| Course | NR 509 Advanced Physical Assessment |
|---|---|
| Week | 6 |
| Paper type | SOAP note |
| Length | About 1,120 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, nurse practitioner core |
| Updated | October 2026 |
Free sample paper for NR 509 Week 6
SOAP Note: A Painful Red Right Eye in a 34-Year-Old Who Sleeps in Her Contact Lenses, With an Assessment That Argues for Bacterial Keratitis and Names the Finding That Excluded Each Alternative
Student Name
College of Nursing, Chamberlain University
NR 509: Advanced Physical Assessment
Instructor Name
Month Day, Year
SOAP Note: A Painful Red Right Eye in a 34-Year-Old Who Sleeps in Her Contact Lenses, With an Assessment That Argues for Bacterial Keratitis and Names the Finding That Excluded Each Alternative
Subjective
CC: "My right eye is red and it really hurts, and the light is killing me."
HPI: Ms. C. D., 34, a pharmacy technician, noticed irritation in the right eye yesterday morning after removing her soft contact lenses, which she had slept in two nights in a row. Over 24 hours the eye became red and painful, rated 7/10, with sensitivity to light and watering. She reports that vision in the right eye is "smeary" and does not clear with blinking. She has had a small amount of white discharge since this morning. She denies trauma, chemical exposure, headache, nausea, halos around lights, or symptoms in the left eye. She has not used any eye drops. She wears monthly disposable soft lenses and rinses the case with tap water.
PMH: None. Medications: None. Allergies: No known drug allergies. Social: Lives with her partner; no recent upper respiratory illness in the household.
ROS, eyes: Positive for pain, light sensitivity, tearing, blurred vision in the right eye, discharge. Negative for itching, double vision, flashes or floaters. ROS, other: Denies fever, rash, joint pain, back pain, genital or oral ulcers.
Objective
Vitals: Temperature 36.9°C, heart rate 78, blood pressure 118/72 mm Hg.
Visual acuity, with glasses, at 20 feet: right eye 20/60, pinhole 20/50; left eye 20/20.
External: Right eyelids mildly swollen; no vesicles on the lids or forehead. Right conjunctiva diffusely injected, most intense in a ring around the cornea. Scant mucopurulent discharge at the medial canthus. Left eye quiet.
Cornea, penlight and fluorescein with cobalt blue light: On the right, a round, white-gray opacity about 2 mm across, just below and temporal to the center of the cornea, with overlying fluorescein uptake of similar size; the surrounding cornea appears hazy. No dendritic staining pattern. Left cornea clear with no uptake.
Anterior chamber: On penlight, right anterior chamber appears deep; no visible layering of white cells at the bottom of the chamber. Pupils: Right 3 mm, left 4 mm; both round and reactive to light; bringing light to the right eye causes pain. Intraocular pressure: Not measured in clinic; the right eye was soft and equal to the left on gentle palpation through closed lids. Preauricular nodes: Not palpable either side. Extraocular movements: Full, painful at the extremes on the right.
Assessment
Leading diagnosis: bacterial keratitis of the right eye, contact lens related. The case for it rests on specific findings: pain and light sensitivity rather than itching or grittiness, reduced acuity that does not correct fully with a pinhole, a focal white corneal infiltrate with an overlying epithelial defect that takes up fluorescein, redness concentrated around the cornea, and a clear risk factor, sleeping in soft lenses and rinsing the case with tap water. In a red eye, reduced vision, significant pain and photophobia point toward a serious cause such as keratitis, and contact lens wear is an important risk factor (Cronau et al., 2010). The finding that most strongly supports keratitis is the infiltrate itself: a white spot in the cornea with an overlying defect is corneal infection until proven otherwise.
Considered and rejected:
Bacterial or viral conjunctivitis: Would cause redness and discharge but not significant pain, photophobia or reduced acuity, and would leave the cornea clear. Rejected by the corneal infiltrate and the fall in acuity to 20/60.
Herpes simplex keratitis: Can cause a painful red eye with corneal staining. Made less likely by the absence of a branching dendritic staining pattern and of vesicles on the lids, though not excluded; the culture will help.
Acute angle-closure glaucoma: Causes a painful red eye with blurred vision, but typically with a mid-dilated, poorly reactive pupil, a hard eye, halos, headache and nausea, and a shallow anterior chamber. Rejected by a small, reactive right pupil, a deep chamber on penlight, a soft eye and no headache or nausea.
Anterior uveitis: Causes photophobia, redness around the cornea and a small pupil, all present here. Made less likely by the focal corneal infiltrate with an epithelial defect, which uveitis does not produce, and the absence of layered cells in the chamber, though a slit lamp is needed to exclude cells in the chamber fully.
What would change the assessment: A slit-lamp finding of cells and flare in the anterior chamber without a true infiltrate would move uveitis up the list. A branching epithelial lesion under magnification would favor herpes simplex and change treatment entirely, because the wrong drop, a corticosteroid, could worsen it. A measured intraocular pressure well above normal would reopen angle closure despite the other findings. Naming these in advance tells the ophthalmologist which questions primary care could not answer at the bedside.
Severity: Acuity of 20/60 in the affected eye and an infiltrate near the visual axis place this at the more serious end of what a primary care clinician sees. That judgment, rather than the diagnosis alone, is what makes the referral same day rather than next week.
