| Course | NR 304 Health Assessment II |
|---|---|
| Week | 8 |
| Paper type | Comprehensive assessment paper |
| Length | About 1,460 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 8
Comprehensive Assessment Paper: A 52-Year-Old Roofer on the Morning After Admission With a Blood Glucose of 486 and Six Weeks of Thirst
Student Name
College of Nursing, Chamberlain University
NR 304: Health Assessment II
Instructor Name
Month Day, Year
Comprehensive Assessment Paper: A 52-Year-Old Roofer on the Morning After Admission With a Blood Glucose of 486 and Six Weeks of Thirst
Identifying Information, Consent and Reason for the Examination
Mr. J. is a 52-year-old roofer admitted through the emergency department at 2200 last night with a blood glucose of 486 milligrams per deciliter. He reports six weeks of thirst, passing urine "every hour, day and night," blurry vision when reading his phone, and a weight loss he estimates at 15 pounds. He has had no regular medical care for eight years. The examination was done on hospital day 2 from 0900 to 0950, in his room, with the curtain drawn. At 0855 the student explained the examination, told him he could decline any part, and he agreed verbally; the primary nurse witnessed and co-signed the consent row on the course form.
The reason for this examination is to record, from head to toe, what the high glucose and the weeks before admission have done to his body, so that the team and the diabetes educator have a baseline. The analytical section at the end answers that reason and draws only on the entries above it. Terms and scales follow the course text (Jarvis & Eckhardt, 2024).
General Survey and Measurements
Position: sitting in the bedside chair for the survey, then as noted in each block.
Appearance: alert; knows who he is, where he is, today's date and why he was admitted; answers in full sentences; drinking from a water cup throughout.
Weight: 84.2 kilograms on the standing scale, in a gown, at 0900; he reports 91 kilograms at a clinic check two months ago (comparator: his report, not a measured value).
Height: 180 centimeters, measured.
Temperature: 36.9 degrees Celsius, oral.
Blood pressure and pulse, lying after 5 minutes: 124/78, pulse 86.
Blood pressure and pulse, standing at 1 minute and 3 minutes: 1 minute, 116/76, pulse 104; 3 minutes, 114/74, pulse 106. Comparator: the lying reading. He reported feeling "a little light in the head" at 1 minute.
Respirations: 16, even, quiet.
Oxygen saturation: 98 percent, room air.
Fingerstick glucose, 0730: 264 milligrams per deciliter (comparator: 486 on admission).
Skin and the Head and Neck Regions
Position: sitting.
Skin, arms and trunk: light tan, warm, dry; when the skin over the collarbone was lifted, it returned to flat in about 3 seconds (comparator: under 2 seconds expected in an adult of his age per the course form); no rashes; small healed cuts on both hands.
Skin, back of the neck and armpits: darker, velvety patches of skin, about 6 by 3 centimeters at the back of the neck, and similar patches in both armpits; he says they have been there "for years."
Head and face: symmetric; no tenderness.
Eyes: whites white; pupils 4 millimeters, equal, both narrowing to light; eye movements full; with each eye in turn, the smallest line read on a near card held 14 inches away was 20/40 (comparator: 20/20 line, which he could not read); inside of the eye not examined.
Ears: canals pink; eardrums pearly gray on both sides.
Mouth: lips dry with small cracks; tongue dry with a thin white coat; gums pink, with redness and swelling along the lower front teeth; two back teeth missing.
Neck: windpipe midline; thyroid not enlarged to touch; no nodes felt.
Chest, Heart and Abdomen
Position: upright for the posterior chest; bed head raised 30 degrees for the anterior chest and heart; flat with knees supported for the abdomen.
Lungs: chest rises equally; resonant to tapping at all sites; breath sounds soft and low-pitched at the bases, equal right and left at all 12 sites; no added sounds.
Heart: apical impulse felt in the left 5th intercostal space where it crosses the midclavicular line; two sounds at all five areas, nothing between them; rate 86, regular, lying.
Abdomen, look: flat; symmetric; no scars.
Abdomen, listen: gurgling sounds in all four quadrants, 8 to 12 in one minute each.
Abdomen, tap: hollow in all four quadrants.
Abdomen, feel: soft in all four quadrants to light and deep pressure; no firm structures; no discomfort.
