you first i'm gon na prescribe you some ibuprofen eight hundred milligrams and you can take that twice a day and that's gon na help you with that swelling and that pain that you currently do have i'm also gon na put you in a a knee brace just to try and support those muscles to allow it to heal and then i want you to ice the knee you can do that for twenty minutes at a time for three to four times a day that should also help with the the swelling of your knee for your hypertension now i'm gon na keep you on that twenty of lisinopril okay because you are taking it and you you're doing pretty good with it i also want to get you a referral to nutrition just to try to help you with that diet you know because right now you are your diet is little bit out of control so we just need to rain you in a little bit and hopefully you know with their help we can eventually get you off that lisinopril alright so do you have any questions for me patient: do i need to elevate my leg or stay off my leg or
D2N078
17
[ "Physical Examination", "Medication", "Other Treatments", "Radiology Examination", "Reassessment", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay so on your knee exam i i see that you do have pain to palpation of the medial aspect of your right knee you have some pain with flexion extension i also identify some edema around the knee and some effusion you have a little bit of fluid in there as well so prior to coming in we did do an x-ray of that right knee and luckily you did n't break anything so there is no fractures no bony abnormalities so let's talk a little bit about my assessment and plan for you so you have what we call a mcl strain so a medial collateral ligament strain so when you fell i think you twisted a little bit and so it irritated you strained that that ligament there so for that what we can do for you first i'm gon na prescribe you some ibuprofen eight hundred milligrams and you can take that twice a day and that's gon na help you with that swelling and that pain that you currently do have i'm also gon na put you in a a knee brace just to try and support those muscles to allow it to heal and then i want you to ice the knee you can do that for twenty minutes at a time for three to four times a day that should also help with the the swelling of your knee for your hypertension now i'm gon na keep you on that twenty of lisinopril okay because you are taking it and you you're doing pretty good with it i also want to get you a referral to nutrition just to try to help you with that diet you know because right now you are your diet is little bit out of control so we just need to rain you in a little bit and hopefully you know with their help we can eventually get you off that lisinopril alright so do you have any questions for me
2,037
doctor: yeah i would yeah you can elevate your leg stay off your stay off your leg you know if you have any kids have them work out in the yard instead of you just to to for a couple of weeks it's a good thing if you want to do that patient: tell him this doctor's order
D2N078
18
[ "Discussion" ]
[ "Plan" ]
yeah i would yeah you can elevate your leg stay off your stay off your leg you know if you have any kids have them work out in the yard instead of you just to to for a couple of weeks it's a good thing if you want to do that
2,038
doctor: tell definitely tell him his doctor tell him i said it patient: alright do you have any other questions no that's it i appreciate you seeing me
D2N078
19
[ "Discussion" ]
[ "Plan" ]
tell definitely tell him his doctor tell him i said it
2,039
doctor: alright so my nurse will be in with the those orders and we will see you next time
D2N078
20
[ "Chitchat" ]
[ "Null" ]
doctor: alright so my nurse will be in with the those orders and we will see you next time
2,040
doctor: hi wayne how're you today patient: i'm doing okay aside from this left shoulder pain that i've been having
D2N079
0
[ "Greetings" ]
[ "Subjective" ]
hi wayne how're you today
2,041
doctor: okay and how long have you had this pain patient: about i want to say a few weeks i think it's been about three weeks now
D2N079
1
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and how long have you had this pain
2,042
doctor: okay and do you remember what you were doing when the pain started patient: honestly i've been trying to recall if i had any specific injury and i ca n't think of that
D2N079
2
[ "Acute Symptoms" ]
[ "Subjective" ]
okay and do you remember what you were doing when the pain started
2,043
doctor: okay alright tell me have you ever had pain in that shoulder before patient: you know i i'm really active and so i i will get some aches and pains here and there but nothing that tylenol ca n't take care of
D2N079
4
[ "Personal History" ]
[ "Subjective" ]
okay alright tell me have you ever had pain in that shoulder before
2,044
