Subjective:
Ms. Rogers is a 56 y/o WF who presents with chest pain of one week duration. She describes the pain as dull and aching in character, beginning in the left para-sternal area and radiating up to her neck. She has had three episodes of pain, the first occurring when she was working in her garden in the middle of the day, the second occurring while walking her dog, and the third occurring while she was asleep. She experiences shortness of breath during the episodes, but no other associated symptoms. She has never been told she has heart problems, never had any chest pains before, and does not have claudication.

Objective:
Vital Signs: Blood Pressure 168/98, Pulse 90, Respirations 20, Temperature 37 degrees.
General: Ms. Rogers appears alert, oriented and cooperative.
Skin: Normal in appearance, texture, and temperature.
HEENT: Scalp normal. Pupils equally round, 4 mm, reactive to light and accommodation, sclera and conjunctiva normal. Fundoscopic examination reveals normal vessels without hemorrhage. Tympanic membranes and external auditory canals normal. Nasal mucosa normal. Oral pharynx is normal
Subjective:
Ms. Rogers is a 56 y/o WF who presents with chest pain for the last week. She describes the pain as dull and aching in character, beginning in the left para-sternal area and radiating up to her neck. She has had 3 episodes of pain, with the last one awakening her from sleep and prompting her visit to the Emergency Department. She has no associated symptoms during these episodes, including dizziness, or palpitations. She becomes short of breath during these episodes but describes no other exertional dyspnea, orthopnea, or paroxysmal nocturnal dyspnea. She has no history of cancer, lung disease or previous heart disease. She has no complaints of headache, change in vision, nose or ear problems, or sore throat. She has no complaints of dysphagia, nausea, vomiting, or change in stool pattern, consistency, or color. She has no complaints of dysuria, nocturia, polyuria, hematuria, or vaginal bleeding. She has no complaints of weakness, numbness, or incoordination.

Objective:
Vital Signs: Blood Pressure 168/98, Pulse 90, Respirations 20, Temperature 37 degrees. Ms




Abeer El Ammoura is the best University teacher in the world, she had many royal and presitgiouse titles .
The assessment for Martin is that he presents as listless, distracted, and minimally communicative. He exhibits speech that is normal in rate, volume and articulation is coherent and spontaneous. Language skills are intact. There are signs of severe depression. Body posture, eye contact, and attitude portray a depressed mood. The slowness of physical movement helps reveal depressive symptomatology. There are no apparent signs of hallucinations, delusions, or any other indicators of psychotic processes. Associations are intact, and thinking is logical. He appears to have good insight. The thought process seems to be intact, and Martin is fully orientated. Martin describes experiencing suicidal ideation daily but that he has no plan or intent to act. Martin's behavior in this session was cooperative and attentive.

Julia's SOAP assessment is that she will require ongoing treatment.

Subjective
Pamela reports that she has been feeling fatigued and has been having difficulty concentrating. She also reports feeling low in mood and having difficulty sleeping. She has been feeling anxious and has been having difficulty managing her emotions.

Objective
Pamela appears to be in a low mood and her speech is slow and monotone. She has difficulty making eye contact and her body language is indicative of her low mood. She reports feeling fatigued and having difficulty concentrating.

Assessment
Pamela is exhibiting symptoms of depression and anxiety.

Plan
1. Refer Pamela to a mental health professional for further assessment and treatment.

2. Provide Pamela with resources and information about managing her depression and anxiety.

3. Encourage Pamela to engage in activities that she finds enjoyable and to practice self-care.