• Read the SOAP notes constructed by your course colleagues.
  • Review the ‘P’s posted by your peers from your advanced practice nursing role perspective –Family nurse practitioner.  From your advanced practice mindset reflect on a discussion you would like to have with two of your course colleagues about their ‘P’. 
  • Post a response individually to each of them that expresses your advanced practice nursing role perspective of their ‘P’.
  • Use scholarly resources relevant to your advanced practice nursing role to support the key elements of the peer discussions you construct. [For example – if you are a nurse practitioner did your peer develop a ‘P’ that aligns with Evidence Based Practice (EPB)/Clinical Practice Guidelines (CPG) and/or the basic sciences, etc.?

Word minimum 150-200.

Please proofread your response carefully for grammar and spelling.

All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format.

Background Information:


You are seeing a 62 year old white female for her annual visit.  Presented below are some pertinent subjective and objective data that you elicited during your comprehensive assessment session with the patient (note – this is not the entire subjective and objective data set for this office visit).

PMH:  HTN, Hyperlipidemia

Social History:  divorced, employed full time as a graduate nursing program professor, no smoking history, reports on a rare occasion she may have a 2 – 3 ounces of wine when dining out [less than 6 times a year]

Health Maintenance Activities: 1 ½ to 2 hours of exercise every morning [45 – 60 minutes of yoga, 45 – 60 minutes of step aerobics]; low glycemic Pescatarian; has not engaged with recommended colonoscopy, does not have screening mammograms, does not get a flu shot and has not had any other recommended adult immunizations

Review of Systems

Cardiovascular: reports hypertension diagnosed at 27 years of age, controlled on 5mg Lisinopril daily; reports elevated total cholesterol level for the last decade or so with no pharmacologic treatment; denies chest pains, palpitations, lower extremity edema

Physical Exam

Constitutional – Ht. 64 inches, Wt. 127 pounds [BMI 21.8], BP 112/60, P 68, T 97.9 temporal, R 16, SpO2 99%

Integument – pink, warm and dry to touch

Eyes – no arcus senilis

Cardiovascular – heart regular rate and rhythm, S1 and S2; no S3 or S4, murmur or gallop; no carotid bruits; radial pulses palpable and pedal pulses 2+; no lower extremity edema; capillary refill < 3 seconds bilateral

Lipid panel – Total cholesterol 302, HDL 117, Triglycerides 45

Construct  an abbreviated SOAP note (Subjective Objective Assessment Plan).

Colleague #1 SOAP note (Nh.He.)

Subjective: A 62-year-old female, with pasted medical history of HTN and hyperlipidemia, arrived in the office for her annual visit. She currently takes 5 mg lisinopril daily. Reports elevated total cholesterol level for the last decade with no pharmacologic treatment. She is divorced, employed full-time as a graduate nursing program professor. Reports she exercises every morning for 1.5-2 hours. Denies smoking but reports occasional alcohol usage. Denies chest pains, palpitations, or lower extremity edema. Denies having recommended colonoscopy or mammograms screening. Denies receiving flu shot or other recommended adult immunizations. 

Objective: Patient Ht. 64 inches, Wt. 127lbs. BMI 21.8. Blood pressure 112/60, P 68, afebrile 97.9 temporal, RR 16, SpO2 99%. Skin is pink, warm, and dry to touch. No arcus senilis noted in the eyes. Regular heart rate and rhythm, S1 and S2; no S3 or S4, murmur or gallop; no carotid bruits; radial pulses palpable and pedal pulses 2+; no lower extremity edema; capillary refill <3 seconds bilateral. Labatory results: Total Cholesterol 302, HDL 117, Triglycerides 45. 

