| Course | NR 603 Advanced Clinical Diagnosis and Practice across the Lifespan Practicum |
|---|---|
| Week | 2 |
| Paper type | Undifferentiated case analysis |
| Length | About 1,110 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Family Nurse Practitioner (FNP) |
| Updated | October 2026 |
Free sample paper for NR 603 Week 2
Undifferentiated Case Analysis: R.M., 58, Three Months of Fatigue and a 4-Kilogram Weight Loss, Three Explanations Kept Open and Ranked by What Would Harm Soonest
Student Name
College of Nursing, Chamberlain University
NR 603: Advanced Clinical Diagnosis and Practice across the Lifespan Practicum
Instructor Name
Month Day, Year
Undifferentiated Case Analysis: R.M., 58, Three Months of Fatigue and a 4-Kilogram Weight Loss, Three Explanations Kept Open and Ranked by What Would Harm Soonest
The Presentation, Including the Misfits
R.M., 58, works as a bookkeeper and came in because "I'm just so tired." Over three months: tired by mid-afternoon, needing to stop halfway up the stairs to catch breath, and a weight loss from 78 to 74 kilograms without trying, about 5%. Stools a little looser than usual for two months, no blood noticed. No fever, no night sweats, no cough. Sleeping eight hours. Mood "fine, just tired." Takes ibuprofen 400 mg most days for low back pain, for about a year. Has never had colorectal cancer screening. Eats a mostly vegetarian diet. No family history of cancer known.
Examination: pale inner eyelids; heart rate 96 at rest; blood pressure 124/76; no enlarged lymph nodes; thyroid not enlarged; abdomen soft with no masses or tenderness; no liver or spleen enlargement; rectal examination shows brown stool, not checked for blood at this visit.
The misfits: the weight loss is more than fatigue alone explains; the breathlessness on stairs is new; the looser stools are mild and could be nothing; the mood is described as fine.
Life Stage as a Variable
At 58, the likelihood of several serious causes rises. Colorectal cancer becomes more common after 50, and R.M. has never been screened, although screening is recommended from 45 (US Preventive Services Task Force, 2021). At 28, the same fatigue and weight loss would more often mean an overactive thyroid, new type 1 diabetes, depression or an eating pattern problem. At 58 those remain possible, but cancer and blood loss move up.
Candidates With Their Discriminators
1. Iron deficiency anemia from blood loss in the gut. Supports: pallor, fast resting heart rate, breathlessness on stairs, daily ibuprofen, change in stools, no screening. Would confirm: low hemoglobin with small red cells and a low ferritin. Would make it unlikely: a normal hemoglobin and ferritin.
2. Overactive thyroid. Supports: weight loss with fatigue, fast heart rate, looser stools. Would confirm: a suppressed thyroid-stimulating hormone with a raised free thyroxine. Would make it unlikely: a normal thyroid-stimulating hormone.
3. New type 2 diabetes with high blood sugar. Supports: fatigue, weight loss. Against: no thirst or frequent urination reported. Would confirm: an A1c at or above the 6.5% diagnostic line. Would make it unlikely: a normal A1c.
Kept further down: depression, which R.M. denies but which presents as fatigue; a cancer elsewhere; heart failure, against which the examination argues; chronic infection such as hepatitis C or HIV.
Ranked by Consequence
The ranking follows what would harm R.M. soonest if missed, not what is most common.
First: iron deficiency anemia from gut blood loss, because its most serious cause, colorectal cancer, grows while it is missed, and because an ulcer from ibuprofen can bleed suddenly.
Second: overactive thyroid, which can strain the heart, particularly with a resting rate of 96.
Third: diabetes, which matters but rarely harms within weeks at this level of symptoms.
Depression is real but would not cause the pallor or the fast heart rate.
A Plan Made Under Uncertainty
Tests today: complete blood count; ferritin, iron and transferrin saturation; thyroid-stimulating hormone; hemoglobin A1c; comprehensive metabolic panel; hepatitis C and HIV antibodies, which are recommended once for adults and which R.M. has never had.
Not today: a stool test for blood. In a patient with symptoms, a normal result would not rule out a cancer, so it would not change the next step if the blood count shows anemia.
Stop ibuprofen today. Use acetaminophen for the back pain.
PHQ-9 questionnaire completed today: score 4, which does not suggest depression.
Return in one week for results; come sooner for tarry or blood-streaked stools, a faint, pain in the chest or breathing that gets worse.
Ko et al. (2020) recommend that adults with iron deficiency anemia and no obvious explanation have both the colon and the upper gut examined, which is why the first test result will decide the next referral.
Why Not Pick a Diagnosis Now
The picture points toward anemia, but I have not yet measured a hemoglobin. Naming iron deficiency now and treating with iron before testing would risk hiding the anemia and delaying the search for its cause. The tests above will narrow three explanations to one or show that none fits.
What R.M. Was Told
That the tiredness and weight loss need a few blood tests to sort out, that one possibility is a low blood count from slow bleeding in the gut, which can come from the ibuprofen or from a growth in the bowel, and that the tests are the next step rather than a cause for alarm. R.M. asked whether it could be "just getting older." I said that tiredness with weight loss at 58 is not something to put down to age without checking.
What a Different Patient Would Change
If R.M. had been 28 with the same story, the overactive thyroid would sit higher and colorectal cancer far lower, though not off the list. If R.M. had been on a blood thinner, the urgency of the anemia workup would rise. If R.M. had reported black stools, the visit would have ended in the emergency department. The ranking is specific to this patient, which is why it is written down rather than assumed, and it will be rewritten when the results arrive.
