NR 511 Week 7 iHuman Virtual Patient Encounter Attempt 3776523 - Virginia Lee

History Notecard by Sydney Smith on case Virginia Lee 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 abd pain 2 days nausea/vomitting x 1day Location mid. abd.,peri-umbilical area Duration intermitent lasting several minutes Characteristics intense wave-like, squeezing from the inside Aggravating eating eating Relieving relief after vomitting Timing / no treatments tried Treatments Severity Attempt: 3776523 Report generated on 2/8/2026, 9:51:49 AM America/Denver Management Plan by Sydney Smith on case Virginia Lee Diagnostic Labs Labs: CBC, CMP (electrolytes/renal function), magnesium, phosphate, serum lactate, lipase, CRP (optional), urinalysis, type & screen. Rationale: Serum lactate helps screen for ischemia or strangulation in SBO (Schick, 2023). Imaging: CT abdomen/pelvis with IV contrast is first-line to confirm SBO, locate transition point, and evaluate for ischemia. Consider oral water-soluble contrast per protocol. Plain radiographs are less sensitive and specific. Initial ED Management Bowel rest: NPO IV fluids: Isotonic crystalloid resuscitation; correct electrolyte abnormalities (K⁺, Cl⁻, Mg²⁺) Nasogastric tube decompression: For persistent vomiting or severe distention Symptom management: Analgesia and antiemetics; avoid routine opioids if they may obscure exam findings, but treat pain appropriately Consult: Early surgical consultation for potential operative intervention Evidence: Most adhesive SBOs may begin with non-operative management if there are no signs of peritonitis, ischemia, or strangulation; urgent surgery is indicated if CT or exam shows complications or if clinical deterioration occurs (SAEM, 2026). Disposition Admit for serial abdominal exams, intake/output monitoring, and repeated laboratory assessment Reassess after fluid resuscitation and NG decompression Proceed to surgery (adhesiolysis) if conservative management fails or if there is evidence of ischemia, strangulation, or clinical deterioration Patient Counseling Likely adhesive SBO related to prior abdominal surgeries Explain planned testing, including labs, imaging, and possible use of NG tube Discuss potential need for surgery if bowel compromise is suspected or if non-operative measures fail Reinforce symptom monitoring and the importance of reporting worsening pain, vomiting, or decreased urine output References (APA 7th edition) Schick, M. A. (2023). Small bowel obstruction. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK448079/ SAEM Clinical Resource. (2026). Small bowel obstruction: ED evaluation and management. Society for Academic Emergency Medicine. https://www.saem.org/about-saem/academies-interest-groups- affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/small-bowel- obstruction Lawrence, E. M. (2021). Evaluating suspected small bowel obstruction with the water-soluble contrast challenge. British Journal of Radiology, 95(1130). https://academic.oup.com/bjr/article/95/1130/20210791 Attempt: 3776523 Report generated on 2/8/2026, 9:51:49 AM America/Denver Family History Category Data entered by Sydney Smith Family History Mother: Age 84, living; history of hypertension, hyperlipidemia, and uterine fibroids Father: Age 85,