| Course | D118 Adult Primary Care for the Advanced Practice Nurse |
|---|---|
| Task | Task 1 |
| Paper type | Adult primary care case write-up |
| Length | About 800 words, 3 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN Family Nurse Practitioner |
| Updated | September 2026 |
Free sample paper for D118 Task 1
Adult Case Write-Up: Ten Weeks of Outer Elbow Pain When Gripping in a 44-Year-Old Finish Carpenter
Student Name
Leavitt School of Health, Western Governors University
D118: Adult Primary Care for the Advanced Practice Nurse, Task 1
Course Instructor
Month Day, Year
Adult Case Write-Up: Ten Weeks of Outer Elbow Pain When Gripping in a 44-Year-Old Finish Carpenter
Presentation
A composite 44-year-old right-handed finish carpenter presents with ten weeks of pain on the outside of his right elbow. It began gradually during a job installing crown molding that involved many hours of screwdriver and nail-gun use. The pain is worst when he grips a hammer, turns a screwdriver, lifts a coffee mug with his arm straight or shakes hands, and it eases with rest. It is sharp with those actions and aches in the evening. He has no numbness or tingling in the hand, no neck pain, no night pain that wakes him, no swelling, locking or catching of the elbow, and no fever. There was no fall or single injury. He has tried ibuprofen 400 mg a few times a week with brief relief. History: hypertension on lisinopril; no diabetes, gout or inflammatory arthritis; no fluoroquinolone use.
Examination: right elbow without swelling, redness or warmth. Point tenderness about 1 cm distal and anterior to the lateral epicondyle over the common extensor origin. Full elbow range of motion without pain at the end of range and without crepitus. Pain at the lateral elbow with resisted wrist extension with the elbow straight, and with resisted extension of the middle finger. Pain-free grip strength by dynamometer, a practical measure for following this condition over time (Bisset & Vicenzino, 2015): 38 kg on the right, stopped by pain, and 52 kg on the left. No tenderness over the radial tunnel, about four fingers below the epicondyle. Neck: full, painless range of motion; Spurling test negative. Neurologic: strength, sensation and reflexes normal in both arms. No tenderness over the medial epicondyle or olecranon.
Problem Statement
Ten weeks of activity-related lateral elbow pain in a middle-aged manual worker after repetitive gripping, with focal tenderness at the common extensor origin, pain on resisted wrist and middle-finger extension, reduced pain-free grip, full elbow motion and a normal neck and neurologic examination.
Ranked Differential Diagnosis
1. Lateral epicondylalgia (lateral epicondylitis, 'tennis elbow'). For: gradual onset after repetitive gripping in a middle-aged patient; pain with gripping and resisted wrist extension; tenderness exactly at the common extensor origin; reduced grip. It is a common condition in middle age, and the diagnosis is usually clinical (Vaquero-Picado et al., 2016). Against: none. Leading diagnosis.
2. Radial tunnel syndrome (compression of the posterior interosseous nerve). For: lateral forearm pain with resisted middle-finger extension can occur. Against: maximal tenderness is at the epicondyle rather than four fingers distal over the radial tunnel, and there is no weakness of finger or thumb extension. Lower probability; it can coexist.
3. Cervical radiculopathy at C6 or C7. For: can refer pain to the lateral elbow. Against: no neck pain, full painless neck motion, negative Spurling test, normal reflexes, sensation and strength. Lower probability.
4. Elbow osteoarthritis or intra-articular problem. For: manual work. Against: full, painless range of motion, no crepitus, no locking or catching, no effusion.
5. Posterolateral elbow instability or ligament injury. Against: no injury, no clicking or giving way.
6. Infection, inflammatory arthritis or a tumor, which must not be missed. Against: no fever, swelling, warmth, night pain or weight loss.
Dangerous Possibilities Considered
Septic arthritis or bursitis, an inflammatory arthritis flare and a bone tumor are unlikely but serious, and each would change management. Their absence is supported by specific recorded findings: no fever, warmth, swelling or effusion; full painless range of motion; and no night pain or constitutional symptoms. Should night pain, swelling or systemic symptoms develop, imaging and laboratory tests would follow.
Diagnostic Studies
No imaging is needed now, because the presentation is typical and imaging would not change initial management. Radiographs would be considered if symptoms fail to improve after about three months of appropriate treatment, to look for arthritis or calcification; ultrasound or magnetic resonance imaging would be reserved for persistent symptoms when another diagnosis, such as a tendon tear or radial tunnel syndrome, needs to be distinguished (Vaquero-Picado et al., 2016). Nerve conduction studies would be considered only if neurologic signs appear.
Working Diagnosis
Right lateral epicondylalgia related to repetitive gripping at work. The diagnosis would be reconsidered if numbness, weakness or neck symptoms developed, if the site of maximal tenderness moved distally, or if symptoms failed to improve with a course of appropriate treatment. Management, including the choice about corticosteroid injection, which a randomized trial found to worsen one-year outcomes compared with placebo injection (Coombes et al., 2013), is addressed in the applied task.
