NR 511 Week 5 iHuman Virtual Patient Encounter Attempt 3752448 - Dorothy Jones

History Notecard by Korren King on case Dorothy Jones 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: 3752448 Report generated on 11/30/2025, 6:22:28 PM America/Denver Management Plan by Korren King on case Dorothy Jones 1. Diagnostic tests: CBC: Doing a CBC will check for leukocytosis or anemia, which may indicate infection, bleeding, or inflammation common in small bowel obstruction patients (Beglaibter & Mazeh, 2019). CMP: CMP will look at any electrolyte abnormalities and the patient's renal function, which may happen due to vomiting and dehydration that are associated with bowel obstructions (De-Madaria et al., 2017). CT Abd/Pelvis with contrast: To identify a small bowel obstruction or perforation. Early imaging improves outcomes and can guide a surgical referral (Beglaibter & Mazeh, 2019). Lactic acid: Can look for any potential bowel ischemia or sepsis (Beglaibter & Mazeh, 2019). Lipase: To rule out acute pancreatitis (De-Madaria et al., 2017). 2. Medications: write a specific prescription for each medication, including over-the-counter medications - Lactated Ringers 100ml per hour to correct dehydration and electrolyte imbalances due to vomiting and poor oral intake. Lactated ringers is preferred and improves outcomes while reducing systemic inflammation in acute abdominal problems compared with normal saline (De-Madaria et al., 2017). - Pantoprazole 40mg IV once daily. Protonix can support mucosal protection in suspected ulcer-related symptoms (Lin et al., 2018). - Ondansetron 4mg IV q4h PRN for nausea/vomiting. Zofran is effective for nausea control, but QT prolongation and Torsades de Pointes have been seen when using this medication so EKG and electrolyte monitoring are recommended (Orozco et al., 2023). - Morphine 4mg IV q4h PRN for abdominal pain. Evidence shows that using IV morphine is effective for acute abdominal pain (Akhgar et al., 2021). 3. Suggested consults/referrals - Gastroenterology to evaluate for the suspected small bowel obstruction. - General surgery for suspected small bowel obstruction and possible surgical intervention. - Nutritionist/Dietician due to NPO status and possible alternatives for nutrition if prolonged SBO. - Case management for discharge planning, post-op care, and family support. 4. Client education - Education on small bowel obstructions including causes like previous surgical history, hernias, inflammation, or tumors and typical treatment course including the use of an NG tube, being NPO, and lab monitoring (Beglaibter & Mazeh, 2019). Patient should be educated on each medication that they're being given and it's uses and