Comprehensive Health Assessment of a 38-Year-Old Woman New to Primary Care: Fatigue, Heavy Periods and Three Priorities
Student Name
American College of Education
NUR4033: Health Assessment
Module 6 Assignment
Instructor Name
April 6, 2026
Health History Summary
The client, 38, manages the front office of a veterinary practice and is establishing care after moving from another state. Everything about her and the practice is invented for teaching purposes. Her main concern is feeling tired all the time for about eight months, worse in the afternoons, with shortness of breath on climbing two flights of stairs that she did not have a year ago. On focused questioning she reports menstrual periods lasting seven to eight days, with two days of changing a super tampon and a pad every two hours and passing clots larger than a quarter; she says her periods have always been heavy but have been heavier since the birth of her second child four years ago. She reports cravings for ice.
She takes no prescription medications and uses ibuprofen for cramps during her periods. She has no known allergies. Her mother has hypertension and her father had a myocardial infarction at 57. She does not smoke, drinks one or two glasses of wine on weekends and walks her dog for 20 minutes most days. She sleeps about six hours a night. On the two-item Patient Health Questionnaire, she reported that on more than half the days in the past two weeks she had felt down and had little interest in things she usually enjoys, giving a score of 4 (Kroenke et al., 2003). She denies thoughts of self-harm.
Physical Examination by System
General survey and vital signs. Alert, well groomed woman who appears her stated age and sits comfortably. Height 165 cm, weight 71 kg, body mass index 26.1. Seated blood pressure after a five-minute rest was 142/92 mm Hg on the right, repeated at 138/90 mm Hg; left arm 140/90 mm Hg. Heart rate 96 and regular, respirations 16, temperature 36.7 degrees Celsius, oxygen saturation 99 percent on room air.
Skin, hair and nails. Skin is pale, most visible in the palmar creases and conjunctivae. Nails are thin, and the nails of both index fingers are flattened with a slight upward curve at the edges. Hair is evenly distributed without thinning. Head, eyes, ears, nose and throat: conjunctivae pale; sclerae white; tympanic membranes intact; the tongue is smooth with reduced papillae along the edges; thyroid not enlarged and without nodules.
Cardiovascular and respiratory. A soft grade 1 of 6 midsystolic murmur is audible at the left upper sternal border, not radiating, with normal S1 and S2 and no gallop. Peripheral pulses are 2+ and equal; capillary refill under two seconds; no edema. Lungs are clear throughout. Abdomen: soft and nontender, no masses, liver span 9 cm at the right midclavicular line, spleen not palpable. Musculoskeletal and neurologic examinations are within normal limits, with full strength and intact sensation. Mental status: speech is clear and organized, affect is subdued, and she became tearful briefly when describing how little energy she has for her children in the evenings.
Interpretation of the Findings
The findings group into three patterns. The first is a picture consistent with iron deficiency anemia due to heavy menstrual bleeding. Fatigue, exertional breathlessness, pallor, a resting heart rate of 96, a soft flow murmur, spoon-shaped change in the nails, a smooth tongue and a craving for ice all fit this pattern, and heavy menstrual bleeding is the most common cause of iron deficiency in women of reproductive age (Camaschella, 2015). No single finding establishes anemia, but eight findings pointing the same way make it the leading explanation and tell the provider which tests to order first. The murmur is interpreted as a likely flow murmur from increased cardiac output, to be reassessed once the anemia is treated.
The second pattern is elevated blood pressure. Readings of 142/92, 138/90 and 140/90 mm Hg fall in the stage 2 range of the 2017 adult blood pressure guideline, under which a top number of 140 or more, or a bottom number of 90 or more, counts as stage 2 (Whelton et al., 2018). The same guideline requires elevated readings on at least two occasions, ideally confirmed outside the office, before hypertension is diagnosed, so this is recorded as elevated blood pressure requiring confirmation. Regular ibuprofen use, short sleep, a strong family history and a raised heart rate from anemia are all relevant contributors.
