| Course | NR 578 Primary Care Management of Older Adults |
|---|---|
| Week | 6 |
| Paper type | Comprehensive visit note |
| Length | About 1,100 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Adult-Gerontology Primary Care NP (AGPCNP) |
| Updated | October 2026 |
Free sample paper for NR 578 Week 6
Comprehensive Visit Note at 88: Every Domain Recorded, and Four Small Decisions Argued About What Continues, What Stops and Which Target Loosens
Student Name
College of Nursing, Chamberlain University
NR 578: Primary Care Management of Older Adults
Instructor Name
Month Day, Year
Comprehensive Visit Note at 88: Every Domain Recorded, and Four Small Decisions Argued About What Continues, What Stops and Which Target Loosens
Visit
Annual comprehensive visit, six months after the hospital discharge. The patient, now 88, came with the daughter. The patient lives alone, sleeps upstairs again since week 3 after discharge and walks to the Saturday market with a four-wheeled walker and a neighbor. The occupational therapy driving evaluation advised stopping driving; the patient stopped in the spring.
History Since the Last Visit
One hospital stay, for fluid overload, six months ago, with a fourteen-day transition at home. The bed returned upstairs in week 3 after physical therapy cleared the stairs. No falls since. Weight steady for three months. The patient stopped driving in the spring after an on-road evaluation, and gets to church with a neighbor. Memory clinic visit in the summer agreed a working diagnosis of mild dementia. Eye injections continue every eight weeks. The daughter still fills the pillbox and handles bills.
Examination
Alert, conversational, wearing hearing aids. Lungs clear. No leg swelling. Heart rate irregular at 74. Feet: skin intact, no ulcers; nails thick, trimmed by podiatry. Walks with the walker, turns in four steps, sits and stands without using the armrests twice. Timed up-and-go 15 seconds, faster than at the first assessment.
Domains Recorded
Weight: 128 pounds today; 132 at last year's visit; 136 at discharge with fluid. Stable over the past three months.
Blood pressure: seated 132/70; standing at three minutes 112/64, with lightheadedness.
Vision: macular degeneration, wet form in the left eye, receiving injections every eight weeks; reading with a magnifier.
Hearing: hearing aids fitted in the summer, worn most days.
Mood: PHQ-2 score 1.
Cognition: Montreal Cognitive Assessment 21, similar to last year. Workup found no reversible cause. Working diagnosis, agreed with the patient and daughter after the memory clinic visit: mild dementia, likely Alzheimer type.
Falls: none since the hospital stay.
Continence: urgency at night, unchanged.
Immunizations: influenza today; pneumococcal and shingles vaccines complete; tetanus booster within ten years.
Advance care planning: health care agent named (the daughter); goals discussed below.
Medications: reviewed; see decisions.
How Life Expectancy Was Considered
The decisions below depend on how long the benefit of each measure takes to appear, set against how long this patient is likely to live. I did not calculate a number for the patient, and none was given to the patient or the daughter. The combination of heart failure with a recent admission, stage 3b kidney disease, mild dementia and age 88 makes a life expectancy of more than ten years unlikely. That is enough to decide measures whose benefit takes a decade, and not enough to decide measures whose benefit arrives within a year or two, such as the eye injections or the blood thinner.
Decision 1: Prostate Cancer Screening Stops
The patient had a PSA test every year until last year. The task force recommends against PSA-based screening for prostate cancer in men aged 70 and older (Grossman et al., 2018). The reason in this patient is not the number 88 but the interval: any benefit from finding an early prostate cancer takes years to appear, longer than this patient is likely to live given heart failure, kidney disease and dementia, while the harms of a positive result, biopsies and treatment, arrive at once. The patient agreed: "I don't want any more needles for something that won't kill me."
Decision 2: Colorectal Cancer Screening Stops
The patient's last colonoscopy, at 78, was normal. The task force does not recommend routine screening after 85 and advises a selective approach between 76 and 85 (Davidson et al., 2021). The benefit of colorectal screening takes about a decade to appear (Lee et al., 2013), and this patient's life expectancy is shorter than that. The decision is recorded as stopped, with the reason, so it does not roll forward unexamined next year.
Decision 3: The Blood Pressure Target Loosens
The standing pressure falls by 20 points with lightheadedness. A tight target would require another medicine, which would raise the risk of falls. The target is loosened to a seated systolic below 150, with no new medicine; amlodipine remains stopped.
Decision 4: Apixaban Continues
The patient has atrial fibrillation and a high stroke risk, and has had no bleeding or falls since the hospital stay. The dose remains the reduced dose for age and kidney function. Stopping would raise stroke risk more than continuing raises bleeding risk at this point. The decision will be revisited if falls recur or if a bleed occurs, and the patient and daughter know that this is a decision to be reviewed, not a fixed rule.
Medication Review
Furosemide 40 mg each morning: continue; weights stable. Potassium chloride: continue; potassium 4.3 last month. Apixaban at the reduced dose: continue; see decision 4. Eye drops after injections as directed by the retina clinic. Acetaminophen as needed for knees, up to 3 grams a day: continue. No sleeping tablets, no anticholinergic drugs. Amlodipine remains stopped. Total: four regular medicines, down from six a year ago, each with a reason recorded beside it in the list.
Goals Discussed
The patient's priorities, in the patient's words: "Keep my eyes, keep my Saturdays, stay in my house." The eye injections continue because they protect reading and recognizing faces. Saturdays continue with the neighbor. Staying at home is the aim every other part of the plan serves.
