| Course | NR 603 Advanced Clinical Diagnosis and Practice across the Lifespan Practicum |
|---|---|
| Week | 3 |
| Paper type | SOAP note |
| Length | About 870 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Family Nurse Practitioner (FNP) |
| Updated | October 2026 |
Free sample paper for NR 603 Week 3
SOAP Note: R.M., 58, Returning for Results, With a Working Problem of Iron Deficiency Anemia and Weight Loss Whose Source Is Not Yet Known
Student Name
College of Nursing, Chamberlain University
NR 603: Advanced Clinical Diagnosis and Practice across the Lifespan Practicum
Instructor Name
Month Day, Year
SOAP Note: R.M., 58, Returning for Results, With a Working Problem of Iron Deficiency Anemia and Weight Loss Whose Source Is Not Yet Known
Subjective
R.M., 58, returns one week after the first visit for blood results. Still tired, unchanged. Stopped ibuprofen as advised; back pain manageable with acetaminophen. Stools still slightly loose, two a day, brown. No black or tarry stools, no visible blood. No chest pain, no fainting. Breathless on the second flight of stairs, unchanged. No difficulty swallowing, no heartburn, no abdominal pain. Weight at home stable this week.
Objective
Weight 73.8 kilograms (74.0 last week). Heart rate 94. Blood pressure 122/74. Inner eyelids pale. Abdomen soft, no masses, no tenderness.
Results from last week:
Hemoglobin 10.2 g/dL (low). Mean cell volume 74 fL (small cells). Platelets 410,000 (mildly raised).
Ferritin 8 ng/mL (low). Transferrin saturation 6% (low).
Thyroid-stimulating hormone 2.1 (normal).
Hemoglobin A1c 5.6% (normal).
Comprehensive metabolic panel: normal kidney and liver function.
Hepatitis C and HIV antibodies: negative.
PHQ-9 at last visit: 4.
Assessment
1. Iron deficiency anemia, moderate, with small red cells and very low iron stores.
2. Unintended weight loss of about 5% over three months.
3. Source of iron loss not yet identified.
The working problem is iron deficiency anemia with weight loss, source unknown. In a 58-year-old who has never had colon screening and has taken daily ibuprofen for a year, the likely sources are blood loss from the colon, including a polyp or cancer, or from the stomach, including an ulcer from ibuprofen. Malabsorption, such as celiac disease, is a less common cause and would also explain the looser stools. A mostly vegetarian diet can lower iron intake but would not usually produce a ferritin of 8 with weight loss on its own.
Overactive thyroid and diabetes, two of the three candidates from last week, are now unlikely given normal results.
Plan
Referral to gastroenterology for both colonoscopy and upper endoscopy, marked urgent, requesting an appointment within two weeks. Guidelines advise examining both the upper and lower gut in adults with iron deficiency anemia (Ko et al., 2020). The referral letter is written separately.
Celiac disease antibody test (tissue transglutaminase IgA with total IgA) today, since a positive result would change what the gastroenterologist looks for.
Oral iron: ferrous sulfate 325 mg (65 mg elemental iron) once every other day, swallowed in the morning with water or juice and kept apart from tea, coffee and dairy, which block absorption. Taking iron on alternate days absorbs as well or better than daily dosing with fewer side effects (Stoffel et al., 2017).
Continue to avoid ibuprofen and other anti-inflammatory medicines. Acetaminophen up to 3 grams a day for back pain.
Starting iron before the endoscopy does not interfere with the examination.
Follow-Up With Thresholds
Hemoglobin and reticulocyte count in 4 weeks. Expected: hemoglobin up by 1 g/dL or more if iron is being absorbed and the bleeding is slow or has stopped.
If hemoglobin has not risen by 1 g/dL at 4 weeks, iron absorption or ongoing loss must be reconsidered, and intravenous iron discussed.
Seek emergency care at once for dark tarry stools or visible blood, a faint, chest pain, or shortness of breath while resting.
Clinic call in 2 weeks to confirm the gastroenterology appointment has been made.
What Changed Since the First Visit
Two of last week's three candidates have been set aside by normal results, and the third has been confirmed and narrowed to a question about its source. The plan has moved from testing broadly to referring for one specific examination. The note records that movement so a reader can follow it.
Results Still Pending
Celiac antibodies, due in three to five days. A positive result would be passed to the gastroenterologist before the procedure so that biopsies of the small bowel are taken.
Patient Education
R.M. was told that the blood count is low because iron stores are very low, that the most important step is finding where the iron is being lost and that this means looking inside the stomach and bowel. R.M. asked whether this could be cancer. I said that it was one of the things the examination would look for, that many causes are not cancer and that finding out quickly was the reason for the urgent referral. R.M. repeated the iron schedule and the warning signs.
