NUR 5160 Module 2 Subjective History Write-Up Example

Six Weeks of Drenching Sweats: A Complete Subjective Section and the Reasoning That Organized It

Student Name

Master of Science in Nursing (MSN), Thomas Edison State University

NUR-5160: Advanced Health Assessment

Mentor Name

Month Day, Year

Six Weeks of Drenching Sweats: A Complete Subjective Section and the Reasoning That Organized It

The second module of Advanced Health Assessment focuses on history taking, and the assignment asks for a complete subjective section done well. Night sweats are a useful symptom for the exercise because they are common, usually benign and occasionally the first sign of something serious. A good history has to sort those possibilities before any examination or testing begins. This paper presents the subjective section for a composite patient, a forty-one-year-old accountant who volunteers weekly at an overnight shelter, followed by an explanation of how the history was organized. Identifying details are invented.

Chief Concern and History of Present Illness

Chief concern, in the patient's words: I've been soaking the sheets most nights for about six weeks. History of present illness: the patient describes drenching sweats on four or five nights a week for six weeks, beginning without an obvious trigger, waking them between two and four in the morning and requiring a change of shirt and sometimes sheets. The bedroom is kept cool and the patient sleeps with one blanket. Sweats do not occur during the day. The patient has noticed a weight loss of about four kilograms over two months without trying, and a dry cough for about three weeks, worse in the morning. The patient has felt warm in the evenings but has not measured a temperature. There is no hemoptysis, chest pain or shortness of breath.

Associated and pertinent negative symptoms: no hot flushes during the day, no menstrual change, no palpitations, tremor or heat intolerance, no new medications or dose changes, no recent travel outside the state, no itching, no new lumps noticed in the neck, armpits or groin, no abdominal pain, no change in bowel habit, no blood in stool, no anxiety attacks and no symptoms of low blood sugar on waking. The patient has tried nothing for the sweats and is mainly worried because a shelter guest was taken to the hospital two months ago with what staff described as a serious lung infection.

Background Histories

Past medical history: seasonal allergic rhinitis; no diabetes, thyroid disease, HIV infection or cancer; no known prior positive tuberculosis test, though the patient recalls a skin test was required for a job about fifteen years ago and was negative. Surgical history: appendectomy at nineteen. Medications: cetirizine 10 milligrams daily in spring; no antidepressants, no hormone therapy, no regular over-the-counter drugs. Allergies: penicillin, rash in childhood. Family history: type 2 diabetes in the mother; lung cancer was the cause of the father's death at seventy after a lifetime of smoking; no family history of lymphoma or tuberculosis known.

Social history: works as a staff accountant; has volunteered one overnight shift a week for three years at an emergency shelter, sleeping in a staff room adjacent to the dormitory. Never smoker; alcohol rarely; no injection or other drug use. Sexual history: one partner for six years, no new partners, has not had an HIV test in more than ten years. Lives with partner, no children, no pets. Born in the United States, no history of incarceration, no recent travel.

Review of Systems

Constitutional: positive for night sweats, unintentional weight loss and subjective evening warmth; negative for chills or rigors. Skin: no rash, itching or new lesions. Head, eyes, ears, nose and throat: no sore throat, sinus pain or dental pain. Respiratory: dry cough for three weeks; no hemoptysis, wheeze or dyspnea. Cardiovascular: no chest pain, palpitations or edema. Gastrointestinal: appetite somewhat reduced; no nausea, abdominal pain or change in stools. Genitourinary: no dysuria or hematuria. Musculoskeletal: no joint pain or swelling. Neurological: no headache or weakness. Endocrine: no heat or cold intolerance, polyuria or polydipsia. Hematologic and lymphatic: no easy bruising and no lumps noticed. Psychiatric: mild worry about the symptoms; sleep otherwise good; no low mood.

How the History Was Organized

Mold et al. (2012) reviewed the literature on night sweats and concluded that the symptom is common and nonspecific, that many suggested causes are poorly supported, and that no evidence-based algorithm for evaluation exists. That finding shaped the history in two ways. First, because the symptom alone points nowhere, the history had to characterize it precisely, including timing, severity, pattern and the bedroom environment, so that ordinary explanations such as a warm room or heavy bedding could be set aside. Second, because no algorithm exists, the questions had to be organized around the categories of cause that matter most if missed: infection, malignancy, endocrine and medication causes, and less dangerous causes such as anxiety or gastroesophageal reflux.

Infection drove several questions. The combination of night sweats, weight loss, cough for more than two weeks and possible fever, in a person with repeated exposure in a congregate setting, matches the symptom pattern public health guidance lists for active tuberculosis (Centers for Disease Control and Prevention, 2025). That is why the history asks about the prior skin test, the shelter guest's illness, the sleeping arrangement at the shelter, travel, incarceration and HIV risk. Malignancy, particularly lymphoma, drove the questions about lumps, itching and weight. Endocrine and medication causes drove the questions about heat intolerance, menstrual change, hypoglycemia and antidepressants.

Bickley et al. (2021) teach that a symptom should be explored with its attributes, its associated symptoms and the setting in which it occurs, and the history above follows that pattern. The setting, in this case, carries the most weight: a symptom that would usually be benign becomes urgent when the history places the patient beside a person with a serious lung infection.

Summary for the Next Clinician

A forty-one-year-old with six weeks of drenching night sweats, four kilograms of unintentional weight loss, three weeks of dry cough and subjective evening fever, with weekly overnight exposure in a congregate shelter where a guest was recently hospitalized with a serious lung infection, and a negative tuberculin skin test about fifteen years ago. No symptoms suggesting thyroid, medication, hormonal or hypoglycemic causes; no reported lymphadenopathy or itching. The history raises concern for active pulmonary tuberculosis and calls for examination, chest imaging, tuberculosis testing and HIV testing, with lymphoma remaining on the list until excluded.

References

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.

Centers for Disease Control and Prevention. (2025). Signs and symptoms of tuberculosis. https://www.cdc.gov/tb/signs-symptoms/index.html

Mold, J. W., Holtzclaw, B. J., & McCarthy, L. (2012). Night sweats: A systematic review of the literature. Journal of the American Board of Family Medicine, 25(6), 878-893. https://doi.org/10.3122/jabfm.2012.06.120033