NRNP 6550 Week 3 iHuman Case Study Treatment Plan Sample
NRNP 6550 Week 3 Assignment Brief: Assessing, Diagnosing, and Treating the iHuman Patient
Course: NRNP 6550: Advanced Practice Care of Adults in Acute Care Settings II
Institution: Walden University
Week: 3
Assignment Type: iHuman Case Study Analysis and Systems-Based Treatment Plan
Length: 4–6 pages (excluding title page and references)
Format: APA 7th Edition
Due: End of Week 3, Day 7, 11:59 p.m. MT
Assignment Context
NRNP 6550 Week 3 requires you to complete the assigned iHuman virtual patient encounter and develop a comprehensive treatment plan for the primary diagnosis. This case involves a 15-year-old male athlete presenting with exertional dyspnea. The assignment assesses your ability to gather a focused history, perform an appropriate physical examination, order relevant diagnostic tests, construct a differential diagnosis, and formulate a systems-based management plan that incorporates health promotion and patient education strategies. The course emphasizes clinical reasoning and evidence-based practice in acute care settings .
This assignment aligns with the Adult-Gerontology Acute Care curriculum’s focus on planning, implementing, and evaluating care for acutely ill patients. You will demonstrate competency in diagnostic reasoning, treatment planning, and interdisciplinary collaboration, skills essential for the acute care nurse practitioner role.
Task Description
Complete the iHuman case study for this week. The patient is a 15-year-old male who presents with exertional dyspnea. Interact with the virtual patient to collect subjective and objective data, order and interpret diagnostic tests, and identify the primary diagnosis. Following the encounter, develop a written treatment plan that addresses each body system, specifies pharmacological and non-pharmacological interventions, outlines pending diagnostics, and details patient education and health promotion strategies. Support all clinical decisions with current, peer-reviewed literature and cite sources in APA format.
Requirements
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Complete the iHuman Virtual Patient Encounter. Conduct a focused history and physical examination, order appropriate diagnostic tests, and identify the primary diagnosis. The case is set in an emergency department with full imaging and laboratory capabilities .
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Construct a Differential Diagnosis. Identify three to five possible conditions to consider for this patient. Explain the clinical reasoning for including each condition and the evidence that supports or refutes it.
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Develop a Systems-Based Treatment Plan. Organize your plan by body system (e.g., Neurological, Cardiovascular, Pulmonary, Gastrointestinal, Genitourinary, Hematology, Endocrine, Infectious Disease, Integumentary). For each system, include:
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Primary diagnosis or problem
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Pending diagnostics
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Pharmacological interventions with dosages, routes, and frequencies
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Supportive care and patient education
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Cite Evidence. Support all clinical decisions with at least five peer-reviewed sources published within the last five years. Use APA 7th Edition in-text citations and a complete reference list.
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Formatting. Include a title page and reference list. Use 12-point Times New Roman, double-spacing, and 1-inch margins. Adhere to APA 7th Edition heading conventions.
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Length. The treatment plan should be 4–6 pages, excluding the title page and references.
