NRNP 6531 WEEK 7 IHUMAN CASE STUDY EVITA ALONSO 48 YEAR
OLD HISPANIC FEMALE CC : ABNOMINAL PAIN DIFFERENT VERSIONS
FROM EXPERT FEEDBACK 2025
CONTENTS: ALL QUESTIONS OLD-CHARTS FOR THE HPI,(PMH,FH,SH AS NEEDED) PHYSICAL
EXAM,EXAMS FEEDBACK,CASE FINDINGS,FEEDBACK,DIFFERENT RANKING,DIAGNOSIS,CASE
PLAN
NAME:
AGE:
VERSION A
CC: abdominal pain
HPI:
48- Year -old Hispanic female. A&O x 4. Appears well developed, well nourished. Patient reports
having intermittent upper right quadrant abdominal pain that started 2 weeks ago. Has
progressively gotten worse over the last 2 days and is now constant. Describes it as a constant
deep abdominal cramping, gnawing, and achiness under right ribs deep inside which radiates
with pain in the right shoulder. Severity 4/10. Reports nausea and vomiting and fever for 2 days.
Reports history of acid reflux. Use of antacids and Ibuprofen provides no relief for her current
abdominal pain. Patient reports pain is brought on by eating food. Patient reports not drinking
adequate amount of fluid because of the vomiting. History of abdominal pain a few times over
the last year that has always gone away on its own, but never this severe. Patient denies
dysphagia, chest pain, SOB, blood in emesis, blood in stool or blood in urine. Denies any one
event or activity associated with the onset of her abdominal pain.
Location: Abdomen
Onset: 2 weeks ago
Character: constant cramping, gnawing, achiness in upper right abdomen under ribs
Associated signs and symptoms: nausea, vomiting, fever, radiating pain to right shoulder.
,Timing: After eating meals
Exacerbating/relieving/factors:/Eating/food/makes/it/worse./No/relieving/factors,/antacids/do/not/w
ork.
Severity:/4/10/today./Starts/as/a/2-3/10/and/increases/up/to/6-
7/10/on/other/days./Allergies:/NKDA/Medications:
• Ibuprofen/400mg/TID/prn/pain
• OTC/antacids/prn/acid/reflux
PMH:
• Occasional/acid/reflux,/heartburn,/relieved/with/OTC/antacids
• Occasional/knee/pain/and/stiffness,/with/frequent/use/of/Ibuprofen/prn
Hospitalizations:/No/open/surgeries./Childbirth./G3P3./Bilateral/tubal/ligation/with/last/delivery./P
reventative/Health:
• CA/Screening/modalities/for/gender/age:/Regular/annual/health/screening/4/months/ago,/y
early/gynecologic/exam/last/year.
• Fitness:/walks/daily,/light/weight/training/3/x/week/at/the/gym.
• Nutrition:/Mediterranean/diet,/avoids/fast/food.
• Stress/reduction:/enjoys/family/time./Social/history:
• Marital/status/Support/system:/Married/x/18/years./Parents/live/3/hours/away.
• Children:/3/children,/doing/well/in/school,/and/physically/active.
• Housing:/Off/base/private/housing
• Occupation:/Army/Lieutenant/Colonel
• Substance/Alcohol/use:/Reports/2/glasses/of/wine/with/dinner./Has/not/had/any/alcohol/fo
r/last/2/days./Denies/tobacco/products/and/illicit/drug/use.
Family/Medical/History:
• Father:/age/70,/well/health./History/of/heart/disease,/Peptic/ulcer/disease
• Mother:/age/69,/well/health./Breast/CA/in/remission;/s/p/cholecystectomy/for/c
holelithiasis.
ROS:
General:/Reports/abdominal/pain,/radiating/right/shoulder/pain/x/2/weeks./Reports/nausea/and/vom
iting,/fever/x/2/days.
HEENT:/Denies/dysphagia
Cardiovascular:/Denies/heart/disease,/chest/pain,/angina./Respiratory:
/Denies/respiratory/difficulty,/SOB.
Gastrointestinal:/Reports/upper/right/quadrant/abdominal/pain/4/10/x/2/weeks,/getting/worse/over/
last/2/days./Reports/nausea/and/vomiting/x/2/days./Denies/blood/in/emesis./Denies
constipation,/diarrhea,/or/blood/in/stool.
, Genitourinary:/Reports/decreased/urine/output/with/dark/colored/urine./Denies/blood/in/urine./Den
ies/menstrual/problems,/or/irregular/menses.
Musculoskeletal:/Reports/radiating/right/shoulder/pain/4/10./Neurolo
gic:/negative
Integument/Breasts:/negative
Psychiatric:/Reports/eating/Mediterranean/diet./Exercising/regularly./Endocrine:
/Reports/fever/x/2/days
Hematologic/Lymphatic:/Denies/bleeding.
Allergic/Immunologic:/Reports/up/to/date/on/vaccinations,/and/flu/vaccination/current.
