Assignment Prompt & Instructions
For the homework you see the instruction attached
– ## Assigmentinstruccionwiththedeseaseasignedtome.docx
– ## SignatureAssingmentInstructions.pdf
– ## SampleSignatureAssignment.pdf
**## Assigmentinstruccionwiththedeseaseasignedtome.docx**
**Title: Comprehensive Case Study – Diagnostic and Treatment Management Plan**
**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**
**Due**: Week #7
You will develop and submit a comprehensive, evidence-based case study analyzing a complex patient presentation for
| |
| — |
| Right Acute Diffuse Otitis Externa |
. 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.
**## SignatureAssingmentInstructions.pdf**
Faculty: Leonardo Trobajo Lobayna, DNP, ARNP-BC
Course: Diagnosis, Symptom, and Illness Management
Title: Comprehensive Case Study – Diagnostic and Treatment Management Plan
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
Assignment Overview:
You will develop and submit a comprehensive, evidence-based case study analyzing a
complex patient presentation. 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.
Case Study Requirements:
1. Patient Scenario (Real or Simulated):
• Age, sex, race/ethnicity
• Chief complaint (CC)
• History of Present Illness (HPI)
• Past Medical History (PMH)
• Family History (FH)
• Social History (SH)
• Review of Systems (ROS)
• Physical Examination Findings (PE)
2. Differential Diagnosis:
• List at least 3 differential diagnoses
• Justify each differential using:
o Presenting signs/symptoms
o Pathophysiology
o Risk factors
o Diagnostic criteria
3. Final Diagnosis:
• Identify the most likely diagnosis
• Explain the rationale
• Cite at least two current evidence-based guidelines or scholarly sources
4. Diagnostic Workup Plan:
• Labs, imaging, or additional testing
• Provide rationale for each
• 5. Treatment & Management Plan:
• Non-pharmacologic interventions
• Patient education
• Follow-up and referrals, if needed
• 6. Cultural, Ethical, or Socioeconomic Considerations:
• Address any relevant patient-specific factors that influence care
• 7. Evaluation of Outcomes:
• How will you measure the effectiveness of your treatment plan?
• Short- and long-term follow-up goals
Formatting Guidelines:
• APA 7th edition formatting
• 4-6 pages (excluding title and reference pages)
• Minimum of 3 peer-reviewed or clinical guideline references (within 5 years)
• Use headings for organization (MRU School)
Grading Rubric Highlights:
• Criteria • Points
• History and Clinical Data • 20
• Differential Diagnosis • 35
• Final Diagnosis Justification • 20
• Management Plan (Rx + Non-Rx) • 10
• Cultural/Patient-Centered Care • 5
• Use of Evidence & Guidelines • 5
• Organization, APA, Grammar • 5
Total • 100
**## SampleSignatureAssignment.pdf**
Faculty: Leonardo Trobajo Lobayna, DNP, ARNP-BC
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):
• 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):
• 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 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.
– 3. Differential Diagnoses
**## SampleSignatureAssignment.pdf**
Faculty: Leonardo Trobajo Lobayna, DNP, ARNP-BC
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):
• 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):
• 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 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.
– 3. Differential Diagnoses
**## Assigmentinstruccionwiththedeseaseasignedtome.docx**
**Title: Comprehensive Case Study – Diagnostic and Treatment Management Plan**
**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**
**Due**: Week #7
You will develop and submit a comprehensive, evidence-based case study analyzing a complex patient presentation for
| |
| — |
| Right Acute Diffuse Otitis Externa |
. 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.
**## SignatureAssingmentInstructions.pdf**
Faculty: Leonardo Trobajo Lobayna, DNP, ARNP-BC
Course: Diagnosis, Symptom, and Illness Management
Title: Comprehensive Case Study – Diagnostic and Treatment Management Plan
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
Assignment Overview:
You will develop and submit a comprehensive, evidence-based case study analyzing a
complex patient presentation. 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.
