NRNP 6531 Week 7 Diabetes SOAP Note Example

Course	NRNP 6531 Primary Care of Adults Across the Lifespan
Week	Week 7
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 7

Diabetes Follow-Up SOAP Note: Rising A1c on Rotating Night Shifts and New Tingling in Both Feet

Student Name

College of Nursing, Walden University

NRNP 6531: Primary Care of Adults Across the Lifespan

Instructor Name

Month Day, Year

What this page is doingThe title names both strands the note must address: control and a new symptom. A follow-up note that treated only the A1c, or only the tingling, would miss half the visit, and the title commits to both.

Diabetes Follow-Up SOAP Note: Rising A1c on Rotating Night Shifts and New Tingling in Both Feet

Subjective

Reason for visit: diabetes follow-up and a new symptom.

Control: R.H. is a 52-year-old woman, constructed for this assignment, who works as a hospital environmental services supervisor on rotating night shifts and has had type 2 diabetes for nine years. She takes metformin 1,000 mg twice daily. Empagliflozin was added a year ago, but she stopped it two months ago when her insurance changed and the copay rose to more than she could afford; she did not call because she assumed nothing could be done. On night weeks she eats at irregular times, often a large meal before bed after her shift and vending machine snacks during it. She mentions without being asked that she has gained about 10 pounds since the spring. She checks her glucose occasionally; morning readings after night shifts are often above 200 mg/dL.

New symptom: for about three months she has had tingling and a pins-and-needles feeling in both feet, symmetric, starting at the toes and now reaching the balls of her feet, worse at night in bed. She has no weakness, no falls, no foot wounds, and no numbness in her hands.

Other: no chest pain, vision change, or urinary symptoms. No alcohol use. Vegetarian diet for the past five years.

Objective

Vital signs: blood pressure 132/82, heart rate 78, weight 188 lb, body mass index 32.3.

Laboratory values from last week as reported: hemoglobin A1c 8.9 percent, up from 7.4 percent six months ago; eGFR 78; albumin in urine at 22 mg/g of creatinine; LDL cholesterol 118 mg/dL.

Foot examination: skin intact without calluses, ulcers, or fissures; nails normal; dorsalis pedis and posterior tibial pulses palpable bilaterally. Monofilament testing (10-g) detected at all sites on both feet. Vibration, tested with the 128-Hz fork, diminished at both great toes and intact at the ankles. Ankle reflexes diminished bilaterally. Strength normal.

Preventive dates: last dilated eye examination two and a half years ago; last urine albumin screening last week, as above.

What this page is doingThe foot examination records each component, monofilament, vibration, reflexes, pulses, and skin, rather than a single word such as normal. That detail supports the neuropathy assessment and shows the protective sensation is still intact, which determines her ulcer risk category.

Assessment

1. Type 2 diabetes, above goal. The reasons for rising A1c, ranked:

a. Stopping empagliflozin because of cost two months ago. This is the most important and most fixable reason, and it removed an agent with cardiovascular and kidney benefits as well as glucose lowering (American Diabetes Association Professional Practice Committee [ADA], 2024a).

b. Irregular meals and late large meals on night shifts, which produce high morning glucose.

c. Weight gain, which increases insulin resistance.

2. Symmetric distal sensory symptoms in both feet. Diabetic peripheral neuropathy leads: the symptoms are symmetric, length-dependent, and worse at night, with reduced vibration sense and diminished ankle reflexes, which is the classic distal polyneuropathy pattern (ADA, 2024b). Vitamin B12 deficiency is kept second, not dismissed, because long-term metformin use is associated with lower B12 levels and B12 deficiency causes an identical neuropathy. In a long-term follow-up of the Diabetes Prevention Program, metformin use was associated with B12 deficiency, and the risk rose with duration of use (Aroda et al., 2016). Her vegetarian diet adds to that risk. Less likely causes, hypothyroidism and alcohol, are addressed by testing and history.

3. Preventive care overdue: dilated eye examination.

4. Cardiovascular risk. At 52 with diabetes, her LDL of 118 mg/dL is above the level at which a moderate-intensity statin is recommended for adults with diabetes aged 40 to 75, and she is not taking one; her blood pressure of 132/82 is slightly above the usual goal of below 130/80 for adults with diabetes. Both add to the risk that the lapse in her SGLT2 inhibitor also raised, and both belong in the same conversation about what her diabetes plan protects against, not only her glucose numbers.

Plan

Cost barrier: the clinic's pharmacy team will check her new plan's formulary; if empagliflozin remains unaffordable, options include the manufacturer's assistance program or a covered SGLT2 inhibitor. She is encouraged to call whenever cost stops a medication. A cost conversation is now part of every medication change in her plan.

Glycemic plan: restart an SGLT2 inhibitor once cost is resolved; continue metformin. Referral to diabetes self-management education with specific attention to meal timing on night shifts, including a smaller pre-sleep meal and planned protein-containing snacks at work.

Neuropathy evaluation: vitamin B12 level, with methylmalonic acid if the result is borderline, and thyroid-stimulating hormone. If B12 is low, supplementation will be started and symptoms reassessed.

Symptom relief: if tingling disturbs sleep after B12 status is known, a trial of duloxetine or pregabalin will be discussed as first-line options for painful diabetic neuropathy (ADA, 2024b).

Foot care: daily foot inspection taught, with well-fitting shoes; her protective sensation is intact, so annual comprehensive foot examination continues with inspection at each visit.

Preventive care: dilated eye examination referral today; urine albumin screening is current and normal.

