| Course | NR 557 Health Assessment for Professional Nursing Practice |
|---|---|
| Week | 3 |
| Paper type | Targeted examination note |
| Length | About 1,110 words, 2 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NR 557 Week 3
Targeted Examination Note: The Chest, Vital Signs and Mental Status of a Breathless 78-Year-Old at Home, Each Region Chosen From the History and Each Finding Reported With Its Unaffected Side
Student Name
College of Nursing, Chamberlain University
NR 557: Health Assessment for Professional Nursing Practice
Instructor Name
Month Day, Year
Targeted Examination Note: The Chest, Vital Signs and Mental Status of a Breathless 78-Year-Old at Home, Each Region Chosen From the History and Each Finding Reported With Its Unaffected Side
Why These Areas
The history pointed to an lower respiratory infection, perhaps pneumonia, layered on chronic obstructive pulmonary disease (COPD), with worsening heart failure and new confusion as alternatives or additions. That made four areas worth the time of a home visit: vital signs, counted carefully; the chest, front and back, comparing sides; signs of fluid overload; and mental status. The abdomen, neurological system beyond mental status, and skin were not examined in detail because nothing in the history pointed to them, and the patient was too breathless for a long examination. The note records why each area was chosen, so it reads as a sequence of decisions rather than a checklist.
Conditions, Before Findings
The patient was seated upright in a recliner in the living room, having been there since the previous evening. The room was warm. The patient's daughter was present throughout. The patient had used a rescue inhaler about 40 minutes before my arrival. The examination began about ten minutes after I arrived, once the patient had rested from walking to the door, which the patient insisted on doing. Lighting was adequate by the window. These conditions matter because breathing rate, oxygen saturation and heart rate all change with recent exertion and recent bronchodilator use.
Vital Signs
Respiratory rate: 28 breaths per minute, counted for a full 60 seconds while I held the patient's wrist, regular rhythm, shallow, with use of neck muscles. The patient's recorded rate on previous visits was 18 to 20, though previous values may have been estimated, a common problem with this vital sign (Badawy et al., 2017). Counted properly, it is one of the most sensitive early markers of deterioration (Cretikos et al., 2008).
Oxygen saturation: 88% on room air at rest, finger probe, good waveform, after two minutes of reading. Usual on previous visits: 92% to 93%.
Heart rate: 104 beats per minute, regular; radial count over half a minute, doubled, matching the oximeter.
Blood pressure: 128/74 mmHg, left arm, seated, appropriately sized cuff. Usual range: 126 to 138 systolic.
Temperature: 38.3 °C oral, 20 minutes after last drinking.
Weight: 71.8 kg on the patient's own scale; usual dry weight recorded by the heart failure clinic: 71.0 kg.
Chest
Why: the history suggested infection and possible consolidation; a comparison between sides is the key test.
Inspection: barrel-shaped chest, as on previous visits. Reduced expansion on the right lower chest compared with the left.
Palpation: tactile fremitus increased at the right base compared with the left base; equal at the upper zones.
Percussion: dull at the right base, posteriorly from about the eighth rib down; resonant at the left base and both upper zones.
Auscultation, right base: bronchial breath sounds, with coarse crackles on inspiration that did not clear with coughing. Left base: diminished vesicular breath sounds as usual for this patient, scattered expiratory wheeze, no crackles. Upper zones, both sides: scattered wheeze, symmetric.
Reporting each finding with its opposite side lets a reader see that the abnormality is one-sided, which matters for the interpretation. Dullness, increased fremitus and bronchial breathing together at one base are the classic signs of consolidation.
Fluid Status
Why: worsening orthopnea and heart failure history raised the question of fluid overload.
Jugular venous pressure: not seen above the collarbone with the patient reclined to 45 degrees; unchanged from previous visits. Ankles: trace pitting edema on both sides, the same as on previous visits. Weight: 0.8 kg above usual dry weight, within the range the heart failure clinic tolerates before adjusting the diuretic. Crackles: confined to the right base, not bilateral. These findings do not suggest significant fluid overload.
Mental Status
Why: the daughter reported new confusion this morning.
The patient was alert and cooperative, oriented to person and place but gave the wrong day of the week and the wrong month. Asked to say the months of the year backward, the patient stopped after three months. On previous visits, the patient was fully oriented and managed the months backward without difficulty. The patient's speech was clear, without slurring, and the patient moved all limbs normally. The findings suggest a new disturbance of attention and orientation, consistent with acute confusion.
How the Examination Was Paced
A breathless patient cannot tolerate a long examination, so the order was chosen to get the most important information first. Vital signs came first, with the respiratory rate counted while I held the wrist so the patient would not change their breathing. The chest came next, starting at the back while the patient leaned forward on a cushion, because the history pointed to the lower lobes. Fluid status took only a minute: a look at the neck, a press at the ankles and the weight, which the daughter helped with. Mental status came last, once the patient had rested, so that breathlessness would not be mistaken for confusion.
Between parts, the patient rested and sipped water. The whole examination took about 15 minutes. Parts that could wait, such as a full neurological examination and a skin check, were left for another visit. That pacing is part of the note, because a reader should know that the examination was brief on purpose and targeted rather than incomplete by accident.
