WEEK 7 I-HUMAN PATIENT CASE STUDY Assessing the
Cardiovascular System — Expanded Clinical Case Study
Patient: James R. Mitchell | 57-Year-Old Male | Chief
Complaint: High Blood Pressure Course: Advanced Health
Assessment | NR 302 | Chamberlain University College of
Nursing Academic Year: 2026-2027
SECTION 1: CASE OVERVIEW AND
LEARNING OBJECTIVES
1.1 Case Summary
Mr. James R. Mitchell is a 57-year-old African American male who presents to the outpatient
primary care clinic for a scheduled follow-up visit related to a recent emergency department
encounter. He was seen in the ED three weeks ago following complaints of persistent headache,
blurred vision, and a blood pressure reading of 186/112 mmHg recorded at home using his
personal automated cuff. He was discharged with a diagnosis of hypertensive urgency and was
started on amlodipine 5 mg orally daily. He has returned today for reassessment and medication
evaluation.
Mr. Mitchell is accompanied by his wife, who provides additional history. He reports only partial
adherence to his new antihypertensive regimen and admits to continued dietary indiscretion
including high sodium intake. He denies any current chest pain or dyspnea at rest but reports
occasional shortness of breath when climbing stairs and mild bilateral lower extremity swelling
noted in the evenings.
1.2 Learning Objectives
Upon completion of this case study, the student will be able to:
1. Perform a comprehensive and systematic cardiovascular history and physical
examination on a patient presenting with hypertension.
2. Accurately interpret subjective and objective cardiovascular assessment data including
vital signs, heart sounds, peripheral vascular findings, and electrocardiographic changes.
3. Identify abnormal cardiovascular findings and correlate them with underlying
pathophysiological mechanisms.
4. Formulate a prioritized problem list and differential diagnosis for a patient with
uncontrolled hypertension and signs of target organ damage.
, 5. Select and justify appropriate diagnostic studies including laboratory tests, imaging, and
cardiac monitoring for the workup of hypertensive disease.
6. Develop an evidence-based management plan incorporating pharmacologic, non-
pharmacologic, and patient education components aligned with 2025/2026 ACC/AHA
guidelines.
7. Apply therapeutic communication techniques during a cardiovascular health encounter
with a patient from a culturally diverse background.
8. Demonstrate accurate and professional clinical documentation using SOAP note format.
1.3 Case Difficulty Level and I-Human Scoring Domains
This case is classified as Intermediate-Advanced difficulty within the I-Human Patients platform.
The following scoring domains are evaluated:
Scoring Domain Weight Key Skills Assessed
History Taking 25% Completeness, relevance, sequence
Physical Examination 30% Accuracy, technique, findings
Differential Diagnosis 20% Prioritization, clinical reasoning
Diagnostic Workup 15% Test selection, interpretation
Management Plan 10% Evidence-based, patient-centered
SECTION 2: PATIENT PROFILE AND
DEMOGRAPHIC INFORMATION
2.1 Patient Identification
Patient Name: James R. Mitchell Date of Birth: March 14, 1967 Age: 57 Years Old Sex: Male
Race / Ethnicity: African American / Black Preferred Language: English Marital Status:
Married (22 years) Occupation: High School Physical Education Teacher and Athletic Coach
Insurance: BlueCross BlueShield PPO — Employer-Sponsored Primary Care Provider: Dr.
Angela Torres, MD — Internal Medicine Visit Type: Follow-Up — Hypertensive Urgency /
Blood Pressure Reassessment Visit Date: Current Encounter — 2025/2026 Academic Year
Allergies: Lisinopril (ACE inhibitor) — Causes severe dry cough and angioedema (documented)
Code Status: Full Code
2.2 Social History
Mr. Mitchell lives in a two-story home with his wife, Patricia, and their adult son who visits on
weekends. He has worked as a physical education teacher and varsity football coach for 27 years.
He describes his job as moderately stressful, particularly during the football season. He coaches
afternoon practices and often skips lunch due to time constraints.
,He does not currently smoke but has a 10-pack-year history of cigarette smoking and quit 15
years ago. He reports social alcohol use — approximately two to three beers on Friday and
Saturday evenings. He denies recreational drug use. He reports low physical activity outside of
work, describing himself as more sedentary in recent years compared to earlier in his career.
