NURS 6512 FLORENCE BLACKMAN I HUMAN CASE
STUDY 49 YEARS OLD FEMALE DIAGONISED WITH
CHEST PAIN | LATEST EXPERT REVIEW AND
COMPLETELY ANALYSED CASE STUDY | ALL
SCREENSHOT: iHuman Case Analysis Week #7 NURS
6512 at Walden University
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NURS 6512 FLORENCE BLACKMAN I HUMAN CASE STUDY 49 YEARS OLD FEMALE DIAGONISED WITH C, Exams of Integrated Case Studies
NURS 6512 FLORENCE BLACKMAN I HUMAN CASE STUDY 49 YEARS OLD FEMALE DIAGONISED WITH CHEST PAIN | LATEST EXPERT REVIEW AND COMPLETELY ANALYSED CASE STUDY | ALL SCREENSHOT: iHuman Case Analysis Week #7 NURS 6512 at Walden University
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2024/2025
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NURS 6512 FLORENCE BLACKMAN I HUMAN CASE
STUDY 49 YEARS OLD FEMALE DIAGONISED WITH
CHEST PAIN | LATEST EXPERT REVIEW AND
COMPLETELY ANALYSED CASE STUDY | ALL
SCREENSHOT: iHuman Case Analysis Week #7 NURS
6512 at Walden University
Full Patient Summary
Patient : Florence Blackman, 49-year-old Caucasian female Chief Complaint : Intermittent “squeezing” chest pain for 2 weeks Setting : Outpatient clinic Course Context : Week 7 assignment for NURS 6512 (Advanced Health Assessment), Walden University Summary : Florence Blackman presents with new-onset, exertional mid-chest pain described as squeezing, radiating to the left arm, rated 6/10, and associated with dyspnea on exertion. The pain began during a skiing trip in cold weather, was relieved by rest, and did not recur during regular exercise in warmer conditions but returned recently during exertion. She denies nausea, vomiting, diaphoresis, palpitations, or syncope. Her medical history includes hypertension (HTN), hyperlipidemia (HLD), and a 20 pack-year smoking history (quit 5 years ago). Family history includes a father with myocardial infarction (MI) at age 55. She reports high stress as a financial analyst. Medications include lisinopril and atorvastatin. The presentation suggests a cardiac etiology, with unstable angina as the leading diagnosis.
History
History of Present Illness (HPI)
Florence Blackman, a 49-year-old female, reports intermittent, exertional chest pain for 2 weeks, described as “squeezing” in the mid-chest, radiating to the left arm, rated 6/10 in severity. The pain is associated with dyspnea on exertion and was first noted during a skiing trip in cold weather. It is relieved by rest within 2–5 minutes and did not recur during regular exercise in warmer conditions but returned with recent exertion. She denies nausea, vomiting, diaphoresis, palpitations, syncope, or fever. The pain is not related to meals, breathing, or position changes. Key History Questions (Multiple-Choice Format) :
- What does the pain in your chest feel like? a. Squeezing b. Burning c. Stabbing d. Aching Correct Answer : a Rationale : Squeezing pain is suggestive of cardiac ischemia.
- How severe is the pain on a scale of 1–10? a. 1– 2 b. 3– 4 c. 5– 6
d. 7– 10 Correct Answer : c Rationale : Pain rated 6/10 indicates moderate severity, consistent with angina.
- Does anything make the pain better or worse? a. No triggers b. Worsens with exertion, improves with rest c. Worsens with eating d. Worsens with deep breathing Correct Answer : b Rationale : Exertional pain relieved by rest is characteristic of angina.
- Do you have any other symptoms with the chest pain? a. No other symptoms b. Dyspnea on exertion c. Nausea and vomiting d. Palpitations Correct Answer : b Rationale : Dyspnea supports a cardiac etiology.
- How long does the chest pain last? a. A few seconds b. 2–5 minutes c. 30 minutes d. Hours Correct Answer : b Rationale : Short duration (2–5 minutes) suggests angina.
