| Course | NRNP 6549 Advanced Primary Care of Adolescents and Children |
|---|---|
| Week | Week 2 |
| Paper type | Growth and puberty write-up |
| 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 2
Growth and Puberty Write-Up: A 14-Year-Old Boy, Shortest in His Class, Tracking His Own Line
Student Name
College of Nursing, Walden University
NRNP 6549: Advanced Primary Care of Adolescents and Children
Instructor Name
Month Day, Year
Growth and Puberty Write-Up: A 14-Year-Old Boy, Shortest in His Class, Tracking His Own Line
Reason for Visit
A composite 14-year-old boy, age 14 years 2 months at this visit, is brought by his mother because he is the shortest boy in ninth grade and has been teased in the locker room. He is otherwise well: no chronic cough, abdominal pain, diarrhea, headaches, visual change, or reduced sense of smell; appetite normal; plays trumpet in the band and runs cross-country. No medications.
Two Curves, Every Point Plotted
All measurements from his chart since kindergarten were plotted on the CDC stature-for-age and BMI-for-age charts for boys aged 2 to 20 (Kuczmarski et al., 2002). Percentiles were calculated from the CDC reference values.
Age 5 years: height 101.6 cm (5th percentile); weight 15.5 kg; BMI 15.0 (36th percentile).
Age 7 years: height 113.0 cm (5th percentile); weight 19.1 kg; BMI 15.0 (34th percentile).
Age 9 years: height 123.3 cm (4th percentile); weight 23.5 kg; BMI 15.4 (33rd percentile).
Age 11 years: height 132.0 cm (4th percentile); weight 28.3 kg; BMI 16.2 (31st percentile).
Age 12 years 6 months: height 139.3 cm (4th percentile); weight 33.1 kg; BMI 17.1 (31st percentile).
Age 14 years 2 months, today: height 150.3 cm (4th percentile); weight 40.6 kg; BMI 18.0 (29th percentile). Height velocity over the last 20 months: about 6.6 cm per year.
Three Sentences of Interpretation
His height sits low on the chart, between the 3rd and 5th percentile lines, but it has tracked that same channel for nine years without crossing downward. His BMI has stayed in the lower-middle range, between the 29th and 36th percentiles, so his weight has followed his height rather than falling behind it, which argues against a chronic illness that limits nutrition. His height velocity over the last 20 months is normal for his age and slightly faster than his earlier childhood rate, which is what would be expected as puberty begins.
Tanner Staging, Recorded and Compared
Examined with his consent and his mother out of the room. Genital development: sexual maturity rating 2, with early scrotal enlargement and reddening of the scrotal skin; testicular volume 4 mL bilaterally by orchidometer. Pubic hair: stage 1. No gynecomastia. Marshall and Tanner (1970) described the normal range of pubertal timing in boys and showed wide variation between individuals in when each stage begins. At 14 years, most boys are well into puberty; he is just beginning. Delayed puberty in boys is usually defined as no testicular enlargement to 4 mL or more by age 14 (Palmert & Dunkel, 2012). He has just reached that threshold, so his puberty is late but has started.
Family History as Evidence
Mother's height 160 cm; she reports her first period at 13. Father's height 170 cm, measured at a previous visit. The father, reached by phone, says he was "the smallest kid on the JV team," did not start shaving until 17, and grew "four inches after high school graduation." Target height from the parents' heights: about 171.5 cm, near the 20th percentile for adult men. A family history of late growth and puberty is one of the strongest supports for constitutional delay (Palmert & Dunkel, 2012).
Assessment
Leading reading: constitutional delay of growth and puberty. Supporting it: a stable low height channel since early childhood, normal weight for height, normal and rising height velocity, puberty just started at 14, a father with a clear history of late development, and no symptoms of chronic illness.
Findings that would overturn it: a fall in height velocity or crossing downward across percentile lines; weight falling faster than height, suggesting inflammatory bowel disease, celiac disease, or another chronic illness; no pubertal progression over the next 6 to 12 months; a reduced sense of smell, which would raise concern for a gonadotropin deficiency; headaches or visual field loss, which would point toward a pituitary cause; or a bone age that is not delayed.
Plan
Bone age radiograph of the left hand and wrist, expected to show delay if the leading reading is correct. Screening laboratory tests only if the bone age is not delayed or velocity falls. Recheck height, weight, and Tanner stage in six months. Referral to pediatric endocrinology if puberty does not progress or any overturning finding appears. Counseling for him and his parents that his final height is likely to fall near his target range and that his growth spurt is still ahead.
His question about a shot was answered directly: growth hormone is not used for constitutional delay in a boy with normal hormone function, and it would not be expected to change a final height that is already heading toward his target. A short course of testosterone to bring puberty forward is an option a pediatric endocrinologist sometimes offers when late puberty is causing real distress, and it was named as something he could raise at the next visit if the teasing and his worry do not ease once the bone age is back. The school counselor was offered as a contact for the locker room situation, and he declined for now.
The Adolescent's Own View
Asked alone what bothered him most, he said: "Being short isn't even the worst part. It's that everybody's voice changed except mine, and in the locker room they all look older than me. I just want to know if I'm going to catch up or if this is it." He asked whether there was a shot that could make him grow. He was told what the plan would find out and that he would get the results himself, not only through his mother.
