,Patient Information
Name: Sarah Mitchell
Age: 36 years old
Gender: Female
Chief Complaint: Itchy rash
Informant: Patient (Sarah Mitchell)
Case Overview
Sarah Mitchell, a 36-year-old female, presents to the primary care clinic
with a five-day history of an intensely pruritic rash on her arms and
torso, which began after gardening. The i-Human simulation for NRNP
6512 (Week 4) challenges learners to perform a comprehensive health
assessment, including a detailed history, a focused dermatologic and
systemic physical exam, a differential diagnosis for the itchy rash,
targeted diagnostic tests, and an evidence-based, patient-centered
management plan. The case emphasizes clinical reasoning, precise rash
characterization, effective patient communication, and integration of
2025 healthcare technologies (e.g., AI-driven skin analysis, telehealth)
to optimize care. The goal is to identify the underlying cause of the
rash, distinguish benign from potentially serious etiologies, and address
,Sarah’s concerns about discomfort, sleep disruption, and cosmetic
appearance, aligning with advanced practice nursing competencies.
Step 1: History of Present Illness (HPI)
Chief Complaint: “I’ve had this super itchy rash on my arms and
stomach for five days, and it’s driving me nuts.”History-Taking (i-Human
Interface Description):
Interface Description: The i-Human history-taking interface
displays a virtual patient (Sarah, a 36-year-old female) seated in a
clinic exam room, scratching her forearm with a concerned
expression. A text input field allows free-text questions, and a
dropdown menu offers categories like “Chief Complaint,”
“Associated Symptoms,” “Environmental Exposures,” and “Social
History.” Patient responses appear in a dialogue box, with
keywords (e.g., “itchy,” “gardening”) highlighted in red to guide
differential diagnosis development. A progress bar in the top right
corner tracks history completeness (e.g., “History: 92%
complete”), and a sidebar suggests follow-up questions (e.g.,
“Have you been exposed to new plants?”). Real-time feedback
highlights strengths (e.g., “Excellent: Explored environmental
, triggers”) or errors (e.g., “Missed asking about household contacts
with similar symptoms”).
Process: The learner employs the OLDCARTS framework (Onset,
Location, Duration, Characteristics, Aggravating/Alleviating
factors, Related symptoms, Treatment, Severity) to systematically
gather a comprehensive history. Open-ended questions (e.g.,
“Can you describe when and how the rash started?”) encourage
detailed responses, while targeted questions (e.g., “Have you
used new soaps, detergents, or plants recently?”) clarify potential
triggers. The learner fosters a supportive environment, addressing
Sarah’s frustration and cosmetic concerns to build trust and elicit
key details.
HPI Details:
Onset: Rash began 5 days ago, noticed the morning after
gardening in her backyard. Onset was gradual, starting with mild
itching and progressing to visible lesions within 24 hours.
Location: Bilateral forearms (extensor surfaces), upper arms, and
anterior torso (abdomen, lower chest, below the bra line). No
involvement of face, scalp, palms, soles, genitals, or mucous
membranes (e.g., oral, conjunctival).
Name: Sarah Mitchell
Age: 36 years old
Gender: Female
Chief Complaint: Itchy rash
Informant: Patient (Sarah Mitchell)
Case Overview
Sarah Mitchell, a 36-year-old female, presents to the primary care clinic
with a five-day history of an intensely pruritic rash on her arms and
torso, which began after gardening. The i-Human simulation for NRNP
6512 (Week 4) challenges learners to perform a comprehensive health
assessment, including a detailed history, a focused dermatologic and
systemic physical exam, a differential diagnosis for the itchy rash,
targeted diagnostic tests, and an evidence-based, patient-centered
management plan. The case emphasizes clinical reasoning, precise rash
characterization, effective patient communication, and integration of
2025 healthcare technologies (e.g., AI-driven skin analysis, telehealth)
to optimize care. The goal is to identify the underlying cause of the
rash, distinguish benign from potentially serious etiologies, and address
,Sarah’s concerns about discomfort, sleep disruption, and cosmetic
appearance, aligning with advanced practice nursing competencies.
Step 1: History of Present Illness (HPI)
Chief Complaint: “I’ve had this super itchy rash on my arms and
stomach for five days, and it’s driving me nuts.”History-Taking (i-Human
Interface Description):
Interface Description: The i-Human history-taking interface
displays a virtual patient (Sarah, a 36-year-old female) seated in a
clinic exam room, scratching her forearm with a concerned
expression. A text input field allows free-text questions, and a
dropdown menu offers categories like “Chief Complaint,”
“Associated Symptoms,” “Environmental Exposures,” and “Social
History.” Patient responses appear in a dialogue box, with
keywords (e.g., “itchy,” “gardening”) highlighted in red to guide
differential diagnosis development. A progress bar in the top right
corner tracks history completeness (e.g., “History: 92%
complete”), and a sidebar suggests follow-up questions (e.g.,
“Have you been exposed to new plants?”). Real-time feedback
highlights strengths (e.g., “Excellent: Explored environmental
, triggers”) or errors (e.g., “Missed asking about household contacts
with similar symptoms”).
Process: The learner employs the OLDCARTS framework (Onset,
Location, Duration, Characteristics, Aggravating/Alleviating
factors, Related symptoms, Treatment, Severity) to systematically
gather a comprehensive history. Open-ended questions (e.g.,
“Can you describe when and how the rash started?”) encourage
detailed responses, while targeted questions (e.g., “Have you
used new soaps, detergents, or plants recently?”) clarify potential
triggers. The learner fosters a supportive environment, addressing
Sarah’s frustration and cosmetic concerns to build trust and elicit
key details.
HPI Details:
Onset: Rash began 5 days ago, noticed the morning after
gardening in her backyard. Onset was gradual, starting with mild
itching and progressing to visible lesions within 24 hours.
Location: Bilateral forearms (extensor surfaces), upper arms, and
anterior torso (abdomen, lower chest, below the bra line). No
involvement of face, scalp, palms, soles, genitals, or mucous
membranes (e.g., oral, conjunctival).
