Running head: NURSING ASSIGNMENT 1

Nursing Assignment
Nursing Assignment

Table of Contents

Abstract ............................................................................................................................... 3

Introduction ......................................................................................................................... 4

Assessment .......................................................................................................................... 4

Primary diagnosis: .......................................................................................................... 4

Secondary diagnosis: ...................................................................................................... 6

Differential diagnosis: ..................................................................................................... 8

Plan ..................................................................................................................................... 8

Diagnostics ...................................................................................................................... 8

Medication .....................................................................................................................11

Education ...........................................................................Error! Bookmark not defined.

Referrals ............................................................................................................................ 15

Follow Up ......................................................................................................................... 17

Medication Cost ................................................................................................................ 19

SOAP Note ........................................................................................................................ 21

References ......................................................................................................................... 22

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Abstract

In this dissertation, the proposed nursing practices are followed in order to address the

problem and issues being faced by 56 years old Hispanic lady. After determining all the past and

current medical history, the results are supported based on the diagnosis being performed.

Afterwards, the medication is propositioned to her in order to best cope up with her medical

condition. In addition to this, the SOAP note is presented containing all the related information

about her, also it contains medical history, clinical exam, and proposed assessment of the disease

and medication plan.

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Introduction

In this case we are asked to diagnose and analyze a 56 year old female, she has been
feeling very exhaust and tired, since 3 months and is also gaining weight because of the
menopause since last year. She has joined gym for the weight loss but does not seem to lose any
weight and is feeling even hungrier and thirsty. She wanted to know the reason behind the
excessive weight gain and tiredness. She also mentioned that she has to go bathroom more
frequently, twice at night and more often during the day and this too is happening since 3
months.
The case consist of 3 types of diagnosis primary, secondary and differential and each
diagnosis include the ICD 10 codes, and is cited with the scholarly reference and guidelines. The
diagnosis is explained by a pathophysiology statements that incorporate both negative and
positive, objective and subjective findings that integrates the diagnosis with the patient.
The purpose of this case study is to develop a management plan for the patient mention in
the case study, after a detailed analysis of the subjective and objective information provided for
the diagnosis, applying the national diabetes guidelines. We are required to suggest an
appropriate health guidelines and strategies for disease prevention. Developing appropriate
evidence based plans and diagnosis for mature and aged individuals, pharmacologic assessment
and incorporation of appropriate tools required in functional assessments. Exhibiting the mastery
in preparing the SOAP note, integrating patient values, health beliefs and cultural preference.

Assessment
Assessment of this case include all three diagnosis categories i.e. primary, secondary and
differential diagnosis including a pathophysiology statement:
Primary diagnosis:
The primary issue of the patient identified is the excessive weight gain, since the last year
menopause. She has been feeling tried and exhaust and does not seem to have enough energy to
perform daily task for 3 months long. Even though she joined gym, she did not lose any weight
and instead of losing weight, she gained 3 pounds of weight and is urinating more frequently.
Diabetes:

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Pathophysiology statement:
The pathophysiology of type 2 diabetes involves a series of dysfunction indicated by
hyperglycemia, resulting from the composition of lacking of insulin secretion and resistance to
the insulin action and uncontrolled glucagon secretion. (Romesh Khardori, 2018).

([Link], ICD-10-CM Codes › E00-E89, 2018).

Signs and symptoms:

 Urinating often.
 Feeling very thirsty.
 Feeling very hungry
 Extreme fatigue.
 Blurry vision.
 Cuts/bruises that are slow to heal.
 Promote hypothyroidism, which can cause weight gain. (american diabetes association, n.d.)
Rational statement:
Extreme fatigue, irritation and tiredness reflects that low blood sugar level, the symptoms
identified reflects the disease of diabetes 2, causing the person feeling thirsty and hungry,
frequent urination and the unexplained weight loss caused due to hypothyroidism, as the diabetes
promote the hypothyroidism, which can cause weight gain.
Hypothyroidism:
Pathophysiology statement:
Hyperthyroidism is a condition causing your thyroid gland to become overactive. Thus
resulting in the over production of the hormone thyroxin. It can significantly activate the body
metabolism, causing increase in weight and an irregular transition in the heartbeat and irritability.
(Aleppo, 2018)
([Link], 2018 ICD-10-CM Diagnosis Code E03.9, 2018)

