NR 509 Week 6 iHuman Virtual Patient Encounter Attempt 3820443 - Kathleen Parks
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History Notecard by Dara Heaston on case Kathleen Parks 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= Sx= Sx= Sx= Sx= Sx= CC Provided Headache Nausea/Vomiting How can I help you? Any other symptoms? HPI Onset/events Location Duration Characteristics Aggravating Reliving Severity What this means Attempt: 3820443 Report generated on 2/12/2026, 9:07:54 PM America/Denver Management Plan by Dara Heaston on case Kathleen Parks Prescribe Sumatriptan 50 mg by mouth at onset of migraine. Dispense #12 tablets, no refills. When NSAIDs or acetaminophen are contraindicated, ineffective, or when migraine pain is moderate to severe, triptans or combination medications are recommended as second-line therapy. All seven available triptans are supported by the Canadian Headache Society, American Headache Society, International Headache Society, and Danish Headache Society, with eletriptan, rizatriptan, sumatriptan, and zolmitriptan identified as among the most efficacious options. Selection of a triptan should be individualized based on patient presentation, history, and preference (El Hussein & Fraser, 2025) Continue NSAIDs like Ibuprofen and acetaminophen as these are recommended as first-line treatment for mild to moderate acute migraine per the American Headache Society. Can take over the counter medication such as Excedrin which is a combination analgesic therapy containing acetaminophen 500 mg, aspirin 500 mg, and caffeine 130 mg. El Hussein and Fraser (2025) reported that this combination was more effective in migraine management compared with 50 mg of sumatriptan in a randomized controlled trial. Ondansetron 4 mg orally disintegrating tablet, one tablet every 6 hours as needed for nausea and vomiting. Dispense #12 tablets, no refills. Education Medication education including side effects from NSAID’s including epigastric pain, GI bleeding/ulceration, heartburn. Education on the concurrent use with other acetaminophen or NSAID-containing products caffeine can cause nervousness, agitation, sleeplessness, rapid heartbeat Patient educated that preventive migraine therapy may be indicated if has greater than four migraine days per month that do not respond to acute treatment or acute medications are not tolerated. Maintain headache diary to monitor frequency, duration, triggers, and medication response. Encourage regular sleep schedule and adequate hydration. Avoid known triggers including stress, missed meals, and excessive caffeine. Encourage routine aerobic exercise as tolerated. Recommend stress-reduction techniques. Follow Up Educate on red flag symptoms that require urgent evaluation at an Emergency Department including sudden severe headache, thunderclap onset, new neurological deficits, vision loss, fever, confusion, weakness, or persistent vomiting. Follow up in 4–6 weeks to assess medication tolerance and symptom response, and to review the headache diary. No referral is needed at this time if the patient reaches the third-line intervention and does not experience relief; may refer to a Neurologist at this time. El Hussein, M. T., & Fraser, L. (2025). Pharmacologic management of
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