question archive Assignment: i-Human Case Study: Evaluating and Managing Cardiovascular Conditions Because cardiovascular conditions are preventable and manageable, it is important that the advanced practice nurse use both their understanding of the cardiovascular system and the impact of patient factors and behaviors that might increase patient risk of such conditions
Assignment: i-Human Case Study: Evaluating and Managing Cardiovascular Conditions Because cardiovascular conditions are preventable and manageable, it is important that the advanced practice nurse use both their understanding of the cardiovascular system and the impact of patient factors and behaviors that might increase patient risk of such conditions
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Assignment: i-Human Case Study: Evaluating and Managing Cardiovascular Conditions
Because cardiovascular conditions are preventable and manageable, it is important that the advanced practice nurse use both their understanding of the cardiovascular system and the impact of patient factors and behaviors that might increase patient risk of such conditions. This critical information can guide you in immediately identifying signs and symptoms that can inform differential diagnoses and lead to identification of appropriate treatment options and a treatment plan.
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For this Case Study Assignment, you will analyze an i-Human simulation case study about an adult patient with a cardiovascular condition. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient.
To prepare:
- Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with cardiovascular conditions.
- Access i-Human from this week’s Learning Resources and review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. Reflect on how the results would be used to make a diagnosis.
- Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.
- Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
- Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with cardiovascular conditions.
Assignment
As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Graduate Programs Help link within the i-Human platform.
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I-Human Case Study: Evaluating and Managing Cardiovascular Conditions
Patient Information
Initials: HH
Age: 57 years.
Sex: Male
Race: Hispanic.
Subjective
Chief complaint (CC): “My blood pressure is too high, and I am here to have it evaluated.”
HPI: A 57-year-old Hispanic male comes to the office complaining of elevated blood pressure. He reports having headaches in the morning that make him tired all day. He says he feels more tired than he felt ten years ago. He also reports fatigue that started about six months ago. He denies any patterns and says that the fatigue occurs just during the day. He also reports not sleeping too well because he wakes up a lot. He reports no aggravating or relieving factors for the fatigue. He says he is taking ibuprofen that helps ease his headache.
Past Medical History – He reports ACL knee surgery
Medication – He denies taking prescribed medications.
Allergies – He denies any allergy.
Social History – He is a father and husband. He works in construction, mostly doing flooring installation. He reports taking alcohol occasionally.
Family History – He denies a family history of fatigue or tiredness. He says that his brother and uncle were diagnosed with hypertension in their 40s. His father succumbed to a stroke, and his mother has diabetes.
Health Maintenance – He reports receiving all childhood immunizations. He denies having a flu shot this year. He does not engage in regular physical activity, reports high salt intake.
Review of Systems
- General – He reports fatigue and denies fever.
- HEENT – He reports headaches and denies trauma. He also denies nasal congestion.
- Neck – He denied neck pain but denied changes in flexibility.
- Respiratory – He denied breathing problems.
- Cardiovascular – He reports elevated blood pressure and denies pounding sensation.
- Gastrointestinal – He denies changes in appetite, nausea, vomiting, or bowel movement.
- Musculoskeletal – He reports fatigue and denies difficulty performing activities of daily living.
- Integumentary – He denies bruises.
- Genitourinary – He denies changes in urine color.
- Neurological – He denies generalized weakness, fainting, lightheadedness, and is oriented.
- Lymphatic – He denies swollen lymph nodes.
- Activity – He reports not being able to have as much work done during the day as he used to.
- Sleep/rest – He reports problems sleeping and snoring.
Objective
- Vital signs – BP 172/94, HR- 90, T 98.6 F, BMI
- General – The patient is well-appearing.
- HEENT – Assessment of the head revealed the absence of trauma and hypertensive retinopathy.
- Neck – Assessment of the neck revealed the absence of visible mass, lymphadenopathy, deformity, and this carotid artery is normal to pulsations.
- Lungs – Assessment of the lungs revealed the absence of tachypnea.
- Cardiovascular– Assessment reveals PMI in the left 5th intercostal space at the midclavicular line and a capillary refill time of less than 3 seconds.
- Integumentary – Assessment revealed blanching.
- Neurological – Neurological assessment revealed normal gait and balance.
- Extremities – His distal extremities are adequately perfused.
Assessment
- Essential hypertension – I10
Primary hypertension occurs in patients without a secondary cause (Iqbal & Jamal, 2020). Some of the causes of this disorder include low calcium intake, stress, sedentary lifestyle, aging, high salt intake, alcohol intake, insulin resistance, and obesity. Worth noting, this HH presents with some of the causes of primary hypertension, including overweight, alcohol intake, sedentary lifestyle, and high salt intake.
- Obstructive sleep apnea (OSA) - G44. 81
This is a sleep-connected breathing disorder that causes one to frequently stop and start breathing while sleeping (Slowik & Collen, 2017). This patient presents with sleep problems, headaches, and fatigue, which makes OSA a likely diagnosis.
- Secondary hypertension - I15. 9
This disorder occurs in patients with underlying disorders, such as kidney disease (Charles, Triscott, & Dobbs, 2017). HH's data is unremarkable for underlying conditions from the history and physical exam, making secondary hypertension unlikely diagnosis.
Plan
- Diagnostics tests – Urinalysis, complete blood count, 12 lead electrocardiogram, echocardiogram, polysomnography, chest x-ray, metabolic panel, and free thyroxine.
Results – left-axis deviation, normal urine osmolarity, odor, pH, and clarity, normal metabolic panel, normal CBC with differential, apnea-hypopnea index of 20, left ventricular hypertrophy, and normal free thyroxine.
- Pharmacological – Begin hydrochlorothiazide 25 mg PO qd.
- Patient teaching – Smoking cessation, avoidance of non-steroidal anti-inflammatory drugs to lower the risk of kidney injury, reduction of salt intake, healthy diet and regular exercise to lower body weight, and regular blood pressure assessment.
- Referral – Refer patient to somnologist for continuous positive airway pressure assessment.
