| Course | NUR 607 Advanced Health Assessment |
|---|---|
| Module | Module 9 |
| Paper type | Final comprehensive history and physical with geriatric assessment |
| Length | About 1,530 words, 8 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 607 Module 9
Final Project: Comprehensive History and Physical Examination With Geriatric Assessment for a 79-Year-Old Woman With Unintended Weight Loss
[Student Name]
Southern New Hampshire University
NUR 607: Advanced Health Assessment
Final Project
[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.
Final Project: Comprehensive History and Physical Examination With Geriatric Assessment for a 79-Year-Old Woman With Unintended Weight Loss
Unintended weight loss in an older adult has no single system to examine. Its causes range from cancer to a painful mouth, from depression to a medication, and in many patients several contribute at once. A focused note would miss most of them. This final project documents a comprehensive history and physical examination for a woman in her late seventies who is losing weight, supplemented by standard geriatric screening tools. It argues that a complete database, recorded precisely, reveals treatable causes that a search for cancer alone would overlook, while still identifying what must be excluded.
Identifying Data and Reason for Visit
Mrs. P. is a 79-year-old retired bookkeeper, widowed ten months ago, living on her own in the two-story family home. She gave the history herself and seems a dependable reporter; her daughter, who drove her, added details with her permission. She comes because her daughter noticed her clothes "hanging off her."
History of Present Illness
Mrs. P. has lost weight over about six months, from 61.0 kg at her last visit to 55.6 kg today, a loss of 5.4 kg or 8.9%. She says she "just isn't hungry" and that food "doesn't taste like much." For about three months her upper denture has felt loose, and a sore spot on the roof of her mouth makes chewing meat and raw vegetables painful, so she eats soup, toast and tea. She often skips supper because cooking for one "doesn't seem worth it." She denies difficulty swallowing, pain after eating, nausea, vomiting, abdominal pain, change in bowel habits, blood in the stool or black stools. She denies fever, night sweats, cough and new lumps. She sleeps poorly, waking at 4 a.m., and says she has felt low since her husband's death.
Past History, Medications and Family History
Medical: type 2 diabetes for 12 years; hypertension; osteoarthritis of both knees; hypothyroidism. Surgical: cholecystectomy at 55; right cataract extraction at 74. Medications: metformin 1,000 mg twice daily, lisinopril 10 mg daily, levothyroxine 75 mcg daily, acetaminophen 500 mg as needed. Allergies: sulfa, rash. Immunizations: influenza vaccine last fall; pneumococcal conjugate vaccine at 75; shingles vaccine series completed; COVID-19 booster status uncertain. Screening: colonoscopy at 72, normal; last mammogram two years ago, normal; bone density at 70 showed osteopenia. Family history: mother died at 84 of heart failure; father died at 70 of lung cancer, a smoker; one sister, 76, with breast cancer at 70.
Personal and Social History
She never smoked and drinks a glass of sherry most evenings. She stopped attending her church group after her husband died. She drives short distances in daylight. Her daughter lives 30 minutes away and visits weekly. She manages her own medications with a weekly pill box and her own finances. She climbs the stairs to her bedroom holding the rail and had one fall in her kitchen four months ago without injury. She has no firearms at home and has an advance directive naming her daughter as health care agent.
Review of Systems
General: weight loss, poor appetite and fatigue as above; no fever. Skin: bruises easily on the arms. Eyes: reading glasses; no vision change since cataract surgery. Ears: some difficulty hearing in noisy rooms. Mouth: loose upper denture and sore palate; dry mouth. Neck: no lumps. Breasts: no lumps or discharge. Cardiovascular: denies chest discomfort, a pounding heart or swollen ankles. Respiratory: no cough or breathlessness. Gastrointestinal: as above. Genitourinary: occasional urge incontinence. Musculoskeletal: knee pain on stairs. Neurologic: no weakness or numbness; occasional unsteadiness. Psychiatric: low mood, early waking, less interest in activities; denies thoughts of self-harm. Endocrine: no heat or cold intolerance. Hematologic: no bleeding.
Physical Examination
Vital signs: blood pressure 128/72 mm Hg sitting and 124/70 mm Hg standing after three minutes; pulse 70 and regular sitting and 74 standing; temperature 36.4 degrees Celsius; respiratory rate 14; oxygen saturation 97%; height 158 cm; weight 55.6 kg; BMI 22.3.