- When did the chest pain first start? a. Today b. 2 weeks ago c. 6 months ago d. 1 year ago Correct Answer : b Rationale : Recent onset indicates a new condition.
- Is the pain related to any specific activities? a. Eating b. Physical exertion c. Lying down d. Emotional stress Correct Answer : b Rationale : Exertional trigger suggests demand ischemia.
- Do you have a history of acid reflux or heartburn? a. Yes, frequent heartburn b. No acid reflux c. Occasional heartburn d. Recent onset of heartburn Correct Answer : b Rationale : No reflux symptoms reduce GERD likelihood.
- Respiratory : No cough, wheezing, or hemoptysis.
- Gastrointestinal : No heartburn, nausea, vomiting, or abdominal pain.
- Musculoskeletal : No chest wall tenderness, joint pain, or muscle aches.
- Neurological : No dizziness, headaches, or weakness.
- Psychiatric : Reports high stress; denies depression or anxiety.
- Endocrine : No heat/cold intolerance or polyuria.
- Hematologic : No easy bruising or bleeding.
- Skin : No rashes or lesions.
Physical Examination Findings
- Vital Signs : o Temperature: 98.6°F (normal) o Pulse: 80 bpm, regular o Blood Pressure: 140/90 mmHg (elevated) o Respirations: 16 breaths/min o SpO2: 98% on room air
- General Appearance : Well-appearing, no acute distress.
- HEENT : o Eyes: PERRLA, no pallor or xanthomas. o Mouth/Pharynx: No cyanosis or lesions. o Nostrils: No flaring or discharge.
- Neck : o Jugular Venous Distension: None. o Carotid Auscultation: No bruits. o Thyroid: Normal, no masses.
- Chest Wall & Lungs : o Inspection: Symmetrical, no deformities. o Palpation: No tenderness or crepitus. o Auscultation: Clear bilaterally, no wheezes or crackles. o Percussion: Resonant bilaterally.
- Cardiovascular : o Inspection: No heaves or lifts. o Palpation: PMI normal, 5th intercostal space, midclavicular line. o Auscultation: S1, S2 normal, no murmurs, rubs, or gallops. o Peripheral Pulses: 2+ bilaterally (radial, femoral, dorsalis pedis).
- Abdomen : o Inspection: Flat, no distension. o Auscultation: Normal bowel sounds. o Palpation: Soft, non-tender, no organomegaly. o Arterial Auscultation: No bruits.
- Extremities : o Inspection: No edema, cyanosis, or clubbing. o Skin: Warm, dry, no lesions.
- Neurological : o Mental Status: Alert and oriented x3. o Motor Strength: 5/5 bilaterally. o Sensation: Intact bilaterally.
Differential & Final Diagnosis
Differential Diagnoses
- Unstable Angina (Leading Diagnosis) : o Pertinent Positives : Exertional squeezing chest pain radiating to left arm, relieved by rest, dyspnea, HTN, HLD, smoking history, family history of heart disease, high stress. o Pertinent Negatives : No nausea, vomiting, diaphoresis, or prolonged pain (> minutes). o Rationale : Symptoms and risk factors align with unstable angina, a form of acute coronary syndrome (ACS).
- Myocardial Infarction (MI) : o Pertinent Positives : Squeezing chest pain, radiation, risk factors (HTN, HLD, smoking, family history). o Pertinent Negatives : Pain resolves with rest, no diaphoresis or nausea, duration <20 minutes. o Rationale : MI must be ruled out due to risk factors, but intermittent nature favors angina.
- Gastroesophageal Reflux Disease (GERD) : o Pertinent Positives : Chest pain. o Pertinent Negatives : No heartburn, acid taste, or postprandial symptoms; not relieved by antacids. o Rationale : GERD is less likely due to exertional trigger and lack of GI symptoms.
- Costochondritis : o Pertinent Positives : Chest pain. o Pertinent Negatives : No chest wall tenderness, pain not reproduced by palpation. o Rationale : Lack of tenderness rules out musculoskeletal causes.
