| Course | NUR 607 Advanced Health Assessment |
|---|---|
| Module | Module 5 |
| Paper type | Focused abdominal and pelvic history and physical write-up |
| Length | About 1,000 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 5
Focused Abdominal and Pelvic Assessment: Right Lower Quadrant Pain and a Positive Pregnancy Test in a 24-Year-Old Woman
[Student Name]
Southern New Hampshire University
NUR 607: Advanced Health Assessment
Module Five Focused Abdominal 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 Abdominal and Pelvic Assessment: Right Lower Quadrant Pain and a Positive Pregnancy Test in a 24-Year-Old Woman
Right lower quadrant pain has a short list of dangerous causes, and in a woman of reproductive age that list includes two conditions that can kill within hours: a perforating appendix and a rupturing ectopic pregnancy. Their examinations overlap. The difference is often made by a single result that should be obtained before anything else, a pregnancy test. This focused note documents the assessment of a young woman with right-sided abdominal pain and shows how a structured history, a complete abdominal and pelvic examination and one early test change the plan.
Subjective
Chief concern: "sharp pain on my right side since last night."
History of present illness: Ms. T., 24, is in graduate school and has had pain in the right lower abdomen that began about 18 hours ago, while she was studying. It started in the same place rather than near the navel and has not moved. She rates it 6 of 10, sharp and constant; walking and every bump on the drive over made it worse. She has had nausea without vomiting and has eaten little since yesterday. She has noticed light brown vaginal spotting since this morning. Her last menstrual period began seven weeks ago; her cycles are usually 30 to 35 days, and she "thought it was just late." She denies fever, diarrhea, urinary burning or frequency and shoulder pain. She has not taken anything for the pain. She has never had pain like this before, and no one else at home is ill.
Past history: no surgeries. One prior episode of pelvic inflammatory disease at 19, treated as an outpatient. Gravida 0. Medications: none; she stopped oral contraceptives four months ago. Allergies: none. Social: one male partner for a year; condoms used "most of the time." Nonsmoker; rare alcohol.
Review of systems: General: no fever or chills. Gastrointestinal: nausea and reduced appetite as above; last bowel movement yesterday, normal. Genitourinary: spotting as above; no dysuria, hematuria or vaginal discharge. Cardiovascular: no palpitations or fainting. Musculoskeletal: no back pain.
Objective
Vital signs: blood pressure 112/70 mm Hg lying and 108/68 mm Hg standing, pulse 88 lying and 96 standing, temperature 37.2 degrees Celsius, respiratory rate 16, oxygen saturation 99% on room air.
General: uncomfortable, walks slowly holding her right side, alert and oriented.
Abdomen: flat, without scars or distension. Bowel sounds present in all four quadrants. Tympanic to percussion throughout, without shifting dullness. Tender in the right lower quadrant, maximal about two thirds of the way from the umbilicus to the anterior superior iliac spine, with voluntary guarding. No rebound tenderness and no pain with gentle heel tap. Rovsing sign negative. Psoas sign negative. Obturator sign negative. No costovertebral angle tenderness. No hepatosplenomegaly or palpable masses.
Pelvic examination, with a chaperone present: external genitalia normal. Speculum: small amount of dark blood in the vault, cervix closed, no discharge. Bimanual: moving the cervix does not provoke pain; the uterus feels of normal size; right adnexa tender without a clearly palpable mass; left adnexa nontender.
Point-of-care testing: urine hCG positive. Urinalysis: trace blood, negative leukocyte esterase and nitrites.
Assessment
Right lower quadrant pain with vaginal spotting and right adnexal tenderness in a 24-year-old with a positive pregnancy test and a history of pelvic inflammatory disease. The leading diagnosis is ectopic pregnancy until proven otherwise. Abdominal pain and vaginal bleeding in early pregnancy are the classic presentation, and prior pelvic infection, which can damage the fallopian tubes, increases the risk (Barnhart, 2009). A mild orthostatic rise in pulse raises concern for early blood loss. Early intrauterine pregnancy with a threatened miscarriage or a ruptured corpus luteum cyst are alternatives.
Appendicitis remains in the differential but is less likely. Individual findings are weak discriminators; peritoneal signs, migration of pain and raised inflammatory markers are the strongest, especially in combination (Andersson, 2004). Ms. T. has localized tenderness and guarding but no migration, no rebound and no fever. An Alvarado score cannot be completed without a white cell count, and a systematic review found that the score overpredicts appendicitis in women at all levels of risk (Ohle et al., 2011), so it would add little here. Ovarian torsion is also possible and would present with adnexal tenderness, though usually with more severe, sudden pain.
Several pertinent negatives narrow the list further and are recorded for that reason. The absence of dysuria, a negative leukocyte esterase and no costovertebral angle tenderness make pyelonephritis and a urinary tract infection unlikely, although trace blood on urinalysis can accompany either an ectopic pregnancy or a stone. No cervical motion tenderness and no discharge argue against a recurrence of pelvic inflammatory disease. Normal bowel habits and the absence of diarrhea make infectious colitis unlikely. None of these findings excludes the leading diagnosis, but each tells the receiving clinician what has already been considered, which shortens the workup in the emergency department.
