Ihuman has come to be appreciated and recognized as an efficient learning tool for students studying medicine. These simulations help to provide real life scenarios that students can work with to better understand their patients.
Below is an Ihuman case study of Jason Towns
Mr. Jason Towns is a 32 y.o male with PMH HTN and back pain related to occupation, presents with acute onset of left flank pain radiating to left groin starting about 2 hours ago. The pain is described as a sharp, shooting, stabbing pain rating it a 7/10. He states he has never had pain like this before. Initially related it a pulled muscle when he first felt it the night before until about 2 hours ago. The pain is intermittent and comes in cycles causing pain to be bearable to unbearable, and then it goes away. When pain intensifies, he is unable to take a deep breath due to pain, stating he is only able to take shallow breaths. Endorses nausea and vomiting, especially with the unbearable episodes of pain.
The patient describes the vomitus as undigested food. Mr. Towns endorses taking Tylenol for pain, as well as using ice and heat to the area without relief of symptoms. Denies chest pain, SOB, fevers, chills, diarrhea. Urinary symptoms include the inability to initiate urine stream, and urine is darker in color than normal per patient. No dysuria, hematuria, pyuria, urgency, or frequency. The patient is noted to be mildly diaphoretic, appears restless and unable to sit still. Denies tobacco or illicit drug use. He does drink 1-2 drinks on the weekend. He works in construction but denies any known injury. He takes HCTZ for blood pressure which is controlled. FMH positive for cardiovascular disease, HTN, DM, and arthritis. Mr. Towns is afebrile, tachycardiac, and hypertensive at time of assessment.
Primary Diagnosis: Nephrolithiasis/kidney calculi
Status/Condition: Stable Code Status: Full Allergies: NKA
Admit to Unit: Medical Activity Level: as tolerated Diet: NPO
IVF: 18g IVL x 2 1L bolus then NS at 125 ml/hr.
Critical Drips: N/a Respiratory: N/A Medications:
Hold HCTZ (can cause hyperuricemia) Amlodipine 5 mg PO now and then QD Tamsulosin 0.4 mg PO now and then QD Metoclopramide 10 mg IV q6h PRN for N/V
Toradol 30 mg IV now and then 15 mg IV Q6H pain
Acetaminophen 1000 mg IV Q6H PRN fever greaterthan 101.5, pain less than 5. maximum4000 mg/day
Morphine 4 mg IV Q4H PRN for breakthrough pain, monitor BP. Do not give if SBP<90 and notify the provider
Nursing Orders:
VS Q4H. Notify provider SBP<90or >150, HR <60 or >100, O2 sat<90% Notify provider of s/s of hypovolemia, respiratory or neurological changes Daily weight
Monitor strict I/O Strain all urine for stone
Follow Up Lab tests:
U/A, Spot urine for calcium,uric acid, citrate,oxalate, sodium, potassium, and creatinine, CBC and CMP daily.
Diagnostic testing:CT abd andpelvis without contrast
Consults:
Urologist-new onset nephrolithiasis
Patient Education and Health Promotion
Pathophysiology of nephrolithiasis risk factors of the disease Symptoms of nephrolithiasis
Prevention of progression of nephrolithiasis
Discharge planning and required follow-up care Discharge patienthome on PO medications when stable F/U with PCP within 24-48 hours.
F/U with surgeon per his orderTake medications as ordered.
Do not stop or skip the medications even if you feel better without consulting the PCP. Call your healthcare provider right away if you have any of the following:
Tiredness that persists for 2 to 3 days,decreased exercise tolerance,
chest pain or pressure feeling,
persistent SOB at rest or with mild activities, fever over 100.4°F (38.0°C),
sweats,
increase and pounding heart rate, difficulty catching breath, persistent cough,
blood in the sputum
feeling of impending doom.
Discharge patient home when symptoms have resolved and patient is hemodynamically stable. F/U with general surgery after discharge
References
Doherty, G. M. (2015). Current diagnosis & treatment: Surgery(14th ed.). New York: McGrawHill Education.
Papadakis, M. A., McPhee, S. & Rabow, M.W. (2019). Current medical diagnosis & treatment 2019 (58th ed.).New York: McGraw Hill Education.
Sabatine, M. S. (2017). Pocket Medicine. The Massachusetts General Hospital Handbook of Internal Medicine (6th ed.). Philadelphia: WoltersKluwer.
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