| Course | NUR 607 Advanced Health Assessment |
|---|---|
| Module | Module 2 |
| Paper type | Focused head and neck history and physical write-up |
| Length | About 1,030 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 607 Module 2
Focused Head and Neck Assessment: A Persistent Left Neck Mass in a 52-Year-Old Man
[Student Name]
Southern New Hampshire University
NUR 607: Advanced Health Assessment
Module Two Focused HEENT Note
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Focused Head and Neck Assessment: A Persistent Left Neck Mass in a 52-Year-Old Man
Adults bring neck lumps to primary care often, and most are reactive lymph nodes that shrink within weeks. A minority are the first sign of head and neck cancer, and in those cases the time between the first visit and diagnosis matters. This focused write-up documents the assessment of a man with a persistent neck mass. It shows how the history and examination identify features that raise the risk of malignancy and how the assessment and plan follow from those findings rather than from the most common explanation.
Subjective
Chief concern: "a lump on the left side of my neck that has not gone away."
History of present illness: Mr. D. is a 52-year-old man who noticed a painless lump below the angle of his left jaw while shaving about five weeks ago. He estimates it has grown slightly. It is not tender and has not changed with meals. He had no sore throat, cold, dental pain or fever before or since it appeared. For about three weeks he has had an intermittent dull ache in his left ear, worse when swallowing, with no hearing change or drainage. He reports no hoarseness, difficulty swallowing, weight loss, night sweats or bleeding from the mouth. He has not tried any treatment.
Past history: hypertension, treated with lisinopril 10 mg daily. No prior surgery on the head or neck and no radiation exposure. Allergies: none known. Family history: father had colon cancer at 70. Social history: never smoked; drinks two or three beers on weekends; married for 24 years; lifetime sexual partners reported as six. Works as an electrician.
Review of systems: General: no fever, fatigue or weight change. Ears, nose and throat: left ear ache as above; no nasal obstruction, epistaxis or sinus pain. Mouth: no sores, bleeding or loose teeth. Respiratory: no cough or hemoptysis. Endocrine: no heat or cold intolerance. Skin: no new lesions on the scalp, face or ears.
Objective
Vital signs: blood pressure 132/84 mm Hg, pulse 72 beats per minute and regular, temperature 36.8 degrees Celsius, respiratory rate 14, weight 86 kg (unchanged from 86 kg one year ago).
Neck: a single mass at left level II, just below and anterior to the angle of the mandible, deep to the sternocleidomastoid. It measures 2.8 by 2.2 cm with calipers, is firm and rubbery, nontender and mobile in the horizontal plane but less so vertically. The overlying skin is intact, without erythema or warmth. No other cervical, supraclavicular or submandibular nodes are palpable. Thyroid gland of normal size, rising with a swallow, without a palpable nodule. Trachea midline.
Oral cavity and oropharynx: dentition in good repair without tenderness to percussion. Mucosa pink and moist; no ulcers, white or red patches. Tongue protrudes midline with full movement. The left tonsil appears larger than the right, grade 2 compared with grade 1, without exudate or ulceration; palpation of the left tonsil is firm but not tender. The base of tongue could not be visualized with a mirror because of a strong gag reflex, and this is recorded as not assessed.
Ears: external canals clear. Both tympanic membranes gray and translucent with normal landmarks and mobility on pneumatic otoscopy. Whisper test normal bilaterally. Nose: septum midline, mucosa pink, no masses. Skin of scalp, face and ears: no suspicious lesions, examined because skin cancers of the scalp and ear can spread to the same nodes (Bickley et al., 2021).
Assessment
Persistent left level II neck mass in a 52-year-old man, with features that increase the risk of malignancy. The adult neck mass guideline identifies a mass that has persisted for two weeks or more without significant change, or one of uncertain duration, as at increased risk, and it lists firmness, fixation, size greater than 1.5 cm and absence of an infectious explanation as concerning (Pynnonen et al., 2017). His mass meets each of these except fixation. His normal ear examination with ear pain on swallowing suggests referred otalgia, which can arise from the tonsil or base of tongue.
The leading concern is metastatic squamous cell carcinoma from the oropharynx. His lack of tobacco use does not reassure: oropharyngeal cancers associated with human papillomavirus rose sharply in the United States from 1988 to 2004, while tobacco-related cancers fell, and they commonly occur in middle-aged men without heavy smoking histories (Chaturvedi et al., 2011). An enlarged, firm tonsil on the same side fits this picture. The differential also includes lymphoma, a reactive node from an unrecognized infection, a second branchial cleft cyst and a salivary gland tumor. In an adult over 40, a cystic lateral neck mass should be regarded as possible metastasis until proven otherwise.
Plan
No antibiotics: there are no signs of bacterial infection, and the guideline advises against routine antibiotic therapy for a neck mass in adults without such signs because it delays diagnosis (Pynnonen et al., 2017). Order contrast-enhanced computed tomography of the neck. Refer urgently to otolaryngology for examination of the pharynx, base of tongue and larynx by flexible endoscopy and for fine-needle aspiration of the mass, which the guideline prefers to open biopsy as the first tissue test. Explain to Mr. D. that the lump needs evaluation to find its cause, that several causes are possible and that the tests will be completed within two to three weeks. Schedule a follow-up call to confirm that imaging and the referral appointment have been made, and document who is responsible for tracking results.
