| Course | PA 541 PA Professional Practice Seminar II |
|---|---|
| Week | 8 |
| Paper type | Encounter write-up |
| Length | About 840 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 541 Week 8
First Contact Write-Up for G.O.: From "Stomach Flu That Won't Quit" to Adrenal Insufficiency After a Hidden Steroid, Told in the Order Things Were Learned, With the Abandoned Impression Kept
Student Name
Chamberlain University
PA 541: PA Professional Practice Seminar II
Instructor Name
Month Day, Year
First Contact Write-Up for G.O.: From "Stomach Flu That Won't Quit" to Adrenal Insufficiency After a Hidden Steroid, Told in the Order Things Were Learned, With the Abandoned Impression Kept
Both Versions of the Complaint
G.O. booked the visit as "stomach flu that won't quit." That is the complaint, and it stays at the top of this account even though the visit ended with a different label. G.O.'s spouse, reached by phone at 3:50 p.m., gave a second version: "It's not the stomach; you've been dragging since the pills ran out." Both versions are recorded because the second one, offered by somebody watching from outside, was closer to the truth.
The Order of Learning
2:40 p.m. History from G.O.: nausea since Friday, vomiting roughly three times daily since Sunday, loose stools on the first day only, aching knees and back, lightheaded when standing. A coworker on the same landscaping crew had a stomach illness the week before. Medications: "nothing regular." G.O. had been prescribed amlodipine but had stopped it about two weeks earlier because of dizziness.
2:55 p.m. Examination: temperature 37.4 °C; blood pressure 104/66 seated and 86/58 standing, pulse 98 then 118; dry mouth; abdomen soft with mild diffuse tenderness and no guarding. I noted a round, full face and bruises on both forearms, and did not yet know what to make of them.
3:10 p.m. Impression written: likely viral gastroenteritis with volume depletion. I listed the orthostatic drop and weight loss as findings that did not fit.
3:25 p.m. At the door, G.O. mentioned running out of "my joint pills" eleven days earlier. They had been taken every day for about eight months.
3:50 p.m. The spouse sent a photo of the bottle: Artri King. The FDA has warned that this product contains undeclared dexamethasone and diclofenac (U.S. Food and Drug Administration, 2022).
4:00 p.m. Results: sodium 128 mmol/L, potassium 4.4 mmol/L, glucose 61 mg/dL, creatinine 1.4 mg/dL (it was 0.9 last spring), eosinophils 6 percent.
Keep the Abandoned Idea
Gastroenteritis was a reasonable first impression and is kept here, not erased. It explained the vomiting and the sick coworker. It did not explain an orthostatic drop this large, two weeks of weight loss, low glucose or the round face. When the bottle was identified, the impression changed to adrenal insufficiency after withdrawal of a hidden glucocorticoid. A viral illness may still have been the trigger that tipped G.O. from a suppressed but coping axis into crisis, which is a common pattern (Beuschlein et al., 2024).
What Was Done
Blood for cortisol and ACTH went into tubes at 4:25 p.m., and seven minutes later the first 100 mg of intravenous hydrocortisone followed, with saline running, as guidance on suspected adrenal crisis advises (Bornstein et al., 2016). G.O. was transferred to the emergency department and admitted overnight. Random cortisol at 3:40 p.m. was later reported at 1.8 micrograms per deciliter, with a low ACTH. G.O. was discharged the next afternoon on oral hydrocortisone in divided doses with sick-day instructions.
Locate the Stop
Certainty ran out at a specific point. The low cortisol with low ACTH, the product history and the timing make glucocorticoid-induced adrenal insufficiency very likely. What remains uncertain is whether anything else is suppressing the pituitary. That question cannot be answered until G.O. is on a lower hydrocortisone dose and a morning cortisol can be measured, which endocrinology plans at six weeks. A second open question is the effect of eight months of hidden diclofenac: ALT was mildly raised at 48 units per liter, and creatinine had not returned to baseline at discharge.
Say What Was Arranged
Endocrinology follow-up in two weeks and a morning cortisol at six weeks. A clinic visit in one week to recheck sodium, creatinine and liver enzymes. A medical alert card stating adrenal insufficiency, and written sick-day rules doubling the hydrocortisone dose during fever or vomiting and going to the emergency department if vomiting prevents taking it. Our pharmacist sent the FDA a MedWatch report before the clinic closed. G.O. was asked to bring the bottle to the next visit and not to buy further supplements without showing them to us first; the remaining tablets were bagged for disposal. Amlodipine remains stopped until blood pressure is rechecked off acute illness.
What I Would Do Differently
Next time I will ask about products from markets, stores and other countries before examining, and I will treat a round face with bruising in a patient who denies steroid use as a question, not a background detail.
The visit took ninety minutes from check-in to ambulance. Most of the useful information arrived in the last forty, after the history I thought was complete. Writing it in the order it arrived is the only way to show that.
