| Course | NR 304 Health Assessment II |
|---|---|
| Week | 6 |
| Paper type | Documentation and SBAR exercise |
| Length | About 1,230 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 304 Week 6
Documentation Exercise: A New Irregular Pulse at 0400 on the Second Night After Knee Replacement, Written Once and Said Once
Student Name
College of Nursing, Chamberlain University
NR 304: Health Assessment II
Instructor Name
Month Day, Year
Documentation Exercise: A New Irregular Pulse at 0400 on the Second Night After Knee Replacement, Written Once and Said Once
The Encounter
Mr. Q. is a 71-year-old retired high school band director on the orthopedic unit, two days after a left total knee replacement. The simulation placed the student as his night nurse. At the 0000 check his pulse was 78 and regular. At 0400 the student found it fast and irregular. This paper holds two versions of that encounter: the written record in the order things happened, and the spoken report to the covering provider, rebuilt around what changed. A short section after them explains the choices. The spoken report uses the SBAR structure, which organizes a call into situation, background, assessment and recommendation and was introduced to give clinicians a shared, predictable way to communicate about a patient (Haig et al., 2006).
Written Record
0000: Sleeping, woke easily to voice, oriented to person, place, date. Pulse 78, radial, one full minute, regular. Blood pressure 128/74, right arm, lying. Respirations 16. Temperature 37.1 degrees Celsius, oral. Oxygen saturation 96 percent, room air. Left knee dressing dry; left foot warm, pink, top-of-foot pulse 2+ on the 0 to 4+ scale, equal to right. Pain 3 of 10, numeric scale, at rest.
0400: Awake, said he woke "with my heart jumping around." Oriented to person, place, date.
0402: Radial pulse, right wrist, one full minute: 124, irregular, with no pattern to the spacing of beats and varying strength from beat to beat. Apical pulse, one full minute, stethoscope at the 5th intercostal space, left midclavicular line: 136, irregular. Difference between apical and radial counts: 12.
0405: Blood pressure 112/70, right arm, lying (0000: 128/74). Respirations 20 (0000: 16). Oxygen saturation 95 percent, room air (0000: 96). Temperature 37.2 degrees Celsius (0000: 37.1).
0406: Denies chest pain or pressure. Reports feeling "a bit lightheaded" when he sat up to use the urinal at 0350. Denies shortness of breath at rest.
0407: Skin warm and dry. Lungs: breath sounds equal both sides, no added sounds at 8 posterior sites. Legs: no swelling; both calves soft, nontender and matching in girth by eye; left knee dressing dry.
0408: Medication record reviewed: last metoprolol 25 milligrams by mouth at 2100; enoxaparin 40 milligrams under the skin at 2100. Admission record: no history of irregular heartbeat.
0409: Unit monitor applied per standing order; rhythm displayed as irregular, rate 120s to 130s. Charge nurse at bedside.
0412: Covering provider paged. Call returned 0415; report given (see spoken version).
0420: Orders received: 12-lead ECG now; basic metabolic panel and magnesium now; continuous monitoring; vital signs every 30 minutes for 2 hours. ECG done 0425.
Spoken Report, 0415, About 40 Seconds
"This is the student nurse with the charge nurse, calling about Mr. Q. in room 12, 71 years old, two days after a left knee replacement. Situation: at 0402 I found a new irregular pulse. Apical rate 136, radial 124, and it was 78 and regular at midnight. Blood pressure is 112 over 70, down from 128 over 74 at midnight. He says his heart is jumping around and he felt lightheaded sitting up about 20 minutes ago. No chest pain, no shortness of breath, saturation 95 percent on room air.
"Background: no history of an irregular heartbeat on admission. He takes metoprolol 25 twice a day, last dose at 2100, and he's on enoxaparin, last dose also at 2100.
"Assessment: the rhythm on the monitor is irregular, rate 120s to 130s, and he is lightheaded with a lower pressure than at midnight. I'm worried the rate is too fast for him.
"Recommendation: I'd like you to come and see him. Would you like an ECG and labs now, and do you want vital signs more often than every four hours?"
Why the Two Versions Differ
The written record follows the order of events, because a later reader, for example the day nurse or a reviewer, needs to know what was done when. It includes the ordinary findings, the clear lungs and the soft calves, because they show that nothing else moved between midnight and 0400, and a later reader needs them to see that the change was limited to the rhythm. Bickley et al. (2021) describe the record as the place where both positive and pertinent negative findings belong, and the clear lungs and soft calves are pertinent negatives here. The spoken version reverses the order. What changed comes first, because a provider woken at 0415 decides in the first seconds how urgent a call is. The spoken version keeps two numbers from midnight, the pulse and the blood pressure, because without them the listener hears 124 and 112 over 70 with nothing to compare them to. It leaves out the clear lungs and the soft calves except for a single statement about breathing, because the listener did not need them to decide whether to come.
Two choices were deliberate. First, the difference between the apical and radial counts appears in the written record but not in the spoken report, because the student judged that the apical rate and the fact that it was irregular carried the point and that one more number would have slowed the report. Second, the spoken report does not name a rhythm, even though the student suspected one. Naming a rhythm aloud would have been faster, but the student is not qualified to interpret a monitor strip and the provider was going to see an ECG. Saying irregular, 120s to 130s, and asking for the ECG gave the listener what was seen and a way to find out the rest.
Checking That the Two Agree
Before handing in the exercise, the student compared every number and time in the spoken version with the written record. Apical 136, radial 124, blood pressure 112 over 70, midnight values 78 and 128 over 74, saturation 95 percent, and the 2100 doses all appear in both, with the same figures. One discrepancy was found and fixed in the first draft: the spoken version had said the lightheadedness began "about an hour ago," while the written record placed it at 0350. The spoken version was corrected to about 20 minutes ago. A listener who later read the chart and found a different time would have had to decide which one was right.
