| Course | NRNP 6540 Advanced Practice Care of Older Adults |
|---|---|
| Week | Week 7 |
| Paper type | Diagnostic workup |
| Length | About 770 words, 5 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NRNP 6540 Week 7
Geriatric Weight Loss Workup: Fourteen Pounds in Six Months in an 83-Year-Old Widower
Student Name
College of Nursing, Walden University
NRNP 6540: Advanced Nurse Practice in Primary Care Adult Gerontology II
Instructor Name
Month Day, Year
Geriatric Weight Loss Workup: Fourteen Pounds in Six Months in an 83-Year-Old Widower
History
H.B., an 83-year-old retired railroad conductor constructed for this workup, has lost 14 pounds over six months, from 162 to 148 pounds, about 9 percent of his body weight. His wife died eight months ago. Grief is named here, and it is real, but it is not allowed to close the history, because weight loss of this size in an older adult has many possible causes and often more than one.
Appetite and eating: he says he is "just not hungry." His wife did all the cooking; he now eats cereal for breakfast, a sandwich at lunch, and often skips supper. His daughter drops off meals twice a week that he eats half of. His upper denture has become loose over the past year, and meat is hard to chew, so he avoids it.
Medications: digoxin for atrial fibrillation, started by his cardiologist several years ago, along with a rate-control agent and an anticoagulant. Digoxin can cause anorexia and nausea, particularly as kidney function declines with age.
Review of systems for serious causes: no dysphagia, abdominal pain, change in bowel habit, blood in the stool, cough, hemoptysis, night sweats, fever, or new lumps. He reports tiredness. He smoked for 20 years and quit 40 years ago.
Screening Instruments
Mini Nutritional Assessment short form: 9 of 14, in the at-risk range for malnutrition, driven by reduced food intake, weight loss, and a low body mass index (Kaiser et al., 2009).
Geriatric Depression Scale short form: 8 of 15, positive, suggesting depression beyond normal grief (Sheikh & Yesavage, 1986).
Frailty, by its components (Fried et al., 2001): unintentional weight loss, present; exhaustion, reported; slowed walking, gait speed 0.6 meters per second over 4 meters; weak grip, grip strength below the threshold for his sex and size by dynamometer; low physical activity, present since his wife's death. Five of five components: frail.
Examination and Laboratory Tests Sent
Body mass index 21.2; temporal wasting; loose upper denture with a sore spot on the gum; no oral lesions. Thyroid normal to palpation. Lungs clear. Heart irregularly irregular, rate 72. Abdomen soft, no masses or organomegaly. No lymphadenopathy. Rectal examination with brown stool, negative for occult blood.
Sent: complete blood count, comprehensive metabolic panel with albumin, thyroid-stimulating hormone, digoxin level, hemoglobin A1c, and urinalysis. A chest radiograph is ordered given his remote smoking history and weight loss.
How Far He Would Want Investigation to Go
Before ordering anything beyond these basic tests, he was asked what he would want if a serious cause, such as cancer, were found. His answer, recorded in his words: "I'd want to know. But I'm not going through what she went through, the chemo and all that. If it's something you can fix with a pill or a small operation, fine. Otherwise I want to be comfortable and stay in my house." That answer sets the limits: tests that could lead to a treatable diagnosis are reasonable; an extensive search for a cancer he would not treat aggressively is not, unless the basic results point strongly to one. It was documented and shared with his daughter at his request.
Plan Across Several Fronts at Once
Dental: referral to reline or replace the denture, since he cannot eat protein he cannot chew.
Dietary: a dietitian referral; home-delivered meals through the local aging services agency; high-calorie, high-protein oral supplements between meals; eating with his daughter or at the senior center where possible, since people eat more in company.
Mood: depression is treated as a real diagnosis, with referral to grief counseling and discussion of an antidepressant; mirtazapine is one option that may also help appetite and sleep.
Social: the senior center's lunch program and a bereavement group were offered; he agreed to try the lunch program.
Medical: digoxin level reviewed, and the cardiologist is asked whether digoxin is still needed for rate control given his other agent; if the level is high or the drug unnecessary, it will be reduced or stopped. Results of the other tests will be reviewed within a week.
Follow-up: weight at every visit every two weeks for two months, with the goal of stopping the loss first and regaining over time. If the basic tests are normal and his weight stabilizes with these measures, no further search is planned, in keeping with his stated limits; if weight loss continues despite them, or if a result points to a specific cause, the next step will be discussed with him against the same limits, and his daughter will be included in that conversation as he asked.