Cardiovascular: start atorvastatin 20 mg daily after discussing benefits and muscle symptoms to report; recheck blood pressure at the next visit with home readings before adding a medication. Follow-up: three months with a repeat A1c and a lipid panel, sooner if cost cannot be solved within two weeks (Dains et al., 2020).

References

American Diabetes Association Professional Practice Committee. (2024a). 9. Pharmacologic approaches to glycemic treatment: Standards of care in diabetes 2024. Diabetes Care, 47(Suppl. 1), S158-S178. https://doi.org/10.2337/dc24-S009

American Diabetes Association Professional Practice Committee. (2024b). 12. Retinopathy, neuropathy, and foot care: Standards of care in diabetes 2024. Diabetes Care, 47(Suppl. 1), S231-S243. https://doi.org/10.2337/dc24-S012

Aroda, V. R., Edelstein, S. L., Goldberg, R. B., Knowler, W. C., Marcovina, S. M., Orchard, T. J., Bray, G. A., Schade, D. S., Temprosa, M. G., White, N. H., & Crandall, J. P. (2016). Long-term metformin use and vitamin B12 deficiency in the Diabetes Prevention Program Outcomes Study. The Journal of Clinical Endocrinology & Metabolism, 101(4), 1754-1761. https://doi.org/10.1210/jc.2015-3754

Dains, J. E., Baumann, L. C., & Scheibel, P. (2020). Advanced health assessment and clinical diagnosis in primary care (6th ed.). Elsevier.

Reading the NRNP 6531 Week 7 instructions

Week 7 of NRNP 6531 tends to pair a chronic disease follow-up with a new symptom raised at the same visit. Diabetes is a common choice because complications arrive quietly. You document interval history for the chronic problem, a full history of the new complaint, a focused examination with the screening tests the guideline expects, and an assessment and plan for each problem. Faculty want current targets stated, not assumed. Cite the ADA Standards and the Dains text in APA 7; length is usually a few pages. The new symptom needs its own differential. Lifestyle and work patterns that affect control belong in the subjective section. The plan should end with a clear follow-up interval and the results you will review then.

How this NRNP 6531 Week 7 example is built

The history splits cleanly. Under control, the note records rotating night shifts, meals at irregular times, a prescribed agent stopped two months ago because of cost, and a weight gain she mentions unprompted. Under the new symptom, it records symmetric tingling in both feet, worse at night, with no weakness. The objective section brings in the latest lab values as reported, a monofilament and vibration exam of both feet, and the dates of her last eye exam and kidney screening. The assessment ranks reasons for poor control with cost first. For the tingling, diabetic neuropathy leads, but vitamin B12 deficiency is kept second because of long metformin use. The plan answers both strands and closes with the preventive items still overdue.

Where the marks sit in the NRNP 6531 Week 7 rubric

Follow-up notes that meet a new complaint are graded on whether both problems received full reasoning, and a note that spends a page on glucose and a line on the feet has treated the new symptom as a footnote. This example gives each strand its own ranked assessment. Credit on guideline use comes from applying the ADA Standards to this patient, including cost and work schedule, rather than reciting targets. Preventive elements a diabetes visit carries are checked as well, and a note with no documented foot exam loses points regardless of the rest. The note is also marked down when neuropathy is assumed without considering the metformin link, when the cost barrier is recorded but never addressed in the plan, and when education is generic advice about diet.

Common NRNP 6531 Week 7 mistakes, and how to avoid them

The usual way this note loses marks is spending a page on glucose and a line on the tingling. Give the new symptom a full differential and a plan. Another common gap is skipping the monofilament and vibration tests, which the ADA expects at least yearly. Writers also forget that metformin can lower vitamin B12, a treatable cause of neuropathy. Check it. Shift work is easy to overlook, yet a night schedule changes when meals and doses happen. Ask about it. Avoid adding a new agent before reviewing timing and adherence. Keep the A1c values and dates consistent through the note. Close with what the patient should check on their feet each day.

Get a NRNP 6531 Week 7 example written to your instructions

Send the Week 7 instructions and rubric along with the chronic condition in your case. What returns is a follow-up note that keeps each problem in its own strand and ranks the reasons behind poor control. The first custom sample costs nothing and arrives in 24-48 hours, cited to the guideline your section names.

More NRNP 6531 papers and FNP samples

NRNP 6531 Week 7 questions, answered

Why split the note into two strands?

Because a follow-up visit that surfaces a new symptom is really two visits sharing a chart entry. Keeping them apart in every section lets each problem receive a ranked assessment and a plan of its own, and it lets a grader verify the reasoning for each. Merged notes tend to under-document whichever problem arrived second, and lose credit there.

Does the example state target lab values?

It reports the patient's values as given in the case and treats her goal as individualized, citing the ADA Standards of Care for that principle. It does not present numeric targets as guidance. Your prompt may require the current recommended goals to be named, in which case the sample cites them from the edition of the standards your section uses.

Why is vitamin B12 deficiency on the list?

Long-term metformin use is associated with lower B12 levels, and B12 deficiency can produce a neuropathy resembling the diabetic kind. The example keeps it second in the ranking for that reason. Graders in primary care courses frequently reward a differential that looks past the obvious cause, especially when the medication list supplies the clue.

Where can I find a free NRNP 6531 Week 7 sample paper?

This page shows the diabetes follow-up note with its two strands, the foot examination, the B12 reasoning and the plan, with margin notes for FNP students.

Why check vitamin B12 for neuropathy in NRNP 6531 Week 7?

Long-term metformin use can lower B12, and deficiency causes a neuropathy that looks like diabetic nerve damage but is treatable, so the example tests for it.