NU-664B Week 7 Assignment 1: IHuman Simulation

Value: 100 points

Due: 7

Gradebook Category: Assignments—iHuman Assignments

nu-664b week 7 assignment 1: ihuman simulation

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Introduction

The iHuman platform is an opportunity for you to interact with a simulated patient and gather data. When working in iHuman, practice as if this were a real patient. For example, the platform allows you to ask several questions when taking a patient history. In real life, you likely will be limited in time. Practice setting yourself a patient history time limit and work on being efficient in your clinical interview.

If you require technical support with the iHuman platform, use the iHuman Help Center to contact iHuman Technical Support directly. Technical support only includes a malfunction of the platform; they cannot help with issues involving content!

Instructions

In this assignment, you will review a patient scenario in iHuman. Please see the course announcement for the case assigned this week. Your deliverable for this assignment is a paper based on the iHuman Soap Note Template (Word).

  • Follow the requirements listed in the iHuman Soap Note Template.
  • When your iHuman Soap Note Template is complete, upload it to this assignment.

All papers must conform to the most recent APA standards.

Please refer to the Grading Rubric for details on how this assessment and plan is graded.

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Differential Diagnoses: 

  1. Essential hypertension: This is elevated blood pressure, stage 1 is blood pressure that is 130-139/80-89 mm Hg and stage 2 is blood pressure that is over 140/90 mm Hg (Dunphy, 2019, p. 463). Hypertension occurs due to genetic or environmental reasons (Dunphy et al., 2019, p. 461). Four weeks ago the patient’s blood pressure was 160/90 mm Hg and today her blood pressure is 140/85 mm Hg on 2 measurements and her HR is 50. The patient reports some vision changes, she drinks wine three times a week, is a former smoker, feels stressed all the time, and does not exercise. All of the above factors can contribute to her having hypertension. A diagnosis of hypertension is made when the patient has had several visits with high blood pressure (Dunphy et al., 2019, p. 461). 
  2. Congestive Heart Failure: This occurs when cardiac output cannot meet the demands of the body (Dunphy, 2019, p. 493). Some of the symptoms of heart failure are peripheral edema, shortness of breath, nausea, abdominal pain, fatigue, weakness, anxiety, and headache (Dunphy et al., 2019, 493). The patient has +2 bilateral pitting edema, elevated creatinine (2.0), shortness of breath prior to starting atenolol, and feels tired, which may be related to work. This condition should be ruled out with an electrocardiogram (ECG), labs: natriuretic peptide, troponin, complete blood count, and liver function test (Colucci & Borlaug, 2023) 
  3. Chronic Kidney Disease: This occurs when there is damage to the kidney for over three months, which can lead to hypertension, peripheral edema, fatigue, weakness, nausea, increased creatinine, and low glomerular filtration rate (GFR) (Fatehi & Hsu, 2023). The patient has several of these symptoms, it is possible she has chronic kidney disease or some level of kidney damage. In order to rule this out, a physical exam, including history, labs: basic metabolic profile (BMP), complete blood count (CBC), urinalysis, and an ultrasound of the kidneys should be done (Fatehi & Hsu, 2023). 
  4. Diabetes Mellitus (DM): Diabetes is a complication that leads to high blood sugar as a result of a lack of insulin (Dunphy et al., 2019, p. 909). Some of the symptoms of diabetes include vision changes, fatigue, and an increase in urination and thirst (Dunphy et al., 2019, 912). The patient has complaints of vision change, on exam, she had cotton wool spots, this diagnosis is unlikely but it is important to exclude. In order to diagnose diabetes a glycosylated hemoglobin should be drawn (A1C), a random blood sugar, and fasting blood sugars should be measured (Dunphy et al., 2019, p. 912). 

Diagnosis: Essential Hypertension   

Pharmacology- 

  1. Gradually taper Atenolol – although the patient’s blood pressure decreased with this medication, the patient’s heart rate is 50 and is still hypertensive with symptoms (Rehman, Sanchez, Shah, 2022).
  2. Lisinopril 5 mg daily -because the patient may have DM or kidney impairment. (Lisinopril: Drug information, 2023).
  3. I would consider starting a thiazide diuretic if the patient returns and still has edema and uncontrolled hypertension-

Chlorthalidone 12.5 daily (Chlorthalidone: Drug information, 2023).

Nonpharmacology –

  1. Measure blood pressure at home several times a day- I would verify the cuff and technique are appropriate (Mann & Flack, 2023). 
  2. Salt restriction
  3. Weight loss 
  4. Dietary Approaches to Stop Hypertension (DASH) diet 
  5. Exercise
  6. Limit alcohol intake 

(Basile & Block, 2023). 

Labs/Diagnostics- 

  1. EKG(Colucci & Borlaug, 2023) 
  2. Natuiretic peptide (BNP) (Colucci & Borlaug, 2023) 
  3. Troponins (Colucci & Borlaug, 2023) 
  4. Complete Blood Count (Colucci & Borlaug, 2023) 
  5. Serum electrolytes (Colucci & Borlaug, 2023) 
  6. Hepatic panel (Colucci & Borlaug, 2023) 
  7. Urinalysis (Fatehi & Hsu, 2023). 
  8. Ultrasound of the kidneys (Fatehi & Hsu, 2023).
  9. A1C, random blood glucose, and fasting glucose (Dunphy et al., 2019, p. 912). 

