daniel
True Blue
Help me out there, looking at this and seeing a possible four, if you see the same thing. Help me out and clear it up for me. And if you see just a level three but a possible level 4, but it's just missing something let me know.
Going to be doing an internal get together with my physicians. Trying to bring all the examples of level fours to light.
Reason for Visit:
ROT- LABS
C/O Cough, chest, cold, X 2wks. Zero going awaY- FEVER X 1 month.
PFSH: NKA
January 00, 2777
RE: what you name
He is a 56- year old gentleman here for follow-up of his lab results. He had started on TriCor for hypertriglyceridemia. He had follow-up blood work done on January 11, 2008. This revealed a drop in his triglycerides from 307 to 133 and his cardiac risk ratio from 4.5 to 3.4. He did, however, have a slight bump in his AST from 28 to 38, about 10% above normal. He has since run out of the TriCor.
In the interim he came down with an upper respiratory infection, initially a cold that moved into his chest. He is coughing productively, having some shortness of breath in the middle of the night, awakenign anxiously, and a low-grade fever. He is concerned that it might be the lisinopril causing his cough. He also has been doing home blood pressure readings which he states average about 130/80 to 85. He is a little higher in th office today at 142/100. His pulse is also 90.
PHYSICAL EXAM:
HEENT: withing normal limits. He does have some nasal congestion but no erythema or purulent drainage. TMs are normal. His pharynx reveeals a little uvular edema, but no exudates.
Neck:Supple
Lungs: No rales or wheezes. A few rhonchi.
I think he has a bronchitits. Will treat him with Zithromax, Mucinex and Zyxel. This may also be related to his elevated LFT, however, it is more likely the TriCor. Given its minimal elevation, we are going to continue the prescription and repeat another lipid and metabolic panel in six weeks. Hopefully his respriatory infection will clear with the above approach as well. We will see him for follow-up thereafter.
Thank You in advance for those who post there opinion.
Going to be doing an internal get together with my physicians. Trying to bring all the examples of level fours to light.
Reason for Visit:
ROT- LABS
C/O Cough, chest, cold, X 2wks. Zero going awaY- FEVER X 1 month.
PFSH: NKA
January 00, 2777
RE: what you name
He is a 56- year old gentleman here for follow-up of his lab results. He had started on TriCor for hypertriglyceridemia. He had follow-up blood work done on January 11, 2008. This revealed a drop in his triglycerides from 307 to 133 and his cardiac risk ratio from 4.5 to 3.4. He did, however, have a slight bump in his AST from 28 to 38, about 10% above normal. He has since run out of the TriCor.
In the interim he came down with an upper respiratory infection, initially a cold that moved into his chest. He is coughing productively, having some shortness of breath in the middle of the night, awakenign anxiously, and a low-grade fever. He is concerned that it might be the lisinopril causing his cough. He also has been doing home blood pressure readings which he states average about 130/80 to 85. He is a little higher in th office today at 142/100. His pulse is also 90.
PHYSICAL EXAM:
HEENT: withing normal limits. He does have some nasal congestion but no erythema or purulent drainage. TMs are normal. His pharynx reveeals a little uvular edema, but no exudates.
Neck:Supple
Lungs: No rales or wheezes. A few rhonchi.
I think he has a bronchitits. Will treat him with Zithromax, Mucinex and Zyxel. This may also be related to his elevated LFT, however, it is more likely the TriCor. Given its minimal elevation, we are going to continue the prescription and repeat another lipid and metabolic panel in six weeks. Hopefully his respriatory infection will clear with the above approach as well. We will see him for follow-up thereafter.
Thank You in advance for those who post there opinion.