doctor: okay good but now are you able to move your arm patient: you know i have trouble when i'm trying to reach for something or lift any objects and i do n't even try to reach it for anything over my head because then it'll really hurt
D2N079
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay good but now are you able to move your arm
2,045
doctor: okay alright and and now are you having the pain all the time or does it come and go patient: the pain is always there and then it gets worse like if i try to put any pressure on it it gets worse so if i'm laying at night if i try to even lay on that shoulder it's unbearable
D2N079
6
[ "Acute Symptoms" ]
[ "Subjective" ]
okay alright and and now are you having the pain all the time or does it come and go
2,046
doctor: okay and then tell me what have you taken for your pain patient: i've been taking two extra strength tylenol every six to eight hours
D2N079
7
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay and then tell me what have you taken for your pain
2,047
doctor: alright and and did that help patient: it does take the edge off but i still have some pain
D2N079
8
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
alright and and did that help
2,048
doctor: okay well i'm sorry to hear that you know you know renovating the basement it can be quite a task and it can take a toll on you patient: yeah i mean it's been fun but yeah i think it really did take a toll on me
D2N079
9
[ "Other Socials" ]
[ "Subjective" ]
okay well i'm sorry to hear that you know you know renovating the basement it can be quite a task and it can take a toll on you
2,049
doctor: yeah what what are you doing with your basement are you are you doing like a a man cave or patient: yeah yeah that's exactly right
D2N079
10
[ "Chitchat" ]
[ "Null" ]
yeah what what are you doing with your basement are you are you doing like a a man cave or
2,050
doctor: that is awesome great well that sounds like fun i hope you get to set it up just the way you you would like for your man cave to be so congratulations to you there so tell me have you experienced any kind of numbness in your arms or in your hands patient: no no numbness or tingling
D2N079
11
[ "Acute Symptoms" ]
[ "Subjective" ]
that is awesome great well that sounds like fun i hope you get to set it up just the way you you would like for your man cave to be so congratulations to you there so tell me have you experienced any kind of numbness in your arms or in your hands
2,051
doctor: okay alright so let's just go ahead and do a quick physical exam on you here i did review your vitals everything here looks good now lem me take a look at your shoulder alright now on your left shoulder exam you have limited active and passive range of motion and how does that feel here patient: that hurts
D2N079
12
[ "Physical Examination" ]
[ "Objective" ]
okay alright so let's just go ahead and do a quick physical exam on you here i did review your vitals everything here looks good now lem me take a look at your shoulder alright now on your left shoulder exam you have limited active and passive range of motion and how does that feel here
2,052
doctor: okay sorry there is tenderness of the greater tuberosity of the humerus but there is no tenderness at the sternoclavicular or acromioclavicular joints you have good hand grips alright and then now on your neurovascular exam of your left arm your capillary refill is less than three seconds and your sensation is intact to light touch alright so what does that all mean well firstly lem me go ahead and take a look at your results of your shoulder x-ray here now i reviewed the results and there are no fractures so that's good so let's go ahead and talk about my assessment and plan here wayne so for your problem of left shoulder pain your symptoms are most likely due to a rotator cuff tendinopathy so this means that you injured the tendons of the muscles that help make up your shoulder muscles so i will be ordering an mri for your left shoulder to be sure that there is nothing else going on with your shoulder okay patient: okay
D2N079
13
[ "Physical Examination", "Radiology Examination", "Diagnostic Testing", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay sorry there is tenderness of the greater tuberosity of the humerus but there is no tenderness at the sternoclavicular or acromioclavicular joints you have good hand grips alright and then now on your neurovascular exam of your left arm your capillary refill is less than three seconds and your sensation is intact to light touch alright so what does that all mean well firstly lem me go ahead and take a look at your results of your shoulder x-ray here now i reviewed the results and there are no fractures so that's good so let's go ahead and talk about my assessment and plan here wayne so for your problem of left shoulder pain your symptoms are most likely due to a rotator cuff tendinopathy so this means that you injured the tendons of the muscles that help make up your shoulder muscles so i will be ordering an mri for your left shoulder to be sure that there is nothing else going on with your shoulder okay
