| Course | NUR-7070 Primary Care Diagnosis, Management and Health Promotion |
|---|---|
| Module | Module 2 |
| Paper type | Differential diagnosis case |
| Length | About 1,051 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7070 Module 2
Thirty Seconds of Spinning on Her Right Side: Building and Narrowing a Differential for Positional Vertigo in a 63-Year-Old Church Organist
Student Name
M.S. in Nursing, Family Nurse Practitioner, Thomas Edison State University
NUR-7070: Primary Care Diagnosis, Management and Health Promotion
Mentor Name
Month Day, Year
Thirty Seconds of Spinning on Her Right Side: Building and Narrowing a Differential for Positional Vertigo in a 63-Year-Old Church Organist
Introduction
Mrs. W. is an invented patient, a 63-year-old church organist from Morristown who comes in with five days of dizziness. It began one night when she turned toward the window side of the bed and the ceiling seemed to whirl for what felt like thirty seconds. It happens again whenever she turns that way, when she tips her head back to reach the top shelf of the hymnal cupboard and once when she bent to tie her shoes. Between spells she feels a little unsteady but otherwise well. She has no hearing loss, ringing, headache, double vision, trouble speaking or weakness. She has hypertension treated with lisinopril and no history of stroke. Dizziness covers many conditions with very different consequences, so this paper builds a differential and narrows it before choosing treatment.
Starting Wide: Six Possibilities
The word dizzy can mean spinning, light-headedness, imbalance or a vague sense of being unwell. Mrs. W. describes true spinning, which points toward the vestibular system, but a careful differential still begins wide. Six conditions are considered: benign paroxysmal positional vertigo, vestibular neuritis, Meniere disease, a posterior circulation stroke or transient ischemic attack, vestibular migraine and orthostatic hypotension from her blood pressure medicine.
Narrowing With the History
Timing and triggers separate these conditions better than any single test. Spells lasting less than a minute and brought on by changes in head position relative to gravity are characteristic of benign paroxysmal positional vertigo, the most common cause of vertigo in adults (Bhattacharyya et al., 2017). Vestibular neuritis causes continuous vertigo for days, which she does not have. Meniere disease causes attacks lasting 20 minutes to hours with fluctuating hearing loss and ringing, which she denies. Vestibular migraine usually comes with headache or light sensitivity and a history of migraine, and she has neither. Orthostatic hypotension causes light-headedness on standing rather than spinning when rolling over in bed. Stroke remains on the list, because a small cerebellar stroke can mimic a peripheral problem, and her age and hypertension raise the risk.
Population data support the leading diagnosis. Von Brevern et al. (2007) estimated that about 2.4 percent of adults experience this condition at some point in life, with a peak in older adults and more women than men, which fits Mrs. W.
Narrowing With the Examination
The Dix-Hallpike maneuver tests the posterior semicircular canal. She sits with her face turned halfway toward her right shoulder, then is lowered briskly onto her back so that her head hangs a little below the edge of the exam table. After a delay of a few seconds, her eyes beat upward and twist toward the right ear, and she reports intense spinning that fades within 30 seconds. On sitting up the nystagmus briefly reverses. The test to the left is negative. This pattern, a short latency, torsional upbeating nystagmus toward the affected ear and fatigue within a minute, is the diagnostic finding for right posterior canal disease (Bhattacharyya et al., 2017). Loose calcium crystals have moved from the utricle into the canal, where they keep moving after the head stops and falsely signal rotation.
Her neurologic examination is normal: cranial nerves intact, no dysmetria on finger-to-nose testing, normal speech and a steady gait between spells. Orthostatic vital signs show no significant drop.
| Possibility | Key finding against or for | Status |
|---|---|---|
| Positional vertigo, right posterior canal | Brief spells on rolling right; positive right Dix-Hallpike | Leading diagnosis |
| Vestibular neuritis | No continuous vertigo | Unlikely |
| Meniere disease | No hearing loss or ringing; spells too short | Unlikely |
| Posterior circulation stroke | Normal neurologic exam; episodic, positional pattern | Unlikely, safety net given |
| Vestibular migraine | No headache or migraine history | Unlikely |
| Orthostatic hypotension | No drop on standing; spinning, not light-headed | Unlikely |
Why Not Stroke, and When to Worry
HINTS pairs three bedside checks (a quick head turn, the direction of the eye beats and a cover test for vertical misalignment) and was built for another picture altogether: dizziness, vomiting and jerking eyes that persist without a break for a day or longer. Kattah et al. (2009) showed that in that setting the three bedside tests identified stroke more reliably than early MRI. HINTS is not the right test for brief positional spells, and applying it to Mrs. W. could mislead. Her episodic, positional pattern with a classic Dix-Hallpike result and normal neurologic exam makes stroke unlikely. Even so, the plan includes clear return precautions: new continuous vertigo, a severe headache, double vision, slurred speech, weakness or numbness, or inability to walk should send her to the emergency department at once.
Management
The guideline recommends a canalith repositioning procedure for posterior canal disease and recommends against routine imaging, vestibular testing and vestibular suppressant medicines such as meclizine (Bhattacharyya et al., 2017). The Epley is done on the exam table: starting from the positive right-sided test position, her head swings a quarter turn to the left, she rolls onto her left shoulder so her nose points at the floor, and then she sits up, pausing in each pose for about half a minute or until the whirling settles. This guides the crystals out of the canal and back into the utricle.