Assessment: Uncontrolled hyperlipidemia 

Plan: Control hyperlipidemia and lower total cholesterol level and LDL. Although the patient is exercising regularly as well as eating a healthy diet, it might not be enough to control her cholesterol. Along with her activities and diet, she might require medication to control her hyperlipidemia, such as a statin medication. Usually Lipitor 40-80mg once a day or Crestor 20-40mg once a day is recommended. The patient should be encouraged to take her medication at nighttime since cholesterol production occurs during sleep (Arcangelo et al., 2017). The patient should be educated on the importance of having her follow-up appointments within one to three months to recheck her levels to ensure her numbers are within normal range. Untreated hyperlipidemia can cause complications like vascular disease, such as coronary artery disease, aneurysms, diabetes and worsen hypertension. Patient should also be educated on the contraindicated in patients with active liver disease, patient should be cautious of consuming alcohol while on a statin. Primary physician usually will manage the disorder but if there are signs of worsening or development of vascular disease, a cardiologist should be consulted (Hill, 2021). Patient should be educated on the importance of colonoscopy and mammograms screening at her age. 


Arcangelo, V. P., Peterson, A. M., Wilbur, V. F., & Reinhold, J. A. (2017). In Pharmacotherapeutics for advanced practice: A practical approach (pp. 275–284). essay, Lippincott Williams & Wilkins/Wolters Kluwer. 

Hill, M. F. (2021). Hyperlipidemia. StatPearls. (Links to an external site.) 

Colleague #2 SOAP note (Wa.Jo.)

S – 62-year-old patient reports no smoking history. Drinks 2-3 ounces of wine when dining out (less than 6 times a year). Exercises 1 ½ to 2 hours every morning. The patient states that they are a Pescatarian and has not completed a colonoscopy or screening mammograms.

O – The following are the patients’ vital signs on the initial visit: B/P 112/60, Pulse 68, temp 97.9F, weight 127 lbs., height:  64 inches. History of hypertension and controlled with 5mg of Lisinopril daily. Total cholesterol 302, HDL 117, and Triglycerides 45. Heart sounds: S1, S2 present with regular rate and rhythm. Capillary refill less than 3 seconds.

A – Patient has done well with controlling their blood pressure and cholesterol levels.

P – Continue the same treatment for cholesterol and blood pressure management. Educate the patient on the importance of mammograms and colonoscopies.

Therapeutics – Cholesterol management using Atorvastatin (Lipitor) can help with lowering cholesterol. Based on the patient’s history I do not see any contraindications. Scheduled dose: Lipitor 40 mg daily.

Educational – Breast cancer has the highest incidence and mortality rate amongst all cancers (excluding melanoma skin cancer). In the US, breast cancer is the leading cause of mortality amongst the female population, accounting for 15.6% in 2015 (Agarwal, 2020). I will educate the patient on the importance of early screening and schedule a mammogram.

Due to the rising incidence and mortality of colorectal cancer in younger adults, in May of 2018, the American Cancer Society lowered the age of colorectal cancer screening initiation from 50 to 45 years for individuals at average risk. Currently, ACS guidelines recommend CRC screening from age 45–75 for individuals in good health with greater than 10 years of life expectancy (Hein, 2021). Educating the patient on early screening can help with detecting the early warning signs of cancer.

Consultation/Collaboration – referral for a nutritionist will assist the patient with forming a meal plan that will lower cholesterol. After all, medical nutrition therapy provided by a qualified professional such as an RDN is linked to improved clinical outcomes and reduced costs related to physician time, medication use, and hospital admissions for persons with obesity, diabetes mellitus, disorders of lipid metabolism, and other chronic diseases (Jortberg, 2014)


Agarwal, R., Díaz, O., Yap, M., Lladó, X., & Martí, R. (2020). Deep learning for mass detection in full-field digital mammograms. Computers in Biology and Medicine121, 103774. (Links to an external site.)

Hein, D., Jones, A. L., Ahn, C., & Sanford, N. N. (2021). Self-reported reasons for colonoscopy among adults aged 45-49 versus 50 years and older from 2010-2018. Cancer Epidemiology74, 101984. (Links to an external site.)

Jortberg, B. T., & Fleming, M. O. (2014). Registered dietitian nutritionists bring value to emerging health care delivery models. Journal of the Academy of Nutrition and Dietetics114(12), 2017–2022. (Links to an external site.)

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