Week 7 iHuman Case Study CARDIOVASCULAR SYSTEM

Week 7 iHuman Case Study

ASSESSING THE CARDIOVASCULAR SYSTEM

i-Human Case Week #7

49 y/o

5′ 6″ (168 cm)

158.0 lb (71.8 kg)

Reason for encounter

Intermittent squeezing chest pain

Case Problem Statement

The patient is a 49-year-old female with exertional mid-chest pain described as “squeezing.” Her chest discomfort occurs in extremely cold weather, is accompanied by dyspnea, and relieved by rest. She has a history of hypertension and hypercholesterolemia and a family history of coronary vascular disease. Per physical examination she is mildly overweight; the remainder of the exam is normal.

This course requires you to complete a series of case studies using the i-Human Patients software application. The i-Human Patients (IHP) Case Player enables you to interact with virtual patients for the purpose of learning patient-assessment and diagnostic-reasoning skills. With IHP, you will be able to independently interview, examine, diagnose, and treat virtual patients and receive expert feedback on your performance.

In order to adequately assess the chest region of a patient, advanced practice nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.

Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?

History Questions for Week 7 iHuman Case
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Case Answers: Management Plan

Key elements of the patient’s management include the following:

Determine need for a coronary angiography based on stress-test results and echocardiogram. Her Duke score of 10.5 is slightly above the moderate risk, and arguments could be made for both a trial at medication intervention since the patient needs improvement on both HTN and hypercholesterolemia.
Augment management of preexisting HTN and hypercholesterolemia with a beta blocker (metoprolol 25 mg extended release daily); a statin (atorvastatin 40 mg daily); and aspirin 81 mg daily.
Continue use of hydrochlorothiazide 25 mg daily.
Refer for nutritional counseling (reduced salt, DASH diet) and weight-reduction support, low cholesterol-plant based diet to further reduce CAD risks.
Encourage lifestyle modification:
Decrease intensity of aerobic workouts.
Limit alcohol intake to two drinks per day.