| Course | NUR 607 Advanced Health Assessment |
|---|---|
| Module | Module 8 |
| Paper type | Focused neurologic history and physical write-up |
| Length | About 1,060 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 8
Focused Neurologic Assessment: A New Temporal Headache With Jaw Claudication in a 56-Year-Old Man
[Student Name]
Southern New Hampshire University
NUR 607: Advanced Health Assessment
Module Eight Focused Neurologic 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 Neurologic Assessment: A New Temporal Headache With Jaw Claudication in a 56-Year-Old Man
Tension-type headache and migraine account for most headache visits in family practice, and most can be diagnosed from the history with a normal examination. A new headache in a person over 50 is different, because the probability of a secondary cause rises with age. Among those causes, giant cell arteritis is the one in which a missed diagnosis can lead to permanent blindness within days. The note that follows records how one man's new headache after 50 was assessed. It shows how a red flag screen, a complete neurologic and visual examination and a directed vascular examination lead to same-day treatment.
Subjective
Chief concern: "a headache on the right side that won't quit."
History of present illness: Mr. K. is a 56-year-old retired machinist with three weeks of headache over the right temple and forehead. It began gradually, has been present most of the day since, and is dull and throbbing at 5 of 10, worse at night. He has noticed that his right scalp is sore when he combs his hair or rests his head on a pillow. For about a week, his jaw has felt tired and achy after two or three minutes of chewing steak or bread, easing when he stops. He has felt more tired than usual, with a low appetite, and thinks he has lost about 2 kg. His shoulders are stiff for about an hour in the morning. Acetaminophen helps a little.
Red flag review using SNNOOP10: no fever or chills; no history of cancer or immunosuppression; no confusion, weakness, numbness, speech change or seizure; onset gradual rather than sudden; age over 50 at onset; no change in pattern of a previous headache, since he has not had headaches before; not positional; not triggered by coughing, straining or exercise; no papilledema reported; not pregnant; no painful red eye; no head trauma; no new medications or overuse of pain relievers. He denies blurred vision, double vision, transient loss of vision and flashing lights.
Past history: hyperlipidemia on atorvastatin 20 mg. No prior headaches or migraine. Allergies: none. Social history: former smoker, quit 10 years ago; drinks one beer a day; lives with his wife.
Objective
Vital signs: pressure 134/82 mm Hg, the same in each arm, pulse 84 and regular, temperature 37.6 degrees Celsius, weight 81 kg, down from 83 kg at a visit four months ago.
Head and vessels: the right superficial temporal artery is thickened and cordlike, tender to light palpation, with a diminished pulse compared with the left. The left temporal artery is soft with a normal pulse. Scalp tenderness over the right parietal area. No temporomandibular joint tenderness or clicking. No carotid bruits.
Eyes: with his glasses on, he reads the 20/25 line with each eye. Visual fields full to confrontation. Pupils equal and briskly reactive; swinging a light between the eyes shows no afferent defect. Extraocular movements full without diplopia. Fundoscopy: sharp optic disc margins bilaterally, no pallor or swelling, normal vessels.
Neurologic examination: alert and oriented, fluent speech. Cranial nerves II through XII intact, including symmetric facial strength and sensation and midline tongue. Motor: bulk and tone unremarkable; full strength, graded 5, throughout all four limbs; arms hold steady without drift. Reflexes 2+ and symmetric; plantar responses flexor. Sensation to light touch and vibration intact. Coordination: finger-to-nose and heel-to-shin normal. Gait normal, tandem walk steady, Romberg negative. Neck supple without meningismus.
Musculoskeletal: mild pain on shoulder abduction beyond 90 degrees bilaterally, with full passive range.
Assessment
New headache after age 50 with scalp tenderness, jaw claudication, constitutional symptoms and an abnormal right temporal artery, without visual loss and with a normal neurologic examination. The leading diagnosis is giant cell arteritis, possibly with coexisting polymyalgia rheumatica given his morning shoulder stiffness. Age over 50 at onset of a new headache is one of the SNNOOP10 flags for a secondary headache (Do et al., 2019). In a rational clinical examination review, jaw claudication was one of only two historical features that substantially raised the likelihood of temporal arteritis, with a positive likelihood ratio of 4.2, and a beaded, prominent or tender temporal artery also raised it; a normal erythrocyte sedimentation rate made the disease much less likely (Smetana and Shmerling, 2002). Mr. K. has several of the informative findings. The differential includes an intracranial mass, which his normal neurologic and fundoscopic examination makes less likely but does not exclude, and a new primary headache, which would be unusual at his age.
Plan
Same-day erythrocyte sedimentation rate, C-reactive protein and complete blood count. Because suspicion is high and vision is at risk, start prednisone 60 mg by mouth daily today rather than waiting for results or biopsy. In its 2021 guidance, the American College of Rheumatology favors prompt high-dose oral steroid therapy when vision is not yet affected and still wants tissue from a temporal artery biopsy to confirm the diagnosis, which remains informative for at least one to two weeks after steroids begin (Maz et al., 2021). Urgent referral to rheumatology and to vascular or general surgery for biopsy within a week. Mr. K. and his wife were told that sudden blurring, double vision or loss of vision in either eye is an emergency requiring immediate care. Start calcium and vitamin D and plan bone density testing, since prolonged glucocorticoids are likely. Check glucose and blood pressure at a visit in one week.
