The purpose of these assignments is to engage the learner in the process of clinical decision making and critical thinking related to developing or revising a plan of care associated with a cardiology focused patient. In this assignment the student will employ self-reflection as part of the learning process to assist with identifying prior knowledge and newly learned knowledge through this process.
Information before you start related to Dx for this case:
Utilize the 3 known cardiology related diagnoses (based on the case) for your three diagnoses on the template. There are some non-cardiology related diagnoses in the case and some other potential diagnoses, but do not include them in your 3. You will have an opportunity in the case questions to explore those.
Patient Case:
Mr. Johnson, a 55-year-old Black American male, presents to the clinic for a follow-up appointment.
HPI: Patient had a myocardial infarction (MI) six months ago. No regular healthcare prior. He received a drug eluding stent (DES) to his left anterior descending coronary artery (LAD) during his hospital stay for his MI. His hospital Echocardiogram showed normal LVEF. He denies any other PMH. Due to a financial issue after his MI (he lost his job), he has only been to one follow-up visit after his MI (1 month after discharge from hospital). He has been renewing and taking some of his previously prescribed meds. He recently regained health insurance coverage as he is slowly recovering financially from his prior issues. He now sees you for follow-up.
He went to a free health fair a month ago and had his BP checked and a blood draw for lipid labs. His LDL cholesterol was 130 mg/dL; HDL was 35 mg/dl, triglycerides were 175 mg/dl, and his blood pressure was 148/85 mmHg. He does not check his BP at home. Labs from his MI hospital stay 6 months ago are not currently available.
PMH: Recent -Myalgia’s with the use of Atorvastatin; MI – stent placed to LAD 6mths ago; New DX’s that happened during his hospitalization 6 mths ago – Type II diabetes, hypertension and hyperlipidemia
FamHX: None given
Allergies: NKDA
Medications: Lisinopril 40mg per day; Metformin 500mg twice a day; Atorvastatin 20mg a day but he indicates he can’t take the atorvastatin due to “muscle pains” as noted in HPI. ASA 81mg qd. He noted he may have been on “one or two more medications” after his MI, but he can’t remember them and did not renew them due to cost. He also notes taking “Aleve” for periodic leg pain, per HPI. He is not clear on specifically how much Aleve he takes – says “1-2 pills a few times a week”.
SocHX: Recently lost his job due his MI; He denies current or past smoking hx or illicit drug use. He does not follow any specific diet, and he indicates he likes “hearty food”. He drinks “a beer or two” most nights. He is married to a female and identifies as a male. He does not exercise but does walk 3-4 blocks most days to walk his dog.
ROS:
Const: States he is OK, acknowledges mild fatigue with activity
HEENT:
Resp: Denies SOB when walking two blocks, does get tired though.
CV: Denies any CP, palpitations or irreg heart beat; denies edema to his lower ext
GI: Denies N/V/D, Abd pain
GU: Notes periodic frequent urination, more often at night
MSK: He indicates he was having muscle pain in his legs when walking after coming home after his MI. One of the new medications that was added in his hospital stay was a statin, and he read online that it was causing the pain, so he stopped taking it. He indicates the pain in his legs he had when taking the statin is now “a little better”, but not gone.
Neuro: He notes periodic HA, which is not new for him nor more intense. He denies any other symptoms,
Psych/Mental health: He does note he felt “down” after he lost his job and is doing “better” now.
PE:
VS in Visit: BP 150/82; HR 88; RR 16; Spo2 94% RA; BMI 35
Const: overweight appearing male in no apparent distress
RESP: Unlabored
CV: RRR, no murmur, rub or gallop, +2 pulse Bilateral radial, femoral, and dorsalis pedis; Mild BLE edema, nothing else remarkable.
GI: Abd soft and non-tender, normal bowel sounds in all quadrants
GU: GU exam deferred
MSK: 5/5 strength in all extremities, no tenderness
Neuro: CN 1-11 grossly intact
Psych/Mental health: Appears calm, answers questions appropriately
Additional Questions:
What other information would have been helpful to have if you could have asks Mr. Jones?
Based on the case, what other diagnoses does Mr. Johnson have or might have that are not related to his MI?
Given Mr. Johnson’s know PMH and exam today, what additional complications is he at risk for – not based on symptoms but at higher risk for developing just based on his history and current status?
