| Course | NRNP 6549 Advanced Primary Care of Adolescents and Children |
|---|---|
| Week | Week 10 |
| Paper type | Multi-visit case study |
| Length | About 940 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NRNP 6549 Week 10
Three Visits, One Pattern: A 16-Year-Old Cross-Country Runner From Sports Physical to Shin Pain
Student Name
College of Nursing, Walden University
NRNP 6549: Advanced Primary Care of Adolescents and Children
Instructor Name
Month Day, Year
Three Visits, One Pattern: A 16-Year-Old Cross-Country Runner From Sports Physical to Shin Pain
Visit 1, July 14: The Sports Physical
S: Composite case. A 16-year-old girl entering eleventh grade requests a preparticipation physical for cross-country. History taken on the standard preparticipation history form (Bernhardt & Roberts, 2019). Cardiac questions: no chest pain or fainting with exercise, no palpitations, no shortness of breath beyond teammates, no family history of sudden death before 35, cardiomyopathy, or arrhythmia. No previous injuries requiring time out of sport. Menstrual history: menarche at 12, regular until this spring; last period about 3 months ago. She attributes it to training: "It happens to a lot of girls on the team." She increased her summer mileage to 40 miles a week.
O: Height 165 cm. Weight 52.2 kg; at her visit 13 months ago, 55.8 kg. BMI 19.2, down from 20.5. Heart rate 54, blood pressure 102/64. Cardiac exam normal, no murmur standing or squatting. Musculoskeletal screen normal.
A: No cardiac contraindication to sport. Two quiet findings logged: a weight below her own earlier point, and periods that have stopped.
P: Follow-up visit in two weeks to address both findings before clearance is finalized; pregnancy test, TSH, prolactin, and FSH ordered.
Visit 2, July 28: The Follow-Up, Alone
S: Seen alone for most of the visit after confidentiality and its limits were explained to her and her father. She says she has been "eating clean" since spring, cut out desserts and most bread, and runs twice on some days. She wants to be lighter because "lighter is faster." She denies vomiting, laxatives, or diet pills. SCOFF eating disorder screen (Morgan et al., 1999): 1 of 5 positive, answering yes only to whether food dominates her life. Energy intake estimated from a two-day recall at roughly 1,500 kcal on training days.
O: Weight 51.9 kg. Lying: heart rate 50, blood pressure 100/62. Standing after 3 minutes: heart rate 66, blood pressure 98/64. Temperature normal. No lanugo, no parotid swelling. Pregnancy test negative; TSH, prolactin, and FSH normal.
A: The Female Athlete Triad links three things: low energy availability, with or without disordered eating; menstrual dysfunction; and low bone mineral density (De Souza et al., 2014). She has the first two. A SCOFF score below the usual cut point of 2 does not remove the concern, because low energy availability can occur without an eating disorder when training rises and intake does not. Her resting heart rate of 50 may be athletic, but in the setting of weight loss it is watched rather than assumed benign, since bradycardia and orthostatic changes are among the markers of medical instability in restrictive eating (Society for Adolescent Health and Medicine, 2022).
P: Clearance deferred. Reasons: continuing weight loss, three months without menses with other causes excluded, and a training load exceeding her intake. Referral to a sports dietitian; target to increase intake before mileage; recheck weight and vital signs in two weeks; plan for clearance with conditions once weight is stable.
Visit 3, September 15: The Shin
S: Cleared with conditions on August 11, when her weight had stabilized at 52.4 kg; still without a period. Now reports three weeks of pain along the inner lower right shin, worse with running and now present when walking down stairs. She has kept running.
O: Weight 51.6 kg, below her August weight. Focal tenderness over a 2 cm area of the posteromedial right tibia, distal third. Pain with single-leg hopping on the right. No swelling of the leg, normal pulses.
A: Suspected bone stress injury of the right tibia, read against the history rather than as a new, unrelated complaint. A bone stress injury in an athlete with low energy availability and amenorrhea is one of the endpoints the Triad produces, and the consensus statement counts a history of bone stress injury among the factors that raise an athlete's risk category for clearance (De Souza et al., 2014).
P: No running; MRI of the right tibia; crutches if walking is painful. Clearance withdrawn until the injury heals and energy availability is restored. Bone density testing to be discussed with sports medicine given months of amenorrhea and a bone stress injury.
The Synthesis
Across three visits, one pattern appears in dated steps. On July 14, weight was 3.6 kg below her own earlier point and menses had been absent for about 3 months. On July 28, the explanation emerged: intake reduced and training doubled, a deliberate pursuit of lightness without a positive eating disorder screen. On September 15, after two months of continued training with little change in weight and no return of menses, a bone stress injury appeared in the tibia. Each visit on its own could be closed as ordinary: a normal sports physical with a runner's weight, a teenager with a quiet period, a shin splint. Read together, the three form the Triad in the order its components usually progress: energy first, menstrual function second, bone third (De Souza et al., 2014). The shin is not a new problem; it is the third finding of the first.
What Is Handed On
To sports medicine: the three dated visits, the MRI result, and the question of bone density testing. To the dietitian: a request to set an energy target that covers training, since return of menses is the practical marker of adequate energy. To her coach, with her consent and limited to what she agrees to share: she is not cleared to run until further notice. To her: that her period coming back is the sign her body has enough energy, and that returning to running will depend on that, not on a date.
References
Bernhardt, D. T., & Roberts, W. O. (Eds.). (2019). PPE: Preparticipation physical evaluation (5th ed.). American Academy of Pediatrics.
