DNP 641 Module 4 Problem-Focused Note: Abdominal Pain in a School-Age Child Example

Reviewed by Ingrid Vasterling, MSN, RN Arizona State University Updated October 2026

This DNP 641 Module 4 sample is the Problem-Focused Note in Advanced Health Assessment Pediatrics, a course in ASU's Doctor of Nursing Practice. In Week 11, during the cardiovascular and abdominal assessment module, ASU DNP 641 gives students a history of present illness and pertinent findings, asks them to outline differential diagnoses, the questions they would ask and the examination they would perform, and then to write a SOAP note from the information. The composite patient, a girl of 10, has had abdominal pain for 18 hours that began around the navel and moved to the right lower quadrant. The note works through six differentials, lists targeted questions and maneuvers, applies the Pediatric Appendicitis Score and ends with same-day imaging and surgical referral.

CourseDNP 641 Advanced Health Assessment Pediatrics
ModuleModule 4
Paper typeProblem-focused pediatric SOAP note
LengthAbout 619 words, 5 pages
FormatAPA 7 student paper
SchoolArizona State University
ProgramDoctor of Nursing Practice
UpdatedOctober 2026

Free sample paper for DNP 641 Module 4

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The Pain That Moved: A Problem-Focused Note on Right Lower Quadrant Pain and Suspected Appendicitis in a 10-Year-Old

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 641: Advanced Health Assessment Pediatrics

Instructor Name

Month Day, Year

What this page is doingThe title names the single historical feature, migration of pain, that most raises suspicion of appendicitis, then the patient and the setting of the note.
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The Pain That Moved: A Problem-Focused Note on Right Lower Quadrant Pain and Suspected Appendicitis in a 10-Year-Old

Information Provided

History of present illness: A 10-year-old girl has had abdominal pain for 18 hours. It began around the umbilicus last evening and this morning moved to the right lower abdomen. She vomited once, has no appetite and had a temperature of 100.4 F at home. Last bowel movement yesterday morning, normal. Pertinent findings: temperature 100.6 F, heart rate 108; she walks slowly and holds her right side; tenderness in the right lower quadrant.

Part 1: Differential Diagnoses

1. Acute appendicitis: periumbilical pain migrating to the right lower quadrant, anorexia, vomiting after pain onset and low-grade fever form the classic pattern.

2. Mesenteric adenitis: can mimic appendicitis, often after a viral illness, with more diffuse tenderness.

3. Constipation: the most common cause of abdominal pain in school-age children, though migration and fever are not typical.

4. Urinary tract infection or pyelonephritis: fever and abdominal or flank pain, with urinary symptoms.

5. Ovarian torsion or cyst: sudden, severe lower abdominal pain with vomiting in a girl approaching puberty.

6. Group A streptococcal pharyngitis: can cause abdominal pain and vomiting in children, usually with sore throat.

Part 2: Questions I Would Ask

Did the pain start before the vomiting? Does it hurt to walk, jump or ride over bumps in the car? Any sore throat, cough or recent illness? Urinary burning, frequency or new wetting? Diarrhea or constipation, and how often she usually stools? Has menarche occurred, and any vaginal discharge? Has she had this pain before? Any recent abdominal injury? Any medicines given, including pain relievers that could mask fever?

Part 3: Physical Assessment I Would Conduct

General appearance and hydration. Throat examination. Abdominal examination in the sequence taught in Bickley et al. (2021): inspection, auscultation, light then deep palpation starting away from the painful area, with attention to McBurney point tenderness, guarding and rebound. Specific signs: pain with coughing or hopping, Rovsing sign, psoas and obturator signs. Costovertebral angle tenderness. External genital inspection if indicated, with a chaperone.

What this page is doingThe first three parts answer the assignment's outline tasks separately, so faculty can see the reasoning before the SOAP note, and each question or maneuver maps to one of the six differentials.
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Part 4: SOAP Note

Subjective: 10-year-old girl, 18 hours of abdominal pain beginning periumbilically and migrating to the right lower quadrant; pain began before a single episode of vomiting; anorexia; fever to 100.4 F; pain worse with walking and in the car. Denies sore throat, urinary symptoms, diarrhea or prior episodes. Premenarchal. No medications given. Normal stool pattern.

Objective: Temperature 100.6 F, heart rate 108, respiratory rate 20, blood pressure 102/64. Ill-appearing, lying still. Mucous membranes moist. Pharynx without erythema or exudate. Abdomen: soft, decreased bowel sounds, tenderness maximal at McBurney point with voluntary guarding; pain in the right lower quadrant with coughing and hopping; positive Rovsing sign; positive psoas sign on the right. No costovertebral angle tenderness. External genitalia normal.

