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The NU 610 Unit 7 case analysis, in full
Sorting Examination Findings in a 74-Year-Old Man at an Annual Wellness Visit
Student Name
Department of Nursing, Herzing University
NU 610: Advanced Health Assessment
Instructor Name
March 16, 2026
Sorting Examination Findings in a 74-Year-Old Man at an Annual Wellness Visit
The Case in Brief
Mr. R., a composite 74-year-old retired machinist, attends an annual wellness visit with no new complaint. He has treated hypertension and hyperlipidemia, smoked a pack a day for 35 years until age 60, and reports that he "doesn't hear the grandkids as well." He walks two miles most days without symptoms. The case supplied a history and asked for an examination plan, documented findings, and an interpretation. The history is not repeated here beyond these lines because it was provided and restating it earns nothing.
Selecting the Examination
An annual visit in a man of this age is not a head-to-toe survey by default, so the examination was chosen by what each region could answer for him specifically. The eyes and ears were examined because age-related change in vision and hearing affects safety and function, and he raised hearing himself. The cardiovascular examination, including carotid auscultation, was chosen because of hypertension, hyperlipidemia, and a heavy smoking history. The abdomen was palpated for aortic width because a man aged 65 to 75 who has ever smoked belongs to the group for whom abdominal aortic aneurysm screening is recommended (Owens et al., 2019), and the bedside examination has some value in slender patients (Lederle & Simel, 1999). The skin was inspected because of decades of outdoor work. Vibration sense and gait were examined because falls and neuropathy change what a clinician recommends at this age.
Documented Findings
General: alert, well-groomed man, appears stated age, body mass index 23.8, walking into the room with a steady, slightly wide-based gait. Blood pressure 148/74 right arm and 146/72 left arm seated, heart rate 68 and regular. Eyes: grayish-white ring at the outer margin of both corneas, with a clear zone between the ring and the limbus; pupils 3 mm, equal, reactive to light. Ears: whispered voice test at arm's length, patient's opposite ear masked, failed on the right and passed on the left; canals clear bilaterally without cerumen impaction.
Neck and heart: a soft, short, high-pitched bruit over the left carotid bifurcation, heard with the bell during a held breath, not present on the right; no bruit over the base of the heart, so a radiating cardiac murmur was not the source. Regular rhythm, S1 and S2 present, soft S4 heard with the bell over the apical impulse after he rolled partly onto his left side, no murmur. Abdomen: patient supine with knees bent, abdomen thin and flat. A pulsatile mass is palpable above the umbilicus, and with both hands placed on either side of it the fingers are pushed apart with each beat, with an estimated width of 4 to 5 cm. No tenderness.
Skin: several flat, dark purple patches 1 to 3 cm on the backs of both forearms, nontender, which he says appear after minor bumps; multiple rough, scaly, skin-colored papules on the scalp and backs of both hands. Musculoskeletal: increased thoracic curvature, nontender. Neurologic: vibration sense with a 128 Hz tuning fork diminished at both great toes, present at both medial malleoli; ankle reflexes 1+ and symmetric; Romberg negative.
Interpreting the Findings
Expected for this patient. The ring at the corneal margin is arcus senilis, common after 60 and not by itself a sign of disease at this age. Increased thoracic curvature, reduced but symmetric ankle reflexes, and a soft S4 are frequently found in healthy older adults and are recorded as expected age-related findings (Bickley et al., 2021). His blood pressure, while above target, fits his known treated hypertension and is a management issue, not a new finding.
Normal variation that could be mistaken for pathology. The purple patches on the forearms are consistent with the fragile skin vessels of sun-damaged older skin; their location on sun-exposed surfaces, lack of tenderness, and history of minor trauma make them a benign variant, though his medication list should be checked for antiplatelet agents. Diminished vibration at the great toes with preserved vibration at the ankles is common after 70 and, in a man without diabetes and with a negative Romberg, is recorded as likely age related rather than neuropathy (Ball et al., 2023).
Unexpected findings. The expansile pulsatile mass above the umbilicus is the most significant finding of the visit. A pulse that pushes the examiner's hands apart, rather than simply lifting them, suggests aortic widening, and in a thin patient with this smoking history it cannot be attributed to a normal aortic pulsation (Lederle & Simel, 1999). The scaly papules on sun-exposed skin are also unexpected in the sense that they need a decision; they are consistent with lesions that warrant dermatologic follow-up. The unilateral failed whispered voice test is expected in part, because age-related hearing loss is common, but its asymmetry moves it out of the purely expected group.
Two findings were deliberately not placed in the expected group even though they are common at his age. Blood pressure that is equal in both arms is expected, but the reading itself is recorded against his treatment goal rather than against an age norm, because age does not make an elevated reading acceptable. The gait was steady, but a slightly wide base in a man with diminished distal vibration sense is documented with a timed walk planned for the next visit, since the same finding can be a benign habit or an early change in balance.
