NR511 CASE STUDIES WEEK 3 & WEEK 6 ASSIGNMENTS 2021/202
NR511 Case Studies (Week 3 & 6)
Part 1:
In Part 1, you are given a patient scenario. Using the information given, answer the following questions:
1. Briefly & concisely summarize the H&P findings as if you were presenting it to your preceptor using
the pertinent facts from the case. Use shorth& where possible & approved medical abbreviations. Avoid
redundancy & irrelevant information.
Example:
“J.S. is a 34yo male with a CC of acute onset ST x 3 days” [provide additional information from
the history that is relevant].
“Physical exam is significant for” [provide relevant physical exam findings].
*Do not simply rewrite the information as it is presented in the case report. This should mimic
how you would present this patient to your preceptor.
2. Provide a differential diagnosis (plural) which might explain the patient’s chief complaint along with a
brief statement of pathophysiology for each.
Example:
Diagnosis #1……… -Pathophysiology statement
Diagnosis #2……… -Pathophysiology statement
Diagnosis #3……… -Pathophysiology statement
3. Analyze the differential by using the pertinent findings from the history & physical to argue for or
against a diagnosis. Rank the differential in order of most likely to least likely. (This is where you present
your argument for EACH DIAGNOSIS in your differential using the patient’s subjective & objective
information that was given).
Example:
Diagnosis # 1, 2, & 3 (provide an analysis for each of the diagnoses listed above). A brief argument as to
why this condition should be considered plus:
-Pertinent positive symptoms which support the diagnosis
-Pertinent negative symptoms which support the diagnosis
4. Identify any additional tests &/or procedures that you feel is necessary or needed to help you narrow
your differential. All testing decisions must be supported with an EBM argument as to why it is necessary
or pertinent in this case. If no testing is indicated or needed, you must also support this decision with
EBM evidence. (This is where you identify, based on what you know thus far, test or test(s) that you
would perform TODAY which would help you narrow your differential diagnosis).
*Do not list all of the possible tests that can be done. You are being evaluated on your diagnostic
reasoning skills as well your ability to make decisions that are in-line with current practice
recommendations. Just because a test is available does not mean it needs to be done.
Example:
Let’s say my differential included bronchitis & pneumonia. In this case, a CXR might be useful in
differentiating the 2 conditions. However, remember that you have to have an EBM argument for this
decision. So make sure you are telling the reader why this is the best choice based on the literature (i.e.,
it is not enough to say the test & cite the author & date). In this instance, my arg Infectious Disease
Society of America (2012) a CXR is considered the gold st&ard for diagnosing pneumonia.” Keep in mind
that you also need an EBM argument if you decide NOT to test too.
Part 2
In Part 2 you might be given some additional history, exam or test findings. Using this information & the
information in Part 1, answer the following questions:
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, 1. What is your primary diagnosis for this patient? Tell the reader how you came to this conclusion using
the information that you were given (i.e., CXR result, lab result). Interpret the results into your diagnosis
decision (i.e., tell how this information helped you to narrow your differential to the one diagnosis that
you chose).
Example:
Diagnosis: Pharyngitis, streptococcal
Rationale: The CBC results are normal which rules out infection & anemia. The RSA test was +
which tells me that she has a very strong likelihood of streptococcal pharyngitis.
In the case where a diagnosis was made based on clinical presentation & history, explain the
criteria with an EBM argument to support.
2. Identify the corresponding ICD-10 Code for the diagnosis.
Example:
J02.0 You can find a link to an ICD-10 code finder by going to the Library homepage>Browse
guides>Course directory tab>select NR511 from the drop down box>select Go. Otherwise, a google
search will provide you with several free options you can use.
