| Course | NUR-5160 Advanced Health Assessment |
|---|---|
| Module | Module 6 |
| Paper type | Comprehensive encounter write-up |
| Length | About 1,042 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Master of Science in Nursing |
| Updated | October 2026 |
Free sample paper for NUR 5160 Module 6
Two Blocks Before the Calf Cramps: A Comprehensive Encounter With Ankle-Brachial Index Interpretation and an Aligned Plan
Student Name
Master of Science in Nursing (MSN), Thomas Edison State University
NUR-5160: Advanced Health Assessment
Mentor Name
Month Day, Year
Two Blocks Before the Calf Cramps: A Comprehensive Encounter With Ankle-Brachial Index Interpretation and an Aligned Plan
The final module of Advanced Health Assessment asks for a comprehensive encounter in which interpretation and plan stay aligned with the history and examination from start to finish. This paper presents such an encounter for a composite patient, a sixty-three-year-old retired transit mechanic with calf pain on walking. It documents the history and examination, interprets an ankle-brachial index measured at the visit, states a numbered assessment and builds a plan in which each step can be traced to a problem and each problem to a finding. Identifying details are invented.
Subjective Data
Chief concern: my left calf cramps up when I walk to the store. History of present illness: for eight months the patient has had a cramping ache in the left calf after walking about two blocks on level ground, sooner uphill, forcing a stop; the pain eases after two to three minutes of standing still and recurs at the same distance. There is no pain at rest, no pain at night relieved by hanging the leg over the bed, no foot wounds, numbness or color change, and no back pain or pain that eases only with sitting or bending forward. The right leg is unaffected. Past history: hypertension diagnosed six years ago, not currently treated after the patient stopped lisinopril because of a cough; elevated cholesterol noted at a work physical, never treated. No known diabetes, heart attack or stroke. Medications: none regularly; ibuprofen occasionally. Allergies: none known.
Family history: father died at sixty-six of a myocardial infarction; brother has had a carotid procedure. Social history: current smoker for forty-five years, about one pack a day, two prior quit attempts; alcohol occasionally; lives with spouse; walked more before retirement and now mostly drives. Review of systems: no chest pain or dyspnea on exertion at the distance walked, no transient weakness, speech change or vision loss, no erectile dysfunction reported, no abdominal pain after eating, no unintentional weight loss.
Objective Data
Vital signs: blood pressure 152 over 88 in the right arm and 148 over 86 in the left, seated after five minutes; heart rate 76 and regular; body mass index 27. General: well appearing. Neck: no carotid bruits. Cardiovascular: regular rhythm, no murmur. Abdomen: no pulsatile mass; no abdominal bruit. Lower extremities: left foot cooler than the right to touch with hair loss over the left shin and dorsum of the foot; capillary refill three seconds on the left great toe and under two seconds on the right; no ulcers, gangrene or fissures. Pulses: femoral two plus bilaterally with a soft left femoral bruit; popliteal two plus right and one plus left; dorsalis pedis and posterior tibial two plus on the right, and on the left the dorsalis pedis is not palpable and the posterior tibial is one plus. Neurological examination of the legs, including strength, sensation and reflexes, is normal; straight leg raise is negative.
Ankle-brachial index measured with a handheld Doppler after ten minutes supine, using the higher brachial pressure of 152 millimeters of mercury: right posterior tibial 146 and dorsalis pedis 142, giving a right index of 146 divided by 152, or 0.96; left posterior tibial 104 and dorsalis pedis 96, giving a left index of 104 divided by 152, or 0.68.
| Measurement | Right | Left |
|---|---|---|
| Brachial systolic (mm Hg) | 152 (used as denominator) | 148 |
| Posterior tibial systolic (mm Hg) | 146 | 104 |
| Dorsalis pedis systolic (mm Hg) | 142 | 96 |
| Ankle-brachial index | 0.96 | 0.68 |
Interpretation
The ankle-brachial index statement of the American Heart Association recommends calculating each leg's index from the larger of that leg's two ankle readings over the larger of the two arm readings, and classifies a value of 0.90 or less as abnormal, 0.91 to 0.99 as borderline and 1.00 to 1.40 as normal (Aboyans et al., 2012). The left index of 0.68 is abnormal and, together with fixed-distance calf claudication, a femoral bruit, diminished distal pulses and the trophic changes, supports a diagnosis of symptomatic peripheral artery disease of the left leg with probable femoropopliteal involvement. The right index of 0.96 is borderline, consistent with less advanced disease. There are no features of chronic limb-threatening ischemia, such as rest pain, wounds or gangrene. Spinal stenosis is less likely given relief on standing and a normal neurological examination.
Bickley et al. (2021) emphasize that peripheral artery disease is a marker of systemic atherosclerosis, and the encounter supports that view: the patient smokes heavily, has untreated hypertension and hyperlipidemia, and has a strong family history of early coronary disease. The diagnosis therefore changes more than the leg plan; it places the patient at high cardiovascular risk.
A borderline result on the right does not end the matter for that leg. Repeating the index after exercise, or measuring toe pressures if the arteries prove stiff, can reveal disease that a resting index misses, and the right leg should be reassessed if new symptoms appear there.
Assessment and Aligned Plan
Assessment: one, symptomatic peripheral artery disease of the left leg, left ankle-brachial index 0.68, without limb-threatening features; two, borderline right index; three, tobacco use disorder, current; four, hypertension, uncontrolled and untreated; five, hyperlipidemia, untreated; six, high cardiovascular risk.
