| Course | NU743 Clinical Decision-Making and Collaboration |
|---|---|
| Unit | Unit 2 |
| Paper type | Differential workup |
| Length | About 780 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NU743 Unit 2
An Alkaline Phosphatase of 212 and Nothing Else Abnormal: A Differential Workup of an Incidental Finding in a 58-Year-Old Retired School Bus Driver, Eight Candidates and the Finding That Moved Each One
[Student Name]
Purdue University Global
NU743: Clinical Decision-Making and Collaboration
Unit 2 Differential Workup
[Instructor Name]
[Date]
The patient is composite; laboratory values, dates and findings are bracketed.
The Case
Ms. [R.], [58], retired from driving a school bus [two] years ago. At an annual visit, a comprehensive panel showed alkaline phosphatase of [212] U/L, with a reference range of [40 to 120]. Her AST, ALT, bilirubin, albumin, calcium of [9.4] mg/dL and creatinine were normal. She takes only [lisinopril] for hypertension. On questioning, she described an ache in her right hip and upper thigh for about a year, worse at night, which she had put down to years of sitting. She has had no fractures, no weight loss and no change in appetite, and her mammogram and colonoscopy are current. Examination showed mild tenderness over the right iliac crest and no bone deformity.
First Question: Liver or Bone?
An isolated alkaline phosphatase elevation comes most often from the liver or from bone, and the first step is to find the source. A normal gamma-glutamyl transferase makes a liver source unlikely, because GGT rises with cholestatic liver disease but not with bone disease (Kwo et al., 2017). Her GGT was [28] U/L, normal. That single result moved the workup from the liver to the skeleton.
One normal GGT did more to narrow this list than any other test, because it decided which organ the rest of the workup would study.
The Eight Candidates
Cholestatic liver disease, including primary biliary cholangitis and bile duct obstruction. For: none beyond the enzyme itself. Against: normal bilirubin, no itching, no right upper quadrant pain. Deciding result: GGT [28]. Status: abandoned.
Infiltrative liver disease, such as granulomatous disease or metastases to the liver. For: can raise alkaline phosphatase with normal transaminases. Against: no weight loss, no hepatomegaly. Deciding result: the normal GGT, which would usually rise. Status: abandoned.
Paget disease of bone. For: age, a localized bone ache worse at night, iliac tenderness and an isolated rise in alkaline phosphatase. Against: no deformity. Deciding result: a pelvic radiograph showing cortical thickening and coarsened trabeculae in the right hemipelvis. Status: leading.
Vitamin D deficiency with osteomalacia. For: diffuse bone pain can occur, and alkaline phosphatase rises. Against: normal calcium and phosphate. Deciding result: 25-hydroxyvitamin D of [14] ng/mL, which is low and may contribute but does not explain a localized radiographic change. Status: open.
Primary hyperparathyroidism. For: can raise bone turnover. Against: calcium [9.4], normal. Deciding result: parathyroid hormone of [48] pg/mL, within range for her calcium. Status: abandoned.
Bone metastases. For: a new bone ache at [58] must include this possibility. Against: no known primary cancer, screening current, no weight loss, and a radiographic pattern more typical of Paget disease than of metastatic lesions. Deciding result: the radiograph. Status: demoted, pending a bone scan to see whether other sites are involved.
Healing fracture. For: fracture repair raises alkaline phosphatase. Against: no injury or fall. Deciding result: history and the radiograph, which showed no fracture line. Status: abandoned.
Hyperthyroidism, which increases bone turnover. For: can raise alkaline phosphatase. Against: no weight loss, tremor or palpitations. Deciding result: TSH [1.9] mIU/L. Status: abandoned.
Why the Order Mattered
A structured approach to an elevated alkaline phosphatase begins by confirming the source and then pursues the causes within it (Siddique & Kowdley, 2012). Ordering many tests at once would have produced more results but not a clearer answer, and could have sent Ms. [R.] for liver imaging she did not need. Here, three inexpensive tests, GGT, calcium with parathyroid hormone, and TSH, cleared five candidates, and one radiograph of the painful site produced the leading diagnosis.
Working Diagnosis and Next Steps
The working diagnosis is Paget disease of the right hemipelvis, with vitamin D deficiency present and possibly contributing to her symptoms. A clinical guideline on Paget disease recommends a radionuclide bone scan to define the extent of skeletal involvement, radiographs of affected sites, and treatment with a bisphosphonate, especially zoledronic acid, for bone pain thought to be due to the disease, after correcting vitamin D deficiency (Ralston et al., 2019). The next two steps are therefore a bone scan and vitamin D repletion, followed by referral to discuss treatment for her pain once the extent is known. The bone scan will also settle the demoted metastasis candidate: Paget disease usually shows intense uptake in a characteristic pattern, while scattered new lesions elsewhere would reopen that question.