Screening Gap
R.M. is 13 years past the age at which colorectal screening is now recommended to begin (US Preventive Services Task Force, 2021). Whatever the endoscopy shows, the result will also serve as screening, and the follow-up interval will be set by the findings.
Why the Note Does Not Name a Cause
The record will be read by the gastroenterologist and possibly others later. Naming an ulcer or a cancer now, without evidence, would mislead them and could be wrong. The note names what is known, iron deficiency anemia with weight loss, and what is not, its source.
References
Ko, C. W., Siddique, S. M., Patel, A., Harris, A., Sultan, S., Altayar, O., & Falck-Ytter, Y. (2020). AGA clinical practice guidelines on the gastrointestinal evaluation of iron deficiency anemia. Gastroenterology, 159(3), 1085-1094. https://doi.org/10.1053/j.gastro.2020.06.046
Stoffel, N. U., Cercamondi, C. I., Brittenham, G., Zeder, C., Geurts-Moespot, A. J., Swinkels, D. W., Moretti, D., & Zimmermann, M. B. (2017). Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: Two open-label, randomised controlled trials. The Lancet Haematology, 4(11), e524-e533. https://doi.org/10.1016/S2352-3026(17)30182-5
US Preventive Services Task Force. (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
Reading the NR 603 Week 3 instructions
The Week 3 note should read as a real record. The subjective section carries the complaint as the patient framed it and the pertinent negatives actually asked, not a recital of every system. The objective section holds only what was examined and the results that bear on the question. The assessment is where the week is won: name a working problem, such as fatigue with unintended weight loss, rather than a diagnosis the evidence does not yet support. Then commit to a plan anyway, with an interval and return criteria. Most rubrics mark down a confident diagnosis the objective section cannot support, a plan that stays general and a subjective section that repeats a template.
Inside the NR 603 Week 3 example
The sample's subjective records persistent fatigue, the stopped ibuprofen and a set of specific negatives: no black stools, no visible blood, no chest pain. The objective section gives weight, pulse, pallor and the results: hemoglobin 10.2, small red cells, ferritin 8 and normal thyroid, A1c, chemistry and infection tests. The assessment names iron deficiency anemia with weight loss, source unknown, and lists the likely sources. The plan refers for both endoscopies, sends celiac antibodies, starts alternate-day iron and sets a four-week hemoglobin target with return criteria. Sections explain what changed, the screening gap, pending results and why the note names no cause. Margin notes mark the working problem and the thresholds.
NR 603 Week 3 rubric: what full points look like
Most lost points sit in the assessment, and this note names a working problem the evidence supports instead of a confident cause. A plan that says follow up as needed costs the next share, while this plan sets a four-week hemoglobin target with a threshold for changing course. A subjective section that repeats a template loses a row, and these negatives were each asked for a reason. Objective findings padded with irrelevant normals lose marks, and this section is short. Explaining why the note avoids naming a cause shows the writer understands who will read it next. Recording what changed since the first visit lets a reader follow the reasoning.
NR 603 Week 3 help from the desk
Weak NR 603 Week 3 notes name a diagnosis the tests have not yet shown. Others end with follow-up as needed and no return criteria. Many fill the subjective section with a full review of systems. Objective sections often list every normal finding. Few explain what result would change the plan. Write the complaint in the patient's terms, record the negatives you actually asked, keep the objective section to what matters and name a working problem. Then set a follow-up with a measurable threshold. Different results call for a different working problem, and a note in this shape can be drafted around yours. Say which pending results could change the plan.
Get a NR 603 Week 3 example written to your instructions
Send the Week 3 documentation template in use in your section, along with the case being written up, and a custom example is written into that template and returned inside 24 to 48 hours. The first one is free. The visit you document in your own submission has to be a visit you saw.
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NR 603 Week 3 questions, answered
Can the assessment say the diagnosis is uncertain?
It can and often should, as long as uncertainty is written in clinical form. Naming a working problem, listing what is still being considered and stating which one you are covering for is documentation. Writing that the cause is unclear and stopping there is not, because the note has to show that someone decided what happens next.
How long should the note be?
Sections differ and the template usually settles it, but length is rarely the problem. Notes lose points for padding far more often than for brevity. A full page of normal findings across systems nobody examined tells a marker the writer is filling a template rather than documenting a visit, and it buries the two findings the case turns on.
Should the plan include patient education?
In most rubrics yes, and it scores when it is written as something said rather than as a heading. A line telling this patient which symptom means come back today, in words they would use, is worth more than a paragraph naming three topics that were discussed at the end of the visit.
Where can I find a free NR 603 Week 3 sample paper?
The full results-visit SOAP note naming iron deficiency anemia with an unknown source is on this page.
What threshold is set in the NR 603 Week 3 note?
Hemoglobin should rise by at least 1 g/dL in four weeks; if it does not, absorption or ongoing loss is reconsidered and intravenous iron discussed.