| Course | NRNP 6566 Advanced Care of Adults in Acute Settings I |
|---|---|
| Week | Week 2 |
| Paper type | Chest pain admission note |
| Length | About 890 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | MSN Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) |
| Updated | October 2026 |
Free sample paper for NRNP 6566 Week 2
Chest Pain Admission Note: A 54-Year-Old With Exertional Pressure, a HEART Score of 5, and Five Life Threats Addressed One by One
Student Name
College of Nursing, Walden University
NRNP 6566: Advanced Care of Adults in Acute Settings I
Instructor Name
Month Day, Year
Chest Pain Admission Note: A 54-Year-Old With Exertional Pressure, a HEART Score of 5, and Five Life Threats Addressed One by One
Focused Present Illness
Composite case. A 54-year-old school cafeteria manager presented at 07:10 with chest pressure. It began 3 days ago while carrying crates up the loading-dock ramp at work: a central pressure, "like a hand pushing on my breastbone," radiating to the left jaw, lasting 5 to 10 minutes and easing when she stopped. It recurred twice more with similar effort, and this morning once while climbing her front steps, lasting 15 minutes, with sweating and nausea. It is not sharp, not tearing, does not go to the back, is not worse with breathing or lying flat, and is not reproduced by pressing on her chest. No sudden breathlessness, no coughing of blood, no leg swelling, no recent surgery, travel, or immobility, no hormone use. No vomiting before the pain. No fever or recent viral illness.
Risk factors, as the history supplied them: hypertension for 12 years; hyperlipidemia, on no statin since stopping it herself 2 years ago; smoked for 25 pack-years before stopping 8 years ago; body mass index 32; father had a myocardial infarction at 58. No diabetes. No cocaine or stimulant use.
Examination Aimed at the Threats
Pain free on arrival in the unit. Heart rate 82, regular. Blood pressure right arm 152/88, left arm 148/86, a difference of 4 mm Hg. Respiratory rate 16; oxygen saturation 97% on room air; afebrile.
Pulses: radial, femoral, and dorsalis pedis equal on both sides; no pulse deficit. Neck: jugular venous pressure not elevated. Heart: regular rhythm, normal first and second sounds, no murmur of aortic regurgitation, no rub, no gallop. Lungs: breath sounds equal on both sides, no crackles. Chest wall: not tender. Legs: no swelling, calves nontender. Neurologic: no focal deficit.
Data at Admission
ECG at 07:14: sinus rhythm, 80 beats per minute; left ventricular hypertrophy by voltage with lateral repolarization changes; no ST elevation; no new Q waves; no change from an ECG 2 years ago. High-sensitivity troponin I at 07:20: below the assay's 99th percentile upper reference limit. Chest radiograph: normal mediastinum, no pneumothorax, clear lungs. Hemoglobin 13.1 g/dL; creatinine 0.8 mg/dL; glucose 108 mg/dL.
Risk Score, Part by Part
The HEART score scores five elements from 0 to 2 each (Six et al., 2008):
History, moderately suspicious (1): exertional central pressure with radiation, relieved by rest, but with nausea and diaphoresis this morning; scored 1 rather than 2 because one of the typical features, a clear response to nitroglycerin, has not been tested.
ECG, nonspecific repolarization disturbance (1): left ventricular hypertrophy with repolarization changes, without significant ST depression.
Age, 45 to 64 (1).
Risk factors, three or more (2): hypertension, hyperlipidemia, obesity, and a family history of premature coronary disease; her smoking ended 8 years ago and is not counted as current.
Troponin, at or below the normal limit (0).
Total: 5, in the 4 to 6 range, which carried major adverse cardiac events within 6 weeks in 16.6% of patients in a prospective validation of 2,440 patients (Backus et al., 2013). That places her well above the low-risk group and argues for admission to observation rather than discharge.