Referrals/Interprofessional Communications- 

A referral would be necessary if the patient had uncontrolled hypertension for further management to a cardiologist or emergency department or if other organs are affected that require a specialist (Dunphy, 2019, p. 471).  

Patient Education

  1. Take medication exactly as prescribed (Dunphy et al., 2019, p. 471). 
  2. Avoid changing positions quickly, the abrupt movement can cause you to feel lightheaded or dizzy (Dunphy et al., 2019, p. 472). 
  3. The goal is for your blood pressure to be ≤140/90 (Dunphy et al., p. 464). 
  4. Lose weight to help lower your blood pressure (Patient education, controlling your blood pressure through lifestyle, 2023). 
  5. Do not have more than one drink a day (Patient education, controlling your blood pressure through lifestyle, 2023). 
  6. Engage in physical activity for at least thirty minutes on more days than less (Patient education, controlling your blood pressure through lifestyle, 2023). 
  7. Adhere to a low-salt diet, <2300 mg a day (Patient education, low sodium diet. The basics, 2023). 
  8. Avoid foods that are high in salt such as canned foods, frozen meals, smoked fish, and cheese (Patient education, low sodium diet. The basics, 2023). 
  9. Lowering your blood pressure can help lower your chance of complications such as having a stroke (Patient education, controlling your blood pressure through lifestyle, 2023). 
  10. Avoid medications such as NSAIDs, and decongestants, as they can increase your blood pressure (Dunphy et al., 2019, p. 471). 
  11. Avoid smoking and drug use, these things can increase your blood pressure, negating the effects of the medications you are taking (Dunphy et al, 2019, p. 471). 
  12. Please follow up with your provider as advised, it is important to follow up on medication management (Dunphy et al., 2019, p. 471). 

Follow up – Follow up in two weeks for blood pressure and lab check. When the blood pressure and creatinine are within normal limits, follow-up can be every three months (Dunphy et al., 2019, p. 471). 

Health maintenance – A major factor in lowering hypertension is related to lifestyle. It is important to stress the significance of modifiable lifestyle changes to patients. At each visit, educate patients on important topics to help them understand the correlation between healthy lifestyle changes and blood pressure (Dunphy et al., 2019, p. 472). An example of a modifiable risk factor is a sedentary lifestyle, teaching patients about why it is helpful to engage in physical activity for a least thirty minutes a day is important (Patient education, controlling your blood pressure through lifestyle, 2023). 

Social determinant – One of the goals of Health People 2030 is to reach health equity (Gomez et al., 2021, p. 250). The patient arrived late, and she is stressed, it is important to understand how a patient’s hardship or situation may affect their health. It is good to be able to care for the patient and help them feel comfortable during their appointment. Approaching care with this mentality can help eliminate disparities in healthcare, and allow for all patients to have a fair chance in improving their health (Gomez et al., 2021, p. 251). 

REFERENCES

Basile, J., Block, M. (2023). Overview of hypertension in adults. UpToDate. Retrieved on February 11, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/overview-of-hypertension-in-adults?search=hypertension&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H27 

Colucci, W., Borlaug, B. (2023). Heart failure, clinical manifestations and diagnosis in adults. UpToDate. Retrieved on February 11, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/heart-failure-clinical-manifestations-and-diagnosis-in-adults?search=chronic%20heart%20failure%20&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H13 

Chlorthalidone: Drug information. (2023). UpToDate. Retrieved on February 11, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/chlorthalidone-drug-information?search=hypertension%20&topicRef=3869&source=see_link#F150699

Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary care: Art and science of advanced practice nursing – An interprofessional approach. (5th ed.). Philadelphia, P.A., F.A. Davis.

Fatehi, P., Hsu, C. (2023). Chronic kidney disease (newly identified): clinical presentation and diagnostic approach in adults. UpToDate. Retrieved on February 11, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/chronic-kidney-disease-newly-identified-clinical-presentation-and-diagnostic-approach-in-adults?search=chronic%20kidney%20disease&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H3359532190 

Lisinopril: Drug information. (2023). UpToDate. Retrieved on February 11, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/lisinopril-drug-information?source=auto_suggest&selectedTitle=1~2—1~2—lisino&search=lisinopril 

Mann, J., Flack, J. (2023) Choice of drug therapy in primary (essential) hypertension. UpToDate. Retrieved on February 11, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/choice-of-drug-therapy-in-primary-essential-hypertension?search=hypertension&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H925312723 

Patient education: Controlling your blood pressure through lifestyle: the basics. (2023). UpToDate. Retrieved on February 11, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/controlling-your-blood-pressure-through-lifestyle-the-basics?search=hypertension&topicRef=15329&source=see_link 

Patient education: low sodium diet: the basics. (2023). UpToDate. Retrieved on February 11, 2023, from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/low-sodium-diet-the-basics?search=hypertension&topicRef=15329&source=see_link 

Rehman B, Sanchez DP, Shah S.(2022). Atenolol. StatPearls Publishing; Available from: https://www.ncbi.nlm.nih.gov/books/NBK539844/