| Course | NU 623 Adult Healthcare |
|---|---|
| Unit | Unit 4 |
| Paper type | Episodic visit note |
| Length | About 790 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 623 Unit 4
Episodic Visit Note: Six Days of Facial Pressure and Nasal Congestion in a 39-Year-Old Man
Student Name
Department of Nursing, Herzing University
NU 623: Adult Healthcare
Instructor Name
February 12, 2026
Episodic Visit Note: Six Days of Facial Pressure and Nasal Congestion in a 39-Year-Old Man
Subjective
Chief complaint: "My face feels full and I can't breathe through my nose." Mr. A., a composite 39-year-old accountant, reports six days of nasal congestion, thick yellow nasal discharge, and pressure over both cheeks that is worse when he bends forward. Symptoms began with a sore throat and sneezing that his children also had. He rates the facial pressure at 4 out of 10. He felt warm on day two but did not measure a temperature and has not felt feverish since. He reports that symptoms were worst on days three and four and are slightly better today; there has been no second worsening after initial improvement. He has used saline spray and pseudoephedrine with some relief.
Targeted history for the differential: no tooth pain or recent dental work, no swelling around the eyes, no vision change, no severe headache, no neck stiffness, and no confusion. He has seasonal allergies in spring but no itchy eyes now. He has had no sinus surgery and no prior episodes needing antibiotics. He does not smoke. Medications: pseudoephedrine 60 mg as needed, loratadine in spring. Allergies: none. Review of systems beyond the presenting problem was limited to the items above and to a negative screen for chest symptoms (no cough beyond throat clearing, no shortness of breath), because those bear on the differential.
Objective
T 98.7 F, HR 76, BP 142/90 (left arm, seated, one reading), RR 14, SpO2 98% on room air.
General: comfortable, speaking in full sentences, voice mildly nasal. Face: mild tenderness to palpation over both maxillary sinuses, none over the frontal sinuses; no facial swelling or erythema. Eyes: no periorbital edema; extraocular movements full without pain. Nose: nasal mucosa red and swollen bilaterally with thick yellow discharge on the inferior turbinates; no polyps seen; septum midline. Throat: mild posterior pharyngeal erythema with postnasal drainage; tonsils not enlarged, no exudate. Ears: tympanic membranes gray with normal landmarks on both sides. Neck: small, mobile, nontender anterior cervical nodes, supple, no meningismus. Teeth: no percussion tenderness of the upper molars. Lungs: clear to auscultation.
Not performed and not recorded: sinus transillumination and imaging, which do not change management here.
Assessment
1. Acute rhinosinusitis, most likely viral, day six. Supporting: symptoms began with a household viral illness, have lasted less than ten days, are already slightly improving, and have not followed a second worsening. Purulent discharge and maxillary tenderness do not by themselves distinguish viral from bacterial infection. The clinical criteria for suspecting acute bacterial rhinosinusitis are persistent symptoms for ten days or more without improvement, severe symptoms with high fever and purulent discharge for three to four consecutive days, or worsening after initial improvement; he meets none of them (Chow et al., 2012; Rosenfeld et al., 2015).
Alternatives still in play: acute bacterial rhinosinusitis, not excluded, because day six is early and a second worsening could still occur. Allergic rhinitis, less likely out of season and without itching. Dental source, unlikely with no dental symptoms and no percussion tenderness. Complicated sinusitis with orbital or intracranial spread, not supported by any finding, and specific warning signs are given to him below.
2. Elevated blood pressure reading, single measurement, not yet assessed. Pseudoephedrine can raise blood pressure, and he has taken it today.
Plan
1. Acute rhinosinusitis. No antibiotic today, because he meets no criterion for bacterial infection and most cases resolve on their own. Symptomatic care: saline irrigation twice daily; intranasal fluticasone 50 mcg, two sprays in each nostril once daily, which modestly improves symptoms in acute rhinosinusitis (Rosenfeld et al., 2015); acetaminophen or ibuprofen as needed for facial pain. Stop pseudoephedrine because of the blood pressure reading. Education given in these words: "This is most likely a virus. It usually takes ten days to two weeks to clear. Antibiotics would not help a virus and can cause side effects." Return precautions: return if symptoms last beyond day ten without improvement, if he gets better and then clearly worse, or if he develops fever above 102 F. Go to the emergency department for swelling or redness around the eyes, double vision, a severe headache, a stiff neck, or confusion.
2. Elevated blood pressure. Deferred to a follow-up visit, not addressed today beyond stopping the decongestant. He will return in four weeks for repeat measurement using proper technique, with a home blood pressure log in the meantime; hypertension is not diagnosed on one reading taken during an acute illness while using a decongestant, and confirmation should rest on properly measured repeat and out-of-office readings (Muntner et al., 2019).
Deferred: preventive care items were not addressed at this visit and are scheduled for his annual examination.
