REVIEW OF SYSTEMS: CONSTITUTIONAL: He has chronic morbid obesity. He has markedly limited exercise tolerance due to obesity and dyspnea. HEENT: No blurred vision, no hearing loss, no sore throat or dysphagia. RESPIRATORY: Chronic shortness of breath with multiple previous intubations. He currently has a tracheostomy. CARDIOVASCULAR: Chronic right heart failure. Echocardiogram was obtained on most recent admission here in July, but this was a severely limited study and showed probably normal left ventricular systolic function. GASTROINTESTINAL: No heart burn, indigestion, constipation, or diarrhea. GENITOURINARY: He reports recent decrease in urine output. No hematuria or nocturia. MUSCULOSKELETAL: Chronic lower extremity edema and recurrent DVT. No current complaint of calf pain. NEUROLOGIC: No headache, dizziness or paresthesias. PSYCHIATRIC: He has chronic undifferentiated schizophrenia. He has been seen by Psychiatry on several admissions here in the past. Recommendation has always been for continuation of current dose of Risperdal.
REVIEW OF SYSTEMS:
CONSTITUTIONAL: Negative for fever, weight loss or weight gain.
EYES: Negative for glaucoma. Positive for questionable cataract on the left.
EARS: Negative for pain. Positive for decreased hearing.
NOSE: Positive for nasal congestion. Negative for rhinorrhea or postnasal drip.
MOUTH: Negative for false teeth.
THROAT: Negative for masses or hoarseness. Positive for snoring.
CARDIOVASCULAR: Negative for chest pain or palpitations.
RESPIRATORY: See HPI.
GASTROINTESTINAL: Negative for nausea, vomiting, diarrhea or heartburn.
GENITOURINARY: Negative for dysuria.
MUSCULOSKELETAL: Positive for arthritis, spinal stenosis.
SKIN: Negative for hives or rashes.
NEUROLOGIC: Negative for headaches or loss of consciousness.
PSYCHIATRIC: Positive for daytime sleepiness and depression. Negative for insomnia.
ENDOCRINE: Positive for diabetes. Negative for thyroid abnormalities.
HEMATOLOGIC: Negative for anemia or blood dyscrasias.
ALLERGIES: Negative for insect stings or food. Positive for seasonal allergies.
REVIEW OF SYSTEMS: CONSTITUTIONAL: Fever and chills as noted above in addition to night sweats and rigors. Also, he had complaints of weakness for the past couple of week at least. The symptoms otherwise have been intermittent in nature. He does have decreased appetite, but he does not believe that he has lost weight. CARDIAC: No chest pain, orthopnea or palpitation. RESPIRATORY: Occasional cough and also recent history of sinus complaints. No wheezing reported. No shortness of breath. GASTROINTESTINAL: No nausea or emesis. No GI bleed. GENITOURINARY: No dysuria, polyuria or hematuria. NEUROLOGIC: There is no TIA or CVA, but he has had muscle aches recently.
REVIEW OF SYSTEMS: Constitutional: No recent fevers or chills but generalized weakness and fatigability. Eyes: No visual changes. ENT: No hearing loss. Cardiovascular: Intermittent claudication down the left lower extremity. No chest pain relieved at rest with exertion. Respiratory: Mild to moderate dyspnea on exertion without orthopnea or PND. GI: No nausea, vomiting, hematochezia. GU: No dysuria or hematuria. Neurologic: Lightheadedness as above. No slurred speech. Endocrine: Denies heat or cold intolerance. Hematologic: Intact. Some easy bruisability.
REVIEW OF SYSTEMS: She denies any history of bleeding or clotting diathesis. There is no history of myocardial infarction, coronary artery disease, congestive heart failure or valvular disease. She has a good functional capacity, uses her bicycle quite frequently, and walks without any issues. No history of diabetes, TIAs, or strokes.
REVIEW OF SYSTEMS:
CONSTITUTIONAL: No significant weight changes.
CARDIOVASCULAR: No history of MI, recent coronary artery disease or heart failure noted. The patient has lymphedema as noted above.
RESPIRATORY: No history of asthma or lung disease other than history of sleep apnea in the past. Currently not on CPAP.
GASTROINTESTINAL: Abdomen, unremarkable.
GENITOURINARY: Unremarkable
ENDOCRINE: No history of diabetes or thyroid disease.
NEUROLOGIC: No history of stroke, weakness or paresthesias noted.
REVIEW OF SYSTEMS:
CONSTITUTIONAL: No recent weight change, fever, chills, night sweats or rashes, development of lumps or bumps other than present.
HEENT: No head, ear, eye, nose or throat pain. No change in vision or hearing.
CARDIAC: Chest tightness on hemodialysis with hypertension as above. No palpitations. No loss of consciousness.
PULMONARY: No cough. No postnasal drip. No dyspnea on exertion.
GASTROINTESTINAL: No nausea, vomiting, diarrhea, constipation, abdominal pain, hematochezia, melena or hematemesis.
GENITOURINARY: Still produces urine. No dysuria.
MUSCULOSKELETAL: No joint pain. No muscle weakness.
SKIN: No rashes. No skin breakdown. No itching.
PSYCHIATRIC: No mood disorder. No deterioration.
NEUROLOGIC: No history of seizures, intermittent weakness, CVAs, change of vision or hearing. Normal gait.
HEMATOLOGY/ONCOLOGY: No history of cancer, easy bruising.
ENDOCRINE: History of diabetes. No history of thyroid or other craniological disorder.
REVIEW OF SYSTEMS:
CONSTITUTIONAL: Negative for fevers or chills.
HEENT: No headache or visual changes.
CARDIOVASCULAR: No chest pain or shortness of breath or abdominal pain.
GASTROINTESTINAL: No nausea, vomiting, diarrhea or constipation. No hematemesis, melena or hematochezia.
GENITOURINARY: Symptoms as per HPI.
EXTREMITIES: No leg swelling or rashes.
PSYCHIATRIC: No depression or hallucination.
All other systems are negative.