References
Kwo, P. Y., Cohen, S. M., & Lim, J. K. (2017). ACG clinical guideline: Evaluation of abnormal liver chemistries. American Journal of Gastroenterology, 112(1), 18-35. https://doi.org/10.1038/ajg.2016.517
Ralston, S. H., Corral-Gudino, L., Cooper, C., Francis, R. M., Fraser, W. D., Gennari, L., Guañabens, N., Javaid, M. K., Layfield, R., O'Neill, T. W., Russell, R. G. G., Stone, M. D., Simpson, K., Wilkinson, D., Wills, R., Zillikens, M. C., & Tuck, S. P. (2019). Diagnosis and management of Paget's disease of bone in adults: A clinical guideline. Journal of Bone and Mineral Research, 34(4), 579-604. https://doi.org/10.1002/jbmr.3657
Siddique, A., & Kowdley, K. V. (2012). Approach to a patient with elevated serum alkaline phosphatase. Clinics in Liver Disease, 16(2), 199-229. https://doi.org/10.1016/j.cld.2012.03.012
The Purdue Global NU743 Unit 2 instructions
For Unit 2 you build a differential diagnosis for a presenting problem and show how each candidate was weighed. Plan to give a focused case, list every candidate that is dangerous to miss or likely from the history, record the findings for and against each, name the result that decided its status, and end with a working diagnosis and next steps. Around 1,000 to 1,200 words built around a table is common. Faculty reward workups in which every abandoned candidate names a specific value, tests are ordered in a sensible sequence, and uncertainty is kept where the evidence does not close a question. Five to nine candidates is usually enough, and a candidate left open at the end is often more honest than a list closed too neatly.
Inside the NU743 Unit 2 example
The case section gives the panel, her medications, the hip ache and the examination. A short section explains why a normal GGT points away from the liver and carries the highlighted sentence about the single most useful test. Eight candidates follow, each with findings for and against, a deciding result and a status: cholestatic and infiltrative liver disease, hyperparathyroidism, healing fracture and hyperthyroidism are abandoned; bone metastases are demoted pending a bone scan; vitamin D deficiency stays open with a level of 14; and Paget disease leads after a radiograph. A section explains why tests were sequenced rather than ordered at once, and the working diagnosis cites a clinical guideline on Paget disease for the next steps.
Reading the NU743 Unit 2 grading rubric
Differential workups are commonly judged on the completeness of the candidate list, the reasoning for each candidate, use of evidence, efficiency of testing and the working diagnosis. Completeness earns credit when dangerous and likely causes are all included without padding. Reasoning is judged row by row: findings for and against and a named deciding result. Evidence points go to guidelines or reviews that support the approach. Efficiency rewards a sequence that uses inexpensive, discriminating tests first. The working diagnosis is credited when it follows from the table, leaves open what the evidence has not settled, and names specific next steps. A clear table and APA citation complete most rubrics, and faculty often check that values are internally consistent across the case and table.
NU743 Unit 2 help from the desk
A common weakness is abandoning candidates on impression, with no specific result named. Another is ordering every test at once, which produces noise and cost. Some workups skip the step of deciding the source of an abnormal value, sending the reader through a long list that one test could shorten. Others close every row, claiming more certainty than the data give. Many forget to include a dangerous cause, such as metastases, or drop it too early. And next steps are often vague. Decide the organ first, give each candidate a status and the value behind it, sequence tests by what they rule out, and end with the two or three things you would do next.
Get an NU743 Unit 2 example written to your instructions
Swollen legs, a chronic cough, unexplained anemia: whichever complaint your prompt supplies, include it, the rubric and whatever table layout the section requires. Written to those instructions, a first custom sample comes free within 24-48h, every discarded candidate leaving with its reason attached and the surviving ones with the test that would settle them. 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.
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NU743 Unit 2 questions, answered
How many candidates should a differential workup carry?
Enough to include every cause that would be dangerous to miss and every cause the history makes likely, which usually lands between five and nine. Longer lists tend to be padded with rarities nobody would test for. Your prompt may set a number; where it does, the sample matches it and explains any candidate it adds or leaves out.
Can the sample use a different presenting complaint?
Yes. Tell us the complaint and any findings your prompt provides, and the workup is rebuilt around them with a fresh table, fresh values and its own leading hypothesis. The row structure with a decided-by column carries over, since that column is commonly what the unit is testing, whatever the case.
Where can I find a free NU743 Unit 2 sample paper?
This page holds the complete NU743 Unit 2 differential workup, with the case, the liver-or-bone step, eight candidates each with a status and deciding result, the reasoning behind the test sequence, and a working diagnosis with next steps, plus three references. A workup for your own case can be requested.
Why is GGT the first test in NU743 Unit 2?
Because alkaline phosphatase comes mostly from liver or bone, and GGT rises with liver causes but not bone causes. A normal GGT made a liver source unlikely and sent the rest of the workup toward the skeleton.
Why is vitamin D deficiency left open in NU743 Unit 2?
Her level of 14 ng/mL is low and can raise alkaline phosphatase and cause bone pain, but it does not explain a localized radiographic change. It may contribute alongside Paget disease, and it should be corrected before any bisphosphonate treatment.