NR 601 Week 5 iHuman Virtual Patient Attempt 3690196 - Heather Nardone

Management Plan by Milleny Perez on case Heather Nardone - Chamberlain Subjective - follow-up for blood pressure recheck, three weeks prior at a health fair her blood pressure was 132/74 and was advised to meet with PCP. Today her blood pressure is 118/72 and denies any symptoms. She reports she does not monitor her blood pressure at home. Also reports having a high-fat, high-salt diet with a sedentary lifestyle. She has a PMH of hypothyroidism and obesity. She also has family history of heart disease. NKDA. Take 75mcg of levothyroxine daily for her hypothyroidism. Patient also reports feeling slight stress due to work and watching her grandchildren. Objective - height: 5'5'', Weight: 188lb, BMI: 31.3, AAOx4, Temperature: 37.1, Pulse: 83, Blood pressure: 118/72 in both arms. Respirations: 18, SPO2: 99% on room air. Physical exam reveals xanthomas and arcus senilis present but otherwise unremarkable exam. ECG shows normal sinus rhythm. CBC, CMP, T4, TSH, and urinalysis are within normal ranges. Lipid panel: cholesterol 255mg/d, HDL 45mg/d, LDL 190 units/L, and triglycerides 100mg/ d Assessment - Dyslipidemia in a patient with obesity and family history of heart disease which means that primary plan for this patient is prevention risk. According to hypertension guidelines, blood pressure target is 130/80 in adults and since she is below the threshold, medication management is not needed at this time (Arnett et al., 2025). For her lipid panel, with an LDL level of 190mg/d, statin therapy is warranted (Grundy et al., 2025; ESC, 2025). For H.N., it is best to focus on lifestyle interventions, statin therapy, and following up with her regularly. Plan - Lifestyle interventions: DASH diet/heart healthy diet, limit sodium to 2,000mg/day, replace saturated fats with unsaturated fats, and limit ultra-processed foods, target a realistic weight loss goal and refer to a dietician and start with aerobic exercise 30 minutes a day such as walking or swimming, limit alcohol intake, blood pressure monitoring regularly. Pharmacological interventions: start patient on 40mg of atorvastatin and recheck labs within 4-6 weeks and monitor for side effects such as myalgia. Make a follow-up every 3-6 months afterwards to monitor and make medication adjustments (ACC, 2025; AHA, 2025). References American College of Cardiology. (2025, July 1). Prioritizing health: Dietary approaches for elevated LDL-C. ACC. https://www.acc.org/Latest-in-Cardiology/Articles/2025/07/01/01/Prioritizing-Health-Dietary-Approaches-For- Elevated-LDL-C American Heart Association. (2025, February 5). 2025 high blood pressure guideline emphasizes prevention, early treatment to reduce CVD risk. AHA Newsroom. https://newsroom.heart.org/news/new-high-blood-pressure- guideline- emphasizes-prevention-early-treatment-to-reduce-cvd-risk Arnett, D. K., Carey, R. M., Davis, A. M., Whelton, P. K., & ACC/AHA Task Force. (2025). 2025 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Circulation. https:// www.ahajournals.org/doi/10.1161/CIR.0000000000001356 Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., & Blumenthal, R. S. (2025). 2025 ACC/AHA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force. Journal of the American College of Cardiology, 85(2), 175–211. https://www.jacc.org/doi/10.1016/j.jacc.2025.04.024 Attempt: 3690196 Report generated on 10/1/2025, 11:42:13 AM America/Denver