| Course | NU 623 Adult Healthcare |
|---|---|
| Unit | Unit 6 |
| Paper type | Specialist referral letter |
| Length | About 770 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 6
Referral Letter to Rheumatology: New Symmetric Small-Joint Polyarthritis in a 44-Year-Old Woman
Student Name
Department of Nursing, Herzing University
NU 623: Adult Healthcare
Instructor Name
March 5, 2026
Referral Letter to Rheumatology: New Symmetric Small-Joint Polyarthritis in a 44-Year-Old Woman
Letter
To: Rheumatology Clinic. From: Primary Care, Family Nurse Practitioner. Re: Ms. B., composite patient, 44 years old. Urgency: requesting an appointment within four weeks, because early treatment of inflammatory arthritis within the first months of symptoms is associated with better long-term joint outcomes (Aletaha & Smolen, 2018), and she is now at week ten.
Question: Do you agree that Ms. B. has early rheumatoid arthritis, and would you like me to start treatment before she is seen? Specifically, would you prefer that I start methotrexate now, start a short course of low-dose prednisone as a bridge, or wait for your assessment? A direct answer to that question, even by phone, would be the most helpful reply.
Relevant History
Ms. B. is a dental hygienist with ten weeks of pain and swelling in both hands and wrists. Morning stiffness lasts about 90 minutes and improves with use. Symptoms are symmetric: second and third metacarpophalangeal joints and the proximal interphalangeal joints of both hands, both wrists, and, for the past three weeks, the balls of both feet. She has had to reduce her work hours because she cannot grip instruments for long. She reports fatigue but no fever, rash, mouth ulcers, dry eyes or mouth, hair loss, Raynaud symptoms, recent diarrhea, genitourinary symptoms, tick exposure, or psoriasis. Her sister has hypothyroidism; there is no family history of inflammatory arthritis or psoriasis. She smoked for ten years and quit five years ago. She is not planning pregnancy and uses a copper intrauterine device. Medications: naproxen 500 mg twice daily for the past six weeks with partial relief. No allergies.
Findings and Workup to Date
Examination on March 2: swelling and tenderness of the second and third metacarpophalangeal joints and second through fourth proximal interphalangeal joints bilaterally, both wrists, and tenderness on lateral squeeze of both forefeet; 12 tender and 10 swollen joints on a 28-joint count. No nodules, rash, nail changes, or dactylitis. Grip is weak bilaterally.
Laboratory results, February 26: rheumatoid factor positive at 88 IU/mL; anti-cyclic citrullinated peptide antibody strongly positive at more than three times the upper limit of normal; C-reactive protein 2.4 mg/dL; erythrocyte sedimentation rate 46 mm/h. Complete blood count normal apart from hemoglobin of 11.6 g/dL. Liver enzymes and creatinine normal. Hepatitis B surface antigen, hepatitis B core antibody, and hepatitis C antibody negative. Antinuclear antibody negative. Thyroid-stimulating hormone normal. Hand and foot radiographs on February 28 showed periarticular osteopenia without erosions. A chest radiograph was normal.
My Assessment
I believe this is early rheumatoid arthritis. Using the 2010 classification criteria, she scores 5 points for joint involvement (more than ten joints including at least one small joint), 3 for high-positive serology, 1 for elevated acute-phase reactants, and 1 for duration of six weeks or more, for a total of 10 of a possible 10; a score of 6 or more classifies definite rheumatoid arthritis (Aletaha et al., 2010). The differential I have considered includes viral arthritis, which is unlikely at ten weeks with strongly positive anti-cyclic citrullinated peptide antibody; psoriatic arthritis, with no skin or nail findings; systemic lupus erythematosus, with negative antinuclear antibody and no systemic features; and hypothyroid arthropathy, with normal thyroid function.
I have deliberately not started a disease-modifying drug or prednisone, because I would like your input on the choice and because steroids started before your examination could make your assessment harder. The hepatitis screening and baseline labs were drawn so that methotrexate could be started without delay if you agree it is the right first agent, consistent with the current guideline recommending methotrexate as the initial conventional disease-modifying drug for most patients with moderate to high disease activity (Fraenkel et al., 2021).
What She Has Been Told
Ms. B. knows that I suspect rheumatoid arthritis, that the blood tests support it, and that a specialist will confirm the diagnosis and discuss long-term treatment. She has been told that effective treatments exist and that starting early matters. She has not been told which medication she will receive. She is anxious about continuing her work and would like to discuss that at your visit. She understands that she may be contacted to start treatment before the appointment if you advise it.
Closing
Meanwhile, I will continue naproxen with omeprazole for stomach protection, recheck her blood count and kidney function in four weeks, and see her in two weeks for symptom review. I will start any treatment you recommend by phone and arrange the monitoring. Please contact me directly through the clinic line; a telephone reply is welcome. Thank you for seeing her.