Dietary history is significant for high sodium intake. His wife prepares most meals and confirms
that salt is added during cooking and at the table. He frequently eats fast food during football
season and relies on vending machines for lunch at school. He drinks approximately two cups of
coffee per day and one to two caffeinated sodas in the afternoon.
2.3 Family History
Family Member Status Relevant Medical History
Father Deceased (age 61) Myocardial infarction, hypertension, type 2 diabetes
Mother Living (age 79) Hypertension, atrial fibrillation, osteoporosis
Brother (age 54) Living Hypertension, hyperlipidemia, obesity
Brother (age 49) Living Type 2 diabetes, hypertension
Maternal Uncle Deceased (age 68) Stroke secondary to uncontrolled hypertension
Maternal Grandmother Deceased (age 72) Congestive heart failure, hypertension
SECTION 3: COMPREHENSIVE HEALTH
HISTORY
3.1 Chief Complaint
"My blood pressure is still running high and I have been getting these headaches almost every
day. My wife made me come in because she is worried about me having a stroke like her uncle
did." — Mr. Mitchell, in his own words.
3.2 History of Present Illness (HPI)
Mr. James Mitchell is a 57-year-old African American male with a known history of
hypertension, first diagnosed approximately 8 years ago at a worksite health screening. He
presents today as a follow-up to his ED visit three weeks ago during which he was found to have
a blood pressure of 186/112 mmHg. He reports that his headaches have continued since that
visit, now occurring daily, described as a dull, pressure-like sensation located bilaterally in the
occipital region, rated 5/10 in severity, worse in the morning upon awakening and partially
relieved by ibuprofen 400 mg which he takes approximately three times per week.
He was started on amlodipine 5 mg orally once daily at the ED visit but admits to missing
approximately three to four doses per week, citing forgetfulness and concern about side effects
, he read about online. He has not made any dietary modifications and continues to use table salt
liberally. He monitors his blood pressure at home using an automated wrist cuff; recent readings
have ranged from 158/96 to 174/108 mmHg over the past two weeks.
He reports mild bilateral ankle edema that he first noticed approximately two weeks ago, present
in the evenings and improved by morning. He denies orthopnea but endorses mild exertional
dyspnea when climbing one flight of stairs, which is a change from his previous functional
baseline. He denies chest pain, palpitations, syncope, or presyncope. He denies nausea, vomiting,
or abdominal pain. He reports nocturia two to three times per night, which has worsened over the
past several months. He denies hematuria or dysuria.
He endorses fatigue and decreased energy levels for the past three to four months, which he
initially attributed to the demands of football season but notes it has persisted beyond that. He
denies vision changes currently but experienced transient blurred vision during the ED visit three
weeks ago. He denies focal neurological deficits, weakness, or slurred speech.
Onset: Hypertension diagnosed 8 years ago; current exacerbation acutely identified 3 weeks ago.
Location: Headache — bilateral occipital region. Edema — bilateral ankles and lower legs.
Duration: Daily headaches ongoing x 3 weeks. Edema x 2 weeks. Fatigue x 3–4 months.
Character: Dull, pressure-like headache. Pitting, dependent edema. Aggravating Factors:
Morning awakening worsens headache. End of day worsens edema. Exertion worsens dyspnea.
High sodium intake. Ibuprofen use. Medication non-adherence. Relieving Factors: Ibuprofen
partially relieves headache. Morning rest reduces edema. Associated Symptoms: Exertional
dyspnea, fatigue, nocturia x2–3 per night. Treatment: Amlodipine 5 mg daily (poorly adhered
to). Ibuprofen 400 mg PRN.