Plan
Same-hour transfer to the emergency department for quantitative serum hCG, transvaginal ultrasound, complete blood count, blood type and Rh status and gynecology consultation. Because of the orthostatic change, she should not drive; her partner will take her, and the emergency department is called ahead with a verbal report. She is told plainly that her pregnancy test is positive, that the pain may be from a pregnancy outside the uterus, which needs urgent testing, and that she should call 911 if she develops severe pain, fainting or shoulder pain on the way. Nothing by mouth until evaluated. A follow-up call is scheduled for tomorrow, and the note records the time of transfer and the person who received the report.
Conclusion
The abdominal examination in this patient could have supported appendicitis, but the history of a late period and spotting and a pregnancy test obtained early moved ectopic pregnancy to the top. Documenting each sign by name and result, the pelvic findings and the orthostatic vital signs gives the receiving team a clear picture and shows why the patient was sent immediately.
References
Andersson, R. E. B. (2004). Meta-analysis of the clinical and laboratory diagnosis of appendicitis. British Journal of Surgery, 91(1), 28-37. https://doi.org/10.1002/bjs.4464
Barnhart, K. T. (2009). Ectopic pregnancy. New England Journal of Medicine, 361(4), 379-387. https://doi.org/10.1056/NEJMcp0810384
Ohle, R., O'Reilly, F., O'Brien, K. K., Fahey, T., & Dimitrov, B. D. (2011). The Alvarado score for predicting acute appendicitis: A systematic review. BMC Medicine, 9, Article 139. https://doi.org/10.1186/1741-7015-9-139
What the NUR 607 Module 5 instructions ask for
A NUR 607 focused abdominal assignment usually presents an abdominal complaint and asks for a focused history and physical: the pain developed by onset, location, migration, character, severity, timing and associated symptoms; relevant gastrointestinal, genitourinary, menstrual and sexual history; a documented abdominal examination in the order of inspection, auscultation, percussion and palpation; special signs by name and result; and an assessment and plan. Expect three to five pages in APA 7. For any patient who could be pregnant, document the menstrual history and a pregnancy test early, and state which parts of the examination, such as a pelvic examination, were performed and which were deferred, with the reason for deferral.
How this NUR 607 Module 5 focused abdominal note example is built
The sample documents a composite 24-year-old graduate student with 18 hours of right lower quadrant pain, nausea, spotting and a last period seven weeks ago. The history records that the pain began in place without migrating, a prior pelvic infection and recent contraceptive changes. The examination documents lying and standing vital signs, tenderness with voluntary guarding, and Rovsing, psoas, obturator and rebound signs as negative, followed by a chaperoned pelvic examination with right adnexal tenderness. A positive urine hCG makes ectopic pregnancy the leading diagnosis. Appendicitis is weighed with the Andersson meta-analysis and the Ohle review of the Alvarado score, and the plan sends her to the emergency department the same hour.
Where the NUR 607 Module 5 rubric puts the points
Abdominal write-up rubrics usually score the pain history, relevant associated history, a correctly ordered and complete examination, special signs documented with results, clinical reasoning with a prioritized differential, an appropriate plan and documentation quality. The top band usually requires documenting pregnancy status in every patient who could be pregnant, recording negative signs as well as positive ones and explaining how the evidence on those signs shapes the differential. Graders tend to reward plans whose urgency matches the leading diagnosis and that address safety, such as transport and warning signs. Recording the chaperone and the handoff shows professional documentation practice and is often a rubric item on its own.
NUR 607 Module 5 help: the mistakes that cost points
Abdominal notes lose points when the pain is not developed along its dimensions, when signs are listed as positive without the negatives, when pregnancy is not considered in a woman of reproductive age or when the plan treats a surgical emergency as routine follow-up. A frequent error is applying a scoring tool without noting its limits in the patient's group or age range. Document migration, menstrual history and pregnancy status early, name each sign with its result, prioritize the differential by danger and match the urgency of the plan to it. If your case is epigastric pain, gallbladder disease or pediatric abdominal pain, send the scenario and template for a note built to fit.
Get NUR 607 Module 5 written to your instructions
Send the abdominal scenario, your template and the rubric. A focused note with the pain fully developed, every sign documented with its result, pregnancy status addressed and a plan that matches the danger will be sent back within 24 to 48 hours, and we do not bill the first one. 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 5 questions, answered
Where can I find a free NUR 607 Module 5 Focused Abdominal Note sample?
Read the full note on this page: right lower quadrant pain and a positive pregnancy test in a 24-year-old woman, documented with each abdominal sign, a pelvic exam, an assessment and a same-hour plan.
Why test for pregnancy in abdominal pain?
Any woman of reproductive age with abdominal pain could have an ectopic pregnancy, which can rupture and cause life-threatening bleeding. A pregnancy test early in the visit changes the differential and the plan.
Which exam findings best suggest appendicitis?
No single finding is strong on its own. Peritoneal signs such as rebound and guarding, migration of pain and raised inflammatory markers discriminate best, especially when several are present together.
Is the Alvarado score reliable in women?
A systematic review found that a score below 5 helps rule out appendicitis, but the score overpredicts appendicitis in women at all risk levels, so it should be interpreted cautiously.
How should abdominal signs be documented?
Name each sign performed, such as rebound, Rovsing, psoas and obturator, and record whether it was positive or negative, along with the location of maximal tenderness and any guarding.