Arms, Legs, Feet and Nerves
Position: lying for the legs and feet; seated at the bedside, legs hanging, for reflexes and strength; standing for gait.
Pulses, 0 to 4+ scale, right and left: radial 2+ and 2+; top of the foot 2+ and 1+; behind the inner ankle bone 2+ and 2+.
Legs: warm to the touch from knee to ankle, matching in color right and left; shin hair on both; no swelling.
Feet, skin: dry on both soles; a yellow callus, 2 by 1.5 centimeters, under the ball of the right foot; a crack about 1 centimeter long in the skin of the right heel, not bleeding, with no redness or drainage around it; toenails thick and yellow on both big toes; skin between the toes dry and intact on both feet.
Feet, footwear: he wears steel-toe work boots 10 hours a day, six days a week; the right boot's inside heel is worn through.
Feet, 10-gram monofilament, four sites on each sole (big toe and the first, third and fifth metatarsal heads), eyes closed: right, felt at 4 of 4 sites; left, felt at 3 of 4, not felt at the first metatarsal head.
Feet, vibration, 128-hertz tuning fork on the bony top of each big toe: right, felt until the student could no longer feel it on her own finger; left, stopped feeling it about 4 seconds before the student did.
Reflexes, 0 to 4+ scale: knee 2+ and 2+; ankle 2+ right, 1+ left.
Strength, 0 to 5 scale: all groups 5 of 5, equal.
Gait: steady, even steps; tandem walk without losing balance.
Analysis: The Findings That Were Not Ordinary
The record above contains six sets of findings that did not match their comparators. They are listed here in the order the student would address them, with the entry each one comes from.
First, signs of fluid loss: standing pulse 20 beats above lying, with lightheadedness at 1 minute; skin over the collarbone slow to return to flat; dry lips and tongue; and constant thirst. These are grouped first because they can be acted on today.
Second, the feet: reduced sensation at one site on the left sole, shorter vibration sense and a weaker ankle reflex on the left, a weaker left top-of-the-foot pulse, a crack in the right heel, a callus, dry skin, and worn work boots. Boulton et al. (2008) recommend that every adult with diabetes have a comprehensive foot examination that includes a 10-gram monofilament and at least one other test such as vibration, and describe loss of protective sensation and a history of skin breaks as important risk factors for foot ulcers. The student cannot say whether nerve damage is present, but the findings, and a man who stands on roofs in steel-toe boots for 60 hours a week, raise the question for the team.
Third, reduced near vision: 20/40 on a near card, with blurred reading for weeks. Recorded for follow-up; the inside of the eye was not examined.
Fourth, weight loss: about 7 kilograms by his report over two months.
Fifth, gums: redness and swelling at the lower front teeth and two missing teeth.
Sixth, darker, velvety skin at the neck and armpits: long-standing by his report; recorded as a finding for the team.
Request
At 1000 the student reported to the primary nurse and asked that: the standing pulse and blood pressure be repeated after the ordered intravenous fluids; the provider be told of the left foot findings and the heel crack; a referral to the diabetes educator include foot care and footwear; and dental and eye follow-up be added to the discharge plan. The student did not name a diagnosis for any finding.
Reflection
The feet came last in a 50-minute examination, and in the first draft they had one line: feet dry, pulses present. That line would have hidden the monofilament result, the heel crack and the worn boot, which together are probably the most important findings for Mr. J.'s future. The course warned that the last regions thin out, and the student had planned for it by writing the foot tests on the form before the examination began. Bickley et al. (2021) describe the value of an organized sequence that ends with the neurologic examination, and following it, with the foot tests written in, kept the last page as detailed as the first.
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.
Boulton, A. J. M., Armstrong, D. G., Albert, S. F., Frykberg, R. G., Hellman, R., Kirkman, M. S., Lavery, L. A., LeMaster, J. W., Mills, J. L., Sr., Mueller, M. J., Sheehan, P., & Wukich, D. K. (2008). Comprehensive foot examination and risk assessment. Diabetes Care, 31(8), 1679-1685. https://doi.org/10.2337/dc08-9021
Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.