Health Promotion
He is due for colorectal cancer screening, which the US Preventive Services Task Force recommends beginning at age 45; his father's cancer at 70 does not change the starting age. Blood pressure is near goal on lisinopril. Discuss limiting alcohol, since drinking adds to head and neck cancer risk.
Conclusion
This write-up documents a neck mass that is persistent, larger than 1.5 cm, firm and without an infectious cause in a man in his fifties with ipsilateral referred ear pain and tonsillar asymmetry. Each of those findings is recorded in measurable terms and linked to the guideline, which leads to imaging and specialist evaluation rather than a trial of antibiotics.
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.
Chaturvedi, A. K., Engels, E. A., Pfeiffer, R. M., Hernandez, B. Y., Xiao, W., Kim, E., Jiang, B., Goodman, M. T., Sibug-Saber, M., Cozen, W., Liu, L., Lynch, C. F., Wentzensen, N., Jordan, R. C., Altekruse, S., Anderson, W. F., Rosenberg, P. S., & Gillison, M. L. (2011). Human papillomavirus and rising oropharyngeal cancer incidence in the United States. Journal of Clinical Oncology, 29(32), 4294-4301. https://doi.org/10.1200/JCO.2011.36.4596
Pynnonen, M. A., Gillespie, M. B., Roman, B., Rosenfeld, R. M., Tunkel, D. E., Bontempo, L., Brook, I., Chick, D. A., Colandrea, M., Finestone, S. A., Fowler, J. C., Griffith, C. C., Henson, Z., Levine, C., Mehta, V., Salama, A., Scharpf, J., Shatzkes, D. R., Stern, W. B., . . . Corrigan, M. D. (2017). Clinical practice guideline: Evaluation of the neck mass in adults. Otolaryngology-Head and Neck Surgery, 157(2 Suppl.), S1-S30. https://doi.org/10.1177/0194599817722550
What the NUR 607 Module 2 instructions ask for
A NUR 607 focused HEENT assignment usually presents a head, eye, ear, nose, throat or neck complaint and asks for a focused history and physical in standard format: chief concern, history of present illness, pertinent past, family and social history, a focused review of systems, the examination, an assessment with differential diagnoses and a plan. Some sections use SOAP headings. Write-ups commonly run three to five pages with a few scholarly sources in APA 7. Keep the scope focused on the complaint while including every system that could explain it, record findings as measurements and include the pertinent negatives that rule dangerous causes in or out, since graders read the note for exactly those choices.
How this NUR 607 Module 2 focused heent note example is built
The sample documents a composite 52-year-old electrician with a painless left neck lump for five weeks and ear pain on swallowing. The history records onset, change, associated symptoms and the risk factors that matter, including tobacco, alcohol and sexual history. The examination measures the mass at 2.8 by 2.2 cm at level II, describes its consistency and mobility, notes an enlarged firm left tonsil, records a normal ear examination and states that the base of tongue was not assessed. The assessment applies the adult neck mass guideline and HPV epidemiology to rank metastatic oropharyngeal cancer first. The plan withholds antibiotics, orders contrast CT, refers for endoscopy and aspiration and assigns follow-up.
Where the NUR 607 Module 2 rubric puts the points
Focused write-up rubrics in this course typically score the completeness and organization of the history, the relevance of the review of systems, the precision of the examination, the differential diagnosis, the plan and documentation standards. Top marks go to notes in which every finding is measurable, subjective and objective data are kept apart and the pertinent negatives match the complaint. Graders reward assessments that cite a guideline or decision rule and plans that follow logically from the findings. Recording what was not assessed, rather than implying it was normal, shows documentation integrity. Brief, specific health promotion tied to age and risk often earns a separate rubric point.
NUR 607 Module 2 help: the mistakes that cost points
HEENT write-ups lose points when a lump is described as enlarged without measurement, when risk-factor history is missing, when the review of systems repeats the present illness or when the plan defaults to antibiotics for a persistent mass. Another common gap is writing oropharynx normal when part of it could not be seen. Measure every finding, include the history that changes risk, keep the review of systems subjective, list pertinent negatives, cite the guideline in your assessment and make the plan follow from it. If your case is a sore throat, ear pain, red eye or sinus complaint, send the scenario and template and the note can be built for that problem.
Get NUR 607 Module 2 written to your instructions
Send the scenario, your section's documentation template and the rubric. A focused write-up with measured findings, pertinent negatives, a guideline-based assessment and a plan that follows from it will be ready in 24 to 48 hours, and your first note is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 607 Module 2 questions, answered
Where can I find a free NUR 607 Module 2 Focused HEENT Note sample?
This page has the complete note: a persistent neck lump in a 52-year-old documented with measured findings, risk history, an assessment based on the adult neck mass guideline and APA 7 references.
When is a neck mass in an adult concerning for cancer?
The adult neck mass guideline flags a mass persisting two weeks or more without change, firmness, fixation, size over 1.5 cm and no infectious cause, especially with risk factors such as age over 40, tobacco, alcohol or HPV.
Should antibiotics be given for a neck lump?
Not routinely. The guideline advises against antibiotics for an adult neck mass without signs of bacterial infection, because a trial of antibiotics can delay the diagnosis of cancer.
How should a lymph node be documented on exam?
Record its location by neck level, size in centimeters, consistency, tenderness, mobility or fixation and the overlying skin, along with whether other nodes are palpable.
Can a nonsmoker get throat cancer?
Yes. HPV-associated oropharyngeal cancer has risen sharply in the United States and often occurs in middle-aged men with little or no smoking history.