| Course | DNP 641 Advanced Health Assessment Pediatrics |
|---|---|
| Module | Module 2 |
| Paper type | Comprehensive pediatric SOAP note |
| Length | About 690 words, 5 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for DNP 641 Module 2
A Dark Band on the Neck at a Sports Physical: A Comprehensive SOAP Note on Nutrition, Weight and Skin for an 11-Year-Old Girl
Student Name
Edson College of Nursing and Health Innovation, Arizona State University
DNP 641: Advanced Health Assessment Pediatrics
Instructor Name
Month Day, Year
A Dark Band on the Neck at a Sports Physical: A Comprehensive SOAP Note on Nutrition, Weight and Skin for an 11-Year-Old Girl
Subjective
Chief concern: "She needs a physical for volleyball." A sports physical is also an opportunity for the full health supervision content recommended for this age (Hagan et al., 2017). Historian: patient and mother, both reliable.
History of present concern: The mother noticed a "dirty-looking" darker area on the back of her daughter's neck about six months ago that does not wash off. It is not itchy or painful. The patient is self-conscious about it. No new medications or skin products. Menarche has not occurred; breast development began about a year ago.
Nutrition history: 24-hour recall: breakfast of sweetened cereal with 2% milk; school lunch of pizza, fries and chocolate milk; after-school snack of chips and a 20-ounce sports drink; dinner of rice, chicken and a small salad; one can of soda in the evening. Sweetened beverages about 40 ounces daily. Eats fast food two to three times a week. Family eats dinner together most nights.
Activity and sleep: Volleyball practice three days a week once the season starts; otherwise walks to school. Screen time about four hours daily. Sleeps 9 p.m. to 6:30 a.m.
Past medical, family and social history: No chronic illness. Immunizations up to date, including human papillomavirus dose 1 last year. Mother has type 2 diabetes diagnosed at 38; father has obesity and hypertension. Sixth grade, good grades, lives with parents and two brothers.
Review of systems: No polyuria, polydipsia, fatigue, headaches, snoring, joint pain, abdominal pain or irregular menses (premenarchal). Skin: neck darkening as above; no acne, hair growth on face or body, or rashes. Mood: denies teasing at school when asked privately; enjoys volleyball.
Objective
Vital signs: blood pressure 116/72 (below the 90th percentile for age, sex and height on the current pediatric tables; Flynn et al., 2017), heart rate 78, respiratory rate 16, temperature 98.4 F.
Growth: height 150 cm (75th percentile); weight 51 kg; BMI 22.7, at the 92nd percentile for age and sex, in the overweight range. Prior BMI at age 9 was at the 84th percentile.
General: well-appearing, cooperative, pubertal stage Tanner 2 for breast development.
Skin: symmetric, hyperpigmented, velvety plaques on the posterior and lateral neck and in both axillae, with skin tags in the left axilla. No striae, acne or hirsutism. Skin otherwise warm, dry and intact; no lesions of concern.
Head, eyes, ears, nose, throat: normocephalic; pupils equal and reactive; tympanic membranes clear; tonsils 1+; dentition with two filled molars.
Neck: supple; thyroid not enlarged; no lymphadenopathy.
Cardiovascular, respiratory and abdomen: regular rhythm, no murmur; lungs clear; abdomen soft, nontender, no hepatomegaly.
Musculoskeletal and neurological: full range of motion; no scoliosis on forward bend; normal gait, strength and reflexes.
Assessment
1. Overweight (BMI at the 92nd percentile), with upward percentile crossing since age 9.
2. Acanthosis nigricans of the neck and axillae, most consistent with insulin resistance given her weight, family history of early type 2 diabetes and pubertal stage. Differential considerations include a medication or endocrine cause (none identified), hereditary acanthosis (onset in later childhood argues against) and, rarely, malignancy-associated acanthosis (sudden, widespread, with weight loss, which does not fit).
3. High intake of sugar-sweetened beverages and low physical activity outside the sports season.
4. Cleared for volleyball participation.
Plan
Diagnostics: For children with overweight and risk factors, the AAP guideline supports screening for abnormal glucose metabolism and lipids starting at age 10 (Hampl et al., 2023). Order fasting lipid panel, hemoglobin A1c and alanine aminotransferase.
Counseling: Discussed findings with the patient and mother using neutral language about health rather than weight. Set one shared goal: replace sweetened drinks with water or milk, starting with the after-school sports drink. Encouraged family meals and a daily activity plan outside volleyball season. Explained that acanthosis may lighten as insulin sensitivity improves and that scrubbing will not remove it.
Referral and follow-up: Offer referral to an intensive health behavior and lifestyle treatment program, as the guideline recommends for children with overweight (Hampl et al., 2023). Return in one month to review labs and the beverage goal.
