Age: 77.0
Sex: M
Vaccine: FLU3
Symptoms: Protein urine present, Restlessness, Specific gravity urine normal, Urine bilirubin decreased, Urine ketone body present
Clinical narrative: Reason for Visit: Assessment requested by S/O: Patient reportedly presented for MH eval for concerns of sudden onset of anxiety, and restlessness. D/t concerns for potential medical contribution to sx, MH requesting nursing assessment. Patient is outside ambulating in lawn across from parking lot; wife waiting in lobby. Patient is A/O x3, gait steady, clean, well kempt. Patient states he is doing ok, he just starting feeling like he needed some air and needed to get outside. MH worker also present. Patient agrees to MH worker, and wife being present. Patient agrees to notify staff if less people during assessment are desired or more space is needed. Patient agrees to UA. Patient denies urinary sx. Urine dark yellow/concentrated, clear. Per POC UA: Glu - BIL - Ket 15 mg/dL SG 1.025 BLO - pH 5.5 PRO Trace URO 0.2 E.U./dL NIT - LEU - Denies h/o DM. Glucose 100. Patient reports he has had approx. 7 day h/o feelings of anxiety and restlessness, feeling uneasy. Veteran c/o sudden onset of claustrophobic-like sx. Patient states when he is in confined spaces, even when in home--rooms with  others, rooms with doors shut, or just sometimes rooms in general, he begins feeling anxious, restless, diaphoretic, begins pacing, and feeling extremely uncomfortable. Veteran reports uneasy feeling in stomach. Patient reports h/o constipation. Reports last BM was approx. 2 days ago, states this is normal for him and he does take Miralax prn. States he did try laxative today to try to ease his stomach uneasiness, but this was not helpful. Abd soft, non-tender, non-distended. BS hypo x4. Veteran reports he is generally healthy. Reports h/o occasional difficulty with SAD; reports that he has used lamps for this before. Patient reports he has tried this with this episode, and it has not been helpful in relieving sx. Patient denies similarity of current sx with previous sx of SAD. Patient and  wife do admit that patient did have sx somewhat similar approx. 15 years ago after patient's retirement. Patient denies recent life changes, increased stressors, onset of personal or family illness.  Patient reports that he works out at the community center 3x/wk. Patient admits that he did complete this routine this week. Reports decreased appetite and po intake. States he did not have breakfast, had a light lunch, and light dinner yesterday. Wife reports last night she made patient's favorite hot dish and raisin cake; states he only had a small portion of each, he just was not interested. Reports that Patient does have an occasional beer with his meal, but mostly drinks water. Veteran adds, that he hardly ever even finishes his beer. Patient states he has not been drinking much water lately either. Wife states she did try to give patient some sleepy time tea to help him be more restful; this was not effective. Patient reports he has had a 4# weight loss recently. States he is always trying to lose weight, so he is pleased with this. Patient admits that he has not been sleeping well in the last week either. Reports having difficulty falling asleep and staying asleep; reported change from previous. Denies pain, other than reported chronic L knee pain. Denies change in pain or concerns. PERRLA 3. NISS 0. Skin pink, warm, dry. Small areas of bruising noted. Patient reports this does happen sometimes. 2+ pitting edema RLE with hemosiderin staining noted. Patient reports this has been unchanged since h/o DVT. - homans. 2+ DTR. CRT 2-3. Lungs clear t/o. RR even and unlabored. HR reg, WNL. Patient denies joint pain or concerns of tick bites. Denies fevers or chills. Patient does admit that he had a flu shot a little over a week ago. Per review of records, flu shot was 9/21/17. Patient denies h/o known vaccination reaction. T 98.7, P 74, R 16, BP 120/75, SPO2 94% RA.