Grading Rubric
| Criteria | Weight | Distinguished (90–100%) | Proficient (80–89%) | Developing (70–79%) | Needs Improvement (0–69%) |
|---|---|---|---|---|---|
| iHuman Case Completion | 20% | Completes the case with ≥95% diagnostic accuracy; orders all high-yield history questions and diagnostic tests | Completes the case with 85–94% accuracy; orders most high-yield questions and tests | Completes the case with 75–84% accuracy; orders some relevant questions and tests | Completes the case with <75% accuracy; misses critical questions or tests |
| Differential Diagnosis | 20% | Identifies ≥5 conditions with precise clinical reasoning and supporting evidence for each | Identifies 4 conditions with sound reasoning and evidence | Identifies 3 conditions with adequate reasoning | Identifies <3 conditions or reasoning lacks evidence |
| Systems-Based Treatment Plan | 30% | Covers all relevant systems with accurate diagnoses, appropriate interventions, and precise dosages; integrates patient education throughout | Covers most systems with appropriate interventions; includes patient education | Covers some systems; interventions may be incomplete or lack specificity | Covers few systems; interventions are inappropriate or missing |
| Evidence and Citations | 15% | Cites ≥5 high-quality, peer-reviewed sources; integrates evidence seamlessly; flawless APA 7th Edition formatting | Cites 4–5 credible sources; minor APA errors | Cites 3–4 sources; several APA errors | Cites <3 sources; significant APA errors |
| Writing and Organization | 15% | Clear, concise, and logically organized; free of grammatical errors | Organized with minor grammatical issues | Some organizational or grammatical issues | Disorganized with frequent grammatical errors |
Sample Answer Excerpts
Primary Diagnosis: Exercise-Induced Laryngeal Obstruction (EILO)
The 15-year-old male athlete presents with exertional dyspnea that worsens during high-intensity activity, a presentation consistent with exercise-induced laryngeal obstruction (EILO). EILO is a common, reversible cause of exertional dyspnea in adolescents and young athletes, characterized by inspiratory distress due to transient supraglottic or glottic narrowing during exertion . Unlike exercise-induced bronchoconstriction, EILO often fails to respond to conventional asthma therapy, and patients may report noisy breathing or throat tightness rather than wheezing. Continuous laryngoscopy during exercise (CLE) is the diagnostic gold standard, with a reported sensitivity exceeding 90% for identifying laryngeal obstruction during symptomatic episodes . Management centers on laryngeal control therapy and respiratory retraining, which have demonstrated symptom reduction in 70–80% of adolescents within three to four sessions . Patient education should emphasize the benign nature of the condition and the importance of proper breathing techniques during competition.
Differential Diagnosis: Spontaneous Pneumothorax
Spontaneous pneumothorax warrants consideration given the patient’s tall, thin body habitus and acute onset of sharp, right-sided chest pain during physical exertion. Primary spontaneous pneumothorax occurs most frequently in tall, thin adolescent males, with an estimated incidence of 7.4 per 100,000 males aged 15–19 years . The sudden onset of pleuritic chest pain followed by dyspnea during basketball practice aligns with the classic presentation. Diagnostic confirmation via chest X-ray would reveal a visible pleural line and absent lung markings on the affected side. A small pneumothorax may be managed conservatively with observation and supplemental oxygen, while larger or symptomatic cases require needle aspiration or chest tube placement. Distinguishing this condition from EILO is critical, as the management pathways diverge significantly.
Differential Diagnosis: Exercise-Induced Bronchoconstriction
Exercise-induced bronchoconstriction (EIB) remains the most common cause of exertional dyspnea in adolescent athletes, affecting up to 20% of competitive athletes without underlying asthma . The patient’s symptoms of chest tightness and difficulty catching his breath during basketball practice could indicate EIB, particularly if symptoms peak 5–10 minutes after exercise initiation and resolve within 30–60 minutes. However, the absence of wheezing and the lack of response to prior bronchodilator therapy would argue against this diagnosis. Diagnostic confirmation requires a bronchoprovocation challenge, such as a eucapnic voluntary hyperpnea test or methacholine challenge, which demonstrates a ≥10% decline in FEV₁ post-exercise. Management includes pre-exercise inhaled beta-agonists and a warm-up routine.
Differential Diagnosis: Paradoxical Vocal Fold Motion
Paradoxical vocal fold motion (PVFM), now classified under EILO, involves inappropriate adduction of the vocal folds during inspiration, producing inspiratory stridor and dyspnea. PVFM disproportionately affects adolescent females, though it occurs in males as well. The condition often coexists with asthma, complicating diagnosis. Laryngoscopy during symptomatic exercise remains the definitive diagnostic approach. Treatment combines speech therapy, breathing retraining, and in refractory cases, botulinum toxin injection into the vocal folds. Recognition of PVFM prevents unnecessary escalation of asthma therapy.
Next Assignment: NRNP 6550 Week 4
Week 4: Assignment – Assessing, Diagnosing, and Treating Conditions of the Cardiovascular System 2
Complete the Week 4 iHuman case study, which focuses on cardiovascular conditions in the acute care setting. The patient presents with symptoms requiring differentiation between cardiac and non-cardiac etiologies. You will conduct a focused cardiovascular assessment, order and interpret diagnostic tests including ECG and cardiac biomarkers, and develop a treatment plan for the primary diagnosis. The assignment requires a 4–6 page systems-based treatment plan with at least five peer-reviewed sources in APA 7th Edition format. The case emphasizes recognition of acute coronary syndrome, heart failure exacerbation, and arrhythmias in the adult-gerontology population.
