| Course | NR 306 Health Assessment |
|---|---|
| Week | 5 |
| Paper type | Cardiovascular examination write-up |
| Length | About 1,130 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 306 Week 5
Cardiovascular Assessment Write-Up: A 66-Year-Old Retired Cafeteria Manager With a Murmur a Doctor Once Mentioned
Student Name
College of Nursing, Chamberlain University
NR 306: Health Assessment
Instructor Name
Month Day, Year
Cardiovascular Assessment Write-Up: A 66-Year-Old Retired Cafeteria Manager With a Murmur a Doctor Once Mentioned
Setting, Scales and Positions
Mrs. Y. is a 66-year-old retired school cafeteria manager with high blood pressure treated with lisinopril 20 milligrams daily. She says a doctor mentioned "a little murmur" at a physical three years ago and told her it was nothing to worry about. She has no chest pain or shortness of breath and walks two miles most mornings. She was examined at 1400 in a clinic room and gave verbal consent at 1355.
Every graded finding carries its scale: pulses on the 0 to 4+ amplitude scale (0 absent, 1+ diminished, 2+ normal, 3+ increased, 4+ bounding); edema on the 1+ to 4+ pitting scale (1+ about 2 millimeters, 2+ about 4 millimeters, 3+ about 6 millimeters, 4+ about 8 millimeters); murmurs on the 1 to 6 intensity scale; and capillary refill in seconds (Jarvis & Eckhardt, 2024). Position is stated at the top of each block because many cardiovascular findings change with it.
Neck Vessels
Position: supine, head of the table raised to 45 degrees, head turned slightly to the left.
Jugular venous pulsation, right side, tangential penlight: highest point of pulsation visible 2 centimeters above the sternal angle, measured with a ruler held vertically from the sternal angle and a card held horizontally from the top of the pulsation.
Hepatojugular test: not performed; not required by the template for this week.
Carotid arteries (palpation, one side at a time, lower third of the neck): 2+ right, 2+ left; smooth upstroke; no thrill.
Carotid arteries (auscultation, bell, breath held): no bruit on the right or left.
Heart
Position: supine at 30 degrees for inspection, palpation and the first round of listening; then left lateral decubitus; then sitting up and leaning forward.
Inspection: no visible pulsations except a faint apical impulse.
Palpation: apical impulse felt at the fifth left interspace, just medial to the MCL, dime-sized (under 2.5 cm) and brief; no heaves; no thrills at any of the five areas.
Auscultation, supine at 30 degrees, diaphragm then bell at each site:
Aortic area (2nd right intercostal space, sternal border): S1 and S2 present; S2 louder than S1. Between S1 and S2, a soft, medium-pitched, harsh sound that rises and falls, starting just after S1 and stopping short of S2; grade 2 on the 1 to 6 scale; heard best with the diaphragm.
Pulmonic area (2nd left intercostal space, sternal border): S1 and S2 present; S2 louder than S1; the same systolic sound, fainter; physiologic splitting of S2 on inspiration.
Erb's point (3rd left intercostal space): S1 and S2 equal; the same systolic sound, faint.
Tricuspid area (4th left intercostal space, lower sternal border): S1 louder than S2; no extra sounds.
Mitral area (apex, fifth interspace at the MCL): S1 louder than S2; no extra sounds.
Radiation: the systolic sound was heard faintly over the right carotid artery at the base of the neck, not over the left.
Left lateral decubitus, bell at the apex: S1 and S2; no S3, no S4, no diastolic sound.
Sitting, leaning forward, breath held after exhalation, diaphragm at the left sternal border: S1 and S2; the systolic sound heard faintly; no diastolic sound.
Rate and rhythm, apical, 60 seconds: 68, regular.
Peripheral Vessels
Position: supine, head of the table at 30 degrees, legs uncovered.
Blood pressure: 142/84 right arm, 138/82 left arm, sitting, after 5 minutes of rest, adult cuff.
Pulse amplitude (0 to 4+), each site with both sides: radial 2+, 2+; brachial 2+, 2+; femoral 2+, 2+; popliteal 1+, 1+ (knees slightly flexed, both hands); dorsalis pedis 2+, 2+; posterior tibial 2+, 1+.
Arms: warm, same color bilaterally; no edema.
Legs, inspection: skin tone the same on both legs; hair present on both lower legs and the dorsum of both feet; no ulcers; no visible varicosities.
Legs, temperature (dorsum of the examiner's hand, moving from thighs to feet): warm and symmetric throughout.
Edema, thumb pressed 5 seconds over the dorsum of the foot, behind each medial malleolus and over each tibia: right, 1+ behind the medial malleolus, 2 millimeters, resolved within 10 seconds; left, 1+ behind the medial malleolus, 2 millimeters, resolved within 10 seconds; no pitting over the dorsum or the tibias bilaterally. She says her ankles are "a bit puffy by supper."
Calves: soft, nontender bilaterally; circumference 10 centimeters below the tibial tuberosity, 36 centimeters right, 36 centimeters left.
Capillary refill, great toenails and thumbnails, pressed 5 seconds, room temperature: 1.5 seconds right toe, 2 seconds left toe; 1.5 seconds both thumbs.
Summary
Mrs. Y. has a grade 2 systolic sound heard best at the aortic area, radiating faintly to the right carotid, with normal S1 and S2 and no extra heart sounds in any position. Reclined at 45 degrees, her highest jugular pulsation sat 2 centimeters above the sternal angle. Blood pressure was 142/84 on the right. Pulses were equal except the posterior tibial, 2+ right and 1+ left. There was 1+ pitting edema behind both medial malleoli. The findings were reported to the instructor. No condition was named. Mrs. Y. was encouraged to mention the murmur and the ankle swelling at her next primary care visit, since she has not had either assessed in three years.
