| Course | NU 610 Advanced Health Assessment |
|---|---|
| Unit | Unit 7 |
| Paper type | Case analysis of examination findings |
| Length | About 1,100 words, 7 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 610 Unit 7
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
Reading the NU 610 Unit 7 instructions
For Unit 7 you analyze a case, usually supplied in the classroom, by selecting an appropriate examination, documenting findings and interpreting them for that patient. Expect to justify the examination you chose instead of performing a complete survey by default. Findings should be written as observations, then classified, for example as expected for age, abnormal and requiring follow-up, or uncertain. Many prompts ask you to explain at least one finding in depth using evidence on its predictive value. The analysis should end with how the findings change the plan: tests, referrals, screening or follow-up timing. Relevant screening guidelines should be cited where they apply. Keep the retelling of the case short. A real patient from your clinical rotation should not be used, and the paper follows APA formatting with references.
How this NU 610 Unit 7 example is built
The paper starts with the case in a short paragraph: age, risk factors, smoking history and the absence of a new complaint. Selection of the examination comes next, with a reason for each region, such as the abdomen because of age, sex and smoking history. Documented findings follow in standard order with measured values, including blood pressure in both arms. Interpretation sorts the results into groups, explaining why a soft S4 and increased thoracic curvature are common in this age group while the pulsatile mass is not. The carotid bruit section weighs the evidence and explains why its presence or absence is a weak guide to narrowing. The final section turns findings into actions: an ultrasound ordered at this visit for the abdominal aorta, a repeat hearing test with masking and a plan for the bruit, each with a cited source.
Where the points sit in the NU 610 Unit 7 rubric
In a Herzing case analysis rubric, points are commonly divided among selection of assessment, documentation of findings, interpretation, plan or follow-up and scholarly writing. Selection is scored on whether the exam fits the patient's age, risks and reason for visit rather than following a fixed template. Documentation points go to precise, measured findings recorded in a logical order. Interpretation tends to carry the most weight; markers look for correct separation of normal aging from pathology and for reasoning supported by evidence. The plan criterion rewards actions that follow from specific findings and match current screening guidance. An honest discussion of an uncertain finding often earns credit under critical thinking. Writing points depend on clear headings, accurate clinical terms and APA citations for the guidelines and studies used.
Common NU 610 Unit 7 mistakes, and how to avoid them
The usual mistake in this case analysis is treating every finding as abnormal, so expected aging changes are reported as disease and the real concerns get lost. Students also perform and document a full head-to-toe exam without explaining why, which misses the selection criterion. Some restate the entire case before any analysis begins, using up length that should go to interpretation. Findings listed without classification leave the grader to do the thinking. Another weak point is a plan that is generic, such as "follow up in one year," with no link to a finding. Screening recommendations should be cited from a current guideline, not from memory. Finally, uncertain findings are often ignored; acknowledging that one result does not fit neatly and explaining how it will be resolved shows the reasoning this unit rewards.
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.
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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.
Where can I find a free NU 610 Unit 7 sample paper?
The whole NU 610 Unit 7 analysis is on this page at no cost, from the choice of examination to the orders it produces, with margin notes explaining the classifications. For a version written on your section's own case, use the request form and a custom analysis is sent free within about two days.
How do you tell normal aging from abnormal findings in an older adult exam?
Compare each finding with what assessment texts describe as common after 65, such as arcus senilis or reduced ankle reflexes, and ask whether it is symmetric, long-standing and without symptoms. New, asymmetric or risk-linked findings, like a pulsatile abdominal mass in a former smoker, need action.