iHuman Case Study – Week 3: Amanda
A. Wheaton – NR 509 – Chamberlain
University (2025/2026)
Abstract
This case study report details the assessment, diagnosis, and management of Amanda A.
Wheaton, a 28-year-old female presenting with fatigue and irregular menses. The report follows
a systematic approach to advanced health assessment, integrating evidence-based practice,
clinical reasoning, and patient-centered care. Sections include patient demographics, history,
physical findings, differential diagnoses, final diagnosis of primary hypothyroidism, and a
comprehensive plan of care. Expanded content includes pathophysiology, cultural
considerations, and extensive patient education to support holistic management. This report
aligns with NR 509 course objectives, emphasizing advanced assessment skills for nurse
practitioners.
Patient Introduction & Demographics
Name: Amanda A. Wheaton
Age: 28 years
Gender: Female
Relevant Background: Ms. Wheaton is a Caucasian female with no significant past medical
history. She works as a graphic designer, a sedentary job requiring prolonged computer use,
which may contribute to fatigue. She is single, lives alone in an urban apartment, and reports a
stable socioeconomic status. She denies smoking, alcohol, or recreational drug use, reducing
substance-related confounders. Her family history includes hypothyroidism (mother, diagnosed
at age 40) and type 2 diabetes mellitus (father, diagnosed at age 55), suggesting a genetic
predisposition to endocrine disorders. Ms. Wheaton maintains a balanced diet (vegetarian, high
in fruits and vegetables) and exercises regularly (yoga 3 times per week, 45-minute sessions).
Her only medication is oral contraceptive pills (ethinyl estradiol/norethindrone) taken daily for 2
years. She reports no known allergies, ensuring safe medication prescribing.
[Note: This section would be expanded to 3 pages with a detailed social history, including
occupational stressors, cultural background (e.g., Caucasian urban lifestyle), and psychosocial
factors like social support, mental health history, and barriers to care, supported by literature on
social determinants of health (Healthy People 2030, 2021).]
Chief Complaint (CC)
“I’ve been feeling really tired and my periods have been irregular for the past few months.”
, History of Present Illness (HPI)
Ms. Amanda Wheaton, a 28-year-old female, presents with a 3-month history of persistent
fatigue, described as a pervasive lack of energy that worsens in the afternoon, impacting her
productivity at work. She rates the fatigue as 7/10 on a numeric scale, with no specific
precipitating events. She reports irregular menstrual cycles, occurring every 6–8 weeks
(previously every 28–30 days), with lighter flow and no significant dysmenorrhea. Associated
symptoms include an 8-pound weight gain despite unchanged diet and exercise, occasional
constipation (1–2 bowel movements per week), dry skin on the face, arms, and legs, and
difficulty concentrating, particularly during detailed design tasks. She denies fever, chills, chest
pain, shortness of breath, palpitations, heavy menstrual bleeding, spotting, or recent stressors.
Ms. Wheaton has taken oral contraceptives consistently for 2 years, with no missed doses or
formulation changes. She denies recent travel, dietary changes, or trauma. No history of similar
symptoms prior to this episode. She attempted over-the-counter multivitamins without relief.
[Note: The HPI would be expanded to 4 pages with a detailed chronological timeline, symptom
analysis using OLDCARTS (Onset, Location, Duration, Characteristics, Aggravating/Alleviating
Factors, Radiation, Timing, Severity), and discussion of potential triggers (e.g., hormonal
interactions, environmental factors), supported by endocrine pathophysiology texts (Chaker et
al., 2022).]
Review of Systems (ROS)
General: Positive for fatigue and weight gain (8 pounds over 3 months). Denies fever,
chills, night sweats, or unintentional weight loss.
HEENT: Positive for dry, flaky skin on face and arms. Denies headache, vision changes,
hearing loss, tinnitus, vertigo, nasal congestion, or sore throat.
Cardiovascular: Denies chest pain, palpitations, edema, syncope, or claudication.
Respiratory: Denies shortness of breath, cough, wheezing, hemoptysis, or chest
tightness.
Gastrointestinal: Positive for occasional constipation (1–2 bowel movements/week).
Denies nausea, vomiting, diarrhea, abdominal pain, or changes in appetite.
Genitourinary: Positive for irregular menses (every 6–8 weeks, lighter flow). Denies
dysuria, hematuria, urinary frequency, urgency, or incontinence.
Musculoskeletal: Denies joint pain, stiffness, swelling, muscle weakness, or back pain.
Neurological: Positive for difficulty concentrating, particularly during work tasks.
Denies dizziness, numbness, tingling, seizures, or memory loss.
Psychiatric: Denies anxiety, depression, mood swings, or suicidal ideation.
Endocrine: Positive for weight gain, dry skin, and fatigue. Denies polyuria, polydipsia,
heat or cold intolerance, or excessive sweating.
Hematologic/Lymphatic: Denies easy bruising, bleeding, lymphadenopathy, or history
of anemia.
Skin: Positive for dry, flaky skin on face, arms, and legs. Denies rashes, lesions, pruritus,
or changes in pigmentation.
Allergic/Immunologic: Denies allergies, frequent infections, or autoimmune disorders.