- Pulmonary Embolism (PE) : o Pertinent Positives : Chest pain, dyspnea. o Pertinent Negatives : No pleuritic pain, no sudden onset, normal SpO2, no immobility. o Rationale : PE is unlikely without acute onset or risk factors.
Final Diagnosis
Management Plan
- Immediate Management : o Administer aspirin 325 mg (chewable) to reduce thrombotic risk. o Sublingual nitroglycerin 0.4 mg every 5 minutes (up to 3 doses) if pain persists. o Urgent referral to emergency department for suspected unstable angina (ACC/AHA Class I recommendation).
- Medications : o Continue lisinopril 10 mg daily for hypertension. o Continue atorvastatin 40 mg daily for hyperlipidemia. o Initiate metoprolol 25 mg daily (beta-blocker) to reduce myocardial oxygen demand. o Initiate aspirin 81 mg daily for secondary prevention. o Consider clopidogrel 75 mg daily if coronary artery disease is confirmed.
- Lifestyle Modifications : o Stress Management : Recommend mindfulness, meditation, or counseling for high-stress job. o Exercise : Moderate aerobic exercise (30 minutes, 5 days/week) once cleared by cardiology. o Diet : Heart-healthy Mediterranean diet (low saturated fat, high fiber, fruits, vegetables). o Smoking Cessation : Reinforce abstinence with counseling support.
- Referrals : o Cardiology : For stress testing and possible coronary angiography. o Behavioral Health : For stress management counseling.
- Monitoring : o Regular blood pressure checks (target <130/80 mmHg). o Lipid profile every 3–6 months to ensure LDL <70 mg/dL.
Patient Education and Follow-Up
- Education : o Explain that chest pain may indicate a heart problem requiring urgent evaluation. o Teach recognition of MI symptoms (prolonged pain >20 minutes, diaphoresis, nausea) and to call 911 immediately. o Discuss medication adherence, potential side effects (e.g., metoprolol: fatigue, bradycardia), and importance of lifestyle changes. o Provide resources (e.g., American Heart Association website) for heart-healthy living.
- Follow-Up : o Schedule follow-up in 1 – 2 weeks to review test results and adjust treatment.
o Cardiology follow-up for stress test or angiography results. o Regular monitoring of BP and lipids every 3–6 months.
Reflection & Rationale
Reflection : This case challenged my ability to differentiate cardiac from non-cardiac causes of chest pain in a 49-year-old female with significant risk factors. The iHuman platform enhanced my clinical reasoning by requiring systematic history-taking, focused physical exams, and evidence-based decision-making. Prioritizing unstable angina was critical due to the patient’s exertional symptoms and risk profile, but ruling out MI and non-cardiac causes (e.g., GERD, PE) required careful consideration of pertinent negatives. The case highlighted the importance of ACC/AHA guidelines in managing suspected acute coronary syndrome and reinforced patient-centered care through education and lifestyle recommendations. Rationale :
- History : Comprehensive questioning using the OLD CART framework (Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors, Radiation, Timing) identified key features of cardiac ischemia.
- Physical Exam : Focused cardiac and pulmonary exams ruled out alternative causes (e.g., no chest wall tenderness for costochondritis).
- Differential Diagnosis : The HEART score (History, ECG, Age, Risk factors, Troponin) supported high suspicion for ACS, with unstable angina as the leading diagnosis due to symptom resolution with rest.
- Management : Urgent referral, anti-ischemic therapy (aspirin, nitroglycerin, beta- blockers), and lifestyle modifications align with ACC/AHA guidelines for unstable angina.
- Learning Outcome : This case strengthened my ability to apply evidence-based guidelines and communicate effectively with patients about serious diagnoses.
Screenshots Placeholders
Note : Actual iHuman screenshots are proprietary and cannot be provided. Below are placeholder descriptions for where screenshots would be inserted, simulating the platform’s interface.
- History-Taking Screen Placeholder : o Description : Screenshot of the iHuman history module showing the question “What does the pain in your chest feel like?” with options (a. Squeezing, b. Burning, c. Stabbing, d. Aching) and the patient’s response (“Squeezing”). The