NURS 6512 Week 3: Assignment 1 Differential Diagnosis Exercise
The assignment this week is intended to demonstrate a method to develop a list of differential diagnosis based on a case study and then how to attach characteristics to those diagnosis to facilitate reaching a realistic working diagnosis.
The first case is an example and will demonstrate the process and information you are expected to generate for the 3 cases that follow.
This is a self-paced exercise. You will receive full credit for completion. Please carefully review the feedback to check your answers.
By Day 7 of Week 3
Complete and submit the Differential Diagnosis Exercise. Click the Take the Survey button below to begin the exercise.
CC – “I have drainage from my eye”
HPI – 26 year old female complains of drainage from her right eye that started 3 days ago and has gotten worse. She describes the drainage as white and stringy. She notices the drainage all day long and is quite bothersome to her. She has tried Visine but it has not made it any better. Nothing specific seems to make it worse. She denies any fever, eye pain, or feeling like there is anything in the eye. Denies any difficulty with her vision. The amount of drainage is significant utilizing one Kleenex an hour to absorb it.
Based on the Case Study – generate 5-7 potential diagnosis based on the patient complaints.
Your Answer:
Based on the patient’s complaints and history, 5-7 potential diagnoses to consider are
1) Allergic conjunctivitis; This is inflammatory response of the conjunctiva caused by allergens such as pollen, dust, or pet dander.
Signs and Symptoms
Stringy or mucoid discharge
Itching. No itching reported
Redness
Tearing.
Unilateral or bilateral; can affect one eye or both, commonly affect both eyes.
Visine did not improve the symptoms, because basic lubrication drops do not address the allergic symptoms.
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2) Viral conjunctivitis; Commonly associated with adenovirus infections, frequently accompanies upper respiratory symptoms. Highly contagious, viral conjunctivitis usually clears up in a couple of weeks.
Signs and Symptoms
Watery or Mucoid discharge
Eye redness
Irritation
Mild swelling of the eyelids.
Persistent drainage and the gradual worsening of the condition over the course of three days can be sign of Viral conjunctivitis
3)Bacterial Conjunctivitis: Bacterial conjunctivitis occurs when bacteria infect and inflame the conjunctiva.
Signs and Symptoms:
- Discharge: Thick, sticky discharge yellow, green, or white, from the eye often accumulating in the corner of the eye and along the lash line
- Eyelid crusting: Lids stuck together when you wake up, sometimes requiring a warm washcloth to open
- Conjunctival redness: The white of the eye appears pink or red
- Mild discomfort: A gritty or sandy feeling, though not the intense itch of allergies
4) Dry Eye Syndrome: This irritation and stringy discharge can be caused by insufficient tear production of tear production and the poor quality of tear.
Signs and Symptoms:
Discomfort
Redness
Feeling of dryness
Although the patient did not report experiencing dryness, persistent irritation and the appearance of stringy discharge could be signs of this condition.
5) Keratitis: inflammation of the cornea
Signs and Symptoms:
Red eye
Difficulty with vision
Eye pain
Sensitive to light
Based on the history, this diagnosis less possible, but it can be early stage.
For Question 1, you should have outlined the following potential diagnosis:
- Bacterial conjunctivitis
- Viral Conjunctivitis
- Allergic Conjunctivitis
- Keratitis (inflamed Cornea)
- Blocked Tear Duct
- Foreign Object in the Eye
- Scratched Cornea
- Glaucoma
Now that you have a list of potential diagnosis utilize your knowledge of each condition to identify common symptoms / characteristics to narrow down the list.
| Potential Diagnosis | Characteristics |
| Bacterial conjunctivitis | Thick yellow or green drainage. Eye lid can be stuck in the morning with crusty colored drainage |
| Viral Conjunctivitis | Drainage is watery, mucous like, eye lid can be stuck in the morning with clear drainage |
| Allergic Conjunctivitis | White or pale yellow stringy drainage, consistent |
| Keratitis (inflamed Cornea) | Red eye, difficulty with vision, eye pain, sensitive to light |
| Foreign Object in the Eye | Complaints of something in the eye – clear drainage |
| Scratched Cornea | Clear drainage (tear like), pain in the eye |
| Glaucoma | Watery eyes, decreased vision, eye pain |
Based on the case study and table above, what is the working diagnosis?
Your Answer:
Allergic Conjunctivitis
For Question 2, you should have determined the working diagnosis is allergic conjunctivitis. Now, let’s move on to Student Case #1:
CC: “I have a cough”
HPI – 36-year-old female complains of a cough. The cough started about 3 weeks ago and occurs nightly, it is non-productive and dry and occurs mostly at bedtime. She feels fine and then goes to bed and starts coughing. She gets up for a drink and it gets better but then gets worse when she lays down again. She has not tried any medications or treatments. Nothing seems to make it better or worse. She denies any wheezing, congestion, nasal stuffiness, or aching.
Generate a list of 5-7 potential diagnosis.