3.3 Past Medical History
Year Diagnosed /
Condition Current Management
Details
Essential Hypertension — Stage 2017 — Worksite Amlodipine 5 mg daily — newly
2 screening started, poor adherence
2020 — Routine lab
Hyperlipidemia Atorvastatin 40 mg at bedtime
screening
Pre-Diabetes / Impaired Fasting Dietary modification (not consistently
2022 — A1c 6.1%
Glucose followed)
No formal weight management program
Obesity — Class I BMI 31.4 kg/m²
enrolled
Benign Prostatic Hyperplasia
2023 Tamsulosin 0.4 mg at bedtime
(BPH)
Osteoarthritis — Bilateral 2021 — X-ray PRN ibuprofen (elevates blood
Knees confirmed pressure)
Hypertensive Urgency — Amlodipine 5 mg started; BP not yet at
3 weeks ago
Recent ED Visit goal
Cardiovascular System — Expanded Clinical Case Study
Patient: James R. Mitchell | 57-Year-Old Male | Chief
Complaint: High Blood Pressure Course: Advanced Health
Assessment | NR 302 | Chamberlain University College of
Nursing Academic Year: 2026-2027
SECTION 1: CASE OVERVIEW AND
LEARNING OBJECTIVES
1.1 Case Summary
Mr. James R. Mitchell is a 57-year-old African American male who presents to the outpatient
primary care clinic for a scheduled follow-up visit related to a recent emergency department
encounter. He was seen in the ED three weeks ago following complaints of persistent headache,
blurred vision, and a blood pressure reading of 186/112 mmHg recorded at home using his
personal automated cuff. He was discharged with a diagnosis of hypertensive urgency and was
started on amlodipine 5 mg orally daily. He has returned today for reassessment and medication
evaluation.
Mr. Mitchell is accompanied by his wife, who provides additional history. He reports only partial
adherence to his new antihypertensive regimen and admits to continued dietary indiscretion
including high sodium intake. He denies any current chest pain or dyspnea at rest but reports
occasional shortness of breath when climbing stairs and mild bilateral lower extremity swelling
noted in the evenings.
1.2 Learning Objectives
Upon completion of this case study, the student will be able to:
1. Perform a comprehensive and systematic cardiovascular history and physical
examination on a patient presenting with hypertension.
2. Accurately interpret subjective and objective cardiovascular assessment data including
vital signs, heart sounds, peripheral vascular findings, and electrocardiographic changes.
3. Identify abnormal cardiovascular findings and correlate them with underlying
pathophysiological mechanisms.
4. Formulate a prioritized problem list and differential diagnosis for a patient with
uncontrolled hypertension and signs of target organ damage.
, 5. Select and justify appropriate diagnostic studies including laboratory tests, imaging, and
cardiac monitoring for the workup of hypertensive disease.
6. Develop an evidence-based management plan incorporating pharmacologic, non-
pharmacologic, and patient education components aligned with 2025/2026 ACC/AHA
guidelines.
7. Apply therapeutic communication techniques during a cardiovascular health encounter
with a patient from a culturally diverse background.
8. Demonstrate accurate and professional clinical documentation using SOAP note format.
1.3 Case Difficulty Level and I-Human Scoring Domains
This case is classified as Intermediate-Advanced difficulty within the I-Human Patients platform.
The following scoring domains are evaluated:
Scoring Domain Weight Key Skills Assessed
History Taking 25% Completeness, relevance, sequence
Physical Examination 30% Accuracy, technique, findings
Differential Diagnosis 20% Prioritization, clinical reasoning
Diagnostic Workup 15% Test selection, interpretation
Management Plan 10% Evidence-based, patient-centered
SECTION 2: PATIENT PROFILE AND
DEMOGRAPHIC INFORMATION
2.1 Patient Identification
Patient Name: James R. Mitchell Date of Birth: March 14, 1967 Age: 57 Years Old Sex: Male
Race / Ethnicity: African American / Black Preferred Language: English Marital Status:
Married (22 years) Occupation: High School Physical Education Teacher and Athletic Coach
Insurance: BlueCross BlueShield PPO — Employer-Sponsored Primary Care Provider: Dr.
Angela Torres, MD — Internal Medicine Visit Type: Follow-Up — Hypertensive Urgency /
Blood Pressure Reassessment Visit Date: Current Encounter — 2025/2026 Academic Year
Allergies: Lisinopril (ACE inhibitor) — Causes severe dry cough and angioedema (documented)
Code Status: Full Code
2.2 Social History
Mr. Mitchell lives in a two-story home with his wife, Patricia, and their adult son who visits on
weekends. He has worked as a physical education teacher and varsity football coach for 27 years.
He describes his job as moderately stressful, particularly during the football season. He coaches
afternoon practices and often skips lunch due to time constraints.
,He does not currently smoke but has a 10-pack-year history of cigarette smoking and quit 15
years ago. He reports social alcohol use — approximately two to three beers on Friday and
Saturday evenings. He denies recreational drug use. He reports low physical activity outside of
work, describing himself as more sedentary in recent years compared to earlier in his career.
