Progressive Renal disease

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Progressive Renal disease에 대한 자료입니다.
본문내용
SOAP note
Subjective
Name Rob Brandon
Age 52
Sex male
Chief complaint “ I’m here to check the results of my urine test ”

Objective
History of Present Illness
Diabetes mellitus
Serum creatinine 1.6mg/dL (1 years ago-1.3mg/dL)
He has been taking his medications faithfully

PMH
Type 2 DM (16 years)
(failed glyburide, currently on insulin)
Hypertension (2 years)
Hypercholesterolemia (5yeas)-noncompliant with diet

FH
Father DM, died 3 years ago
Mother HTN, died at the age of 50 secondary to MI

SH
No smoke
Occasional alcohol ( 2 or 3 bears on weekends)
Diet breakfast egg and sausages
lunch turkey sandwiches
dinner pasta and salad