*NURSING > QUESTIONS and ANSWERS > SOAP Note Template ALL ANSWERS 100% CORRECT SPRING FALL-2022 LATEST SOLUTION GUARANTEED GRADE A+ (All)
Initials: BF Age: 58 Height Weight BP HR RR Temp SPO2 Pain Allergies 5’ 11 197lbs 146/ 90 104 19 36.7C 98% Medication: Codeine : reports causes nausea and vomiting Food: none Environm... ent: none History of Present Illness (HPI) Chief Complaint (CC) Chest pain Onset While doing strenuous acitivties, earlier this month. Location Middle of chest. Does not radiate. Duration 3 episodes for the past month. Each episode lasts for a couple of minutes. Characteristics Chest tightness in the middle of chest without radiation. Aggravating Factors Yard work and climbing stairs at work. Relieving Factors Taking a break or sat down to rest. Treatment Reports no treatment uses Current Medications: Include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products. Medication (Rx, OTC, or Homeopathic) Dosage Frequency Atorvastatin (Lipitor) PO 10mg Daily at HS Metoprolol (Lopressor) PO 100mg Daily Omega-3 Fish Oil PO 1200mg Daily Tylenol “Whatever the bottle recommends for an adult” PRN Ibuprofen “Whatever the bottle recommends for an adult” PRN [Show More]
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