2,053
doctor: now i'm also going to refer you to physical therapy for approximately six to eight weeks and during that time you may also continue to take tylenol now if your symptoms do n't improve we can consider a steroid injection for your shoulder which can provide some relief do you have any questions about your plan at all patient: so do you think this pain will ever go away
D2N079
14
[ "Discussion", "Medication", "Referral" ]
[ "Plan" ]
now i'm also going to refer you to physical therapy for approximately six to eight weeks and during that time you may also continue to take tylenol now if your symptoms do n't improve we can consider a steroid injection for your shoulder which can provide some relief do you have any questions about your plan at all
2,054
doctor: now well many patients are very successful with the physical therapy those will those help strengthen you know they do a lot of strengthening exercises with you to help strengthen you know your muscles so that it's not your movements not always relying on those joints predominantly so we're gon na go ahead and start with that and then see how you do okay patient: okay okay
D2N079
15
[ "Discussion" ]
[ "Plan" ]
now well many patients are very successful with the physical therapy those will those help strengthen you know they do a lot of strengthening exercises with you to help strengthen you know your muscles so that it's not your movements not always relying on those joints predominantly so we're gon na go ahead and start with that and then see how you do okay
2,055
doctor: alright okay well do you have any other questions for me patient: no i think that's it
D2N079
16
[ "Discussion" ]
[ "Plan" ]
alright okay well do you have any other questions for me
2,056
doctor: okay well i'm gon na have the nurse check you out and she's also gon na give you some educational materials on the physical therapy and what to expect and and then go ahead and schedule a follow-up visit with me as well after you you do your physical therapy okay patient: okay
D2N079
17
[ "Follow-up", "Referral" ]
[ "Plan" ]
okay well i'm gon na have the nurse check you out and she's also gon na give you some educational materials on the physical therapy and what to expect and and then go ahead and schedule a follow-up visit with me as well after you you do your physical therapy okay
2,057
doctor: alright well have a good day patient: okay you too
D2N079
18
[ "Chitchat" ]
[ "Null" ]
alright well have a good day
2,058
doctor: thanks patient: okay bye
D2N079
19
[ "Chitchat" ]
[ "Null" ]
thanks
2,059
doctor: okay hi andrea well i patient: hello
D2N080
0
[ "Greetings" ]
[ "Subjective" ]
okay hi andrea well i
2,060
doctor: i understand you're you've come in with some right knee pain can you tell me about it what's going on patient: it it's not the right knee it's the left knee
D2N080
1
[ "Acute Symptoms" ]
[ "Subjective" ]
i understand you're you've come in with some right knee pain can you tell me about it what's going on
2,061
doctor: okay the left knee patient: and it just happens occasionally less than once a day when i'm walking all of a sudden it is kind of like gives out and i think here i'm going to fall but i usually catch myself so lot of times i have to hold a grocery cart and that helps a lot so it comes and goes and it it passes just about as quickly as it comes i do n't know what it is whether i stepped wrong or i just do n't know
D2N080
2
[ "Acute Symptoms" ]
[ "Subjective" ]
okay the left knee
2,062
doctor: okay well so where does it hurt like in on the inside or the outside or patient: internally and it it just the whole kneecap fades
D2N080
3
[ "Acute Symptoms" ]
[ "Subjective" ]
okay well so where does it hurt like in on the inside or the outside or
2,063
doctor: okay well did you hear or feel a pop at any point patient: no
D2N080
4
[ "Acute Symptoms" ]
[ "Subjective" ]
okay well did you hear or feel a pop at any point
2,064
doctor: have you ever had any type of injury to that knee i mean did you fall or bump it against something or patient: no not that i can recall
D2N080
6
[ "Personal History" ]
[ "Subjective" ]
have you ever had any type of injury to that knee i mean did you fall or bump it against something or
2,065
doctor: okay and have is it painful have you taken anything for for pain patient: no because it does n't last that long
D2N080
7
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay and have is it painful have you taken anything for for pain
2,066
doctor: so is it interfering with your just things you like to do and patient: hmmm no not really
D2N080
9
[ "Other Socials" ]
[ "Subjective" ]