3. Provide a treatment plan for this patient’s primary diagnosis which includes:
a) Medication-all prescriptions & OTC medications should be written in RX format with an EBM to
support:
Medication Name & Medication Strength
Dispensing quantity:
Sig: …………..RF:
b) Any additional testing necessary for this particular diagnosis-typically done when you need more
information to confirm a diagnosis or differentiate the diagnosis. Do not state all of the possibilities that
are available. To assess your diagnostic reasoning skill, you will need to be decisive.
c) Patient education-self explanatory
d) Referral-self explanatory
e) F/U plan-include if & when the patient should follow-up *If part of the plan does not warrant an
action, you must explain why. ALL medication & testing decisions (or decisions not to treat with
medication or additional testing) MUST be supported with an EBM argument as you did in Part 1.
Example:
a. Penicillin VK 500mg, Disp #20, Sig: 1 tab twice daily x 10days; RF: 0 (full RX required)
Rationale: Penicillin is the 1st line treatment recommendation for Group A Beta-hemolytic streptococcal
pharyngitis, based on their narrow spectrum of activity, infrequency of adverse reactions, & modest cost.
(Shulman, Bisno, Clegg, Gerber, Kaplan, Lee, Martin, & Van Beneden, 2012). My patient has no noted
allergies, so PCN VK is appropriate.
b. No additional testing will be performed today.
Rationale: Point of care, rapid strep antigen tests are highly specific (approximately 95%) when
compared with throat cultures, so false-positive test results are highly unusual. Consequently, a
therapeutic decision can be confidently made based on the positive result which was reported for this
patient in the scenario (Shulman, Bisno, Clegg, Gerber, Kaplan, Lee, Martin, & Van Beneden, 2012).
c. Patient instructions:
-take all medication as prescribed (Reference, date)
-F/U in 10-14 days if symptoms are not resolved or sooner if they become worse, etc.,
(Reference, date)
-Etc..
4. Provide an active problem list for this patient based on the information given in the case. This is where
you list all of the known medical problems of the patient. This is different than a differential.
Example:
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NR511 Case Studies (Week 3 & 6)
Part 1:
In Part 1, you are given a patient scenario. Using the information given, answer the following questions:
1. Briefly & concisely summarize the H&P findings as if you were presenting it to your preceptor using
the pertinent facts from the case. Use shorth& where possible & approved medical abbreviations. Avoid
redundancy & irrelevant information.
Example:
“J.S. is a 34yo male with a CC of acute onset ST x 3 days” [provide additional information from
the history that is relevant].
“Physical exam is significant for” [provide relevant physical exam findings].
*Do not simply rewrite the information as it is presented in the case report. This should mimic
how you would present this patient to your preceptor.
2. Provide a differential diagnosis (plural) which might explain the patient’s chief complaint along with a
brief statement of pathophysiology for each.
Example:
Diagnosis #1……… -Pathophysiology statement
Diagnosis #2……… -Pathophysiology statement
Diagnosis #3……… -Pathophysiology statement
3. Analyze the differential by using the pertinent findings from the history & physical to argue for or
against a diagnosis. Rank the differential in order of most likely to least likely. (This is where you present
your argument for EACH DIAGNOSIS in your differential using the patient’s subjective & objective
information that was given).
Example:
Diagnosis # 1, 2, & 3 (provide an analysis for each of the diagnoses listed above). A brief argument as to
why this condition should be considered plus:
-Pertinent positive symptoms which support the diagnosis
-Pertinent negative symptoms which support the diagnosis
4. Identify any additional tests &/or procedures that you feel is necessary or needed to help you narrow
your differential. All testing decisions must be supported with an EBM argument as to why it is necessary
or pertinent in this case. If no testing is indicated or needed, you must also support this decision with
EBM evidence. (This is where you identify, based on what you know thus far, test or test(s) that you
would perform TODAY which would help you narrow your differential diagnosis).
*Do not list all of the possible tests that can be done. You are being evaluated on your diagnostic
reasoning skills as well your ability to make decisions that are in-line with current practice
recommendations. Just because a test is available does not mean it needs to be done.
