Personal Social History

Normocephalic atraumatic. Pupils equally round and reactive to light, extraocular motions intact. Oral cavity shows oropharynx clear but slightly dried mucosal membranes. TM (tympanic membranes) clear. Neck, supple. There is no thyromegaly, no JVD. No cervical supraclavicular, axillary, or inguinal lymphadenopathy.

PHYSICAL EXAMINATION: Vital Signs. TEMPERATURE: 101.0, Blood Pressure- 127/179, Heart Rate-129, Respirations- 185, Weight-215. Situations 96% on room air. Pain Scale- 8/10. HEENT-Normal cephalic, atrumatic pupils equally round and reactive to light. Extra ocular motions intact. ORAL: Shows oral pharynx clear but slightly dry mucosal membranes. TMS: Clear. NECK: Supple, No thrangegally or JVD. No cervical, subclavicular, axilarry or lingual lymphinalpathy.

She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palate. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate.

Anticholinergics can be used to decrease secretion and counteract smooth muscle contraction to help with comfort levels of T.B. Also attempting to use none medication therapy such as massage, or relaxation techniques can be used to relieve pain.

HEENT are basically unrevealing. Temp in the office today is 98.4. The outer area of the mouth extending into the chin reveals macules, vesicles, copious purulent exudate forming honey- colored crust on a erythematous base. Skin on trunk, arms and legs is clear. No other symptomology

1. What medication would you choose next to manage the pain? Why would you choose this medication?

Administer Dilaudid 1.5 tab for pain as per physician order. Apply voltaren gel 1% 2 gram transdermal (Diclofenac Sodium) for pain as per physician order……………………………………………………………..….L.Gotora PNS2/WATC

Cardiovascular Assessment: No visible pulsations, no heaves or lifts. Apical pulse present in the fifth intercostal space at the left midclavicular line. Auscultation of apical rate 62 beats per minute, normal rhythm regular S1 - S2 heart sounds present. Pulsations present when supine and disappear at a 45 degree angle position. Extremities are brown color without redness, cyanosis, lesions or varicosities bilaterally. Temperature warm bilaterally, Allen test was negative. Homan’s sign negative. Carotids: +2 and present bilaterally. Right Radial +2, left radial +1 , Right Brachial: +2

There is no specific cure for shingles. Your health care provider will likely prescribe medicines to help you manage any pain, recover faster, and avoid long-term problems. Medicines may include antiviral drugs, anti-inflammatory drugs, and pain medicines. If the area involved is on your face, you may be referred to a specialist, such as an eye doctor (ophthalmologist) or an ear, nose, and throat (ENT) doctor to help you avoid eye problems, chronic pain, or disability.

No known allergies, no sinus, tenderness, no epistaxis, no bleeding gums, patient has partial dentures, one dental carrier noted, tongue is slightly coated, no swelling, lumps or tenderness noted in throat,

Osteopathic manipulation (an entire system of evaluation and treatment designed to achieve and maintain health by restoring the body's normal function)

patient was not having any pain or significant discomfort in the area. The throat was

Head and Neck: Patient skull is of normocephalic, atraumatic and without masses. The patient 's facial expression and facial contours are normal. The parotid glands are normal. The sinuses are non-tender. Palpation of the temporal and masseter muscles reveals normal strength of muscle contraction. There is symmetry of the nasolabial folds. There is no facial droop noted. Trachea midline. Thyroid is smooth, no goiter or

Current medications: Prescribed Antacids, Nexium, q24h, or when pain is severe, Tylenol 500 mg, PO, q12h.

4.) Acetaminophen-Oxycodone (Trade Name: Percocet 5/325) 1-2 tablets by mouth, every four hours; used for decreasing pain as well as decreasing a temperature (Deglin & Vallerand, 2007).