| Course | NRNP 6810 Primary Care Approaches for Children |
|---|---|
| Week | Week 3 |
| Paper type | Focused SOAP note |
| Length | About 800 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 6810 Week 3
Focused SOAP Note: Vomiting Then Diarrhea in a 22-Month-Old From a Daycare Cluster, Graded With the Clinical Dehydration Scale
Student Name
College of Nursing, Walden University
NRNP 6810: Primary Care Approaches for Children
Instructor Name
Month Day, Year
Focused SOAP Note: Vomiting Then Diarrhea in a 22-Month-Old From a Daycare Cluster, Graded With the Clinical Dehydration Scale
Subjective
Composite patient: a 22-month-old boy brought by his mother. Counts, as she gave them: vomiting began last night at about 22:00; six episodes since then, the last at 09:30 this morning; none green and none with blood. Diarrhea began this morning at about 07:00; three watery stools since, no blood or mucus. Wet diapers: two since 06:00; usually he has had four by midday. Kept down: about 2 ounces of diluted apple juice at 10:30, with no vomiting since. Fever: "felt warm" overnight, not measured. Three children in his daycare room have had vomiting and diarrhea this week, according to a note from the daycare.
Her words, kept whole: "He just seems so tired. He's not himself. He usually runs around, and today he just wants to lie on me."
Pertinent history: no prior surgeries; immunizations up to date, including rotavirus in infancy; no recent antibiotics or travel; no sick adults at home.
Objective
Weight 11.6 kg; 11.9 kg at his well visit 3 weeks ago on the same scale, a loss of 0.3 kg, about 2.5%. Temperature 38.1 °C. Heart rate 138. Respiratory rate 28. Capillary refill 2 seconds.
Hydration, examined directly and scored on the Clinical Dehydration Scale, which rates four signs from 0 to 2 each (Friedman et al., 2004). General appearance: tired, lying against his mother, irritable when examined but consolable: 1. Eyes: not sunken: 0. Mucous membranes: sticky: 1. Tears: present but decreased when crying during the ear exam: 1. Total: 3.
Abdomen: not distended; soft; no guarding or rebound; no mass; bowel sounds active; he cried with palpation in all quadrants equally but settled when his mother held his hand, and no focal tenderness was found on repeat exam while he was calm. Skin: no rash, no mottling. Alert, tracks the examiner, reaches for his mother.
Assessment
Acute gastroenteritis, most likely viral, with some dehydration by a Clinical Dehydration Scale score of 3. In the validation study, scores of 1 to 4 defined some dehydration, and children in that group received intravenous fluids less often than those scoring 5 to 8 (Goldman et al., 2008). Against a surgical abdomen: vomiting that is not bilious, diarrhea following the vomiting as expected in gastroenteritis, a soft abdomen with no focal tenderness on calm repeat exam, no blood in stool, and a cluster of the same illness in his daycare room.
What Was Not Ordered, and Why
No blood tests: with some dehydration by the scale, an alert child, and a trial of oral fluids planned, electrolytes would not change today's plan; they would be drawn if the oral trial fails and intravenous fluids are needed. No stool culture: no blood in the stool, no travel, no recent antibiotics, and a known cluster at daycare make a bacterial cause unlikely enough that a culture would not change management. No abdominal imaging: the repeat exam found no focal tenderness, and the history follows the expected order of gastroenteritis. Each of these is reconsidered if the evening phone check or a return visit finds him worse, and the note records that the decision was made rather than overlooked.
Plan, in the Family's Order
The mother asked three questions, and the plan follows them.
"How do I get him to keep anything down?" A single dose of oral ondansetron is given in the clinic before oral rehydration begins; in a randomized trial of children with gastroenteritis and dehydration, a single oral dose reduced vomiting during oral rehydration from 35% to 14% and reduced the use of intravenous fluids (Freedman et al., 2006). Then oral rehydration solution, 5 mL by syringe or spoon every 1 to 2 minutes, increasing as tolerated; a trial of about 30 to 60 minutes in the clinic, watched by our nurse, to confirm he is drinking and keeping it down before he leaves. At home: continue small frequent amounts of rehydration solution, aiming for roughly 50 to 100 mL per kilogram over the next 4 hours, then return to his usual diet as he wants it. Juice is stopped because its sugar can worsen diarrhea.
"When should I bring him back or go to the emergency room?" Return or go to the emergency department for: green or bloody vomit; blood in the stool; no wet diaper for 8 hours; very sleepy and hard to wake; vomiting everything despite small sips; belly pain that makes him cry constantly or will not let him be touched. A phone check by our nurse this evening.
"When can he go back to daycare?" When he has had no vomiting or diarrhea for 24 hours, or per the daycare's policy if it is stricter. Handwashing with soap for everyone in the house, since this spreads easily.
