AA Hypertension Stage 2, and Overweight Scenario Description: Ms. A presents with complaints of headache and general fatigue. She also reports that she has had periodic nosebleeds.

Assignment Criteria

Level III

Level II

Level I

Not Present

Criteria 1

Level III

Points: 80

Level II

Points: 64

Level I

Points: 48

Not Present

0 Points

Total Score

· Within Exam Mode, obtains 65 to 80 points of the required total components for virtual reality patient scenario

· Within Exam Mode, obtains between 49 to 64.9 points of the required total components for virtual reality patient scenario

· Within Exam Mode, obtains between 33 to 48.9 points of the required total components for virtual reality patient scenario

· Does not attempt in Exam Mode

· Does not meet the criteria

Criteria 1

Level III Max Points

Points: 8

Level II Max Points

Points: 6.4

Level I Max Points

Points: 4.8

0 Points

Content Quality- Subjective Data

Subjective data displays complete understanding of all critical concepts of virtual reality patient case including:

· Name, age, gender

· Chief complaint

· History of present illness (HPI) that follows OLD CARTS pneumonic

· Medications

· Allergies

· Past medical history

· Past surgical history

· Pertinent family history

· Social history

· Review of Systems

· Subjective data displays understanding of critical concepts of chosen virtual reality patient case; there may be 1-2 critical concepts with errors/omissions or lack of details.

· Subjective data displays understanding of critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details.

· Does not meet criteria

Criteria 2

Level III Max Points

Points: 8

Level II Max Points

Points: 6.4

Level I Max Points

Points: 4.8

Not Present

0 Points

Content Quality- Objective Data

Objective data displays complete understanding of all critical concepts of chosen virtual reality patient case including:

· Vital signs

· Body systems that are pertinent to specific case

· Objective data displays understanding of critical concepts of chosen virtual reality patient case; there may be 1-2 critical concepts with errors/omissions or lack of details.

· Objective data displays understanding of critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details

· Does not meet criteria

Criteria 3

Level III Max Points

Points: 4

Level II Max Points

Points: 3.2

Level I Max Points

Points: 2.4

Not Present

0 Points

Content Quality- Assessment

Assessment displays complete understanding of all critical concepts of chosen virtual reality patient case including:

· Primary diagnosis

· Pathophysiology of primary diagnosis

· Three differential diagnoses

· Rationales for differential diagnoses

· Assessment displays understanding of critical concepts of chosen virtual reality patient case; there may be 1 critical concept with errors/omissions or lack of details.

· Assessment displays understanding of critical concepts of chosen virtual reality patient case; there may be 2 critical concepts with errors/omissions or lack of details.

· Does not meet criteria

Criteria 4

Level III Max Points

Points: 4

Level II Max Points

Points: 3.2

Level I Max Points

Points: 2.4

Not Present

0 Points

Content Quality- Plan of Care

Plan displays complete understanding of all critical concepts of chosen virtual reality patient case including:

· Medications

· Non-pharmacological recommendations

· Diagnostic tests

· Patient education

· Cultural considerations

· Health promotion

· Referrals

· Follow-Up

· Plan displays understanding of critical concepts of chosen virtual reality patient case; there may be 1 critical concept with errors/omissions or lack of details.

· Plan displays understanding of critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details.

· Does not meet criteria

Criteria 5

Level III Max Points

Points: 3

Level II Max Points

Points: 2.4

Level I Max Points

Points: 1.8

Not Present

0 Points

Collegiate-level academic writing

· Includes no more than three grammatical, spelling, or punctuation errors that do not interfere with the readability.

· Supports all opinions and ideas with relevant and credible reference sources of information.

· Provides three or more peer-reviewed or evidence-based practice scholarly references sources.

· All reference sources are within the past five years.

· Includes no more than four grammatical, spelling, or punctuation errors that do not interfere with the readability.

· Supports many opinions and ideas with relevant and credible sources of information.

· Provides two peer-reviewed or evidence-based practice scholarly references sources.

· All reference sources are within the past five years.

· Includes five or more grammatical, spelling, and punctuation errors that makes understanding parts of assignment difficult, but does not interfere with readability.

· Not all references utilized are relevant and/or credible sources of information.

· Provides one peer-reviewed or evidence-based practice scholarly references source.

· Reference sources are within the past five years.

· Does not meet criteria

Criteria 6

Level III Max Points

Points: 3

Level II Max Points

Points: 2.4

Level I Max Points

Points: 1.8

0 Points

Citations and Formatting

● The overall order of information is clear and contributes to the meaning of the assignment. There may be 1-2 sentences, or one paragraph that is out of order, or other minor organization issues.

● Correctly citing all reference sources. One or two formatting, in-text, or reference citation errors may occur.

● Quotation marks and citations make authorship clear.

● The overall order of information is confusing in places due to 3-4 sentences, or two paragraphs that may be out of order, or other organization issues that interfere with the meaning or intent of the paper.