References
Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., Wei, R., Curtin, L. R., Roche, A. F., & Johnson, C. L. (2002). 2000 CDC growth charts for the United States: Methods and development (Vital and Health Statistics, Series 11, No. 246). National Center for Health Statistics. https://www.cdc.gov/nchs/data/series/sr_11/sr11_246.pdf
Marshall, W. A., & Tanner, J. M. (1970). Variations in the pattern of pubertal changes in boys. Archives of Disease in Childhood, 45(239), 13-23. https://doi.org/10.1136/adc.45.239.13
Palmert, M. R., & Dunkel, L. (2012). Delayed puberty. The New England Journal of Medicine, 366(5), 443-453. https://doi.org/10.1056/NEJMcp1109290
Reading the NRNP 6549 Week 2 instructions
In Week 2, NRNP 6549 sections commonly ask for a write-up on growth and pubertal development in a child or adolescent. You plot growth on the correct chart, interpret percentiles and channel crossing, stage puberty with Tanner criteria, gather family history such as parental heights and timing of puberty, and form an assessment with a plan. Faculty check interpretation first, so a percentile with no comment earns little. Cite CDC or WHO growth references and pediatric endocrinology sources in APA 7. Midparental height is often expected. The adolescent's own concerns and how he feels about his size belong in the write-up. Referral criteria for endocrinology should be stated, even when the plan is to watch and wait.
How the NRNP 6549 Week 2 example is put together
The first page carries two plotted curves from the CDC growth charts, stature-for-age and BMI-for-age, with every earlier measurement from the composite record marked, so the reader sees a channel rather than a dot. Beneath them, three sentences interpret the pattern: height low on the chart but tracking its own line, weight following it, no crossing downward. A pubertal section records the sexual maturity rating by Tanner staging and states that it sits behind most boys his age. The parents' reported heights appear, along with a father who describes starting his own growth late. The assessment names constitutional delay as the leading reading and then lists the findings that would overturn it. A closing block, just ahead of a brief plan, records what the adolescent himself said about being the shortest, quoted and not paraphrased.
NRNP 6549 Week 2 rubric: what earns full marks
A grader reading this week checks interpretation first. Percentiles stated without meaning, a height reported as a number with no comment on the channel, earn little even when every plot is correct. The example meets that criterion in the three sentences under the charts. Many sections give pubertal staging its own criterion, and without a recorded stage no argument about timing is possible. Sources count here too: the chart set is named, and the staging system is cited, not taken for granted. Deductions cluster around single-point reasoning, where one measurement is read as a trend, and around assessments that name a cause without saying what would disprove it. The subtler loss is tone, a plan that reassures the parents and forgets the adolescent sitting in the room.
NRNP 6549 Week 2 help from the desk
Growth write-ups lose most of their credit when percentiles are stated without saying what they mean for this child. Comment on the channel he follows and whether he has crossed lines. Another common gap is skipping midparental height, which tells you whether his height fits his family. Calculate it. Writers also leave out the father's late growth spurt, the strongest clue to constitutional delay. Ask about both parents' timing of puberty. Avoid ordering a large endocrine panel when the history fits a normal variant; a bone age often answers the question. Record Tanner stages for both pubic hair and genital development. Make sure the plotted points match the measurements in the text. Finally, include what he thinks and how the teasing affects him, since that shapes the plan.
Get a NRNP 6549 Week 2 example written to your instructions
Pass the Week 2 prompt and rubric to the desk, along with the age and concern your section assigned, and the desk returns a growth and puberty write-up with its own plotted composite. The first sample is free, returned in 24-48 hours, with interpretation sentences you can hold against your own charts.
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NRNP 6549 Week 2 questions, answered
Does the write-up state normal ranges for height or puberty?
It does not, by design. The example points to the growth charts and to Tanner staging as the published references and interprets the composite child against them, but it never restates thresholds as though they were advice. Your own write-up draws its comparisons from the references your prompt names, and the sample shows where those citations belong on the page.
Why is the child a boy who is simply short, rather than a clear problem?
Because a probably normal variant is harder to write well than an obvious disorder. The example has to argue that watching is reasonable, which only convinces when the growth pattern, pubertal stage and family history are all on the page. A dramatic case lets a weak write-up hide behind the diagnosis; this one gives it nowhere to hide.
Is the eighth grader drawn from a real clinic?
He is a composite, put together from a presentation common in adolescent primary care, with his height, family and team invented. No measurement was taken from a chart. Measurements you have taken on real patients belong to your own record, and the desk never asks for them or rebuilds them. If you need a different age or concern modeled, name it and the composite changes.
Where can I find a free NRNP 6549 Week 2 sample paper?
The short 14-year-old's growth and puberty write-up is on this page, with both plotted curves, the three-sentence interpretation, Tanner staging, family history and his own view.
What is constitutional delay in NRNP 6549 Week 2?
A normal variant in which a child grows steadily along a lower channel and enters puberty late, often like a parent, then catches up. The example supports it with history and a bone age.