| Course | NRNP 6549 Advanced Primary Care of Adolescents and Children |
|---|---|
| Week | Week 5 |
| Paper type | Acute illness SOAP note |
| 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 6549 Week 5
Acute Illness SOAP Note: A 6-Year-Old Girl With Dysuria and Fever, Dosed by Today's Weight
Student Name
College of Nursing, Walden University
NRNP 6549: Advanced Primary Care of Adolescents and Children
Instructor Name
Month Day, Year
Acute Illness SOAP Note: A 6-Year-Old Girl With Dysuria and Fever, Dosed by Today's Weight
Subjective: From the Parent
Composite case. A 6-year-old girl brought by her father for two days of burning with urination, going to the bathroom "every half hour," and one daytime wetting accident at school, unusual for her. Fever to 38.4 C at home last night, treated with a children's ibuprofen dose that he measured with a kitchen spoon. Eating less; drinking normally. No vomiting, no diarrhea. Last bowel movement yesterday, soft. No new soaps or bubble baths. No previous urinary infections. No known drug allergies. Immunizations up to date.
Subjective: From the Child
Asked where it hurts, she pointed low in the middle of her belly, below the navel, and said it "stings when the pee comes out." Asked about her back, she said it does not hurt. She said she was scared to use the school bathroom because it hurts, so she "held it" until the accident.
Objective
Weight: 21.8 kg, measured today on the clinic scale, in light clothing without shoes. Her last recorded weight, 19.9 kg, was 11 months ago and is not used for dosing.
Temperature 38.3 C oral; heart rate 108; respiratory rate 20; well-appearing, playful between questions. Abdomen soft, mild suprapubic tenderness, no tenderness elsewhere, no rebound; no costovertebral angle tenderness on either side. External genitalia with no redness, discharge, or lesions, examined with her father present. No rash.
Urinalysis, clean-catch midstream: leukocyte esterase positive (2+), nitrite positive, blood trace, protein negative. Microscopy: 25 to 50 white cells per high-power field, bacteria many. Urine culture: sent to the laboratory today; result expected in 48 hours.
Assessment, Ranked
1. Urinary tract infection, lower tract most likely: dysuria, frequency, new daytime wetting, suprapubic tenderness, fever, and a urinalysis with both leukocyte esterase and nitrite positive and pyuria on microscopy. Culture pending for confirmation and sensitivities.
2. Early upper tract infection: cannot be excluded because she has fever, but she has no flank pain, no costovertebral angle tenderness, no vomiting, and looks well. Would move up if fever rises, vomiting starts, or back pain develops.
3. Vulvovaginitis from irritation: argued against by a normal external exam, no new soaps, and a urinalysis with nitrite and pyuria, which irritation would not explain.
4. Voiding dysfunction or constipation: holding urine at school may have contributed, and it is worth addressing, but her stools are soft and regular, and it does not explain fever or positive nitrite.
Plan: Medication Lines, Stacked
Cephalexin
Weight: 21.8 kg (today).
Reference: FDA-approved labeling, pediatric patients over 1 year, 25 to 50 mg/kg/day in equally divided doses (National Library of Medicine, 2026a).
Calculation: 21.8 kg x 50 mg/kg/day = 1,090 mg/day; divided every 12 hours = 545 mg per dose.
Dose chosen: 500 mg every 12 hours = 1,000 mg/day = 45.9 mg/kg/day.
Check against maximum: within the labeled 25 to 50 mg/kg/day range, and well under the 4 g/day adult maximum.
Volume: suspension 250 mg/5 mL; 500 mg = 10 mL, twice a day, measured with an oral syringe.
Duration: 7 days, reassessed when the culture returns; in children aged 2 months to 10 years who were improving after 5 days, stopping at day 5 had a small increase in treatment failures in a randomized trial but met its noninferiority margin (Zaoutis et al., 2023), so a shorter course will be discussed if she is well at the culture call.
Ibuprofen, for fever and pain
Weight: 21.8 kg = 48 lb.
Reference: the product's labeled dosing chart, 48 to 59 lb, 10 mL of 100 mg/5 mL, every 6 to 8 hours, no more than 4 times a day (National Library of Medicine, 2026b).
Calculation: 10 mL = 200 mg = 9.2 mg/kg per dose.
Check against maximum: 4 doses = 800 mg/day = 36.7 mg/kg/day, within the label's limit of 4 doses in 24 hours.
Volume: 10 mL with the dosing cup packaged with the product, not a kitchen spoon.
Return Precautions and Follow-Up
Return today or go to the emergency department for: vomiting that prevents her from keeping down the antibiotic; pain in her back or side; fever of 39.0 C or higher after 48 hours of antibiotic; unusual sleepiness or difficulty waking her; or passing very little urine. Clinic will call with the culture result in 48 hours and change the antibiotic if the organism is resistant. Recheck visit if still febrile at 48 hours. Timed bathroom breaks every 2 to 3 hours at school, with a note for her teacher, and a reminder to her that it is fine to use the bathroom even though it stings.