so is it interfering with your just things you like to do and
2,067
doctor: so i know you said that you like to do a lot of travel patient: yeah i've got a trip planned here in the next month or so and we are going down to columbus georgia to a a lion's club function and probably be doing a lot of walking there and they got some line dances planned and i do n't think i will be able to participate in that because of the knee
D2N080
10
[ "Other Socials" ]
[ "Subjective" ]
so i know you said that you like to do a lot of travel
2,068
doctor: is that where you would be kicking your leg out or something patient: no it's do n't you know what line dancing is like dancing in theories of fairly fast moves but it's mostly sideways motion
D2N080
11
[ "Other Socials" ]
[ "Subjective" ]
is that where you would be kicking your leg out or something
2,069
doctor: and is and that you think that's when your knee might give out then or just not gon na take the chance patient: not gon na take the chance
D2N080
12
[ "Other Socials" ]
[ "Subjective" ]
and is and that you think that's when your knee might give out then or just not gon na take the chance
2,070
doctor: okay yeah that sounds like a good idea have you thought about even having a a cane just in case or do you think that's does that happen often enough patient: wrap it i would n't be able to keep track of it so no no pain
D2N080
13
[ "Acute Symptoms", "Therapeutic History" ]
[ "Subjective" ]
okay yeah that sounds like a good idea have you thought about even having a a cane just in case or do you think that's does that happen often enough
2,071
doctor: okay okay well so since you're in how about your blood pressure how how is it doing and have you been taking your blood pressures at home like we talked about patient: yes they are doing fine still about the same
D2N080
14
[ "Personal History" ]
[ "Subjective" ]
okay okay well so since you're in how about your blood pressure how how is it doing and have you been taking your blood pressures at home like we talked about
2,072
doctor: so what has it been running patient: i ca n't really remember it's been several days since i took it but i think it runs around one twenty over seventy somewhere along in there
D2N080
16
[ "Personal History" ]
[ "Subjective" ]
so what has it been running
2,073
doctor: okay alright and so what about your medication we have you on some medication for your blood pressure right patient: yes i take take them regularly at eight thirty in the morning and eight thirty at night
D2N080
17
[ "Therapeutic History" ]
[ "Subjective" ]
okay alright and so what about your medication we have you on some medication for your blood pressure right
2,074
doctor: and what is the medication and the dosage that you are taking patient: i'm taking a farxiga and amlodipine
D2N080
18
[ "Therapeutic History" ]
[ "Subjective" ]
and what is the medication and the dosage that you are taking
2,075
doctor: that but yeah go ahead patient: no that was it i just take them regularly eight thirty in the morning eight thirty at night
D2N080
20
[ "Therapeutic History" ]
[ "Subjective" ]
that but yeah go ahead
2,076
doctor: yeah well that's good i i know you said you set an alarm on your phone to make sure that you get them taken at the right time so that's really good and how are your blood sugars doing how is your diet doing patient: my blood sugar has been running a little higher at about one thirty
D2N080
21
[ "Personal History" ]
[ "Subjective" ]
yeah well that's good i i know you said you set an alarm on your phone to make sure that you get them taken at the right time so that's really good and how are your blood sugars doing how is your diet doing
2,077
doctor: is that in the morning when you're fasting patient: yes
D2N080
22
[ "Personal History" ]
[ "Subjective" ]
is that in the morning when you're fasting
2,078
doctor: and are you taking your metformin patient: yes yes that's along with the blood pressure medicine morning and night
D2N080
24
[ "Therapeutic History" ]
[ "Subjective" ]
and are you taking your metformin
2,079
doctor: okay alright so are you are you eating like late at night or anything like that patient: no we usually eat by six
D2N080
25
[ "Vegetative History" ]
[ "Subjective" ]
okay alright so are you are you eating like late at night or anything like that
2,080
doctor: okay okay alright well hopefully we can get you to feeling better okay so i want to do a quick physical exam really check that knee out so your vital signs look good they they look alright your temperature is ninety eight . two your pulse is seventy two respirations are sixteen blood pressure is one twenty two over seventy so that looks fine i'm gon na go ahead and take a listen to your heart and lungs so on your heart exam it's a nice regular rate and rhythm but i appreciate a slight two over six systolic ejection murmur at the left base here on your lung exam your lungs are clear to auscultation bilaterally okay now let's take a quick look at that knee so does it hurt when i press on it patient: no
