Table of Contents

Alexis Arnold iHuman Case Study

Alexis Arnold is a 29-year-old African American female presenting at 36 weeks and 3 days gestation with chief complaint of headache and elevated blood pressure. She reports symptoms beginning around 34 weeks of pregnancy and exhibits signs consistent with preeclampsia, including hypertension, peripheral edema, and severe headaches.

In this comprehensive guide, we’ll walk you through how to approach her case, from initial obstetric assessment through maternal-fetal monitoring to the final diagnosis of preeclampsia with severe features. You’ll learn the key clinical reasoning steps for pregnancy-related hypertensive disorders, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this complex obstetric case simulation involving maternal-fetal medicine and critical pregnancy complications.

Alexis Arnold iHuman Case Overview (Doorway Information)

Patient Overview: Alexis Arnold is a 29-year-old African American female at 36 weeks and 3 days gestation presenting with chief complaint of headache and high blood pressure. This is her first pregnancy and she was brought to the hospital after experiencing worsening symptoms that began around 34 weeks gestation.

Key Background Information:

Age/Gender: 29-year-old African American female
Chief Complaint: Headache and high blood pressure
Gestational Age: 36 weeks and 3 days (first pregnancy)
Duration: Symptoms started around 34 weeks gestation
Blood Pressure: 148/88 mmHg at hospital, 166/? mmHg at home
Presenting Situation: Labor and delivery unit presentation with pregnancy-related hypertension
Associated Symptoms: Peripheral edema, severe headaches (6/10 pain), no previous medical diagnoses
Significant History: No previous medical diagnosis, no previous surgery and hospitalization
Risk Factors: African American female, nulliparous, family history of hypertension, cerebrovascular accident, diabetes mellitus, and seizures
Maternal-Fetal Status: FHR in 140s, maternal vital signs showing hypertension

The patient appears alert and cooperative during assessment, with notable maternal findings including severe hypertension, peripheral edema, and neurological symptoms consistent with preeclampsia. Her presentation is consistent with preeclampsia with severe features, making this an excellent case for learning systematic obstetric assessment and maternal-fetal medicine management skills.

Alexis Arnold (29 y/o female) – Obstetric Emergency Assessment

CC: Headache and high blood pressure
MSAP: Preeclampsia with severe features at 36 weeks gestation in nulliparous African American female
Associated symptoms: Severe headaches, peripheral edema, elevated blood pressure, neurological symptoms
History: First pregnancy, no previous medical conditions, family history significant for hypertensive and neurological disorders
High-risk factors: African American ethnicity, nulliparity, family history of hypertension and seizures, late third trimester presentation

History Questions:

How can I help you today, Ms. Arnold?
Can you tell me more about your headache and when it started?
When did you first notice your blood pressure was high?
Tell me about any swelling you’ve been experiencing
Have you had any vision changes or seeing spots?
Any nausea, vomiting, or upper abdominal pain?
How has your baby been moving lately?
When did these symptoms begin during your pregnancy?
Have you checked your blood pressure at home?
Any family history of high blood pressure or pregnancy complications?
Tell me about your prenatal care and previous blood pressure readings
Have you experienced any seizures or felt like you might have one?
Any shortness of breath or chest pain?
Tell me about your urine – any changes in color or amount?
Have you had any bleeding or fluid leakage?
How is your overall energy level and appetite?
Any previous pregnancies or pregnancy complications?
Current medications or supplements you’re taking?
Tell me about stress levels and your support system
Any recent weight gain or changes?

Physical Exam:

Vitals: Temperature 98°F, pulse 66 bpm, blood pressure 162/90 mmHg, respirations 20 bpm, oxygen saturation 99% on room air, pain 6/10 headache, FHR 140s
General appearance: Alert, cooperative 29-year-old female appearing stated gestational age, mild to moderate distress secondary to headache
Maternal Assessment:
- Neurological examination for headache, visual changes, hyperreflexia
- Cardiovascular assessment for elevated blood pressure and edema
- Respiratory evaluation for pulmonary edema
- Abdominal examination for uterine tenderness and fetal positioning
- Extremity assessment for peripheral edema and deep tendon reflexes
Fetal Assessment:
- Fetal heart rate monitoring and variability
- Uterine contraction assessment
- Fundal height measurement
- Fetal movement evaluation
Laboratory Considerations: Protein levels, liver function, platelet count, creatinine
Obstetric Risk Assessment: Maternal stabilization needs, delivery timing considerations

