Discuss the Mr. Rodriquez’s history that would be pertinent to his gastrointestinal problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

Week 3: Gastrointestinal Discussion

Chief complaint: For the past three days, Mr. Rodriguez has been experiencing nausea and abdominal pain.

HPI: Mr. Rodriguez reported that three days ago he felt discomfort in his abdomen. It has since gotten worse, and radiates down to his back. Also, he complains about nausea but not vomiting and diarrhea. He hasn’t had any fever or chills, and denies any recent weight loss or changes in appetite or bowel habits.

Social history: Mr. Rodriguez, a forty-year-old male lives at home with his wife and their two teenage kids. He works as a contractor for 10 years. He admitted that he smoked 2 packs of cigarettes per day over the last 20 years. On weekends, he only drinks 1 beer and does not smoke illicit drugs.

Family History: His mother died from complications of colon cancer when she was 50 years old; otherwise there are no other significant illnesses reported among family members including siblings or grandparents/parents on either parent’s side of the family tree.

Past Medical History: There is nothing remarkable about Mr. Rodriguez’s medical history except that he has high blood pressure which he manages with medication prescribed by a primary care provider as well as occasional headaches managed with over-the-counter medications such as ibuprofen or acetaminophen when needed; In addition to this there is no history of other medical problems relevant to gastrointestinal problems nor any surgical procedures done in the past related to gastrointestinal issues that would be pertinent here either.

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