| Course | NR 304 Health Assessment II |
|---|---|
| Week | 2 |
| Paper type | Focused examination write-up |
| Length | About 1,270 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 304 Week 2
Focused Examination Write-Up: A 26-Year-Old Line Cook Who Rolled His Right Ankle Stepping Off a Loading Dock
Student Name
College of Nursing, Chamberlain University
NR 304: Health Assessment II
Instructor Name
Month Day, Year
Focused Examination Write-Up: A 26-Year-Old Line Cook Who Rolled His Right Ankle Stepping Off a Loading Dock
Complaint, Onset and the Systems That Follow
Mr. E., a 26-year-old line cook, was seen in the simulation center's urgent care room at 1930. He reports that at 1715 he stepped backward off the restaurant's loading dock, about 40 centimeters high, and his right foot turned in under him. He heard a pop, sat down at once and could not put weight on the foot for about ten minutes. He then walked, limping, to his car and drove here. His words: "It's the outside of my ankle, it's throbbing, and it's getting fat." He has no other injuries, did not hit his head and did not lose consciousness. He has had no previous injury to either ankle.
Because the complaint is a twisting injury to one ankle with an intact lower leg and no fall from height onto the head or back, the examination is aimed at two systems: the musculoskeletal system of the right ankle and foot, and the circulation and nerve supply below the injury. The left ankle serves as the comparator for every musculoskeletal and neurovascular entry. Other systems are covered in one line each below. The questions that decide whether an X-ray is needed come from the Ottawa ankle rules, which were developed to identify which acute ankle injuries need radiography and use bone tenderness at named points and the ability to bear weight (Stiell et al., 1992).
Musculoskeletal: Right Ankle and Foot, Left as Comparator
Reason for this block: the injured region.
Position: sitting on the exam table, both legs hanging, socks and shoes off.
Look, swelling: right ankle swollen over the outer side, in front of and below the outer ankle bone; left ankle with no swelling. Circumference in a figure-of-eight around the ankle and foot with a tape measure: right 55 centimeters, left 51 centimeters.
Look, color: right ankle pink-red over the swollen area with a 3 by 2 centimeter purple-blue patch below the outer ankle bone; left ankle pale pink, even.
Look, skin: no breaks in the skin on either side.
Feel, warmth: right outer ankle warmer to the back of the hand than the same area on the left.
Feel, bone tenderness at the Ottawa points, pressing with two fingertips: right outer ankle bone, back edge and tip, lower 6 centimeters: not tender; right inner ankle bone, back edge and tip, lower 6 centimeters: not tender; base of the right fifth long bone of the foot (outer border, midfoot): not tender; right navicular bone (inner midfoot): not tender. Same points on the left: not tender.
Feel, soft tissue: right, tender to light pressure in the soft hollow just in front of the outer ankle bone, rated 6 out of 10 on the 0 to 10 numeric scale; left, same spot, 0 out of 10.
Movement, active, with the knee bent: right, points the foot down to about 30 degrees and up to about 10 degrees before stopping with pain; turning the sole inward causes pain at the outer ankle; turning the sole outward is painless. Left, down to about 45 degrees and up to about 20 degrees, painless in all directions.
Weight bearing: took four steps across the room on the right foot, limping, with his weight shifted to the heel; on the left, even steps.
Knee and foot above and below the injury: right knee not tender, moves fully; right toes move fully and are not tender; the upper end of the fibula, just below the outer knee, not tender to pressing on either side.
Circulation and Nerves Below the Injury, Left as Comparator
Reason for this block: swelling after an ankle injury can press on vessels and nerves, so function below the injury is recorded before any wrapping or ice.
Pulses on the 0 to 4+ scale: top of the foot, right 2+, left 2+; behind the inner ankle bone, right 1+ (hard to feel under swelling), left 2+.
Color return after pressing the big toenail for 5 seconds: right under 2 seconds, left under 2 seconds.
Toe color and warmth: pink and warm on both sides.
Light touch with a cotton wisp, eyes closed: felt on the top of the foot, the sole, and between the first and second toes on both sides, equal.
Toe movement: wiggles all toes and pushes the big toe up and down against the student's finger, equal on both sides.
Other Systems, Compressed
General survey: alert, talking in full sentences, sitting upright, grimaces when the right foot moves.
Vital signs at 1935: temperature 36.9 degrees Celsius oral; pulse 88, regular; respirations 16; blood pressure 132/80 left arm sitting; oxygen saturation 99 percent on room air.
Head and neck: no tenderness or swelling to inspection and touch; neck turns fully without pain; asked because of the fall.
Skin elsewhere: no other bruises, scrapes or wounds seen on the exposed arms and legs.
Heart and lungs: not examined beyond the vital signs; no complaint and no mechanism involving the chest.
What Was Not Done, and Why
Special stress tests of the ankle ligaments (for example, pulling the foot forward on the shin): not done; they are painful when the ankle is freshly swollen, and the instructor's protocol for this case defers them to a follow-up visit.
Full head-to-toe examination: not done; the injury was confined to one ankle and there was no head strike, no loss of consciousness, and no complaint elsewhere.
Examination of the hip and back: not done; no pain there, full ability to sit and stand, and a mechanism limited to a twisted foot.
Abdominal examination: not done; no complaint, no blow to the body.