Rubric
HOPPE rubric
HOPPE rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeDiagnosis and disease state status
10 to >8.0 pts
Competent
Correct & appropriate leading DX’s identified. Leading DX rationale clearly demonstrates critical reasoning based upon patient scenario. Pt status correct. Other DX if appropriate accurate with rationale. References present
8 to >4.0 pts
Beginning Competence
Leading DX’s identified, rationale and status requires some revision for accuracy. Pt status correct. Other DX if appropriate accurate with rationale. References present
4 to >1.0 pts
Adv Beginner
Leading DX may not be correctly placed as the leading DX, maybe present though as one of the other DX’s. Rationale and status requires some revision for accuracy. Pt status may or may not be correct. Other DX if present – rationale and correlation may require revision References may or may not be present
1 to >0.0 pts
Novice
Lead DX is incorrect and the other DX may not be appropriate based upon the scenario if present. Review of course learning’s for this subject matter needed. 1 or 11.0 pts
Competent
Leading DX & other appropriate DX’s based on the scenario presentation have correctly associated critical reasoning elements associated with pertinent positives and negatives. Determination of disease status is able to be ascertained correctly for DX(s) presented. All appropriate DX present with Pos/Neg data. References present
11 to >7.0 pts
Beginning Competence
Leading DX based on the scenario presentation has mostly correct associated critical reasoning elements associated with pertinent positives and negatives. Determination of disease status is able to be ascertained correctly for DX(s) presented. Appropriate DX(s) present with Pos/Neg data – minor revisions needed. References present
7 to >3.0 pts
Adv Beginner
Leading Dx may not be correct. Major revisions may be needed. Pertinent positives (S/S present) and negatives (S/S absent) from case presentation not correctly presented – key elements missing. Determination of disease status is spoken to, rationale may require revision. If other DX(s) presented, Mostly appropriate DX(s) present with Pos/Neg data – minor revisions needed. References may or may not be present
3 to >0 pts
No Marks
Leading DX is incorrect based on the case scenario, Critical thinking correlation from Subjective/Objective data not properly thought through. Remaining DX pos/neg information if appropriate requires clearer association to the respective. DX’s; Key sub/obj elements missed by student in determining leading and or subsequent DX(s). 3 or 11.0 pts
Competent
Succinctly and correctly addresses appropriate/critical/ necessary care recommendations for the correct leading. Pt education addressed key factors that must be included associated with the leading DX & other Dx’s if appropriate At least two references present using correct APA format.
11 to >7.0 pts
Beginning Competence
Identified appropriate care recommendations. Minor revisions needed to better assimilate to correct leading DX. Pt education addressed most key factors included associated with the leading DX & other Dx’s if appropriate At least one reference present using correct APA format
7 to >3.0 pts
Adv Beginner
Mentions care recommendations. Care elements missing, fragmented. not correctly presented Expansion is needed. Inference to reference but not written.
3 to >0 pts
Novice
Student’s plan of care is inadequate with gross deficiencies. (3 or fewer points)
15 pts
This criterion is linked to a Learning OutcomeLearning needs/Additional questions
5 pts
Competent
If assignment required: Learning articulately and concise presented. Needs reflect clear association to clinical reasoning expansion associated with the final diagnosis and plan. If assignment required: Additional questions answered appropriately, application of critical thinking evident and correctly/appropriately demonstrated reflecting understanding as it relates to the scenario. Min of 1 reference cited
4 pts
Beginning Competence
If the assignment required: Learning is appropriately presented. Clinical reasoning association to final diagnosis is present. Minor revisions for conciseness/clarity needed. If assignment required: Additional questions answered, application of critical thinking with minor elements of continued learning needed as it relates to the questions/scenario. Min of 1 reference cited
2 pts
Adv Beginner
If the assignment required: Learning is reflected upon, clinical reasoning association to the final diagnosis is difficult to understand from what is written. Additional questions answered, application of critical thinking with major elements of continued learning needed as it relates to the questions/scenario. References may or may not be cited
0 pts
Novice
Learning element and/or question(s) were written on by the student. Clinical reasoning association questions and/or learning need is not understandable revision to improve clarity/conciseness needed.(1 or fewer points) No references
5 pts
This criterion is linked to a Learning OutcomeAPA formatting, Spelling, Grammar
3 pts
Competent
All correctly demonstrated
2 pts
Adv Beginner
1-2 errors present
0 pts
Improvement needed
3 or more errors present
3 pts
Total Points: 48