Example:
Let’s say my differential included bronchitis & pneumonia. In this case, a CXR might be useful in
differentiating the 2 conditions. However, remember that you have to have an EBM argument for this
decision. So make sure you are telling the reader why this is the best choice based on the literature (i.e.,
it is not enough to say the test & cite the author & date). In this instance, my arg Infectious Disease
Society of America (2012) a CXR is considered the gold st&ard for diagnosing pneumonia.” Keep in mind
that you also need an EBM argument if you decide NOT to test too.
Part 2
In Part 2 you might be given some additional history, exam or test findings. Using this information & the
information in Part 1, answer the following questions:
This study source was downloaded by 100000842568006 from CourseHero.com on 05-01-2022 00:46:57 GMT -05:00
https://www.coursehero.com/file/56774611/NR-511-Week-3-and-Week-Case-Study-Assignmentsdocx/
, 1. What is your primary diagnosis for this patient? Tell the reader how you came to this conclusion using
the information that you were given (i.e., CXR result, lab result). Interpret the results into your diagnosis
decision (i.e., tell how this information helped you to narrow your differential to the one diagnosis that
you chose).
Example:
Diagnosis: Pharyngitis, streptococcal
Rationale: The CBC results are normal which rules out infection & anemia. The RSA test was +
which tells me that she has a very strong likelihood of streptococcal pharyngitis.
In the case where a diagnosis was made based on clinical presentation & history, explain the
criteria with an EBM argument to support.
2. Identify the corresponding ICD-10 Code for the diagnosis.
Example:
J02.0 You can find a link to an ICD-10 code finder by going to the Library homepage>Browse
guides>Course directory tab>select NR511 from the drop down box>select Go. Otherwise, a google
search will provide you with several free options you can use.
3. Provide a treatment plan for this patient’s primary diagnosis which includes:
a) Medication-all prescriptions & OTC medications should be written in RX format with an EBM to
support:
Medication Name & Medication Strength
Dispensing quantity:
Sig: …………..RF:
b) Any additional testing necessary for this particular diagnosis-typically done when you need more
information to confirm a diagnosis or differentiate the diagnosis. Do not state all of the possibilities that
are available. To assess your diagnostic reasoning skill, you will need to be decisive.
c) Patient education-self explanatory
d) Referral-self explanatory
e) F/U plan-include if & when the patient should follow-up *If part of the plan does not warrant an
action, you must explain why. ALL medication & testing decisions (or decisions not to treat with
medication or additional testing) MUST be supported with an EBM argument as you did in Part 1.
Example:
a. Penicillin VK 500mg, Disp #20, Sig: 1 tab twice daily x 10days; RF: 0 (full RX required)
Rationale: Penicillin is the 1st line treatment recommendation for Group A Beta-hemolytic streptococcal
pharyngitis, based on their narrow spectrum of activity, infrequency of adverse reactions, & modest cost.
(Shulman, Bisno, Clegg, Gerber, Kaplan, Lee, Martin, & Van Beneden, 2012). My patient has no noted
allergies, so PCN VK is appropriate.
b. No additional testing will be performed today.
Rationale: Point of care, rapid strep antigen tests are highly specific (approximately 95%) when
compared with throat cultures, so false-positive test results are highly unusual. Consequently, a
therapeutic decision can be confidently made based on the positive result which was reported for this
patient in the scenario (Shulman, Bisno, Clegg, Gerber, Kaplan, Lee, Martin, & Van Beneden, 2012).
c. Patient instructions:
-take all medication as prescribed (Reference, date)
-F/U in 10-14 days if symptoms are not resolved or sooner if they become worse, etc.,
(Reference, date)
-Etc..
4. Provide an active problem list for this patient based on the information given in the case. This is where
you list all of the known medical problems of the patient. This is different than a differential.
Example:
This study source was downloaded by 100000842568006 from CourseHero.com on 05-01-2022 00:46:57 GMT -05:00
https://www.coursehero.com/file/56774611/NR-511-Week-3-and-Week-Case-Study-Assignmentsdocx/