Life Threats, One at a Time
1. Acute coronary syndrome, leading. For: exertional pressure relieved by rest, radiation to the jaw, diaphoresis, multiple risk factors, and a crescendo pattern over 3 days. Against: first troponin normal and ECG unchanged; neither excludes unstable angina.
2. Pulmonary embolism. For: chest discomfort. Against: no sudden dyspnea, no pleuritic quality, no hemoptysis, no leg swelling, no recent surgery or immobility, no hormone use, normal oxygen saturation and heart rate. She fails the pulmonary embolism rule-out criteria only on age, since the rule requires age under 50 (Kline et al., 2004), so the rule cannot be used to exclude embolism, but her clinical probability is low and the pattern is exertional and relieved by rest, which embolism does not typically produce.
3. Aortic dissection. For: hypertension. Against: pain is pressure, not tearing, and not to the back; arm pressures differ by 4 mm Hg; no pulse deficit; no murmur of aortic regurgitation; no neurologic deficit; normal mediastinum. Considered and not supported.
4. Pneumothorax. Against: equal breath sounds and a normal chest radiograph.
5. Pericarditis with effusion or tamponade. Against: pain not positional or pleuritic, no rub, neck veins not elevated, no fever or recent illness.
Why Observation
She is admitted to observation on telemetry because her HEART score places her at intermediate risk and the story is typical enough that one normal troponin does not settle it. The 2021 chest pain guideline recommends further evaluation for patients at intermediate risk after acute coronary syndrome has not been excluded, with the choice of test tailored to the patient (Gulati et al., 2021). Plan: repeat high-sensitivity troponin at the assay's interval; aspirin 325 mg now, then 81 mg daily; sublingual nitroglycerin for recurrent pain, which will also score the history; high-intensity statin started; telemetry. If troponins stay normal and she remains pain free, coronary CT angiography or stress testing before discharge, as the guideline allows for intermediate-risk patients. If troponin rises or pain recurs at rest, she moves to the acute coronary syndrome pathway with cardiology involved. Her daughter, her contact, was called with her permission.
References
Backus, B. E., Six, A. J., Kelder, J. C., Bosschaert, M. A., Mast, E. G., Mosterd, A., Veldkamp, R. F., Wardeh, A. J., Tio, R., Braam, R., Monnink, S. H., van Tooren, R., Mast, T. P., van den Akker, F., Cramer, M. J., Poldervaart, J. M., Hoes, A. W., & Doevendans, P. A. (2013). A prospective validation of the HEART score for chest pain patients at the emergency department. International Journal of Cardiology, 168(3), 2153-2158. https://doi.org/10.1016/j.ijcard.2013.01.255
Gulati, M., Levy, P. D., Mukherjee, D., Amsterdam, E., Bhatt, D. L., Birtcher, K. K., Blankstein, R., Boyd, J., Bullock-Palmer, R. P., Conejo, T., Diercks, D. B., Gentile, F., Greenwood, J. P., Hess, E. P., Hollenberg, S. M., Jaber, W. A., Jneid, H., Joglar, J. A., Morrow, D. A., . . . Shaw, L. J. (2021). 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain. Circulation, 144(22), e368-e454. https://doi.org/10.1161/CIR.0000000000001029
Kline, J. A., Mitchell, A. M., Kabrhel, C., Richman, P. B., & Courtney, D. M. (2004). Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. Journal of Thrombosis and Haemostasis, 2(8), 1247-1255. https://doi.org/10.1111/j.1538-7836.2004.00790.x
Six, A. J., Backus, B. E., & Kelder, J. C. (2008). Chest pain in the emergency room: Value of the HEART score. Netherlands Heart Journal, 16(6), 191-196. https://doi.org/10.1007/BF03086144
What the NRNP 6566 Week 2 instructions ask for
The second NRNP 6566 week commonly asks for an admission note on chest pain. You take a focused history, examine for dangerous causes, interpret admission data, apply a validated risk score, address the life-threatening diagnoses one at a time, and justify the disposition. Faculty look first for explicit handling of dissection, embolism and other threats, not just the most likely cause. Cite the AHA/ACC chest pain guideline and the risk score's validation study in APA 7. Each element of the risk score should be shown so the total can be checked. Exact test orders may be left out in some sections. The note should say why the patient is admitted or observed rather than sent home. Times of symptom onset and troponin draws matter and should be recorded.