The third pattern is a positive depression screen with supporting examination findings: a subdued affect, tearfulness and loss of energy for activities she values. A score of 3 or more on the two-item questionnaire is the usual threshold for further evaluation (Kroenke et al., 2003). Anemia can produce fatigue that resembles depression, and the two may coexist, so neither should be assumed to explain the other. The pertinent negatives also carry weight in the interpretation. A normal thyroid examination, no weight change, a liver span within normal limits, no splenomegaly and no bruising or petechiae make thyroid disease, liver disease and a bleeding disorder less likely as explanations for her fatigue, although each would still be ruled in or out by laboratory testing rather than by examination alone.
Priorities and Rationale
The first priority is the probable iron deficiency anemia. It explains the largest number of findings, it is the most likely cause of the client's main concern, and it has a treatable source. The nurse reported the findings and recommended a complete blood count, ferritin and a referral to discuss management of the heavy bleeding. The client was taught to record the number of pads and tampons used each day of her next period, which gives the provider an objective measure. Her ibuprofen use was also reviewed, because a nonsteroidal drug can raise blood pressure even as it reduces menstrual flow.
The second priority is the positive depression screen. It is ranked above blood pressure because the client's safety and her capacity to follow any plan depend on it, even though she denied thoughts of self-harm. The nurse recommended a full nine-item questionnaire at this visit and a conversation with the provider about support options, and she gave the client the number of the national crisis line.
The third priority is the elevated blood pressure. It is ranked third not because it is unimportant but because it needs confirmation before any treatment decision, and two of its contributors, anemia and ibuprofen, may change within weeks. Before she left, the nurse checked the client's upper-arm home monitor against the clinic device, found the two within 4 mm Hg of each other, and taught her to use it with a properly fitted cuff. The client was also offered a clinic monitor on loan as a backup and taught to record two morning and two evening readings for one week, with a follow-up visit in two weeks. Ranking the problems is itself a clinical judgment, and stating the reason for the order is what lets the next nurse agree or disagree with it.
Conclusion
A comprehensive assessment is only as useful as the connections it draws. Jarvis and Eckhardt (2024) describe the goal of a complete examination as a database that supports clinical judgment, and judgment depends on relating one finding to another rather than recording each in isolation. The client came in describing fatigue, and a checklist examination would have recorded pale skin, a murmur, odd-looking nails, a high blood pressure and a low mood as five separate items. Organized into patterns, the same findings describe probable iron deficiency from heavy periods, a mood problem that needs its own attention and a blood pressure that needs confirming. Stating the priorities and the reasons for their order turns the assessment into a plan the client and the provider can act on.
References
Camaschella, C. (2015). Iron-deficiency anemia. New England Journal of Medicine, 372(19), 1832-1843. https://doi.org/10.1056/NEJMra1401038
Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003). The Patient Health Questionnaire-2: Validity of a two-item depression screener. Medical Care, 41(11), 1284-1292. https://doi.org/10.1097/01.MLR.0000093487.78664.3C
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Jr., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Jr., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., Sr., . . . Wright, J. T., Jr. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065
How this NUR 4033 Module 6 example is structured
NUR 4033 Module 6 usually asks for a comprehensive write-up with findings interpreted and priorities stated; your classroom's instructions decide the client, the template and the length. This example condenses the history into what the examination needs, reports the examination by system with normal findings stated briefly and abnormal ones described precisely, and then gives interpretation its own section, where related findings are grouped into patterns. The priorities section ranks three problems and explains the ranking, which is the step most comprehensive write-ups leave implicit. The order moves from data to meaning to action, the same order a clinician reads a note.
NUR4033 Module 6 questions, answered
What is NUR4033 Module 6 usually about?
NUR4033 Module 6 usually asks for a comprehensive health assessment write-up that brings together history and a full examination, with findings interpreted and priorities stated. Many sections treat it as the course's culminating assignment. Your classroom's instructions decide the client, the template, whether a recorded examination is required and how long the write-up should be.
How do I interpret findings in a comprehensive assessment?
Group related findings into patterns instead of interpreting each one alone. Pallor, a fast resting heart rate, spoon-shaped nails and fatigue together point toward anemia in a way none of them does separately. For each pattern, name the supporting findings, cite a source for any threshold and say what still needs to be confirmed by testing or a repeat measurement.
How many priorities should the write-up include?
Three well-defended priorities are usually stronger than a long list. Rank them, and explain why each sits where it does, using safety, the number of findings explained and whether the problem is confirmed yet. Attach specific actions and teaching to each priority so the reader can see how the assessment leads to care.
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