For this, you will take on the role of a clinician who is building a health history for the following case:
Chief Complaint
(CC) “I am here today due to frequent and watery bowel movements”
SubjectiveFever and chills, Lost appetite Flatulence No mucus or blood on stools
History of Present Illness (HPI)A 37-year-old European American female presents to your practice with “loose stools” for about three days. One event about every three hours
PSHAppendectomy at the age of 14
Drug Hx
No meds
AllergiesPenicillin
PE B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8
General well-developed female in no acute distress, appears slightly fatigued
HEENT Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.
NeckSupple
Cardiology S1S2 without rub or gallop
Abdomen positive bowel sounds (BS) in all four quadrants; no masses; no organomegaly noted; diffuse, mild, bilateral lower quadrant pain noted Mild diffuse tenderness.
Integumentary good skin turgor noted, moist mucous membranes
Once you received your case number, answer the following:
- What other subjective data would you obtain?
- What other objective findings would you look for?
- What diagnostic examination do you want to order?
- Name 3 differential diagnoses based on this patient presenting symptoms?
- Give rationales for your each differential diagnosis.
Requirements:
at least 500 words ( 2 complete pages of content) formatted and cited in current APA style 7 ed with support from at least 3 academic sources which need to be journal articles or books from 2019 up to now. NO WEBSITES allowed for reference entry. Include doi, page numbers, etc. Plagiarism must be less than 10%.
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