Need Soap Note in the same format as I have it in the attachment.  Needs to be 100% Plagiarism free.  No excuses on it not from Internet or any University either.  Please check turnit in before submitting it. 3-4 references as well.  Its on womens Health. Please see the attached paper. Thank You

SOAP Note

Patient Name: Jane Doe
Date: October 10, 2021

Subjective:
The patient, Jane Doe, is a 35-year-old female who presents with complaints of irregular menstrual cycles and lower abdominal pain. She reports that her menstrual cycles have become increasingly irregular over the past year, with cycles ranging from 21 to 45 days in length. She describes the pain as a dull ache that is present throughout her menstrual cycle and is worsened during menstruation. The pain is localized in the lower abdomen and does not radiate. She denies any associated symptoms such as dyspareunia, dysuria, or abnormal vaginal discharge. The patient reports no significant medical history and is not taking any medications or contraceptives.

Objective:
– Vital Signs:
– Blood pressure: 120/80 mmHg
– Heart rate: 72 beats per minute
– Respiratory rate: 16 breaths per minute
– Temperature: 98.6°F

– Physical Examination:
– General appearance: The patient appears well-nourished and in no acute distress.
– Abdomen: The abdomen is soft, non-tender, and non-distended. No masses or organomegaly appreciated on palpation. No rebound tenderness or guarding observed.
– Pelvic examination:
– External genitalia: No abnormalities observed.
– Speculum examination: Normal appearing cervix with no lesions or discharge. No cervical motion tenderness.
– Bimanual examination: Uterus is midline and of normal size. No adnexal masses or tenderness appreciated.

Assessment:
Based on the patient’s symptoms and physical examination findings, the following differential diagnoses are considered:

1. Primary dysmenorrhea: The patient’s symptoms are consistent with primary dysmenorrhea, which is characterized by painful menstrual cramps without an identifiable pelvic pathology. This condition typically begins in adolescence and can persist into adulthood. It is often associated with prostaglandin release during menstruation, leading to uterine contractions and pain.

2. Secondary dysmenorrhea: Secondary dysmenorrhea refers to menstrual pain caused by an underlying pelvic pathology. Conditions such as endometriosis, adenomyosis, pelvic inflammatory disease, and uterine fibroids can lead to secondary dysmenorrhea. Further investigations are needed to rule out these conditions.

3. Ovarian cyst: The patient’s lower abdominal pain could be attributed to the presence of an ovarian cyst. Ovarian cysts can cause pain and irregular menstrual cycles. Imaging studies, such as ultrasound, may be necessary to evaluate for the presence of ovarian cysts.

4. Hormonal imbalance: Hormonal imbalances, such as polycystic ovary syndrome (PCOS), can result in irregular menstrual cycles and lower abdominal pain. However, the absence of other associated symptoms of PCOS makes this diagnosis less likely.

Plan:
1. Further investigations:
– Pelvic ultrasound: To evaluate the pelvic organs and assess for the presence of any abnormalities, such as ovarian cysts or uterine fibroids.
– Complete blood count (CBC): To assess for signs of infection or anemia.
– Hormonal panel: To evaluate hormone levels and rule out hormonal imbalances.
– Cervical cultures: To screen for any infectious causes of the patient’s symptoms.

2. Symptom management:
– Nonsteroidal anti-inflammatory drugs (NSAIDs): Advise the patient to take over-the-counter NSAIDs, such as ibuprofen, for pain relief during menstruation.
– Heat therapy: Encourage the use of heat packs or warm baths to alleviate abdominal discomfort.
– Lifestyle modifications: Discuss the importance of regular exercise, a healthy diet, and stress reduction techniques in managing menstrual symptoms.

3. Follow-up:
– Schedule a follow-up appointment in two weeks to review the results of investigations and evaluate the effectiveness of symptom management strategies.

References:
1. American College of Obstetricians and Gynecologists. (2018). Dysmenorrhea: Painful periods. ACOG Patient Education Pamphlet.
2. Speroff, L., & Fritz, M. A. (2014). Dysmenorrhea. In Clinical gynecologic endocrinology and infertility (8th ed., pp. 1013-1030). Lippincott Williams & Wilkins.
3. Munro, M. G., Critchley, H. O., Broder, M. S., Fraser, I. S., & FIGO Working Group on Menstrual Disorders. (2011). FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynaecology and Obstetrics, 113(1), 3-13.

Note: This is a fictional case and does not represent an actual patient. The information provided is solely for educational purposes.