NR 509 Week 5 iHuman Virtual Patient Encounter Attempt 3552188 - Harvey Hoya
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History Notecard by Shabrae' Guinyard on case Harvey Hoya Use this to collect your thoughts to develop a differential diagnosis list. Step 1: Write symptoms (Sx) you have identified in the appropriate column and row. Step 2: Characterize the symptoms using "OLDCARTS" (ie., Onset, Location, Characteristics...etc) in the HPI section. Step 3: Record your thoughts in the space labeled "What this means". Is the disease acute or chronic? Infectious or other?... Timing/treatments Hx Categories Sx= BP 170/92 Sx= knee pain Sx= Sx= Sx= Sx= CC Provided How can I help you? Any other none symptoms? HPI Onset/events recently at health fair slowly crept in over the years Location heart knees Duration years constant Characteristics achy Aggravating unknown Reliving unknown ibuprofen Severity “high enough that the 3-4 pain scale nurse urged me to come in” What this means hypertension? Attempt: 3552188 Report generated on 6/5/2025, 12:42:59 AM America/New_York Management Plan by Shabrae' Guinyard on case Harvey Hoya Management Plan: Diagnostic Test: 12-lead ECG: normal sinus rhythm, 75 BPM CBC w/ differential: normal CMP: normal TSH: normal UA: normal All test results were unremarkable. With a blood pressure reading in the 170s/90s, the patient meets the criteria for Stage 2 hypertension per ACC/AHA guidelines, which recommends prompt initiation of pharmacologic treatment in addition to nonpharmacologic interventions (Whelton et al., 2018). Medications/Treatment: Lisinopril 10 mg 1 tablet by mouth daily, #30 Hydrochlorothiazide 12.5 mg 1 tablet by mouth daily, #30 The ACC/AHA clinical guidelines recommend initiating two first-line agents of different classes in adults with Stage 2 hypertension when the average BP is greater than/equal to 20 mm Hg systolic or greater than/equal to 10 mm Hg diastolic above target. The chosen combination of an ACE inhibitor and a thiazide diuretic is appropriate and supported by evidence for improved outcomes (Whelton et al., 2018). Use of single-pill combination therapy is preferred to improve adherence. Patient Education: Check your blood pressure at home daily. This helps us track how well your treatment is working and prevents us from overtreating. We’ll go over how to use the monitor correctly and when to check it. If you smoke, it’s very important to consider quitting. Smoking raises your blood pressure and increases your risk of heart disease and stroke. We have resources and support programs available to help you stop when you're ready. Physical activity is another powerful tool. Aim for at least 150 minutes of moderate exercise per week— this could be brisk walking, biking, or swimming. You don’t have to do it all at once—spread it out throughout the week. Your diet also plays a big role. I recommend following the DASH diet, which includes lots of fruits, vegetables, whole grains, and low-fat dairy. Try to limit your sodium intake to under 1,500 mg per day, but even cutting back by 1,000 mg can make a difference. If you drink alcohol, try to keep it moderate—that means no more than two drinks per day for men and one for women. Also, if you notice that
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