NU 665 Week 2 Assignment 1: iHuman Simulation

Sample Answer for NU 665 Week 2 Assignment 1: iHuman Simulation

Assessment

Hypertrophic cardiomyopathy – is an inherited cardiovascular disease characterized by non-dilated left ventricular hypertrophy as demonstrated by echocardiography. It manifest at any phase of life and majority of those affected have a normal life expectancy without the need for intervention (de Oliveira Antunes & Scudeler, 2020).  Some patients may develop progressive heart failure or sudden cardiac death. Among asymptomatic individuals, physical exam is often normal. Findings may include; rapidly increasing carotid pulse, an inverted paradoxical pulse, elevated jugular venous pulse, and mitral regurgitation, or a systolic murmur (de Oliveira Antunes & Scudeler, 2020). An abnormal transthoracic echocardiogram that’s consistent with hypertrophic cardiomyopathy further supports this diagnosis.

Exercise Induced bronchoconstriction (EIB) – is commonly observed I athletes engaged in sports. Its pathophysiology is associated with cold air, hyperventilation, and damage to the epithelium caused by fine particles and chlorine in inspired air (Koya et al., 2020). It develops within 15 minutes of high-intense aerobic training and resolves within 60 minutes. For this patient’s case, the evidence of a normal peak flow rules out an EIB diagnosis.  

Viral cardiomyopathy – patients with viral cardiomyopathy may present with nonspecific symptoms such as shortness of breath (SOB), and fatigue that mimic other respiratory and cardiovascular conditions (Olejniczak et al., 2020). Following the initial acute phase, a patient may experience full clinical recovery or the viral infection can persist or cause an autoimmune mediated inflammatory process with heart failure symptoms.

Caffeine excess – caffeine (tea and coffee) is a psychoactive stimulant with potential adverse cardiovascular effects. However, evidence from currently existing evidence demonstrates that habitual consumption of 2-3 cups of coffee daily is safe and further beneficial tin regards to heart failure, diabetes mellitus, arrhythmias, and atherosclerosis (Voskoboinik, Koh & Kistler, 2019).

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Final Diagnosis: Hypertrophic cardiomyopathy

Plan

Pharmacology

Verapamil 40mg PO 8 hourly not to exceed 480 mg per day

Non-Pharmacology

• Recommend avoidance of strenuous  physical activity  including competitive sports
• Encourage a low-sodium diet for a healthy heart
• Emphasize the essence of maintaining a healthy weight

Diagnostics

• No additional diagnostics needed in this visit

Consults/Referrals

• Consider referral  to a pediatric cardiologist for further evaluation and management and currently restrict the patient from exercise
• Also consider involvement of a psychologist in the patient’s care for psychological counseling, support and ongoing care as they adjust to the information shared (diagnosis).  

Patient Education

• Educate both the father and son  about hypertrophic cardiomyopathy including its etiology, risk factors,  signs and symptoms, and the essence of adherence to the management plan
• Provide the patient with information on how to recognize and report  symptoms of a worsening heart disease

Follow Up

• Patient to return for follow up in 2 weeks  for close monitoring  and adjustment of  the management plan as needed
• Encourage patient to seek emergent care

References

de Oliveira Antunes, M., & Scudeler, T. L. (2020). Hypertrophic cardiomyopathy. IJC Heart & Vasculature, 27, 100503. https://doi.org/10.1016/j.ijcha.2020.100503

Koya, T., Ueno, H., Hasegawa, T., Arakawa, M., & Kikuchi, T. (2020). Management of exercise-induced bronchoconstriction in athletes. The Journal of Allergy and Clinical Immunology: In Practice, 8(7), 2183-2192. https://doi.org/10.1016/j.jaip.2020.03.011

Mirabelli, M. H., Devine, M. J., Singh, J., & Mendoza, M. (2015). The preparticipation sports evaluation. American family physician, 92(5), 371-376.

Olejniczak, M., Schwartz, M., Webber, E., Shaffer, A., & Perry, T. E. (2020). Viral myocarditis—Incidence, diagnosis and management. Journal of cardiothoracic and vascular anesthesia, 34(6), 1591-1601. https://doi.org/10.1053/j.jvca.2019.12.052

Voskoboinik, A., Koh, Y., & Kistler, P. M. (2019). Cardiovascular effects of caffeinated beverages. Trends in cardiovascular medicine, 29(6), 345-350. https://doi.org/10.1016/j.tcm.2018.09.019