Assessment Note: A.A. is a 29-year-old G1P0 African American female at 36 weeks 3 days gestation presenting with severe headaches and hypertension consistent with preeclampsia with severe features. Physical examination notable for elevated blood pressure, peripheral edema, and neurological symptoms. Fetal status appears stable with reassuring heart rate. This presentation requires immediate maternal stabilization and consideration for delivery.

Diagnostic Testing: Complete metabolic panel, liver function tests, complete blood count with platelets, 24-hour urine protein or protein/creatinine ratio, coagulation studies, fetal monitoring

Diagnosis: Preeclampsia with severe features

Plan:

Immediate maternal stabilization with antihypertensive therapy
Magnesium sulfate for seizure prophylaxis
Continuous maternal and fetal monitoring
Preparation for delivery after maternal stabilization
Corticosteroids for fetal lung maturity if indicated
Multidisciplinary team approach with maternal-fetal medicine

Alexis Arnold SOAP Note

Patient: Alexis Arnold

Subjective Data

CC: 29-year-old G1P0 female at 36 weeks 3 days gestation presents with “headache and high blood pressure”

HPI: 29-year-old African American female gravida 1 para 0 at 36 weeks and 3 days gestation presents to labor and delivery with complaints of severe headache and elevated blood pressure. Patient reports symptoms began around 34 weeks gestation and have been progressively worsening. Home blood pressure readings have been elevated at 166/? mmHg, with current hospital reading of 148/88 mmHg on arrival. Patient describes headache as severe, throbbing, located in frontal and temporal regions, rated 6/10 in intensity, not relieved by acetaminophen. She also reports peripheral edema in hands, face, and lower extremities that has been worsening over the past two weeks.

Patient denies vision changes, epigastric pain, nausea, vomiting, or seizure activity. Fetal movement has been appropriate according to patient. She reports normal prenatal care with no previous complications noted. This is her first pregnancy and she has been compliant with prenatal visits.

Medications: Prenatal vitamins, no antihypertensive medications prior to admission

Allergies: No known drug, food, or environmental allergies reported

PMH: No previous medical diagnosis, no previous surgery and hospitalization

Obstetric History: G1P0, current pregnancy uncomplicated until recent onset of symptoms at 34 weeks. Regular prenatal care, normal fetal growth, no gestational diabetes or other complications reported.

Family History: Significant for hypertension, cerebrovascular accident, diabetes mellitus, and seizures

Social History: 29-year-old married female, non-smoker, denies alcohol or illicit drug use during pregnancy. Works full-time in office environment. Strong family support system. No history of domestic violence.

Review of Systems: Notable for severe headaches, peripheral edema, and hypertension. Denies visual disturbances, epigastric pain, nausea, vomiting, shortness of breath, chest pain, or seizure activity. Reports appropriate fetal movement and no vaginal bleeding or fluid leakage.

Objective Data

General: Alert, cooperative 29-year-old African American female at stated gestational age. Mild to moderate distress secondary to headache. Well-nourished and well-developed.

Maternal Vital Signs: Temperature 98°F, pulse 66 bpm, blood pressure 162/90 mmHg, respirations 20 bpm, oxygen saturation 99% on room air, pain 6/10 headache

Physical Examination:

Neurological: Alert and oriented x4, severe frontal headache, no visual field defects, deep tendon reflexes 3+ with clonus, no focal neurological deficits
Cardiovascular: Regular rate and rhythm, no murmurs, elevated blood pressure, peripheral edema 2+ in lower extremities, 1+ in hands and face
Respiratory: Clear lung sounds bilaterally, no respiratory distress, no signs of pulmonary edema
Abdominal: Gravid uterus appropriate for gestational age, fundal height 34 cm, no tenderness, vertex presentation
Extremities: Peripheral edema present, 2+ pitting edema bilateral lower extremities
Skin: No rash, normal pigmentation changes of pregnancy

