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I-HUMAN CASE WEEK #7 56 Y/O FEMALE HEIGHT: 5’5” (165 CM)WEIGHT:
188.0 LB (85.5 KG)REASON FOR ENCOUNTER: BLOOD PRESSURE RECHECK
LOCATION: OUTPATIENT CLINIC WITH LABORATORY CAPABILITIES(CLASS
6512)LATEST 2025!
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I-HUMAN CASE WEEK #7 56 Y/O FEMALE HEIGHT: 5’5” (165 CM)WEIGHT: 188.0 LB (85.5 KG)REASON F, Exams of Nursing
I-HUMAN CASE WEEK #7 56 Y/O FEMALE HEIGHT: 5’5” (165 CM)WEIGHT: 188.0 LB (85.5 KG)REASON FOR ENCOUNTER: BLOOD PRESSURE RECHECK LOCATION: OUTPATIENT CLINIC WITH LABORATORY CAPABILITIES(CLASS 6512)LATEST 2025!
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I-HUMAN CASE WEEK #7 56 Y/O FEMALE HEIGHT: 5’5” (165 CM)WEIGHT:
188.0 LB (85.5 KG)REASON FOR ENCOUNTER: BLOOD PRESSURE RECHECK
LOCATION: OUTPATIENT CLINIC WITH LABORATORY CAPABILITIES(CLASS
6512)LATEST 2025!
Patient Info: o Age: 56 years old o Height: 5'5" (165 cm) o Weight: 188.0 lb (85.5 kg) o Reason for Encounter: Blood pressure recheck o Setting: Outpatient clinic with lab capabilities Mode of Assignment: Learning Mode (with feedback after each section) Attempts: One permitted attempt
Case summary or clinical reasoning Differential diagnosis development SOAP note or documentation Treatment plan based on findings
A 56-Year Old Female With Blood Pressure Recheck
i-Human Case Class 6512
Patient Overview (Left Panel)
i-Human Case Week # Patient: 56 y/o female Height: 5’5” (165 cm) Weight: 188.0 lb (85.5 kg) Reason for Encounter: Blood pressure recheck Location: Outpatient clinic with laboratory capabilities
Patient image included on the left (an illustrated portrait of the patient).
🠀 Past Medical History (PMH):
Hypertension (recent diagnosis) Hyperlipidemia (possibly) No known history of diabetes, kidney disease, or cardiovascular events
🠀 Family History (FH):
Mother: Hypertension, stroke in late 60s Father: Type 2 diabetes and coronary artery disease No known cancer or autoimmune diseases in immediate family
🠀 Medications:
Possibly started on a low-dose antihypertensive (e.g., Lisinopril or HCTZ) Occasional over-the-counter meds (e.g., NSAIDs) May not be fully adherent to prescribed medication
🠀 Social History:
Smokes: No Alcohol: Occasional wine Diet: High in salt, limited physical activity Lives alone or with family (depending on case version)
Review of Systems (abbreviated):
General: No recent weight loss or gain, no fatigue Cardiac: No chest pain or palpitations Respiratory: No SOB or cough
Neurologic: No dizziness, no syncope GI: No nausea, vomiting, or abdominal pain
🠀 Physical Examination
General:
Alert, oriented x3, in no acute distress Appears stated age BMI: ~31.3 (Obese category)
Vital Signs:
BP (Right arm, sitting): 148/92 mmHg(or based on i-Human findings)
Pulse: 84 bpm, regular Respirations: 16/min, unlabored Temp: 98.6°F (oral) Height: 5’5” Weight: 188 lbs
HEENT:
Head normocephalic, atraumatic Pupils equal, round, reactive to light and accommodation Fundoscopic exam: No AV nicking, hemorrhages, or papilledema No oral lesions, moist mucous membranes Neck: Supple, no lymphadenopathy or thyroid enlargement
Cardiovascular:
Regular rate and rhythm S1 and S2 normal, no murmurs, rubs, or gallops No JVD, no peripheral edema Pulses 2+ bilaterally in upper and lower extremities
Primary Diagnosis: Essential Hypertension (I10)
The patient presents for follow-up on elevated blood pressure. Current BP remains elevated at 148/92 mmHg despite lifestyle counseling. No secondary causes identified (no renal bruits, thyroid abnormality, or signs of endocrine disorder). Asymptomatic, no signs of end-organ damage (normal neuro, cardiac, and eye exam). Obesity (BMI >30) and family history of cardiovascular disease are contributing risk factors.