Objective
Vitals:/Ht./5’6”,/170.0/lbs.,/BMI/27.4./Temp./100.0/°/F./B/P/left/arm,/lying:/136/78,/narrow,/elevate
d/pulse/pressure./HR/92,/Resp./12,/SPO2/98%/on/ambient/air.
General:/48-year-old/Hispanic/female./A/&/O/x/4./Appears/stated/age,/well/developed,/well-
/nourished.
HEENT:/Head,/neck,/and/face/appear/symmetrical./Mild/conjunctival/icterus/OU./No/unusual/brea
th/odor./Swallow/normal,/thyroid/moves/with/swallowing,/no/edema.
Cardiovascular:/RRR,/no/murmurs,/gallops./PMI/at/5th/intercostal/space/at/mid-
clavicular/line./No/visual/peripheral/edema./Peripheral/pulses/less/than/3/seconds/bilateral/finge
rs/and/toes./Quincke’s/test/negative.
Respiratory:/Chest/symmetrical./AP/diameter/is/normal./The/excursion/with/respiration/is
symmetrical/and/there/are/no/abnormal/retractions/or/use/of/accessory/muscles./Unlabored,/regular
/respiratory/rate./Clear/to/auscultation/in/all/fields./No/splinting.
Gastrointestinal:/Abdomen/atraumatic,/soft,/round,/mildly/obese,/non-
distended./Hyperactive/bowel/sounds./No/hepatosplenomegaly,/palpable/gallbladder,/mass,/hernia
tion,/or/abnormal/pulsations./Tender/to/RUQ/palpation,/voluntary/guarding/present,/no/rebound./Po
sitive/Murphy’s/sign./Reported/discomfort/with/right/flank/percussion./Non-
tender/throughout/remainder/of/exam./No/scars,/masses,/or/rashes.
Genitourinary:/oliguria./Drinking/Gatorade.
Musculoskeletal:/Well-
developed,/good/tone/and/musculature./MAEW./Neurologic:/CN/I-
XII/intact./Thought/processes/and/speech/appropriate.
Integument/Breasts:/Skin/warm/and/dry./Quincke’s/test;/blanching/observed./Normal/skin/turgor./N
o/pallor,/jaundice,/rash,/or/lesions./No/ecchymosis,/or/petechiae.
Psychiatric:/Appropriate/mood/and/affect./Endocrine
:/Febrile./Temp/100°/F.
Hematologic/Lymphatic:/No/lymphadenopathy.
OLD HISPANIC FEMALE CC : ABNOMINAL PAIN DIFFERENT VERSIONS
FROM EXPERT FEEDBACK 2025
CONTENTS: ALL QUESTIONS OLD-CHARTS FOR THE HPI,(PMH,FH,SH AS NEEDED) PHYSICAL
EXAM,EXAMS FEEDBACK,CASE FINDINGS,FEEDBACK,DIFFERENT RANKING,DIAGNOSIS,CASE
PLAN
NAME:
AGE:
VERSION A
CC: abdominal pain
HPI:
48- Year -old Hispanic female. A&O x 4. Appears well developed, well nourished. Patient reports
having intermittent upper right quadrant abdominal pain that started 2 weeks ago. Has
progressively gotten worse over the last 2 days and is now constant. Describes it as a constant
deep abdominal cramping, gnawing, and achiness under right ribs deep inside which radiates
with pain in the right shoulder. Severity 4/10. Reports nausea and vomiting and fever for 2 days.
Reports history of acid reflux. Use of antacids and Ibuprofen provides no relief for her current
abdominal pain. Patient reports pain is brought on by eating food. Patient reports not drinking
adequate amount of fluid because of the vomiting. History of abdominal pain a few times over
the last year that has always gone away on its own, but never this severe. Patient denies
dysphagia, chest pain, SOB, blood in emesis, blood in stool or blood in urine. Denies any one
event or activity associated with the onset of her abdominal pain.
Location: Abdomen
Onset: 2 weeks ago
Character: constant cramping, gnawing, achiness in upper right abdomen under ribs
Associated signs and symptoms: nausea, vomiting, fever, radiating pain to right shoulder.
,Timing: After eating meals
Exacerbating/relieving/factors:/Eating/food/makes/it/worse./No/relieving/factors,/antacids/do/not/w
ork.
Severity:/4/10/today./Starts/as/a/2-3/10/and/increases/up/to/6-
7/10/on/other/days./Allergies:/NKDA/Medications:
• Ibuprofen/400mg/TID/prn/pain
• OTC/antacids/prn/acid/reflux
PMH:
• Occasional/acid/reflux,/heartburn,/relieved/with/OTC/antacids
• Occasional/knee/pain/and/stiffness,/with/frequent/use/of/Ibuprofen/prn
Hospitalizations:/No/open/surgeries./Childbirth./G3P3./Bilateral/tubal/ligation/with/last/delivery./P
reventative/Health:
• CA/Screening/modalities/for/gender/age:/Regular/annual/health/screening/4/months/ago,/y
early/gynecologic/exam/last/year.
