IHuman Case Week #7 56-Year-Old Female Reason for Encounter: Blood Pressure Recheck, 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: oHypertension (diagnosed 2 years ago) oHyperlipidemia oNo diabetes oNo known allergies oSurgical: Appendectomy
• Medications: oLisinopril 10 mg daily (non- adherent) oAtorvastatin 20 mg at bedtime
• Social History: oNon-smoker oDrinks wine occasionally o Sedentary lifestyle o High-stress job

• Family History: oMother: Hypertension, deceased due to stroke oFather: Alive with diabetes and hypertension
• Review of Systems (ROS): oNegative for headaches, vision changes, chest pain, palpitations, or edema. Objective Data
• Vital Signs: oBP: 152/92 mmHg (repeat: 148/ mmHg) oHR: 82 bpm oRR: 16/min oTemp: 98.6°F o BMI: 30.2 (Obese Class I)

• Physical Exam: oGeneral: Alert, in no acute distress oCardiovascular: Regular rhythm, no murmurs or gallops oLungs: Clear to auscultation bilaterally oAbdomen: Soft, non-tender oExtremities: No edema oNeurological: Intact, no deficits
• Labs (prior records): oLDL: 142 mg/dL oHDL: 42 mg/dL oTriglycerides: 185 mg/dL o A1C: 5.8% (Pre-diabetes) o Creatinine: 1.0 mg/dL o Electrolytes: Within normal limits Assessment

• Increase Lisinopril to 20 mg daily Educate on consistent medication adherence Reassess in 4 weeks Continue atorvastatin 20 mg at bedtime Lifestyle Modifications:

DASH diet with low sodium intake Begin 30-minute walks , 5x/week Weight loss goal: 5–10% of current body weight Stress management techniques Monitoring:

Home BP log : Record twice daily for 2 weeks Repeat labs in 4–6 weeks: renal panel, electrolytes, lipid panel

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

• Age/Gender: 56-year-old female Reason for Visit: Blood pressure recheck History of Present Illness (HPI): The patient presents for follow-up evaluation of elevated blood pressure. She reports that she has been prescribed lisinopril 10 mg daily for the past 2 years but admits to taking it inconsistently. She occasionally skips doses, especially when she feels “fine.” She denies experiencing chest pain, palpitations, dizziness, shortness of breath, headache, or visual disturbances. She does report occasional fatigue, which she attributes to work- related stress. She is concerned about her BP staying high

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:

• Drug Use: Denies illicit drug use Diet: High in sodium and processed foods; low in fruits/vegetables Activity: Sedentary lifestyle; no regular exercise Living Situation: Lives alone, works full-time in a high-stress administrative role Review of Systems (ROS):

General: Mild fatigue, no weight change, no fever or chills Cardiovascular: No chest pain, palpitations, or edema Respiratory: No cough or shortness of breath Neurologic: No dizziness, headache, or syncope

• 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

**4. Obesity (Class I)

5. Pre-diabetes**

ICD -

Rationale 10 labs; common comorbidity with HTN. BMI of 30.2; contributes to elevated BP, E66. insulin resistance, and dyslipidemia. A1C of 5.8%; indicates R73.03 diabetes risk, often part of metabolic syndrome.

Diagnosis

**6. White Coat Hypertension

7. Left Ventricular Hypertrophy (LVH)**

ICD-

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