NR 576 Week 3 iHuman Virtual Patient Encounter Attempt 3198444 - Jenna James

History Notecard by Suzy Hanah on case Jenna James 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: 3198444 Report generated on 7/13/2024, 7:30:45 PM America/Los_Angeles Management Plan by Suzy Hanah on case Jenna James PLAN Diagnostic tests: Rapid group A strep test, influenza swab, Covid swab, throat culture Rationale: Compared to throat cultures, rapid antigen detection assays for GAS are around 70% to 90% sensitive and 95% specific, with the benefit of instantaneous point-of-care testing. When GAS is suspected, throat culture should be performed after a negative antigen test. Medications: Penicillin V 500mg BID x 10 days (if throat culture results positive) Acetaminophen 500mg Q6hr PRN pain and fever Rationale: If the throat culture comes back positive but the fast test for GAS comes back negative, it seems sense to treat the patient with no antibiotics at all and check up the following day. Every patient who has symptoms compatible with GAS pharyngitis but a negative fast antigen test for GAS should have a throat culture performed. Sore throat, headache, and fever symptoms may be treated with analgesics. Education: Avoid contact with infected people during outbreaks. Off-school note provided. Thorough hand washing, especially during cold weather months, do not share drinking glasses, eating utensils, etc. Gargle with warm salt water. Can use anesthetic sprays/lozenges for throat discomfort. Increase fluid intake. Patient education about disease, course, and treatment. Change toothbrush after treatment. Possible complications include: upper airway obstruction, Acute post-strep glomerulonephritis after strep infection, May develop sloughing of skin on fingertips and toes in weeks following strep infection. Rationale: To prevent spread of infection to self and others. Gargling with salt water has not been shown to be effective, although it is safe. Pharyngitis discomfort may be momentarily relieved by anesthetic sprays or lozenges. To prevent dehydration. Change toothbrush to prevent spread of infection with others in home when applying toothpaste. Referral: none Rationale: no referral needed for pharyngitis Follow up: return to office if fever and pain persist after 3 days. If your symptoms do not improve or continue to worsen, or you develop shortness of breath or chest pain, immediately go to the nearest emergency department for evaluation. Rationale: if pharyngitis symptoms have not improved after 3 to 4 days, alternate diagnoses should be considered. Electronic Health Record by Suzy Hanah on case Jenna James History