therapy (Zosyn 3.375 g IV every 6 hours for 7 days), and

therapy (Zosyn 3.375 g IV every 6 hours for 7 days), and nothing per mouth (Vollmer, 2021). Zofran 4mg IV every 6 hours as needed for nausea/vomiting. POC blood glucose every 4 hours to monitor for hypoglycemia due to NPO status. Non-pharmacologic therapies may consist of cool wash cloth to head and neck for nausea. Keep head of bed elevated. Consider NG tube insertion if emesis persists after used of Zofran. Health Promotion: Pap smear and lipid panel previously performed at visit 4 months ago. Mammogram previously ordered at visit 4 months ago using walk-in clinic service, follow up on completion of testing and results. Breast Cancer Screening: With family history of breast cancer in first degree relative- mammograms yearly and consider BRCA gene testing. Colorectal Cancer Screening: Grade B recommendation for adults aged 45-49 (US Preventive Services Task Force, 2021a). Prediabetes/Type 2 Diabetes Screening: Grade B recommendation for adults ages 35-70 who are overweight or obese (US Preventive Services Task Force, 2021b). Order hemoglobin A1C, due to age and BMI of 27.4. Immunizations: yearly influenza vaccine, Covid series including booster if eligible, tdap every 10 years Patient education: The gallbladder is a small organ that is a part of your gastrointestinal system which stores and excrete bile to help the body break down fat. Gallstones can form and clog the organ. In your case the gallstones have caused symptoms such as the abdominal pain, right shoulder pain, nausea, and vomiting. You need to be admitted to the hospital because according to the tests we ran you may have a clogged duct leading to inflammation and infection. This is not a disease process that is typically treated as an outpatient. You may require surgery or additional testing such as an MRCP to look at the ducts. The surgery which may be needed is called a cholecystectomy. It is a very common procedure performed and is often done laparoscopically and can sometimes be performed as an outpatient procedure. The procedure itself does have some risks since anesthesia is required, but after the gallbladder is removed there will be no return of gallstones. You have an increased risk of forming gallstones when you are overweight (Crowley & Martin, 2022). After discharge, and you are cleared to resume a regular diet, try to increase your compliance with your diet by devoting one day a week to meal prep. This allows you to have meals already packed and ready to eat when you are in the middle of your busy day and decreases the incidence of eating fast food. Additionally, for your knee pain it is ok to take some ibuprofen, but you may try to alternate between ibuprofen and acetaminophen to prevent injury to your stomach lining. Try ice, rest, and elevation of knees at the end of a long day. You can also use OTC topicals such as BioFreeze, Tiger Balm, or Voltaren gel. Your knee pain may decrease with weight loss. If not, we can look at consulting Orthopedics in the future. Disposition/follow-up instructions: Follow up in clinic 1-3 weeks after discharge. If gallbladder is removed, decrease fat in diet and eat small meals. Avoid any strenuous activities or lifting. Take pain medication as prescribed. Contact physician if pain is not adequately controlled. If you have symptoms of infection such as fever/chills or bleeding, contact office sooner for an appointment. Get plenty of res