NR 601 Week 5 iHuman Virtual Patient - Cynthia Francis

Cynthia Francis is a 56-year-old female with history of hypothyroidism and long-standing obesity presenting for a follow-up blood pressure evaluation after a workplace health fair recorded a reading of 132/74. She is currently asymptomatic and denies chest pain, shortness of breath, leg swelling, fatigue, or mood disturbances. She reports sedentary lifestyle and a high- fat, high-salt diet. She reports moderate stress related to caregiving responsibilities. On physical exam, her blood pressure today is normotensive at 118/72 bilaterally, BMI is elevated at 31.3, and she has yellow waxy lesions above the medial bilateral eyes. No AV nicking or edema noted. Her thyroid physical exam is unremarkable, and cardiovascular and respiratory assessments are normal. Differential diagnosis 1. Hyperlipidemia 2. Hypertension 3. Diabetes mellitus type 2 Tests 1.12 lead ECG- NSR 2. CBC- normal 3. CMP- normal 4. Free T4- normal 5. TSH- normal 6. A1C- normal 7. urinalysis- normal 8. cholesterol- 255, HDL- 45, LDL- 190, triglyceride -100 Diagnosis- Hyperlipidemia Management Plan diagnostic tests 12 lead ECG- NSR • Patient has multiple cardiovascular risk factors including obesity, sedentary lifestyle, strong family history of premature heart disease and borderline elevated BP at health fair. ECG rules out any cardiac cause. • Consult a dietician for personalized advice regarding heart health, lipid-lowering dietary options, and weight management methods (Su et al., 2021). - Nutrition counseling is first-line in managing hyperlipidemia (Giles, L.A., 2024). client education • Educate patient on hyperlipidemia. Increase in bad cholesterol “LDL” increases risk for heart disease and stroke. Xanthelasma is sign of long-standing high cholesterol and combining with family history of heart disease makes cholesterol-lowering treatment urgent. • Educate patient on Atorvastatin. Educate on possible side effects such as muscle aches, dark urine or unusual fatigue which needs to be reported to physician immediately (Ruscica et al., 2022). Avoid large amount of grapefruit juice while taking this medication (Ruscica et al., 2022). • Check blood pressure at home 2-3 times/ week and keep a log • Lifestyle changes education - Choose heart healthy diet including vegetables, fruits, legumes, nuts, whole grain and fish (Giles, L.A., 2024). Avoid food that has high cholesterol and saturated fat, processed meats, refined carbohydrates and sweetened beverages (Giles, L.A., 2024). - Engage in at least 150 minutes per week of moderate intensity (brisk walking, biking, dancing, active yoga, swimming) or 75 minutes per week of vigorous intensity physical activity (jogging/running) (Giles, L.A., 2024). - Start physical activity gradually if you haven’t been active. - Focus on losing weight with diet and exercise which can improve cholesterol and heart health - Manage stress with relaxation techniques, hobbies or consider counseling if needed. follow-up • Follow up in 6-12 weeks to assess statin effectiveness and monitor for any side effects (Su et al., 2021). • Notify physician of severe muscle pain, weakness, dark urine (Ruscica et al., 2022). • Seek immediate medical attention if you experience chest pain, shortness of breath, sudden weakness, numbness, slurred speech. Reference Giles, L. A. (2024). Hyperlipidemia prevention and management utilizing lifestyle