Signs and symptoms:

 Weight gain

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 Fatigue

 Breath issues

 Increase in blood sugar levels

 Change in appetite

 Vision changes

Rational statement:
A person having hyperthyroidism will produce excessive amount of hormones T3 and
T4, causing thyroid. These hormones modulate the metabolism, dealing with how body uses
energy and processes, the over production of the hormones can lead to a symptoms of high
metabolism, speeding the body process resulting in an increased weight gain.
It is possible that one should not experience all the symptoms mentioned, as the
symptoms vary according to the production of the thyroid gland and the age. ((Mira), 2018)
Secondary diagnosis:
Apart from the primary diagnosis that was the excessive weight gain and extreme fatigue,
she also mentioned that she feels that her bladder has fallen because of the frequent urinating.
She wakeup twice at night and urine more frequently at day time and this too is occurring for
about more than 3 months.
Prolapse bladder:
Pathophysiology statement:
Bladder a hollow organ that stores urine in the pelvis, when the bladder is filled with
urine it creates pressure that create the desire to urinate. In case of women bladder is supported
by the front wall of vagina that became weak and damage with the age, childbirth and if weaken
enough it can prolapse and will be of no longer supportive and will fall into the vagina and will
lead to various difficulties. (prolapsed bladder, 2017).
([Link], 2018 ICD-10-CM Diagnosis Code N81.2, 2018)

Signs and symptoms:

The symptoms that leads to the prolapsed bladder are as following:

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 Unrationing frequently

 Feeling the presence of tissue in vagina.

 Pain and feeling un comfortable in the pelvis

Rational statement:

There are many factors associated with the fallen bladder but the most common factor

linked with it is the menopause. Women bodies tend to create the hormone known as estrogen

prior to menopause. When menopause occur the women bodies stop creating the required

amount of estrogen to prevent the bladders to prolapse and as a result the muscles weaken,

causing the bladder to fall.

PCOS:

Pathophysiology statement:

Polycystic ovary syndrome is a hormonal issue, ordinary among the middle age women.

Women having PCOS, will affect their menstrual cycle. It is caused due to the collection of small

follicles around ovaries making it difficult to release eggs due to hoist androgens in females.

(PCOS, 2017)

([Link], 2018 ICD-10-CM Diagnosis Code E28.2, 2018)

Signs and symptoms:

 Irregular periods

 Menopause

 Polycystic ovaries

Rational statement:

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The cause of PCOS is due to numerous factors that might lead to it. Excess insulin is one

of the primary cause, the resistant in the production of insulin can increase the blood sugar level

of the body making you feel low and tired. It can cause level 2 diabetes, depression and eating

disorder. (staff, 2018)

Differential diagnosis:

DIABETES HYPERTHYROIDISM

 Urinating often. Weight gain

 Feeling very thirsty. Fatigue
 Feeling very hungry
Breath issues
 Extreme fatigue.
 Blurry vision. Increase in blood sugar levels
 Cuts/bruises that are slow to heal. Change in appetite
Promote hypothyroidism, which can cause Vision changes
weight gain.

Plan

Diagnostics

Cystocele/Fallen bladder:

There are number of test must be conducted by urologist for determining fallen bladder;

some of them are listed below;

1. Physical inspection or checkup which also includes pelvic exam.

2. Voiding Cyst urethrogram is the x-ray which is done while urination so that bladder

shape as well as any obstruction would be determine.

3. Uroflowmetry would tend to measure the speed and amount of urine.

4. Cystometry test must be conducted in order to look for the issues with emptying and
filling of the bladder. The amount of urine would also be measured by this test.

