NR 511 Week 7 iHuman Virtual Patient Encounter Attempt 3812567 - Virginia Lee

History Notecard by Thien Le 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 = abdominal pain Sx Sx Sx Sx Sx = = = = = Onset 2 days ago, after dinner Location right in the middle, around the belly button Duration lasts for several minutes then slowly goes away Characteristics cramps, now feels like squeezing from the inside, bloating, non-radiating, getts full faster Aggravating pushing on the belly Relieving throwing up Timing / none Treatments Severity 8-9/10 pain Attempt: 3812567 Report generated on 2/3/2026, 11:41:13 PM America/Denver Management Plan by Thien Le on case Virginia Lee MANAGEMENT NOTE : Diagnostic tests: CBC (Klingbeil et al., 2023) CMP (Klingbeil et al., 2023) Lactic Acid, blood (Podda et al., 2021) Lipase, blood (Podda et al., 2021) CT abdomen/pelvis with contrast (Klingbeil et al., 2023) Medications/Treatments: NG tube for decompression (Podda et al., 2021) IV hydration for bowel rest (Klingbeil et al., 2023) Laparotomy (Klingbeil et al., 2023) Consults/Referrals: Consult for general surgery for laparotomy (Klingbeil et al., 2023) Consult to GI for management (Klingbeil et al., 2023) Client education: Although some patients may not need surgical intervention, patients who receive surgical intervention are associated with higher rates of complications as opposed to patients who do not receive surgical intervention had a higher readmission rate (Jose et al., 2025) Patients should be mindful of malnutrition and dehydration due to inability to keep food and liquids down (Klingbeil et al., 2023) Follow-up: Follow up with GI doctor outpatient within 30 days of discharge (Jose et al., 2025) If surgical sites show signs of infection (fever, warmth, redness, purulent discharge), follow up immediately at the emergency room (Jose et al., 2025) References Jose, A. M., Kirsch, J., Prabhakaran, K., Rafieezadeh, A., Mehta, R., Shnaydman, I., ... & Zangbar, B. (2025). Should we let the sun set or rise on a small bowel obstruction: mortality and readmission rates in operative versus nonoperative management. Surgical Endoscopy, 39(11), 7698-7706. Klingbeil, K. D., Wu, J. X., Osuna-Garcia, A., & Livingston, E. H. (2023). Management of small bowel obstruction and systematic review of treatment without nasogastric tube decompression. Surgery Open Science, 12, 62-67. Podda, M., Khan, M., & Di Saverio, S. (2021). Adhesive small bowel obstruction and the six w’s: who, how, why, when, what, and where to diagnose and operate?. Scandinavian Journal of Surgery, 110(2), 159-169. Attempt: 3812567 Report generated on 2/3/2026, 11:41:13 PM America/Denver Family History Category Data entered by Thien Le