NU 610 Unit 4 Sample Paper

Focused Assessment of Recurrent Right Upper Quadrant Pain in a 44-Year-Old Adult

Author Name

Department of Nursing, Herzing University

NU 610: Advanced Health Assessment

Unit 4 Assignment

Instructor Name

January 26, 2026

What this page is doingThe title sheet does two jobs at once. It names one presentation in one patient, so the paper cannot drift into a textbook tour of the abdomen, and it carries the course line in the form the classroom expects. Readers grading a focused write-up look for a title that has already committed to a complaint. A title such as Abdominal Assessment promises coverage; this one promises a decision, and the body then delivers that decision in order.

Subjective Data

Chief complaint: recurring pain under the right ribs that comes on after eating. A 44-year-old woman presents to a family practice clinic with a two-month history of intermittent right upper quadrant pain. She describes five discrete episodes, the most recent two days ago. Each episode begins 30 to 60 minutes after a meal, builds over roughly 20 minutes to a steady 7 out of 10, sits under the right costal margin, and radiates to the right scapula. Episodes last 2 to 4 hours and resolve on their own. She reports nausea with three of the five episodes and one episode of nonbloody emesis. Fried food preceded two episodes and a cream sauce preceded a third. Nothing reliably relieves the pain, and ibuprofen 400 mg had no effect. She denies fever, chills, jaundice, dark urine, pale stools, and unintentional weight loss.

Review of systems focused to the complaint is otherwise limited. She denies heartburn, regurgitation, dysphagia, early satiety, and epigastric burning between episodes, and she has never taken a proton pump inhibitor. She denies diarrhea, constipation, melena, and hematochezia. She denies chest pain, exertional dyspnea, and palpitations, and she reports no pain brought on by activity rather than by food. Genitourinary review is negative for dysuria, frequency, flank pain, and hematuria. Menstrual cycles are regular at 28 to 30 days, the last period ended 12 days ago, and she reports no dyspareunia or abnormal discharge. She reports no recent trauma to the chest wall or abdomen and no heavy lifting before the episodes.

Past medical history includes hypertension for six years and gestational diabetes with her second pregnancy. Surgical history is limited to a cesarean birth in 2015. Medications are lisinopril 20 mg daily and a daily multivitamin; she took a combined oral contraceptive for eleven years and stopped four years ago. She reports no drug allergies. Family history includes gallbladder removal in her mother at age 49 and in a maternal aunt in her fifties. She has never smoked, drinks two to three alcoholic beverages per month, and takes no herbal or over the counter supplements beyond the multivitamin. She works day shift in a school office, has gained roughly 18 pounds over two years, and reports eating restaurant meals more often since a schedule change.

What this page is doingNotice what the history finishes before a single examination finding appears. The symptom analysis is complete enough to be read line by line: onset, timing relative to meals, quality, location, radiation, duration, associated symptoms, aggravating factors, and what failed to relieve it. The negatives are chosen rather than listed at random, and each one belongs to a diagnosis that appears later in the differential. Rubrics for a focused write-up usually separate the symptom analysis from the general history, and keeping them in that order earns both.

Objective Data

Vital signs: temperature 98.2 F oral, heart rate 78 and regular, respirations 16 and unlabored, blood pressure 132/80 in the right arm seated, oxygen saturation 98 percent on room air, height 64 inches, weight 183 pounds, body mass index 31.4. The patient is alert, oriented, and in no acute distress, seated comfortably on the examination table and moving without guarding. She is not diaphoretic. Skin is warm and dry with no jaundice, and sclerae are anicteric under natural light. Oral mucosa is moist and pink. She is afebrile and normotensive for her baseline today, and she reports being pain free since the episode two days ago.

Abdominal examination: the abdomen is rounded and symmetric, with no visible distention, no hernia, and no scars other than a low transverse surgical scar. Bowel sounds are present and normoactive in all four quadrants. Percussion is tympanic throughout, with a liver span of approximately 9 cm at the right midclavicular line and no shifting dullness. Light palpation is comfortable in all quadrants except the right upper quadrant, where the patient reports mild tenderness. Deep palpation reproduces focal tenderness beneath the right costal margin without rebound, without rigidity, and without a palpable mass. Murphy sign is negative today, as the patient does not arrest inspiration during subcostal palpation. There is no epigastric or left upper quadrant tenderness.

The remainder of the examination is unremarkable and is documented because it narrows the differential. Lungs are clear to auscultation bilaterally with no wheeze or crackles. Heart rate and rhythm are regular, S1 and S2 are present, and there is no murmur, rub, or gallop. There is no costovertebral angle tenderness on either side. The chest wall is nontender to direct pressure over the right lower ribs, and the pain is not reproduced by trunk rotation or by resisted flexion. Point of care urinalysis is negative for leukocyte esterase, nitrites, blood, and glucose, and a urine pregnancy test is negative. Laboratory work drawn today includes a complete blood count, a comprehensive metabolic panel, and a lipase.