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Additionally, this test would help in determining the pressure that is builds inside the
human bladder because it tends to store urine.
5. Urethral pressure profile also helps in measuring the different pressures as a catheter in
urethra.
6. Urodynamics test also helps in evaluating that how well sphincter muscles and bladder
works.
7. Study of pressure flow would measures the required pressure to urinate and it would
then identify the outlet obstruction of bladder.
8. Cystoscopy would help in viewing the inside of the urethra and bladder through thin
tube.
9. Fluoroscopy is another technique widely used to examining the bladder visually
(Cystocele/Fallen Bladder, 2017).
Rational statement:
There are many factors associated with the fallen bladder but the most common factor
linked with it is the menopause. Women bodies tend to create the hormone known as estrogen
prior to menopause. When menopause occur the women bodies stop creating the required
amount of estrogen to prevent the bladders to prolapse and as a result the muscles weaken,
causing the bladder to fall.
Hypothyroidism:
In order to diagnose hypothyroidism, there are different blood test required which are
listed below;
1. Through Thyroid stimulating hormone (TSH) test, the amount of T4 (thyroxine)
can be measured that is being signaled by thyroid to make. If TSH is on high
level, it means that the person is having hypothyroidism.
2. T4 testing is also tested by doctors, it is the T4 thyroid hormone portion available
to tissue in the human body bloodstream.
3. Anti-thyroid microsomal antibodies testing is useful in determining the presence
of the antibodies which later on ensures thyroid damage and eventually lead to
the hypothyroidism (hypothyroidism-diagnosis, 2017).
Rational statement:

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Nursing Assignment

A person having hyperthyroidism will produce excessive amount of hormones T3 and

T4, causing thyroid. These hormones modulate the metabolism, dealing with how body uses
energy and processes, the over production of the hormones can lead to a symptoms of high
metabolism, speeding the body process resulting in an increased weight gain. It is possible that
one should not experience all the symptoms mentioned, as the symptoms vary according to the
production of the thyroid gland and the age.
PCOS:
As it is the genetic component and most likely runs in relatives or families, so it is
important to evaluate the presence of the PCOS like symptoms in the close female relatives. The
lab test and techniques used to diagnose the PCOS are tabulated below;
1. The physical examination is necessary which helps in looking for high level
androgens signs such as acne and hair growth on one’s body. The current weight
of the patient is gotten by nurse, additionally the pelvic exam also helps in
checking ovaries.
2. Imaging and blood test is recommended to measure the pelvic ultrasound and
hormones level so that the nurse or doctor would get a closer look of the patient
ovaries. There are some additional blood tests required in order to measure the
fasting cholesterol level, glucose tolerance and triglyceride levels (Polycystic
ovary syndrome (PCOS), 2017).
Rational statement:

The cause of PCOS is due to numerous factors that might lead to it. Excess insulin is one
of the primary cause, the resistant in the production of insulin can increase the blood sugar level
of the body making you feel low and tired. It can cause level 2 diabetes, depression and eating
disorder.
Diabetes:
For the identification of the diabetes, following test are required which indicates the
blood sugar level;
1. Glycated hemoglobin (A1C) test helps in indicating the average level of the blood
sugar for the early 2-3 months. The blood sugar percentage can be measured by it
as well attached to the oxygen carrying protein hemoglobin in the red blood cells.
Due to this, the blood sugar level would be higher in case when having more

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hemoglobin with attached sugar. If A1C level is 6.5% or higher than this on two
test reports, there is an indication of diabetes.
2. Random blood sugar test can be taken at any time. Irrespective of what the patient
has eaten last, if the blood sugar level is 200 mg/dL or higher than this, it suggest
diabetes especially when it tends to be coupled with symptoms and signs such as
extreme thirst and frequent urination.
3. The fasting blood sugar level can be measured by Oral glucose tolerance test.
Afterwards, the sugar liquid is taken, also on the periodic basis the blood sugar
levels are tested.
Rationale statement:
Extreme fatigue, irritation and tiredness reflects that low blood sugar level, the symptoms
identified reflects the disease of diabetes 2, causing the person feeling thirsty and hungry,
frequent urination and the unexplained weight loss caused due to hypothyroidism, as the diabetes
promote the hypothyroidism, which can cause weight gain.
Medication
Cystocele/Fallen bladder:
The medication or treatment of the cystocele highly depends upon the presence of
symptoms and severity of the cystocele. If the cystocele does not bother women, a health care
provider would recommend to avoid straining or heavy lifting because this might worsen the
women’s cystocele.
If the women is get bothered by the symptoms and want medication or treatment, the
pelvic muscle exercise, surgery and vaginal pessary might be recommended to her by health care
provider.
Furthermore, the exercise are recommended including relaxing and tightening muscles
that would conversely support pelvic organ.
The surgery is required for large cystocele in order to keep and move bladder into a
normal position. This might performed by urologist, gynecologist or urogynecologits. For the
purpose of repairing cystocele the procedures involves making incision in the vagina wall, also
to repair the arena through creating support for the bladder and tightening the tissue layers which
are responsible in separating the organs. In order to get fully recovered by the medication or