Fetal Assessment: FHR 140s with moderate variability, no decelerations, reactive non-stress test, appropriate amniotic fluid volume

Laboratory Results: Pending – complete metabolic panel, liver function tests, complete blood count with platelets, urine protein

Assessment

Primary Diagnosis: Preeclampsia with severe features (O14.12)

Secondary Concerns:

Risk for maternal seizures (eclampsia)
Risk for HELLP syndrome
Potential need for preterm delivery
Fetal growth restriction monitoring

Differential Diagnoses

Preeclampsia with severe features: New-onset hypertension after 20 weeks gestation with severe features including blood pressure ≥160/110 mmHg, severe headaches, and peripheral edema. Patient meets criteria with severe hypertension, neurological symptoms, and edema in third trimester.

Gestational hypertension: Elevated blood pressure without proteinuria or other severe features. However, patient’s presentation with severe headaches and peripheral edema suggests progression beyond simple gestational hypertension.

Chronic hypertension with superimposed preeclampsia: Unlikely given patient’s history of no previous medical conditions and normal early pregnancy blood pressures.

HELLP syndrome: Hemolysis, elevated liver enzymes, and low platelets. Requires laboratory confirmation, which is pending.

Secondary hypertension: Other causes of hypertension in pregnancy, but less likely given acute onset and clinical presentation consistent with preeclampsia.

Most Likely Diagnosis: Preeclampsia with severe features evidenced by blood pressure ≥160/110 mmHg, severe persistent headaches, and peripheral edema after 20 weeks gestation.

Plan

Health Promotion: ✓ Maternal-Fetal Health Monitoring – Continuous assessment of maternal and fetal well-being with serial blood pressure monitoring and fetal heart rate assessment ✓ Preeclampsia Education – Comprehensive education about preeclampsia, warning signs, and importance of immediate medical attention ✓ Postpartum Follow-up – Planning for continued monitoring postpartum as preeclampsia can worsen after delivery ✓ Family Planning – Future pregnancy counseling regarding recurrence risk and preventive measures

Screening: ✓ Laboratory Monitoring – Serial assessment of liver function, platelet count, kidney function, and protein levels ✓ Fetal Surveillance – Continuous fetal heart rate monitoring and assessment of fetal growth and amniotic fluid ✓ Maternal Monitoring – Neurological assessment, blood pressure monitoring, and assessment for HELLP syndrome

Interventions: ✓ Immediate Stabilization – Antihypertensive therapy with IV labetalol or hydralazine, magnesium sulfate for seizure prophylaxis ✓ Delivery Planning – Consideration for delivery after maternal stabilization at 36 weeks gestation ✓ Multidisciplinary Care – Maternal-fetal medicine consultation, anesthesia consultation for delivery planning ✓ Corticosteroids – Administration if delivery anticipated before 37 weeks for fetal lung maturity

Complete Step-by-Step Guide to Writing the Alexis Arnold iHuman Case Study

Completing the Alexis Arnold iHuman case requires a systematic approach focused on pregnancy-related hypertensive disorders and maternal-fetal medicine. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.

Step 1: Pre-Case Preparation and Initial Approach

Before diving into the case, take a moment to review the doorway information and formulate your initial clinical approach.

Key Information to Note:

29-year-old African American female at 36 weeks gestation
Presenting with headache and elevated blood pressure
First pregnancy with symptoms starting at 34 weeks
Consider preeclampsia and maternal-fetal complications

Initial Clinical Mindset: Approach this case with preeclampsia as your primary consideration. The gestational age, ethnicity, symptoms, and nulliparity immediately suggest potential preeclampsia, making this a high-priority obstetric emergency requiring systematic maternal-fetal assessment.