References
American Heart Association. (2023). 2023 AHA/ACC guideline for the management of patients with chronic coronary disease. Journal of the American College of Cardiology, 82(9), 833–955. https://doi.org/10.1016/j.jacc.2023.04.003
Ferraro, R., Latina, J. M., Alfaddagh, A., Michos, E. D., Blaha, M. J., Jones, S. R., & Arbab-Zadeh, A. (2020). Evaluation and management of patients with stable angina: Beyond the ischemia paradigm. Journal of the American College of Cardiology, 76(19), 2252–2266. https://doi.org/10.1016/j.jacc.2020.08.078
Griffin, S. A., Walsted, E. S., & Hull, J. H. (2019). Infographic: The breathless athlete: EILO. British Journal of Sports Medicine, 53(11), 721–722. https://doi.org/10.1136/bjsports-2018-100135
Nielsen, E. W., Hull, J. H., & Backer, V. (2024). Exercise-induced laryngeal obstruction. Immunology and Allergy Clinics of North America, 44(2), 1–14. https://doi.org/10.1016/j.iac.2024.01.002
Røksund, O. D., Heimdal, J. H., Clemm, H., Vollsaeter, M., & Halvorsen, T. (2024). Exercise-induced laryngeal obstruction in children and young people: Approaches to assessment and management. Paediatric Respiratory Reviews, 50, 1–8. https://doi.org/10.1016/j.prrv.2024.02.005
Discussion Post for Week 4
Week 4 Discussion: Differential Diagnosis in Acute Cardiovascular Presentations
Post an initial response of 300–500 words analyzing the Week 4 iHuman case. Identify the primary diagnosis and discuss the clinical reasoning that supports your conclusion. Explain how you differentiated between at least two alternative diagnoses and the diagnostic tests that were most useful in narrowing the differential. Discuss one evidence-based intervention from the treatment plan and explain its mechanism of action and patient education considerations. Support your response with at least two peer-reviewed sources. Reply to at least two colleagues by offering a substantive critique of their diagnostic reasoning or by suggesting an additional differential diagnosis they may have overlooked.
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NRNP 6550 · Week 3 · Walden University
Exercise-Induced Laryngeal Obstruction in an Adolescent Athlete
A provisional diagnosis, a five-condition differential, and a systems-based treatment plan for a 15-year-old basketball player who cannot catch his breath at full speed.
Introduction
The NRNP 6550 brief identifies a 15-year-old male athlete with exertional dyspnea, yet it stops short of supplying the completed iHuman history, examination, or test results. This analysis therefore treats exercise-induced laryngeal obstruction (EILO) as a provisional diagnosis and works from the illustrative symptoms named in the brief, not from unreported encounter findings. Those assumptions must give way to the actual iHuman data before submission. Timing and objective testing matter because exercise-induced bronchoconstriction (EIB), asthma, and laryngeal obstruction feel similar to the patient while demanding different care (Vollsæter et al., 2022).
Primary Diagnosis: Exercise-Induced Laryngeal Obstruction
EILO is transient narrowing of the larynx during intense exercise. Inspiratory noise and throat tightness that peak at maximal effort and resolve quickly with rest support the diagnosis, whereas expiratory wheeze or symptoms that peak after exercise point toward EIB (Clemm et al., 2022). In an international registry of 1,007 referrals, 586 patients had EILO, diagnosis followed symptom onset by roughly two years, and one fifth discontinued asthma medication that had never helped (Walsted et al., 2021). These referral figures do not establish population prevalence, though they show how easily clinicians mislabel EILO as asthma.
Continuous laryngoscopy during exercise (CLE) remains the diagnostic standard because it visualizes the larynx at peak symptoms. The finding must be read alongside the reported history, since laryngeal narrowing also occurs in healthy athletes who describe no breathing complaints (Carlsen et al., 2024).