• Fitness:/walks/daily,/light/weight/training/3/x/week/at/the/gym.
• Nutrition:/Mediterranean/diet,/avoids/fast/food.
• Stress/reduction:/enjoys/family/time./Social/history:
• Marital/status/Support/system:/Married/x/18/years./Parents/live/3/hours/away.
• Children:/3/children,/doing/well/in/school,/and/physically/active.
• Housing:/Off/base/private/housing
• Occupation:/Army/Lieutenant/Colonel
• Substance/Alcohol/use:/Reports/2/glasses/of/wine/with/dinner./Has/not/had/any/alcohol/fo
r/last/2/days./Denies/tobacco/products/and/illicit/drug/use.
Family/Medical/History:
• Father:/age/70,/well/health./History/of/heart/disease,/Peptic/ulcer/disease
• Mother:/age/69,/well/health./Breast/CA/in/remission;/s/p/cholecystectomy/for/c
holelithiasis.
ROS:
General:/Reports/abdominal/pain,/radiating/right/shoulder/pain/x/2/weeks./Reports/nausea/and/vom
iting,/fever/x/2/days.
HEENT:/Denies/dysphagia
Cardiovascular:/Denies/heart/disease,/chest/pain,/angina./Respiratory:
/Denies/respiratory/difficulty,/SOB.
Gastrointestinal:/Reports/upper/right/quadrant/abdominal/pain/4/10/x/2/weeks,/getting/worse/over/
last/2/days./Reports/nausea/and/vomiting/x/2/days./Denies/blood/in/emesis./Denies
constipation,/diarrhea,/or/blood/in/stool.
, Genitourinary:/Reports/decreased/urine/output/with/dark/colored/urine./Denies/blood/in/urine./Den
ies/menstrual/problems,/or/irregular/menses.
Musculoskeletal:/Reports/radiating/right/shoulder/pain/4/10./Neurolo
gic:/negative
Integument/Breasts:/negative
Psychiatric:/Reports/eating/Mediterranean/diet./Exercising/regularly./Endocrine:
/Reports/fever/x/2/days
Hematologic/Lymphatic:/Denies/bleeding.
Allergic/Immunologic:/Reports/up/to/date/on/vaccinations,/and/flu/vaccination/current.
Objective
Vitals:/Ht./5’6”,/170.0/lbs.,/BMI/27.4./Temp./100.0/°/F./B/P/left/arm,/lying:/136/78,/narrow,/elevate
d/pulse/pressure./HR/92,/Resp./12,/SPO2/98%/on/ambient/air.
General:/48-year-old/Hispanic/female./A/&/O/x/4./Appears/stated/age,/well/developed,/well-
/nourished.
HEENT:/Head,/neck,/and/face/appear/symmetrical./Mild/conjunctival/icterus/OU./No/unusual/brea
th/odor./Swallow/normal,/thyroid/moves/with/swallowing,/no/edema.
Cardiovascular:/RRR,/no/murmurs,/gallops./PMI/at/5th/intercostal/space/at/mid-
clavicular/line./No/visual/peripheral/edema./Peripheral/pulses/less/than/3/seconds/bilateral/finge
rs/and/toes./Quincke’s/test/negative.
Respiratory:/Chest/symmetrical./AP/diameter/is/normal./The/excursion/with/respiration/is
symmetrical/and/there/are/no/abnormal/retractions/or/use/of/accessory/muscles./Unlabored,/regular
/respiratory/rate./Clear/to/auscultation/in/all/fields./No/splinting.
Gastrointestinal:/Abdomen/atraumatic,/soft,/round,/mildly/obese,/non-
distended./Hyperactive/bowel/sounds./No/hepatosplenomegaly,/palpable/gallbladder,/mass,/hernia
tion,/or/abnormal/pulsations./Tender/to/RUQ/palpation,/voluntary/guarding/present,/no/rebound./Po
sitive/Murphy’s/sign./Reported/discomfort/with/right/flank/percussion./Non-
tender/throughout/remainder/of/exam./No/scars,/masses,/or/rashes.
Genitourinary:/oliguria./Drinking/Gatorade.
Musculoskeletal:/Well-
developed,/good/tone/and/musculature./MAEW./Neurologic:/CN/I-
XII/intact./Thought/processes/and/speech/appropriate.
Integument/Breasts:/Skin/warm/and/dry./Quincke’s/test;/blanching/observed./Normal/skin/turgor./N
o/pallor,/jaundice,/rash,/or/lesions./No/ecchymosis,/or/petechiae.
Psychiatric:/Appropriate/mood/and/affect./Endocrine
:/Febrile./Temp/100°/F.
Hematologic/Lymphatic:/No/lymphadenopathy.