General: thin, neatly dressed, flat affect, cooperative. Skin: several ecchymoses on the forearms; no rashes or suspicious lesions. Head: temporal wasting bilaterally. Eyes: pupils equal and reactive; right lens implant; fundi without hemorrhages. Ears: moderate cerumen, left canal; whispered voice test missed at 60 cm on the left. Mouth: upper denture loose, rocking with light pressure; a 6 by 4 mm shallow ulcer on the hard palate under the denture flange, without induration; dry mucosa; lower natural teeth with two carious molars. Neck: no lymph nodes palpable in any cervical or supraclavicular group; thyroid not enlarged, without nodules. Breasts: symmetric, no masses, skin changes or nipple discharge; axillae without nodes. Lungs: clear throughout. Heart: rhythm regular, both heart sounds normal, no murmur heard. Abdomen: soft, nontender, no organomegaly or masses; well-healed cholecystectomy scars. Extremities: no edema; knees with crepitus and bony enlargement, full range; pedal pulses present. Neurologic: oriented to person, place and date; cranial nerves II to XII without deficit; hip flexors 4 of 5 on both sides, all other muscle groups full; reflexes 1+ and symmetric; vibration sense reduced at the great toes; she felt the monofilament at every site tested on both feet.
Geriatric Assessment
MNA-SF score 7 out of a possible 14, which falls in the malnourished band; the tool was validated as a quick screen that correctly classifies most older adults compared with the full assessment (Kaiser et al., 2009). PHQ-9: 12, moderate depressive symptoms, item 9 scored 0. Mini-Cog: three-word recall 3 of 3 and a normal clock, total 5 of 5, a negative screen for cognitive impairment. Timed Up and Go: completed in 14 seconds, slowing noticeably at the turn. Activities of daily living: independent. Instrumental activities: independent except that she has stopped cooking regular meals.
Assessment
Clinically significant unintended weight loss of 8.9% over six months with malnutrition by MNA-SF. In a prospective cohort of 2,677 patients with unintentional weight loss, the most common causes were nonmalignant and malignant digestive disorders and psychosocial conditions, and among patients aged 65 and older, oral disorders were second only to non-blood cancers (Bosch et al., 2017). A review of the problem similarly emphasizes that several causes often coexist and that medications and depression are frequently overlooked (Wong, 2014). For Mrs. P., the findings point to three contributing causes that can be treated now: a painful, poorly fitting denture with a palatal ulcer that limits chewing; depression following bereavement, with a PHQ-9 of 12, social withdrawal and loss of interest in cooking; and metformin, which can suppress appetite and cause taste change, in a woman whose last hemoglobin A1c was 6.1%, below the less stringent targets appropriate at her age. Malignancy must still be considered because of her age and a sister with breast cancer, but her normal breast, node, abdominal and respiratory examinations and absence of gastrointestinal symptoms lower its probability. Hypothyroid overtreatment, which can cause weight loss, and vitamin B12 deficiency from long-term metformin, which could explain reduced vibration sense, also need testing. Secondary findings: increased fall risk, with a prior fall, slow Timed Up and Go and hip flexor weakness; left-sided hearing loss with cerumen; and osteopenia.
Plan
Tests: blood count, metabolic panel with liver and kidney function, TSH, B12 level, hemoglobin A1c, C-reactive protein and urinalysis; age-appropriate evaluation for cancer will be guided by these results and by any new symptom rather than by broad imaging. Mouth: urgent dental referral for denture relining and care of the carious molars; the palatal ulcer will be rechecked in two weeks and biopsied if it has not healed once the denture is adjusted. Diabetes: reduce metformin to 500 mg twice daily. Mood: discuss grief and depression, offer referral to bereavement counseling and a primary care behavioral health visit; mirtazapine can be considered if symptoms persist, since it may also improve sleep and appetite. Nutrition: referral to a home-delivered meal program and a registered dietitian; oral nutritional supplement twice daily. Falls: refer to community exercise or physical therapy for strength and balance training, an approach the 2024 federal task force statement endorses for a woman like her who is over 65, not in a facility and has already fallen (US Preventive Services Task Force, 2024). Hearing: cerumen removal and recheck. Follow-up in four weeks with weight, PHQ-9 and laboratory review.
Health Promotion
Mammography: evidence is insufficient to recommend for or against screening at 79, so a shared decision will consider her health, her sister's history and her wishes. Colorectal screening after 75 is individualized, and a normal colonoscopy at 72 makes further screening unlikely to help. Bone health: repeat bone density testing and calcium and vitamin D intake review. Immunizations: update the COVID-19 vaccine. Alcohol: discuss the nightly sherry in light of her falls, mood and weight. Advance directive: confirmed and on file.
Conclusion
The comprehensive assessment of Mrs. P. found three treatable reasons for her weight loss that a search for cancer alone would have missed: a sore under a loose denture, depression after the loss of her husband and a diabetes medication she no longer needs at full dose. Recording the history, examination and geriatric screens completely made those causes visible while keeping cancer and other serious conditions in view.
