For this week, you will analyze an i-Human simulation case study about an adult patient with a cardiovascular condition Fred O. MacIntyre V5 PC. Please review the help documents posted one more time before you do it. If HPI is not written under EMR it will not be graded. If all data elements under management/ plan section is not addressed, you will lose a lot of points there as well.

For this week, you will analyze an i-Human simulation case study about an adult patient with a cardiovascular condition Fred O. MacIntyre V5 PC. Please review the help documents posted one more time before you do it. If HPI is not written under EMR it will not be graded. If all data elements under management/ plan section is not addressed, you will lose a lot of points there as well. The references that you provide must be peer reviewed journal references. CDC documents or Mayo clinic documents are not acceptable. Also review due dates in blackboard. Assignment: i-Human Case Study: Evaluating and Managing Cardiovascular ConditionsFred Macintyre is a 62 year old male who presents with a two month history of chest pressure/pain that radiates to cause “throat tightness”. Episodes occur with exertion or emotional upset and are relieved by rest. He denies palpitations, lightheadedness, or syncope but had SOB and diaphoresis during one episode. PE is positive for HTN (140/94), R carotid and L femoral bruits, no cardiac murmurs or edema. PMH includes HTN, elevated cholesterol levels treated with diet alone due to medication side effects, and > 50 packs-year history of smoking. FH is significant for both parents dying of CVD and now an older sister s/p MI. Please follow Template Belowe BelowBelow is the template you are to follow when developing your management plan.  It is to be completed as a Word document and then you can copy and paste it in to i-Human.  Also, always be sure to complete the EMR on the case.  Use this template with each case.   It is not a SOAP format as that is not required. 30 points will be deducted for not utilizing the template.   • Primary Diagnosis and ICD-10 code: Also include any procedural codes.  • 3-5 Differential Diagnoses- Why? What made you select each one as a DDX? How did you rule out? This would be a good area to include references.  • Additional laboratory and diagnostic tests: May be necessary to establish or evaluate a condition. Some tests, such as MRI, may require prior authorization from the patient’s insurance carrier.  • Consults: referrals to specialists, therapists (physical, occupational), counselors, or other professionals. If you are sending to hospital, what orders would you write for a direct admit?  • Therapeutic modalities: pharmacological and nonpharmacological management. For pharmacologic management you must write out the scripts. • Health Promotion: Address risk factors as appropriate. Consider age-appropriate preventive health screening.  • Patient education: Explanations and advice given to patient and family members.  • Disposition/follow-up instructions: when the patient is to return sooner, and when to go to another facility such as the emergency department, urgent care center, specialist or therapist.  • References (minimum of 3, timely, that prove this plan follows current standard of care).” Please Read very ImportantI-human approach for this week 1. Focused history: Think about your case study patient as a real patient who came to see you in your clinic and you as the provider. Consider high-quality cost-effective care. You get a 15-20 minutes to spend with the patient for focused visit and need to come up with a system of asking problem focused questions to aid you in the diagnosis. Be mindful of duplicate questions and not relevant questions. Prior to going in an exam room, you will quickly look at the chart and get an idea of the patient. This includes their name, demographics, PMH and any notes that is of interest. So typically, you will not repeat those questions and will use your valuable time to get more information on their presenting problem. You may ask up to 100 questions but try to get to your LOCATES/OLDCART by the first 25-30 questions. Also use the history hint blue button on the bottom to guide you. You can get at least 5 hints from that button.                  You may also type a phrase in see all associated questions and pick most appropriate question from the drop down. 3. HPI: Next go to the show patient record tab and document chief complaint and HPI. If no HPI written I cannot give credit for that section. It carries 15 points. Also, all areas must be addressed from OLDCART/ LOCATES in a narrative form. Bullet points are not acceptable. Once you have finished entering HPI, you can return to the patient by clicking the “Hide Patient Record” icon. 4. Physical exam: Complete only a focused exam. You would lose points if you included PE that is not indicated for the visit. I saw a lot f tests like dynamic auscultation, Etco2, Quincke’s test etc with the first one which are typically not indicated. Please review the physical exam for the body system your patient has complaints on prior to doing i-human. 5. Assessment: complete all tabs along with differentials. For DD type your words in the search bar and hit enter to see the listings. Then select the most appropriate ones. Be Specific. For eg: PNA or dermatitis might not give you points. Need to be specific like CAP or allergic contact dermatitis. Remember you do not need tests to diagnose each condition. If you are ordering inappropriate tests for a clinic visit you will lose points.RUBRICRubric Detail Name: NRNP_6531_Week4_Assignment_Rubric
 NoviceCompetentProficientHPI statement0 (0%) – 5 (5%)Poorly written HPI statement. Incomplete ideas and sentences. Lacks basic history taking skills6 (6%) – 10 (10%)Well written HPI statement but may be missing 1-2 key components from the history11 (11%) – 15 (15%)Clearly written HPI statement with comprehensive information gathering from case questions.History0 (0%) – 6 (6%)Incomplete history missing 3 or more aspects of the OLDCARDS critical to patient’s diagnosis.7 (7%) – 8 (8%)Fairly complete history covering most of the requirements but may be missing 1-2 aspects of OLDCARDS critical to patient’s diagnosis.9 (9%) – 10 (10%)Complete history covering all critical components of a focus exam. Includes all aspects of OLDCARDSPhysical Exam0 (0%) – 6 (6%)Incomplete physical examination. May be missing 3 or more key exam findings that are critical to patient’s diagnosis.7 (7%) – 8 (8%)Fairly complete physical examination but may be missing 1-2 key exam findings critical to patient’s diagnosis.9 (9%) – 10 (10%)Complete physical examination covering all critical components of a focus exam.Testing0 (0%) – 6 (6%)Includes 3 or more inappropriate exams or tests. May include contraindicated testing.7 (7%) – 8 (8%)Tests ordered are generally apprropriate. May include 1-2 unnecessary exams or tests.9 (9%) – 10 (10%)Tests that are ordered are appropriate for patient and cost effective.Differential Diagnosis Summary0 (0%) – 9 (9%)Primary diagnosis may be wrong.Differential diagnosis list too brief and inconclusive. May be missing 3 or more critical components.10 (10%) – 14 (14%)Correct primary diagnosis identified. Well written differential diagnoses. May be missing 1-2 critical components. Priority list may be out of order15 (15%) – 20 (20%)Primary diagnosis identified. Clearly written differential diagnoses.Plan for patient0 (0%) – 15 (15%)Poorly written plan. May be missing 3 or more key issues that are critical to patient’s diagnosis.16 (16%) – 25 (25%)Well written plan but may be missing 1-2 key issues critical to patient’s diagnosis.26 (26%) – 30 (30%)Clearly written plan covering all critical components for patient’s final diagnosis.Exercises0 (0%) – 2 (2%)Correctly answered 0-69% of the clinical questions.3 (3%) – 4 (4%)Correctly answered 70-89% of the clinical questions.0 (0%) – 5 (5%)Correctly answered 90-100% of the clinical questions.Total Points: 100Name: NRNP_6531_Week4_Assignment_Rubric

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