R.T. is a 64-year-old man who went to his primary care
provider's office for a yearly examination. He initially
reported having no new health problems; however, on further questioning, he admitted to having
developed some fatigue, abdominal bloating, and intermittent constipation. His physical examination
findings were normal except for stool positive for occult blood. He had a complete blood count (CBC) with
differential, basic metabolic panel (BMP), and carcinoembryonic antigen (CEA) testing and was referred
to a gastroenterologist for a colonoscopy. Colonoscopy revealed a 5-cm mass in the sigmoid colon, which
was diagnosed as adenocarcinoma of the colon. A distant metastatic workup is negative, and R.T. is being
scheduled for a laparoscopic sigmoidectomy with anastomosis.
Please help me write an SBAR for this case
Here is the situation : Mr R.T. is having some fatigue, abdominal bloating and intermittent constipation.
The supporting background information is that he is positive for occult blood .He had a complete blood count ( CBC ) with differential, basic metabolic panel (BMP ) and carcinoembryonic antigen (CEA ) testing and Colonoscopy. Colonoscopy revealed 5 cm mass in sigmoid colon
My assessment of the situation is that he has adenocarcinoma of Colon
Recommendation for laparoscopic sigmoidectomy with anastomosis.
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