Step 2: Conducting the History of Present Illness (HPI)

The HPI is crucial for establishing the foundation of your obstetric diagnosis. Use systematic questioning while keeping maternal-fetal considerations in mind:

Onset: Ask about when symptoms started and progression

Key points to elicit: Timeline relative to gestational age and symptom progression

Location: Determine maternal and fetal impact

Target response: Headache location, edema distribution, fetal movement

Duration: How long symptoms have persisted

Important detail: Progression since 34 weeks gestation

Character: Detailed description of symptoms

Critical descriptors: Headache quality, blood pressure readings, edema severity

Aggravating factors: What makes symptoms worse

Essential findings: Activity, position, stress factors

Relieving factors: What provides relief

Key response: Rest, medications tried, position changes

Timing: Pattern and relationship to pregnancy

Important pattern: Third trimester onset, daily variation

Severity: Impact on daily functioning and pregnancy

Typical response: Functional impairment, concern for fetal well-being

Associated Symptoms:

Ask specifically about: Vision changes, epigastric pain, nausea, fetal movement
Key findings: Neurological symptoms, right upper quadrant pain

Step 3: Review of Systems (ROS)

Conduct a thorough but focused ROS, paying special attention to maternal and fetal systems:

Neurological:

Headaches, vision changes, hyperreflexia
Seizure activity or aura symptoms
Mental status changes

Cardiovascular:

Blood pressure patterns, chest pain, palpitations
Peripheral edema and progression
Shortness of breath

Renal:

Urine output changes, proteinuria
Flank pain or urinary symptoms
Oliguria or anuria

Hepatic:

Right upper quadrant pain, nausea, vomiting
Epigastric pain radiating to back
Changes in appetite

Obstetric:

Fetal movement patterns
Uterine contractions or pain
Vaginal bleeding or fluid leakage

Step 4: Past Medical History, Social History, and Family History

Past Medical History:

Previous pregnancies and complications
History of hypertension or kidney disease
Previous preeclampsia or gestational hypertension

Social History:

Current pregnancy support system
Work environment and stress levels
Tobacco, alcohol, or drug use
Prenatal care compliance

Family History:

Family history of hypertension, cerebrovascular accident, diabetes mellitus, and seizures
Previous preeclampsia in family members
Autoimmune or genetic conditions

Step 5: Physical Examination Strategy

Perform a comprehensive maternal-fetal examination:

Maternal Assessment:

Expected findings: Elevated blood pressure, peripheral edema, hyperreflexia
Critical components: Neurological exam, cardiovascular assessment, renal evaluation

Fetal Assessment:

Look for: Appropriate fetal heart rate, movement, growth parameters
Assess: Amniotic fluid levels, fetal presentation, placental function

Laboratory Correlation:

Protein levels, liver function, platelet count
Kidney function and electrolyte balance
Coagulation studies if indicated

Risk Assessment:

Comprehensive maternal stabilization needs
Delivery timing and method considerations
Neonatal care requirements

Step 6: Developing Differential Diagnoses

Propose at least 3-4 appropriate differentials with rationales:

Primary Consideration: Preeclampsia with severe features

Supporting evidence: Hypertension ≥160/110 mmHg, severe headaches, peripheral edema after 20 weeks gestation

Secondary Considerations:

Gestational hypertension: Elevated blood pressure without severe features
HELLP syndrome: Hemolysis, elevated liver enzymes, low platelets
Chronic hypertension: Pre-existing hypertension, less likely given history

Step 7: Diagnostic Test Interpretation

Interpret provided test results to support your diagnosis:

Expected Key Findings:

Elevated blood pressure readings consistently ≥160/110 mmHg
Proteinuria or elevated protein/creatinine ratio
Possible abnormal liver function or low platelets

Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)

Primary Diagnosis: Preeclampsia with severe features

Justification:

Blood pressure ≥160/110 mmHg in pregnancy after 20 weeks
Severe persistent headaches and neurological symptoms
Peripheral edema and rapid onset
Nulliparous African American female at risk

MSAP Selection: Choose “Preeclampsia with severe features” as your Most Significant Active Problem, as this represents the primary condition requiring immediate intervention and delivery planning.

