NR 603 Week 5 iHuman Virtual Patient Encounter and Reflection Attempt 3688153 - Karen Floyd

History Notecard by on case Karen Floyd 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: 3688153 Report generated on 10/5/2025, 9:26:15 AM America/Denver Management Plan by on case Karen Floyd a. Diagnostic tests: No further diagnostic tests indicated. A diagnosis of irritable bowel syndrome (IBS) is based on Rome IV criteria and may be one of exclusion (Nathani, Sodhani & Vadakekut, 2025). Testing performed during the iHuman simulation is intended to rule out other diagnoses. b. Medications: Mixed IBS or IBS-M is characterized by alternating periods of constipation and loose stools; therefore, medications will be tailored to symptom relief. Rx: Polyethylene glycol 3350 powder (Osmotic laxative: PRN constipation) Take 1 capful (17 grams) and dissolve in 4-8 oz of liquid and take orally once a day for 1-4 days to produce bowel movement. Max dose twice daily (Dabaka & Abbas, 2023). Disp: 1 bottle, 510g container. Refill: 1 Rx: Dicyclomine 20mg tablet (Antispasmodic: PRN abdominal pain) Take one tablet orally up to four times daily PRN for abdominal cramping, bloating and pain. Max dose 160mg daily. Disp: 120 tablets. Refill: 1 Rx: Loperamide 2 mg tablet (Anti-diarrheal: PRN diarrhea) Take two tablets orally up to three times a day PRN for loose stool. Max dose 16mg daily (Sahi et al., 2023). Disp: 180 tablets. Refill: 1 RX: Amitriptyline 10 mg tablet (Tricyclic Antidepressant: Daily IBS-M abdominal pain) Take one tablet orally at bedtime daily for prevention of abdominal pain, cramping and bloating associated with IBS-M. Max dosing 50mg daily (Thour & Marwaha, 2023). Disp: 30 tablets. Refill: 1 c. Suggested consults/referrals: Patient should be referred to a gastroenterologist for evaluation and treatment of symptoms, as well as evaluation of any red flags or overlapping symptoms that may suggest comorbid GI pathologies. Referral to a registered dietician may be useful in providing nutritional counseling and reinforcement of avoidance of trigger foods. Referral to a mental health professional may be helpful in managing stress related to the stigma of diagnosis. Managing stress can be impactful in the reduction of symptoms. d. Client education: Patient should be educated on disease process, risk factors, triggers, medications, lifestyle and dietary modifications. IBS is a complex disorder of the gut-brain interaction characterized by recurrent abdominal pain and altered bowel habits including diarrhea, constipation or a mix of both (Nathani, Sodhani & Vadakekut, 2025).