| Course | NUR 616 Primary Care of Adults and Gerontological Patients |
|---|---|
| Module | Module 6 |
| Paper type | SOAP note for knee osteoarthritis in an older adult |
| Length | About 1,010 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 616 Module 6
SOAP Note: Bilateral Knee Osteoarthritis in a 66-Year-Old Man Requesting Stronger Pain Medicine
[Student Name]
Southern New Hampshire University
NUR 616: Primary Care of Adults and Gerontological Patients
Module Six SOAP 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.
SOAP Note: Bilateral Knee Osteoarthritis in a 66-Year-Old Man Requesting Stronger Pain Medicine
Knee osteoarthritis causes more pain and disability in older adults than almost any other condition, and it is often managed with the wrong tools: imaging that does not change treatment, oral anti-inflammatory drugs in people whose kidneys or blood pressure cannot tolerate them, supplements with no benefit and, too often, opioids. This SOAP note documents a patient with knee osteoarthritis who asks for stronger medicine. It argues that the diagnosis can be made clinically, that the most effective treatments are exercise and weight loss and that a topical NSAID is a safer and adequate step for his pain.
Subjective
Chief concern: "My knees are killing me. Can I get something stronger?"
History of present illness: Mr. W. is a retired long-haul truck driver, 66, with pain in both knees for two years, worse on the right. The pain comes on with walking more than two blocks, climbing stairs and getting up from a chair, and eases with rest. His knees are stiff for about 15 minutes after waking. He rates the pain 6 of 10 on most days. There has been no injury, locking, giving way or knee swelling that came on suddenly. Ibuprofen 400 mg helps partly, and he takes it most days. He has stopped walking his dog because of pain and has gained 6 kg in the last year. A neighbor told him oxycodone "fixed" her knee pain.
Past history: hypertension on lisinopril 20 mg and amlodipine 5 mg; prediabetes. No gastrointestinal bleeding or ulcers. Allergies: none. Social: lives with his wife; former smoker; drinks two beers a week. Goals: walk the dog again and travel to see his grandchildren without stopping every hour.
Review of systems: General: no fever or weight loss apart from the gain above. Musculoskeletal: no other joint pain, no morning stiffness of the hands, no back pain. Skin: no rash. Cardiovascular: no chest pain or breathlessness with exertion.
Objective
Vital signs: blood pressure 146/88 mm Hg and 144/86 on repeat; pulse 74; weight 102 kg; BMI 32.2.
Knees: bony enlargement of the medial joint lines bilaterally, more on the right; no warmth, redness or effusion on bulge and patellar tap tests. Crepitus with active flexion of both knees. Range of motion: right 0 to 115 degrees, left 0 to 125 degrees, with pain at the end of flexion on the right. Medial joint line tenderness bilaterally. Ligaments stable to varus and valgus stress and to anterior drawer. McMurray test negative. Mild genu varum. Hips: full, painless range of motion bilaterally, which makes referred hip pain unlikely.
Function: rises from a chair using his arms; gait slightly antalgic on the right.
Laboratory results from last month: creatinine 1.0 mg/dL, eGFR 78, potassium 4.5, A1c 6.2%.
Assessment
1. Primary osteoarthritis of both knees, right worse than left. The diagnosis is clinical: age over 45, activity-related pain and morning stiffness under 30 minutes, supported by bony enlargement and crepitus without warmth or effusion. Radiographs would not change management and are not needed to start treatment.
2. Hypertension above goal, likely made worse by his daily ibuprofen, since NSAIDs retain sodium and work against ACE inhibitors.
3. Obesity and prediabetes, both contributing to knee load and to cardiovascular risk.
In its 2019 guideline, the ACR and Arthritis Foundation give their strongest endorsement to exercise, to losing weight when overweight, tai chi, a cane when needed and topical NSAIDs for knee osteoarthritis, and it recommends oral NSAIDs, with attention to comorbidities. It strongly recommends against glucosamine, chondroitin, bisphosphonates, hydroxychloroquine and platelet-rich plasma or stem cell injections, and it favors tramadol only conditionally while advising against other opioids when alternatives exist (Kolasinski et al., 2020). Weight loss is supported by trial evidence: in the IDEA trial of adults with knee osteoarthritis and overweight or obesity, those assigned to diet plus exercise lost an average of 11.4% of their weight over 18 months and had less pain and better function than those assigned to exercise alone (Messier et al., 2013). Topical NSAIDs reach the knee with far lower blood levels than oral forms; a Cochrane review found topical diclofenac provided meaningful pain relief in knee and hand osteoarthritis with few systemic adverse effects (Derry et al., 2016).
Plan
Pain: stop daily oral ibuprofen. Start diclofenac 1% gel, 4 g to each knee four times daily, measured with the dosing card. Acetaminophen up to 3 g daily may be used as an adjunct, though its benefit is small. An intra-articular corticosteroid injection is an option for a flare. Opioids were discussed and not prescribed: the evidence of benefit in osteoarthritis is weak, and the risks of falls, constipation and dependence are real. Exercise: referral to physical therapy for six sessions focused on quadriceps and hip strengthening and a home program, then a walking goal of 20 minutes five days a week, starting with the dog. Tai chi classes at the senior center were offered. Weight: referral to the clinic's lifestyle program with a goal of losing 10% of body weight, about 10 kg, over a year. Blood pressure: recheck in four weeks after stopping ibuprofen before adding medication. Follow-up in six weeks to assess pain, function and weight, using the WOMAC or a simple walking distance as the measure.
