NURS 623 SOAP Note Adult 1 Topic UTI.

NURS 623 SOAP Note Adult 1 Topic UTI..O.A.P. Note A 36-year-old female presents with twenty-four-hour history of urinary frequency and burning with urination. She is recently divorced. Chief Complaint Frequency and urgency with urination for the last 24 hours. History of Present Illness A 36-year-old female presents to the clinic with frequency and burning with urination. She reports this started roughly 24 hours ago. Patient reports the pain with urination is a 3 out of 10. She has not tried taking anything for the pain or frequency. She reports that she is recently divorced and has no new sexual partners. Patient reports that she has not had a urinary tract infection in years. Past Medical History Past Medical history: None Past surgical history: ACL reconstruction in 2010 Patient is current in her immunizations No Medication or seasonal allergies Current medications: None Family History Include parents, siblings; grandparents if applicable/known, cause of death, age, pertinent medical illnesses Mother: Asthma, hypertension and type 2 diabetes Father: Hypertension Brother: Unknown Personal/Social History Education, marital status, occupation, alcohol/drug use, smoking status, sexual history if relevant, exercise, nutrition, religious preference if known Patient has a Bachelors degree in Engineering and works full time at Hill Air Force Base, is a divorced heterosexual. Pt denies any alcohol or illicit drug use. She does not smoke or use chewing tobacco. Pt does moderate exercise 3 times a week and is on a regular diet.