NR 602 Week 5 iHuman Case 3 Grading Rubric Overview
11 August 2024NR 602 Week 5 iHuman Case 3: Grading Rubric Overview
This rubric provides a detailed guide to evaluate your performance in the iHuman case study. Each section is crucial for successfully diagnosing and managing the patient’s condition. Below is a breakdown of how to approach each section:
1. History Questions (40%)
- Objective: Gather a comprehensive history using structured and patient-centered questions.
- Steps:
- Start with open-ended questions like, “How can I help you today?” and “Do you have any other symptoms or concerns?”
- Use the “OLDCARTS” mnemonic for a thorough History of Present Illness (HPI):
- O: Onset – When did the symptoms start?
- L: Location – Where is the discomfort? Does it radiate?
- D: Duration – How long have the symptoms lasted?
- C: Characteristics – Describe the symptoms (e.g., sharp, dull, cramping).
- A: Aggravating factors – What worsens the symptoms?
- R: Relieving factors – What alleviates the symptoms?
- T: Treatments – What treatments have been tried, and were they effective?
- S: Severity – How severe are the symptoms on a scale of 1 to 10?
- PMH: Update or gather Past Medical History, allergies, medications, and any Over-the-Counter (OTC) drugs the patient is using.
- FH: Obtain or update Family History.
- SH: Social History should include lifestyle, occupation, and any major recent changes (e.g., loss of a job, death of a partner).
- ROS: Perform a Review of Systems, focusing on areas not covered in the HPI.
2. Physical Exam (30%)
- Objective: Conduct a thorough physical examination based on the history provided.
- Steps:
- Perform relevant physical assessment maneuvers.
- Use a system-based approach to ensure that no significant finding is missed.
- Document all findings accurately, especially those that correlate with the patient’s symptoms.
3. Differential Diagnosis List (10%)
- Objective: Formulate a list of possible diagnoses based on the patient’s history and physical exam.
- Steps:
- Consider all potential diagnoses before ordering tests.
- Use evidence and clinical reasoning to narrow down the list.
- Rank the differentials by likelihood based on the clinical presentation.
4. Ranking the Differential Diagnosis (10%)
- Objective: Prioritize the differential diagnoses from most to least likely.
- Steps:
- Rank the differential diagnoses by considering the most significant active problem (MSAP).
- Justify the ranking based on key findings from the history and physical exam.
5. Lab Tests (10%)
- Objective: Order appropriate tests to confirm or rule out the differential diagnoses.
- Steps:
- Choose tests that will help refine your differential list.
- Consider tests that are most likely to yield diagnostic information.
- Review and interpret test results to guide the final diagnosis.
6. Science Exercises (0%)
- Objective: Engage in interactive exercises throughout the case to enhance understanding.
- Steps:
- Complete all “Gear Head” exercises.
- Utilize these exercises to reinforce clinical reasoning skills and apply theoretical knowledge.
7. Management Plan (0%)
- Objective: Develop a management plan tailored to the final diagnosis.
- Steps:
- Write a comprehensive treatment plan that includes medication, patient education, follow-up, and referrals if necessary.
- Consider both pharmacological and non-pharmacological interventions.
- Address any psychosocial factors that may impact the patient’s treatment and recovery.
Case Help
Patient: Paisley Ward
- Demographics:
- 16-year-old female, 5’5” (165 cm), 150.0 lb (68.2 kg), BMI 25, alert and oriented x4.
- Reason for Encounter: Cough and shortness of breath (SOB).
- Vital Signs:
- Temp: 37.0°C (98.6°F), Pulse: 88 bpm, BP: 112/82 (L arm) & 114/80 (R arm), RR: 26 bpm, SpO2: 94%.
- History:
- Psych: Stress at home due to financial issues; no anxiety or suicidal ideation (SI).
- PMH: Eczema, well-controlled with daily moisturizer; no recent flares.
- Hosp/Surg: Normal birth, no major medical or surgical history.
Steps to Complete the Case
- History Taking:
- Begin with open-ended questions, followed by specific HPI questions using OLDCARTS.
- Collect a detailed PMH, FH, SH, and complete ROS.
- Physical Exam:
- Focus on respiratory and cardiovascular systems due to the chief complaints (cough and SOB).
- Document all findings and correlate with the history.
- Differential Diagnosis:
- Consider common conditions like asthma, bronchitis, or anxiety-related hyperventilation.
- Rank them based on the history and physical exam findings.
- Lab Tests:
- Consider ordering a chest X-ray, complete blood count (CBC), and possibly spirometry if asthma is suspected.
- Interpret the results to refine your differential diagnosis.
- Final Diagnosis and Management Plan:
- Based on the test results and clinical reasoning, choose the most likely diagnosis.
- Develop a management plan that includes patient education, lifestyle modifications, and follow-up.
- Science Exercises:
- Engage in the exercises provided during the case to reinforce your understanding.
- Summary:
- Review the entire case and submit it. Check the “see evaluation” button to review your performance.