Reflection
The first draft of the spoken report was the written record read aloud from the top. It took over two minutes, and the irregular pulse arrived after the 0000 vital signs, which described a patient who was fine. Rebuilding it around the change, rather than trimming it, was the step that mattered. Haig et al. (2006) describe SBAR as a way to make the critical information predictable, and ending with a request made the student decide what she actually needed before dialing, which the first draft never did. Jarvis and Eckhardt (2024) note that an irregular pulse should be counted for a full minute and checked at the apex, and that step made the difference between reporting a rate of about 120 and reporting two counts that told the listener something more.
References
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.
Haig, K. M., Sutton, S., & Whittington, J. (2006). SBAR: A shared mental model for improving communication between clinicians. Joint Commission Journal on Quality and Patient Safety, 32(3), 167-175. https://doi.org/10.1016/S1553-7250(06)32022-3
Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.
What the NR 304 Week 6 assignment asks for
For Week 6 you document a change in a patient's condition twice: once as a written nursing record and once as a spoken report to a provider, often using SBAR. Expect the instructions to ask for timed entries, objective findings with comparisons, a report script and a short explanation of your choices. The written record follows events in time order and includes normal findings that show what was checked. The spoken report is rebuilt, not shortened: lead with the change, give the earlier value aloud because the listener has no chart and end with a clear request. Check that every number and time matches across the two versions. Avoid naming a diagnosis.
How this NR 304 Week 6 example is built
The paper opens with Mr. Q., two days after a left knee replacement, and the encounter at 0400. The written record runs from 0000 to 0420, each entry timed, with an apical rate of 136 and radial of 124, blood pressure 112/70 beside 128/74 at midnight, clear lungs, soft calves and the 2100 metoprolol and enoxaparin doses. The spoken report follows as a 40-second SBAR call, leading with the new irregular pulse and ending with a request to come and see him, using the structure from Haig et al. (2006). A section explains why each version is ordered differently. Another checks every figure. The reflection describes the two-minute first draft.
NR 304 Week 6 rubric: what full points look like
Documentation exercises are usually graded on accuracy and timeliness of entries, objective language, use of comparators, the structure and clarity of the spoken report, consistency between versions and reflection on choices. The spoken report carries particular weight, so it leads with the change and ends with an actionable request. Timed entries with comparators earn credit in the written record. Objective language scores when the patient's words are quoted and no diagnosis is named. Consistency is checked number by number, which the paper does explicitly. Including normal findings in the record shows what was ruled out. Reflection is credited when it discusses choices, such as leaving the pulse deficit out of the call.
NR 304 Week 6 help from the desk
The heaviest deduction is a spoken report that is only the record shortened, with the change still buried. Close behind is a report that requests nothing. A comparator in the record but missing from the call, missing times, figures that differ between versions, a condition named aloud because it is faster and a reflection describing the exercise instead of the choices all cost points. A spoken report that runs too long to follow also loses marks. Aim for under a minute aloud. Keep the written record complete even when the call is short. Interpretation belongs in the call only as a concern. Bring your scenario, and both versions can be drafted to match.
Get a NR 304 Week 6 example written to your instructions
Send the Week 6 instructions with both templates if your classroom issued two, and a custom example is written into them and returned inside 24 to 48 hours. The first one is free. Where the exercise rests on somebody you looked after, those readings live in an employer's record and stay there, so send us the printed case or a scenario of your own.
More NR 304 papers and pre-licensure samples
- NR 304 Week 1: Symptom Timing Question Post
- NR 304 Week 2: Focused Ankle Exam Write-Up
- NR 304 Week 3: Abnormal Findings Report
- NR 304 Week 4: Pain Assessment Write-Up
- NR 304 Week 5: Older Adult Findings Ranking Case
- NR 304 Week 7: Risk Assessment Write-up
- NR 304 Week 8: Comprehensive Assessment Paper
- NR 324 Week 6: Perioperative Write-up
- NR 302 Week 6: Cardiovascular Assessment Write-Up
- NR 325 Week 6: Treatment Safety Analysis
- NR 293 Week 6: Older Adult Opioid Case Response
NR 304 Week 6 questions, answered
How much shorter should the spoken version be?
Short enough to say without a pause, which usually means a small fraction of the written record. Sections rarely print a word count for it and instead mark whether a listener could act on it. The test worth applying is whether somebody hearing it once, with no chart open, would know what changed, by how much, since when, and what you are asking them to do about it.
Does the written record still need everything if the spoken one is short?
Yes, and the gap between them is the point of the assignment. The record is where completeness lives, including the ordinary findings and the rows that turned up nothing. The spoken version selects from it under pressure. A student who thins the written half to match the spoken one has removed the material the selection was supposed to be made from and there is nothing left to mark.
Should the spoken half include my interpretation?
It should include what concerns you, stated as a concern, and stop short of a name. Saying that a reading has moved twice in four hours and that you want somebody to look is a concern. Saying what the underlying condition is takes you into another course's territory and, in this exercise, usually replaces the figures that would have justified the call in the first place.
Where can I find a free NR 304 Week 6 sample paper?
The complete Week 6 exercise, with the timed record of Mr. Q.'s new irregular pulse and the 40-second SBAR call to the provider, is published on this page.
What request ends the NR 304 Week 6 SBAR call?
The student asks the provider to come and see Mr. Q. and whether to order an ECG and labs now and check vital signs more often than every four hours.