Plan, traced to each problem. For problems one, two and six, the 2024 multisociety guideline for lower extremity peripheral artery disease recommends antiplatelet therapy, high-intensity statin therapy, blood pressure control and a structured exercise program, preferably supervised, for patients with claudication (Gornik et al., 2024); start aspirin or clopidogrel after discussing bleeding risk, start a high-intensity statin, and refer to a supervised exercise therapy program, with foot care education and instructions to seek emergency care for sudden pain, coldness, pallor or numbness of the leg. For problem three, advise quitting clearly, offer pharmacotherapy and quitline referral, since smoking cessation is central to slowing the disease. For problem four, choose an antihypertensive other than an angiotensin-converting enzyme inhibitor because of the prior cough, and recheck in two to four weeks. For problem five, check a fasting lipid panel before and after starting the statin. Add a hemoglobin A1c, basic metabolic panel and electrocardiogram to complete the cardiovascular risk assessment. Refer to vascular medicine if symptoms limit life despite exercise therapy. Follow up in four weeks.
References
Aboyans, V., Criqui, M. H., Abraham, P., Allison, M. A., Creager, M. A., Diehm, C., Fowkes, F. G. R., Hiatt, W. R., Jönsson, B., Lacroix, P., Marin, B., McDermott, M. M., Norgren, L., Pande, R. L., Preux, P.-M., Stoffers, H. E., & Treat-Jacobson, D. (2012). Measurement and interpretation of the ankle-brachial index: A scientific statement from the American Heart Association. Circulation, 126(24), 2890-2909. https://doi.org/10.1161/CIR.0b013e318276fbcb
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.
Gornik, H. L., Aronow, H. D., Goodney, P. P., Arya, S., Brewster, L. P., Byrd, L., Chandra, V., Drachman, D. E., Eaves, J. M., Ehrman, J. K., Evans, J. N., Getchius, T. S., Gutiérrez, J. A., Hawkins, B. M., Hess, C. N., Ho, K. J., Jones, W. S., Kim, E. S., Kinlay, S., . . . Wilkins, L. R. (2024). 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease. Circulation, 149(24), e1313-e1410. https://doi.org/10.1161/CIR.0000000000001251
What the NUR 5160 Module 6 instructions ask for
The closing module of NUR-5160 often asks for a comprehensive encounter that brings together history, examination, interpretation of findings or point-of-care tests, a prioritized problem list and an evidence-based plan. Directions in many sections ask that every plan element be justified by a finding and supported by current guidelines, and some require a specific bedside measurement, such as an ankle-brachial index, peak flow or visual acuity, to be documented and interpreted. Check the TESU classroom for whether medications should be named with doses or classes, whether a standardized patient case is assigned, and how many guideline sources are required. Show the method and arithmetic for any bedside test you report.
How this NUR 5160 Module 6 example is built
The example states its goal of alignment, then presents subjective data that separate vascular claudication from its mimics and search other vascular beds. Objective data include a full lower extremity vascular examination and a measured ankle-brachial index with pressures, arithmetic and a table. The interpretation section applies the AHA thresholds, rules out limb-threatening ischemia and spinal stenosis, and places the finding in the context of systemic cardiovascular risk. A numbered assessment of six problems follows, and the plan addresses each one with recommendations attributed to the 2024 guideline, plus testing to complete the risk assessment, emergency precautions and follow-up. Emergency instructions for sudden limb ischemia sit inside the plan itself.
Reading the NUR 5160 Module 6 grading rubric
Comprehensive encounter papers are typically graded on completeness and relevance of the history and examination, accurate measurement and interpretation of any bedside test, a prioritized and numbered assessment, a plan aligned with the assessment and supported by current guidelines, and writing. Mentors check alignment closely: each plan item should correspond to a problem, and each problem should rest on documented findings. Bedside tests earn credit when the method, values and calculation are shown and interpreted with a cited threshold. Plans that address systemic risk as well as the presenting complaint, and that include safety instructions, usually reach the top band. Current guideline citations matter at this level. Current guideline citations for each major recommendation carry weight at this level.
NUR 5160 Module 6 help: mistakes that cost marks
Final encounter papers lose points when the plan contains items with no matching problem, or problems with no plan. Number both lists and check them against each other. Another frequent issue is reporting a test result without the method or calculation, which makes interpretation impossible to verify. Students also treat the presenting complaint in isolation, missing the systemic risk it reveals. Cite the current guideline for each major recommendation and include safety-net instructions. Characterize the main symptom well enough to separate it from its common mimics. A comprehensive encounter built from your own findings can be written at the desk. Make sure safety instructions are concrete enough for the patient to act on.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 5160 Module 6 questions, answered
Where can I find a free NUR 5160 Module 6 sample paper?
The complete claudication encounter is above, index table and all, with a note beside each sheet. Carry its numbered, aligned structure over to your own case.
How do I calculate an ankle-brachial index?
For each leg, divide the higher of the two ankle systolic pressures by the higher of the two brachial systolic pressures, measured with a Doppler after the patient rests supine. Report the pressures and the calculation as well as the result.
What ankle-brachial index values are abnormal?
A value of 0.90 or less is abnormal and consistent with peripheral artery disease, 0.91 to 0.99 is borderline, 1.00 to 1.40 is normal, and values above 1.40 suggest noncompressible arteries.
How do I make the plan align with the assessment?
Number your problems, then write the plan problem by problem, naming which problem each step addresses. Read the plan backward to confirm every step has a reason in the assessment.
Should the NUR-5160 plan include medications?
At the MSN level, many sections expect medication classes or specific drugs consistent with current guidelines. Follow your directions on whether doses are required and always cite the guideline behind each recommendation.