(Answered) NR511 Week 6: Clinical Case Study Part Two Discussion


Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice.  The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

  1. Synthesize clinical knowledge, didactic learning and research findings to provide appropriate primary care to patients with common acute and stable chronic conditions. (WO6.1) (CO 1, 2, 4 & 5)

Due Date: 

Student enters initial post to part one by 11:59 p.m. MT on THURSDAY; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT.

A 10% late penalty will be imposed for discussions posted after the deadline on THURSDAY 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT.

Total Points Possible:  50


  1. What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
  2. Identify the corresponding ICD-10 code.
  3. Provide a treatment plan for this patient’s primary diagnosis which includes:
    • Medication*
    • Any additional testing necessary for this particular diagnosis*
    • Patient education
    • Referral
  4. Provide an active problem list for this patient based on the information given in the case.
  5. Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBM argument for each treatment or testing decision.
  6. Provide an appropriate F/U plan.

*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an evidence-based medicine (EBM) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.


Case Study

Now, assume that you sent your patient for labs and she returns the following day, as instructed, to review the results.

CBC with differential

WBC 8.6 x10E3/uL
RBC 4.44 x 10E6/uL
Hemoglobin 14.0 g/dL
Hematocrit 41.2%
MCV 93fL
MCH 31.5 pg
MCHC 34.0 g/dL
RDW 13%
Platelet 241 x 10E3/uL
Neutrophils % 67%
Lymphocytes % 22%
Monocytes % 8%
Eosinophils % 3%
Basophils % 0%
Absolute Neutrophils 5.7 x 10E3/uL
Absolute Lymphocytes 1.9 x 10E3/uL
Absolute Monocytes 0.7 x 10E3/uL
Eosinophils Absolute 0.3  x 10E3/uL
Basophile Absolute 0.0  x 10E3/uL
Immature Grans % 0%
Absolute Immature Grans 0.0 x 10E3/uL

TSH with Reflex to FT4

TSH 6.770 uIU/mL
FT4 0.62 ng/dL

PHQ-9 Depression Score=10 (previous was 5 at last visit 6 months ago)


Case Study Presentation part 2

Primary Diagnosis at this Time with Pertinent Positive and Negatives

The primary diagnosis for the patient at this time is hypothyroidism (ICD Code: E03.9).  The pertinent positive findings supporting hypothyroidism diagnosis in this patient include increased fatigue even after resting and sleeping for 8 hours every night, dry skin, weight gain +5lb since 6 months ago, cold intolerance, reduced muscle strength, constipation, thick nails, intermittent cramping of calf muscles, and depression (Drake, 2018).

To primary diagnostic test for hypothyroidism is the thyroid-stimulating hormone (TSH) Test which is used to test any abnormalities in TSH levels. Abnormally high (> 4.0 mU/L) TSH levels indicate possible hypothyroidism (Drake, 2018). High TSH levels in with 2 separate tests with low T4 levels means the patient has hypothyroidism.Please click the icon below to purchase the full solution at $5