NR 601 Week 2 iHuman Virtual Patient Case - Bill Buxton

throats, or difficulty swallowing Do you have problems with nausea, vomiting, constipation, diarrhea, coffee grounds in your None of that vomit, dark tarry stool, bright red blood in your bowel movements, early satiety, or bloating? Do you have any problems with muscle or joint pain, redness, swelling, muscle cramps, No problems with my joints or redness, back pain, neck or shoulder pain, or hip pain? PMH, FH, SH as Needed Asked Approach Question Response PMH Can you tell me about any current or Just the heart problems and all the past medical problems you have stuff with that. You know, high blood had? pressure and the cholesterol stuff PMH Are you taking any over-the- No, unless you count a rare Tylenol. counter or herbal medications? Oh, I guess the aspirin take counts too. PMH Do you have any allergies? None that I know of PMH Have you ever been hospitalized? Just the one time, very briefly for my heart condition 6 months ago. PMH Are you taking any prescription I can't remember them off the top medications? of my head. I brought my list with me metoprolol, ramipril aspirin, clopidogrel, and atorvastatin. It's quite a list I'm not sure what they all do SH Do you now or have you ever I did for years, up to 6 months ago smoked or chewed tobacco? when I had the stent put in the artery I smoked about a pack a day for 50 years. SH Do you have any children? Spouse? Yes, my wife Sonia and I have Significant partner? been married for 49 years. My one adull son and his family live nearby. SH Can you tell me about your diet? Well, my wife's not that big on What do you normally eat? cooking any more. We eat out or have prepared meals often. I was told by the cardiologist not to use the salt shaker, but I can't say I actively avoid salty foods. SH Do you drink alcohol? If so, what do I have about one to two drinks per you drink and how many drinks per day I've been drinking since my day? college days, started when I was 19. SH Has drinking alcohol ever caused Not as far as I'm concerned. you problems? EXTRA QUESTIONS TO HELP FILL OUT EMR (Make sure you don’t go past 50!) These questions are not graded. ● Auscultate heart -You performed the simulation correctly. o You documented murmur - pansystolic with S3 and it should have been murmur - pansystolic. ● Auscultate lungs o You didn't listen for at least one cycle at anterior lower left. o You did not auscultate in the correct order. o You documented left lung and right lung correctly. o Lung sounds: bibasilar crackles ● Blood pressure: You documented systolic/diastolic correctly. o You did not document anything for pulse pressure. o You did not document anything for assessment. o You performed the simulation correctly. ● Palpate anterior & posterior chest o Tactile fremitus is increased