NR 511 Week 7 iHuman Virtual Patient Encounter Attempt 3819281 - Virginia Lee

History Notecard by Ariel Tate 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 Location Duration Characteristics Aggravating Relieving Timing / Treatments Severity Attempt: 3819281 Report generated on 2/9/2026, 11:06:19 AM America/Denver Management Plan by Ariel Tate on case Virginia Lee 1. diagnostic tests CBC can indicate inflammation and infection: WBC elevated, Hct elevated, monocytes decreased CMP can indication electrolyte imbalance related to dehydration and vomiting episodes: elevated BUN/Cr ratio, consistent with mild dehydration; low-normal K and low chloride, consistent with emesis CT abd/pelvis with contrast: There are dilated loops of proximal small bowel measuring up to 4 cm in caliber. There is the transition to non-distended loops in the distal small bowel in the right hemi-pelvis. lactate can indicate tissue hypoxia: normal lipase can indicate pancreatic involvement or strangulation: normal 2. medications: management of SBO will be done inpatient and will involve fluid management, electrolyte replacement, and symptom control until surgical intervention can be done (Aka at el., 2021). Lactated ringer's 1L bolus; maintenance fluid of LR at 100mL/hr Ondansetron 8 mg IV q8h PRN for nausea/vomiting Ketorolac 30 mg IM/IV q6h for moderate to severe pain PRN; Max: 120 mg/day Zosyn 3.375g IV q6hr up to 4-7 days 3. suggested consults/referrals: Effective management of small bowel obstruction (SBO) is reliant upon coordinated efforts among general surgeons and gastroenterologists. Such interdisciplinary collaboration promotes patient-centered care, decreases complication rates, and improves clinical outcomes while reducing the likelihood of recurrence. Referral to Gastroenterology Referral to General Surgery 4. client education Nasogastric tube will be placed is decrease gastric distention and vomiting as well as prevent aspiration. Bowel rest: nothing by mouth to minimize exacerbating gastric distention Frequent monitoring of vital signs, abdominal exams, and laboratory tests keep HOB elevated at least 30 degrees Due to client history of cholecystectomy, risk of development of scar tissue and adhesions is increased therefore increasing risk of bowel obstruction. Water-soluble contrast studies with agents such as gastrograffin can help resolve those adhesions (Schick et al., 2023). Adhesion barriers during surgical intervention can also be introduced. If all these interventions fail to resolve obstruction, surgical intervention may be indicated. Indications for surgical intervention include evidence of strangulation, such as fever, tachycardia, localized tenderness, leukocytosis, or acidosis (Schick et al., 2023). surgical techniques include Adhesiolysis, which is most commonly used, is performed laparoscopically or open surgery to release fibrous bands that