NRNP 6531 Week 3 Chronic Cough Differential Example

Course	NRNP 6531 Primary Care of Adults Across the Lifespan
Week	Week 3
Paper type	Differential diagnosis write-up
Length	About 860 words, 6 pages
Format	APA 7 student paper
School	Walden University
Program	MSN Family Nurse Practitioner (FNP)
Updated	October 2026

Free sample paper for NRNP 6531 Week 3

Chronic Cough in a 49-Year-Old Woman on an ACE Inhibitor: A Differential Diagnosis Write-Up

Student Name

College of Nursing, Walden University

NRNP 6531: Primary Care of Adults Across the Lifespan

Instructor Name

Month Day, Year

What this page is doingThe title names the symptom, its chronicity, and the one medication that shapes the differential. A cough write-up is graded on whether each cause is argued and tested, and naming the ACE inhibitor in the title shows the author noticed the most correctable cause before starting.

Chronic Cough in a 49-Year-Old Woman on an ACE Inhibitor: A Differential Diagnosis Write-Up

Case Summary

The patient in this write-up is invented. M.K. is a 49-year-old high school librarian with a dry cough for ten weeks. It began after a cold in late winter and never resolved. She coughs most when lying down at night and on first waking, clears her throat constantly during the day, and has noticed a tickle at the back of her throat. She has heartburn two or three nights a week, especially after late dinners. Cold air on her walk to work sets off coughing fits. She has hypertension treated with lisinopril 20 mg daily, started 14 months ago. She has never smoked, has no known asthma, and has no pets. She denies fever, weight loss, night sweats, hemoptysis, and shortness of breath at rest. Her chest radiograph from a recent urgent care visit was read as normal. Examination today shows cobblestoning of the posterior pharyngeal wall and clear lungs without wheeze; vital signs are normal. A cough lasting longer than eight weeks in an adult is classified as chronic, which directs the evaluation toward the common persistent causes rather than acute infection (Dains et al., 2020).

Differential Table

Upper airway cough syndrome: supported by postinfectious onset, throat clearing, a tickle, and pharyngeal cobblestoning; test or trial is a first-generation antihistamine and decongestant trial.

Cough-variant asthma: supported by cough triggered by cold air and worse at night; tested by spirometry with bronchodilator response or, if normal, bronchoprovocation, and a trial of inhaled corticosteroid.

Gastroesophageal reflux: supported by nighttime heartburn and cough when lying down; trial of lifestyle measures and a proton pump inhibitor.

ACE inhibitor cough: supported by lisinopril use and a dry, tickling cough; tested by stopping the drug.

Pertussis (dangerous but unlikely): a postinfectious cough of this duration keeps it on the list; red flags absent.

Malignancy (dangerous but unlikely): red flags absent; normal radiograph.

The Four Leading Causes

ACE inhibitor cough. Supporting: she takes lisinopril, and ACE inhibitors cause a dry cough in a meaningful minority of patients through accumulation of bradykinin and substance P in the airway (Rosenthal & Burchum, 2021). Opposing: the cough began 14 months after starting the drug, and it began with a cold. Onset can occur weeks to months after starting, however, and the CHEST guideline advises stopping an ACE inhibitor in any patient with chronic cough, regardless of timing, because the cause is so easily tested (Irwin et al., 2018). Settling the question: stop lisinopril and substitute an angiotensin receptor blocker; the cough typically resolves within one to four weeks, occasionally longer.

Upper airway cough syndrome. Supporting: postinfectious onset, constant throat clearing, and cobblestoning. Opposing: no nasal congestion or visible postnasal drainage. Settling: a two- to three-week trial of a first-generation antihistamine with a decongestant; improvement supports the diagnosis.

Cough-variant asthma. Supporting: nighttime cough and cold-air triggers. Opposing: no wheeze or dyspnea, and no atopic history. Settling: spirometry with bronchodilator testing; if normal, bronchoprovocation testing or a trial of inhaled corticosteroid.

Gastroesophageal reflux. Supporting: nighttime heartburn and cough when lying down. Opposing: reflux cough can occur without heartburn, so its presence is supportive but not specific. Settling: an eight-week trial of dietary measures, head-of-bed elevation, and a proton pump inhibitor, since reflux-related cough responds slowly.

What this page is doingEach cause gets supporting findings, opposing findings, and the test or trial that would settle it, which is the reasoning this write-up is scored on. The ACE inhibitor paragraph addresses the obvious objection, late onset, and answers it with guidance rather than ignoring it.

Dangerous but Unlikely

Pertussis. A cough persisting weeks after a respiratory infection keeps pertussis on the list in adults, whose immunity from childhood vaccination wanes. Absent here: paroxysms with an inspiratory whoop, post-tussive vomiting, and known exposure. If paroxysms develop, testing would be considered, although polymerase chain reaction testing is most useful in the first weeks of illness.

Malignancy. Absent: smoking history, weight loss, hemoptysis, night sweats, and a change in a longstanding cough; her chest radiograph is normal. Placing both in a separate tier keeps them visible without letting them drive the workup, and the plan names what would bring either back to the top.

Sequenced Plan

Step 1, today: stop lisinopril and start losartan 50 mg daily, with a basic metabolic panel in two weeks. Because the other causes can coexist, and chronic cough often has more than one contributor, begin the antihistamine and decongestant trial at the same time only if the cough is disrupting sleep; otherwise wait so that the ACE inhibitor effect can be judged alone. She chose to wait. She is also asked to keep a simple cough diary, rating nighttime and daytime cough each day, so that improvement is judged against a record rather than memory.