She is told that a single maneuver resolves symptoms for many patients, that she may feel unsteady for a few days and that the condition can return. Because she lives alone and is at risk of falling, she is advised to get up slowly at night and keep a light on. She is not given meclizine, which would add sedation and fall risk without treating the cause.
Follow-Up
Mrs. W. returns in one week, or calls sooner if the spells continue. If the Dix-Hallpike is still positive, the maneuver is repeated, and she may be taught to perform it at home. If symptoms persist after several treatments, or if a new pattern appears, she is referred for vestibular therapy or to a specialist.
Conclusion
A broad differential for Mrs. W.'s dizziness was narrowed by the timing and triggers of her spells and confirmed by a positive right Dix-Hallpike. Stroke was considered and judged unlikely, with clear safety advice. Treatment followed the guideline: a repositioning maneuver in the clinic, no suppressant medicine and a plan for follow-up and fall prevention.
References
Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., Holmberg, J. M., Mahoney, K., Hollingsworth, D. B., Roberts, R., Seidman, M. D., Steiner, R. W. P., Do, B. T., Voelker, C. C. J., Waguespack, R. W., & Corrigan, M. D. (2017). Clinical practice guideline: Benign paroxysmal positional vertigo (update). Otolaryngology-Head and Neck Surgery, 156(3 Suppl.), S1-S47. https://doi.org/10.1177/0194599816689667
Kattah, J. C., Talkad, A. V., Wang, D. Z., Hsieh, Y.-H., & Newman-Toker, D. E. (2009). HINTS to diagnose stroke in the acute vestibular syndrome: Three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke, 40(11), 3504-3510. https://doi.org/10.1161/STROKEAHA.109.551234
von Brevern, M., Radtke, A., Lezius, F., Feldmann, M., Ziese, T., Lempert, T., & Neuhauser, H. (2007). Epidemiology of benign paroxysmal positional vertigo: A population based study. Journal of Neurology, Neurosurgery and Psychiatry, 78(7), 710-715. https://doi.org/10.1136/jnnp.2006.100420
What the NUR 7070 Module 2 instructions ask for
The catalog entry for NUR-7070 asks students to develop clinical reasoning and begin to formulate differential diagnoses, and no syllabus for the course is posted where the public can read it, so this second module is set on a differential diagnosis case. Expect a focused case in which you list the plausible causes of a symptom, use the history and examination to rank and remove them, identify the leading diagnosis and the dangerous one you must not miss, and write a plan with safety instructions. Some classrooms supply the case as a video or a set of findings. Check the directions for format, often a SOAP note, and for length. Name each examination maneuver you use and what a positive result means.
How the NUR 7070 Module 2 example is put together
A 63-year-old organist with five days of brief spinning when she rolls onto her right side opens the paper. Six possibilities are listed before any test. The history section uses timing and triggers to set aside neuritis, Meniere disease, migraine and orthostatic hypotension, keeping stroke on the list, and population data support the leading diagnosis. The examination section describes the right Dix-Hallpike and its nystagmus in detail and records a normal neurologic exam, and a six-row table shows the status of each possibility. A section explains when HINTS applies and why it does not here, with return precautions, and the plan covers the Epley maneuver, avoiding meclizine and fall safety.
NUR 7070 Module 2 rubric: what earns full marks
Differential diagnosis papers are graded on the breadth of the initial list, the logic used to narrow it, accurate description of the examination and recognition of dangerous alternatives. Mentors look for findings that support or argue against each possibility, not just a list of names. Correct interpretation of a maneuver, including what a positive result looks like, earns credit. A plan that follows the current guideline, avoids unnecessary tests and medicines, and includes return precautions shows safe practice. Fall prevention and follow-up for an older adult add value. Recent sources in clean APA add the final points, and a running table of each candidate diagnosis lets the reader follow your elimination step by step.
Common NUR 7070 Module 2 mistakes, and how to avoid them
The most common weakness in differential papers is a list that is either too short, with only the correct answer, or too long, with conditions that do not fit the presentation. Choose plausible alternatives and give a finding for each. Students also describe examination tests incorrectly, such as the direction of nystagmus or which test belongs to which presentation. Explain what you saw and what it means. Many papers forget the dangerous diagnosis; say how you excluded it and what would make you reconsider. Avoid ordering imaging that the guideline does not support. Include patient safety. If your case is a different symptom, such as chest pain or headache, follow the same steps; the desk will draft that NUR-7070 case to your instructions and waive the fee on the first.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7070 Module 2 questions, answered
Where can I find a free NUR 7070 Module 2 sample paper?
Every sheet of the vertigo paper is printed here, with notes beside each one. It narrows positional vertigo in a 63-year-old woman from six possibilities to posterior canal BPPV.
What does a positive Dix-Hallpike test look like?
After a few seconds' delay, upbeating and torsional nystagmus beats toward the lower ear with brief vertigo that fades within a minute, indicating posterior canal positional vertigo on that side.
When should the HINTS exam be used?
In the acute vestibular syndrome, with continuous vertigo, nausea and nystagmus lasting hours to days, to separate a peripheral cause from a stroke. It is not meant for brief positional spells.
Should meclizine be used for BPPV?
The otolaryngology guideline advises against it as routine care: meclizine leaves the loose crystals where they are and makes an older patient drowsier and likelier to fall.
How is BPPV treated in primary care?
With a canalith repositioning procedure such as the Epley maneuver, performed in the office and repeated if symptoms persist.