References
Aletaha, D., & Smolen, J. S. (2018). Diagnosis and management of rheumatoid arthritis: A review. JAMA, 320(13), 1360-1372. https://doi.org/10.1001/jama.2018.13103
Aletaha, D., Neogi, T., Silman, A. J., Funovits, J., Felson, D. T., Bingham, C. O., III, Birnbaum, N. S., Burmester, G. R., Bykerk, V. P., Cohen, M. D., Combe, B., Costenbader, K. H., Dougados, M., Emery, P., Ferraccioli, G., Hazes, J. M. W., Hobbs, K., Huizinga, T. W. J., Kavanaugh, A., ... Hawker, G. (2010). 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatism, 62(9), 2569-2581. https://doi.org/10.1002/art.27584
Fraenkel, L., Bathon, J. M., England, B. R., St. Clair, E. W., Arayssi, T., Carandang, K., Deane, K. D., Genovese, M., Huston, K. K., Kerr, G., Kremer, J., Nakamura, M. C., Russell, L. A., Singh, J. A., Smith, B. J., Sparks, J. A., Venkatachalam, S., Weinblatt, M. E., Al-Gibbawi, M., ... Akl, E. A. (2021). 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care & Research, 73(7), 924-939. https://doi.org/10.1002/acr.24596
The Herzing NU 623 Unit 6 instructions
The Unit 6 assignment asks you to write a referral or consultation letter to a specialist for a patient in your case. Expect to state the reason for referral and the specific question or request at the start, along with the urgency. The letter should include only the history, findings and results the specialist needs, with dates. Many sections expect your own assessment, so the specialist knows what you think and why. What the patient has been told and what they expect from the visit are often required. Interim management and the plan for follow-up before the appointment should be stated. Cite classification criteria or guidelines where you use them, in APA 7. The rubric sets length, usually shorter than a paper. Use a composite patient and professional letter format.
Inside the NU 623 Unit 6 example
The letter begins with sender, recipient, patient identifier and urgency, and asks for an appointment within four weeks because early treatment improves joint outcomes. The history section is selective: duration, morning stiffness of about ninety minutes, symmetry, affected joints and function at work. Findings and workup list the examination with joint counts and a date, followed by laboratory results such as inflammatory markers and antibodies. The assessment states early rheumatoid arthritis and shows the classification score by domain. A short section explains what the patient knows and her questions. The closing lists the interim regimen with stomach protection, the laboratory recheck at four weeks, the two-week symptom visit and a direct contact for the specialist. The letter ends with a clear request for treatment recommendations and shared follow-up.
Where the points sit in the NU 623 Unit 6 rubric
Herzing rubrics for a referral letter usually score clarity of the request, relevance of clinical information, the referring clinician's assessment, communication with the patient, interim plan and professional writing. The request criterion rewards a specific question and stated urgency in the opening lines. Relevance points go to selected history and dated findings rather than a full chart. The assessment is often weighted heavily, and markers credit a working diagnosis supported by criteria. Patient communication points require stating what the patient has been told. Interim plan points depend on safe management until the appointment and named follow-up. Professional writing covers letter format, concise language and citations for any criteria or guidelines referenced, and a tone that respects the specialist's time.
Common NU 623 Unit 6 mistakes, and how to avoid them
Referral letters often lose points by burying the question at the end or never stating it. Students also include the whole history, which makes the letter long and hides the important findings. Laboratory results without dates or units are hard for the specialist to use. Many letters leave out the referring clinician's own assessment, which weakens the communication. Urgency is sometimes missing, though it often decides when the patient is seen. Interim management and follow-up are commonly skipped. Another frequent gap is not saying what the patient has been told, which can create confusion at the first specialist visit. Finally, use a professional letter structure; a letter written as an essay does not match the genre the unit is grading.
Get a NU 623 Unit 6 example written to your instructions
Send the Unit 6 instructions and the rubric from your NU 623 classroom, plus the case and the specialty your referral is addressed to. We write a custom example with a specific question, the workup summarized and the referrer's own assessment included, returned in 24 to 48 hours. The first custom sample is free.
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NU 623 Unit 6 questions, answered
What makes a referral question specific?
It names what would count as an answer. Please assess and advise invites whatever that specialist usually addresses; does this patient meet criteria for the procedure, given these findings, tells them exactly what you need. Specific questions come back faster and more usefully, and the assignment is graded on whether yours could be answered directly.
How much history should the letter carry?
What bears on the question, written by you. A pasted problem list and three years of notes is a chart transfer rather than a referral, and the specialist has to reconstruct the relevant thread themselves. Summarize the course of the problem, the treatments tried and the results, and leave everything else out.
Should I include my own assessment?
Yes, and it changes the quality of the reply. Stating your working diagnosis and the alternatives you are holding gives the specialist your reasoning to engage with rather than a blank slate, and colleagues respond to that differently. It also demonstrates the clinical thinking the rubric is grading, which a bare request cannot show.
Where can I find a free NU 623 Unit 6 sample paper?
The NU 623 Unit 6 rheumatology referral letter is reproduced in full on this page, free, with the request, findings, assessment and interim plan. For a referral to another specialty, send your case and you will receive a free custom letter, usually within two days.
What should a referral letter include?
State the question and urgency first, then give only the history, dated findings and results the specialist needs. Add your own assessment, what the patient has been told, interim management and how to reach you.