| Course | NSG 121 Health Assessment |
|---|---|
| Unit | Unit 7 |
| Paper type | Developmental variation notes |
| Length | About 800 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 121 Unit 7
What Changes at Age Four: Examination Notes for a Preschooler at a Well-Child Visit, Written as Differences From the Adult Pattern
Student Name
Department of Nursing, Herzing University
NSG 121: Health Assessment
Instructor Name
February 26, 2026
What Changes at Age Four: Examination Notes for a Preschooler at a Well-Child Visit, Written as Differences From the Adult Pattern
The Person
A composite 4-year-old girl attends a well-child visit at a family clinic with her father. She attends preschool three days a week, has had two ear infections, and takes no regular medicines. She is talkative, a little shy with strangers, and brought a stuffed rabbit. Everything below refers to her.
Expected Findings That Differ From the Adult Pattern
Heart rate: faster than in adults. A large systematic review of observational studies found that heart rates in children fall steadily with age, so the adult range cannot be used; the range for her age centers well above the adult resting rate (Fleming et al., 2011). Her rate of 102 while sitting on her father's lap is expected.
Breathing rate: also faster, and it falls with age by the same review. Her rate of 24 is expected. Children of this age breathe with more abdominal movement than adults, so the rate is counted by watching the belly rather than the chest.
Blood pressure: measured with a child-size cuff chosen by arm circumference, and compared with charts by age, sex, and height percentile rather than with the adult thresholds (Jarvis, 2020).
Tonsils: often larger than in adults at this age, and may reach partway toward the midline without meaning anything is wrong; the size is recorded with a grade rather than called enlarged.
Lymph nodes: small, soft, mobile nodes in the neck, often called shotty, are common in preschool children who pick up frequent colds, and are recorded by size and character in the adult way.
Liver: the lower edge may be felt 1 to 2 cm below the right costal margin, which would be unexpected in an adult.
Teeth: 20 primary teeth; no permanent teeth expected yet.
Vision: tested with a picture or letter chart suited to preschoolers; the passing line for her age is lower than the adult 20/20 standard and was taken from the screening guidance used by the clinic.
How the Sequence Changes
Adults are examined head to toe. A preschooler is examined from least to most upsetting. She stays on her father's lap for the first half. The heart and lungs are listened to first, while she is quiet, since crying makes both hard to hear. Then the abdomen, the arms and legs, and the skin. Height, weight, and vision come in the middle, when she has warmed up. The ears, mouth, and throat, which children of this age most often dislike, are examined last. The reflexes and the neurologic examination are done mostly by watching her play: walking, hopping on one foot, climbing onto the table, drawing a circle, and stacking blocks give more information than formal testing would.
Two parts of the adult sequence were left out entirely rather than moved. Percussion of the chest was not done, since it adds little in a healthy preschooler and she found the tapping ticklish. The blood pressure, which she might resist, was taken after the vision test rather than at the start, when she was calm and interested in the cuff inflating.
How She Is Approached, and What Is Explained
Adults are asked for permission and told what will happen. A 4-year-old is shown. She was invited to listen to her rabbit's heart with the stethoscope before hers was listened to, and the otoscope light was shone on the rabbit's ear first. Explanations were short and concrete: "I'm going to count how fast your heart goes," not "I'm checking your heart rate." She was given choices where a real choice existed, such as which ear to look in first, but not where none existed. Praise was given for helping, not for being brave, which can suggest something frightening is coming.
Who Else Is in the Room
Her father stayed throughout, which changes the adult pattern in three ways. The history came mostly from him, with her own answers recorded in her words where she gave them. He held her in a hug position for the ear examination so her head was steady. And the plan and any findings were explained to him, with a short version for her. Growth and development questions, such as whether she can dress herself or speaks in full sentences, were asked of him and checked by watching her (Hagan et al., 2017).
What Stays the Same
The listening sites for the heart are the same landmarks, counted the same way. The descriptive vocabulary for skin, nodes, and sounds is the same. Findings are still written out in full rather than marked as normal. Hand hygiene, draping, and explaining before touching still apply. The difference is the order, the approach, and the reference values, not the discipline of the examination.
References
Fleming, S., Thompson, M., Stevens, R., Heneghan, C., Plüddemann, A., Maconochie, I., Tarassenko, L., & Mant, D. (2011). Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: A systematic review of observational studies. The Lancet, 377(9770), 1011-1018. https://doi.org/10.1016/S0140-6736(10)62226-X
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2017). Bright futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). American Academy of Pediatrics.
Jarvis, C. (2020). Physical examination & health assessment (8th ed.). Elsevier.