Reflection
Estimating jugular venous pressure was the step I found hardest. On my unit it is charted as JVD present or absent, and I realized I have rarely measured it. Cook and Simel (1996) reviewed the bedside examination of central venous pressure and found only moderate agreement between examiners, which is why the entry names the angle, the reference point and the measurement rather than a word. Bickley et al. (2021) list the features to record for any murmur: timing, shape, location of maximal intensity, radiation, intensity, pitch and quality, and I used that list as a checklist at each site. Describing the murmur by its features instead of naming it took discipline; it would have been faster to write aortic murmur. But the course marks what was heard, and every feature I recorded is something another examiner can listen for and confirm or dispute. The pulse difference behind the left ankle surprised me, because I had expected the examination of a well woman who walks two miles a day to be unremarkable below the knee. It is a small finding, and it may mean nothing, but it only exists because the two sides were written on the same line. On my unit I would have charted pedal pulses present and never compared them.
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.
Cook, D. J., & Simel, D. L. (1996). Does this patient have abnormal central venous pressure? JAMA, 275(8), 630-634. https://doi.org/10.1001/jama.1996.03530320054034
Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.
Reading the NR 306 Week 5 instructions
The Week 5 assignment asks for a complete cardiovascular examination: neck vessels, precordium and peripheral vessels, written up with technique, position and findings. The template typically lists venous pressure in the neck, carotid pulses and bruits, the point of maximal impulse, sounds at the five listening areas in more than one position, blood pressure in both arms, pulses at every site, edema, skin and capillary refill. Print each grading scale you use. State the position for each block. Describe any murmur by location, timing, shape, pitch, quality, grade and radiation without naming a cause. Write both sides of every pulse on one line. Time refill in seconds and give edema a depth.
Inside the NR 306 Week 5 example
The write-up opens with Mrs. Y., her lisinopril, the mentioned murmur and the three scales printed in full. Neck vessels come first: jugular pulsation measured with a ruler and card, carotids 2+ with no bruits. The heart section moves through 30 degrees, left lateral and sitting forward, describing S1 and S2 at each area and a grade 2 systolic sound at the aortic area radiating faintly to the right carotid. A rate of 68 is counted apically. Peripheral vessels follow: blood pressure in both arms, paired pulses with one posterior tibial at 1+, ankle edema of 1+ and refill of 1.5 to 2 seconds. A summary and a reflection on measuring venous pressure close it, citing Cook and Simel (1996).
Reading the NR 306 Week 5 grading rubric
Cardiovascular rubrics typically grade correct technique and positions, complete coverage of sites, use of grading scales, precise description of heart sounds and any murmur, bilateral comparison and a summary without diagnosis. Murmur description carries significant weight, so the extra sound has every feature the textbook lists. Scale use is credited when each number sits against a printed range. Coverage scores when jugular pressure, carotids and every pulse site appear. Bilateral comparison earns points when both sides share a line, which makes the one asymmetric pulse visible. Positions stated for each block protect findings that depend on posture. Reflection on how rarely venous pressure is measured at work shows growth.
NR 306 Week 5 help: mistakes that cost points
A number with no scale is the first thing to cost points. A missing pair, a pulse on one foot only, comes next. Heart sounds without sites, a murmur with no place in the cycle, jugular pressure skipped as too advanced, refill called normal instead of timed, edema with no depth and posture never stated all lose marks. Naming a diagnosis costs more than any of these. If you cannot feel a foot pulse, ask the instructor to check before writing absent and record what you did. Grade any murmur you hear using the 1 to 6 scale. The vascular section is required, not optional. Forward your pulse grades and heart sound notes, and the record can be built with a scale beside every number.
Get a NR 306 Week 5 example written to your instructions
Send the Week 5 instructions along with the cardiovascular form your section uses, and a custom example is written into its rows and scales and returned inside 24 to 48 hours. The first one is free. The pulses were felt on somebody who agreed to be examined, and that arrangement stays between the two of you.
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NR 306 Week 5 questions, answered
I could not feel one of the foot pulses. Do I write absent?
Write what happened, in the terms your form allows: not palpable, or absent by palpation, on that side, with the other side reported as found. Do not upgrade it to present because you expect it to be there on a well person. A finding you could not obtain is still a finding, and inventing the reassuring version is the one error in this week that cannot be argued back.
Do I need to grade a murmur if I hear one?
Describe it first and grade it only if your template asks. Location, where it falls in the cycle, how it sounds and whether it changes with position are all recordable at this level. Assigning a grade and reasoning toward a valve is advanced practice work and belongs to a later course. An undergraduate write-up is marked on whether the sound was located and described accurately.
How much of the vascular section is really required?
All of the rows your template prints, which usually reaches further than people expect. The carotids, the neck veins, both arms and both legs tend to appear, and the marks are distributed across them evenly. Skipping the ones that feel unlikely on a healthy volunteer is the most common way this week goes wrong, because the missing rows are visible at a glance.
Where can I find a free NR 306 Week 5 sample paper?
The complete Week 5 cardiovascular write-up on Mrs. Y., with the jugular measurement, the graded systolic sound and paired pulses, is printed further down this page.
How is the murmur described in the NR 306 Week 5 example?
As a soft, medium-pitched, harsh systolic sound at the aortic area that rises and falls, grade 2 of 6, starting after S1 and stopping before S2, radiating faintly to the right carotid.