Purpose and Learning Outcomes:
This signature assignment aligns with the following course and program outcomes:
- Demonstrate advanced clinical reasoning in diagnosing acute and chronic illness
- Develop evidence-based management plans
- Integrate social determinants of health and cultural competence into care
- Apply current guidelines to clinical decision-making
Develop and submit a comprehensive, evidence-based case study (New onset Diabetes Mellitus Type 1) analyzing a complex patient presentation for which a specific Main diagnosis will be assigned to each student randomly. This assignment demonstrates your ability to collect and synthesize clinical data, formulate accurate differential diagnoses, and implement a patient-centered treatment plan grounded in current practice guidelines.
A rubric is included in the Instructions paper added on this activity area.
The paper must be presented following the APA 7th edition format and must be uploaded to Moodle in a PDF format document.
Also, a short sample assignment is provided to bring a little bit more clarification about what is needed, and You as student must include in Your assignment all body systems positive and negative findings in a descriptive manner for ROS and Physical Exam area.
Sample Signature Assignment Course: Diagnosis, Symptom, and Illness Management Title: Comprehensive Case Study – Diagnostic and Treatment Management Plan Student Name FNP Program, University Name Date 1. Patient Scenario Patient Information: • Name: Mrs. Linda Thompson • Age: 56 years old • Sex: Female • Ethnicity: African American • Chief Complaint (CC): “I’m tired all the time and short of breath when I walk.” 2. History and Clinical Data History of Present Illness (HPI): Mrs. Thompson reports progressive fatigue and dyspnea on exertion over the past 6 weeks. She denies chest pain but has occasional palpitations. She notices ankle swelling in the evenings and finds herself needing extra pillows to sleep at night. Past Medical History (PMH): • Hypertension (diagnosed 8 years ago) • Type 2 Diabetes Mellitus • Hyperlipidemia Family History (FH): • Father died of myocardial infarction at age 60 • Mother has congestive heart failure and type 2 diabetes Social History (SH): • Smoked one pack/day for 20 years (quit 5 years ago) • Drinks Wine Occasionally • No illicit drug use • Works as a school administrator • Lives with husband Review of Systems (ROS): • Positive: fatigue, dyspnea on exertion, orthopnea, ankle swelling • Negative: fever, chills, chest pain, weight loss Physical Exam (PE): • Vital signs: BP 152/88, HR 92, RR 20, Temp 98.6°F, SpO2 95% RA
General: alert, appears fatigued • Heart: S1, S2 normal; S3 present • Lungs: bibasilar crackles • Extremities: 1+ pitting edema in ankles bilaterally • Skin: no cyanosis or rash 3. Differential Diagnoses 1. Congestive Heart Failure (CHF) • Rationale: Symptoms of dyspnea, orthopnea, fatigue, edema, S3 heart sound, and bibasilar crackles point toward CHF. Her risk factors include hypertension, diabetes, and smoking history. 2. Anemia • Rationale: Fatigue and dyspnea can also suggest anemia, especially in postmenopausal women. Need labs to confirm. 3. Chronic Obstructive Pulmonary Disease (COPD) • Rationale: Former smoker with dyspnea may suggest COPD, but clear l but clear lungs and no wheezing make it less likely.
4. Final Diagnosis
Diagnosis: Congestive Heart Failure – NYHA Class II
• Rationale: Classic presentation and physical findings match systolic heart failure. She has exertional symptoms but is comfortable at rest.
References:
• Yancy et al. (2022). ACC/AHA Guidelines for the Management of Heart Failure
• UpToDate Clinical Summary: Heart failure with reduced ejection fraction (HFrEF)
5. Diagnostic Workup Plan
Test
Purpose
BNP (B-type natriuretic peptide)
Elevated in CHF
EKG
Assess for arrhythmias or LV hypertrophy
Chest X-ray
Look for pulmonary edema or cardiomegaly
Echocardiogram
Gold standard to evaluate ejection fraction
CBC
Rule out anemia
BMP
Assess electrolytes, kidney function
A1c and Lipid Panel
Diabetes and cardiovascular risk
6. Management Plan
a. Pharmacologic:
1. Lisinopril 10 mg PO daily – ACE inhibitor for BP and heart failure
2. Furosemide 20 mg PO daily – Loop diuretic for volume overload
3. Metoprolol succinate 25 mg PO daily – Beta-blocker to reduce cardiac workload
4. Atorvastatin 40 mg PO at bedtime – Hyperlipidemia
b. non-pharmacologic:
• Sodium-restricted diet (<2g/day)
• Fluid restriction (<2L/day)
• Daily weights at home
• Moderate physical activity as tolerated
• Smoking cessation reinforcement
• c. Patient Education:
• Educate on signs of fluid overload
• Importance of medication adherence
• When to seek medical attention (e.g., rapid weight gain, worsening dyspnea)
• d. Referrals and Follow-Up:
• Refer to cardiology
• Nutrition consults for heart-healthy diet
• Recheck labs in 1–2 weeks
• Follow-up in clinic in 2 weeks
7. Cultural and Socioeconomic Considerations
• Mrs. Thompson lives in an underserved urban area with limited access to specialists. Will use telehealth for cardiology.
• Discussed potential medication costs and prescribed generics when possible.
• Cultural consideration: Incorporate dietary preferences into low-sodium plan (e.g., seasoning alternatives for traditional Southern dishes).
8. Outcome Evaluation Plan
• Goal: Symptom improvement within 2 weeks
• Monitoring: Daily weights, BP log, symptom diary
• Labs: Reassess BMP and BNP at follow-up
• Long-term: Maintain EF > 40%, prevent hospitalization
9. References
1. Yancy, C. W., et al. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation.
2. UpToDate. (2024). Heart failure with reduced ejection fraction: Clinical manifestations and diagnosis.
3. American Diabetes Association. (2023). Standards of Care in Diabetes.