● Correctly citing all reference sources. 3-4 formatting, in-text, or reference citation errors may occur.

● Quotation marks and citations generally, make authorship clear.

● The overall order of information is confusing in places due to 5-6 sentences or three paragraphs that may be out of place, or other organization issues that interfere with the meaning or intent of the paper.

● Attempts to cite. 5-6 formatting, in-text, or reference citation errors may occur.

● Quotation marks and citations may be missing or incorrect.

● Authorship may be unclear in areas.

· Does not meet criteria

Maximum Total Points

30

24

18

Minimum Total Points

25

19

Criteria 1

Level III Max Points

Points: 15

Level II Max Points

Points: 12

Level I Max Points

Points:9

0 Points

Content Quality- Subjective Data

Presentation of subjective data displays complete understanding of all critical concepts of chosen virtual reality patient case including:

· Name, age, gender

· Chief complaint

· History of present illness (HPI) that follows OLD CARTS pneumonic

· Medications

· Allergies

· Past medical history

· Past surgical history

· Pertinent family history

· Social history

· Review of Systems

· Presentation of subjective data displays understanding of all critical concepts of chosen virtual reality patient case; there may be 1-2 critical concepts with errors/omissions or lack of details.

· Presentation of subjective data displays understanding of all critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details.

· Does not meet the criteria

Criteria 2

Level III Max Points

Points: 15

Level II Max Points

Points: 12

Level I Max Points

Points:9

0 Points

Content Quality- Objective Data

Presentation of objective data displays complete understanding of all critical concepts of chosen virtual reality patient case including:

· Vital signs

· Body systems that are pertinent to specific case

· Presentation of objective data displays understanding of all critical concepts of chosen virtual reality patient case; there may be 1-2 critical concepts with errors/omissions or lack of details.

· Presentation of objective data displays understanding of all critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details.

· Does not meet the criteria

Criteria 3

Level III Max Points

Points: 15

Level II Max Points

Points: 12

Level I Max Points

Points:9

0 Points

Content Quality- Assessment

Presentation of assessment displays complete understanding of all critical concepts of chosen virtual reality patient case including:

· Primary diagnosis

· Pathophysiology of primary diagnosis

· Three differential diagnoses

· Rationales for differential diagnoses

· Presentation of assessment displays understanding of all critical concepts of chosen virtual reality patient case; there may be one critical concept with errors/omissions or lack of details.

· Presentation of assessment displays understanding of all critical concepts of chosen virtual reality patient case; there may be two critical concepts with errors/omissions or lack of details.

· Does not meet the criteria

Criteria 4

Level III Max Points

Points: 15

Level II Max Points

Points: 12

Level I Max Points

Points:9

0 Points

Content Quality- Plan of Care

Presentation of plan displays complete understanding of all critical concepts of chosen virtual reality patient case including:

· Medications

· Non-pharmacological management

· Diagnostic tests

· Patient education

· Cultural considerations

· Health promotion

· Referrals

· Follow-Up

· Presentation of plan displays understanding of all critical concepts of chosen virtual reality patient case; there may be one critical concept with errors/omissions or lack of details.

· Presentation of plan displays understanding of all critical concepts of chosen virtual reality patient case; there may be 3-4 critical concepts with errors/omissions or lack of details.s

· Does not meet the criteria

Criteria 5

Level III Max Points

Points: 15

Level II Max Points

Points: 12

Level I Max Points

Points:9

0 Points

Quality of Oral Presentation

· Presentation demonstrated thorough organization and delivery.

· All ideas were stated in a clear and logical manner.

· Presentation was on topic and relevant.

· Presentation time no longer than 5 minutes

· Presentation was organized and well spoken.

· All ideas were stated in a clear and logical manner.

· Presentation was on topic and relevant.

· Presentation >5 minutes

· Presentation needed more details or content inconclusive.

· Presentation >5 minutes

· Does not meet the criteria

Maximum Total Points

75

60

45

0

Minimum Total Points

61

46

1

Name: 

 Pt. Encounter Number:

Date:

Age:

Sex:

SUBJECTIVE

CC: 

Reason given by the patient for seeking medical care “in quotes”

HPI: 

Describe the course of the patient’s illness, including when it began, character of symptoms, location where the symptoms began, aggravating or alleviating factors, pertinent positives and negatives, other related diseases, past illnesses, and surgeries or past diagnostic testing related to the present illness.

Medications: (List with reason for med )

Allergies: (List with reaction)

Medication Intolerances:

Past Medical History:

Chronic Illnesses/Major traumas

Hospitalizations/Surgeries

“Have you ever been told that you have  diabetes, HTN, peptic ulcer disease, asthma, lung disease, heart disease, cancer, TB, thyroid problems, kidney problems, or psychiatric diagnosis?”

Family History

Does your mother, father, or siblings have any medical or psychiatric illnesses?  Is anyone diagnosed with: lung disease, heart disease, HTN, cancer, TB, DM, or kidney disease?