Dietary history is significant for high sodium intake. His wife prepares most meals and confirms
that salt is added during cooking and at the table. He frequently eats fast food during football
season and relies on vending machines for lunch at school. He drinks approximately two cups of
coffee per day and one to two caffeinated sodas in the afternoon.
2.3 Family History
Family Member Status Relevant Medical History
Father Deceased (age 61) Myocardial infarction, hypertension, type 2 diabetes
Mother Living (age 79) Hypertension, atrial fibrillation, osteoporosis
Brother (age 54) Living Hypertension, hyperlipidemia, obesity
Brother (age 49) Living Type 2 diabetes, hypertension
Maternal Uncle Deceased (age 68) Stroke secondary to uncontrolled hypertension
Maternal Grandmother Deceased (age 72) Congestive heart failure, hypertension
SECTION 3: COMPREHENSIVE HEALTH
HISTORY
3.1 Chief Complaint
"My blood pressure is still running high and I have been getting these headaches almost every
day. My wife made me come in because she is worried about me having a stroke like her uncle
did." — Mr. Mitchell, in his own words.
3.2 History of Present Illness (HPI)
Mr. James Mitchell is a 57-year-old African American male with a known history of
hypertension, first diagnosed approximately 8 years ago at a worksite health screening. He
presents today as a follow-up to his ED visit three weeks ago during which he was found to have
a blood pressure of 186/112 mmHg. He reports that his headaches have continued since that
visit, now occurring daily, described as a dull, pressure-like sensation located bilaterally in the
occipital region, rated 5/10 in severity, worse in the morning upon awakening and partially
relieved by ibuprofen 400 mg which he takes approximately three times per week.
He was started on amlodipine 5 mg orally once daily at the ED visit but admits to missing
approximately three to four doses per week, citing forgetfulness and concern about side effects
, he read about online. He has not made any dietary modifications and continues to use table salt
liberally. He monitors his blood pressure at home using an automated wrist cuff; recent readings
have ranged from 158/96 to 174/108 mmHg over the past two weeks.
He reports mild bilateral ankle edema that he first noticed approximately two weeks ago, present
in the evenings and improved by morning. He denies orthopnea but endorses mild exertional
dyspnea when climbing one flight of stairs, which is a change from his previous functional
baseline. He denies chest pain, palpitations, syncope, or presyncope. He denies nausea, vomiting,
or abdominal pain. He reports nocturia two to three times per night, which has worsened over the
past several months. He denies hematuria or dysuria.
He endorses fatigue and decreased energy levels for the past three to four months, which he
initially attributed to the demands of football season but notes it has persisted beyond that. He
denies vision changes currently but experienced transient blurred vision during the ED visit three
weeks ago. He denies focal neurological deficits, weakness, or slurred speech.
Onset: Hypertension diagnosed 8 years ago; current exacerbation acutely identified 3 weeks ago.
Location: Headache — bilateral occipital region. Edema — bilateral ankles and lower legs.
Duration: Daily headaches ongoing x 3 weeks. Edema x 2 weeks. Fatigue x 3–4 months.
Character: Dull, pressure-like headache. Pitting, dependent edema. Aggravating Factors:
Morning awakening worsens headache. End of day worsens edema. Exertion worsens dyspnea.
High sodium intake. Ibuprofen use. Medication non-adherence. Relieving Factors: Ibuprofen
partially relieves headache. Morning rest reduces edema. Associated Symptoms: Exertional
dyspnea, fatigue, nocturia x2–3 per night. Treatment: Amlodipine 5 mg daily (poorly adhered
to). Ibuprofen 400 mg PRN.
3.3 Past Medical History
Year Diagnosed /
Condition Current Management
Details
Essential Hypertension — Stage 2017 — Worksite Amlodipine 5 mg daily — newly
2 screening started, poor adherence
2020 — Routine lab
Hyperlipidemia Atorvastatin 40 mg at bedtime
screening
Pre-Diabetes / Impaired Fasting Dietary modification (not consistently
2022 — A1c 6.1%
Glucose followed)
No formal weight management program
Obesity — Class I BMI 31.4 kg/m²
enrolled
Benign Prostatic Hyperplasia
2023 Tamsulosin 0.4 mg at bedtime
(BPH)
Osteoarthritis — Bilateral 2021 — X-ray PRN ibuprofen (elevates blood
Knees confirmed pressure)
Hypertensive Urgency — Amlodipine 5 mg started; BP not yet at
3 weeks ago
Recent ED Visit goal
