Understanding Abnormal Behavior 10th Edition Sue Test Bank - Verified Q&A, Exams of Nursing

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Chamberlain University

NR 509 / NR

Week 3 iHuman

Virtual Patient Encounter

(Rubric & Case)

Case: Patient: Amanda Wheaton,

23-year-old female law student

Week 3: NR509 iHuman Virtual Patient Encounter Rubric

Week 3: NR509 iHuman Virtual Patient Encounter Rubric

Criteria Ratings Pts

This criterion is linked to a Learning OutcomeFocused Health History Complete a

20 pts Excelle nt

18 pts Very Good

16 pts Satisfacto ry

10 pts Need s

0 pts Unsatisfactory 20 p

Achieve a Achievea Achievea Improvement Achieve a ts focused health history (scores are automatically calculated within the iHuman platform)

score of 90- 100%.

score of 80- 89%.

score of 70- 79%.

Achieve a score of 50- 69%.

score of 0-49%.

This criterion is linked to a Learning OutcomeFocused Physical Exam Complete a

20 pts Excelle nt

18 pts Very Good

16 pts Satisfacto ry

10 pts Need s

0 pts Unsatisfactory 20 p

Achieve a Achievea Achievea Improvement Achieve a ts focused physical exam (scores are automatically calculated within the iHuman platform

score of 90- 100%.

score of 80- 89%.

score of 70- 79%.

Achieve a score of 50- 69%.

score of 0-49%.

n

Week 3: NR509 iHuman Virtual Patient Encounter Rubric

Criteria Ratings Pts

Documentation must be:

1. accurate
2. detailed
3. written using professional terminology
4. pertinent to the chief complaint
5. include objective findings only

This criterion is linked to a Learning OutcomeKey Findings Organize the key findings with the most important findings first and least important findings last on the list.

5 pt ots

5 pts Satisfactory The key findings were organized.

2.5 pts Needs Improvement The key findings were partially organized.

0 pts Unsatisfactory The key findings were organized.

Week 3: NR509 iHuman Virtual Patient Encounter Rubric

Criteria Ratings Pts

This criterion is linked to a Learning OutcomeProblem Statement 4 Required Criteria Document a brief, accurate problem statement using professional language. Include the following components:

1. name or initials, age
2. chief complaint
3. positive and negative subjective findings
4. positive and negative objective findings

or^5 y pt mensts

5 pts Excellent All requiremen ts met.

4.5 pts Very Good 3 requiremen ts met.

4 pts Satisfacto ry 2 requiremen ts met.

2.5 pts Needs Improveme nt 1 requirement met.

0 pts Unsatisfa ct No require met.

depth, and

Week 3: NR509 iHuman Virtual Patient Encounter Rubric

Criteria Ratings Pts

This criterion is linked to a Learning OutcomeReflectio n 4 Required Criteria Address the following question: How would the management plan change for the Week 3 virtual patient if the patient were uninsured? Include the following components:

1. write 150- words in a Microsoft Word document
2. demonstrate clinical judgment appropriate to the virtual patient scenario
3. cite at least one relevant scholarly source as defined by program expectations
4. Responses were substantive (adds importance,

or^1 y 0 p menttss

10 pts Excellent All requirements met.

9 pts Very Good 3 requirements met.

8 pts Satisfactory 2 requirements met.

5 pts Needs Improvement 1 requirement met.

0 pts Unsatisfact No require met.

Week 3: NR509 iHuman Virtual Patient Encounter Rubric

Criteria Ratings Pts

This criterion is linked to a Learning OutcomeFormatti ng Use current APA format for citations and references in management plan and reflection and is free of errors.

5 pt y (^) s rors.

5 pts Excellen t 0- errors.

4 pts Very Good 2-3 errors.

3 pts Satisfacto ry 4- errors.

2 pts Needs Improvement 6-7 errors.

0 pts Unsatisfact or More than 7 er

This criterion is linked to a Learning OutcomeLate Penalty Deduction

ys 0 pt s

0 pts a. Full credit On time

0 pts b. - points 1 day late

0 pts c. - 2 days late

0 pts d. - 3 days late

0 pts e. More than three (3) da late No credit.

