| Course | NU 610 Advanced Health Assessment |
|---|---|
| Unit | Unit 6 |
| Paper type | Documentation critique with rewrite |
| Length | About 1,050 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 610 Unit 6
Critique of a Peripheral Vascular Examination Note for Exertional Calf Pain
Student Name
Department of Nursing, Herzing University
NU 610: Advanced Health Assessment
Instructor Name
March 9, 2026
Critique of a Peripheral Vascular Examination Note for Exertional Calf Pain
The Note Under Examination
The excerpt below is a composite written for teaching. It is reproduced unedited so every claim in this critique can be checked against the same words.
"67 y/o M c/o L calf pain w/ walking x 3 mo. Exam: Ext WNL. Pulses nml. No edema. Skin intact. Cap refill ok. Sensation grossly intact. Hair loss LE. Neg Homans. Pt ambulatory. A: claudication vs MSK. P: ABI, f/u prn. Same as prior visit."
The standard applied is the descriptive documentation standard for the peripheral vascular examination in Bickley et al. (2021): each finding names the structure, the side, the method used to obtain it, and a description a second clinician could reproduce. For a patient with exertional leg pain, the expected content also follows the examination elements that Khan et al. (2006) found to carry real diagnostic value for lower extremity arterial disease, namely palpation of the foot pulses, auscultation for femoral bruits, comparison of skin temperature and color between the legs, and inspection of the feet.
Defects by Type
Labeled findings in place of descriptions. "Ext WNL," "Pulses nml," and "Cap refill ok" each report a verdict rather than an observation. The reader cannot tell which pulses were palpated, what grade was felt, or whether capillary refill took one second or three. For a patient whose complaint suggests arterial insufficiency, the pulses are the central finding, and "nml" makes it impossible to know whether the popliteal, dorsalis pedis, and posterior tibial pulses were examined at all.
Missing laterality. The complaint is on the left, yet no finding in the note has a side except the complaint itself. "Hair loss LE" could mean one leg or both, and the difference matters: symmetric hair thinning is common with age, while hair loss confined to the symptomatic leg supports reduced arterial flow on that side. "No edema" and "Skin intact" also lack sides, so a later clinician who finds a small ulcer on the left heel cannot know whether it was missed or new.
Maneuvers without method, and one maneuver that should not be there. "Sensation grossly intact" does not say whether light touch, monofilament, or vibration was tested, or where. "Neg Homans" records a test for deep vein thrombosis that has poor accuracy and does not address the complaint in the note, which is exertional pain that suggests an arterial cause; including it signals a template rather than an examination chosen for this patient. Nothing records whether femoral bruits were listened for, whether the feet were inspected between the toes, or whether skin temperature was compared side to side.
Ambiguous abbreviations and carried-forward text. "Nml" and "WNL" are shorthand of the kind that safety bodies treat as error-prone when it stands in for measured values (Institute for Safe Medication Practices, 2021), and "f/u prn" leaves the follow-up to the patient's judgment. The final sentence, "Same as prior visit," is the most serious defect. Weis and Levy (2014) describe how copied or referenced text makes it impossible to tell which findings were examined on the day of the note. If the prior visit was for a different complaint, the whole examination may never have been performed today.
What the Note Does Well
A fair critique also records what the original gets right, because the rewrite should keep it. The complaint is localized to the left calf, tied to walking, and given a duration of three months, which is the core of an exertional pain history. The assessment offers two named possibilities rather than a single label, which shows the writer was reasoning rather than filling in a diagnosis. The plan names a specific test, the ankle-brachial index, that directly addresses the leading possibility. Those three elements are the skeleton of a good entry; the defects above sit in the examination between them, which is exactly the part of the record this course asks students to master.
The note is also short, and brevity is not itself the problem. A peripheral vascular entry for this complaint can be written in six or seven lines and still meet the standard. The issue is that the brevity here was achieved by replacing observations with verdicts, which saves the writer a few seconds and costs every later reader the examination.
Rewritten Passage
Original: "Pulses nml. No edema. Cap refill ok. Hair loss LE."
Rewritten, at comparable length: "Pulses by palpation, patient supine: femoral 2+ R and L; popliteal 2+ R, 1+ L; DP 2+ R, absent L; PT 2+ R, 1+ L. No femoral bruit R or L. Cap refill great toe under 2 s R, 4 s L. Hair absent over dorsum of L foot and lower L shin; present R. No pitting edema either leg."
The rewrite is not longer in any meaningful sense and does not change the style of the original. It changes what a reader can do with it. A clinician reading the revision knows the left foot pulses are diminished or absent, knows the right is the comparison, and can repeat each finding in the same position to see whether anything has changed.
Who Reads This Note Next
Three readers depend on this entry. The vascular specialist who receives the ankle-brachial index referral needs the baseline pulse examination to judge whether the disease has progressed by the time of the appointment; with the original note, that specialist must repeat the full examination and cannot compare it with anything. The next primary care clinician needs the side-by-side findings to recognize a change such as a new cool foot or a new absent pulse, which would move the urgency from routine to same day. The patient, finally, is poorly served by "f/u prn," because a person with claudication should be told which changes, such as pain at rest or a wound that will not heal, mean he should return promptly.
