NURS 680 B week 4 __ Already Graded A
Identifying data: Patient C DOB: 7/28/1966 MR# Source and reliability of history: 54-year-old female, reliable historian. Demographics: • Gender: Female • Age: 54 • Marital status: N /A • Ethnicity: N/A • Social/occupation: N/A S: Subjective A 54-year old woman complain of left side drooling and facial drooping since earlier this morning. CC: Left side drooling and facial drooling since early this morning. HPI: Onset: When did it start? What were you doing when this episode occurred? Last time seen well? Location: Left side of face, does it radiate anywhere else? Duration: Since earlier this morning, have you experience these symptoms before? Characteristic: Left side drooling and facial drooping. Any other symptoms? Aggravating factors: Is there anything that makes it worse? Relieving factors: What have you tried to relieve your symptoms? Treatment: Have you taken any medication? If so, what medications did you tried? Have you tried any other treatment? Did it help? How long did you take it? How frequent? Severity: Any loss of sensation? Affecting any other parts of the body? PMH: • Childhood Illnesses: Did you have any childhood illnesses?
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