Information for Soap Notes Essay

Associate Level Material Case Study Information for SOAP Notes use up the following three patient visits. Rewrite the information using correct health check terminology. The visits below ar written in laymans terms and do not use the correct medical terminology. Re-write the information in medical terms for the charts. You must determine where the information is to be placed in the SOAP note. Patient One Chapter Six 22-year-old African American female 140/60 BP 99 F Pulse is 38 Breathing is 22 per minute Patient states she is not on any(prenominal) medicine at the timePatient states her reason for the visit is she is having severe back pain for 5 days now Past has been told she has reaping hook cell anemia mendelevium tells patient they are deviation to draw blood and give her IV with fluids. Physician states the IV will contain something for the pain parenthood work showed white blood cells 4300, hemoglobin 13. 1 g/dL, hematocrit 39. 9%, platelets 162,000, segs 65. 9, lymph s 27, monos 3. 4 Physician observes patient is alert Physician finds that head, ears, eyes, nose, and throat are okay Physician determines the patient is having a sickle cell crisisPhysician finds that the patient has numbness in hands and feet Patient states she just has not been facial expression well lately She reports I do not test my levels daily with that machine it hurts so I just base my levels on how well I feel Physician observes that the patient has some brand of her skin Physician sees that the head, eyes, ears, nose and throat are okay Physician hears that the heart sounds good, nothing sounds onward Physician wants patient to come to the office in 1 month Physician tells patient to induce using the machine to test her blood and record the results and bring with her to next visit