612 soap 2

/in /by

Home>Homework Answsers>Nursing homework helpnursingMasters21 days ago12.06.202520Report issuefiles (3)612soap2.docxSOAPNOTETEMPLATEBLANK.docxSOAPNoteRubric.pdf612soap2.docxSOAP Note 2Patient is a 77 year male coming in because he keeps on wetting the bed. Has no history of surgeries. Has a wife and 2 kids. No family histories. Wife does have type 2 diabetes. And he has mild hypertension but that started in his early 60’s.A SOAP note is a method of documentation employed by healthcare providers to record and communicate patient information in a clear, structured, and in an organized manner. This assignment will provide students with the necessary tools to document patient care effectively, enhance their clinical skills, and prepare them for their roles as competent healthcare providers.Instructions:SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan. The episodic SOAP note is to be written using the attached template below.For all the SOAP note assignments, you will write a SOAP note about one of your patients and use the following acronym:S=Subjective data: Patient’s Chief Complaint (CC).O=Objective data: Including client behavior, physical assessment, vital signs, and meds.A=Assessment: Diagnosis of the patient’s condition. Include differential diagnosis.P=Plan: Treatment, diagnostic testing, and follow upClick here to access and download the SOAP Note TemplateDownload Click here to access and download the SOAP Note TemplateSubmission Instructions:· Your SOAP note should be clear and concise and students will lose points for improper grammar, punctuation, and misspellings.· You must use the template provided. Turnitin will recognize the template and not score against it.image1.pngSOAPNOTETEMPLATEBLANK.docxSOAP NOTE TEMPLATEReview the Rubric for more GuidanceDemographicsChief Complaint (Reason for seeking health care)History of Present Illness (HPI)AllergiesReview of Systems (ROS)General:HEENT:Neck:Lungs:CardioBreast:GI:M/F genital:GU:NeuroMusculo:Activity:Psychosocial:Derm:Nutrition:Sleep/Rest:LMP:STI Hx:Vital SignsLabsMedicationsPast Medical HistoryPast Surgical HistoryFamily HistorySocial HistoryHealth Maintenance/ ScreeningsPhysical ExaminationGeneral:HEENT:Neck:Lungs:CardioBreast:GI:M/F genital:GU:NeuroMusculo:Activity:Psychosocial:Derm:DiagnosisDifferential DiagnosisICD 10 CodingPharmacologic treatment planDiagnostic/Lab TestingEducationAnticipatory GuidanceFollow up planPrescriptionSee Below (scroll down)ReferencesGrammarEA#: 101010101 STU Clinic LIC# 10000000Tel: (000) 555-1234 FAX: (000) 555-12222Patient Name: (Initials)______________________________ Age ___________Date: _______________RX ______________________________________SIG:Dispense: ___________ Refill: _________________No SubstitutionSignature:____________________________________________________________Signature (with appropriate credentials):_____________________________________References (must use current evidence-based guidelines used to guide the care [Mandatory])SOAPNoteRubric.pdfThis file is too large to display.View in new windowSOAPNoteRubric.pdfThis file is too large to display.View in new window612soap2.docxSOAP Note 2Patient is a 77 year male coming in because he keeps on wetting the bed. Has no history of surgeries. Has a wife and 2 kids. No family histories. Wife does have type 2 diabetes. And he has mild hypertension but that started in his early 60’s.A SOAP note is a method of documentation employed by healthcare providers to record and communicate patient information in a clear, structured, and in an organized manner. This assignment will provide students with the necessary tools to document patient care effectively, enhance their clinical skills, and prepare them for their roles as competent healthcare providers.Instructions:SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan. The episodic SOAP note is to be written using the attached template below.For all the SOAP note assignments, you will write a SOAP note about one of your patients and use the following acronym:S=Subjective data: Patient’s Chief Complaint (CC).O=Objective data: Including client behavior, physical assessment, vital signs, and meds.A=Assessment: Diagnosis of the patient’s condition. Include differential diagnosis.P=Plan: Treatment, diagnostic testing, and follow upClick here to access and download the SOAP Note TemplateDownload Click here to access and download the SOAP Note TemplateSubmission Instructions:· Your SOAP note should be clear and concise and students will lose points for improper grammar, punctuation, and misspellings.