Focused Assessment and Diagnostics
The history should establish when symptoms begin, whether inspiration or expiration feels harder, how long recovery takes, and whether cough, wheeze, chest pain, palpitations, or syncope appear. Asthma, allergy, recent infection, family history of sudden cardiac death, vaping, and smoke exposure all belong in the record. Examination covers vital signs, oxygen saturation, work of breathing, bilateral breath sounds, heart rhythm, pulses, and signs of distress.
- Spirometry before and after bronchodilator, with an exercise or eucapnic voluntary hyperpnea challenge when EIB is suspected.
- CLE for suspected EILO, since direct visualization identifies the level of obstruction.
- Chest radiography for acute pleuritic pain or asymmetric breath sounds, and a 12-lead electrocardiogram when cardiac red flags appear.
Self-reported dyspnea alone confirms neither EIB nor EILO, so symptom reproduction paired with objective findings should drive the diagnosis (Ersson et al., 2020).
Differential Diagnosis
Five conditions deserve consideration. EIB and asthma carry the strongest prior probability, pneumothorax and glottic-level obstruction require targeted exclusion, and a cardiac cause is unlikely while carrying the greatest risk.
| Condition | Supports | Argues against | Next test |
|---|---|---|---|
| Exercise-induced bronchoconstriction | Exertional dyspnea is the cardinal symptom, and prevalence reaches 23.1% in adolescent athletes (Ersson et al., 2020). | No wheeze or cough; no relief from a prior bronchodilator; symptoms peak during effort rather than after it. | Exercise or eucapnic voluntary hyperpnea challenge, FEV1 fall of 10% or more (Hostrup et al., 2024). |
| Primary spontaneous pneumothorax | Young males carry 73% of inpatient admissions, and the incidence peaks between 15 and 34 years (Hallifax et al., 2018). | Relief within minutes of stopping, recurrent weekly pattern, no pleuritic pain at rest. | Chest radiography. |
| Paradoxical vocal fold motion | Inspiratory noise and throat tightness fit a functional laryngeal mechanism (Clemm et al., 2022). | Glottic closure accounted for 18% of confirmed registry cases against 60% supraglottic (Walsted et al., 2021). | CLE to define the level of collapse. |
| Asthma | Exertional dyspnea is a cardinal symptom, and the two conditions frequently coexist (Vollsæter et al., 2022). | No nocturnal cough, atopic history, or bronchodilator response; breath sounds clear at rest. | Spirometry with reversibility, fractional exhaled nitric oxide. |
| Structural cardiac disease | Symptoms arise at peak exertion in an athlete population with a small but real risk (Dores et al., 2024). | No syncope, palpitations, chest pain, or family history of sudden cardiac death. | Resting electrocardiogram; echocardiography only if abnormal. |
Exercise-Induced Bronchoconstriction
EIB is a leading alternative, affecting an estimated 23.1% of adolescent athletes in one sports-school cohort (Ersson et al., 2020). Symptoms usually peak after exercise begins and may persist after activity. A fall in forced expiratory volume in one second of at least 10% after a standardized challenge supports EIB (Hostrup et al., 2024). The inspiratory timing and rapid recovery described in the case make EIB less likely, not impossible.
Asthma
Asthma may cause exertional cough, wheeze, and chest tightness, and it can coexist with EILO (Vollsæter et al., 2022). Absent nocturnal symptoms, atopy, reversible airflow obstruction, and bronchodilator benefit would weaken the diagnosis. Spirometry and, when indicated, fractional exhaled nitric oxide help assess asthma, and inhalers should not be escalated on symptoms alone.
Primary Spontaneous Pneumothorax
A spontaneous pneumothorax can cause abrupt dyspnea in a young male, particularly with sudden pleuritic pain, asymmetric breath sounds, or persistent symptoms at rest; inpatient admissions for the condition rose from 9.1 to 14.1 per 100,000 population in England between 1968 and 2016, and males account for 73% of them (Hallifax et al., 2018). Recurrent episodes limited to intense exertion with quick recovery argue against it. Chest radiography is appropriate whenever the history or examination raises concern.
Paradoxical Vocal Fold Motion
Paradoxical vocal fold motion is glottic-level EILO, caused by inappropriate vocal fold closure during inspiration (Clemm et al., 2022). CLE distinguishes glottic closure from supraglottic collapse and guides therapy. The inspiratory symptom pattern supports this possibility, although direct visualization is needed to identify the level of obstruction.