References
National Library of Medicine. (2026a). Cephalexin capsule [Drug label]. DailyMed. https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=cephalexin
National Library of Medicine. (2026b). Children's ibuprofen oral suspension [Drug label]. DailyMed. https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=children%27s+ibuprofen
Zaoutis, T., Shaikh, N., Fisher, B. T., Coffin, S. E., Bhatnagar, S., Downes, K. J., Gerber, J. S., Shope, T. R., Martin, J. M., Muniz, G. B., Green, M., Nagg, J. P., Myers, S. R., Mistry, R. D., O'Connor, S., Faig, W., Black, S., Rowley, E., Liston, K., & Hoberman, A. (2023). Short-course therapy for urinary tract infections in children: The SCOUT randomized clinical trial. JAMA Pediatrics, 177(8), 782-789. https://doi.org/10.1001/jamapediatrics.2023.1979
Reading the NRNP 6549 Week 5 instructions
NRNP 6549 Week 5 centers on an acute pediatric illness where every dose depends on weight. You take history from the parent and, where possible, the child, examine, test appropriately, rank a differential, and write medication orders showing the weight, the reference, the mg/kg calculation and a check against the maximum dose. Faculty read the medication row most strictly. Cite the relevant AAP guideline and a named dosing reference in APA 7. Return precautions and follow-up must be specific. Constipation and voiding habits deserve attention in a child with urinary symptoms. Some sections ask you to show the calculation; others accept the final dose with its basis.
How the NRNP 6549 Week 5 example is put together
The note follows SOAP order. The subjective section records the history from the parent and, separately, what the six-year-old could say about where it hurts. Objective findings include a weight taken at this visit, in kilograms, with the date beside it, because a remembered weight is not evidence. Urinalysis results are reported and a culture is noted as sent. The assessment ranks a urinary tract infection first and states what argues against the alternatives. The plan is where the page earns its name: each medication line runs weight, reference, calculation, check against the maximum, and conversion to a volume a parent can measure, set out as separate short lines. No figure is hidden inside a sentence. A return section names specific warning signs and a follow-up tied to the culture result.
NRNP 6549 Week 5 rubric: what earns full marks
Of all the rows in a midterm note, the medication row is read most strictly. A dose written without a stated weight, a named reference or a check against the maximum counts as unsupported no matter how reasonable the figure seems, and the example avoids that by laying out each step. Assessment accuracy is marked next: a urinary infection named without the urinalysis findings that support it, or without the alternatives considered, collects partial credit at best. Notes lose points when the weight comes from the parent's memory, when the antipyretic line skips the math the antibiotic received, and when follow-up ignores the pending culture. Return precautions phrased as call if worried are marked as absent, because a family cannot act on them. Formatting of the reference list closes out the smaller rows.
Common NRNP 6549 Week 5 mistakes, and how to avoid them
Pediatric notes lose credit most quickly when a dose appears without a stated weight, a named reference or a maximum check. Show all three for every drug, including the antipyretic. Another common gap is skipping the child's own account, though a 6-year-old can describe where it hurts. Ask her. Writers also forget constipation, a frequent contributor to urinary infections in children. Ask about stools. Avoid bag specimens for culture; use a clean catch or catheter. Name the culture follow-up and who will call the family. Return precautions should name signs a parent can see, such as vomiting or back pain. Check that the weight used matches today's measurement. Close with follow-up timing. Writers also forget that a febrile urinary infection in a child may need imaging after the first episode, depending on age and response. Note the guideline's advice.
Get a NRNP 6549 Week 5 example written to your instructions
Attach the Week 5 prompt and rubric and name the acute presentation your section assigned; the note is written to it, dosing lines laid out step by step with the reference your program uses. Your first sample is free and returns in 24-48 hours, ready to compare with your own arithmetic.
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NRNP 6549 Week 5 questions, answered
Will the sample show actual doses I can use?
No, and it is not meant to. The example models how the reasoning is laid out, with weight, reference, arithmetic and maximum each on its own line, but prescribing figures come from the dosing reference your program assigns, applied to whatever case your prompt sets. A sample is never a source for a dose, and graders expect the reference itself in your citations.
Which dosing reference does the example cite?
It names a standard pediatric drug reference of the kind most programs assign, in the text beside the calculation and again in the reference list. Programs differ on which one they expect, so the sample written to your request uses whichever your syllabus or prompt points to. What matters to the grader is that a named source stands behind every figure.
Is the first grader based on a real visit?
Not at all. The child, her fever and her urinalysis results were made up for teaching and match no chart anywhere. A composite lets the note show every step without any risk of identifying a family. Cases from your own clinical experience stay in your records; sketch a presentation in outline and a fictional child is built around it.
Where can I find a free NRNP 6549 Week 5 sample paper?
The 6-year-old's dysuria and fever note is laid out here with both accounts, the ranked assessment, the stacked medication lines and the return precautions.
How should doses be written in NRNP 6549 Week 5?
With today's weight, the dosing reference, the mg/kg calculation and a check against the adult maximum, for every medication, as the example shows line by line.