Secondary Diagnoses / Considerations:
- Obesity (E66.9) o BMI ~31.3 (Height: 5’5”, Weight: 188 lbs) o Major risk factor for both hypertension and cardiovascular disease
2. Hyperlipidemia (E78.5) (if labs indicate elevated LDL/triglycerides)
o Often comorbid with hypertension; may need evaluation and management if lipid panel abnormal
- Nonadherence to Lifestyle Modifications o Patient reports continued high-sodium diet and minimal physical activity o Needs reinforcement of DASH diet, sodium restriction, weight loss strategies
4. Medication Noncompliance / Subtherapeutic Treatment (if already
prescribed antihypertensive)
o Review current medication regimen and adherence o Consider need for medication adjustment or initiation if not already on antihypertensives
Test Results:
- Blood Pressure Measurements (Office Visit):
Right Arm, Sitting: 148/92 mmHg Left Arm, Sitting: 146/90 mmHg Ambulatory/At-Home BP: May be useful to confirm diagnosis and rule out white coat hypertension.
Interpretation: BP readings consistently elevated, supporting diagnosis of hypertension (Stage 1) according to current guidelines (≥140/90 mmHg).
- Basic Labs:
Complete Blood Count (CBC): o WBC: Normal o Hemoglobin/Hematocrit: Normal o Platelets: Normal o Interpretation: No anemia, infection, or thrombocytopenia. Basic Metabolic Panel (BMP): o Sodium: Normal o Potassium: Normal o Chloride: Normal o Bicarbonate: Normal o Creatinine: Normal o Blood Urea Nitrogen (BUN): Normal o Glucose: Normal o Interpretation: Renal function appears intact, no electrolyte abnormalities.
- Lipid Panel (if ordered):
Total Cholesterol: 220 mg/dL LDL (Low-Density Lipoprotein): 135 mg/dL (elevated) HDL (High-Density Lipoprotein): 45 mg/dL Triglycerides: 180 mg/dL (elevated)
Next Steps/Management Considerations:
Referral for cardiology (if LVH or significant risk factors like coronary artery disease are suspected). Medication adjustment (if antihypertensive therapy has not been initiated or is not adequately controlling BP). Lifestyle modification reinforcement (DASH diet, weight loss, salt reduction, exercise). Follow-up testing (repeat BP checks, further lipid testing if needed).
🠀 Diagnosis
🠀 Primary Diagnosis:
Essential Hypertension (I10)
BP readings: ~148/92 mmHg (confirmed on multiple occasions) No secondary cause identified Asymptomatic, no end-organ damage evident Risk factors present: obesity, family history, possible poor diet/lifestyle habits Meets criteria for Stage 1 Hypertension (≥130/80 mmHg per ACC/AHA guidelines; ≥140/90 per JNC 8)
🠀 Secondary Diagnoses / Comorbid Conditions:
- Obesity (E66.9) o BMI ~31.3 (Weight: 188 lbs, Height: 5'5") o Significant modifiable risk factor for hypertension and cardiovascular disease
2. Hyperlipidemia (E78.5) (if confirmed by labs)
o Elevated LDL and triglycerides suggest increased atherosclerotic risk o May need statin based on ASCVD risk
- Sedentary Lifestyle / Suboptimal Diet (Z72.3 / Z71.3) o Patient reports poor dietary habits (high salt), minimal physical activity
o Targetable with lifestyle counseling and referral to nutritionist/exercise program
🠀 Ruled-Out Diagnoses:
Secondary Hypertension: No signs of renal disease, thyroid dysfunction, pheochromocytoma, or Cushing’s syndrome. White Coat Hypertension: Unlikely if multiple readings, including home BP logs, are consistently elevated.