Step 9: Comprehensive Management Plan

Develop a multi-faceted treatment approach:

Immediate Management:

Maternal stabilization with antihypertensive therapy (IV labetalol/hydralazine)
Magnesium sulfate for seizure prophylaxis
Continuous maternal and fetal monitoring

Short-term Management:

Blood pressure control and maintenance
Laboratory monitoring for HELLP syndrome
Fetal surveillance and growth assessment

Long-term Management:

Delivery planning after maternal stabilization
Corticosteroids for fetal lung maturity if needed
Postpartum monitoring and follow-up

Patient Education:

Preeclampsia pathophysiology and prognosis
Warning signs requiring immediate medical attention
Postpartum monitoring importance and recurrence risk

Follow-up Plan:

Postpartum blood pressure monitoring
Future pregnancy planning and risk assessment
Long-term cardiovascular health screening

Step 10: Documentation and Submission Tips

Writing Your Summary:

Create a concise 350-word summary explaining your clinical reasoning for obstetric emergencies
Include how you arrived at the problem list with consideration of maternal-fetal medicine
Cite specific assessment findings and risk factor correlations
Use professional obstetric terminology appropriate for maternal-fetal care

Key Documentation Elements:

Assessment Statement: Brief patient summary with key obstetric findings
Clinical Reasoning: Explain diagnostic thought process for preeclampsia
Risk Assessment: Link symptoms to maternal and fetal safety concerns
Management Rationale: Justify treatment choices and delivery timing

Final Submission Checklist:

✓ Complete obstetric history with systematic maternal-fetal questioning
✓ Comprehensive physical examination including maternal and fetal assessment
✓ Appropriate differential diagnoses with pregnancy considerations
✓ Correct final diagnosis and MSAP
✓ Evidence-based management plan including delivery planning
✓ Professional documentation with proper obstetric terminology

Alexis Arnold iHuman Case Summary

Grading Criteria

The Alexis Arnold iHuman case will evaluate you across several critical domains to ensure comprehensive obstetric emergency assessment skills. Here’s what you need to focus on to maximize your score:

(1) History Taking (Major Points): You must ask targeted questions about obstetric symptoms and maternal-fetal status to get full credit. Essential questions include: gestational age confirmation, symptom timeline, blood pressure patterns, fetal movement assessment. Don’t miss asking about: vision changes, epigastric pain, family history of preeclampsia, previous pregnancy complications. The rubric specifically rewards students who ask about symptom progression and maternal-fetal risk factors.

(2) Physical Examination (High Weight): Focus your exam on systematic obstetric assessment and maternal-fetal evaluation. Must-do components: blood pressure measurement, neurological assessment, fetal heart rate monitoring, edema evaluation. Pro tip: The rubric awards points for thorough maternal stabilization assessment and fetal surveillance – key components that relate directly to preeclampsia management.

(3) Differential Diagnosis (Critical for Scoring): You need to propose at least 3 appropriate differentials with brief rationales. Expected differentials include: Preeclampsia with severe features, gestational hypertension, HELLP syndrome, and chronic hypertension. Scoring secret: The rubric rewards students who can distinguish between preeclampsia severity levels and understand delivery timing implications.

(4) Final Diagnosis & MSAP: You must correctly identify Preeclampsia with severe features as your Most Significant Active Problem (MSAP). Justification is key – cite the blood pressure criteria, severe symptoms, and gestational age as supporting evidence.

(5) Management Plan (Heavily Weighted): The rubric expects comprehensive obstetric emergency management including: appropriate maternal stabilization, delivery planning, maternal-fetal monitoring, and multidisciplinary care. High-scoring responses mention: antihypertensive therapy, magnesium sulfate, fetal surveillance, and delivery timing considerations.

(6) Patient Communication: Demonstrate appropriate communication for obstetric patients in crisis. Bonus points for: explaining the diagnosis in understandable terms, discussing delivery planning, addressing maternal and fetal safety concerns, and providing resources for ongoing support.

Example of a High-Scoring Clinical Summary

Here’s how a top-performing student might document this case:

Patient Summary – Alexis Arnold

Situation: 29-year-old G1P0 African American female at 36 weeks 3 days gestation presenting with severe headaches and hypertension consistent with preeclampsia with severe features.

