NR509 Week 6 iHuman Case: Bebe Babbit
(100% accurate patient history key questions, physical assessment activities, EHR, and management plan for Bebe Babbit case)

Key patient history questions

Physical assessment activities

Blood pressure
Pulse
Auscultate lungs
EHR
Diagnosis
History Feedback
Ask relevant problem-focused questions to create an accurate initial differential diagnosis list. Various questions may yield the same information. Examples of high-yield questions for this case include: • Performed X Missed |
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Pivotal Concept Addressed |
Category |
Question |
Response |
• |
HPI |
How can I help you today? |
I’ve been having these really bad headaches over the last few months. I don’t have one now, and haven’t had one in about a week, but I thought l’d have it checked out anyway. |
• |
HPI |
Do you have any other symptoms or concerns we should discuss? |
Just the symptoms that I always have had with these headaches, like nausea and vomiting. There’s nothing else I can think of off the top of my head. |
HPI |
When did your headache start? |
They have gotten worse over the last few months. |
|
HPI |
What are the events surrounding the start of your headache? |
In the past, they were much less frequent and they felt more like I had the hat from hell strapped to my head. These ones feel bad but a little different than that. They might correlate with stress. I have had a lot going on lately. |
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• |
HPI |
How long does your headache last? |
It’s not always the same, but they can last the whole day, like 15 hours. |
HPI |
Does your headache come and go? |
Yeah, I’m super glad they’re not constant. |
|
• |
Symptom |
Do you have new headaches that you have not experienced previously? |
Maybe? I don’t know. There’s definitely some cross over. I have been having these headaches every 1-2 months for the past ten years, but the past few months they’re happening more frequently, like every 1-2 weeks, which is why I’m here. The pain is also worse. |
HPI |
Any change in your headache since it began? |
Only in terms of how often I get it. |
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