card ihuman

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School

Chamberlain College of Nursing *

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Course

578

Subject

Medicine

Date

Apr 3, 2024

Type

pdf

Pages

11

Uploaded by DeaconRockPorpoise26

Report
Report generated on 12/3/2023, 7:45:14 AM America/Denver Performance Overview fo The following table summarizes your performance on each section of the case, whether you completed that section or not. Time spent: 7hr 3min 17sec Status: Submitted Case Section Status Your Score Time spent Performance Details History Done 66% 1hr 25min 54sec 100 questions asked, 31 correct, 16 missed relative to the case's list Physical exams Done 100% 23min 35sec 82 exams performed, 16 correct, 0 partially correct, 0 missed relative to the case's list Key findings organization Done 1min 7sec 13 findings listed; 9 listed by the case Problem statement Done 2min 31sec 125 words long; the case's was 67 words Differentials Done 38% 15min 24sec 9 items in the DDx, 3 correct, 5 missed relative to the case's list Differentials ranking Done 38% (lead/alt score) 25% (must not miss score) 0sec Tests Done 75% 1hr 50min 46sec 6 correct tests ordered, 6 extraneous, 2 missed relative to the case's list Diagnosis Done 100% 8sec Management plan Done 2hr 28min 4sec 778 words long; the case's was 111 words Exercises Done 42% (of scored items only) 6min 33sec 3 of 8 correct (of scored items only) 1 partially correct Attempt: 2957890
Report generated on 12/3/2023, 7:45:14 AM America/Denver History Notecard by on case Susi Green Use this worksheet to organize your thoughts before developing a differential diagnosis list. 1. Indicate key symptoms ( Sx ) you have identified from the history. Start with the patient's reason(s) for the encounter and add additional symptoms obtained from further questioning. 2. Characterize the attributes of each symptom using "OLDCARTS" . Capture the details in the appropriate column and row. 3. Review your findings and consider possible diagnoses that may correlate with these symptoms. (Remember to consider the patient's age and risk factors.) Use your ideas to help guide your physical examination in the next section of the case. HPI Sx = Sx = Sx = Sx = Sx = Sx = Onset Location Duration Characteristics Aggravating Relieving Timing / Treatments Severity Attempt: 2957890
Report generated on 12/3/2023, 7:45:14 AM America/Denver Problem Statement by case Susi Green S.G. is a 63 y/o female, presents with sudden shortness of breath and severe difficulty breathing today as she was getting off a plane, had to stop from walking to catch her breath. She also reports difficulty with stairs, needing to stop walking every 10 or 20 yards. She denies SOB at rest, cough, wheezing, BLE swelling, or fever. She also denies any palpitations, chest pain, or excessive sweating. She has a history of HTN, COPD, anxiety, and depression. She also has hy of smoking @19 y/o x17 years. Patient appears to be stressed/anxious. She has elevated BP 155/90, S4 gallop heard at auscultation, RR at 26- labored breathing, O2 sat- 70%. Lung sounds were clear all lung fields, no wheezing/rales; no BLE edema noted. Attempt: 2957890
Diagnosis: CHF/Heart Failure with preserved ejection fraction (HFpEF) DIAGNOSTIC TESTS >12 Lead ECG: Normal sinus rhythm with left ventricular hypertrophy and with left atrial enlargement Serial echocardiograms can find changes in ejection fraction (EF), structural remodeling, and valvular function. ECG provides crucial information including worsening ventricular or valvular function. This can also be used as a follow- up assessment of LVEF and remodeling after a patient receive treatments (American College of Cardiology, 2022). >BNP: high 10 Measurement of BNP and NT-proBNP levels in a suspected cardiac cause of patient with dyspnea symptoms provides an additional diagnostic value to clinical judgment when the cause of dyspnea is vague and the physical examination is ambiguous. In the emergency setting, they are more useful for ruling out HF. The higher levels have high positive predictive value to diagnose heart failure (American College of Cardiology, 2022). >CXR Pulmonary edema, cardiomegaly In patients with suspected heart failure, a chest x-ray is ordered to assess the size of the heart and congestion in the lung. This also detect other cardiac and pulmonary diseases such as pneumonia, that may have caused the symptoms of the patient (American College of Cardiology, 2022). >Troponin I <0.03 Cardiac enzymes such as Troponin confirms if a heart attack has occurred and the extent of the damage (American Heart Association, 2023). >ABG: PaO2 36, SaO2 71% Low oxygen levels is a sign that the heart is not pumping enough oxygen-rich blood to the body, as one of the symptoms of CHF (American Heart Association, 2023). >CBC: WBC 11,100- Mild leukocytosis and Hemoglobin 13.2- mild anemia Abnormal results may indicate a strain on the heart or on other organs, which often results from heart failure. When there is not enough oxygen carried by red blood cells, the heart moves at a faster heart rate to move the small number of cells and becomes overtaxed from the effort (American Heart Association, 2023). MEDICATIONS >Increase frequency of patient's Hydrochlorotiazide to 25 mg 1 tab PO 2x daily To prevent morbidity, patients with HFpEF and hypertension needs to have medication titrated to reach a blood pressure targets in line with the published clinical practice guidelines. Thiazide diuretics such hydrochlorothiazide are considered in patients with hypertension and HF with mild fluid retention. In patients with evidence of congestion or fluid retention, diuretics should be prescribed. This also helps avoid recurrent symptoms (American College of Cardiology, 2022). >Start Jardiance (empagliflozin) 10 mg 1 tab PO daily SGLT2i empagliflozin showed a significant benefit in symptomatic patients with HF with LVEF >40% and elevated natriuretic peptides, according to the study of Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction. The study also found that it showed a significant reduction in total HF hospitalizations, a decrease in eGFR decline, and a fair improvement in quality of life in patients at 52 weeks (American College of Cardiology, 2022).
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