De Souza, M. J., Nattiv, A., Joy, E., Misra, M., Williams, N. I., Mallinson, R. J., Gibbs, J. C., Olmsted, M., Goolsby, M., & Matheson, G. (2014). 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad. British Journal of Sports Medicine, 48(4), 289. https://doi.org/10.1136/bjsports-2013-093218
Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: Assessment of a new screening tool for eating disorders. BMJ, 319(7223), 1467-1468. https://doi.org/10.1136/bmj.319.7223.1467
Society for Adolescent Health and Medicine. (2022). Medical management of restrictive eating disorders in adolescents and young adults. Journal of Adolescent Health, 71(5), 648-654. https://doi.org/10.1016/j.jadohealth.2022.08.006
The Walden NRNP 6549 Week 10 instructions
The tenth week of NRNP 6549 commonly asks for a case study that follows one child or adolescent across several encounters. You document each visit, then write a synthesis showing how findings connect into a pattern, and plan handoff or ongoing care. Faculty mark integration in the synthesis section. Cite sports medicine, adolescent medicine and eating disorder sources in APA 7. Confidential time should appear where relevant. Management of a serious condition may be limited to referral. The case should be composite or fully de-identified. NRNP 6549 faculty want each visit dated and documented in its own section, then a synthesis that ties them together. The synthesis should name the pattern and the evidence from each visit. A handoff section says who manages what next. Confidential parts of the visits should be marked.
Inside the NRNP 6549 Week 10 example
The case study is divided by visit, each with its own date heading and its own brief SOAP structure. The first is a preparticipation evaluation built on the standard history form from the Preparticipation Physical Evaluation monograph, with the cardiac questions answered and the exam recorded. Two quiet findings are logged there: weight below her own earlier point and periods that have stopped. The second visit picks them up. The adolescent is seen alone, an eating screen is reported, vital signs are taken lying and standing, and the author names the female athlete triad as the frame linking energy, menstruation and bone. Clearance is deferred with reasons. The third visit, for shin pain, reads the new symptom against that history. A synthesis section closes the document and argues the pattern across all three.
NRNP 6549 Week 10 rubric: what earns full marks
Integration is what a culminating case exists to test, and it is marked in the synthesis, not in the visits. A document that presents three competent encounters and never connects them earns the visit-level rows and loses the one weighted most. The example makes the connection explicit and traceable to dated findings. Sports clearance is a common trap: deferring without reasons, or clearing without addressing the missed periods, both cost the safety criterion. A named eating screen helps only when its result is read as well as reported. The adolescent interview counts too, since an eating concern discussed only with the parent misses the person most able to describe it. Deductions also follow hindsight, visits rewritten to foreshadow the answer, which graders read as reasoning that never happened in real time.
NRNP 6549 Week 10 help: mistakes that cost marks
Multi-visit cases lose credit when three competent visits never connect. Write a synthesis that names the pattern and the evidence from each visit. Another common gap is missing the early clues, weight loss and missed periods at the sports physical. Flag them when they appear. Writers also treat the stress injury as a standalone problem. Link it to energy deficiency. Avoid managing an eating disorder alone in primary care; name the referral team. Record what she said when seen privately. Keep dates and weights consistent. Close with what the next clinician needs to know. Writers also forget bone health, which low energy availability can damage. Mention a plan for it. Another frequent slip is clearing her for running without addressing the cause. Tie return to sport to nutrition and team input.
Get a NRNP 6549 Week 10 example written to your instructions
Name the visit types your Week 10 case has to span, attach the prompt and rubric, and a multi-visit case study is written to that shape, synthesis included. It is back in 24-48 hours, the first sample costs you nothing, and the adolescent at its center is invented.
More NRNP 6549 papers and MSN samples
- NRNP 6549 Week 1: Child Versus Adult Care Post
- NRNP 6549 Week 2: Growth and Puberty Write-Up
- NRNP 6549 Week 3: Newborn Follow-Up Note
- NRNP 6549 Week 4: Catch-Up Immunization Post
- NRNP 6549 Week 5: Acute Illness SOAP Note
- NRNP 6549 Week 6: Respiratory Differential
- NRNP 6549 Week 7: Acne and Abdominal Pain Notes
- NRNP 6549 Week 8: School Performance Case
- NRNP 6549 Week 9: Confidential Adolescent Visit
- NRNP 6549 Week 11: Birth-to-adolescence synthesis post
- NRNP 6557 Week 10: Case presentation
- NRNP 6547 Week 10: Position Paper
- NRNP 6559 Week 10: Gender-affirming primary care case
- NRNP 6540 Week 10: Goals of Care Note
NRNP 6549 Week 10 questions, answered
Does the case study manage the eating disorder?
No. It screens, documents, defers clearance and refers, which is the part primary care owns in an episodic setting, and it stops there on purpose. Long-term treatment planning sits with a specialized team and lives in its own records. If your prompt extends further, the sample can be scoped to what your section actually asks for.
Why follow one patient across three visits?
Because some findings mean little alone and a great deal together, and the culminating week tests whether the author can see that. A weight point at a sports physical and shin pain months later are separate complaints until someone reads them side by side. The example shows that reading happening in a synthesis you can check against the dated visits.
Is the runner a real adolescent?
She is a composite, and her team, her season and her history were written for teaching. No actual athlete, form or clinic record sits behind the case. The desk does not reconstruct patients; it builds new ones whose presentations resemble what your prompt describes, so the document can be specific without pointing to anyone you have cared for.
Where can I find a free NRNP 6549 Week 10 sample paper?
The runner's three-visit case is reproduced here with the sports physical, the private follow-up, the shin visit, the synthesis and the handoff.
What pattern connects the visits in NRNP 6549 Week 10?
Relative energy deficiency in sport: weight loss and missed periods at the physical, restrictive eating at follow-up, and a stress injury later, all from too little energy for her training.