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treatment, the women has to stay in hospital and take complete rest for four to six weeks
(cystocele-prolapsed-bladder, 2017).
Hypothyroidism:
The treatment and medication for hypothyroidism includes regular use of the synthetic
thyroid hormone levothyroxine (synthroid, levothroid and others). This sort of medication would
restores the adequate level of hormone, as well as reversing the symptoms and signs of the
hypothyroidism.
The treatment would most probably lower fatigue as well as cholesterol level that has
been elevated by the disorder or disease. The levothyroxine treatment is lifelong but the dosage
has to be changed and the TSH level has to be checked by the doctor every year.
The alternate medication for hypothyroidism includes natural extracts and synthetic
thyroxine which contains thyroid hormone from the thyroid pig’s glands are available. All of
these products includes triiodothyronine and thyroxine.
Extracts are easily available by prescriptions and they must not be confused with the
glandular concentrates which are normally sold in stores offering natural foods. The food and
drug administration does not usually regulated these products, also the purity and potency of
these products is not guaranteed (Hypothyroidism (underactive thyroid), 2017)
PCOS:
The treatment of polycystic ovary syndrome helps in managing the disease symptoms.
Additionally, it would also lower the odds for the health problem which are long term such as
heart disease and diabetes.
The proper exercise and eating habit are the best way to cope up with this disease because
there are many overweight and obese who has been suffering from this problem. The disease can
be prevented through losing body weight from 5 percent to 10 percent of the, it would also make
the patient periods regular and undisrupted. In addition to this, it would help in managing the
ovulation and blood sugar levels.
As PCOS leads high sugar level, it is recommended that the sugar and starchy food must
be limited.
The most common treatment is birth control for women, additionally hormonal birth pills,
control, vaginal rings, shots, skin patch or a hormonal IUD could help in restoring periods.

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All of these birth control methods can lower the probability of having the endometrial
cancer in the uterus. Progestin is a hormone, which can help sin preventing the pregnancies and
treat unwanted acne and hair growth (treatment-pcos, 2017).
Diabetes:
The people with type 2 diabetes can attain their target blood level with exercise and diet
alone, but many of them requires insulin therapy and diabetes medication. The best medication
depends upon number of factors including the patient’s blood sugar level and other health
oriented issues.
The first prescribed medication is metformin for type 2 diabetes, it improve the
sensitivity of the tissues to insulin so that the human body can effectively use insulin. The
glucose production can be lowered as well in liver.
Another medication is sulfonylureas which helps in secreting more insulin. It includes
glipizide (Glucotrol), glyburide and glimepiride.
GLP-1 receptor agonists helps in slowing the process of digestion and lower the level of
blood sugar. Another medication is DPP-4 inhibitors which helps in reducing the level of blood
sugar and it has modest effect.
Insulin therapy is suggested or prescribed due to its utmost benefits, the mixture of
insulin types are recommended by doctor.
Taking effective decision of different medication or drugs should be based on the factors
such as cost and health aspects, in addition to the medication of diabetes, aspirin therapy of low
dose is also suggested as well as cholesterol lowering and blood pressure medication in order to
prevent the blood vessel and heart disease (diagnosis-treatment, 2017).
Education

Since the patient is facing the multiple diseases and is diagnosed with the Thyroid,
initially, the following medication and exercise plan is proposed.