References
Chow, A. W., Benninger, M. S., Brook, I., Brozek, J. L., Goldstein, E. J. C., Hicks, L. A., Pankey, G. A., Seleznick, M., Volturo, G., Wald, E. R., & File, T. M., Jr. (2012). IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clinical Infectious Diseases, 54(8), e72-e112. https://doi.org/10.1093/cid/cir1043
Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., Myers, M. G., Ogedegbe, G., Schwartz, J. E., Townsend, R. R., Urbina, E. M., Viera, A. J., White, W. B., & Wright, J. T., Jr. (2019). Measurement of blood pressure in humans: A scientific statement from the American Heart Association. Hypertension, 73(5), e35-e66. https://doi.org/10.1161/HYP.0000000000000087
Rosenfeld, R. M., Piccirillo, J. F., Chandrasekhar, S. S., Brook, I., Ashok Kumar, K., Kramper, M., Orlandi, R. R., Palmer, J. N., Patel, Z. M., Peters, A., Walsh, S. A., & Corrigan, M. D. (2015). Clinical practice guideline (update): Adult sinusitis. Otolaryngology-Head and Neck Surgery, 152(2 Suppl.), S1-S39. https://doi.org/10.1177/0194599815572097
NU 623 Unit 4 instructions, in plain terms
The Unit 4 assignment asks for documentation of an episodic or acute visit, typically in SOAP format, from a case in the classroom. Expect a focused subjective section with the chief complaint in quotation marks, a history of present illness and the pertinent negatives that matter for the diagnosis. The objective section should include vital signs and a focused exam. The assessment should state the diagnosis with supporting reasoning and, where appropriate, alternatives not yet excluded. The plan should cover treatment, education, follow-up and return precautions, and many sections expect guideline support for decisions such as antibiotic use. Incidental findings, like an elevated blood pressure, should be addressed rather than ignored. Cite current guidelines in APA 7. The note should read like real documentation, concise and specific, and the case should be composite.
How the NU 623 Unit 4 example is put together
The note opens with the patient's words and a history that places the symptoms in time: six days, beginning with a household cold, now slightly improving. Pertinent negatives include no fever above a stated level, no severe unilateral pain and no worsening after initial improvement. The objective section lists vital signs with the blood pressure reading, then nasal, sinus, ear and throat findings. The assessment numbers two problems. The first is acute rhinosinusitis, most likely viral, with the reasons and the guideline criteria for bacterial disease shown as not met. The second is elevated blood pressure on a single reading. The plan explains why no antibiotic is prescribed, gives saline irrigation and intranasal steroid instructions, lists return precautions and arranges home readings with a technique guide and a follow-up visit.
Where the points sit in the NU 623 Unit 4 rubric
Herzing rubrics for visit documentation commonly split credit among the four SOAP parts plus documentation quality. In the subjective part, credit goes to a focused story of the illness with the negatives that matter for sinusitis. Objective points require complete vital signs and an exam matched to the complaint. Graders tend to weight the assessment most, rewarding a diagnosis supported by the data, with criteria for alternatives addressed. Plan points depend on guideline-based decisions, including the reason for withholding an antibiotic, clear education and specific return precautions. Many rubrics also credit recognizing and addressing an incidental problem. Documentation quality covers concise language, standard abbreviations and APA citations for the guidelines used, and markers notice whether each plan item connects to a numbered problem.
NU 623 Unit 4 help: mistakes that cost points
Episodic notes frequently lose points when antibiotics are prescribed without meeting the criteria for bacterial sinusitis, or withheld without explaining why. Students also skip pertinent negatives, which are what justify the diagnosis. An elevated blood pressure noted in the vitals and never mentioned again is a common and costly omission. Plans that say "supportive care" without specifics earn partial credit. Return precautions are often missing or vague. Some notes include a full review of systems that adds length without value for a focused visit. Another frequent problem is listing only one diagnosis when the assessment should acknowledge alternatives not yet excluded. Finally, keep the note in documentation style, not essay style, since graders read it as a chart entry.
Get a NU 623 Unit 4 example written to your instructions
Send the Unit 4 instructions and the rubric from your NU 623 classroom, plus the visit scenario your note documents. We write a custom example focused to the presenting problem, with pertinent negatives, live alternatives and a plan tied to the assessment, returned in 24 to 48 hours. The first custom sample is free.
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NU 623 Unit 4 questions, answered
How much review of systems belongs in an episodic note?
What bears on the differential and no more. A focused visit for a specific complaint does not produce a fourteen-system review, and recording one suggests either a template was used or the history was not actually taken. Cover the presenting problem thoroughly, include the systems that would change your reasoning, and leave the rest out.
Why record pertinent negatives?
Because they carry your reasoning. Noting that a patient denies a particular symptom is what shows an assessor why you moved a diagnosis down the list, and without them the assessment appears to arrive from nowhere. They also demonstrate that the history was directed by a differential rather than collected as a checklist.
Should I list diagnoses I have not excluded?
Yes, with what would distinguish them. An assessment naming one condition and nothing else gives a reader no view of your reasoning, and in practice it is how alternatives get forgotten. Name the two or three still live, say what feature or test would separate them, and state which way the current evidence points.
Where can I find a free NU 623 Unit 4 sample paper?
The whole NU 623 Unit 4 visit note is available here free, including the viral versus bacterial reasoning, the second problem and the plan. If your scenario is a different acute complaint, send it and we will draft a custom note for it free, most often in a day or two.
Should I prescribe antibiotics for sinusitis in a NU 623 note?
Only when the guideline criteria for bacterial sinusitis are met, such as symptoms beyond ten days without improvement, severe symptoms with high fever, or worsening after initial improvement. Otherwise document why antibiotics are withheld and give symptomatic care and return precautions.