NUR 629 Case Study One Updated 2025.
Student’s Name:
It is early December. Mark, a 7-year-old boy, is in your office this morning
with his father after a very restless night; mom is out of town. Dad states
that his son was sent home from school 3 days ago after vomiting. Mark
awoke the next morning with a fever of 102°F, body aches, a cough, a sore
throat, and a runny nose. After 2 days of taking over-the-counter children’s
cold medicine, he still had a fever. In your office this morning, you note he is
febrile, pale, and shaky; his skin is clammy and sweaty. There are no sick
contacts in his home. Dad is not sure if the children have received flu
vaccinations this season and your EMR has no flu vaccine documentation
(but the immunization could have been received elsewhere).
Allergies: sulfa drugs
PMH: No ongoing conditions, normal growth and development, no regular
medications. No past surgeries or hospitalizations.
Last ill visit was in March for strep
throat. Vital signs:
Temp: 103.4 temporal HR: 92 RR: 24 B/P: 126/86 Wt.: 25 kg
General: Pale, limited engagement
Ears: TM’s with sharp cone of light, translucent, slightly
injected Eyes: Conjunctiva and sclera clear, no eyelid
puffiness
Nose: Moderate opaque discharge, thin
Pharynx: 2+ rosy pink tonsils and soft palate erythema
Neck: 2+ anterior cervical and submandibular lymph nodes, bilateral
Lungs: Slightly diminished sounds throughout, no rales, rhonchi or
wheezing. No increased work of breathing.
Abdomen: Soft and flat, non-tender. No
organomegaly Skin: Damp and clammy. Good
skin turgor
, List five differential diagnoses that you feel are likely to explain this patient’s
presentation List your most likely diagnosis first (“working diagnosis”), followed
by 4 other reasonable alternatives. Using the grid below each diagnosis, enter the
inclusion or exclusion rationale from the history and the physical examination
that support each one.
Differential Inclusion Rationale Exclusion Rational Working
Diagnosis Diagnosi
s
(20 points)
(✓)
1. Influenza The patient from the The exclusion criteria ✓
case study presents from the HPI and
with fever for three Physical assessment
days, diminished breath would be the vomiting
sounds, body aches, and diminished breath
sore throat, and runny sounds that could
nose. Given the acute potentially indicate
illness is occurring in pneumonia secondary
December and these to influenza.
symptoms coincide with
seasonal influenza
symptoms this is the
most likely diagnosis
(Dolin, 2023).
2. Covid-19 The patient from the The exclusion criteria
case study presents from the HPI and
with fever for three physical assessment
days, diminished breath for Covid-19 would be
sounds, body aches, the vomiting.
sore throat, and runny
nose. Should the patient
be negative for
influenza, this is the
second most likely
diagnosis.
3. Streptococcal The patient presents Exclusion criteria for
Pharyngitis with fever for three this diagnosis would
days, body aches, rosy, include the
pink tonsils, soft palate diminished breath
erythema and sore sounds as this is
throat. Given the typically not
findings from the HPI associated with
and physical streptococcal
assessment, pharyngitis.
streptococcal
pharyngitis cannot be
ruled out until a rapid
Student’s Name:
It is early December. Mark, a 7-year-old boy, is in your office this morning
with his father after a very restless night; mom is out of town. Dad states
that his son was sent home from school 3 days ago after vomiting. Mark
awoke the next morning with a fever of 102°F, body aches, a cough, a sore
throat, and a runny nose. After 2 days of taking over-the-counter children’s
cold medicine, he still had a fever. In your office this morning, you note he is
febrile, pale, and shaky; his skin is clammy and sweaty. There are no sick
contacts in his home. Dad is not sure if the children have received flu
vaccinations this season and your EMR has no flu vaccine documentation
(but the immunization could have been received elsewhere).
Allergies: sulfa drugs
PMH: No ongoing conditions, normal growth and development, no regular
medications. No past surgeries or hospitalizations.
Last ill visit was in March for strep
throat. Vital signs:
Temp: 103.4 temporal HR: 92 RR: 24 B/P: 126/86 Wt.: 25 kg
General: Pale, limited engagement
Ears: TM’s with sharp cone of light, translucent, slightly
injected Eyes: Conjunctiva and sclera clear, no eyelid
puffiness
Nose: Moderate opaque discharge, thin
Pharynx: 2+ rosy pink tonsils and soft palate erythema
Neck: 2+ anterior cervical and submandibular lymph nodes, bilateral
Lungs: Slightly diminished sounds throughout, no rales, rhonchi or
wheezing. No increased work of breathing.
Abdomen: Soft and flat, non-tender. No
organomegaly Skin: Damp and clammy. Good
skin turgor
, List five differential diagnoses that you feel are likely to explain this patient’s
presentation List your most likely diagnosis first (“working diagnosis”), followed
by 4 other reasonable alternatives. Using the grid below each diagnosis, enter the
inclusion or exclusion rationale from the history and the physical examination
that support each one.
Differential Inclusion Rationale Exclusion Rational Working
Diagnosis Diagnosi
s
(20 points)
(✓)
1. Influenza The patient from the The exclusion criteria ✓
case study presents from the HPI and
with fever for three Physical assessment
days, diminished breath would be the vomiting
sounds, body aches, and diminished breath
sore throat, and runny sounds that could
nose. Given the acute potentially indicate
illness is occurring in pneumonia secondary
December and these to influenza.
symptoms coincide with
seasonal influenza
symptoms this is the
most likely diagnosis
(Dolin, 2023).
2. Covid-19 The patient from the The exclusion criteria
case study presents from the HPI and
with fever for three physical assessment
days, diminished breath for Covid-19 would be
sounds, body aches, the vomiting.
sore throat, and runny
nose. Should the patient
be negative for
influenza, this is the
second most likely
diagnosis.
3. Streptococcal The patient presents Exclusion criteria for
Pharyngitis with fever for three this diagnosis would
days, body aches, rosy, include the
pink tonsils, soft palate diminished breath
erythema and sore sounds as this is
throat. Given the typically not
findings from the HPI associated with
and physical streptococcal
assessment, pharyngitis.
streptococcal
pharyngitis cannot be
ruled out until a rapid