Name: Amanda Wheaton Age:

23 years old

Sex: Female

Interview Questions

1. How can I help you today?- sore throat
2. Any other symptoms? Headache, come and go—swollen and tender neck gland
3. Anyone else develop symptom—contact?- roommate with bad sore throat- earlier in week—was check out at clinic but don’t know Dx
4. How severe is sore throat?—“ hurts like hell”- “ like ice pick”-worse that I’have had in my life—11/10 pain scale
5. Sore throat make better or worse- acetaminophen (just little), ice cream
6. Sore throat tx- Tylenol
7. When did your sore throat start?- two days ago

HPI

Sx = sore throat

Sx = headac he

Sx = swollen and tender neck gland

Sx = fever with

Sx =difficulty swallowin

S

x = Onse t

two days ago

two days ago two days ago

two days ago

Two days ago Locatio n

throa t

hea d

neck

Duratio n

days

come and go n/a Come and go

persiste nt Characteristi cs

" like ice pick"

mild headac he

very tender.painful to

temp 101.8, " felt horrible"

“hurts”

Aggravatin g

non e

non e

none With sore throa Relievin g

tyenol and ice cream helps a little

tyleno l

none

Tylenol but fever comes back

none

Timing / Treatment

tyleno l

tyleno l

tyleno l

tyleno l Severit y

hurts like hell"

mild painful to touch, tender

History

1. Reason for encounter - The patient presents with a sore throat 2. History of present illness (HPI) Amanda Wheaton, a 23-year-old female law student with a history of infectious mononucleosis at age 15, presents with a severe sore throat for two days. She describes the pain as “sharp like an ice pick” and rates it “11/10” in severity. She also reports intermittent fever with chills (temperature 101.8 F last night), a mild headache, and swollen, tender neck glands that are painful to touch, which started two days ago. Acetaminophen has provided only temporary relief, and she notes that ice cream offers slight relief for her sore throat. She denies any specific aggravating factors. She reports sick contact with her roommate, who had a sore throat earlier in the week. 3. Review of systems ● General- The patient reports feeling healthy before symptoms onset. The patient reports fever (temperature 101.8F last night) and chills. Denies any weight loss. ● HEENT/neck H- headache E- denies eye pain, redness, swelling, itching or discharge

E- denies ear pain, bleeding, or discharge N- denies any nasal congestion, post-nasal drip, or nosebleed T- sore throat, throat pain, and difficulty with swallowing ● Cardiovascular- denies chest pain or discomfort ● Respiratory- denies cough and difficulty breathing ● Gastrointestinal- denies nausea, vomiting or bloating ● GU- not assessed ● Musculoskeletal/osteopathic structural examination- denies muscle pain or cramping ● Neurologic- headache ● Integumentary/breast- no rash ● Psychiatric- not assessed ● Endocrine- not assessed ● Hematologic/lymphatic- bilateral swollen and tender neck glands ● Allergic/immunologic- no known allergies ● Past medical history- infectious mononucleosis at age 15 ● Hospitalization/surgeries- none ● Preventative health- no flu shot this year otherwise compliant with immunization including COVID shots, birth control pills ● Medications Rx: drospirenone/ estradiol (oral contraceptive pill (OCP))- 3mg/0.02 mg tabs; 1 tab PO daily for contraception OTC: Acetaminophen as needed ● Allergies- no known allergies ● Social history

1. Tobacco: denies
2. Alcohol: two to three drinks per week; CAGE- 0/
3. Drugs: denies use of any illicit drugs
4. Diet: includes campus food and some home-cooked meals
5. Stressors: denies
6. Living situation/housing: lives with a roommate
7. Occupation: law student
8. Sexual history: sexually active, heterosexual, monogamous, no history of STI, occasional oral sex ● Family history
9. Mother- high blood pressure
10. Father-unknown
11. Grandparents-unknown

Physical Exam

● Chest/respiratory- Chest symmetric, no accessory muscle use, lung sound clear bilaterally ● Abdomen- No lesions or scars, liver is at 8 cm at the midclavicular line, edge palpable just below the costal margin. Spleen not palpable, abdomen soft, non-distended, non-tender, no rebound tenderness. Positive bowel sounds in all four quadrants ● GU/rectal- Not assessed ● Musculoskeletal- Not assessed ● Neurologic- AO x 4, negative for Kernig’s sign and Brudzinski’s sign ● Skin- Warm, dry, no lesions, rashes, or diaphoresis. Good skin turgor, no pallor. ● Lymphatic- Bilateral tender cervical lymphadenopathy, nodes approximately 1.5 cm in size, rubbery and mobile ● Psychiatric- appropriate eye contact, no distress observed.