References
Beuschlein, F., Else, T., Bancos, I., Hahner, S., Hamidi, O., van Hulsteijn, L., Husebye, E. S., Karavitaki, N., Prete, A., Vaidya, A., Yedinak, C., & Dekkers, O. M. (2024). European Society of Endocrinology and Endocrine Society joint clinical guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency. Journal of Clinical Endocrinology & Metabolism, 109(7), 1657-1683. https://doi.org/10.1210/clinem/dgae250
Bornstein, S. R., Allolio, B., Arlt, W., Barthel, A., Don-Wauchope, A., Hammer, G. D., Husebye, E. S., Merke, D. P., Murad, M. H., Stratakis, C. A., & Torpy, D. J. (2016). Diagnosis and treatment of primary adrenal insufficiency: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 101(2), 364-389. https://doi.org/10.1210/jc.2015-1710
U.S. Food and Drug Administration. (2022, April 20). Public notification: Artri King contains hidden drug ingredients. https://www.fda.gov/drugs/medication-health-fraud/public-notification-artri-king-contains-hidden-drug-ingredients
Reading the PA 541 Week 8 instructions
The final week asks for a continuous account of one encounter, usually three to five pages, written in the order things were learned rather than in the order of a standard note. Begin with the complaint in the patient's own words and keep it visible even after the visit is relabeled; include a second telling if someone else described it differently. The middle should follow the encounter as it happened, including any answer that arrived late and reorganized what came before. Keep the impression you abandoned and the facts that displaced it. Then locate the point where certainty stopped, naming the question or result it stopped on. Finish with what was arranged: follow-up, tests, safety steps and who will do each. The instructions warn against writing backward from the answer, where every detail points neatly at the ending.
How this PA 541 Week 8 example is built
The write-up opens with both complaints: G.O.'s "stomach flu that won't quit" and the spouse's "you've been dragging since the pills ran out." A timed sequence follows: history at 2:40, examination at 2:55 with the round face noted but not yet understood, the impression at 3:10, the doorway disclosure at 3:25, the bottle photo at 3:50, matched to the FDA notice (U.S. Food and Drug Administration, 2022), then results at 4:00. The abandoned impression section explains what gastroenteritis did and did not account for and how a viral illness may have triggered the crisis (Beuschlein et al., 2024). Treatment and transfer follow, with guideline support (Bornstein et al., 2016) and the cortisol of 1.8. The stopping point is located at the six-week morning cortisol and the diclofenac effects. Arrangements list endocrinology, labs, an alert card, sick-day rules and the MedWatch report, and the paper closes on two changes in practice.
Where the points sit in the PA 541 Week 8 rubric
The costliest move in this write-up is telling the story backward from the answer, so every detail points at the diagnosis and nothing is ever surprising. It loses the largest share. Next, graders penalize a stopping place that is asserted rather than located; saying certainty ran out without naming the result or question it ran out on earns little. Dropping the original complaint once the visit is relabeled costs further points, as does erasing the abandoned impression. Credit goes to a clear order of learning with times, a late answer shown where it arrived and a second telling kept beside the first. Arrangements must name who does what and when. Cited sources for the decisive facts and treatment, in APA form, round out the rubric.
PA 541 Week 8 help: mistakes that cost points
Write-ups most often lose marks by reading like a tidy admission note, with the diagnosis at the top and the history arranged to fit it. Another weakness is a vague ending such as "further workup is needed." Some also drop the patient's words in favor of the final label. If your section asks you to write up your own first encounter, or a case with a different late disclosure, send the notes you have; an account drafted from them would follow the order things were learned, keep both versions of the complaint and the abandoned idea, locate exactly where certainty stopped and list each arrangement with its owner. If your program wants a standard note alongside it, that can be supplied as a separate section.
Get a PA-541 Week 8 example written to your instructions
Send the assignment, the rubric and any encounter your classroom supplies, and a custom PA-541 Week 8 write-up comes back inside 24-48h, the first one free. If your section builds this on a real visit of your own, the example arrives on invented material and stays a model of the ordering rather than a document about your patient.
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PA 541 Week 8 questions, answered
Does the write-up follow a standard clinical note format?
Only if your classroom asks for one. Many sections want narrative precisely because a formatted note hides the order in which things were learned, which is what this week is marked on. Where a template is supplied, the example fills it and puts the reasoning into the sections that allow prose, usually the history of the present illness and the assessment.
How is this different from the presentation draft earlier in the term?
The spoken draft compresses an encounter for a listener who needs the conclusion fast. This one expands it for a reader who wants to see the thinking, including the parts that went nowhere. One is judged on what it leaves out, the other on what it keeps, which is why the same encounter produces two very different documents.
Can the encounter end without a diagnosis?
Yes, and many of the strongest ones do. Naming the moment the account stops being sure is part of what is handed in, so an ending with a working impression, an open question and an arrangement to close it is a complete answer. What is not complete is an ending that stops at the uncertainty without saying what was done about it.
Where can I find a free PA 541 Week 8 sample paper?
A complete PA 541 Week 8 first contact write-up, told in the order things were learned and ending with arrangements for adrenal insufficiency, is on this page.
Where does certainty stop in the PA 541 Week 8 sample?
It stops at whether anything else suppresses the pituitary, which waits for a morning cortisol at six weeks, and at the effect of months of hidden diclofenac.