A. Wheaton – NR 509 – Chamberlain
University (2025/2026)
Abstract
This case study report details the assessment, diagnosis, and management of Amanda A.
Wheaton, a 28-year-old female presenting with fatigue and irregular menses. The report follows
a systematic approach to advanced health assessment, integrating evidence-based practice,
clinical reasoning, and patient-centered care. Sections include patient demographics, history,
physical findings, differential diagnoses, final diagnosis of primary hypothyroidism, and a
comprehensive plan of care. Expanded content includes pathophysiology, cultural
considerations, and extensive patient education to support holistic management. This report
aligns with NR 509 course objectives, emphasizing advanced assessment skills for nurse
practitioners.
Patient Introduction & Demographics
Name: Amanda A. Wheaton
Age: 28 years
Gender: Female
Relevant Background: Ms. Wheaton is a Caucasian female with no significant past medical
history. She works as a graphic designer, a sedentary job requiring prolonged computer use,
which may contribute to fatigue. She is single, lives alone in an urban apartment, and reports a
stable socioeconomic status. She denies smoking, alcohol, or recreational drug use, reducing
substance-related confounders. Her family history includes hypothyroidism (mother, diagnosed
at age 40) and type 2 diabetes mellitus (father, diagnosed at age 55), suggesting a genetic
predisposition to endocrine disorders. Ms. Wheaton maintains a balanced diet (vegetarian, high
in fruits and vegetables) and exercises regularly (yoga 3 times per week, 45-minute sessions).
Her only medication is oral contraceptive pills (ethinyl estradiol/norethindrone) taken daily for 2
years. She reports no known allergies, ensuring safe medication prescribing.
[Note: This section would be expanded to 3 pages with a detailed social history, including
occupational stressors, cultural background (e.g., Caucasian urban lifestyle), and psychosocial
factors like social support, mental health history, and barriers to care, supported by literature on
social determinants of health (Healthy People 2030, 2021).]
Chief Complaint (CC)
“I’ve been feeling really tired and my periods have been irregular for the past few months.”
, History of Present Illness (HPI)
Ms. Amanda Wheaton, a 28-year-old female, presents with a 3-month history of persistent
fatigue, described as a pervasive lack of energy that worsens in the afternoon, impacting her
productivity at work. She rates the fatigue as 7/10 on a numeric scale, with no specific
precipitating events. She reports irregular menstrual cycles, occurring every 6–8 weeks
(previously every 28–30 days), with lighter flow and no significant dysmenorrhea. Associated
symptoms include an 8-pound weight gain despite unchanged diet and exercise, occasional
constipation (1–2 bowel movements per week), dry skin on the face, arms, and legs, and
difficulty concentrating, particularly during detailed design tasks. She denies fever, chills, chest
pain, shortness of breath, palpitations, heavy menstrual bleeding, spotting, or recent stressors.
Ms. Wheaton has taken oral contraceptives consistently for 2 years, with no missed doses or
formulation changes. She denies recent travel, dietary changes, or trauma. No history of similar
symptoms prior to this episode. She attempted over-the-counter multivitamins without relief.
[Note: The HPI would be expanded to 4 pages with a detailed chronological timeline, symptom
analysis using OLDCARTS (Onset, Location, Duration, Characteristics, Aggravating/Alleviating
Factors, Radiation, Timing, Severity), and discussion of potential triggers (e.g., hormonal
interactions, environmental factors), supported by endocrine pathophysiology texts (Chaker et
al., 2022).]
Review of Systems (ROS)
General: Positive for fatigue and weight gain (8 pounds over 3 months). Denies fever,
chills, night sweats, or unintentional weight loss.
HEENT: Positive for dry, flaky skin on face and arms. Denies headache, vision changes,
hearing loss, tinnitus, vertigo, nasal congestion, or sore throat.
Cardiovascular: Denies chest pain, palpitations, edema, syncope, or claudication.
Respiratory: Denies shortness of breath, cough, wheezing, hemoptysis, or chest
tightness.
Gastrointestinal: Positive for occasional constipation (1–2 bowel movements/week).
Denies nausea, vomiting, diarrhea, abdominal pain, or changes in appetite.
Genitourinary: Positive for irregular menses (every 6–8 weeks, lighter flow). Denies
dysuria, hematuria, urinary frequency, urgency, or incontinence.
Musculoskeletal: Denies joint pain, stiffness, swelling, muscle weakness, or back pain.
Neurological: Positive for difficulty concentrating, particularly during work tasks.
Denies dizziness, numbness, tingling, seizures, or memory loss.
Psychiatric: Denies anxiety, depression, mood swings, or suicidal ideation.
Endocrine: Positive for weight gain, dry skin, and fatigue. Denies polyuria, polydipsia,
heat or cold intolerance, or excessive sweating.
Hematologic/Lymphatic: Denies easy bruising, bleeding, lymphadenopathy, or history
of anemia.
Skin: Positive for dry, flaky skin on face, arms, and legs. Denies rashes, lesions, pruritus,
or changes in pigmentation.
Allergic/Immunologic: Denies allergies, frequent infections, or autoimmune disorders.
