Cough in a composite former smoker, carried through a full MN566 Unit 10 write-up: complete history, focused exam, ranked differential, plan with health maintenance, and a dated follow-up. Searches like "mn 566 unit 10 assignment example", "mn566 unit 10 sample" and "mn566 unit 10 example" land here.
Comprehensive Case Write-Up: Twenty-Five Days of Dry Cough in a 57-Year-Old Woman Started on Lisinopril
[Student Name]
Purdue University Global
MN566: NP I - Introduction to Primary Care for the Nurse Practitioner
Unit 10 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Orders are bracketed composites; nothing here is a prescribing instruction.
Identifying Data and Chief Complaint
A school bus driver, 57, female, composite, seen at her primary care clinic. Chief complaint: "This dry cough won't quit, and it's keeping me up at night."
History of Present Illness
She has had a dry, tickling cough for 25 days. It began gradually, without a cold or fever beforehand. It is worst at night and when she lies down, and sometimes in bursts that leave her hoarse. She brings up no sputum. She has no fever, chills, night sweats, coughing of blood, weight loss, wheeze or shortness of breath. She has no heartburn, sour taste or postnasal drip that she notices. Cough drops help briefly. She started lisinopril for blood pressure about 65 days ago, so the cough began roughly 40 days after the first dose. No one in her household is coughing.
Past Medical History, Medications and Allergies
Hypertension, diagnosed three months ago. Hyperlipidemia. No asthma, COPD or heart failure. Medications, with start dates: lisinopril [a composite dose], started about 65 days ago; atorvastatin, started two years ago. No allergies. Immunizations: influenza vaccine last fall; pneumococcal vaccine not recorded.
Family and Social History
Mother had breast cancer at 70; father died of a heart attack at 66. Former smoker: one pack daily from age 17 to 47, stopping a decade ago, for 30 pack-years. No vaping. Drinks rarely. Drives a school bus, with no known exposure to dust or fumes at work. Lives with her husband; no pets.
Review of Systems
Respiratory: dry cough as above; no hemoptysis, wheeze or dyspnea. Cardiac: no chest pain, orthopnea, leg swelling or palpitations. Ear, nose and throat: no nasal congestion, postnasal drip or sinus pain. Gastrointestinal: no heartburn, regurgitation or dysphagia. Constitutional: no fever, night sweats or weight loss.
Physical Examination
Vital signs: BP 128/78; pulse 76; breathing 14 a minute; afebrile at 36.8 °C; SpO2 98 percent breathing room air. Her weight has not changed since the last visit. Ears: normal. Nose: mucosa not swollen, no discharge. Pharynx: no cobblestoning or visible drainage. Neck: no lymph nodes palpable. Lungs: clear to auscultation, no wheeze or crackles, normal forced expiration. Heart: regular rhythm, no murmur, no extra sounds, jugular veins not distended. Extremities: no clubbing or edema.
Assessment
Leading diagnosis: cough caused by the ACE inhibitor. The cough is dry, began weeks after lisinopril was started, and comes without fever, sputum or other symptoms. The ACCP guideline on ACE inhibitor cough describes a dry cough that can begin within hours or up to months after the first dose, usually resolves within one to four weeks of stopping the drug, and sometimes takes up to three months (Dicpinigaitis, 2006). Its timing and character fit that description well enough that stopping the drug is both the treatment and the test.
Alternatives, ranked:
1. Upper airway cough syndrome. Supporting: worse at night and lying down. Against: no postnasal drip, congestion or cobblestoning. Test: an empiric trial of a first-generation antihistamine and decongestant if the cough persists after lisinopril is stopped.
2. Cough from gastroesophageal reflux. Supporting: worse lying down. Against: no heartburn or regurgitation. Test: an acid suppression trial if the cough persists.
3. Cough-variant asthma. Supporting: nocturnal cough. Against: no wheeze, no history of asthma, normal forced expiration. Test: spirometry with bronchodilator response, and a methacholine challenge if spirometry is normal.
Upper airway cough syndrome, asthma and reflux are the most common causes of chronic cough in adults who do not smoke and are not taking an ACE inhibitor (Irwin et al., 2006).
Must-not-miss: lung cancer. She has 30 pack-years of smoking history and quit 10 years ago. She has no hemoptysis, weight loss or clubbing and her lungs are clear, which lowers the probability, but a new cough in a former heavy smoker must not be attributed to a medication without looking at the chest.
Plan
Diagnostics: a chest radiograph now, because of her smoking history.
Therapeutics: stop lisinopril and replace it with [an angiotensin receptor blocker at a composite dose], since angiotensin receptor blockers cause cough far less often (Dicpinigaitis, 2006). Honey or a cough suppressant at night as needed.