References
Freedman, S. B., Adler, M., Seshadri, R., & Powell, E. C. (2006). Oral ondansetron for gastroenteritis in a pediatric emergency department. The New England Journal of Medicine, 354(16), 1698-1705. https://doi.org/10.1056/NEJMoa055119
Friedman, J. N., Goldman, R. D., Srivastava, R., & Parkin, P. C. (2004). Development of a clinical dehydration scale for use in children between 1 and 36 months of age. The Journal of Pediatrics, 145(2), 201-207. https://doi.org/10.1016/j.jpeds.2004.05.035
Goldman, R. D., Friedman, J. N., & Parkin, P. C. (2008). Validation of the clinical dehydration scale for children with acute gastroenteritis. Pediatrics, 122(3), 545-549. https://doi.org/10.1542/peds.2007-3141
The Walden NRNP 6810 Week 3 instructions
For Week 3, NRNP 6810 sections commonly ask for a focused SOAP note on an acute pediatric illness. You take a targeted history with the parent's counts and timing, examine what matters for the complaint, grade severity with a validated tool, name the diagnosis, explain tests not ordered, and write a plan the family can follow. Faculty penalize padding such as a full review of systems as much as they penalize gaps. Cite the severity tool and current guidance in APA 7. Fluid amounts may or may not be specified, depending on the section. Warning signs should be ones his mother can spot at home. Many instructors also want a sentence on daycare exclusion and hand hygiene, since the case comes from a cluster.
Inside the NRNP 6810 Week 3 example
Quantified wherever the mother could quantify, the subjective section stays short: when vomiting began, how many episodes, when diarrhea followed, how many wet diapers since morning, what the child has kept down. A cluster of similar illness at daycare is noted. Her words about the child seeming tired are quoted rather than converted into a finding. Objective data include a weight compared with the last recorded one, temperature, heart rate, and the hydration signs examined directly: tears, mouth, skin, capillary refill, alertness. The assessment names acute gastroenteritis, grades the dehydration with a published clinical scale, and lists what argues against a surgical abdomen. The plan describes oral rehydration with CDC guidance cited, what the family is asked to avoid, and return signs worded for a parent. A follow-up call is scheduled.
NRNP 6810 Week 3 rubric: what earns full marks
Focused notes lose marks for padding nearly as often as for gaps. A full review of systems attached to a vomiting toddler reads as template habit, and some criteria say so explicitly. The heavier row is the severity judgment: calling a child mildly dehydrated without naming the signs that support the grade is an unsupported conclusion, and the example ties its grade to a published scale and the findings listed above it. Blurring what the mother said into what the examiner found is a recurring deduction in this course. Plans slip when rehydration is advised without a source, when antiemetic or antidiarrheal questions are ignored, or when return precautions are vague. The surgical-abdomen line is small but checked, because missing it is the error with the worst consequence.
Common NRNP 6810 Week 3 mistakes, and how to avoid them
Focused notes lose marks when a template review of systems is pasted under a vomiting toddler. Keep the history to what changes the assessment. Another common gap is calling hydration fine without a score or the findings behind it. Use the Clinical Dehydration Scale and list each item. Writers also order stool cultures or blood work by habit. Explain why they are not needed here. Avoid giving the plan in clinical shorthand; write it in the order parents will use it, starting with small frequent sips of oral rehydration solution. Name the signs that mean come back today, such as no wet diaper in eight hours. Mention ondansetron only if your section allows it. Keep the counts and times consistent. Close with when he can return to daycare.
Get a NRNP 6810 Week 3 example written to your instructions
Send across the Week 3 prompt and rubric along with the complaint your section assigned, and the focused SOAP note that comes back argues its central judgment from counted evidence. Your first sample is free, reaches you within 24-48 hours, and is trimmed to the systems your complaint actually involves.
More NRNP 6810 papers and MSN samples
- NRNP 6810 Week 1: Discussion Post
- NRNP 6810 Week 2: Well-Child Case Write-Up
- NRNP 6810 Week 4: Developmental screening analysis
- NRNP 6810 Week 5: Discussion post
- NRNP 6810 Week 6: Acute care case analysis
- NRNP 6810 Week 7: Anticipatory guidance plan
- NRNP 6810 Week 8: Differential reasoning paper
- NRNP 6810 Week 9: Discussion post
- NRNP 6810 Week 10: Family education plan
- NRNP 6810 Week 11: Reflection
- NRNP 6821 Week 3: Management plan
- NRNP 6654 Week 3: Access Barrier Analysis
- NRNP 6831 Week 3: Care coordination plan
- NRNP 6644 Week 3: Collateral Summary
NRNP 6810 Week 3 questions, answered
Why is the review of systems so short?
A focused note documents the complaint and the systems that bear on it, and padding it with a full template signals habit rather than judgment. The example keeps gastrointestinal, hydration and the abdominal red flags, and leaves the rest out on purpose. If your section's template requires every system, the sample fills it, but the reasoning that earns marks stays in the hydration findings.
Does the plan specify fluid amounts?
It does not. The plan names oral rehydration as the approach, cites the guidance behind it, and describes how the family will know it is working, but volumes and schedules come from the references your program uses and are not stated here as advice. What the example shows is where that citation sits and how the return signs are worded.
Is the toddler from a real clinic day?
The two-year-old is fictional, as are the daycare outbreak and the mother's counts, all written to make the hydration reasoning visible. Nothing is drawn from a chart or an encounter anyone had. Send the complaint your section assigned and the desk invents a new child for it, so no real family appears in the note you receive.
Where can I find a free NRNP 6810 Week 3 sample paper?
The toddler gastroenteritis SOAP note is on this page with the mother's counts, the dehydration score, what was not ordered and the plan in the family's order.
How is dehydration graded in NRNP 6810 Week 3?
With the Clinical Dehydration Scale, which scores appearance, eyes, mucous membranes and tears. The example records each item and the total.