Advance Care Planning, Recorded
The daughter is the named health care agent, with the document scanned into the record. The patient's stated wishes: treatment for problems that can be fixed, no admission to intensive care for a breathing machine, and no resuscitation if the heart stops. A portable medical order reflecting these wishes was completed and signed at this visit, with a copy for the refrigerator door at home. The patient asked that the son be told, and the daughter agreed to call the son this week.
What Continues Without Argument
Furosemide and potassium at current doses, daily weights, home exercises, hearing aids, the pillbox filled by the daughter, the alert pendant and an annual influenza vaccine.
Next Visit
Three months, with a metabolic panel beforehand. Earlier if weight rises or falls recur. It is set for a late Wednesday afternoon, when driving is possible for the daughter.
References
Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Owens, D. K., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C.-W., & Wong, J. B. (2021). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238
Grossman, D. C., Curry, S. J., Owens, D. K., Bibbins-Domingo, K., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Ebell, M., Epling, J. W., Kemper, A. R., Krist, A. H., Kubik, M., Landefeld, C. S., Mangione, C. M., Silverstein, M., Simon, M. A., Siu, A. L., & Tseng, C.-W. (2018). Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA, 319(18), 1901-1913. https://doi.org/10.1001/jama.2018.3710
Lee, S. J., Leipzig, R. M., & Walter, L. C. (2013). Incorporating lag time to benefit into prevention decisions for older adults. JAMA, 310(24), 2609-2610. https://doi.org/10.1001/jama.2013.282612
What the NR 578 Week 6 assignment asks for
The Week 6 note should be wide without being flat. Cover every domain your template names, but let two or three of them carry real argument while the rest are recorded and left. The center of the visit is usually a set of small decisions about what continues: a screening test kept, another stopped with the reason given as an interval or a state rather than an age, a target loosened. Most prompts reward weights and values given with earlier comparisons, and maintenance items that are either continued or stopped rather than rolled forward without thought. Advance care planning should be recorded as specific wishes.
Inside the NR 578 Week 6 example
The note opens with the visit and the patient's situation, then a history since the last visit and a focused examination. Every domain is recorded briefly, from weight with comparisons to advance care planning. A section explains how life expectancy entered the decisions. Four decisions follow: prostate screening stopped with the task force recommendation and an interval, colorectal screening stopped with the lag-time argument, the blood pressure target loosened because of standing drops and apixaban continued. A medication review, the patient's goals in their words, the advance care planning record, the items continuing without argument and the next visit close it. Each stopped test is recorded so it does not roll forward next year.
NR 578 Week 6 rubric: what full points look like
The biggest deduction goes to a note covering every domain and arguing none; this one argues four decisions inside the grid. Next is a maintenance section left silent, where screening simply rolls forward; this note stops two screens explicitly. An age given as the reason for a decision, instead of an interval or a state, costs a row, and each stop here uses time to benefit. A weight entered with no earlier values loses credit, so comparisons are given. Recording advance care planning as specific wishes, with where the order is kept, earns the planning criterion. Explaining how life expectancy was weighed, without inventing a number, shows judgment rather than formula.
NR 578 Week 6 help: mistakes that cost points
Many NR 578 Week 6 notes fill every template box and make no decision. Others continue every screening test by default. Reasons such as too old appear where an interval or health state would explain the choice. Weights and pressures are given without earlier values for comparison. Advance care planning is recorded as discussed with no detail. If your patient's visit differs, send the problem list and the screening history; a note can be written that covers the domains and argues the decisions that matter. Choose the three or four decisions that matter this year, argue them, and record the rest briefly. Give each stopped test a reason in time, not in years of age.
Get a NR 578 Week 6 example written to your instructions
Send the Week 6 template your section uses and the patient it supplies, and a custom note is written into it and returned inside 24 to 48 hours, free the first time. Your clinical time is the one part this desk will not touch: the hour tally, the entries against it, and any evaluation a supervising clinician puts a name to come from you alone.
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NR 578 Week 6 questions, answered
How do I tell what to argue and what to simply record?
Let the assignment's own case decide. Whatever the vignette spends its detail on is usually what the rubric wants argued, and the remaining domains are there to show that you looked. Two or three worked through properly, with the rest recorded accurately, reads as clinical judgment. Everything argued at equal length reads as a writer who could not choose.
Should the note say anything about how long this patient is likely to live?
Only where a decision in the note turns on it, and then as a range with something behind it rather than a figure produced from nowhere. Written next to the choice it informs, it is reasoning a rubric can mark. Written into the assessment as a standalone statement about the person, it is unmarkable as well as unpleasant, and sections treat it that way.
Can a screening test be stopped in a note like this?
It can be proposed, with the working shown. What sections mark is whether the decision has a shape: what the measure was for, roughly how long it takes to return anything, what this patient's situation is now, and what the patient said when it was raised. A test dropped without comment reads as an oversight rather than as a decision somebody made.
Where can I find a free NR 578 Week 6 sample paper?
The full comprehensive visit note at 88, with four argued decisions and every domain recorded, is on this page.
Why is colorectal screening stopped in the NR 578 Week 6 note?
Its benefit takes about ten years to appear, which is longer than this patient's likely life span given heart failure, kidney disease and dementia, and the task force does not advise routine screening after 85.