Focused Health Assessment of a 54-Year-Old Woman with Stage 2 Hypertension and Rising A1C at a Community Health Center
[Author Name]
Nursing Program, Southern New Hampshire University
NUR 325: Patient Assessment and Health Literacy
Module 3 Assignment
[Instructor Name]
August 11, 2026
Composite patient written as a model document. No real person, clinic or employer is described.
Subjective Data
Ms. B is a composite 54-year-old woman who came to a community health center for a follow-up visit three months after a screening table at a neighborhood health fair recorded a blood pressure of 168/98 mm Hg and told her to have it checked again. She reports a dull band of headache across the forehead on four of the past seven mornings, gone by mid-morning, and denies chest pain, breathlessness, palpitations, blurred vision, dizziness and swelling in her legs. She has had type 2 diabetes for three years. She has never smoked, drinks alcohol a few times a year, and takes care of her mother on the days she is not working.
She brought her medicines in a plastic grocery bag rather than a list. The bag held metformin 500 mg twice daily, refilled on time every month; lisinopril 10 mg daily, a 30-day supply last filled four months ago; and a store brand naproxen 220 mg that she takes most days for knee pain. Asked what each one is for, she named the metformin as 'my sugar pill' and said of the lisinopril, 'I think that one is for sugar too, or maybe my heart.' She did not include the naproxen when asked to list her medicines, explaining that she buys it off a shelf, so it did not count.
She holds two part-time jobs, sleeps five to six hours a night, buys lunch from a vending machine on most working days and eats canned soup four evenings out of seven. She owns a glucose meter and checks, in her words, 'when I feel funny,' which comes to about twice a month. She has no blood pressure cuff at home. At the front desk she asked the clerk to read the intake form aloud, saying she had left her glasses at home, and she finished the form after about forty minutes. She could not recall her most recent A1C number but remembered being told that it went up.
Objective Findings
Blood pressure was measured after five minutes of quiet sitting with the back supported, feet flat on the floor and the arm supported at heart level, using a large adult cuff matched to a mid-arm circumference of 34 cm. The right arm read 162/96 mm Hg, the right arm again after three minutes read 158/94, and the left arm read 160/94, giving an average of 160/95 for the two right arm readings. Heart rate was 82 and regular, respiratory rate 16, temperature 36.7 C, and oxygen saturation 98 percent on room air. Height was 163 cm and weight 88 kg, for a body mass index of 33.1.
Point of care hemoglobin A1C was 8.4 percent, against 7.6 percent recorded eight months earlier, and a capillary glucose taken two hours after lunch was 189 mg per dL. On cardiovascular examination there was no carotid bruit, the jugular venous pressure was not raised with the head of the bed at 45 degrees, S1 and S2 were present without an S3, S4 or murmur, and radial and pedal pulses were 2+ and equal with no peripheral edema. Lungs were clear to auscultation in all fields, and the abdomen was soft with no bruit over the aorta or renal arteries. Her last retinal screening was more than two years ago.
Monofilament testing at ten sites found sensation absent at two sites on the right foot, at the plantar surface of the great toe and over the first metatarsal head, and intact at all ten sites on the left. A firm callus sat under the right first metatarsal head. The skin was otherwise intact, with no ulcer, fissure, maceration between the toes or erythema, and both feet were warm with capillary refill under three seconds. Two observations were recorded as findings in their own right: she held each bottle at arm's length and read the drug name in large print but not the smaller direction line beneath it, and she asked whether twice daily meant morning and lunchtime.
Interpretation of the Findings
Two readings taken minutes apart in the same arm with a correctly sized cuff, confirmed by a third in the other arm, put her average at 160/95 mm Hg, which sits in the stage 2 range of current national guidance and agrees with the 168/98 recorded three months earlier. One high reading at a health fair would not carry that weight; two occasions three months apart under controlled conditions describe a pattern rather than an anxious moment. At the same time there is no carotid bruit, no raised jugular venous pressure, no S3 and no edema, so this reads as sustained elevation without signs of acute organ injury, which sets the pace of the plan in months rather than hours.
Two findings explain much of the number. A 30-day supply of lisinopril last filled four months ago means she has been without that medicine for most of the interval, and naproxen taken on most days works directly against blood pressure control while adding kidney risk alongside an ACE inhibitor and diabetes. Neither finding reads as refusal. She could not say what the lisinopril treats, and she did not classify a product bought from a shelf as a medicine at all. That distinction matters, because a plan built on reminding her to take her pills would miss the real gap, which is that the information she was given never became usable to her.
