card ihuman
.pdf
keyboard_arrow_up
School
Chamberlain College of Nursing *
*We aren’t endorsed by this school
Course
578
Subject
Medicine
Date
Apr 3, 2024
Type
Pages
11
Uploaded by DeaconRockPorpoise26
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).
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help