D2N080
26
[ "Physical Examination" ]
[ "Objective" ]
okay okay alright well hopefully we can get you to feeling better okay so i want to do a quick physical exam really check that knee out so your vital signs look good they they look alright your temperature is ninety eight . two your pulse is seventy two respirations are sixteen blood pressure is one twenty two over seventy so that looks fine i'm gon na go ahead and take a listen to your heart and lungs so on your heart exam it's a nice regular rate and rhythm but i appreciate a slight two over six systolic ejection murmur at the left base here on your lung exam your lungs are clear to auscultation bilaterally okay now let's take a quick look at that knee so does it hurt when i press on it
2,081
doctor: okay can you bend your knee and straighten it out patient: yes
D2N080
27
[ "Physical Examination" ]
[ "Objective" ]
okay can you bend your knee and straighten it out
2,082
doctor: okay i'm gon na do some maneuvers and i'm gon na just gon na call out my findings on this okay on your right knee exam no ecchymosis or edema no effusion no pain to palpation of the of the left medial knee is there any decreased range of motion do you feel you feel like you're you're able to fully move that as you should the same as the other knee patient: yeah
D2N080
28
[ "Physical Examination" ]
[ "Objective" ]
okay i'm gon na do some maneuvers and i'm gon na just gon na call out my findings on this okay on your right knee exam no ecchymosis or edema no effusion no pain to palpation of the of the left medial knee is there any decreased range of motion do you feel you feel like you're you're able to fully move that as you should the same as the other knee
2,083
doctor: okay so no decreased range of motion negative varus and valgus test okay and so with your x-rays i reviewed the result of your left knee x-ray which showed no evidence of fracture or bony abnormality so lem me tell you a little bit about my plan so your left knee pain i think you just have some arthritis in that i want to prescribe some meloxicam fifteen milligrams a day we might do some physical therapy for that just to strengthen the muscles around that area and prevent any further problems with that okay and so for your second problem the hypertension so i wan na continue the lisinopril at twenty milligrams a day and order an echocardiogram just to evaluate that heart murmur alright and patient: okay
D2N080
29
[ "Medication", "Radiology Examination", "Referral", "Reassessment", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
okay so no decreased range of motion negative varus and valgus test okay and so with your x-rays i reviewed the result of your left knee x-ray which showed no evidence of fracture or bony abnormality so lem me tell you a little bit about my plan so your left knee pain i think you just have some arthritis in that i want to prescribe some meloxicam fifteen milligrams a day we might do some physical therapy for that just to strengthen the muscles around that area and prevent any further problems with that okay and so for your second problem the hypertension so i wan na continue the lisinopril at twenty milligrams a day and order an echocardiogram just to evaluate that heart murmur alright and
2,084
doctor: for the diabetes mellitus i wan na order a hemoglobin a1c to see if we need to make any adjustments to your metformin and i'm also gon na order a lipid panel okay do you have any questions patient: no i do n't think so when will all this take place
D2N080
30
[ "Discussion", "Medication", "Diagnostic Testing", "Reassessment" ]
[ "Assessment", "Plan" ]
for the diabetes mellitus i wan na order a hemoglobin a1c to see if we need to make any adjustments to your metformin and i'm also gon na order a lipid panel okay do you have any questions
2,085
doctor: we will get you scheduled for the echocardiogram i will have my nurse come in and we will get that set up okay
D2N080
31
[ "Chitchat" ]
[ "Null" ]
doctor: we will get you scheduled for the echocardiogram i will have my nurse come in and we will get that set up okay
2,086
doctor: so beverly is a 53 -year-old female with a recent diagnosis of stage three nonsmile cell lung cancer who presents for follow-up during neo agit chemotherapy she was diagnosed with a four . four centimeter left upper lobe nodule biopsy was positive for adenocarcinoma molecular testing is pending at this time alright hello beverly how are you patient: i'm good today
D2N081
0
[ "Personal History", "Greetings" ]
[ "Subjective" ]
so beverly is a 53 -year-old female with a recent diagnosis of stage three nonsmile cell lung cancer who presents for follow-up during neo agit chemotherapy she was diagnosed with a four . four centimeter left upper lobe nodule biopsy was positive for adenocarcinoma molecular testing is pending at this time alright hello beverly how are you
