| Course | NRNP 6531 Primary Care of Adults Across the Lifespan |
|---|---|
| Week | Week 2 |
| Paper type | Follow-up SOAP note |
| Length | About 860 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | MSN Family Nurse Practitioner (FNP) |
| Updated | October 2026 |
Free sample paper for NRNP 6531 Week 2
Hypertension Follow-Up SOAP Note: Ranking the Reasons Blood Pressure Remains Above Goal in a 58-Year-Old Man
Student Name
College of Nursing, Walden University
NRNP 6531: Primary Care of Adults Across the Lifespan
Instructor Name
Month Day, Year
Hypertension Follow-Up SOAP Note: Ranking the Reasons Blood Pressure Remains Above Goal in a 58-Year-Old Man
Subjective
Reason for visit: three-month follow-up of hypertension.
Interval history: G.S. is a 58-year-old bus mechanic, created for teaching, with hypertension diagnosed two years ago and treated with amlodipine 10 mg daily, increased from 5 mg at his last visit. He brought home readings on his phone from the past two weeks, averaging 148/92 in the morning. By his own count, he misses about two doses a week, usually on weekends when his routine changes. Since the dose increase he has noticed swelling around both ankles by evening, which is gone in the morning. He takes naproxen 220 mg most mornings for right knee pain from years of kneeling at work. His wife, who came with him, reports that he snores loudly and sometimes seems to stop breathing for a few seconds at night; he says he wakes tired and dozes off watching television.
Pertinent negatives: no chest pain, shortness of breath, orthopnea, palpitations, headache, vision changes, or weakness. No new medications apart from naproxen, no decongestants, no stimulants.
Other history: body mass index at last visit 31. He has two or three beers on Saturday and Sunday evenings. Former smoker, quit ten years ago. Family history of hypertension in both parents.
Objective
Blood pressure: 152/94 in the right arm and 150/92 on repeat after five minutes, seated with feet flat and arm supported, using a large adult cuff chosen for a mid-arm circumference of 36 cm. His home device, checked against the office device at this visit, read within 4 mm Hg of the office measurement. Heart rate 76 and regular. Weight 226 lb, body mass index 31.5. Neck circumference 17.5 inches.
Cardiovascular: regular rate and rhythm, no murmur, rub, or gallop; point of maximal impulse not displaced; no carotid bruits. Lungs clear. Extremities: 1+ pitting edema at both ankles, symmetric, without calf tenderness or skin change. Fundoscopic exam: sharp disc margins, no hemorrhages or exudates, mild arteriolar narrowing without nicking. Oropharynx: crowded airway with enlarged tonsillar pillars.
Assessment
1. Hypertension, above goal, confirmed by office and validated home readings. The goal for most adults with hypertension is below 130/80 (Carey et al., 2022). The likeliest reasons for poor control, ranked:
a. Missed doses. Two missed doses a week is roughly 30 percent of doses. Amlodipine's long half-life softens the effect of an occasional miss, but a regular weekend gap still lowers average exposure and is the simplest explanation to address.
b. Daily naproxen. Nonsteroidal anti-inflammatory drugs raise blood pressure by promoting sodium and water retention and blunting renal prostaglandin-mediated vasodilation, and they reduce the effect of most antihypertensives (Carey et al., 2022). Daily use is a probable contributor.
c. Possible obstructive sleep apnea. Loud snoring, witnessed pauses, daytime sleepiness, a neck circumference over 17 inches, male sex, age over 50, hypertension, and body mass index over 30 give him a STOP-Bang score of at least 7, indicating high risk (Chung et al., 2016). Untreated sleep apnea is a recognized secondary contributor to resistant hypertension.
d. Alcohol and weight, lesser contributors.
2. Ankle edema, most likely a medication effect rather than a new problem. Dihydropyridine calcium channel blockers dilate precapillary arterioles, raising capillary hydrostatic pressure and causing dose-related dependent edema that does not reflect fluid overload (Rosenthal & Burchum, 2021). It began after the dose increase, is bilateral and dependent, and resolves overnight; lungs are clear and there is no orthopnea. Heart failure and venous thrombosis are unlikely but will be reconsidered if edema persists after the medication change or becomes asymmetric.
3. Chronic right knee pain, likely osteoarthritis, relevant here because of its treatment.
Plan
Missed doses: discussed without judgment; he will set a daily phone alarm and keep a pill organizer in his truck for weekends.
Naproxen: stop daily use. For knee pain, topical diclofenac gel up to four times daily and acetaminophen up to 3 g daily; referral to physical therapy for knee strengthening.
Edema and regimen: reduce amlodipine to 5 mg daily, which is expected to reduce the edema, and add lisinopril 10 mg daily, since adding a renin-angiotensin blocker both lowers blood pressure and reduces calcium channel blocker edema by dilating postcapillary venules. He is told that lisinopril can cause a dry cough, which should be reported rather than tolerated, and, rarely, swelling of the lips or tongue, which needs emergency care. Because his job involves physical exertion in a hot garage, he is also told to report lightheadedness when standing, since the combination may lower his pressure more than expected at first.
Sleep apnea: referral for a sleep study; counseled not to drive when drowsy, which matters for his work.
Lifestyle: limit alcohol to no more than two drinks on any day and reduce sodium; discussed a modest weight goal.