What this page is doingThe objective sheet carries no interpretation, which is the discipline this section is scored on. Numbers appear with their units, the abdominal examination moves in the documented order of inspection, auscultation, percussion, and palpation, and the negative Murphy sign is recorded as an observation rather than as evidence for a conclusion. Writing the absent findings down is what allows the next sheet to argue. A write-up that saves its examination findings for the impression loses credit twice, once here and once there.

Assessment: Impression and Differential Reasoning

Impression: symptomatic cholelithiasis in a biliary colic pattern, without evidence of acute cholecystitis or biliary obstruction at this visit. The history supplies the pattern that names the problem: postprandial onset after fatty meals, a steady rather than crampy quality, right subcostal location with scapular radiation, self-limited episodes of 2 to 4 hours, and associated nausea. The examination does not contradict any part of that history. It adds focal right upper quadrant tenderness in a patient who is afebrile, anicteric, and hemodynamically stable, with a negative Murphy sign in the interval between attacks. Risk factors drawn from the history point the same direction: female sex, age in the fifth decade, body mass index 31.4, recent weight gain, prolonged estrogen exposure, and two relatives who required cholecystectomy (National Institute of Diabetes and Digestive and Kidney Diseases, 2017).

The competing diagnoses were tested against the same two data sets rather than dismissed by preference. Acute cholecystitis typically presents with pain that has not resolved, fever, and inspiratory arrest on subcostal palpation; Trowbridge and colleagues (2003) reported that no single history or examination finding rules that diagnosis in or out alone, so the absence of ongoing pain, fever, and a positive Murphy sign is recorded here as an argument against active inflammation rather than as proof of its absence. Peptic ulcer disease and gastroesophageal reflux disease fit poorly, since there is no interval epigastric burning, no heartburn or regurgitation, no nocturnal symptoms, and no epigastric tenderness (Katz et al., 2022). Nephrolithiasis is unlikely with no flank pain, no costovertebral angle tenderness, and a bland urinalysis.

Right upper quadrant ultrasound is the appropriate first imaging study for this presentation and is the study most likely to confirm or refute the working impression, because it identifies stones, wall thickening, and ductal dilation without radiation exposure (American College of Radiology, 2023). The laboratory work serves a narrower purpose: a normal white blood cell count supports the absence of acute inflammation, normal total bilirubin and alkaline phosphatase argue against choledocholithiasis, and a normal lipase makes pancreatitis unlikely (Bickley et al., 2021). The note deliberately records the negatives that carry weight, because the anicteric sclerae, the negative Murphy sign between attacks, and the bland urinalysis are the observations keeping the differential honest. Return precautions were reviewed for pain lasting beyond five hours, fever, persistent vomiting, or jaundice.

What this page is doingThe impression is stated first, then supported, then defended against the alternatives using data already on the page. Nothing new enters the argument, which is the mark of a well-built write-up: every clause points back at a line the reader has already seen. Competing diagnoses are set aside with named findings instead of the phrase less likely. Ordering the ultrasound at the end shows reasoning that continues past the visit rather than stopping at a label.

References

American College of Radiology. (2023). ACR appropriateness criteria: Right upper quadrant pain. https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.

Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, 117(1), 27-56.

National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Gallstones. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones

Trowbridge, R. L., Rutkowski, N. K., & Shojania, K. G. (2003). Does this patient have acute cholecystitis? JAMA, 289(1), 80-86.

How this NU 610 Unit 4 example is structured

The paper follows the shape of a clinical note, which is the shape this NU 610 Unit 4 example needs: subjective data first, objective data second, and the impression last, so the reader can watch the conclusion assemble itself. Herzing University publishes no unit-by-unit deliverable name for Advanced Health Assessment, so this is written as the genre the unit almost certainly wants. In many sections this unit asks for a focused, single-system write-up on one presenting complaint; your classroom instructions and rubric decide the exact form. The subjective sheet carries a full symptom analysis and the negatives that shape the differential. The objective sheet records only what was measured and observed. The final sheet names one impression, then argues the competing diagnoses down using findings already documented, which is what graduate nurse practitioner work rewards.

NU 610 Unit 4 questions, answered

What does a focused assessment write-up in NU 610 have to include?

A focused write-up covers one presenting complaint in depth instead of every system briefly. It carries a complete symptom analysis, the pertinent positives and negatives tied to the differential, the relevant history, a documented examination of the involved system and its neighbors, and one impression with the competing diagnoses argued down. The example above shows each of those parts in its usual order.

Herzing does not publish a deliverable name for this unit, so how was the paper chosen?

The genre was inferred from the course and from where the unit sits in the term. Advanced Health Assessment moves system by system, and by the middle of the term the graded writing is commonly a focused write-up on a single complaint. Your classroom instructions and rubric decide the exact form, including which system is in scope and which note template is required.

Is the patient in this NU 610 example a real case?

No. The patient, the clinic, and every number in the chart are composite and illustrative, written for a model document produced by our desk. Nothing here is de-identified from a real case, because no real case was used, and nothing in the paper is offered as clinical advice. Read it as a shape to write against, not as findings to copy.

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 Herzing 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.

NU 610 Unit 4: sample paper, in real form