References
Bisset, L. M., & Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia. Journal of Physiotherapy, 61(4), 174-181. https://doi.org/10.1016/j.jphys.2015.07.015
Coombes, B. K., Bisset, L., Brooks, P., Khan, A., & Vicenzino, B. (2013). Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: A randomized controlled trial. JAMA, 309(5), 461-469. https://doi.org/10.1001/jama.2013.129
Vaquero-Picado, A., Barco, R., & Antuña, S. A. (2016). Lateral epicondylitis of the elbow. EFORT Open Reviews, 1(11), 391-397. https://doi.org/10.1302/2058-5241.1.000049
What the D118 Task 1 instructions ask
The first D118 task asks you to work through an adult primary care case to a working diagnosis. Most versions ask for the presentation, a problem statement, a ranked differential diagnosis with supporting and opposing findings, consideration of dangerous diagnoses, diagnostic studies with rationale and a working diagnosis. The case may be composite or drawn from practicum with details removed. Evaluators look for clinical reasoning that is explicit and ranked, not a list of possible conditions. They also look for evidence-based decisions about testing, including when not to test, and a working diagnosis that states what would make you reconsider it.
How this D118 Task 1 example is built
The write-up begins with the presentation in the patient's terms and the examination findings. The problem statement condenses the case into one sentence using clinical descriptors. The differential lists diagnoses in order of likelihood, each with findings for and against, which makes the ranking transparent. A separate section addresses dangerous possibilities so they are not lost in the list. The diagnostic studies section explains why imaging is not needed initially and when it would be. The working diagnosis restates the conclusion and names the developments that would prompt a new look. Sources include a clinical review and a randomized trial on treatment options. The ranking logic is visible, so a preceptor could disagree with a specific step rather than the whole conclusion.
Where the D118 Task 1 rubric puts the marks
D118 Task 1 aspects are rated competent, approaching competence or not evident. A presentation aspect checks that relevant history and examination findings are included. A problem statement aspect rewards concise clinical synthesis. A differential aspect looks for ranked diagnoses with reasoning for each. A dangerous diagnoses aspect asks whether serious conditions were considered. A diagnostics aspect wants tests justified by evidence, including decisions not to test. A working diagnosis aspect checks that the conclusion follows from the reasoning. Evaluators expect current clinical sources and precise documentation throughout. Evaluators notice when each diagnosis in the differential has at least one finding for and one against, because that is what makes a ranking defensible. Decisions not to order imaging earn credit when they cite evidence and state when imaging would become appropriate.
D118 Task 1 help: what sends it back
An unranked list of possible diagnoses is the usual reason D118 write-ups come back. Order diagnoses by likelihood and give reasons for and against each. Second, dangerous diagnoses are omitted. Name them and explain why they are unlikely. Third, tests are ordered by habit. Justify each study or explain why none is needed. Fourth, the problem statement repeats the history. Condense it into one sentence with key features. Finally, state what would change your diagnosis. That shows the reasoning is open, which evaluators expect from a nurse practitioner making decisions with incomplete information. Keep the problem statement to one sentence.
Get a D118 Task 1 example written to your instructions
Send the D118 Task 1 instructions and the rubric aspects exactly as your course of study words them, plus the case if one was assigned to you. We write a custom example against those aspects, with the differential ranked and each diagnosis argued from findings, and return it in 24-48h. The first custom sample is free.
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D118 Task 1 questions, answered
How many diagnoses belong in the differential?
Follow your instructions where they set a number, and otherwise argue three to five properly rather than naming eight. Each entry has to carry supporting and opposing evidence to earn anything, and thin entries dilute the strong ones. Add any condition that would be dangerous to miss even when it sits at the bottom, and say plainly why it stays.
Can the case come from my clinical practicum?
Check the instructions, and if a real presentation is allowed, remove every identifier before drafting. Constructed patients tend to produce cleaner submissions because you control which findings exist to reason from. Practicum hours and the patients behind them are your record, and no part of that documentation is ever ghostwritten for you.
Does D118 have more than one task?
In many versions the course carries a reasoning task and an applied management task, and some versions also require a proctored objective assessment, which is entirely your own to sit. Treat your own course of study as the authority, since the arrangement changes between revisions. We write to whatever instructions and rubric aspects you send us and assume nothing about the rest.
How many diagnoses belong in a D118 differential?
Enough to cover the likely and the dangerous, often three to five, ranked with reasons. The sample ranks lateral epicondylalgia first and addresses serious possibilities in a separate section.
Where can I find a free D118 Task 1 sample paper?
The complete case write-up appears on this page with margin notes. Share your D118 task and case details, and the first tailored write-up is prepared for you at no charge.