Monitoring: basic metabolic panel with creatinine and potassium now as a baseline and again in one to two weeks after starting lisinopril; urinalysis for protein. Home readings twice daily for two weeks before the next visit.
Follow-up: return in four weeks with home readings, sooner for chest pain, severe headache, facial or lip swelling, or worsening leg swelling (Dains et al., 2020).
References
Carey, R. M., Moran, A. E., & Whelton, P. K. (2022). Treatment of hypertension: A review. JAMA, 328(18), 1849-1861. https://doi.org/10.1001/jama.2022.19590
Chung, F., Abdullah, H. R., & Liao, P. (2016). STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest, 149(3), 631-638. https://doi.org/10.1378/chest.15-0903
Dains, J. E., Baumann, L. C., & Scheibel, P. (2020). Advanced health assessment and clinical diagnosis in primary care (6th ed.). Elsevier.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
NRNP 6531 Week 2 instructions, in plain terms
In Week 2, NRNP 6531 typically asks for a SOAP note on a chronic disease follow-up visit, often hypertension, diabetes or hyperlipidemia. You document interval history, adherence, home monitoring, a focused examination and relevant results, then reassess the condition and adjust the plan. The prompt usually expects reference to current guidelines for targets and treatment steps. Expect a few pages with APA 7 citations. Faculty look for reasoning about why the condition is or is not controlled. Lifestyle factors and medication review belong in the note. A clear follow-up interval closes the plan. NRNP 6531 faculty want the current blood pressure target stated and compared with the readings, not assumed. Bring home readings into the objective section with the dates and times they were taken. If the case suggests a secondary cause, such as sleep apnea, say why and how you will screen for it. The plan should name what changes today and what waits for the next visit.
How the NRNP 6531 Week 2 example is put together
Interval history comes first: home readings brought in on a phone, two missed doses a week by the patient's own count, new ankle swelling, and an over-the-counter anti-inflammatory taken most mornings for knee pain. His partner reports loud snoring. The objective block records two seated office readings with cuff size noted, a check of the home device against the office one, and a focused cardiovascular and fundoscopic exam. The assessment is the center of the note. It ranks the likeliest reasons for poor control, from missed doses to the anti-inflammatory to possible sleep apnea, and it names the ankle swelling as a probable medication effect rather than a new problem. The plan answers each ranked reason in turn, then records labs to monitor kidney function and electrolytes.
Where the marks sit in the NRNP 6531 Week 2 rubric
A reassessment is what a follow-up visit exists for, and a note that restates the original diagnosis and renews the prescription has reassessed nothing. This example earns that credit by asking why control failed before touching the regimen. Guideline currency is graded next; the ACC/AHA blood pressure guideline is cited for its central idea, that treatment decisions track overall cardiovascular risk and not the reading alone. Credit drops where medication changes arrive with no reason tied to the assessment, where adherence is assumed rather than asked about, and where lifestyle counseling is one generic line about diet and exercise. Missing kidney and electrolyte monitoring after a regimen change also costs, since graders read it as an unsafe gap.
NRNP 6531 Week 2 help from the desk
Follow-up notes lose credit when they restate the diagnosis and renew the medication without asking why control is poor. Rank the possible reasons. Another common gap is ignoring home blood pressure readings or failing to check how they were taken. Writers also overlook drugs that raise blood pressure, such as NSAIDs or decongestants. Screen for secondary causes when the history suggests one. Avoid adding a second drug before addressing adherence. Keep the vital signs and readings consistent through the note. Name the next check and the target. Writers also forget to check how the home cuff was used, though a wrong cuff size or measuring after coffee can push readings up. Ask the patient to bring the cuff. Another frequent miss is counseling on sodium and alcohol in general terms only; give a specific target. Close with a date for the next reading review.
Get a NRNP 6531 Week 2 example written to your instructions
Share the Week 2 instructions, the rubric, and the chronic condition set for follow-up in your section. What comes back is a reassessment note built on that condition, with reasons for poor control ranked before any change to the plan. The first custom sample carries no charge and is ready within 24-48 hours.
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NRNP 6531 Week 2 questions, answered
What makes a follow-up note different from a first-visit note?
The diagnosis is already established, so the reasoning moves to control, adherence, side effects, and complications. The example keeps a ranked assessment, but the items ranked are reasons the condition is off target rather than candidate diagnoses. Rubrics for chronic care weeks tend to reward that shift, and they penalize notes that simply repeat the problem list and renew what was already prescribed.
Does the note need home blood pressure readings?
Not every prompt supplies them, but the example uses a record of home readings because it lets the assessment weigh measurement error and white-coat effect alongside true poor control. When your case includes only office readings, the finished sample works from those and states which additional measurements would sharpen the assessment, a move graders tend to credit as sound reasoning.
Which guideline does the example cite?
It cites the ACC/AHA blood pressure guideline for its central principle and a current primary care text for the medication review. Sections sometimes name a required guideline or set a minimum number of scholarly sources, and a sample written to your instructions follows those requirements. What matters most is that each citation sits beside the decision it supports rather than in a list at the end.
Where can I find a free NRNP 6531 Week 2 sample paper?
The hypertension follow-up note appears here with the ranked reasons for poor control, the home reading comparison and the stepwise plan, with margin notes.
Why is the blood pressure still high in NRNP 6531 Week 2?
The note ranks possible reasons, adherence, home measurement technique, sodium and alcohol, possible sleep apnea and an interfering drug, and plans for each.