| Course | NU 610 Advanced Health Assessment |
|---|---|
| Unit | Unit 5 |
| Paper type | Discussion post with two replies |
| Length | About 630 words, 4 pages |
| Format | Discussion post, APA 7 citations |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 610 Unit 5
Unit 5 Discussion: Initial Post and Two Replies
"Murmur Noted" Is Worse Than Leaving the Line Blank
Initial Post
My position is that an entry reading "murmur noted" or "soft systolic murmur" does more harm than a blank line, because it tells the next clinician something was heard while giving them nothing they can compare against. A blank line at least signals that the finding needs to be checked. A vague entry signals that it was checked and leaves the next examiner unable to say whether the murmur is new, louder, or unchanged.
Bickley et al. (2021) describe a murmur by its timing in the cardiac cycle, shape, location of maximal intensity, radiation, intensity grade, pitch, and quality, and each of those attributes answers a different question. Intensity is graded on the six-point scale that descends from Freeman and Levine (1933), which is only useful if the next person knows the grade the last person heard. Here is the entry I would want to inherit from a colleague, written for a composite 72-year-old patient: "Grade 3/6 harsh, medium-pitched midsystolic murmur with a crescendo-decrescendo shape, heard best at the second right interspace beside the sternum, with radiation to both carotid arteries; S2 softer than expected at the right upper sternal border; no thrill; patient seated, leaning forward, diaphragm." That entry takes about thirty seconds longer to write. A clinician six months later can hear a grade 4/6 murmur and know it changed.
The same logic applies to the pertinent negatives around the murmur. Writing that there is no thrill, that the murmur does not change with inspiration, and which position and chest piece were used tells the next examiner how to reproduce the conditions. Without those details, a later difference in the finding could mean a change in the patient or only a change in technique, and nobody reading the chart can tell which.
The part of my claim I am least sure about: is there a setting, such as a busy screening clinic seeing mostly healthy young adults, where the full description is not worth the time and a shorter standard would be safer overall?
Reply to Classmate A
You made the point that most vague murmur entries in your unit's charts are not typed fresh but carried forward from an admission note. I think that strengthens the case against "murmur noted" rather than weakening it. Weis and Levy (2014) reviewed copy-and-paste practices in electronic records and found that carried-forward text spreads outdated and inaccurate findings through later notes, because the reader has no way to tell which lines were examined that day. A full description written once and then copied at least preserves the original finding accurately; "murmur noted" copied forward preserves nothing but the fact that someone once heard something. Your example suggests a rule we could adopt: if a murmur line is carried forward, it should carry the date of the examination that produced it.
Reply to Classmate B
I disagree with one specific part of your post, the claim that the intensity grade alone is enough to communicate how serious a systolic murmur is. In the review by Etchells et al. (1997), the loudness of a murmur was a weak guide to how severe aortic stenosis was, and features such as a late-peaking murmur, a diminished or absent second heart sound, and a slow carotid upstroke carried more information about severity. A grade 2/6 murmur with a soft S2 in an older adult can be more important than a grade 3/6 murmur with a normal S2. If you are right that grade is enough, I would expect those studies to show intensity tracking severity closely, and they do not. I would still record the grade, but next to the timing, the shape, and the second heart sound, which is where the argument for referral usually comes from.
References
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.
Etchells, E., Bell, C., & Robb, K. (1997). Does this patient have an abnormal systolic murmur? JAMA, 277(7), 564-571. https://doi.org/10.1001/jama.1997.03540310062036
Freeman, A. R., & Levine, S. A. (1933). The clinical significance of the systolic murmur: A study of 1000 consecutive noncardiac cases. Annals of Internal Medicine, 6(11), 1371-1385. https://doi.org/10.7326/0003-4819-6-11-1371
Weis, J. M., & Levy, P. C. (2014). Copy, paste, and cloned notes in electronic health records. Chest, 145(3), 632-638. https://doi.org/10.1378/chest.13-0886
Reading the NU 610 Unit 5 instructions
The Unit 5 prompt asks for an initial discussion post on a question about cardiovascular assessment or documentation, followed by replies to classmates. Most versions expect the post to take a clear position in the opening lines and to back it with a peer-reviewed or guideline source cited in APA style. Replies are usually required on separate days and must add something: a new source, a counterpoint, or a clinical application the first post missed. Expect a word range for the initial post and a shorter one for each reply, both stated in the classroom. The tone should be professional and collegial, and a disagreement should be directed at a claim, never at the classmate. Posting deadlines matter here, since many sections require the first post well before the week closes and grade late posts down. Patient details must come from a case or composite, not from your clinical site.