A Finding That Was Hard to Classify
The soft left carotid bruit did not fit neatly into any group. A carotid bruit in an older adult with vascular risk factors can reflect turbulence from narrowing at the bifurcation, but it can also be transmitted from elsewhere or heard without significant stenosis, and many important narrowings produce no bruit at all. It was recorded as unexpected, with the reason for uncertainty stated, and the absence of a basal cardiac murmur was documented to exclude a radiated sound. What would settle the classification is not a further bedside maneuver but the imaging decision the primary care clinician makes next.
What Happens Next in the Record
The abdominal finding makes the recommended one-time ultrasound screening an explicit order at this visit rather than a routine reminder. The asymmetric hearing result will be rechecked with the left ear masked more carefully and documented for audiology referral. The scalp and hand lesions will be measured and photographed with consent at the next visit if not referred sooner. The forearm patches, arcus, and kyphosis will be documented as baseline so that a later examiner can recognize change. Blood pressure will be rechecked at the follow-up visit for medication review.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel's guide to physical examination: An interprofessional approach (10th ed.). Elsevier.
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.
Lederle, F. A., & Simel, D. L. (1999). Does this patient have abdominal aortic aneurysm? JAMA, 281(1), 77-82. https://doi.org/10.1001/jama.281.1.77
Owens, D. K., Davidson, K. W., Krist, A. H., Barry, M. J., Cabana, M., Caughey, A. B., Doubeni, C. A., Epling, J. W., Jr., Kubik, M., Landefeld, C. S., Mangione, C. M., Pbert, L., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2019). Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement. JAMA, 322(22), 2211-2218. https://doi.org/10.1001/jama.2019.18928
What a finished NU 610 Unit 7 case analysis looks like
The finished example spends very little space retelling the case and most of it on the examination the case requires. The selection is justified in a few lines: this presentation, in this person, at this age, calls for these regions and these maneuvers. The documented findings follow in the physical language the course expects, with sides and positions attached. Then comes the part that belongs to this unit specifically, a sorted interpretation in which findings are placed into three groups: expected for this patient, normal variation that could be mistaken for pathology, and genuinely unexpected. Age related and developmental variation gets its own treatment, because that is where healthy findings are most often written up as abnormal. The closing lines say what would be examined or documented next.
How a NU 610 Unit 7 example is structured
The example runs from case to selection to record to meaning. It opens with a compressed restatement of the case, deliberately short, since the case was supplied and reproducing it earns nothing. The second part justifies the examination chosen, naming what each region is expected to answer, which is the move that turns a case into clinical work. The third part is the documentation itself, written to the same standard the earlier units set, with technique and laterality intact. The fourth part sorts the findings, and this is where the example is longest, because expected findings, benign variants and unexpected findings each need a reason attached. The closing part states significance and names the next examination or the next record entry, stopping before the differential argument that a separate course exists to handle.
Examination chosen before it is performed
The example states which regions the presentation requires and what each is expected to answer, so the record reads as a plan rather than a sweep.
Findings sorted, not simply listed
Every documented finding is placed into expected, benign variation or unexpected, and each placement carries a stated reason behind it.
Normal variation handled separately
Age related and developmental findings get their own treatment, because healthy variants are the ones most often written up as pathology in this work.
Significance stated without diagnosing
The interpretation says what a finding means for this patient and stops there, since arguing a full differential belongs to the reasoning course.
The next entry named
The closing lines state what would be examined again, monitored or documented at the following visit, which keeps the analysis clinically live.
Where marks go in NU 610 Unit 7
This work loses marks in both directions. Analyses that leap to a diagnosis abandon the criterion actually being scored, which is whether the writer can produce and interpret assessment data. Analyses that stop at a list of findings, with no sorting and no significance, leave the interpretation criterion empty instead. Between those sits the most common single error, treating expected variation as an abnormal finding, which reads to faculty as a gap in the underlying knowledge. Findings presented with no examination behind them are a fourth loss, since the case cannot have supplied them. Retelling the supplied case at length wastes the space the interpretation needs. The strongest versions name a finding they were unsure how to classify and say what would settle it.
Get a NU 610 Unit 7 example written to your instructions
Send the Unit 7 instructions and the rubric from your NU 610 classroom together with the case your section was assigned. We write a custom example that justifies the examination, documents it to the standard the course expects and sorts the findings by significance, returned inside 24 to 48 hours. The first custom sample is free.
NU 610 Unit 7 questions, answered
Should this case analysis include a differential list?
Read your instructions first, since a small number of possibilities is sometimes requested. Where it is open, keep the emphasis on assessment. This course is scoring whether you can gather, describe and interpret findings, and a long diagnostic argument tends to crowd out the documentation the rubric is actually looking for. A named leading concern with the findings behind it is usually enough.
How much of the supplied case should I restate?
Only enough to orient a reader who has the case in front of them anyway, which is a short paragraph at most. Faculty already know the scenario, so retelling it earns nothing while consuming the space where selection and interpretation should sit. Quote a specific detail when your reasoning depends on it, then move to what you would examine and why.
Can I substitute a patient I saw in clinical?
Only where the instructions allow it, and only fully de-identified. Note as well that logged clinical time and any preceptor signed paperwork belong to you alone and fall outside anything drafted on your behalf. Supplied cases are usually the safer choice here, because the rubric was written against the findings that particular case contains and scored on how you read them.