References
Flynn, J. T., Kaelber, D. C., Baker-Smith, C. M., Blowey, D., Carroll, A. E., Daniels, S. R., de Ferranti, S. D., Dionne, J. M., Falkner, B., Flinn, S. K., Gidding, S. S., Goodwin, C., Leu, M. G., Powers, M. E., Rea, C., Samuels, J., Simasek, M., Thaker, V. V., & Urbina, E. M. (2017). Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics, 140(3), Article e20171904. https://doi.org/10.1542/peds.2017-1904
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2017). Bright Futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). American Academy of Pediatrics.
Hampl, S. E., Hassink, S. G., Skinner, A. C., Armstrong, S. C., Barlow, S. E., Bolling, C. F., Avila Edwards, K. C., Eneli, I., Hamre, R., Joseph, M. M., Lunsford, D., Mendonca, E., Michalsky, M. P., Mirza, N., Ochoa, E. R., Sharifi, M., Staiano, A. E., Weedn, A. E., Flinn, S. K., ... Okechukwu, K. (2023). Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics, 151(2), Article e2022060640. https://doi.org/10.1542/peds.2022-060640
Reading the DNP 641 Module 2 assignment instructions
SOAP 2 is due in Week 6, when DNP 641 covers assessment of nutritional status and the integumentary system. The syllabus defines a comprehensive SOAP note as a written note covering all components of the SOAP format, prepared from a health assessment of a child you identify, and it reminds students to use a different child for each assessment assignment. Written data must protect privacy under HIPAA. The note category, which also holds SOAP 1 and the problem-focused note, carries 15% of the grade, and the syllabus expects later notes to show that earlier faculty feedback has been used. Given the week's topics, a strong note documents growth with percentiles, a dietary and activity history and a careful skin examination alongside the rest of the complete exam.
Inside the DNP 641 Module 2 example
Four parts follow the SOAP order. The subjective section gives the chief concern, the history of the skin finding, a 24-hour dietary recall with amounts, activity, sleep, family history and a focused review of systems that includes a private question about teasing. The objective section reports vital signs against pediatric percentiles, growth with BMI percentile and its change since age 9, and a full examination with a detailed description of the skin lesion. The assessment numbers four problems and gives a short differential for acanthosis nigricans with reasons for each exclusion. The plan ties every problem to an action: guideline-based screening labs, counseling built around one shared goal, a referral and follow-up. The references cover obesity, blood pressure and growth chart methods.
Where the marks sit in the DNP 641 Module 2 rubric
Canvas holds the SOAP rubric. Comprehensive pediatric SOAP notes are usually scored on completeness of each section, accuracy of growth and vital sign interpretation against pediatric norms, a thorough examination documented in proper terminology, an assessment that is supported by the data and includes reasonable differentials, a plan that follows from the assessment and uses current guidelines, privacy protection and professional writing. Points are commonly lost for BMI reported without a percentile, blood pressure without a percentile, skin findings described vaguely, an assessment that lists diagnoses without reasoning and a plan that orders tests without saying why. Incorporating feedback from SOAP 1 is part of the expectation, and evidence-based references should generally be from the last 10 years.
DNP 641 Module 2 help with common mistakes
The most frequent error in pediatric notes is using adult reference values. Report BMI and blood pressure as percentiles for age and sex. Another is describing a skin finding in one word; give location, color, texture and distribution. Keep subjective and objective data in their own sections. Make the assessment more than a list by giving the reasons for your leading diagnosis and the alternatives. Write counseling in nonjudgmental language, especially about weight. Avoid identifiers and the reference sources the syllabus excludes, such as UpToDate and StatPearls. If you share your de-identified draft with the desk, it can review whether each section supports the next.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 641 Module 2 questions, answered
Where can I find a free DNP 641 Module 2 sample paper?
A full DNP 641 Module 2 sample is above: a comprehensive pediatric SOAP note for an 11-year-old with overweight and acanthosis nigricans, with growth data, a full exam and a guideline-based plan.
What is acanthosis nigricans a sign of in children?
Most often insulin resistance, especially in a child with overweight whose parents or siblings have type 2 diabetes; less common causes include medications, endocrine disorders and, rarely, malignancy.
How is BMI interpreted in children?
Plot BMI on the CDC chart for the child's sex and age; at or above the 85th but under the 95th percentile counts as overweight, and the 95th percentile and higher counts as obesity.
When should children with overweight be screened for diabetes and lipids?
The AAP guideline supports screening for glucose and lipid abnormalities from age 10 in children with overweight and additional risk factors.
What is the difference between SOAP 1 and SOAP 2 in DNP 641?
SOAP 1 is a written complete history in Week 3; SOAP 2 is a full comprehensive SOAP note in Week 6 covering subjective, objective, assessment and plan.