Reading the NSG 121 Unit 7 instructions
Unit 7 asks you to describe how assessment varies at a developmental stage, compared with the adult pattern. Expect to describe the person, list expected findings that differ, explain how the sequence changes, describe approach and explanation, address who else is present and note what stays the same. Many versions ask whether to cover more than one stage and where stage-specific findings come from. Check your section's expectations. Bright Futures and pediatric reference ranges are standard sources. Sequence matters for young children, since upsetting parts come last. Approach carries real weight: showing equipment and using play gains cooperation. Parents supply history and comfort but also change the dynamic. Noting what stays the same keeps the comparison balanced.
How this NSG 121 Unit 7 example is built
The notes open with the child, her age and the visit purpose. The findings section lists differences from adults, each with a source, such as faster heart and breathing rates. The sequence section explains the least-to-most-upsetting order with examples. The approach section describes how she was shown equipment and given choices. The section on her father explains three ways his presence changes the examination. The final section lists what does not change, such as landmarks and vocabulary. The notes are framed as differences from the adult pattern, which helps a student who has learned adult assessment adapt it. Each difference cites a pediatric source.
Reading the NSG 121 Unit 7 rubric
Herzing's rubric for developmental variation notes typically covers accuracy of stage-specific findings, sequence adaptation, approach, attention to caregivers, what stays the same and sources. Pediatric ranges are checked against current sources, which is where errors most often appear. Sequence points reward a developmentally appropriate order. Approach criteria look for techniques that gain cooperation, such as play and choice. Caregiver points go to how a parent's presence changes history and comfort. Balance earns credit when similarities with the adult pattern are noted. Framing the notes as differences from adult assessment is often credited for usefulness. A clear structure helps the reader. Fleming's review of children's vital signs and the Bright Futures guidelines are the key references.
Common NSG 121 Unit 7 mistakes, and how to avoid them
Developmental notes in Unit 7 often slip by using adult ranges or outdated pediatric values. Another frequent problem is keeping the adult head-to-toe sequence for a young child, which upsets her early and loses cooperation. Students often skip approach. The parent's role is ignored or overstated. What stays the same is left out. Sources for ranges are missing. Play and choices are not mentioned. Developmental milestones are listed without connection to the examination. Safety, such as a parent holding the child for the ear examination, is not described. Finally, frame findings as differences from the adult pattern, because graders reward notes that help a student adapt what they know.
Get a NSG 121 Unit 7 example written to your instructions
Send the Unit 7 instructions and the rubric from your NSG 121 classroom, and tell us the stage of life the notes have to cover. We write a custom example fixed on one composite patient, with every change framed against the adult pattern, expected findings sourced and the unchanged parts named. First custom sample free, returned in 24 to 48 hours.
More NSG 121 papers and BSN samples
- NSG 121 Unit 1: Assessment technique sequence
- NSG 121 Unit 2: Equipment use record
- NSG 121 Unit 3: Expected versus unexpected findings chart
- NSG 121 Unit 4: Landmark and positioning guide
- NSG 121 Unit 5: Head to toe rehearsal log
- NSG 121 Unit 6: Documentation practice set
- NSG 121 Unit 8: Assessment competency file
- NSG 222 Unit 7: Family assessment write-up
- NSG 223 Unit 7: Multi problem patient record
- NSG 233 Unit 7: Urgent report script
- NSG 298 Unit 7: Study plan derivation record
NSG 121 Unit 7 questions, answered
Can the notes cover more than one stage?
Only if your instructions ask for that, and then keep each stage anchored to its own composite patient. The common failure is a document that treats stages as headings and produces a paragraph on each, which shows coverage rather than understanding. If you must cover two, write them as two sets of notes with the same structure rather than as one continuous account.
Where do expected findings for a stage come from?
Your assessment text, the growth or development references your course supplies, and any table your section provides, all cited. Expected findings at particular stages vary between sources and are revised, so an unattributed figure is a weak point in an otherwise sound paper. Note the edition, since tables change between them more often than students expect.
Does approach really carry marks?
In most sections of this course it does, and it is easy to underwrite. Describe what was explained, in what order, and how the examination was arranged around the person, since those are observable decisions. What earns nothing is a general statement about building rapport, which could sit in any paper about any patient at any stage.
Where can I find a free NSG 121 Unit 7 sample paper?
The full NSG 121 Unit 7 preschooler notes are on this page free of charge, findings, sequence, approach and the parent's role. Notes for a different developmental stage can be written on request.
How is a physical exam different for a four-year-old?
The order moves from least to most upsetting, the child is shown equipment and given choices, vital sign ranges differ and a parent usually stays. This sample records those differences from the adult pattern.