What the Examination Settles and What It Does Not
The examination found a counted respiratory rate of 28, oxygen saturation well below this patient's usual, fever, a raised heart rate, signs of consolidation at the right lung base and new confusion, with no sign of significant fluid overload. It settles that this is not an ordinary bad COPD day. It strongly supports a lower respiratory infection with consolidation, most likely pneumonia, which is consistent with evidence that combinations of examination findings raise the likelihood of pneumonia more than any single finding (Metlay et al., 1997). It does not confirm pneumonia, which requires a chest radiograph, and it cannot exclude other causes of consolidation or a coexisting heart failure exacerbation without further testing. The next write-up interprets these findings against the patient's usual values and decides what they mean for the next hour.
Every finding above can be compared with the next visit's note, because each was recorded with its side, position and conditions.
References
Badawy, J., Nguyen, O. K., Clark, C., Halm, E. A., & Makam, A. N. (2017). Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults. BMJ Quality & Safety, 26(10), 832-836. https://doi.org/10.1136/bmjqs-2017-006671
Cretikos, M. A., Bellomo, R., Hillman, K., Chen, J., Finfer, S., & Flabouris, A. (2008). Respiratory rate: The neglected vital sign. Medical Journal of Australia, 188(11), 657-659. https://doi.org/10.5694/j.1326-5377.2008.tb01825.x
Metlay, J. P., Kapoor, W. N., & Fine, M. J. (1997). Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA, 278(17), 1440-1445. https://doi.org/10.1001/jama.1997.03550170070035
What the NR 557 Week 3 assignment asks for
The third week asks you to perform and document a focused physical examination. Instructions usually request the systems examined, techniques used, findings and their significance. State one reason from the history for each area you examine, and say which areas you left out and why. Record the conditions before findings: position, setting, recent exertion or medication, who was present. Report paired structures together, affected and unaffected sides in one entry, so a reader can see whether a finding is one-sided. Give vital signs with how they were obtained, such as the duration of a count. Describe findings as observations with location. Explain how you paced the examination. Close by stating what the examination establishes and what it cannot. Cite evidence on examination findings in APA 7.
How this NR 557 Week 3 example is built
The note opens by linking each examined area to the history and naming areas left out. A conditions section records position, room temperature, the daughter's presence and a rescue inhaler 40 minutes earlier. Vital signs follow, with a 60-second respiratory count of 28 and saturation compared with the patient's usual level. The chest section reports inspection, palpation, percussion and auscultation with right and left together, showing dullness, increased fremitus, bronchial breathing and crackles only at the right base. Fluid status and mental status sections follow. A section describes pacing. The final section states that the examination strongly supports consolidation but cannot confirm pneumonia without imaging. It also explains the fifteen-minute pacing.
Where the points sit in the NR 557 Week 3 rubric
Targeted examination notes are commonly assessed on relevance of the systems chosen, correct technique, precise documentation, attention to conditions and a clear statement of significance. A reason for each examined area shows the examination was planned. Recording conditions first shows awareness that findings depend on context. Reporting paired sides together makes one-sided findings visible and reads as skilled documentation. Stating how vital signs were obtained, such as a full-minute count, adds credibility. Explaining pacing shows attention to the patient. A closing statement of what the examination settles and leaves open prepares for interpretation and referral. Research on examination accuracy, referenced in APA 7, backs the note.
NR 557 Week 3 help from the desk
Examination notes often list every system without saying why, which hides the reasoning. Give a reason for each area. Another weakness is recording one side of the chest without the other, making it impossible to see whether a finding is focal. Report pairs together. Some students omit conditions such as recent exertion or medication, which change many findings. Record them. Avoid writing interpretations such as pneumonia present in the findings; describe what you saw, felt and heard. State how vital signs were measured. End with the limits of the examination, since an examination can support a diagnosis without confirming it. Time the examination so readers know how long the patient tolerated it, and note anything deferred.
Get a NR 557 Week 3 example written to your instructions
Send the Week 3 instructions and the note template your classroom prints, and a custom example is written into it and returned inside 24 to 48 hours, the first one free. If the case comes from somebody you examined yourself, take out anything that would let a reader place them before it reaches us. The hands-on half of the week stays with you.
More NR 557 papers and MSN samples
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NR 557 Week 3 questions, answered
Do I record the areas I checked on the way past?
Only where they bear on the reason you narrowed, and then in a line each. The value of this note is depth in one place, and a page that drifts back across the body reads as a short version of a full examination. If a neighboring area matters, say what made it matter, which keeps it inside the note's argument rather than beside it.
The conditions feel like padding. Do graders want them?
They are the difference between a finding and an impression. A reading taken through clothing, a comparison with no side named, a pulse counted straight after the person walked in: none of those can be used by whoever picks the note up next. Recording the circumstances costs a clause each and is usually the cheapest set of points available in the week.
Who is this note actually written for?
Somebody who was not in the room and will act on it without repeating your examination. That is why the conditions and the hour matter more here than the prose does. Write it so a person picking it up cold can tell what you found, under what circumstances, and what you already set in motion, and the structure a rubric wants tends to follow on its own.
Where can I find a free NR 557 Week 3 sample paper?
The targeted chest examination note is the NR 557 Week 3 sample shown above, complete on this page. If you are documenting a different examination, send us the history and findings and a note can be written.
Why report paired findings together in NR 557 Week 3?
So a reader can see whether an abnormality is one-sided. In the sample, dullness and bronchial breathing appear only at the right base, which points to consolidation.