References
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., & McBurnie, M. A. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology: Series A, 56(3), M146-M157. https://doi.org/10.1093/gerona/56.3.M146
Kaiser, M. J., Bauer, J. M., Ramsch, C., Uter, W., Guigoz, Y., Cederholm, T., Thomas, D. R., Anthony, P., Charlton, K. E., Maggio, M., Tsai, A. C., Grathwohl, D., Vellas, B., & Sieber, C. C. (2009). Validation of the Mini Nutritional Assessment short-form (MNA-SF): A practical tool for identification of nutritional status. The Journal of Nutrition, Health & Aging, 13(9), 782-788. https://doi.org/10.1007/s12603-009-0214-7
Sheikh, J. I., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist, 5(1-2), 165-173. https://doi.org/10.1300/J018v05n01_09
NRNP 6540 Week 7 instructions, in plain terms
Week 7 of NRNP 6540 often asks for a workup of unintended weight loss or failure to thrive in an older adult. You quantify the loss, take a broad history including social and psychological factors, screen for malnutrition, depression and frailty, examine, select tests, and plan treatment across several causes at once. Faculty penalize stopping at one explanation. Cite guidance on weight loss and validated screening tools in APA 7. The person's wishes about the extent of investigation matter. Social factors such as cooking and eating alone deserve attention. Follow-up weights should be scheduled. NRNP 6540 faculty expect the percent of body weight lost calculated and its time frame stated. Name each screening tool and its score. Explain why each laboratory test was sent. Record how far he wants investigation to go in his words.
Inside the NRNP 6540 Week 7 example
Grief is named in the history but not allowed to close it. The note records his appetite, what he eats and who cooks it, loose dentures that make meat hard to chew, and a medication list that includes a drug known to blunt appetite. The Mini Nutritional Assessment places him at risk, and the Geriatric Depression Scale is positive. Frailty is described by its components, slowed walking and weaker grip measured, exhaustion reported. A section on serious causes records the review of systems for malignancy and the labs sent, then asks him how far he would want an investigation to go if something were found. His answer, clear and recorded in his words, sets the limits. The plan runs across dental, dietary, mood, social, and medical fronts at once.
Where the marks sit in the NRNP 6540 Week 7 rubric
One cause found and the inquiry stopped: that is the weak version of this workup, attributing the loss to grief and planning counseling alone. This example examines six categories. Credit for the older-adult lens depends on the practical causes, dentures and meals, that a disease-focused workup overlooks. The goals conversation earns substantial credit when it visibly shapes the investigation, and loses it when recorded and then ignored. Graders check for a named nutrition screen and for attention to frailty. An exhaustive malignancy search ordered without asking what he wants counts against the note, and so do appetite stimulants proposed without their risks weighed and a plan that never says when he will next be weighed.
NRNP 6540 Week 7 help: mistakes that cost marks
Weight loss workups lose the most when the loss is blamed on grief and the plan is counseling alone. Look for medical, dental, medication and social causes as well. Another common gap is not calculating the percent of body weight lost, which sets the urgency. Do the math. Writers also order every test without asking what the patient wants. Ask how far he wants to go. Avoid ignoring who cooks now that his wife has died. Screen for depression with a tool built for older adults. Include frailty. Close with a weight check date. Writers also forget dentition and swallowing, which can make eating hard. Ask about both. Another frequent slip is ignoring alcohol, which may rise after a loss. Screen for it.
Get a NRNP 6540 Week 7 example written to your instructions
Send your Week 7 case, the prompt, and the rubric. A workup comes back that looks past the first explanation, runs the named screens your course uses, and records the goals conversation that sets its limits. Your first custom sample is free, with turnaround inside 24-48 hours, and its frailty measures match the ones in your materials.
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NRNP 6540 Week 7 questions, answered
Why not attribute the weight loss to grief and stop?
Because grief is a likely contributor, not a proven sole cause, and weight loss in an older adult frequently has several sources at once. The example keeps bereavement on the list while checking dentures, meals, medications, mood, and disease. Rubrics for geriatric workups commonly penalize a single-cause explanation reached before the other categories were examined.
Why ask how far he wants the investigation to go?
Because the burden of an extensive search, and of the treatment it might lead to, falls on him. An older adult who would decline aggressive treatment may reasonably decline the tests that only lead there. The example records his answer before writing the plan, so the plan visibly reflects it, and that link is what graders look for.
What does the frailty section add?
It shows what the weight loss is doing to him. Slowed walking, weaker grip, and exhaustion, alongside the loss itself, describe the frailty phenotype, and naming it changes the plan's urgency and its focus on strength and nutrition. The example measures or reports each component rather than labeling him frail on impression. He, his son, and the belt are all invented.
Where can I find a free NRNP 6540 Week 7 sample paper?
H.B.'s weight loss workup appears here with the history, the screening tools, the tests sent, his wishes on investigation and the plan on several fronts.
Why not blame grief alone in NRNP 6540 Week 7?
Grief can reduce appetite, but losing 9 percent of body weight in six months needs a search for other causes. The example looks for medical, dental and social factors too.