Structural Cardiac Disease
Hypertrophic cardiomyopathy, anomalous coronary anatomy, or myocarditis can present with exertional dyspnea. Syncope, palpitations, exertional chest pain, abnormal pulses, or a family history of sudden death would raise concern. A resting electrocardiogram is appropriate when those features appear, and screening guidance supports its use in athletes who report warning symptoms (Dores et al., 2024). Abnormal findings warrant urgent cardiology evaluation and restriction from sport until assessment is complete.
Systems-Based Treatment Plan
Care is organized by body system so that each problem carries its own pending diagnostics, pharmacological decisions, and education. Systems without an established problem still receive targeted screening when the history supports it.
Pulmonary Primary problem
- Problem
- Suspected EILO, with EIB and asthma still under evaluation.
- Pending diagnostics
- CLE, spirometry before and after bronchodilator, exercise or eucapnic voluntary hyperpnea challenge, fractional exhaled nitric oxide, and chest radiography when indicated.
- Pharmacological interventions
- No drug reverses laryngeal closure itself (Clemm et al., 2022). If testing confirms EIB, albuterol HFA 90 mcg per actuation, two inhalations 15 minutes before exercise as needed; frequent use or poor response calls for reassessment rather than escalation. Montelukast 10 mg by mouth nightly is reserved for persistent EIB, with counseling on neuropsychiatric warning signs (Hostrup et al., 2024).
- Supportive care and education
- Refer for speech-language pathology laryngeal-control and breathing therapy, typically three to four sessions. A prospective cohort of 59 teenagers reported greater activity participation, lower inhaler use, and fewer breathing problems at six months, although quality-of-life scores did not improve (Fujiki et al., 2023). Teach a gradual warm-up, symptom-control breathing, and a stepwise return to sport.
Cardiovascular
- Problem
- No structural disease established.
- Pending diagnostics
- Electrocardiogram if red flags appear; echocardiography or cardiology referral follows abnormal findings only (Dores et al., 2024).
- Pharmacological interventions
- None indicated.
- Supportive care and education
- Advise the athlete and caregiver to seek urgent evaluation for exertional syncope, sustained palpitations, or chest pain that persists at rest. Discourage energy drinks and stimulants before practice.
Neurological and Psychosocial
- Problem
- Anxiety or activity avoidance secondary to unexplained breathlessness, still to be screened.
- Pending diagnostics
- GAD-7 with a brief sleep and mood review.
- Pharmacological interventions
- Behavioral therapy first. Fluoxetine 10 to 20 mg by mouth daily only for a confirmed anxiety disorder, with monitoring for activation in an adolescent.
- Supportive care and education
- Adolescents describe fear of symptoms returning, missed seasons, and embarrassment in front of teammates, and delayed diagnosis deepens that burden (Fujiki et al., 2024). Explain that symptoms are real and treatable, then refer when screening shows persistent impairment.
Gastrointestinal, Genitourinary, Hematologic, and Endocrine
- Problem
- None established in the supplied case.
- Pending diagnostics
- Complete blood count, ferritin, and thyroid-stimulating hormone only when fatigue, pallor, or exercise intolerance supports them.
- Pharmacological interventions
- Omeprazole 20 mg by mouth daily for eight weeks if laryngopharyngeal reflux is confirmed, paired with meal timing changes. Iron at 65 mg of elemental iron daily only when ferritin falls below 30 ng/mL with documented deficiency.
- Supportive care and education
- Discuss hydration before practice, meal timing around training, and urine color as a simple readiness marker.
Infectious Disease and Integumentary
- Problem
- No infectious or dermatologic source of dyspnea.
- Pending diagnostics
- None routine; review immunization status and atopic skin findings.
- Pharmacological interventions
- Antibiotics have no role.
- Supportive care and education
- Confirm annual influenza vaccination and current immunizations. Ask about vaping, cannabis, and secondhand smoke, since these exposures keep the larynx and lower airway irritated alongside the primary diagnosis (Vollsæter et al., 2022).