Case Study Requirements:
1. Patient Scenario (Real or Simulated):
• Age, sex, race/ethnicity
• Chief complaint (CC)
• History of Present Illness (HPI)
• Past Medical History (PMH)
• Family History (FH)
• Social History (SH)
• Review of Systems (ROS)
• Physical Examination Findings (PE)
2. Differential Diagnosis:
• List at least 3 differential diagnoses
• Justify each differential using:
o Presenting signs/symptoms
o Pathophysiology
o Risk factors
o Diagnostic criteria
3. Final Diagnosis:
• Identify the most likely diagnosis
• Explain the rationale
• Cite at least two current evidence-based guidelines or scholarly sources
4. Diagnostic Workup Plan:
• Labs, imaging, or additional testing
• Provide rationale for each
• 5. Treatment & Management Plan:
• Non-pharmacologic interventions
• Patient education
• Follow-up and referrals, if needed
• 6. Cultural, Ethical, or Socioeconomic Considerations:
• Address any relevant patient-specific factors that influence care
• 7. Evaluation of Outcomes:
• How will you measure the effectiveness of your treatment plan?
• Short- and long-term follow-up goals
Formatting Guidelines:
• APA 7th edition formatting
• 4-6 pages (excluding title and reference pages)
• Minimum of 3 peer-reviewed or clinical guideline references (within 5 years)
• Use headings for organization (MRU School)
Grading Rubric Highlights:
• Criteria • Points
• History and Clinical Data • 20
• Differential Diagnosis • 35
• Final Diagnosis Justification • 20
• Management Plan (Rx + Non-Rx) • 10
• Cultural/Patient-Centered Care • 5
• Use of Evidence & Guidelines • 5
• Organization, APA, Grammar • 5
Total • 100
**## SampleSignatureAssignment.pdf**
Faculty: Leonardo Trobajo Lobayna, DNP, ARNP-BC
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):
• 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):
• 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 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.
– 3. Differential Diagnoses
**## Assigmentinstruccionwiththedeseaseasignedtome.docx**
**Title: Comprehensive Case Study – Diagnostic and Treatment Management Plan**
**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**
**Due**: Week #7
You will develop and submit a comprehensive, evidence-based case study analyzing a complex patient presentation for
| |
| — |
| Right Acute Diffuse Otitis Externa |
. 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.
**## SignatureAssingmentInstructions.pdf**
Faculty: Leonardo Trobajo Lobayna, DNP, ARNP-BC
Course: Diagnosis, Symptom, and Illness Management
Title: Comprehensive Case Study – Diagnostic and Treatment Management Plan
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
Assignment Overview:
You will develop and submit a comprehensive, evidence-based case study analyzing a
complex patient presentation. 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.
Case Study Requirements:
1. Patient Scenario (Real or Simulated):
• Age, sex, race/ethnicity
• Chief complaint (CC)
• History of Present Illness (HPI)
• Past Medical History (PMH)
• Family History (FH)
• Social History (SH)
• Review of Systems (ROS)
• Physical Examination Findings (PE)
2. Differential Diagnosis:
• List at least 3 differential diagnoses
• Justify each differential using:
o Presenting signs/symptoms
o Pathophysiology
o Risk factors
o Diagnostic criteria
3. Final Diagnosis:
• Identify the most likely diagnosis
• Explain the rationale
• Cite at least two current evidence-based guidelines or scholarly sources
4. Diagnostic Workup Plan:
• Labs, imaging, or additional testing
• Provide rationale for each
• 5. Treatment & Management Plan:
• Non-pharmacologic interventions
• Patient education
• Follow-up and referrals, if needed
• 6. Cultural, Ethical, or Socioeconomic Considerations:
• Address any relevant patient-specific factors that influence care
• 7. Evaluation of Outcomes:
• How will you measure the effectiveness of your treatment plan?
• Short- and long-term follow-up goals
Formatting Guidelines:
• APA 7th edition formatting
• 4-6 pages (excluding title and reference pages)
• Minimum of 3 peer-reviewed or clinical guideline references (within 5 years)
• Use headings for organization (MRU School)
Grading Rubric Highlights:
• Criteria • Points
• History and Clinical Data • 20
• Differential Diagnosis • 35
• Final Diagnosis Justification • 20
• Management Plan (Rx + Non-Rx) • 10
• Cultural/Patient-Centered Care • 5
• Use of Evidence & Guidelines • 5
• Organization, APA, Grammar • 5
Total • 100
**## SampleSignatureAssignment.pdf**
Faculty: Leonardo Trobajo Lobayna, DNP, ARNP-BC
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):
• 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):
• 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 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.
– 3. Differential Diagnoses
– 1
– 2
– 3