Education: the cough may take one to four weeks to go away after stopping lisinopril, and sometimes longer. She should call if she coughs up blood, has a fever, loses weight or becomes short of breath. She should not take lisinopril or other ACE inhibitors again.
Follow-up: a telephone check in two weeks and a visit in four to six weeks. If the cough persists after four weeks off lisinopril, the ranked alternatives are tested in order. Her blood pressure will be checked at the visit to confirm the new agent controls it.
Why the Cough Is Not Simply Attributed to the Drug
It would be easy to stop the lisinopril and say no more. The write-up resists that for two reasons. First, an ACE inhibitor cough is a diagnosis confirmed by what happens after the drug is stopped, not by the history alone, so the plan must say what happens if the cough continues. Second, her smoking history means that a coincidental cause must be looked for before the obvious one is accepted. A chest radiograph costs little and answers the most serious question now, while the drug change answers the most likely one over the following weeks. If both come back reassuring and the cough resolves, the case is closed; if the radiograph shows anything, the cough is investigated on its own terms, whatever happens after the drug is stopped.
The choice of replacement also matters. Her blood pressure is controlled on lisinopril, so the new agent is chosen to keep it controlled while avoiding the cough. An angiotensin receptor blocker acts on the same pathway without the buildup of bradykinin thought to cause the cough, which is why it is the usual substitute.
Health Maintenance
Screening eligibility is drawn from the history already taken. Lung cancer screening: at 57, with 30 pack-years and having quit within 15 years, she meets the USPSTF criteria for annual low-dose CT (US Preventive Services Task Force, 2021), and a shared decision-making discussion and referral are planned at the follow-up visit after the chest radiograph is reviewed. The chest radiograph does not replace low-dose CT screening. Colorectal and breast cancer screening status will be confirmed at the same visit, and her pneumococcal vaccine status will be reviewed.
References
Dicpinigaitis, P. V. (2006). Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest, 129(1 Suppl.), 169S-173S. https://doi.org/10.1378/chest.129.1_suppl.169S
Irwin, R. S., Baumann, M. H., Bolser, D. C., Boulet, L.-P., Braman, S. S., Brightling, C. E., Brown, K. K., Canning, B. J., Chang, A. B., Dicpinigaitis, P. V., Eccles, R., Glomb, W. B., Goldstein, L. B., Graham, L. M., Hargreave, F. E., Kvale, P. A., Lewis, S. Z., McCool, F. D., McCrory, D. C., ... Tarlo, S. M. (2006). Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest, 129(1 Suppl.), 1S-23S. https://doi.org/10.1378/chest.129.1_suppl.1S
US Preventive Services Task Force. (2021). Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(10), 962-970. https://doi.org/10.1001/jama.2021.1117
How this MN566 Unit 10 example is structured
Conventional order is kept because the point is to show every element working together. Its HPI is written as a narrative that already hints at the leading cause through timing. Past history and medications carry dates, since the start date of the antihypertensive is the deciding datum. The review of systems concentrates on respiratory, cardiac and gastrointestinal systems, with pertinent negatives grouped. The exam is focused but complete for those systems. The assessment names the leading diagnosis with a justification paragraph, then ranks the alternatives, pairing each with its supporting finding and the step that would test it. The plan runs diagnostics, therapeutics, education and follow-up in that order, citing the 2006 ACCP guideline on ACE inhibitor cough. Health maintenance closes the document, drawing screening eligibility from data already in the history.
Get an MN566 Unit 10 example written to your instructions
Attach the Unit 10 case materials and whatever write-up template and grading rubric your MN566 instructor posted, noting any page limit. The full write-up arrives within 24-48h, free as a first sample, with every section consistent with the others, a ranked differential that names its must-not-miss, and health maintenance drawn from the case. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN566 Unit 10 questions, answered
How long should the final case write-up be?
Long enough to include every required section and short enough that each one does work. Many sections expect six to ten pages, but your rubric may set a limit. Length usually grows in the wrong places, a sprawling review of systems or a pathophysiology essay, while the assessment and plan stay thin. Put the extra space into reasoning.
Does pathophysiology belong in the final write-up?
A little, where it explains a clinical decision. A sentence on why ACE inhibitors cause cough, for instance, supports the plan to switch agents. A multi-page disease overview does not, unless the rubric asks for it. Graders in this unit reward reasoning about the patient over general knowledge about the condition.
How is this different from the earlier SOAP notes?
Scope and integration. The earlier notes typically documented one problem in focused form; the final write-up carries a complete history, a broader exam, a ranked differential, a full plan and health maintenance in one document. The test is whether every part agrees with every other, so a finding in the history reappears where it matters in the assessment and plan.