NursingCase studyHeart failure

B.C. dyspnea and fatigue case study guide: full chart

A full chart case — CC through labs — asking for differentials ruled out on the data, primary and secondary diagnoses confirmed on the data, and an evidence-based treatment plan with education, referrals, and follow-up.

Aug 12, 2026

Editorial process

Last reviewed · August 12, 2026

Written by

Aaron Bishop

MA, Education

assignment interpretation and research-methods coaching across disciplines

Reviewed by

Dr. Nathan Cole

PhD, Rhetoric & Composition

Argumentation and thesis development

On this page

Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

What is the chart's data cluster actually saying?

The assignment's grading logic is written into its own instructions: every differential you discard and every diagnosis you keep must be pinned to named subjective or objective data from the chart. That makes the chart the whole exam, and this one is generous with signal. B.C. reports orthopnea on two to three pillows, ankle swelling, an eight-pound month, dyspnea worsening over weeks, and drug-store blood pressures of 158/102; the exam adds 168/100 with a BMI of 34, rales at the bases, a systolic ejection murmur, bilateral pitting edema, and an urgent-care chest film showing cardiomegaly with clear lungs. Read as a cluster, that is a heart-failure picture sitting on top of long-untreated hypertension — and the risk inventory the social history supplies, from the half-pack-a-day habit and weekend drinking to the high-salt takeout diet and five-plus years without a provider, is there to become your secondary-diagnosis and education material rather than color.

The assessment portion wants the reasoning shown in both directions. Differentials that deserve the courtesy of explicit rule-outs include the viral illness urgent care already offered — the week of persistence and the cardiac findings argue against it — plus pulmonary causes the smoking history invites, anemia and thyroid disease for the fatigue, and the normal CBC and CMP doing quiet work in several of those arguments. The primary diagnosis then gets confirmed the same way, symptom by finding, and the secondaries — the hypertension itself, obesity, tobacco use disorder — each get their own data line. Note what the mild liver-enzyme elevation and the systolic murmur contribute to the picture: neither finding decides anything on its own, but both belong, acknowledged and weighed, in a write-up that claims to have used the whole chart honestly.

The treatment plan is graded on sourcing as much as selection: medications for each diagnosis are to come from evidence-based guidelines, with the guideline named on the reference page, and the non-pharmacologic side — sodium restriction, smoking cessation, alcohol reduction, activity guidance — is required with the same citation discipline. The instructions also ask you to justify any additional testing, and this case fairly begs for an echocardiogram to characterize the failure and a lipid panel and A1c for the metabolic picture; each order needs its one-line why. Close with the referral logic the asterisked note describes — if this belongs with cardiology, write the plan the specialist would run rather than deferring it — and a concrete follow-up interval. A cleaning note: this record circulated with a student's completed write-up ahead of the chart; the brief above is the case and assignment only.

Likely learning objectives

Inferred from the brief — check these against your own rubric.

01
Read the chart as a cluster — orthopnea, edema, weight gain, rales, cardiomegaly, sustained hypertension — rather than as isolated findings.
02
Rule differentials out with named data, including the viral-illness label urgent care already applied.
03
Confirm primary and secondary diagnoses with per-diagnosis data lines, using the normal CBC/CMP where it argues.
04
Build a guideline-cited plan: medications per diagnosis, non-pharmacologic therapy, and education matched to the social history.
05
Justify additional testing and the cardiology referral, and set a concrete follow-up interval.

Assignment instructionsQuoted verbatim

Read the full question

Review every instruction before using the planning guidance that follows.