The A1C of 8.4 percent against 7.6 percent eight months earlier shows control moving in the wrong direction, and the meal pattern of vending machine lunches and canned soup accounts for both the glucose and a sodium load that pushes the blood pressure the same way. The two insensate sites with a callus over the right first metatarsal head change her risk category more than any number does, because a foot that cannot feel pressure and already carries the mark of it is the foot that ulcerates. Glucose checks made twice a month and triggered by symptoms cannot detect a rise that produces no symptoms, so her monitoring is not currently capable of warning her.
Teaching Plan and Confirmation of Understanding
The printed sheet she had been given at the health fair used the words hypertension, adherence and cardiovascular risk, and ran to two dense pages in small type. It was replaced with one card in 16 point type, written at about a fifth grade reading level, holding one instruction per line: 'Take the small white pill every morning. It lowers your blood pressure. Take it even when you feel fine.' The line about pain medicine reads: 'Do not use store pain pills like Aleve or ibuprofen. Ask us which pain pill is safe for you.' Every term was chosen from ordinary speech, so the card says high blood pressure rather than hypertension and kidney rather than renal.
Teaching was given in three short pieces with understanding checked after each one rather than at the end. The wording placed the burden on the teacher: 'I want to be sure I explained this clearly. When you get home tonight, what will you take and when?' On the first check she named the sugar pill twice a day and the small white pill each morning. On the second she said she would stop the store pain pills until the clinic told her which one is safe. The third check, on the home cuff, needed a second pass, because she first described sitting with her legs crossed and the cuff placed over her sleeve.
She then demonstrated the cuff twice on a bare arm, with her back supported, feet flat, five minutes of sitting first, the cuff edge two finger widths above the elbow crease, and a second reading one minute after the first. She will record two morning and two evening readings on four days out of seven, on a paper log with printed boxes instead of blank lines, and will bring both the log and the bag of bottles to a visit scheduled one month from today. She agreed to check her feet every night using a mirror, which she also demonstrated, and to call the clinic for any reading above 180/110 or any new sore, blister or dark spot on either foot.
References
Agency for Healthcare Research and Quality. (2024). AHRQ health literacy universal precautions toolkit (3rd ed.). U.S. Department of Health and Human Services. https://www.ahrq.gov/health-literacy/improve/precautions/index.html
American Diabetes Association Professional Practice Committee. (2024). Standards of care in diabetes-2024. Diabetes Care, 47(Suppl. 1). https://diabetesjournals.org/care/issue/47/Supplement_1
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. (2023). Plain language materials and resources. U.S. Department of Health and Human Services. https://www.cdc.gov/healthliteracy/developmaterials/plainlanguage.html
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (n.d.). Health communication. Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-communication
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., ... Wright, J. T. (2018). 2017 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13-e115.
How this NUR 325 Module 3 example is structured
In many sections the module 3 assignment in an assessment course asks for a written health assessment of one person, with the data organized, interpreted and turned into teaching; your classroom's instructions and rubric decide the exact form, so read them before using this NUR 325 Module 3 example as a shape. The paper is laid out in four moves. Subjective data comes first in the patient's own words and includes what she carried into the visit. Objective data follows, with the conditions of measurement written down so the readings can be trusted. The interpretation section then does the part students most often skip: it says what the numbers mean together rather than one at a time. The teaching section closes the loop by showing the exchange itself, so a reader watches understanding being checked instead of assumed.
NUR 325 Module 3 questions, answered
What does a NUR 325 Module 3 paper usually ask for?
In many sections the module 3 assignment in an assessment course is a written health assessment of one person: subjective data, objective findings, an interpretation, and teaching that follows from it. Your classroom's instructions and rubric decide the exact form, including whether a specific template is required. Read those first, then use this example for the shape of the reasoning.
How do you show health literacy work without just naming the technique?
Write down what you did and what came back. Give the reading level and type size of the card you wrote, quote the words you swapped, quote the question you asked, and record the answer, including the check that failed on the first pass. A written exchange earns credit for teaching. The sentence teach-back was used earns almost none.
Do measurement conditions really belong in the paper?
Yes, and they are quick points. Cuff size, rest time, arm position, the interval before the repeat and which arm was used all decide whether a reading means anything. Graders reading an assessment paper look for exactly that, and an interpretation built on a number with no conditions attached is an interpretation the reader cannot check.
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 Southern New Hampshire 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.