Plan
Referral: Same-day ophthalmology evaluation, arranged by phone before she leaves, for slit-lamp examination and corneal scraping for culture before antibiotics begin, given the size and near-central location of the infiltrate. Contact lens keratitis can progress quickly and threaten vision, so this is not deferred to a routine appointment.
Lenses: Stop contact lens wear in both eyes. Bring the lenses and case to the ophthalmology visit for culture. Do not wear lenses again until cleared.
Treatment: Topical antibiotic therapy as directed by ophthalmology after cultures. No topical corticosteroid and no eye patch in primary care. Oral acetaminophen or ibuprofen for pain.
Education: Explained the likely diagnosis in plain terms and why it is urgent. Taught that sleeping in lenses and rinsing the case with tap water raise the risk of corneal infection, and that she should return to the emergency department if vision worsens or pain increases before the appointment.
Follow-up: Clinic to phone her tomorrow to confirm she was seen and to review the plan; primary care review after ophthalmology discharge to discuss safer lens habits.
Documentation for the handoff: The referral note will state the acuity in each eye, the size and location of the infiltrate, the fluorescein findings, the lens history and the time symptoms began, so that the receiving clinician can triage her without repeating the history.
References
Cronau, H., Kankanala, R. R., & Mauger, T. (2010). Diagnosis and management of red eye in primary care. American Family Physician, 81(2), 137-144.
The Chamberlain NR 509 Week 6 instructions
Week 6 asks for a full SOAP note on one focused problem. Graders look for subjective and objective data, an assessment with a differential diagnosis, a plan covering diagnostics, treatment, education, referral and follow-up, and APA. Record subjective data in the patient's words where it helps. Put every finding the assessment will use in the objective section, including negatives. State the leading diagnosis with the findings that support it. For each alternative, name the finding that makes it less likely. Say what would change your assessment. Rate severity and let it shape the plan. Make the plan specific: who, when and what the referral note will say.
How this NR 509 Week 6 example is built
The subjective section quotes Ms. C. D. on redness, pain and light sensitivity, and records irritation since removing lenses she had slept in, with no medical history and an eye review of systems. The objective section gives vital signs, visual acuity with pinhole, swollen lids, perilimbal injection, a round infiltrate below and temporal to the center with an overlying staining defect, a deep chamber and pupil findings. The assessment argues for contact lens related bacterial keratitis and rejects each alternative with a reason, such as no branching dendrite for herpes and a reactive pupil for angle closure. The severity section explains why acuity and location make this urgent. The plan arranges same-day ophthalmology, stops lens wear and covers education, follow-up and the referral note.
Reading the NR 509 Week 6 grading rubric
SOAP note rubrics in NR 509 usually score complete subjective and objective data, an argued assessment, an appropriate differential, a specific plan, patient education, follow-up and APA. The week tests whether the assessment argues, and the note answers by attaching a finding to every diagnosis kept or rejected. Objective data are credited because every finding the assessment uses appears there. The differential scores through four alternatives, each dismissed by evidence. The plan earns points for same-day referral, cultures before antibiotics and no steroids. Education is credited for explaining lens risks. The handoff content shows professional communication. Cronau and colleagues support the plan.
Common NR 509 Week 6 mistakes, and how to avoid them
The characteristic Week 6 loss is the listed differential: three or four diagnoses in order with no evidence attached and no finding that rejects any of them. Another loss is an objective section missing the negatives the assessment needs. Students also treat a sight-threatening problem as routine, prescribe steroids or patching for a possible infection or write a plan with no follow-up. Two to four differentials are usually enough if each is argued. An assessment is argued when each diagnosis has a finding beside it. A strong assessment still needs a specific plan. Send your case and an NR 509 SOAP note can be written with every diagnosis argued.
Get a NR 509 Week 6 example written to your instructions
Send the Week 6 instructions, your SOAP template and the case context, and a custom note is written into your template with the differential argued rather than listed, inside 24 to 48 hours. The first one is free, and the encounter it reports stays yours.
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NR 509 Week 6 questions, answered
How many differentials should the assessment carry?
Enough to show the reasoning and few enough to argue each one. Three well argued candidates score better than six named. What a grader marks is whether each has evidence attached and whether the rejected ones were rejected for a stated reason rather than by omission.
What makes an assessment argued rather than listed?
Evidence attached to each candidate and a stated reason for every rejection. A listed differential could sit under any patient with a similar complaint. An argued one could not, because it points at findings that belong to this encounter and would change if the findings did.
Can the plan be brief if the assessment is thorough?
It can be short but it has to be specific. A plan that would read identically under a different leading diagnosis tells a grader the assessment did no work. Naming what you would do, what you would order and what result would change your mind is usually enough.
Where can I find a free NR 509 Week 6 sample paper?
The complete Week 6 SOAP note for a painful red eye in a contact lens wearer, with subjective and objective data, the argued assessment, rejected alternatives, the plan and the reference, is on this page.
Why is herpes simplex keratitis less likely in the NR 509 Week 6 note?
Because fluorescein showed a round staining defect over a focal infiltrate rather than the branching dendritic pattern typical of herpes, and there were no lid vesicles.