How the Candidates Arrived
The first three candidates came from the history in a particular order: the breathlessness and pallor made me think of anemia, the weight loss with a fast pulse made me think of the thyroid and the fatigue with weight loss made me think of sugar. Depression came from asking the mood question directly. Writing down where each idea came from makes it easier to see which findings are carrying the most weight, and which single finding, if it turned out to be wrong, would change the ranking most. Kroenke et al. (1992) found that common symptoms in primary care often have more than one contributing cause, which is a reason not to stop at the first explanation that fits.
Limits
A single visit. The weight loss is reported, not measured over time; one weight from a visit eight months ago, 77.5 kilograms, supports it.
References
Ko, C. W., Siddique, S. M., Patel, A., Harris, A., Sultan, S., Altayar, O., & Falck-Ytter, Y. (2020). AGA clinical practice guidelines on the gastrointestinal evaluation of iron deficiency anemia. Gastroenterology, 159(3), 1085-1094. https://doi.org/10.1053/j.gastro.2020.06.046
Kroenke, K., Lucas, C. A., Rosenberg, M. L., Scherokman, B., Herbers, J. E., Jr., Wehrle, P. A., & Boggi, J. O. (1992). Causes of persistent dizziness: A prospective study of 100 patients in ambulatory care. Annals of Internal Medicine, 117(11), 898-904. https://doi.org/10.7326/0003-4819-117-11-898
US Preventive Services Task Force. (2021). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238
NR 603 Week 2 instructions, in plain terms
The Week 2 analysis presents a picture that will not close, written by someone who is fine with that. Let three explanations survive the history, and say so plainly rather than forcing a winner. Give each surviving candidate two things: the finding that would confirm it and the finding that would rule it out. Rank them by consequence, so the explanation that would harm the patient soonest comes first. Treat life stage as a variable. End with a plan made under uncertainty. Most rubrics mark down a forced verdict the case does not support, an analysis so even-handed that the patient leaves with nothing, and a dangerous possibility mentioned once and never ranked.
How this NR 603 Week 2 example is built
The sample's patient is a bookkeeper with fatigue, breathlessness on stairs, 5% weight loss, looser stools, daily ibuprofen and no colon screening. The findings that do not fit are named. Age is used to explain why blood loss and cancer move up at 58. Three candidates, iron deficiency from gut bleeding, overactive thyroid and new diabetes, each get supporting findings and both discriminators. The ranking puts gut bleeding first because of what it could hide. The plan lists tests, a reason for not ordering a stool test, stopping ibuprofen and a PHQ-9. Sections cover why no diagnosis is named, what the patient was told, how a different patient would change it and where each candidate came from.
Reading the NR 603 Week 2 grading rubric
The expensive failure is the forced verdict, and this analysis explicitly declines to name a diagnosis before the blood count. The reverse error, an analysis so balanced that nothing happens, costs nearly as much; here the plan includes tests, a medicine change and return precautions. A dangerous possibility mentioned and never ranked loses a row, while colorectal cancer drives the top ranking. Candidates without discriminators lose marks, and each has two. Ranking by consequence rather than frequency earns the reasoning criterion, and tracing where each candidate came from adds transparency. Explaining why no diagnosis is named yet shows restraint was a decision, not indecision. Saying what a different patient would change shows the ranking is specific.
NR 603 Week 2 help from the desk
Weak NR 603 Week 2 analyses pick one diagnosis early and explain away the findings that do not fit. Others list several possibilities and leave the patient with no plan. Many mention a serious cause once and then ignore it. Few give each candidate a finding that would confirm it and one that would rule it out. Age is often left out of the reasoning. Keep two or three candidates open, give each two discriminators, rank them by what would harm the patient soonest and still make a plan. Bring your own history and examination findings, and a parallel sample can be written that keeps your candidates open the same way.
Get a NR 603 Week 2 example written to your instructions
Send the case your section issued for Week 2 with its instructions, and a custom example is built to those requirements and returned inside 24 to 48 hours. The first one is free. If your case is your own choosing, send the presentation and the ranking you already have in mind.
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NR 603 Week 2 questions, answered
Is it acceptable to end without a diagnosis?
In this course it is often the correct answer, provided the paper says what the picture is and what is being done about it. Ending with three candidates, a stated first concern and a concrete plan is a finished piece of work. Ending with three candidates and no decision is not, since the patient in the case still needs something to happen.
How many differentials should be kept open?
Three or four is the range that reads as considered. Beyond that the paper stops being an argument and turns into a list, and the marker cannot tell what you actually think. Each one has to earn its place by being possible in this patient at this age, and the one with the worst consequences belongs there even at low probability.
Do I need current sources for an analysis like this?
Yes, and they work best attached to the discriminating moves rather than to the conditions in general. A citation supporting how well a particular finding separates two explanations is doing something. A citation describing a disease everybody in the section already recognizes is filling space, and markers read a great many of those.
Where can I find a free NR 603 Week 2 sample paper?
The full undifferentiated case analysis of fatigue and weight loss at 58, with three ranked candidates, is published on this page.
Why is gut bleeding ranked first in the NR 603 Week 2 analysis?
Its most serious cause, colorectal cancer, grows while missed, and an ulcer from daily ibuprofen can bleed suddenly, so it would harm the patient soonest.