· You must use the template provided. Turnitin will recognize the template and not score against it.image1.pngSOAPNOTETEMPLATEBLANK.docxSOAP NOTE TEMPLATEReview the Rubric for more GuidanceDemographicsChief Complaint (Reason for seeking health care)History of Present Illness (HPI)AllergiesReview of Systems (ROS)General:HEENT:Neck:Lungs:CardioBreast:GI:M/F genital:GU:NeuroMusculo:Activity:Psychosocial:Derm:Nutrition:Sleep/Rest:LMP:STI Hx:Vital SignsLabsMedicationsPast Medical HistoryPast Surgical HistoryFamily HistorySocial HistoryHealth Maintenance/ ScreeningsPhysical ExaminationGeneral:HEENT:Neck:Lungs:CardioBreast:GI:M/F genital:GU:NeuroMusculo:Activity:Psychosocial:Derm:DiagnosisDifferential DiagnosisICD 10 CodingPharmacologic treatment planDiagnostic/Lab TestingEducationAnticipatory GuidanceFollow up planPrescriptionSee Below (scroll down)ReferencesGrammarEA#: 101010101 STU Clinic LIC# 10000000Tel: (000) 555-1234 FAX: (000) 555-12222Patient Name: (Initials)______________________________ Age ___________Date: _______________RX ______________________________________SIG:Dispense: ___________ Refill: _________________No SubstitutionSignature:____________________________________________________________Signature (with appropriate credentials):_____________________________________References (must use current evidence-based guidelines used to guide the care [Mandatory])SOAPNoteRubric.pdfThis file is too large to display.View in new window612soap2.docxSOAP Note 2Patient is a 77 year male coming in because he keeps on wetting the bed. Has no history of surgeries. Has a wife and 2 kids. No family histories. Wife does have type 2 diabetes. And he has mild hypertension but that started in his early 60’s.A SOAP note is a method of documentation employed by healthcare providers to record and communicate patient information in a clear, structured, and in an organized manner. This assignment will provide students with the necessary tools to document patient care effectively, enhance their clinical skills, and prepare them for their roles as competent healthcare providers.Instructions:SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan. The episodic SOAP note is to be written using the attached template below.For all the SOAP note assignments, you will write a SOAP note about one of your patients and use the following acronym:S=Subjective data: Patient’s Chief Complaint (CC).O=Objective data: Including client behavior, physical assessment, vital signs, and meds.A=Assessment: Diagnosis of the patient’s condition. Include differential diagnosis.P=Plan: Treatment, diagnostic testing, and follow upClick here to access and download the SOAP Note TemplateDownload Click here to access and download the SOAP Note TemplateSubmission Instructions:· Your SOAP note should be clear and concise and students will lose points for improper grammar, punctuation, and misspellings.· You must use the template provided. Turnitin will recognize the template and not score against it.image1.pngSOAPNOTETEMPLATEBLANK.docxSOAP NOTE TEMPLATEReview the Rubric for more GuidanceDemographicsChief Complaint (Reason for seeking health care)History of Present Illness (HPI)AllergiesReview of Systems (ROS)General:HEENT:Neck:Lungs:CardioBreast:GI:M/F genital:GU:NeuroMusculo:Activity:Psychosocial:Derm:Nutrition:Sleep/Rest:LMP:STI Hx:Vital SignsLabsMedicationsPast Medical HistoryPast Surgical HistoryFamily HistorySocial HistoryHealth Maintenance/ ScreeningsPhysical ExaminationGeneral:HEENT:Neck:Lungs:CardioBreast:GI:M/F genital:GU:NeuroMusculo:Activity:Psychosocial:Derm:DiagnosisDifferential DiagnosisICD 10 CodingPharmacologic treatment planDiagnostic/Lab TestingEducationAnticipatory GuidanceFollow up planPrescriptionSee Below (scroll down)ReferencesGrammarEA#: 101010101 STU Clinic LIC# 10000000Tel: (000) 555-1234 FAX: (000) 555-12222Patient Name: (Initials)______________________________ Age ___________Date: _______________RX ______________________________________SIG:Dispense: ___________ Refill: _________________No SubstitutionSignature:____________________________________________________________Signature (with appropriate credentials):_____________________________________References (must use current evidence-based guidelines used to guide the care [Mandatory])SOAPNoteRubric.pdfThis file is too large to display.View in new window123Bids(54)PROVEN STERLINGMiss DeannaDr. Ellen RMEmily ClareDr. Aylin JMMISS HILLARY A+Dr Michelle Ellaabdul_rehman_STELLAR GEEK A+ProWritingGuruWIZARD_KIMProf. TOPGRADEfirstclass tutorProf Double RDr. Adeline ZoenicohwilliamIsabella HarvardMUSYOKIONES A+Dr CloverPROF_ALISTERShow All Bidsother Questions(10)review questions for math 102 ( college Algebra )The Case of the Terrible Tigerfeld is a shoemaker who came to America from Poland. He has a helper named Sobel. Feld wishes that his…ProgressivismClarksonFinanceAnnoying Ways people use sourcesPayment linkHistory Reaction Paperusing your own experience (or a friend or relative), what is the meaning, significance, and what are the features of lactose intolerance? How has lactose intolerance changed your dietary habits?

Needs help with similar assignment?

We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper

Get Answer Over WhatsApp Order Paper Now