, Rebecca Fields 23yo F law school student - fever & sore throat
History:
Vitals:
Temp: 38.6C (101.5)
HR 94bpm, regular rhythm, normal strength
RR 14bpm regular rhythm, unlabored effort
Pulse ox: 98%
Cognitive: A&O x4
General Observation: skin warm & dry
HISTORY (SUBJECTIVE):
ow can you ave rea sore ro
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Do you have any other symptoms or concerns we Iscuss ave some ml ea ac es
should —
me and go, oh yeah & my glands are really swollen & tender. Here on both sides of my
nec
ave you had any contact with other sick people - my roommate said she had a real
e week. She got checked out at the clinic but I don't know what the diagnosis was
4.
5. What are the events surrounding the start of your sore throat - nothing really, it just started hurting like crazy
7. Does the pain in your throat radiate someplace else, where? - no
8. What does the pain in your throat feel like? - like an ice pick in there
owsevere your sore roat. - ju say at myt roat u
10. What treatments have you had for your sore throat? - acetaminophen
11. Does your sore throat come and go? - I wish it did
12. When did your headache start? - 2 days ago
13. What are the events surrounding the start of your headache? - come on since my throat got sore and I started
feeling so sick
14. Does anything make your headache better or worse? Acetaminophen helps a bit
15. Severity of headache - pretty mild you ave any pro ems with hea es a on go awaywl asa, y en ou e or urre VISI
Ifficulty with night vision, problems hearing, ear pain, sinus problem
17. When did you first notice your swollen lymph nodes? - 2 days ago
18. When did your fever start - two days ago
19. Does anything make fever better or worse? - acetaminophen
20. Do you have any other symptoms with your fever? - sore throat, tender glands, headaches
21. Do you have ear pain - no
22. Do you have runny nose, nasal congestion? - no
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