Education
Mr. W. was told that his knees show wear-and-tear arthritis, that movement protects the joint rather than damaging it and that losing weight reduces the load on his knees with every step. He was taught to apply the gel to clean, dry skin, to wash his hands afterward and to avoid heating pads over it. He agreed that walking his dog again is the goal the plan is built around.
Conclusion
Mr. W. asked for stronger medicine, but the treatments with the best evidence for his knees are exercise, weight loss and a topical NSAID that spares his blood pressure. Documenting the clinical diagnosis, the guideline's recommendations and what it advises against allowed a plan that aims at his real goal of walking again.
References
Derry, S., Conaghan, P., Da Silva, J. A. P., Wiffen, P. J., & Moore, R. A. (2016). Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database of Systematic Reviews, 2016(4), Article CD007400. https://doi.org/10.1002/14651858.CD007400.pub3
Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., . . . Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 72(2), 149-162. https://doi.org/10.1002/acr.24131
Messier, S. P., Mihalko, S. L., Legault, C., Miller, G. D., Nicklas, B. J., DeVita, P., Beavers, D. P., Hunter, D. J., Lyles, M. F., Eckstein, F., Williamson, J. D., Carr, J. J., Guermazi, A., & Loeser, R. F. (2013). Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: The IDEA randomized clinical trial. JAMA, 310(12), 1263-1273. https://doi.org/10.1001/jama.2013.277669
What the NUR 616 Module 6 instructions ask for
SOAP notes in NUR 616 often address a musculoskeletal or chronic pain condition in an older adult and ask for a history, focused examination, assessment and plan with both drug and nondrug treatment. The case may include a patient request, such as for opioids or imaging, that the plan must address. Expect three to five pages in APA 7 with a current guideline and trial evidence. Base the diagnosis on stated clinical criteria, check comorbidities before choosing a drug and include the guideline's recommendations against common treatments as well as for them, since graders look for plans that reflect the full guideline rather than a single prescription and that address the request respectfully and without judgment.
How this NUR 616 Module 6 soap note example is built
This sample follows a composite 66-year-old retired truck driver with obesity, hypertension and two years of bilateral knee pain who asks for stronger medication. The history records activity-related pain, 15 minutes of morning stiffness, daily ibuprofen and his goal of walking his dog. The examination documents bony enlargement, crepitus, no effusion, stable ligaments and normal hips. The assessment makes a clinical diagnosis, links ibuprofen to his raised blood pressure and applies the 2019 ACR guideline, the IDEA trial and a Cochrane review of topical NSAIDs. The plan stops oral ibuprofen, starts diclofenac gel, declines opioids with reasons and refers him for physical therapy and weight loss.
Where the NUR 616 Module 6 rubric puts the points
Rubrics for this note usually weigh a history that supports the diagnosis, a focused examination with pertinent negatives, an accurate assessment with comorbidities, an evidence-based plan with drug and nondrug treatment, patient education and APA 7 support. The top band often goes to notes that apply the guideline fully, including treatments it advises against, and that match drug choice to comorbidities such as hypertension or kidney disease. Graders reward plans with measurable goals tied to the patient's priorities and a clear, respectful explanation when a requested treatment is not given. Documenting why imaging was not ordered also tends to earn credit under diagnostic reasoning and cost-conscious care.
NUR 616 Module 6 help: the mistakes that cost points
Osteoarthritis notes lose points when an x-ray is ordered before a clinical diagnosis is considered, when oral NSAIDs are continued in a patient with uncontrolled blood pressure, when supplements like glucosamine are recommended or when opioids are prescribed without weighing risks. Another common gap is naming exercise without a specific plan. State the clinical criteria, check comorbidities before choosing an analgesic, prefer topical NSAIDs where appropriate, refer for structured exercise and weight loss with goals and explain decisions about requested treatments. If your case involves hip or hand osteoarthritis or chronic back pain, send the case and template, and the note can be written around that joint and your patient's comorbidities.
Get NUR 616 Module 6 written to your instructions
Send the case, your SOAP template and the rubric. A note that makes the diagnosis on clinical criteria, matches treatment to comorbidities, applies the full guideline and responds respectfully to the patient's request will be returned in 24 to 48 hours, with the first sample 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 616 Module 6 questions, answered
Where can I find a free NUR 616 Module 6 SOAP Note sample?
This page includes the whole SOAP note: bilateral knee osteoarthritis in a 66-year-old requesting stronger medicine, managed with exercise, weight loss and topical diclofenac under the 2019 ACR guideline.
Is an x-ray needed to diagnose knee osteoarthritis?
Not usually. In adults over 45 with activity-related knee pain and morning stiffness of 30 minutes or less, the diagnosis can be made clinically, and imaging rarely changes initial treatment.
What does the ACR guideline recommend for knee osteoarthritis?
It strongly recommends exercise, weight loss for people who are overweight, tai chi, a cane when needed and topical NSAIDs, with oral NSAIDs used with attention to comorbidities.
Are opioids recommended for knee osteoarthritis?
The 2019 guideline gives tramadol only a conditional recommendation and advises against other opioids where alternatives exist, because benefit is modest and risks such as falls and dependence are significant.
How much weight loss helps knee osteoarthritis?
In the IDEA trial, adults who lost about 11% of their body weight through diet and exercise had less pain and better function than those who exercised alone.