CC: “I have been feeling tired and have had some shortness of breath over the 2-3 weeks.” HPI: B.C, a 49-year-old AA male, presents to the office with complaints of feeling tired and having some shortness of breath over the Assignment Case Study of a Patient with Dyspnea and Fatigue past 2-3 weeks, worsening over the past few days. He reports that he has been around other family members who have been sick and feels that his symptoms may be related to that. He was seen at urgent care one week ago and was diagnosed with a viral illness. He was not pleased with that visit and he felt that he should have been evaluated more than he was. He checked his blood pressure on several days at the local drug store and reports that his blood pressure was 158/102 and 156/98. He reports that fatigue may be due to not sleeping well at night due to SOB when lying down. He also reports recent weight gain which has caused a decrease in his ability to work “as usual.” He denies dizziness, chest pain, syncope but reports dry cough. He has not had a physical examination or been seen by a medical provider in greater than 5 year. Past Medical History: negative Medications: No current prescribed medications or use of OTC medications. NKDA Past surgical history: Left inguinal hernia repair Social History: Divorced. Sexually active with one partner; does not wear condom. Employed as an Electrical engineer. He denies regular exercise. He eats at diet high in carbohydrates, fats, cholesterol and salt. He “eats out” for most of his meals. Smokes ½ PPD for past 20 years. Denies recreational drugs. Drinks 6-pack of beer and 4 shots on the weekends to help him relax. Family History: Mother – HTN, DM and breast cancer. Father – HTN, MI at age 62 and CAD; Sister – Hyperlipidemia; Brother – HTN; Brother – no medical problems. ROS: Constitutional: reports 8 lb. weight gain in 1 month; denies fever/chills HEENT: denies any change in vision, nasal drainage, nasal congestion, sore throat, sinus pain/congestion or ear symptoms Pulmonary: denies sputum production or hematemesis Cardiovascular: denies palpitations; reports swelling in ankles and having to sleep on 2-3 pillows at night Gastrointestinal: reports decrease in appetite; denies nausea, vomiting, constipation and diarrhea Genitourinary: denies frequency, urgency, hesitancy or penile discharge Neurological: denies tremors, numbness, weakness, tingling or loss of sensation Endocrine: denies night sweats, increased thirst, increased hunger Physical examination: VS: 98.7-102-20 and 168/100. Pain 0 out of 10. Height: 5’9” and weight: 230 BMI:34 O2 saturation = 95% General: well-developed, well-nourished AA male in NAD but mildly anxious HEENT: face symmetrical; PERRLA EOMI, sclera anicteric; TMs pearly gray with appropriate light reflex; nares patent and without nasal drainage; pharynx non-erythematous, tonsils 1+, non-erythematous and without exudate, fair dentition; no sinus tenderness Neck: supple; no lymphadenopathy or thyroid enlargement Pulmonary / Lungs – CTA in right upper lobe, right middle lobe and left upper lobe and rales auscultated in the bases, respiration even and unlabored Cardiovascular – RRR without gallops or rubs, II/VI systolic ejection murmur is auscultated at the left sternal border to the apex of the heart; no jugular venous distention. Abdomen – soft, protuberant, nontender, nondistended with active BS X4 quadrants; no hepatosplenomegaly, no masses Extremities: skin is W/D/I; no cyanosis or clubbing in the upper or lower extremities. Pulses 3+ in all extremities. 1+ pitting edema noted around the ankles bilaterally Neurological: A&OX3, cranial nerves II – XII intact, follows commands EKG in office– NSR Chest X-ray from urgent care – lungs clear and cardiomegaly Labs from urgent care – CBC normal, CMP – normal except mild elevation of liver enzymes Assignment: For the assessment portion of the assignment: 1. identify potential differentials and specify the subjective and/or objective data that rules the differential out as the primary diagnosis 2. identify primary diagnoses and specify the subjective and/or objective data that confirms the diagnoses 3. identify secondary diagnoses and specify the subjective and/or objective data that confirms the diagnoses. For the treatment plan portion of the assignment: 1. identify appropriate medications based on evidence-based guidelines for each diagnosis (primary and secondary) and list the medication as if you were writing a prescription or escribing (medication name, dose, how to take, number to dispense and if refills will be provided) 2. identify appropriate non-pharmacological therapies and patient education based on evidence-based guidelines 3. identify if additional diagnostic testing or referrals are warranted and justify why the labs and or is warranted 4. identify when the patient is to return for follow-up *If you feel that the patient needs to be referred for the diagnosis, develop the treatment plan based on evidence-based pharmacological and non-pharmacological therapies that would be utilized by the specialist. *Remember to list the evidence-based guidelines that you utilized to develop the treatment plan on a reference page.

Turn the brief into deliverables

01
An assessment: differentials with rule-out data, primary and secondary diagnoses with confirming data.
02
A treatment plan: guideline-based medications per diagnosis, non-pharmacological therapies, and patient education.
03
Justified additional testing and referrals, a follow-up interval, and the guidelines listed on a reference page.

How should assessment and plan be structured?

The chart, read as a cluster

Assemble the presentation: weeks of dyspnea and fatigue, orthopnea, edema, weight gain, rales, murmur, cardiomegaly, and blood pressures persistently in the 150s-160s over 100.

Differentials, ruled out on data

Work through the viral label, pulmonary causes from the smoking history, anemia, and thyroid disease, discharging each with the chart lines — including the normal labs — that argue against it.

Diagnoses, confirmed on data

Confirm the heart-failure-on-hypertension primary and the secondaries — hypertension, obesity, tobacco use — each with its own confirming findings.

The guideline-cited plan

Medications per diagnosis from named guidelines, lifestyle therapy and education matched to his documented habits, justified echo and metabolic testing, the cardiology referral, and follow-up.

Where are the guideline sources for the plan?

Recommended databases

NHLBI
MedlinePlus

Search sequence

1.
Read the heart-failure overview for the symptom cluster and evaluation pathway the chart maps onto.
2.
Review the hypertension material for the staging and treatment thresholds his pressures cross.
3.
Pull the current guideline documents for each diagnosis for the reference page.
4.
Draft assessment then plan, pinning every claim to its chart line.

Reference shortlist

These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.

Nothing here is cleared for citation until you have read it.

01
What Is Heart Failure?
National Heart, Lung, and Blood Institute · 2024
The authoritative frame for the presentation cluster — orthopnea, edema, fatigue — and the evaluation and management pathway the plan should mirror.
02
Heart Failure
MedlinePlus, U.S. National Library of Medicine · 2024
The plain-language diagnosis and treatment overview behind the education element of the plan.
03
High Blood Pressure
MedlinePlus, U.S. National Library of Medicine · 2024
The hypertension context for the secondary diagnosis: what sustained readings above 150/100 mean and the lifestyle therapy the education section draws on.

Review before submission

Common mistakes

Asserting diagnoses without the named subjective/objective data the instructions demand for every single one.
Dismissing the urgent-care viral diagnosis without argument when it is the differential the case plants first.
Treating the social history as color instead of as the secondary-diagnosis and education material it is.
Prescribing without naming the guideline — the reference page is a graded requirement, not a formality.
Ordering an echo and labs without the one-line justification each order needs.
Deferring the plan to a future specialist when the note says to write the plan the specialist would use.

Submission checklist

Differentials each ruled out on named chart data.
Primary and secondary diagnoses each confirmed on named chart data.
Medications guideline-based per diagnosis; guidelines on the reference page.
Non-pharmacologic therapies and education tied to the documented risk factors.
Additional testing and referrals justified; follow-up interval stated.

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