Summary
The right ankle shows swelling 4 centimeters greater in figure-of-eight measurement than the left, a patch of purple-blue color below the outer ankle bone, warmth, and soft-tissue tenderness in front of the outer ankle bone. None of the Ottawa bony points was tender on either side, and Mr. E. took four steps on the right foot with a limp. Pulses, color return, sensation and toe movement below the injury were present, with the pulse behind the right inner ankle bone weaker than the left. The student reported the findings to the simulation instructor, who played the role of the provider, and noted the weaker pulse so it could be checked again after swelling care. The student did not name a diagnosis. Bachmann et al. (2003) reviewed studies of the ankle rules and found them highly sensitive for excluding fractures, which is why the Ottawa points were recorded individually rather than summed up as no bony tenderness.
Reflection on Narrowing
The hard part of this week was writing so little about the rest of the body without feeling that something had been missed. In Health Assessment I every region got the same space, and the student's first draft of this exam carried a paragraph each on lungs and abdomen. That draft buried the one finding that mattered, the unequal pulse, under a normal abdomen. Writing a reason at the top of each block made the choice visible, and the list of deferrals meant nothing was simply absent. Jarvis and Eckhardt (2024) describe a focused examination as one directed by the presenting problem, and this write-up tries to show on the page that the direction came from the complaint and the mechanism.
References
Bachmann, L. M., Kolb, E., Koller, M. T., Steurer, J., & ter Riet, G. (2003). Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: Systematic review. BMJ, 326(7386), 417. https://doi.org/10.1136/bmj.326.7386.417
Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.
Stiell, I. G., Greenberg, G. H., McKnight, R. D., Nair, R. C., McDowell, I., & Worthington, J. R. (1992). A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Annals of Emergency Medicine, 21(4), 384-390. https://doi.org/10.1016/S0196-0644(05)82656-3
What the NR 304 Week 2 assignment asks for
For Week 2 you perform and document a focused examination for a specific complaint, usually in the simulation center with a standardized patient. Expect the instructions to ask for the history of the complaint, the systems examined and why, detailed findings in the affected region, brief findings elsewhere and a summary. The key skill is narrowing: examine what the complaint points to and say why other systems were not examined. Compare the affected side with the unaffected side in the same line. Record onset as a clock time and the mechanism in the person's words. List each deferred test with a reason. Keep interpretation out of the findings rows.
How this NR 304 Week 2 example is built
The write-up opens with Mr. E., his fall at 1715 and the sentence naming two systems: the right ankle and the circulation and nerves below it. The musculoskeletal block gives a reason, a position and findings for look, feel and movement, each set against the left ankle. The Ottawa points are listed one by one, all not tender, supported by Stiell et al. (1992) and Bachmann et al. (2003). The circulation block records a 1+ posterior tibial pulse under swelling and normal sensation. Other systems are compressed to a few lines. A section lists four deferrals with reasons. The summary states what was found, and the reflection explains how the first draft grew too wide.
Reading the NR 304 Week 2 grading rubric
Focused exam rubrics typically reward appropriate selection of systems, thorough examination of the affected region, comparison with the unaffected side, accurate documentation, justification of what was omitted and a summary without diagnosis. Selection and justification carry special weight this week, so a sentence explains why two systems follow from the complaint and each deferral has its reason. Thoroughness scores when every Ottawa point is recorded, since those findings decide the next step. Comparison is credited when both ankles appear in one line. Accurate documentation includes measurements, scales and times. A summary that reports findings rather than naming an injury fits the course scope. Clear units on every measurement protect the documentation row.
Common NR 304 Week 2 mistakes, and how to avoid them
The top loss is a narrow examination that silently grows back to full width, burying the key finding under twelve equal regions. Next is narrowing nobody justified, where systems are simply missing. Entries with a result and no site, findings called reduced with nothing they are reduced against, paired structures reported as one line, onset written as recently and deferrals with no reason all cost points. Interpretation in a findings row loses marks too. Record ordinary findings inside the focused region. If the complaint points to two systems, examine both and say why. Send the complaint and your notes, and an NR 304 focused write-up can be drafted with its deferrals defended.
Get a NR 304 Week 2 example written to your instructions
Give us the Week 2 instructions and the focused examination form your section posted, and a custom example is written into its rows inside 24 to 48 hours, with the complaint you were given driving which regions open up. The first one is free. Send the case text too where your prompt supplies one, since the narrowing has to follow what it actually says.
More NR 304 papers and pre-licensure samples
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- NR 304 Week 5: Case Study Analysis
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- NR 304 Week 8: Comprehensive Assessment Paper
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NR 304 Week 2 questions, answered
How do I know when a focused examination has gone too wide?
Ask what each region would change. If a positive finding there would alter what you do next, or would rule out something the complaint raises, it belongs. If it would only add a line to the page, it is padding and it dilutes the part being marked. Writing that test into the document as a short reason under each heading protects you when a marker disagrees with one of your choices.
The complaint could point at two different systems. Do I pick one?
Examine both and say so in the opening sentence. A complaint that reaches two systems is common, and a write-up naming both, then working each, reads as reasoning rather than as indecision. What loses marks is examining both while writing as though only one was intended, because the reader then cannot tell which regions were planned and which were afterthoughts added on the way through.
Do I still record the ordinary findings inside the focused region?
Yes, and they are worth real points here. A complaint region where three things were ordinary and one was not is a far stronger document than one reporting only the problem, because the ordinary entries are what show the region was actually covered. They also give the abnormal entry something local to stand against, which is the comparison this course keeps asking for.
Where can I find a free NR 304 Week 2 sample paper?
The full Week 2 focused exam of Mr. E.'s right ankle, with the Ottawa points, the left ankle comparison and the defended deferrals, is reproduced on this page.
Why are ligament stress tests deferred in the NR 304 Week 2 example?
They are painful on a freshly swollen ankle, and the instructor's protocol for the case moves them to a follow-up visit, so the write-up lists them as not done with that reason.