How the NU 610 Unit 5 example is put together
The initial post opens with its position in one sentence, then explains why a blank line is safer: it at least tells the reader the exam was not documented. A second paragraph lists the seven descriptors of a murmur in the order a clinician would record them and cites an assessment text for that convention. The post closes with a short example entry describing a grade 2 midsystolic murmur at the right upper sternal border radiating to the neck. Reply A takes the classmate's point about copied notes and adds evidence on cloned documentation, showing how a vague entry travels through a chart unchanged. Reply B disagrees with the claim that grade alone signals danger, using the review by Etchells and colleagues to show that timing and radiation say more. Each reply ends by naming the practical change for a note.
Where the points sit in the NU 610 Unit 5 rubric
A Herzing discussion rubric tends to judge the first post on content, critical thinking, use of evidence and writing, and score replies on how much they add to the thread. Content points go to a post that answers the actual prompt with accurate clinical detail rather than general comments. Critical thinking is credited when the writer takes a position and defends it, which is why the opening sentence matters. Evidence points require scholarly sources cited in the body and listed in APA format, and many rubrics specify recent peer-reviewed work. Reply points depend on substance: extending an argument, introducing a new source or offering respectful disagreement with reasons. Timeliness is a separate line in many rubrics and costs points automatically when missed. Writing scores cover grammar, clarity and professional tone. A reply that only praises the classmate's post usually earns little or nothing.
Common NU 610 Unit 5 mistakes, and how to avoid them
The commonest loss on this discussion is a reply that agrees and repeats, such as "great post, I also think documentation matters," which adds nothing to the thread. Initial posts often lose points when they restate the prompt for half their length before reaching a point. Students also cite a textbook for an opinion that needs a study, or list references at the end that never appear in the body. Murmur descriptions that skip timing or location undercut the very argument the post is making. Late first posts are a frequent and avoidable deduction. Some writers treat a disagreement as a personal criticism, and tone is scored. Keep each reply to one clear contribution with its own source, and close with something a classmate could answer, so the thread continues instead of ending with your reply.
Get a NU 610 Unit 5 example written to your instructions
Send the Unit 5 discussion prompt and the rubric your instructor uses in NU 610, plus the number of replies your section requires and any posts you are answering. We write a custom example post and matching replies to those criteria and return them in 24 to 48 hours. The first custom sample is free.
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NU 610 Unit 5 questions, answered
How many replies does a Herzing discussion normally require?
Your instructions carry the number and the deadlines, and sections differ. What matters more is what the replies contain, because two substantive responses that add evidence tend to outscore four that agree. Check whether your rubric separates the initial post from the responses, since in many sections the responses hold a large share of the available points.
Do discussion posts really need citations?
Almost always. A post asserting how something ought to be documented is making a practice claim, and practice claims carry support like any other written work in the course. One or two current references, cited in APA form and placed beside the claim they hold up, is normally enough. Reference formatting is scored here exactly as it would be in a paper.
Can I reuse my discussion post inside the graded assignment?
Not as written, and not without checking your instructions. The two are different deliverables: a post argues one narrow point for peers, while the assignment produces a record or a paper for faculty. Recycling the text usually reads as thin in the longer piece and can raise similarity flags. Reuse the idea, then write it again at the length the assignment expects.
Where can I find a free NU 610 Unit 5 sample paper?
The full NU 610 Unit 5 discussion, the initial post and both replies with their references, is on this page free of charge. If your discussion question differs, submit it through the request form and a custom post with replies built on your prompt is returned free within about two days.
How do you document a heart murmur for NU 610?
Record timing in the cardiac cycle, the location where it is loudest, radiation, intensity grade, pitch, quality and how it changes with position or maneuvers. A line such as "murmur noted" leaves out all seven and cannot be compared at the next visit.