IHuman Case Week #7 56-Year-Old Female Reason for Encounter: Blood Pressure Recheck Class, Exams of Nursing

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IHuman Case Week #7 56 - Year-Old Female Reason for Encounter: Blood Pressure Recheck Class 6512 I Human Case Week #7[BEST COMPREHENSIVE 2025]

Patient: 56 - Year-Old Female Reason for Encounter: Blood Pressure Recheck Course: NURS 6512 – Advanced Health Assessment Simulation Platform: i-Human Week: 7 Subjective Data

• Chief Complaint: “I’m here to have my blood pressure checked.”
• History of Present Illness (HPI): The patient presents for follow-up of previously elevated blood pressure readings. She has been on lisinopril 10 mg daily for 2 years but admits to inconsistently taking the medication. She reports mild fatigue but denies

chest pain, shortness of breath, headaches, visual changes, dizziness, or palpitations.

• Past Medical History: o Hypertension (diagnosed 2 years ago) o Hyperlipidemia o No diabetes o No known allergies o Surgical: Appendectomy
• Medications: o Lisinopril 10 mg daily (non- adherent) o Atorvastatin 20 mg at bedtime
• Social History: o Non-smoker o Drinks wine occasionally o Sedentary lifestyle o High-stress job o Lives alone

• Physical Exam: o General: Alert, in no acute distress o Cardiovascular: Regular rhythm, no murmurs or gallops o Lungs: Clear to auscultation bilaterally o Abdomen: Soft, non-tender o Extremities: No edema o Neurological: Intact, no deficits
• Labs (prior records): o LDL: 142 mg/dL o HDL: 42 mg/dL o Triglycerides: 185 mg/dL o A1C: 5.8% (Pre-diabetes) o Creatinine: 1.0 mg/dL o Electrolytes: Within normal limits Assessment

Primary Diagnosis:

• Essential Hypertension (I10): Confirmed by persistently elevated BP readings and history. Non- adherence to antihypertensives and lifestyle risk factors contribute. Differential Diagnoses:

1. Medication Non-Adherence (Z91.14)
2. Hyperlipidemia (E78.5)
3. Obesity (E66.9)
4. White Coat Hypertension (R03.0)
5. Pre-Diabetes (R73.03) Plan Medications:

Education:

• Medication adherence is critical
• Risks of uncontrolled HTN: stroke, heart disease, kidney damage
• Discuss diet, exercise, and stress reduction Follow-Up:
• Revisit in 4 weeks for BP check and lab review
• Adjust therapy based on response Reflection This case highlights the critical role of regular follow-up in managing chronic conditions like hypertension. Non- adherence, poor diet, sedentary habits, and stress significantly contribute to

inadequate blood pressure control. Addressing these issues through patient education, motivational interviewing, and supportive care is essential in advanced nursing practice. Monitoring for associated metabolic issues like hyperlipidemia and pre-diabetes is also key for cardiovascular risk reduction. Here’s the HISTORY section of the case study for the 56 - year-old female i- Human patient (Week #7, Class 6512) with a reason for encounter: Blood Pressure Recheck : Patient History Identifying Information:

and is open to reviewing her medications and lifestyle habits. Past Medical History (PMH):

• Hypertension (diagnosed 2 years ago)
• Hyperlipidemia
• No history of diabetes, kidney disease, stroke, or heart disease
• No known drug allergies
• Immunizations up to date Past Surgical History (PSH):
• Appendectomy (remote, uncomplicated) Medications:

• Lisinopril 10 mg PO daily (non- adherent)
• Atorvastatin 20 mg PO at bedtime Family History:
• Mother: History of hypertension and stroke (deceased)
• Father: Hypertension, type 2 diabetes (alive)
• No known genetic disorders Social History:
• Tobacco Use: Denies current or past smoking
• Alcohol Use: Drinks wine occasionally ( 1 – 2 glasses on weekends)

• GI/GU: Denies nausea, vomiting, diarrhea, or urinary complaints
• Musculoskeletal: No joint or muscle pain
• Psych: Denies depression or anxiety, but reports work-related stress Absolutely! Let’s expand the differential diagnoses and treatment options for the 56 - year-old female i-Human Week # case , based on her presentation for a blood pressure recheck. These additions consider comorbidities , risk factors , and potential conditions commonly seen with poorly controlled hypertension. Expanded Differential Diagnoses

Diagnosis

**1. Essential Hypertension

2. Medication Non-Adherence

Hyperlipidemia**

ICD -

Rationale 10 Elevated BP readings at multiple visits, I10 history of HTN, and lifestyle risks (poor diet, inactivity, stress). Patient admits to skipping BP Z91.14 medications, leading to uncontrolled BP. Elevated LDL E78.5 and triglycerides on

Diagnosis

**6. White Coat Hypertension

7. Left Ventricular Hypertrophy (LVH)** ICD- 10 R03. I51. Rationale Considered due to clinical setting; home BP log or 24- hour ambulatory BP would help rule in/out. Longstanding, uncontrolled HTN can lead to cardiac remodeling, though asymptomatic now—consider EKG/echo if

Diagnosis

**8. Chronic Kidney Disease (early)

9. Anxiety- related BP elevation** ICD- 10 N18. F41. Rationale symptoms develop. Hypertension is both a cause and result of CKD; although creatinine is normal now, monitor for early renal changes. Patient reports high job stress, which could elevate BP through