2,087
doctor: you're good today yeah you've been going through a lot lately i know you just had your treatment how how are your symptoms patient: my symptoms are pretty good today i just kind of have a minimal cough and a sore throat
D2N081
1
[ "Acute Symptoms" ]
[ "Subjective" ]
you're good today yeah you've been going through a lot lately i know you just had your treatment how how are your symptoms
2,088
doctor: okay and how about fatigue have you been feeling more tired patient: yes a little bit
D2N081
3
[ "Vegetative History" ]
[ "Subjective" ]
okay and how about fatigue have you been feeling more tired
2,089
doctor: okay and how about any nausea or vomiting patient: no not as of today
D2N081
4
[ "Vegetative History" ]
[ "Subjective" ]
okay and how about any nausea or vomiting
2,090
doctor: okay and i know you were mentioning a cough before how is it as far as walking are you having any shortness of breath patient: i have n't noticed any shortness of breath it just kind of seems to be a lingering kind of light dry cough
D2N081
5
[ "Vegetative History" ]
[ "Subjective" ]
okay and i know you were mentioning a cough before how is it as far as walking are you having any shortness of breath
2,091
doctor: cough okay is it any mucus with it or is it a dry cough patient: more dry
D2N081
6
[ "Vegetative History" ]
[ "Subjective" ]
cough okay is it any mucus with it or is it a dry cough
2,092
doctor: a dry cough okay and tell me more about this sore throat patient: this kind of seems to be persistent comes and goes it will be worse sometimes and then others it feels better trying to drink lots of fluids
D2N081
7
[ "Vegetative History" ]
[ "Subjective" ]
a dry cough okay and tell me more about this sore throat
2,093
doctor: okay and when you mention drinking and eating is do you feel like anything is getting stuck there patient: no i do n't feel like anything is getting stuck right now and i have n't been i have been eating but not as much as i normally would
D2N081
9
[ "Vegetative History" ]
[ "Subjective" ]
okay and when you mention drinking and eating is do you feel like anything is getting stuck there
2,094
doctor: okay okay alright and how are you doing as far as like just emotionally and mentally how are you doing i'm just talking a little bit about your support systems patient: the nursing staff and the office has been very good to help you know with anything that i need as far as support so just since we are just getting started so far on the journey i do feel like i have support and mentally you know still feel strong
D2N081
10
[ "Other Socials" ]
[ "Subjective" ]
okay okay alright and how are you doing as far as like just emotionally and mentally how are you doing i'm just talking a little bit about your support systems
2,095
doctor: okay and how about with family or friends have you been able to turn to anyone patient: i do have good family members that have been supportive and they have come to my treatment with me
D2N081
11
[ "Other Socials" ]
[ "Subjective" ]
okay and how about with family or friends have you been able to turn to anyone
2,096
doctor: okay excellent excellent and so right now you're on a combination of two different chemotherapies the cisplestan as well as the eupside and you had your last treatment just a few days ago but you're saying right now you've been able to tolerate the nausea and the fatigue patient: yes i have n't had any nausea but you know just slight fatigue it does n't seem to be overwhelming
D2N081
12
[ "Vegetative History" ]
[ "Subjective" ]
okay excellent excellent and so right now you're on a combination of two different chemotherapies the cisplestan as well as the eupside and you had your last treatment just a few days ago but you're saying right now you've been able to tolerate the nausea and the fatigue
2,097
doctor: okay okay so we are gon na go ahead if it's okay with you and start your physical exam reviewing your vitals so vitals look good especially your oxygen especially with the chemotherapy you've been getting and the cough so your oxygen looks good so i'm happy with that so now i'm just examining your neck especially with your sore throat and i do n't appreciate any cervical lymphadenopathy and also no supraclavicular adenopathy listening to your heart you have a nice regular rate and rhythm with no murmurs that i appreciate now on your lung exam when you're taking some deep breaths i do notice some crackles in your lungs bilaterally and what that means is there is there is some faint sounds that i'm hearing which could represent some fluid there so on looking at your skin exam on your chest you do have some erythema on the anterior side of the chest on the left side and this could be related to the radiation so on your lower