Directions

1. Access the Michael Granger Case Assignment in iHuman by clicking on the “Load Assignment in a New Window” button at the bottom of this assignment page. If prompted, select to load the case in a new browser window.
   • Note: It may take a few moments for iHuman cases to load in your web browser, so please be patient.
2. Complete the prework questions associated with the case. Prework is required to be completed before you can move on or before you can replay a case. Be sure that you have submitted each pre-work exercise for evaluation before you move on to the next. Your answers are not graded but are intended to get you thinking about the case.
3. Begin the case and complete these sections: (100 points total, immediate feedback/grade will be provided to you by iHuman when complete)
   • EHR Review
   • Health History
   • Physical Assessment
   • Note: there is no time limit on completing cases
4. As you move through your first attempt and once you complete the case, you will receive feedback from the “Expert” on the important findings that you included (or should have included), and information that should have been collected on the health history and physical assessment. The system will also tell you if you asked questions or performed assessments that are considered extraneous or inappropriate for that particular case. Review this information carefully and take notes to be used on your second attempt, if you would like to work toward a higher score.
5. If you must leave the case for any reason before you have totally completed it, the program will save your spot and will return you to the same point when you re-enter the case. (Look for the green “Resume” arrow at the bottom of the screen.) If you had fully completed a section, you will be able to review the section, but you will not be able to change your answers. You will only be able to move forward in the case.
6. Type your responses to the questions in the Nurse Notes section in the box provided (50 points, graded by instructor after submission). The Nurse Notes will be graded by your instructor, not iHuman. See the grading rubric to understand how it is evaluated. Note: You only need to type out the Nurse Notes once. Your instructor can see both attempts. If you make revisions on your second attempt, inform your instructor.
7. When you have completed a case review the final score and feedback provided by iHuman. You have the option to complete this case a second time before the submission deadline (total of 2 attempts) to improve your score. Your instructor will convert your highest score in iHuman to points earned in the grading rubric. Scores are adjusted based on your performance level.

Solution/ Answer

This is part of the solution to the iHuman case for Michael Granger. I hope it helps! The full solution is available too; just place a custom order via our email address or by contacting us through the chat window on our website. We have a full range of academic solutions to a lot of the iHuman cases.

iHuman Patient: Michael Granger

Subjective Data

There is weight gain, shortness of breath, and edema. He has had 10 lb weight gain within 3 days, worsening lower extremity edema, and shortness of breath. The patient notes that he was diagnosed with heart failure earlier in the previous year but this is the first instance where symptoms have manifested themselves.

Objective Data

Mr. Granger is a direct admission from his PCP office for treatment of his first exacerbation of stage II right sided heart failure.+2 pitting edema noted on lower extremities, a new S3 beat was auscultated, and crackles on the lungs were auscultated as well, dyspnea on exertion, and orthopnea were noted.Pulse: 78, B/P: 126/72, RR: 16 bpm and 98% on room air, Temp: 98.6F,Pain: 0/10, Weight: 10lb gain in the last 3 days, Ejection Fraction: 40%,BNP: Elevated. Patient is a smoker. Coronary Artery Disease, Hyperlipidemia, Hypertension, MI 3 years ago

Assessment

EMR Review: Stage II Right-Sided Heart Failure, Coronary Artery Disease, Hyperlipidemia, Hypertension, MI 3 years ago.

Nursing Dx: Heart Failure, MI, Coronary Artery Disease, High cholesterol, Hypertension

EMR Review: Heart Failure Exacerbation Nursing Dx: Decreased Cardiac Output R/T altered preload AEB 10lb weight gain in 3 days, SOB, and worsening peripheral edema. Mr. Granger came in from his PCP’s office as a direct admission for an acute exacerbation of heart failure. He reports 10lb weight gain in the last 3 days, night sweats, SOB, and peripheral edema.

Plan Strict I&O, SCD’s to bilateral lower extremities when not ambulating, Titrate to keep 02 saturations above 92%. Furosemide, Aspirin, Enoxaparin, Fish oil, Hydralazine, Metropolol, Normal Saline, Simvastatin, Spironolactone, Valsartan.

Short-term goal:

Clear up lungs to promote effective airway. Weigh the patient daily at the same time and keep him on a high fowler’s position.

Implementation

Prior to discharge, the patient must be educated on medications following the medication regimen, adopting healthy lifestyle choices, cardiovascular conditions including heart failure, and the importance of fulfilling the activity order. Follow-up appointments, and the cessation of smoking compliance. Adherence to a low sodium diet in order to prevent worsening of heart failure and related complications

Reassessment of problems

The patient responded well to treatment of electrolyte and fluid imbalance; ejection fraction time has increased a bit. Now that his perfusion, oxygenation, and fluid electrolyte

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