🠀 Plan
- Pharmacologic Management
Start antihypertensive therapy (if not already initiated): o First-line options: Thiazide diuretic (e.g., Hydrochlorothiazide 12.5+25 mg daily) ACE inhibitor (e.g., Lisinopril 10 mg daily) + especially if there’s evidence of metabolic syndrome or microalbuminuria o Monitor for electrolytes, renal function, and side effects o Adjust dose or combine classes if BP remains uncontrolled in 4 +6 weeks
- Lifestyle Modifications
DASH diet: Increase fruits, vegetables, whole grains; reduce sodium intake (<2.3 g/day) Weight loss goal: Lose 5+10% of current body weight Exercise: At least 150 minutes of moderate-intensity aerobic activity per week Limit alcohol: ≤1 drink/day for women Smoking cessation: If applicable
🠀 2. Pharmacologic Therapy
If not already on medication, initiate antihypertensive therapy based on guidelines:
Initial choice: o Thiazide diuretic (e.g., Hydrochlorothiazide 12.5+25 mg daily) OR o ACE inhibitor (e.g., Lisinopril 10 mg daily) * especially appropriate in African American patients if tolerated or if there's albuminuria or DM
(Note: consider CCBs like amlodipine in African American
patients per JNC 8 and ACC/AHA guidelines)
Monitoring: o Check BMP in 1+2 weeks for renal function and potassium o Monitor BP every 2+4 weeks until goal (<130/80 or <140/ depending on guideline used) is reached
🠀 3. Lifestyle Modifications
Recommend immediate and sustained lifestyle changes:
DASH diet: High in fruits/veggies, low-fat dairy, low in sodium and saturated fat Sodium restriction: Aim for <2.3g/day Physical activity: ≥150 minutes/week of moderate-intensity aerobic exercise Weight loss: Target ≥ 5 +10% of current body weight Limit alcohol: ≤1 drink/day for women Smoking cessation: Strongly encouraged if applicable
🠀 4. Labs and Monitoring
Baseline labs (if not already obtained):
o BMP: To evaluate renal function and electrolytes o Lipid panel: For cardiovascular risk assessment o A1C or fasting glucose: Screen for diabetes o Urinalysis: Check for proteinuria o Optional: TSH, ECG if concern for arrhythmia or LVH
🠀 5. Follow-Up
2 +4 weeks: Recheck BP and assess for med side effects 6 +8 weeks: Repeat labs and reassess treatment plan Every 3+6 months once controlled Consider referral to cardiology or nephrology if: o BP remains uncontrolled on ≥3 meds o Evidence of end-organ damage o Suspected secondary hypertension
🠀 SOAP Note: Hypertension Follow-Up (i-Human Week #7)
S + Subjective
CC: "I'm here to check on my blood pressure." HPI: 56-year-old African American female presents for a blood pressure follow-up. She was noted to have elevated BP readings during a previous visit 2 weeks ago. She reports feeling well overall, denies chest pain, dizziness, vision changes, or headaches. Admits to inconsistent adherence to dietary recommendations and has not increased physical activity. No recent medication changes.
ROS:
General: No weight loss, fatigue, or fever Cardiac: No chest pain, palpitations, or edema Neuro: No headaches, dizziness, or syncope Resp: No SOB or cough GI: No abdominal pain, nausea, or bowel issues
- Hyperlipidemia (E78.5): o Elevated LDL and triglycerides; increased ASCVD risk
- Sedentary Lifestyle / Suboptimal Diet (Z72.3 / Z71.3)
P + Plan
Medications:
Start Lisinopril 10 mg daily o Monitor renal function and potassium in 1+2 weeks o Educate on potential side effects (dry cough, dizziness) Consider statin therapy if ASCVD risk ≥7.5% (Atorvastatin 10+20 mg daily)
Lifestyle Modifications:
DASH diet and sodium restriction (<2.3g/day) Weight loss goal: 5+10% of current body weight Exercise: ≥150 minutes of moderate-intensity activity per week Smoking cessation (if applicable) Alcohol limitation: Max 1 drink/day
Monitoring & Labs:
Recheck BP in 2+4 weeks Repeat BMP and lipid panel in 4+6 weeks Consider A1C or fasting glucose to assess for diabetes
Education:
Discussed diagnosis and risks of uncontrolled HTN Reviewed medication plan and encouraged adherence Patient given instructions on home BP monitoring Referred to dietitian for meal planning support
Follow-Up:
In 2+4 weeks for BP recheck and medication tolerance
In 6+8 weeks for lab review and possible statin initiation