Step 2, four weeks: if the cough has resolved, the cause is established and no further testing is needed. If it has improved but persists, start the upper airway trial. If unchanged, order spirometry with bronchodilator testing.

Step 3, eight weeks: if spirometry is normal and the upper airway trial has not helped, begin a reflux trial with a proton pump inhibitor and lifestyle measures, recognizing that response may take eight weeks.

Return sooner for hemoptysis, weight loss, fever, whooping or vomiting after coughing, or shortness of breath; any of these would move a dangerous cause to the top of the list and prompt chest imaging or referral.

References

Dains, J. E., Baumann, L. C., & Scheibel, P. (2020). Advanced health assessment and clinical diagnosis in primary care (6th ed.). Elsevier.

Irwin, R. S., French, C. L., Chang, A. B., Altman, K. W., & CHEST Expert Cough Panel. (2018). Classification of cough as a symptom in adults and management algorithms: CHEST guideline and expert panel report. Chest, 153(1), 196-209. https://doi.org/10.1016/j.chest.2017.10.016

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.

NRNP 6531 Week 3 instructions, in plain terms

The third week of NRNP 6531 often asks for a differential diagnosis write-up for a common primary care complaint. You summarize the case, list and rank possible diagnoses with supporting and opposing findings, address serious conditions that must be excluded, and propose a plan to narrow the differential. A table is commonly used. NRNP 6531 write-ups of this kind run three to five pages, with guidelines and the Dains text cited in APA 7. The case can be composite. Faculty look for justification of the ranking and a logical sequence of testing. Pertinent negatives deserve as much attention as positives. NRNP 6531 instructors usually want each diagnosis supported by at least one finding from the case and opposed by another. Name the guideline that sets the time frame for chronic cough in adults. The plan should say what you will do first, what you will do if that fails, and when the patient returns.

How the NRNP 6531 Week 3 example is put together

A brief case summary gives the facts once: the cough began after a cold in late winter, is worse lying down, comes with throat clearing and nighttime heartburn, and tightens in cold air. A medication list shows an ACE inhibitor started the previous year. Then the write-up turns into a table and six short arguments. Upper airway cough, cough-variant asthma, reflux, and the ACE inhibitor each get a paragraph with supporting findings, opposing findings, and the test or trial that would settle the question. Two further entries, pertussis and malignancy, sit in a separate tier labeled dangerous but unlikely, each with the red flags that are absent. The closing section sequences the plan so the first result changes what is done second. Nobody real stands behind the case.

Reading the NRNP 6531 Week 3 rubric

The heaviest credit in a differential write-up goes to justification, and a list of plausible causes with a sentence each has named possibilities without weighing them. Here every entry is scored against the same recorded facts. The medication review draws its own attention, because an ACE inhibitor cough overlooked in a patient taking one is precisely the error a case like this is usually built to expose. Separating common from dangerous causes earns credit for safety reasoning, and leaving malignancy off entirely in a long-standing adult cough loses it even when the likelihood is low. Deductions also follow when the plan orders everything at once with no rationale, and when sources are generic textbook pages instead of current practice guidance on cough.

Common NRNP 6531 Week 3 mistakes, and how to avoid them

Differential write-ups lose the most credit when they list plausible causes with a sentence each and never weigh them. Say why one sits above another. Another common gap is leaving out dangerous causes such as malignancy or tuberculosis because they seem unlikely. Address them briefly and explain what lowers the risk. Writers also order every test at once instead of sequencing them. Test the simplest explanation first, as the example does with the ACE inhibitor. Keep the table and text consistent. Avoid diagnosing before the plan has run. Cite the cough guideline for timing, such as how long after stopping the drug the cough should settle. Another frequent gap is ignoring the timing of the cough, worse lying down and on waking, which points toward reflux or upper airway cough syndrome.

Get a NRNP 6531 Week 3 example written to your instructions

Send the case your Week 3 prompt supplies with the rubric, and the desk argues a differential write-up on that complaint rather than on cough, its tiers and sequence intact. Free for a first custom sample, and delivered inside 24-48 hours with sources matched to the diagnoses on your list.

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NRNP 6531 Week 3 questions, answered

How is a differential write-up different from the assessment in a SOAP note?

Length and depth. A note's assessment gives a ranked list with brief support; this document argues each candidate in full, compares them, and connects the order of the list to the order of the workup. Prompts that ask for a differential write-up usually expect that fuller argument, and a note-length assessment submitted in its place tends to score low on analysis.

Why keep malignancy on the list if it is unlikely?

Because the rubric is assessing safety reasoning as well as probability. A persistent cough in an adult calls for an explicit statement about serious causes, and the example records which red flags are absent rather than silently leaving the diagnosis out. Graders read a missing dangerous cause as a gap in thinking, not as a sign of confidence, and mark it that way.

Can the example be adapted to a different complaint?

The two-tier structure transfers to most persistent symptoms, including fatigue, abdominal pain, and dizziness. The facts and the diagnoses change entirely. If your section assigned another presentation, send the case as written and the finished sample takes it as its subject, keeping the tiered argument and the sequenced plan that this example uses to connect reasoning with workup.

Where can I find a free NRNP 6531 Week 3 sample paper?

M.K.'s chronic cough write-up is printed here with the differential table, the four leading causes, the dangerous but unlikely section and the sequenced plan.

Why stop the ACE inhibitor first in NRNP 6531 Week 3?

It is a common, easily tested cause of dry cough. The example stops it and waits several weeks before moving to the next explanation in sequence.