Diagnosis
The primary issue of the patient identified is the excessive weight gain, since the last year
Menopause. She has been feeling tried and exhaust and does not seem to have enough energy to
perform daily task for 3 months long. Even though she joined gym, she did not lose any weight
And instead of losing weight, she gained 3 pounds of weight and is urinating more frequently.

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Medication Purpose
In order to treat thyroid, Glucophage 20 gm is proposed, that will regulate the thyroid
glands and will help in maintaining the hormone balance. In addition to this, the age of the
patient, weight, thyroid level will also be measured before prescribing the above medicine.

Side Effect
Since from past, the patient has gained 3 pounds, it is determined that the patient has
hyper thyroid, making her gain [Link] order to deal with such issue, the Glucophage is
prescribed for 3 months with brisk walk, since it promotes Hunger.

Diet and Exercise

Under the eating plan, the use of vegetables and timely eating is prescribed, so to
maintain the eating habits of the patient. The 5 times meals are prepared for the patient,
incorporating vegetables, nuts and proteins only, cutting the carbohydrate, that are triggering the
weight gain.

Such plan will allow the patient to burn the fats fast and maintain her eating habits. Also
to maintain the snaking and avoid unhealthy food, the patient is prescribed to maintain the diet
plan and follow it religiously. The inclusion of vegetables and protein is focused only, avoiding
rice and bread in the plan for three months.

Diagnosis
Apart from this, in order to deal with Cystocele, the patient is given pessary, but it
depends on the condition of the patient and the position of the gall bladder. It is presume, that the
excess of urinating is due to the damage posited to the bladder.

Medication Purpose
IN order to deal with such issue, the 6 month medication is prescribed, to see of the
condition of the patient improves, and however, it is also keep in consideration, that in the future,
if the condition does not regain or improves, the surgery may be carried, in order to help patient.

Warning Signs
Also, the precaution such as heavy lifting and floor suiting along with the staircase
moving will be restricted during such period. In addition to this, since cyst weakens the bladder,

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with the exercise plan will be developed, including the lunges and the leg exercise, to strengthen
the bladder and the core.

Recommendation
Though in initial, the rigorous exercise plan will not be offered, similar exercise will be
given, that will be home based. Perhaps, to keep her motivated, different motivational clips and
the healthy lifestyle video will be continually shared with her on her personal number, in order to
keep her motivation high and sustained.

Diagnosis
Next, Since Polycystic ovary syndrome is an endocrine disorder that disturbs the balance
between the two hormones of reproductive system i.e. testosterone and estrogen. It can result in
unexplained weight gain as it also interferes with the way the human body uses insulin.

Proposed Medication and Side Effect

It is recommended, that the patients should go for MRI in order to remove the cyst from
the system. Though in this stage, the issue of cyst is at secondary level, however, it is
recommended that she may consider it through proper check routines. Perhaps, the PCOS will be
treated once her Bladder issue is resolved.

Diet and Recommendations

Lastly, this patient considering the symptoms is that of Diabetes type II. As in diabetes
the unexplained weight loss or weight gain can occur along with increased urination, and fatigue
i.e. the feeling of weakness and tiredness. All the symptoms match to that of our patient. Hence
to deal with this, the patient should maintain the Insulin Ph level in the body. For this the insulin
n injections are given, but not on regularly basis.

This is due to the fact, that since the patient will following the above given plan, it will
help her maintain the sugar intake and will also help her in maintaining the weight. This will also
have an impact on her overall diabetes issue, making her improve the overall health.

Referrals

The referrals are made according to the different diagnosis identified in the above

sections. A total of 4 diagnosis are made and a referral is made for each of them.
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Hypothyroidism

As mentioned earlier, the first diagnosis is that of hypothyroidism, as its symptoms are

same as that shown by the patient. The patient is feeling low and is experiencing low energy, thus

for this purpose, it is recommended that the patient should visit an endocrinologist.

Though, hypothyroidism is common as 5 percent of Americans are experiencing this and

a primary care manager can take care of it. But, it is recommended to see an endocrinologist for

once when the patient is diagnosed with hypothyroidism at first, so that a specialist can review

the test results, the current situation and the treatment plan. If the condition is serious then the

endocrinologist can take care of it and if it is not then the primary care doctor can take care of the

patient himself. (Orenstein, 2018)

Cystocele

The second issue that the patient is facing is that she is going to bathroom for urinating

more often than before. For this issue, she has been diagnosed with cystocele which represents

the loss of support for the bladder and leads to urinary leakage.