extremities i appreciate no edema and everything else looks good and thank you i know you did a chest x-ray before coming in so on your results for the chest x-ray it does look like you have some mild radiation pneumonitis which basically means some inflammation of the lungs most likely due to the radiation so what does this all mean so for your assessment and plan so for the first diagnosis the first problem of the lung cancer so what we're gon na do is we're gon na continue with the current regimen of your chemotherapy of the cisplacin and the etoside and we're gon na continue with your current dose of radiation at forty five grade and when that's complete we will repeat some imaging and hopefully you know the tumor will shrink down enough that we can remove it surgically okay for problem number two so the radiation pneumonitis so that's what causing that cough as well as some of the shortness of breath i know you're not experiencing it much now so what i'm gon na do for that is actually gon na prescribe you a low dose of prednisone and so that's an will help with the inflammation i'm gon na give you forty milligrams daily for five days and so hopefully that will help reduce the inflammation and so that you can continue with the radiation okay how does that sound so far patient: that sounds great thank you
D2N081
13
[ "Physical Examination", "Discussion", "Medication", "Radiology Examination", "Reassessment", "Other Treatments" ]
[ "Objective", "Assessment", "Plan" ]
okay okay so we are gon na go ahead if it's okay with you and start your physical exam reviewing your vitals so vitals look good especially your oxygen especially with the chemotherapy you've been getting and the cough so your oxygen looks good so i'm happy with that so now i'm just examining your neck especially with your sore throat and i do n't appreciate any cervical lymphadenopathy and also no supraclavicular adenopathy listening to your heart you have a nice regular rate and rhythm with no murmurs that i appreciate now on your lung exam when you're taking some deep breaths i do notice some crackles in your lungs bilaterally and what that means is there is there is some faint sounds that i'm hearing which could represent some fluid there so on looking at your skin exam on your chest you do have some erythema on the anterior side of the chest on the left side and this could be related to the radiation so on your lower extremities i appreciate no edema and everything else looks good and thank you i know you did a chest x-ray before coming in so on your results for the chest x-ray it does look like you have some mild radiation pneumonitis which basically means some inflammation of the lungs most likely due to the radiation so what does this all mean so for your assessment and plan so for the first diagnosis the first problem of the lung cancer so what we're gon na do is we're gon na continue with the current regimen of your chemotherapy of the cisplacin and the etoside and we're gon na continue with your current dose of radiation at forty five grade and when that's complete we will repeat some imaging and hopefully you know the tumor will shrink down enough that we can remove it surgically okay for problem number two so the radiation pneumonitis so that's what causing that cough as well as some of the shortness of breath i know you're not experiencing it much now so what i'm gon na do for that is actually gon na prescribe you a low dose of prednisone and so that's an will help with the inflammation i'm gon na give you forty milligrams daily for five days and so hopefully that will help reduce the inflammation and so that you can continue with the radiation okay how does that sound so far
2,098
doctor: okay and then lastly for the painful swallowing that you're having so the inflammation you're having it not only in your lungs but it also in your esophagus as well so what i'm gon na do is prescribe you you're taking the the prednisone i'm also gon na give you a lidocaine swish and swallow and you can do that four times a day and so that will be able to help you so you can eat immediately after taking it and it can also help so that you can continue to take food and fluids prevent dehydration and any further weight loss patient: great
D2N081
14
[ "Medication", "Other Treatments", "Reassessment" ]
[ "Assessment", "Plan" ]
okay and then lastly for the painful swallowing that you're having so the inflammation you're having it not only in your lungs but it also in your esophagus as well so what i'm gon na do is prescribe you you're taking the the prednisone i'm also gon na give you a lidocaine swish and swallow and you can do that four times a day and so that will be able to help you so you can eat immediately after taking it and it can also help so that you can continue to take food and fluids prevent dehydration and any further weight loss
2,099