NR 601 Week 5 iHuman Virtual Patient Attempt 3775732 - Cynthia Francis...

Management Plan by Megan Collins on case Cynthia Francis Subjective Cynthia Francis is a 56-year-old female with a past medical history of elevated body mass, hypothyroidism who presents for a blood pressure recheck after a workplace health fair 3 weeks ago. Her blood pressure at that time was 132/74 mmHg, and she was advised to follow up. She has not been monitoring her blood pressure at home and has not yet established care with a primary care provider since relocating 5 months ago. She reports a high- fat, high-salt diet, physical inactivity, and a family history of heart disease. She denies chest pain, shortness of breath, leg swelling, weakness, numbness, tingling, polyuria, polydipsia, polyphagia, and fatigue. She is asymptomatic. Objective Vital signs: BP 118/72 mmHg, HR 83bpm, RR 18bpm unlabored, SpO₂ 99%. General: Alert and oriented ×4, elevated body mass. HEENT: Xanthelasmas noted bilaterally. Corneal arcus present. Thyroid mobile, non-tender, no nodules. Cardiovascular: Regular rate and rhythm, no murmurs, rubs, or gallops. No carotid bruits. No peripheral edema. Pedal pulses +2 bilaterally. Respiratory: Clear bilaterally. Skin: Warm and dry. Labs: Total cholesterol 255 mg/dL, LDL 190 mg/dL, HDL 45 mg/dL, triglycerides 100 mg/dL. Assessment 1. Hyperlipidemia with LDL ≥190 mg/dL and physical findings consistent with lipid disorder, with multiple ASCVD risk factors including obesity, family history, sedentary lifestyle, and hypothyroidism (Grundy et al., 2019). 2. Obesity. 3. Hypothyroidism, stable on 75mcg levothyroxine. 4. Normotensive at today’s visit. Plan Hyperlipidemia: Initiate high-intensity statin therapy with atorvastatin 40–80 mg PO daily. Goal is ≥50% reduction in LDL cholesterol. Patient educated on medication adherence and potential adverse effects, including myalgias and hepatotoxicity. Instructed to report muscle pain, weakness, or dark urine. Lifestyle modifications: Counsel on heart healthy diet with reduced saturated fat and increased fiber intake. Encourage weight loss and at least 150 minutes of moderate-intensity physical activity per week (American Heart Association, 2021). Monitoring: Obtain baseline CMP and liver function tests. Repeat fasting lipid panel in 4-12 weeks to assess treatment response and adherence. Hypothyroidism: Continue levothyroxine 75 mcg PO daily. Order TSH due to its role in lipid metabolism. Blood pressure: BP within normal limits today. Continue lifestyle modifications. No antihypertensive therapy