Red flags requiring emergency escalation. Exertional syncope, sustained palpitations, chest pain at rest, sudden unilateral pleuritic pain, hemoptysis, or breathlessness that does not resolve with rest. Any of these overrides the working diagnosis and triggers immediate evaluation.
Conclusion
The strongest plan names EILO as provisional, confirms it with CLE, and tests for coexisting EIB or asthma before committing to long-term respiratory medication. Speech-language therapy, focused education, and a safe return to activity address the likely cause, while red-flag precautions protect against the less likely emergencies. Follow-up in two to four weeks allows the team to review testing, track symptoms, and confirm participation in sport.
References
- Carlsen, P. H., Muralitharan, P., Fenne, H., Hammer, I. J., Engan, M., Vollsæter, M., Bovim, L. P., Røksund, O. D., Halvorsen, T., & Clemm, H. H. (2024). Laryngeal response to high-intensity exercise in healthy athletes. BMJ Open Sport & Exercise Medicine, 10(2), Article e001850. https://doi.org/10.1136/bmjsem-2023-001850
- Clemm, H. H., Olin, J. T., McIntosh, C., Schwellnus, M., Sewry, N., Hull, J. H., & Halvorsen, T. (2022). Exercise-induced laryngeal obstruction (EILO) in athletes: A narrative review by a subgroup of the IOC Consensus on “acute respiratory illness in the athlete.” British Journal of Sports Medicine, 56(11), 622–629. https://doi.org/10.1136/bjsports-2021-104704
- Dores, H., Dinis, P., Viegas, J. M., & Freitas, A. (2024). Preparticipation cardiovascular screening of athletes: Current controversies and challenges for the future. Diagnostics, 14(21), Article 2445. https://doi.org/10.3390/diagnostics14212445
- Ersson, K., Mallmin, E., Malinovschi, A., Norlander, K., Johansson, H., & Nordang, L. (2020). Prevalence of exercise-induced bronchoconstriction and laryngeal obstruction in adolescent athletes. Pediatric Pulmonology, 55(12), 3509–3516. https://doi.org/10.1002/ppul.25104
- Fujiki, R. B., Johnson, R., Fujiki, A. E., & Thibeault, S. L. (2024). Effects of exercise-induced laryngeal obstruction in adolescents: A qualitative study. American Journal of Speech-Language Pathology, 33(4), 1911–1929. https://doi.org/10.1044/2024_AJSLP-23-00296
- Fujiki, R. B., Olson-Greb, B., Braden, M., & Thibeault, S. L. (2023). Therapy outcomes for teenage athletes with exercise-induced laryngeal obstruction. American Journal of Speech-Language Pathology, 32(4), 1517–1531. https://doi.org/10.1044/2023_AJSLP-22-00359
- Hallifax, R. J., Goldacre, R., Landray, M. J., Rahman, N. M., & Goldacre, M. J. (2018). Trends in the incidence and recurrence of inpatient-treated spontaneous pneumothorax, 1968–2016. JAMA, 320(14), 1471–1480. https://doi.org/10.1001/jama.2018.14299
- Hostrup, M., Hansen, E. S. H., Rasmussen, S. M., Jessen, S., & Backer, V. (2024). Asthma and exercise-induced bronchoconstriction in athletes: Diagnosis, treatment, and anti-doping challenges. Scandinavian Journal of Medicine & Science in Sports, 34(1), Article e14358. https://doi.org/10.1111/sms.14358
- Vollsæter, M., Stensrud, T., Maat, R., Halvorsen, T., Røksund, O. D., Sandnes, A., & Clemm, H. (2022). Exercise related respiratory problems in the young: Is it exercise-induced bronchoconstriction or laryngeal obstruction? Frontiers in Pediatrics, 9, Article 800073. https://doi.org/10.3389/fped.2021.800073
- Walsted, E. S., Famokunwa, B., Andersen, L., Rubak, S. L., Buchvald, F., Pedersen, L., Dodd, J., Backer, V., Nielsen, K. G., Getzin, A., & Hull, J. H. (2021). Characteristics and impact of exercise-induced laryngeal obstruction: An international perspective. ERJ Open Research, 7(2), Article 00195-2021. https://doi.org/10.1183/23120541.00195-2021
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