NR 602 Week 5 iHuman Case 3 Grading Rubric Overview

11 August 2024

NR 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

  1. History Taking:
    • Begin with open-ended questions, followed by specific HPI questions using OLDCARTS.
    • Collect a detailed PMH, FH, SH, and complete ROS.
  2. Physical Exam:
    • Focus on respiratory and cardiovascular systems due to the chief complaints (cough and SOB).
    • Document all findings and correlate with the history.
  3. Differential Diagnosis:
    • Consider common conditions like asthma, bronchitis, or anxiety-related hyperventilation.
    • Rank them based on the history and physical exam findings.
  4. 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.
  5. 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.
  6. Science Exercises:
    • Engage in the exercises provided during the case to reinforce your understanding.
  7. Summary:
    • Review the entire case and submit it. Check the “see evaluation” button to review your performance.