The defect in this note that most changes what the next clinician would do is the undocumented pulse examination. If the left dorsalis pedis pulse is truly absent, the patient has objective evidence of arterial disease and needs risk factor management and a timely index measurement. If it is present, the working impression of claudication is weaker and the musculoskeletal explanation deserves more attention. As written, the note supports neither path.
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.
Institute for Safe Medication Practices. (2021). ISMP list of error-prone abbreviations, symbols, and dose designations. https://www.ismp.org/recommendations/error-prone-abbreviations-list
Khan, N. A., Rahim, S. A., Anand, S. S., Simel, D. L., & Panju, A. (2006). Does the clinical examination predict lower extremity peripheral arterial disease? JAMA, 295(5), 536-546. https://doi.org/10.1001/jama.295.5.536
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 6 instructions
The Unit 6 assignment asks you to critique a supplied or composite examination note against accepted documentation standards and to show how it should be written. Expect to quote or reproduce the note so that every criticism can be checked against its words. The critique should group problems by type, such as vague terms, missing elements, unsafe abbreviations or unsupported conclusions, rather than listing them line by line. Many sections also ask you to recognize what the note does well. A rewritten version of at least one passage is commonly required, written to the standard you have described. Some prompts add a reflection on who uses the note and what harm a poor entry could cause. The paper should cite an assessment text for the documentation standard and any evidence about record quality. Avoid using a real note from your clinical placement.
How this NU 610 Unit 6 example is built
The sample begins by presenting the note as a teaching composite, reproduced exactly. The defects section is organized into categories: labeled findings in place of descriptions, absent side-to-side comparison, missing measurements such as capillary refill time, and abbreviations flagged by a medication safety list. Each category quotes the original phrase and explains what information is lost. A short section credits the note for localizing the complaint to the left calf and tying it to walking distance, which the rewrite keeps. The rewritten passage replaces four vague entries with graded dorsalis pedis and posterior tibial pulses on both sides, measured refill, hair distribution and skin temperature. The final section explains how a vascular specialist, a covering provider and a coder each rely on the note. References support the standard and the risk of copied documentation.
Reading the NU 610 Unit 6 rubric
A Herzing rubric for a documentation critique usually awards points for identification of deficiencies, application of standards, the rewrite, analysis of consequences and scholarly writing. Identification points require specific problems quoted from the note, not general comments that it lacks detail. Application of standards is scored on whether each criticism is tied to a cited convention from an assessment text or a safety source. The rewrite criterion carries significant weight in many sections, and markers look for measured findings, bilateral comparison and correct terminology in the revised passage. Consequence analysis earns credit when the paper explains who reads the note and how a gap would affect a decision. Balance is sometimes part of the score, so acknowledging strengths can help. Writing points cover organization by theme, a professional tone toward the original author and correct APA style.
Common NU 610 Unit 6 mistakes, and how to avoid them
Critiques often lose points by becoming a list of every line in the note with "this is wrong" beside it, which shows no organizing judgment. Another common gap is criticizing vague terms without showing the better wording, so the rewrite never appears or covers only one phrase. Students sometimes use a real note from their own placement, which raises privacy problems and is usually not allowed. Standards stated without a citation are treated as opinion. Harsh language about the note's author costs tone points and adds nothing. Some rewrites introduce findings that were never in the original scenario, which is invention rather than correction. Finally, papers that stop at the note itself and never say why the defects matter to the next reader miss the consequence criterion that many rubrics include.
Get a NU 610 Unit 6 example written to your instructions
Send the Unit 6 instructions and the rubric from your NU 610 classroom, along with the note your section supplied for critique. We write a custom example that applies a stated standard, sorts the defects and includes the rewritten passage, returned in 24 to 48 hours. The first custom sample is free. If the note came from practice, strip the identifiers before you send it.
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NU 610 Unit 6 questions, answered
What standard should I judge the note against?
Start with whatever your instructions name, then support it with the documentation expectations already taught in this course and with published guidance on record keeping. The point is that the standard exists on the page before the critique begins. A critique measuring against an unstated internal sense of good charting cannot be scored for accuracy, however sound the observations underneath it are.
Can I critique a note from my own clinical site?
Only if your instructions permit it and only after every identifier is removed, including dates, unit names and anything that narrows the patient. Hours you log in practice, and any evaluation a preceptor puts a signature on, sit outside what anyone else can write for you. Where a section supplies its own sample note, use that instead, since faculty are scoring the critique rather than its source.
Is a rewrite required in a documentation critique?
Check the instructions, but include one even when it is optional. A rewritten passage is the fastest proof that the writer can produce the standard being demanded, and rubrics that reward application usually have somewhere to put it. Keep the rewrite the same length as the original so the improvement is clearly the documentation and not simply more words.
Where can I find a free NU 610 Unit 6 sample paper?
This page contains the complete NU 610 Unit 6 critique, the original composite note, the grouped defects, the rewrite and the consequences section, free to read. If you were given a different note to critique, send it with your prompt and a custom critique comes back free within about two days.
How do I critique a nursing documentation note?
Reproduce the note, then group its problems by type, such as verdict words, missing comparisons, absent measurements and risky abbreviations, citing a standard for each. Credit what it does well, rewrite the weakest passage properly, and explain who depends on the note and how the gaps would affect them.