NR 603 Week 5 iHuman Virtual Patient Encounter and Reflection - Karen Floyd, 45-year-old

intake of rye wheat or barley, family history of IBD, colon polyps or colon cancer, history of bowel obstructions, colon cancer or polyps, use of laxatives, enemas or suppositories GU Denie difficulty urinating, and menstrual irregularities Musculoskeletal Denies arthritis Neurologic Positive for occasional headaches Denies dizzy or lightheadedness, tingling and numbness Skin/breast Positive for dry skin Psychiatric Denies feelings of sad, depressed, or hopelessness Endocrine Positive for occasional hot flashes Denies change in thirst and night sweats Hematologic/ Denies bruising or bleeding easily or history of lymphatic anemia Allergic/ UTD on immunizations including flu vaccine immunologic denies rash Past Medical History: PMH 10-year history of abdominal pain Occasional hot flashes Dry skin headaches Hospitalization/ c-section at 27 years old – no complications surgeries bike accident at 17 yo – complicated right tibia fracture with surgery Preventive Mammogram – denies PAP smear – last year and results were normal Immunizations – up-to-date, annual flu shot Annual exam – last year Medications Multi-vitamin daily Acetaminophen prn for stress headaches Allergies NKA Social History Diet: average diet with no special considerations Fluids: normal amount Sleep: sleeps through the nights Tobacco: denies Alcohol: daily glass of wine Drugs: denies Occupation: manager at local restaurant Finances: has insurance Family history Mother – arthritis Father – (68yo) healthy Key findings: Hematochezia Mucousin the stool Chronic, pellet, period, pain, Stress and eating urgency, sensation, acute Blood, significant anorexia False All the above CBC, CRP, celiac sprue panel Problem statement: • K.F. is 45-year-old female who presents with a 10-year history of abdominal pain, feeling of bloating and significant amounts of flatulence and belching; along with episodes alternating between constipation and diarrhea. The pain is described as mild cramping with intermittent episodes of severe stabbing pain that affects daily living and lasts between a few minutes to an hour or so. There are no events surrounding the start of abdominal pain, bowel movement eases some of the pain, while stress and specific diet intake aggravates pain and symptoms. The client has not tried any previous treatments. The physical exam was pertinent for abdominal tenderness with deep palpation. The rest of the physical exam was unremarkable. She denies worsening abdominal pain, blood in stool, nausea and vomiting. She Pain does not radiate, localized to abdomen, specifically lower half. She denies any symptoms after consuming rye, wheat, or barley. Denies any treatments tried. • K.F. a 45-year-old presents with a 10-year history of intermittent chronic lower cramping like abdominal pain relieved with bowel movement. She admits to episodes of diarrhea and constipation. She reports working long hours at her job and will often skip a meal due to the pain and bloating. She denies chest pain, worsening of abdominal pain, trauma, blood in stools, or trouble urinating. Exam is positive for mild tenderness with deep palpation of lower abdomen on both sides. Rectal exam unremarkable. Differentials: o Fiber-bulking agents – polyethylene glycol 3350 (MiraLax) ▪ 17 g PO once daily PRN ▪ Used for constipation as needed ▪ Dispense #1