NR 304 Week 8 instructions, in plain terms
The final assignment asks for a comprehensive head-to-toe assessment with an analysis of the findings. Expect the instructions to require consent, a general survey with measurements, every system with comparators, a section analyzing abnormal findings in priority order and recommendations or requests, in APA with sources. State the reason for the examination near the top so the record answers to it. Keep posture, units and comparators in every block. Give the last regions the same detail as the first. Every finding in the analysis must trace back to an entry in the record. End with what you request from the team, not a diagnosis. Reusing earlier write-ups is not acceptable.
Inside the NR 304 Week 8 example
The paper opens with Mr. J., his glucose of 486, his symptoms and the one-sentence reason for the examination. The general survey gives weight against his reported clinic weight and lying and standing pressures, with the pulse rising from 86 to 106. Skin and head and neck follow, including slow skin turgor, velvety patches and near vision of 20/40. Chest, heart and abdomen are recorded with positions. The feet get full detail: a heel crack, a callus, worn boots, a left sole site not felt with the monofilament and shorter vibration on the left, per Boulton et al. (2008). The analysis ranks six findings. A timed request and a reflection on tiring by the feet close it.
Reading the NR 304 Week 8 grading rubric
Comprehensive assessment rubrics usually grade completeness, consistency of detail, comparators and measurements, organization, analysis traced to the record, prioritization and professional recommendations. Analysis traced to the record carries a large share, so every item in the analysis points back to an entry above it. Consistency is credited when the feet receive the same density as the head. Measurements score when they include units, method and comparators, as the orthostatic readings do. Prioritization is graded on order with reasons. Recommendations earn points when they are requests within scope. Consent with its time and witness meets the professional documentation criterion. Citing the diabetic foot exam guidance supports the most important findings.
NR 304 Week 8 help from the desk
The biggest loss is an analysis that quotes findings the record never contains, which costs credit in both halves. Almost as expensive is a record that thins toward the end because the writer tired. Comparators present early and missing later, times that disagree, one structure called two names, missing consent and ordinary findings compressed until the abnormal ones have nothing to stand against all cost points. A closing section that names a condition instead of asking for something loses marks. Do not reuse earlier weeks. Keep analysis tied to findings. Everything needs a comparator, even if it is the person's report. Send your examination notes, and the paper can be drafted with the analysis traced to them.
Get a NR 304 Week 8 example written to your instructions
Send the Week 8 instructions and the full form your section prints, and a custom comprehensive example is written into every row it carries, in your section's terms, inside 24 to 48 hours. The first one is free. Include the case or complaint the paper starts from, since the argument at the end is only as good as the reason you were sent to look.
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 6: Written Record and SBAR Exercise
- NR 304 Week 7: Deterioration Risk Assessment Write-Up
- NR 324 Week 8: Discharge Summary Paper
- NR 302 Week 8: Head to Toe Assessment Write-Up
- NR 325 Week 8: Deterioration Case Paper
- NR 293 Week 8: Polypharmacy Medication Care Plan
NR 304 Week 8 questions, answered
Can I reuse the write-ups from earlier weeks in this paper?
Reuse the wording, never the entries. The phrasings that worked in weeks two to seven are exactly what should be on your desk while you write, and collecting them is legitimate preparation. Pasted entries are a different matter and they give themselves away, because the times stop agreeing and the person described drifts slightly between blocks. Running one fresh encounter is usually quicker than reconciling old text.
How much analysis does the paper want next to the record?
Enough to order what fell outside and say what each item raises, which is normally a small proportion of the document. The record is the larger part and carries most of the rows. What loses marks is an analysis long enough to have become an essay about the condition, since the assignment is testing whether findings were produced accurately and then weighed, not whether a topic can be discussed at length.
Does everything really need something to be judged by?
Every finding you intend to argue from does, and in practice that is most of them. The comparator can be modest: the other side, the entry from earlier in the same document, the range your form prints. What cannot happen is a paper that reports a figure, calls it significant, and never says significant relative to what, because the whole argument in the final section then rests on nothing a reader can check.
Where can I find a free NR 304 Week 8 sample paper?
The complete Week 8 comprehensive assessment of Mr. J., from consent and orthostatic readings to the foot exam and the ranked analysis, appears on this page.
What foot findings stand out in the NR 304 Week 8 paper?
A left sole site not felt with the 10-gram monofilament, shorter vibration sense and a weaker reflex on the left, a 1-centimeter heel crack, a callus and a work boot worn through at the heel.