How this NRNP 6566 Week 2 example is built
Three pages or so, and the differential occupies more of them than the history does. A focused present illness records character, radiation, exertional pattern, and the features bearing on each dangerous cause: a tearing quality, pleuritic change, sudden breathlessness. Risk factors are listed as the history supplied them. The examination records pulses and pressures in both arms, lung sounds, heart sounds and any new murmur, because each speaks to a specific cause. The initial tracing and first cardiac marker are reported as findings. The HEART score is calculated with every component shown so a reader can check it. The differential then takes acute coronary syndrome, pulmonary embolism, aortic dissection, pneumothorax and pericardial disease in turn, each with the finding that keeps it open or closes it. The man in it was invented for this example.
Where the marks sit in the NRNP 6566 Week 2 rubric
Graders on this note look first at whether dangerous causes were addressed explicitly. A differential that jumps to the likely diagnosis and never mentions dissection or embolism has skipped the reasoning the week exists to test, even when the final answer is right. Risk scores reported as a bare total lose points, because the components are where errors hide. Examination sections documenting a routine heart and lung exam, without the targeted findings each threat requires, show a template rather than thought. The observation plan is marked on its rationale; categories listed without reasons read as protocol. Minor deductions come from risk factors stated vaguely, such as a family history of heart trouble with no relative or age of onset named, and from a tracing described as normal with no features given.
NRNP 6566 Week 2 help: mistakes that cost marks
Chest pain notes lose the most when the differential jumps to the likely coronary cause and never mentions dissection or embolism. Give each life threat its own line and the finding that weighs on it. Another common gap is a HEART score total with no breakdown, so the grader cannot check it. Show each part. Writers also forget timing, though troponin interpretation depends on when symptoms began and when blood was drawn. Record both. Avoid ordering every test for every threat; let the history and examination narrow the list. Compare blood pressure in both arms if dissection is considered. Keep ECG findings consistent through the note. Close with the disposition argument and the plan for the next troponin.
Get a NRNP 6566 Week 2 example written to your instructions
Attach the Week 2 prompt with its rubric, plus any case data your section released, and the desk builds a chest pain admission note around that presentation. It costs nothing the first time and comes back in 24 to 48 hours. Every finding in it belongs to an invented man, never to anyone who was admitted.
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NRNP 6566 Week 2 questions, answered
Why does the note discuss diagnoses the patient probably does not have?
Because the course grades whether dangerous causes were considered, not only whether the likely cause was found. In the example, dissection, embolism and pneumothorax each receive a short block naming the finding that argues against them. That work is what separates an acute care differential from a list of probable causes, and a note that omits it tends to lose marks even when its working diagnosis is correct.
Is the HEART score required?
Not by every section. The example uses it because it is widely taught for stratifying chest pain in this setting and because showing each component makes the reasoning checkable. If your prompt names a different tool or asks for none, the sample follows the prompt. What carries over regardless of tool is the practice of showing the parts rather than reporting a total alone.
Does the plan say which tests to order?
It names categories and the reasoning for each, such as repeat cardiac markers answering a time-dependent question or rhythm monitoring aimed at a specific concern, without listing orders, drug names or doses. The page describes a graded document, not care for anyone. Specific ordering decisions belong to the treating team and to the guidance your course assigns.
Where can I find a free NRNP 6566 Week 2 sample paper?
The exertional chest pain admission note is shown here with the focused history, the HEART score part by part, the five life threats and the case for observation.
Why discuss unlikely diagnoses in an NRNP 6566 Week 2 chest pain note?
Because missing dissection or embolism can be fatal. The example names each threat and the finding that makes it less likely, so the reasoning is visible.