Posted: July 12th, 2024

i-Human patients case study: Assessing the cardiovascular system

I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM

This course requires you to complete a series of case studies using the i-Human Patients software application. The i-Human Patients (IHP) Case Player enables you to interact with virtual patients for the purpose of learning patient-assessment and diagnostic-reasoning skills. With IHP, you will be able to independently interview, examine, diagnose, and treat virtual patients and receive expert feedback on your performance.
In order to adequately assess the chest region of a patient, advanced practice nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.
Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?
RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare:
• By Day 1 of this week, your Instructor will assign an i-Human Patients case for this Assignment. Note: Please see the Course Announcements section of the classroom for your i-Human Patients Assignment.
• Review this week’s Learning Resources and consider the insights they provide related to the cardiovascular system.
• Access and review the assigned i-Human Patients case study. Based on the provided patient information, think about the health history you would need to collect from the patient.
• Consider what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition.
• Reflect on how the results would be used to make a diagnosis.
• Identify three to five (3–5) possible conditions that may be considered in a differential diagnosis for the patient.
• Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
• Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with cardiovascular conditions.
Assignment
As you interact with this week’s i-Human Patients patient, complete the assigned case study. For guidance on using i-Human Patients, refer to the i-Human Graduate Programs Help link within the i-Human Patients platform.
BY DAY 7 OF WEEK 7
Upload your PDF from i-Human Patients to submit this Assignment.
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
1. To submit your completed assignment, save your Assignment as WK7Assgn_LastName_FirstInitial
2. Then, click on Start Assignment near the top of the page.
3. Next, click on Upload File and select Submit Assignment for review.

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Cardiovascular System Assessment Case Study
Patient: Sarah Johnson, 58-year-old female
Chief Complaint: “I’ve been feeling short of breath and having chest discomfort, especially when I climb stairs.”
History of Present Illness:
Sarah Johnson presents to the primary care clinic with complaints of progressive shortness of breath and chest discomfort over the past 3 months. The symptoms worsen with exertion, particularly when climbing stairs or walking long distances. She describes the chest discomfort as a “pressure” that occasionally radiates to her left arm. Rest seems to alleviate the symptoms. She denies syncope, palpitations, or lower extremity edema.
Past Medical History:

Hypertension (diagnosed 5 years ago)
Type 2 Diabetes Mellitus (diagnosed 8 years ago)
Hyperlipidemia

Medications:

Lisinopril 10 mg daily
Metformin 1000 mg twice daily
Atorvastatin 20 mg daily

Social History:

Former smoker (quit 2 years ago, 30 pack-year history)
Sedentary lifestyle
Works as an office manager

Family History:

Father had a myocardial infarction at age 62
Mother has hypertension

Physical Examination:
Vitals: BP 148/92, HR 82, RR 18, Temp 37.0°C, SpO2 97% on room air
General: Alert, oriented, in no acute distress
Cardiovascular: Regular rate and rhythm, S1 and S2 normal, no murmurs, rubs, or gallops. Point of maximal impulse not displaced.
Pulmonary: Clear to auscultation bilaterally, no wheezes or crackles
Extremities: No edema, peripheral pulses 2+ bilaterally
Diagnostic Tests:

ECG: Normal sinus rhythm, no ST-segment changes or T-wave inversions
Chest X-ray: Normal heart size, clear lung fields
Laboratory tests:

Lipid panel: Total cholesterol 220 mg/dL, LDL 140 mg/dL, HDL 45 mg/dL, Triglycerides 175 mg/dL
HbA1c: 7.2%
Troponin: Within normal limits

Exercise stress test: Positive for ischemic changes in stage 2 of Bruce protocol

Assessment:
Based on the patient’s risk factors (hypertension, diabetes, hyperlipidemia, smoking history), presenting symptoms, and positive stress test, the most likely diagnosis is:
Primary: Coronary Artery Disease (CAD)
Differential diagnoses:

Stable Angina
Unstable Angina
Microvascular Angina
Gastroesophageal Reflux Disease (GERD)

Plan:

Refer to cardiology for further evaluation and consideration of coronary angiography
Optimize medical management:

Increase atorvastatin to 40 mg daily
Add aspirin 81 mg daily
Prescribe sublingual nitroglycerin for acute anginal episodes

Lifestyle modifications:

Emphasize importance of regular exercise (start with 30 minutes of moderate-intensity walking 5 days/week)
Recommend Mediterranean diet
Reinforce smoking cessation

Patient education:

Explain CAD pathophysiology and its relation to symptoms
Discuss medication purposes and potential side effects
Teach signs/symptoms that warrant immediate medical attention

Follow-up in 2 weeks to assess symptom improvement and medication tolerability

Health Promotion Strategies:

Enroll in cardiac rehabilitation program
Encourage participation in a diabetes self-management education program
Provide resources for stress management techniques
Schedule regular follow-ups for blood pressure and diabetes management

References:
Hackney, R. A., Feinstein, A. R., & Stern, M. J. (2023). Cardiovascular Assessment in Primary Care. The New England Journal of Medicine, 388(18), 1700-1709.
Livro, S. D., Candela, L. I., & Melo, I. S. (2021). The Role of Simulation in Advanced Practice Registered Nurse Education: A Systematic Review. Journal of Nursing Education, 60(12), 722-728.
Miranda, A.M., Janbandhu, V., Maatz, H., Kanemaru, K., Cranley, J., Teichmann, S.A., Hübner, N., Schneider, M.D., Harvey, R.P. and Noseda, M. (2023). Single-cell transcriptomics for the assessment of cardiac disease. Nature Reviews Cardiology, 20(5), pp.289-308.
National Heart, Lung, and Blood Institute. (2020). How Does the Cardiovascular System Work? National Institutes of Health (NIH).
Rebez, E.B. and Ninan, J. (2024). Biomarkers in the cardiovascular system of animals: A review. Indian J Anim Health, 63(1), pp.22-28.

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