Missed- inspect eyes, palpate sinuses

Key findings

● Sore throat ● Enlarged tonsils, right slightly larger than left- prominent exudates ● Fever, temp 101.8 last night ● Mild chills ● Difficulty swallowing ● Posterior pharynx erythema ● Swollen and tender neck glands-mobile nodes ● Roommate with sore throat for a week ● Mild headache ● Sexually active, with one partner only ● No flu shot, + COVID shots ● No known allergies

Recommended

● Sore throat ● Fever, temp 101. ● Headache ● Pharyngeal erythema and tonsillar exudate ● Swollen glands, tender cervical lymphadenopathy ● Infectious contact

● Infectious mononucleosis at age 15----missed ● Lack of cough----missed ● Lack of flu vaccine ● Additional PMH: no change ● Additional SH: habits and lifestyle ● Medications/Allergies ● ROS: no other constitutional, dermatologic or cardiopulmonary symptoms ● Communications-effect on patient’s life

Problem statement

Amanda Wheaton, a 23-year-old law student with a history of infectious mononucleosis

at age, presents with a severe sore throat for two days, accompanied by fever, chills,

difficulty swallowing, and swollen and tender cervical lymph nodes. She reports sick

contact with her roommate, who had a sore throat for a week. She also states that she has not received a flu vaccine for this year but is compliant with COVID-19 shots. On

physical exam, the patient has enlarged tonsils with bilateral exudates, the right slightly

larger than the left, and posterior pharyngeal erythema. Her temperature is 101.5F,

indicating a fever. However, the patient denies cough, shortness of breath, ear pain, skin

rash, or chest pain.

Case problem statement

This 23-year-old female with a history of mononucleosis presents with acute pharyngitis

and associated fever, headache, and tender cervical lymphadenopathy. The physical

exam is notable for temp 101.5 orally, posterior pharyngeal erythema, mild to moderate tonsillar enlargement without uvular deviation, prominent tonsillar exudate, and tender

bilateral anterior cervical lymphadenopathy without nuchal rigidity or

hepatosplenomegaly.

Test results

Group A streptococcal rapid antigen test- negative Influenza PCR

(Nasal swab)- negative

SARS-CoV-2 antigen- negative

Diagnosis- viral pharyngitis (which is wrong)

Although the Group A streptococcus (GAS) PCR test is negative, treatment should be initiated based on the Centor score (Pellegrino et al., 2023). A Centor score of 4 ( temp 101.5 = 1 point, absence of cough= 1 point, tender cervical lymphadenopathy = 1 point, tonsillar exudate and enlargement = 1 point)for this patient indicates a high risk for GAS pharyngitis, and it warrants empiric antibiotic therapy (Pellegrino et al., 2023; Mustafa & Ghaffari, 2020). Clinical practice Guidelines recommend narrow-spectrum penicillin as the preferred treatment if the patient is not allergic to penicillin (Pellegrino et al., 2023). Penicillin V is the first-line choice due to its effectiveness, narrow spectrum, and minimal resistant risk (Pellegrino et al., 2023). A 10-day course is necessary to ensure complete eradication, prevent acute rheumatic fever (ARF), and reduce transmission (Pellegrino et al., 2023). ● Cepacol extra strength sore throat lozenges (benzocaine/ menthol). Take 1 lozenges PO every 2 hours as needed for sore throat (Epocrates, 2024a). Cepacol can be prescribe for sore throat management as it contains menthol which act as mild-antitussive and mild analgesic and benzocaine which provides mild analgesic effects (Kandiwa et al., 2022).

3. Consults/referrals:
   • No referrals or consults are needed at this time.
   • Clinical practice guidelines recommend symptomatic management and antibiotics to manage mild cases of strep throat (Kruger et al., 2021). A consult or referral to an ENT specialist is necessary for patients experiencing recurrent strep throat, a suspected peritonsillar abscess, difficulty swallowing or signs of airway obstruction due to tonsillar enlargement (Kruger et al., 2021). An infectious disease consultation is recommended in cases of antibiotic resistance or treatment failure following initial therapy (Kruger et al., 2021). Immediate hospital admission is required for patients who develop stridor, difficulty breathing, severe systemic illness, or serious suppurative complications such as acute rheumatic fever or post-streptococcal glomerulonephritis (Kruger et al., 2021).
4. Follow-up:
   • Follow-up in 3-4 days if there is no improvement in symptoms. Seek immediate medical attention if you are having chest pain, stridor, difficulty breathing or swallowing, develop an allergic reaction to medication, or persistent fever lasting more than 24 hours.
   • According to clinical practice guidelines, the patient should follow up in 3- days if symptoms do not improve, and a physician should reassess the current medication regimen to ensure its appropriateness and make necessary adjustments (Kruger et al., 2021). Guidelines also advise considering differential diagnoses such as infectious mononucleosis or the

development of antibiotic resistance in such cases (Kruger et al., 2021). In

addition, if any life-threatening symptoms such as chest pain, stridor,

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