Social History

Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, and marijuana.  Safety status

ROS Student to ask each of these questions to the patient: “Have you had any…..”

General

Weight change, fatigue, fever, chills, night sweats,  and energy level

Cardiovascular

Chest pain, palpitations, PND, orthopnea, and edema

Skin

Delayed healing, rashes, bruising, bleeding or skin discolorations, and any changes in lesions or moles

Respiratory

Cough, wheezing, hemoptysis, dyspnea, pneumonia hx, and TB

Eyes

Corrective lenses, blurring, and visual changes of any kind

Gastrointestinal

Abdominal pain, N/V/D, constipation, hepatitis, hemorrhoids, eating disorders, ulcers, and black, tarry stools

Ears

Ear pain, hearing loss, ringing in ears, and discharge

Genitourinary/Gynecological

Urgency, frequency burning, change in color of urine.

Contraception, sexual activity, STDs

   Female: last pap, breast, mammo, menstrual complaints, vaginal discharge, pregnancy hx

  Male: prostate, PSA, urinary complaints

Nose/Mouth/Throat

Sinus problems, dysphagia, nose bleeds or discharge, dental disease, hoarseness, and throat pain

Musculoskeletal

Back pain, joint swelling, stiffness or pain, fracture hx, and osteoporosis

Breast

SBE, lumps, bumps, or changes

Neurological

Syncope, seizures, transient paralysis, weakness, paresthesias, and black-out spells

Heme/Lymph/Endo

HIV status, bruising, blood transfusion hx, night sweats, swollen glands, increase thirst, increase hunger, and cold or heat intolerance

Psychiatric

Depression, anxiety, sleeping difficulties, suicidal ideation/attempts, and previous dx

OBJECTIVE

Weight         BMI

Temp

BP

Height

Pulse

Resp

General Appearance

Healthy-appearing adult female in no acute distress. Alert and oriented; answers questions appropriately. Slightly somber affect at first and then brighter later.

Skin

Skin is brown, warm, dry, clean, and intact. No rashes or lesions noted.

HEENT

Head is normocephalic, atraumatic, and without lesions; hair evenly distributed. Eyes:  PERRLA. EOMs intact. No conjunctival or scleral injection. Ears: Canals patent. Bilateral TMs pearly gray with positive light reflex; landmarks easily visualized. Nose: Nasal mucosa pink; normal turbinates. No septal deviation. Neck: Supple. Full ROM; no cervical lymphadenopathy; no occipital nodes. No thyromegaly or nodules. Oral mucosa, pink and moist. Pharynx is nonerythematous and without exudate. Teeth are in good repair.

Cardiovascular

S1, S2 with regular rate and rhythm. No extra sounds, clicks, rubs, or murmurs. Capillary refills two seconds. Pulses 3+ throughout. No edema.

Respiratory

Symmetric chest wall. Respirations regular and easy; lungs clear to auscultation bilaterally.

Gastrointestinal

Abdomen obese; BS active in all the four quadrants. Abdomen soft, nontender. No hepatosplenomegaly. 

Breast

Breast is free from masses or tenderness, no discharge, no dimpling, wrinkling, or discoloration of the skin.

Genitourinary

Bladder is nondistended; no CVA tenderness. External genitalia reveals coarse pubic hair in normal distribution; skin color is consistent with general pigmentation. No vulvar lesions noted. Well estrogenized. A small speculum was inserted; vaginal walls are pink and well rugated; no lesions noted. Cervix is pink and nulliparous. Scant clear to cloudy drainage present. On bimanual exam, cervix is firm. No CMT. Uterus is antevert and positioned behind a slightly distended bladder; no fullness, masses, or tenderness.  No adnexal masses or tenderness. Ovaries are nonpalpable.

(Male:  Both testes are palpable, no masses or lesions, no hernia, and no uretheral discharge.)

(Rectal as appropriate:  No evidence of hemorrhoids, fissures, bleeding, or masses—Males: Prostrate is smooth, nontender, and free from nodules, is of normal size, and sphincter tone is firm).

Musculoskeletal

Full ROM seen in all four extremities as the patient moved about the exam room.

Neurological

Speech clear. Good tone. Posture erect. Balance stable; gait normal.

Psychiatric

Alert and oriented. Dressed in clean slacks, shirt, and coat. Maintains eye contact. Speech is soft, though clear and of normal rate and cadence; answers questions appropriately.

Lab Tests

Urinalysis—point of care test done today in the office- results positive for nitrites and blood, negative for leukocytes.

Urine culture collected in office—pending results, sent to lab

Wet prep collected in office—pending results, sent to lab

Assessment

· Include at least three differential diagnoses

· Provide rationale for each differential diagnosis

· Final diagnosis

· Pathophysiology of primary and rationale for choosing as final

Plan

· Medications

· Non-pharmacological recommendations

· Diagnostic tests

· Patient education

· Culture considerations

· Health promotion

· Referrals

· Follow up