For this issue, the patient is recommended to visit any urogynecologits. As the

urogynecologits are specialized in pelvic floor disorders which are caused due to child birth, over

weight and C-section surgery. (UNC School of Medicine, 2018)

An urogynecologits is specialized in women’s pelvic floor disorders and would help the

patient in developing correct treatment plans and exercises that a primary health care may not be

do so appropriately. (Thomas, 2018)

PCOS

Polycystic ovary syndrome is an endocrine disorder that disturbs the balance between the

two hormones of reproductive system i.e. testosterone and estrogen. It can result in unexplained

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weight gain as it also interferes with the way the human body uses insulin. The sugar can be

converted into energy through insulin hormone and if it stops happening then it results into

weight gain and low energy, which is the case of our patient as well. Other than this, if the

menstrual cycle is off then this becomes a must to diagnose.

For this condition, the patient can either be referred to a gynecologist who is a specialist

in the reproductive system of women or an endocrinologist who is specialist in treating problems

related to hormones. (Polycystic ovary syndrome , 2018)

Diabetes

The primary diagnosis of this patient considering the symptoms is that of Diabetes type

II. As in diabetes the unexplained weight loss or weight gain can occur along with increased

urination, and fatigue i.e. the feeling of weakness and tiredness. All the symptoms match to that

of our patient.

For most of the problems and difficulties related to diabetes, a specialized nurse in

diabetes or a nurse consultant is enough. But, depending upon the seriousness of the condition of

the patient, a consultant diabetologist can also be referred to. This can be done in the form of the

virtual referral so that the consultant would have the full access to the primary care health

records of the patient. Apart from this, if the patient is also facing psychological issues or any

difficulty in adjustment then a psychologist can also be recommended. But, as in this case there

is no psychological issue thus only a diabetologist is recommended to the patient. (Cardiol, 2010)

Follow Up

Follow up refers to the return visit that the patient would have to do after post-therapeutic

scrutiny and post-hospitalization surveillance.

The follow up plans for all the diagnoses are discussed below.

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Hypothyroidism

For Hypothyroidism, it is suggested that after seven weeks of levothyroxine therapy, the

patient should be called again for examination. The health care provider should measure the

serum thyroid stimulating hormone, if it is normal, then the patient should be called again after 5

months as the clearance of the underlying therapy increases in the normal state.

But, if it is not normal and a change in dosage is required thus adjustments should be

made in every 6 weeks, depending upon the values of serum TSH. This should continue till the

TSH value would reach the range of reference.

Once the health care provider has successfully maintained the prescription of

levothyroxine, the patient should once again be evaluated and after that the serum of TSH should

be obtained on an annual basis to keep a check. (Hamilton, 2009)

Cystocele

Once the surgery has been performed, it is likely that women would need to have another

surgery, as the first surgery usually fails in this case or it may happen that cystocele would return

or any other problem regarding pelvic floor would arise.

Other than this, the use of meshes can cause serious complications for the patient, which

includes the likes of tract infections, pelvic pain, genital pain, and mesh exposure in vagina.

Thus, considering all the complications and the chance of a failed surgery a follow up

plan is a must in a cystocele.

The follow up schedules can be scheduled at the 2nd week, 3rd month, 6th month, and then

after a year. Patient should be asked if she feels any pain, or any bleeding. The pessary should be

removed and the vagina should be checked for any erosion or ulceration. If the health care

provider notes any vaginal lesions, then the pessary should not be inserted back rather the lesions

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should be allowed to heal first. If there are no vaginal lesions then the pessary can be inserted

back. (KUNCHARAPU, 2010 )

PCOS

After the surgery, women are asked to keep a record of their menstrual cycle. In case the

menstrual cycle started within 6 weeks, a blood sample would be obtained in order to measure

the concentration of serums FSH, LH, SHBG, and testosterone. Another blood sample is to be

taken on the 21st day of the same cycle.

