NSG 6020 iHuman case: Rachael Hardy V3 PC

The NSG 6020 iHuman case: Rachael Hardy V3 PC presents an advanced clinical scenario that challenges nurse practitioner students to integrate pathophysiology, pharmacology, and patient-centered care principles in a real-world context. This case is part of the Advanced Health Assessment and Diagnostic Reasoning course, a critical component of the MSN curriculum.

In this simulation, students assess Rachael Hardy, a 37-year-old female presenting with complaints of fatigue and abnormal vaginal bleeding. The case requires a systematic approach to differential diagnosis, diagnostic workup, patient counseling, and management, simulating the role of an advanced practice provider in a primary care setting.

NSG 6020 iHuman case: Rachael Hardy V3 PC Overview

The Rachael Hardy V3 PC case is designed to simulate a primary care encounter where the practitioner must assess a complex case of gynecologic dysfunction. Students must demonstrate the ability to conduct a focused HPI, review systems, perform a virtual physical examination, and interpret diagnostic findings to develop a comprehensive care plan.

Patient History and Clinical Presentation

• Age: 37 years
• Sex: Female
• Chief Complaint: “I feel tired all the time and I’ve been bleeding between periods.”
• History of Present Illness:
  • Duration: 3 months
  • Associated symptoms: Fatigue, irregular menstrual cycles, intermenstrual spotting, pelvic discomfort
  • No history of STIs, but limited contraception use
  • No significant past medical history except for a history of anemia in her teenage years
• Social History:
  • Sexually active, occasional use of condoms
  • No tobacco or illicit drug use
  • Moderate alcohol intake
• Family History:
  • Mother: Breast cancer, diagnosed at 48
  • Sister: Polycystic ovary syndrome (PCOS)
• Medications: None regularly

NSG 6020 iHuman case: Rachael Hardy V3 PC Differential Diagnosis

Students must apply advanced diagnostic reasoning to consider multiple gynecologic and systemic causes. The leading differential diagnoses include:

1. Dysfunctional Uterine Bleeding (DUB)
2. Uterine Fibroids (Leiomyomas)
3. Polycystic Ovary Syndrome (PCOS)
4. Endometrial Hyperplasia
5. Thyroid Dysfunction (Hypothyroidism)
6. Iron-deficiency Anemia (secondary to chronic blood loss)
7. Pregnancy-related complications (e.g., miscarriage, ectopic pregnancy)
8. Perimenopause (if premature ovarian aging)

Diagnostic Workup

To refine the differential, students must select appropriate evidence-based diagnostic tests, including:

• Pelvic Ultrasound: Assess for uterine abnormalities such as fibroids or thickened endometrium
• Pap Smear & HPV Co-testing: Rule out cervical pathology
• Endometrial Biopsy: If risk factors for hyperplasia are present
• Serum hCG: Exclude pregnancy
• Complete Blood Count (CBC): Evaluate anemia
• Thyroid Panel (TSH, Free T4): Check for thyroid dysfunction
• FSH/LH, Prolactin, Estradiol: If PCOS or ovarian failure suspected

Proper documentation and justification of these choices are critical in the iHuman system scoring rubric.

Final Diagnosis and Justification

Based on clinical data and diagnostic results (depending on the version), the most likely diagnosis is:

Endometrial Hyperplasia with Secondary Anemia

• Justification:
  • Abnormal uterine bleeding pattern
  • Endometrial thickening on ultrasound
  • Low hemoglobin and hematocrit
  • History of irregular ovulatory cycles

If the biopsy reveals atypical cells, this elevates the concern for precancerous endometrial changes, warranting further intervention or referral.

Pharmacologic and Non-Pharmacologic Management

Pharmacologic:

• Oral Progestins (e.g., medroxyprogesterone acetate): To regulate the endometrial lining
• Iron Supplementation: For anemia management
• Oral Contraceptives: For cycle regulation (if no contraindications)

Non-Pharmacologic:

• Lifestyle modifications: Weight management and reduction of alcohol intake
• Patient Education: On menstrual tracking, importance of follow-up
• Referral to GYN: If endometrial hyperplasia persists or atypia is confirmed

SOAP Note Considerations

Students are expected to construct a detailed SOAP Note, with:

• Subjective: HPI, ROS, pertinent history
• Objective: Physical exam, lab/imaging findings
• Assessment: Differential diagnosis, supporting evidence
• Plan: Diagnostics, pharmacologic treatment, follow-up

Accurate documentation is critical for grading and reflects real-world practice standards.

Clinical Decision-Making Skills Targeted

The Rachael Hardy V3 PC case evaluates multiple domains of nurse practitioner competence:

• History Taking
• Evidence-Based Diagnostics
• Interpretation of Lab/Imaging Results
• Pathophysiological Reasoning
• Pharmacologic Management
• Communication and Patient Education

Mastery of this case ensures readiness for real-life gynecologic primary care encounters.

How iHuman Assignment Help Can Assist

At iHuman Assignment Help, we specialize in providing expert guidance for NSG 6020 iHuman case studies. For the Rachael Hardy V3 PC case, we offer:

• Fully customized SOAP notes
• Differential diagnosis guidance
• Evidence-based management plans
• Plagiarism-free documentation
• One-on-one tutoring on clinical reasoning

Our team of advanced practice nurses ensures that you not only pass but also learn effectively through the process.

FAQs: NSG 6020 iHuman Case – Rachael Hardy V3 PC