Your Answer:
Gastroesophageal reflux disease (GERD)
Asthma:
Bronchitis
Postnasal Drip:
Allergies.
Add characteristics for each of the potential diagnoses, outlined in question 3.
| Potential Diagnosis | Characteristics |
Your Answer:
Gastroesophageal reflux disease (GERD)
Cough starts when laying flat
no wheezing
nigh time symptoms
non productive
Asthma:
Coughing
Wheezing
Chest tightness
Consistent symptoms day / night
Bronchitis
Symptoms throughout the day
Wheezing
Chest tightness
Postnasal Drip:
Dry cough, especially when lying down.
Allergies. Dry cough, even without significant nasal symptoms.
Here are some potential diagnosis and characteristics to compare to your answers:
| Diagnosis | Characteristics |
| Bronchitis | Symptoms throughout the day, wheezing, chest tightness |
| Asthma | Coughing, wheezing, chest tightness, Consistent symptoms day / night |
| Pneumonia | Productive cough, fever, wheezing, symptoms day / night |
| Cold (virus) | Nasal congestion, achy, consistent symptoms through the day / night |
| Allergies | Sneezing, runny nose, wheezing, itchy eyes Consistent symptoms through the day / night |
| Gastroesophageal reflux disease (GERD) | Cough starts when laying flat, no wheezing, nigh time symptoms (positional) non productive |
The mostly likely working diagnosis would be GERD.
How did you do?
Your Answer:
The diagnosis of GERD can be supported by the presence of symptoms such as a persistent non-productive cough, which often worsens when one is lying down.
Cough symptoms. Lying down can trigger a cough in people with gastroesophageal reflux disease (GERD). It can be caused by the stomach acid moving into the esophagus. This condition usually improves with sitting up.
The absence of a persistent wheezing is a strong indication that you have GERD. The symptoms of GERD often get worse after eating or sleeping, and this can lead to nighttime coughing.
CC: “I have pain in my abdomen”
HPI – 56-year-old male complains of pain in his abdomen that started about a month ago. He states the pain comes and goes and is usually worse after meals. He points to his right upper abdomen for the location of the pain. He has some nausea but no vomiting. He describes the pain as severe, sharp, and crampy after eating and radiates into the shoulder and back. He denies any bloating or diarrhea. His stools have been a clay like color recently. He denies any fever or chills. Eating bland food seems to make the pain better. He has tried antacids and omeprazole without much effect. The worse pain was rated a 9 after a meal of cheeseburger and fries.
Generate a list of 5-7 potential diagnosis related to this case.
Your Answer:
Hepatitis
Pancreatitis
Appendicitis
Peptic Ulcer Disease
Cholecystitis
Add characteristics for each of the potential diagnosis:
| Potential Diagnosis | Characteristics |
Your Answer:
Hepatitis
Pain or bloating in the belly
Nausea/vomiting
Fatigue
Jaundice
Dark urine
Pale stools
Diarrhea,
Pancreatitis
Pain worsens after eating
Pain radiates to back / chest
Swelling / tenderness of abdomen
Diarrhea
Fluid buildup in the abdomen
No change in the color of the stool
Appendicitis
Pain usually starts periumbicular and then moves to right lower quadrant
Fever is late sign
Nausea / vomiting
Pain usually not related to meals
Increase pain with cough or ambulation
Peptic Ulcer Disease
Dull pain or burning in upper abdomen
Nausea / vomiting
Bloating
Belching
Heartburn
Pain worsens after eating
Black or bloody stools
Cholecystitis
Pain worsens after eating
Pain radiates to back / chest,
Color change in stools,
Nausea / Vomiting
Bloating
Compare your answers to these:
| Potential Diagnosis | Characteristics |
| Pancreatitis | Pain worsens after eating, pain radiates to back / chest, swelling / tenderness of abdomen, diarrhea, fluid build up in the abdomen, no change in the color of the stool |
| Appendicitis | Pain usually starts periumbicular and then moves to right lower quadrant, fever is late sign, nausea / vomiting, pain usually not related to meals, increase pain with cough or ambulation |
| Peptic Ulcer Disease | Dull pain or burning in upper abdomen, nausea / vomiting, bloating, belching, heartburn, pain worsens after eating, black or bloody stools |
| Cholecystitis | Pain worsens after eating, pain radiates to back / chest, color change in stools, nausea / vomiting, bloating |
| Kidney Infection | Pain is located more in the CVA, pain not related to meals, usually fever associated, not as common in men |
| Hepatitis | Pain or bloating in the belly, nausea/vomiting, fatigue, jaundice, dark urine, pale stools, diarrhea, |
The working Diagnosis: Cholecystitis
How did you do?
Your Answer:
- Right Upper Abdominal Pain: Pain worsens after eating,
- Pain Radiates. Pain radiates to back / chest
- Nausea Often accompanying the abdominal pain.
- Clay like stool.
The presence of above symptoms supports the diagnosis of Cholecystitis