Women who are diagnosed with polycystic ovary syndrome are required to follow up

routinely with their respective health care providers, for the treatment of the after effects of

surgery and for the management of hormonal effects as well. (Conrad, 2018)

Diabetes

Individuals diagnosed with diabetes should follow up with their health care providers for

a physical assessment once a year and for the assessment of diabetes they should visit their

health care providers once every six months.

Different tests as per the recommendation of the health care provider should be taken in

these visits that would indicate how the patient is maintaining their health. (Saudek, 2009 )

Medication Cost (Monthly)

PCOS:

Drug name Price/cost

Clomid (clomiphene) $65
Serophene (clomiphene) $65
Total cost $130*4= $520
(PCOS, 2017)

Diabetes type 2:

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Drug name Price/cost

Glucophage (metformin) $11
Glucophage XR Metformin ER (Glucophage $18
XR)
Lantus $421
Total cost $450*4= $1800
(diabetes-type-2, 2017)

Cystocele/Fallen bladder:

Drug name Price/cost

Ditropan XL (oxybutynin er) $29
oxybutynin $25
Hyosyne (hyoscyamine) $31
Total cost $85*4= $336
(overactive-bladder, 2017)

Hypothyroidism:

Drug name Price/cost

Synthroid (levothyroxine) $13
Armour Thyroid $29
Cytomel (liothyronine) $21
Total cost $63*4= $252
(hypothyroidism, 2017)

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SOAP Note

Patient’s name: Mrs. R Age: 56 years Gender: Female

Subjective:

Mrs. R has reported low energy level and instead of losing weight after gym and walk she has

been gaining. Additionally she has reported fallen bladder and has urinating problem. Her past

medical history shows that she has been through a left knee arthritis. No allergy is reported.

Objective:

Vital Signs: BP 118/80 Pulse: 76 regular Respiration: 16 regular

Clinical exam:

Hemoglobin A1C is 6.9% which is higher than 6.5% level means that she has diabetes.
TSH: 2.35, Free T 4 0.9 ng/dL, this value is greater than normal range of TSH level depicting
that she has underactive thyroid.
Cholesterol level is high, high borderline blood LDL cholesterol.
VLDL cholesterol is high which can cause heart attack and clog her arteries.
High triglycerides increases the risk of heart stroke and attack and includes high BP,
cholesterol level and blood sugar level.

Assessment:

Cystocele: Physical inspection, Voiding Cyst urethrogram, Uroflowmetry test and Cystometry
test.
Hypothyroidism: Thyroid stimulating hormone (TSH) test, T4 testing and Anti-thyroid
microsomal antibodies testing.
PCOS: Physical examination and Imaging and blood test.
Diabetes: Glycated hemoglobin (A1C) test, Random blood sugar test and Oral Glucose
tolerance test.

Plan:

Cystocele: Avoid straining or heavy lifting, pelvic muscle exercise, surgery and vaginal
pessary, surgery or repairing cystocele procedure.
Hypothyroidism: Regular use of the synthetic thyroid hormone levothyroxine, alternative
medication plan is natural extracts and synthetic thyroxine
PCOS: Manage the disease symptoms, proper exercise and eating habit.
Diabetes: Metformin, sulfonylureas, GLP-1 receptor agonists and insulin therapy

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References

(n.d.). Retrieved from american diabetes association: [Link]

basics/symptoms/

(Mira), K. (2018, june 7). Hyperthyroidism Symptoms. Retrieved from endocrine web:

[Link]

(2018). Retrieved from UNC School of Medicine:

[Link]

reconstructive-pelvic-surgery/our-services/About_Urogynecology

Aleppo, G. (2018, july 7). hyperthyroidism,. Retrieved from

[Link]

overactive-thyroid

Cardiol, B. J. (2010, May). 10 steps before you refer for diabetes . Retrieved from The British

Journal of Cardiology : [Link]

diabetes/

Conrad, M. (2018). Polycystic Ovarian Syndrome (PCOS) . Retrieved from emedicinehealth:

[Link]

hat_is_the_prognosis_for_pcos

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