Background: Significant risk factors including African American ethnicity, nulliparity, and family history of hypertensive disorders. Symptoms began at 34 weeks with progressive worsening of blood pressure and neurological symptoms. Current vital signs show severe hypertension at 162/90 mmHg with peripheral edema and severe headaches.

Assessment: Physical examination notable for severe hypertension, 3+ deep tendon reflexes with clonus, peripheral edema, and neurological symptoms consistent with preeclampsia with severe features. Fetal assessment shows reassuring heart rate in 140s with appropriate movement.

Primary Diagnosis: Preeclampsia with severe features

Recommendation:

Immediate maternal stabilization with antihypertensive therapy and magnesium sulfate
Continuous maternal and fetal monitoring
Laboratory assessment for HELLP syndrome and organ function
Delivery planning after maternal stabilization given gestational age
Multidisciplinary team approach with maternal-fetal medicine
Corticosteroids if delivery before 37 weeks

Patient and Family Education Provided: Explained preeclampsia diagnosis and severity, discussed need for immediate delivery planning, emphasized importance of continuous monitoring, and provided information about postpartum monitoring and future pregnancy risks.

Conclusion

By following this comprehensive approach to the Alexis Arnold case, you’ll demonstrate the obstetric emergency assessment skills that iHuman evaluates. Remember, success in obstetric emergency cases requires understanding maternal-fetal medicine principles: gather detailed obstetric history about symptom progression and risk factors, perform systematic maternal-fetal examination with thorough blood pressure and neurological assessment, consider preeclampsia in pregnant patients with hypertension and severe symptoms, and develop emergency-centered management plans addressing both maternal stabilization and delivery planning. The key is treating each iHuman simulation as you would a real obstetric emergency – be thorough, consider the complexity of maternal-fetal care, and always prioritize maternal and fetal safety. With this guide, you’re well-prepared to excel in this challenging but important obstetric emergency case simulation.

Frequently Asked Questions

Q1: What is the correct diagnosis for Alexis Arnold’s obstetric presentation?

Alexis Arnold’s primary diagnosis is Preeclampsia with severe features. The key distinguishing features that point to this diagnosis include blood pressure ≥160/110 mmHg, severe persistent headaches, peripheral edema, and onset after 20 weeks of pregnancy. Students often struggle between gestational hypertension and preeclampsia with severe features, but remember that severe features include systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥110 mmHg, severe headaches, visual disturbances, or other organ dysfunction symptoms.

Q2: What are the critical maternal-fetal assessment components I need to perform to score well?

Essential maternal-fetal assessment elements include comprehensive blood pressure monitoring, neurological examination for preeclampsia complications, fetal heart rate assessment, and evaluation for severe features of preeclampsia. Many students miss points by inadequately assessing for HELLP syndrome components or failing to evaluate fetal well-being adequately. Don’t forget to assess deep tendon reflexes, check for visual disturbances, evaluate for epigastric pain, and ensure continuous fetal monitoring for any signs of compromise.

Q3: How do I pass the Alexis Arnold case and meet the 70% requirement?

You must score a cumulative 70% on the iHuman assessments to successfully complete the required lab component. To achieve this score, focus on thorough obstetric history-taking using systematic maternal-fetal questioning, complete all recommended physical exam components with attention to preeclampsia severity assessment, propose appropriate differential diagnoses (including preeclampsia with severe features, gestational hypertension, and HELLP syndrome), and develop a comprehensive obstetric emergency management plan that includes maternal stabilization, delivery planning, and multidisciplinary care. The key is being systematic and remembering that obstetric emergency cases require immediate maternal-fetal safety assessment and intervention planning.

Q4: What management interventions should I include in my treatment plan?

The comprehensive management plan should address both immediate maternal stabilization and delivery planning. Include antihypertensive therapy with IV labetalol or hydralazine, magnesium sulfate for seizure prophylaxis, continuous maternal and fetal monitoring, and preparation for delivery after maternal stabilization. Students often forget to address the timing of delivery considerations, corticosteroid administration for fetal lung maturity, and postpartum monitoring plans, which are crucial components for managing preeclampsia and can impact your overall score. Remember that patients at 37 weeks gestation or beyond with preeclampsia should undergo delivery rather than expectant management.