The documentation of this visit also protects continuity. The biopsy surgeon needs to know which side is abnormal and when steroids began; the rheumatologist needs the baseline visual examination and the inflammatory markers drawn before treatment; and any clinician who sees Mr. K. for new visual symptoms needs to know that his fundi and fields were normal on this date. For that reason, the note records the time the first prednisone dose was taken in the clinic, lists the right temporal artery as the biopsy target and copies the visual findings into the referral letters rather than summarizing them as normal.
Conclusion
A headache that is new after 50 changed the questions, and the answers, jaw claudication, scalp tenderness and an abnormal temporal artery, changed the plan. Documenting a complete visual and neurologic examination showed that vision was not yet affected and allowed treatment to start the same day, before it could be.
References
Do, T. P., Remmers, A., Schytz, H. W., Schankin, C., Nelson, S. E., Obermann, M., Hansen, J. M., Sinclair, A. J., Gantenbein, A. R., & Schoonman, G. G. (2019). Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology, 92(3), 134-144. https://doi.org/10.1212/WNL.0000000000006697
Maz, M., Chung, S. A., Abril, A., Langford, C. A., Gorelik, M., Guyatt, G., Archer, A. M., Conn, D. L., Full, K. A., Grayson, P. C., Ibarra, M. F., Imundo, L. F., Kim, S., Merkel, P. A., Rhee, R. L., Seo, P., Stone, J. H., Sule, S., Sundel, R. P., . . . Mustafa, R. A. (2021). 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis. Arthritis Care & Research, 73(8), 1071-1087. https://doi.org/10.1002/acr.24632
Smetana, G. W., & Shmerling, R. H. (2002). Does this patient have temporal arteritis? JAMA, 287(1), 92-101. https://doi.org/10.1001/jama.287.1.92
What the NUR 607 Module 8 instructions ask for
The NUR 607 neurologic assignment usually asks for a focused history and physical for a neurologic complaint such as headache, dizziness, numbness or weakness, with a complete neurologic examination documented: mental status, cranial nerves, motor, reflexes, sensation, coordination and gait, plus related systems such as the eyes. Many versions ask for a differential and a plan, usually over three to five pages in APA 7. Screen the history against a recognized red flag list and record each item, document the visual examination whenever a headache could threaten vision and name every test you performed with its result, since graders read the note for the negatives that exclude dangerous causes. Date and time each finding.
How this NUR 607 Module 8 focused neurologic note example is built
The sample documents a composite 56-year-old retired machinist with three weeks of new right temple headache, scalp tenderness, jaw claudication, fatigue, weight loss and morning shoulder stiffness. The history records every SNNOOP10 item and asks directly about visual symptoms. The examination finds a thickened, tender right temporal artery with a weak pulse, then documents visual acuity, fields, pupils with the swinging flashlight test and fundi, followed by a complete neurologic examination. The assessment uses the SNNOOP10 flag for age and the likelihood ratios from the Smetana and Shmerling review to rank giant cell arteritis first. The plan orders inflammatory markers, starts prednisone 60 mg the same day and arranges biopsy.
Where the NUR 607 Module 8 rubric puts the points
Neurologic write-up rubrics typically weigh the history with red flags, completeness of the neurologic examination, related system examinations, clinical reasoning, the plan and documentation. The top band usually requires every part of the neurologic examination to be recorded with specific findings, a red flag screen documented item by item and an assessment that uses evidence about which findings matter. Graders tend to reward plans that match urgency to the danger, such as starting treatment before confirmation when vision is at risk, and that anticipate treatment complications. Clear safety instructions to the patient and family are often scored under the plan as well, along with communication to the specialists who receive the referral.
NUR 607 Module 8 help: the mistakes that cost points
Neurologic notes lose points when the examination is summarized as grossly intact, when the eyes are not examined in a headache that could affect vision, when red flags are listed as negative without naming them or when treatment waits for a test in an emergency. Another common gap is ignoring the patient's age as a red flag. Record each component of the neurologic examination, document visual acuity, fields, pupils and fundi, screen red flags item by item, cite the evidence for the key findings and set a plan whose timing matches the risk. If your case involves dizziness, numbness or a first seizure, send the scenario and template for a note built around it.
Get NUR 607 Module 8 written to your instructions
Send the neurologic scenario, your template and the rubric. A focused note with every red flag documented, a complete neurologic and visual examination and a plan timed to the danger will be in your inbox within 24 to 48 hours, and the first one is free of charge. 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 8 questions, answered
Where can I find a free NUR 607 Module 8 Focused Neurologic Note sample?
This page carries a complete note: a new temporal headache in a 56-year-old man, with SNNOOP10 red flags, a full neurologic and visual examination and same-day treatment for suspected giant cell arteritis.
Why is a new headache after age 50 a red flag?
The chance of a secondary cause, such as giant cell arteritis, a mass or a vascular event, rises with age. SNNOOP10 lists onset after 50 as a flag that calls for further evaluation.
What findings suggest giant cell arteritis?
Jaw claudication and diplopia were the historical features that most raised likelihood in a systematic review, along with a beaded, prominent or tender temporal artery. A normal sedimentation rate makes it much less likely.
Should steroids wait for a temporal artery biopsy?
No. When suspicion is high, guidelines support starting high-dose glucocorticoids promptly to protect vision, because the biopsy remains informative for at least one to two weeks after treatment starts.
What belongs in a complete neurologic exam write-up?
Mental status, cranial nerves, motor strength, tone and drift, reflexes, sensation, coordination and gait, each recorded with specific findings, plus the eye examination when relevant.