References
Bosch, X., Monclus, E., Escoda, O., Guerra-Garcia, M., Moreno, P., Guasch, N., & Lopez-Soto, A. (2017). Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients. PLOS ONE, 12(4), Article e0175125. https://doi.org/10.1371/journal.pone.0175125
Kaiser, M. J., Bauer, J. M., Ramsch, C., Uter, W., Guigoz, Y., Cederholm, T., Thomas, D. R., Anthony, P., Charlton, K. E., Maggio, M., Tsai, A. C., Grathwohl, D., Vellas, B., & Sieber, C. C. (2009). Validation of the Mini Nutritional Assessment short-form (MNA-SF): A practical tool for identification of nutritional status. Journal of Nutrition, Health and Aging, 13(9), 782-788. https://doi.org/10.1007/s12603-009-0214-7
US Preventive Services Task Force. (2024). Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. JAMA, 332(1), 51-57. https://doi.org/10.1001/jama.2024.8481
Wong, C. J. (2014). Involuntary weight loss. Medical Clinics of North America, 98(3), 625-643. https://doi.org/10.1016/j.mcna.2014.01.012
What the NUR 607 Module 9 instructions ask for
The NUR 607 final project typically asks for a complete history and physical examination: identifying data, reason for visit, present illness, past, family and social history, a full review of systems, a head-to-toe examination with vital signs, an assessment with a prioritized differential, a plan and health promotion. For older adults, many versions add functional or geriatric screening. Expect eight to twelve pages in APA 7, often in your section's template. Keep subjective and objective data in their places, measure every finding you can, record what was not examined and make the assessment follow from the documented data, since the final project is graded on completeness, precision and reasoning together. Build in time to revise.
How this NUR 607 Module 9 final project example is built
This sample documents a composite 79-year-old widow who has lost 8.9% of her weight in six months. The history quantifies the loss, records a loose denture, eating patterns, bereavement and a full medication list, and the review of systems stays in her words. The examination includes orthostatic vital signs, temporal wasting, a measured palatal ulcer, node and breast examinations and a neurologic screen. The geriatric assessment adds MNA-SF, PHQ-9, Mini-Cog and Timed Up and Go scores. The assessment uses the Bosch cohort and Wong review to rank oral, psychosocial and medication causes ahead of cancer, and the plan addresses each cause, falls and individualized screening, with four sources behind it.
Where the NUR 607 Module 9 rubric puts the points
Final project rubrics in this course generally weigh completeness of the history and review of systems, a thorough and precise examination, appropriate use of screening tools, clinical reasoning with a prioritized differential, a plan linked to findings, individualized health promotion and APA 7 documentation. Top-band projects measure findings, record validated tool scores with interpretation, use evidence to rank the differential and address every problem found, not only the chief concern. Graders reward health promotion that reflects the patient's age, including honest statements where evidence is insufficient. A note that another clinician could use to continue care without re-examining the patient is the standard the rubric describes.
NUR 607 Module 9 help: the mistakes that cost points
Final projects lose points when sections are incomplete, when the examination relies on normal or within normal limits, when screening tools are named without scores, when the assessment jumps to one diagnosis without a differential or when health promotion ignores age. A common error with older adults is missing medications as causes. Quantify the chief problem, complete every section, record tool scores, weigh the differential with evidence, address secondary problems and individualize screening. If your final project patient happens to be a child, an adolescent or a pregnant woman, or your section uses a specific template, send it with the scenario for a comprehensive note built to that format.
Get NUR 607 Module 9 written to your instructions
Send your template, the patient scenario or encounter notes and the final project rubric. A comprehensive history and physical with measured findings, scored screening tools, an evidence-based differential and an individualized plan will come back in 24 to 48 hours, and the first draft 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 9 questions, answered
Where can I find a free NUR 607 Module 9 Final Project sample?
The complete project is published here: a comprehensive history and physical with geriatric assessment for a 79-year-old woman with 9% weight loss, including a differential, plan and APA 7 references.
How much weight loss is clinically significant?
A loss of about 5% or more of body weight over 6 to 12 months without trying is generally considered clinically significant and warrants evaluation, especially in older adults.
What causes unintended weight loss in older adults?
Common causes include cancer, gastrointestinal disease, depression and social factors, medications and oral problems. In one large cohort, oral disorders were the second most common cause after cancer in patients 65 and older.
Which geriatric screening tools belong in a comprehensive assessment?
Common choices include the MNA-SF for nutrition, PHQ-9 for depression, Mini-Cog for cognition and the Timed Up and Go for mobility and fall risk, each recorded with its score and interpretation.
Should a 79-year-old still have screening mammograms?
The USPSTF finds insufficient evidence for or against screening at 75 and older, so the decision is individualized based on health, life expectancy, family history and the patient's preferences.