Assessment: Acute abdominal pain, most consistent with acute appendicitis. Pediatric Appendicitis Score so far is 7 of 10 (migration 1, anorexia 1, nausea or vomiting 1, right lower quadrant tenderness 2, cough, percussion or hopping tenderness 2), before the 3 points available from fever of 38 C or higher and the white blood cell and neutrophil results (Samuel, 2002). Her temperature of 100.6 F (38.1 C) adds 1, for a score of at least 8. Differential: mesenteric adenitis, ovarian torsion and urinary infection remain to be excluded by testing.

Plan: Same-day referral to the pediatric emergency department with surgical consultation. Recommend complete blood count with differential, C-reactive protein, urinalysis and abdominal ultrasound as the first imaging test, which avoids radiation in children (Rentea & St. Peter, 2017). Nothing by mouth. Explained to the father the reasons for urgent evaluation and the signs of rupture, such as worsening pain or rising fever.

What this page is doingThe note applies a validated pediatric score transparently, item by item, and its plan matches the score's high-risk category with imaging chosen for children, showing the step from assessment to action.
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References

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.

Rentea, R. M., & St. Peter, S. D. (2017). Pediatric appendicitis. Surgical Clinics of North America, 97(1), 93-112. https://doi.org/10.1016/j.suc.2016.08.009

Samuel, M. (2002). Pediatric appendicitis score. Journal of Pediatric Surgery, 37(6), 877-881. https://doi.org/10.1053/jpsu.2002.32893

DNP 641 Module 4 instructions, in plain terms

In Week 11, during the cardiovascular system and abdomen module, DNP 641 students complete the Problem-Focused Note, worth 30 points. Unlike the comprehensive SOAP notes, this assignment starts from information the course provides: the components of the history of present illness and the pertinent physical findings. The syllabus asks you to document the differential diagnoses, the questions you would ask and the physical assessment you would conduct, and then to write a SOAP note based on the information. It sits alongside Quiz 4 in the same week, after the third immersion on the thorax and lungs. Because the case is given rather than gathered, the grade depends on reasoning: which questions you would add, which maneuvers you would perform and how the note follows from them.

Inside the DNP 641 Module 4 example

Four parts carry the note, mirroring the assignment's steps. The first lists six differential diagnoses, each with a one-line reason it belongs. The second lists the additional questions, each chosen to confirm or exclude one of the differentials. The third sets out a focused examination in the correct order, from inspection to deep palpation, with the specific signs for appendicitis and the checks for urinary, gynecologic and throat causes. The fourth is the SOAP note itself, in which the subjective section adds the answers to those questions, the objective section records the findings, the assessment applies the Pediatric Appendicitis Score item by item and the plan matches that score with same-day referral and ultrasound.

Where the marks sit in the DNP 641 Module 4 rubric

The Canvas rubric awards the 30 points. Problem-focused notes are generally graded on a relevant and prioritized differential, questions and examination steps that are specific and linked to the differential, correct pediatric examination technique and terminology, a SOAP note that stays focused on the problem rather than becoming a full physical, an assessment supported by the findings and a plan that matches the level of concern. Notes lose points when the outline and the SOAP note do not connect, when examination maneuvers are named without results, when a scoring tool is cited without showing the calculation and when the plan for a possible surgical abdomen is delayed. The syllabus also asks that previous feedback be visible in later notes.

DNP 641 Module 4 help with common mistakes

A frequent problem is a SOAP note that ignores the outline written above it. Make sure the questions you listed are answered in the subjective section and the maneuvers appear in the objective section. Another is a list of differentials without the age- and sex-specific causes, such as ovarian torsion in an older girl. Report each examination sign as positive or negative. If you use a clinical score, show the points. Keep a problem-focused note focused; a full review of every system belongs in the comprehensive notes. Do not cite UpToDate or StatPearls, which the syllabus excludes. If you share the provided case and your draft with the desk, it can check that the outline and note connect.

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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More DNP 641 and Doctor of Nursing Practice sample papers

DNP 641 Module 4 questions, answered

Where can I find a free DNP 641 Module 4 sample paper?

This page holds a full DNP 641 Module 4 sample: a problem-focused note on suspected appendicitis in a 10-year-old, with differentials, questions, exam plan and a SOAP note.

What is a problem-focused note?

A note limited to one presenting problem, with a focused history, a targeted examination, an assessment with differentials and a plan, rather than a complete head-to-toe record.

What is the Pediatric Appendicitis Score?

Samuel's 10-point tool adds points for pain that moved, poor appetite, vomiting, right lower tenderness, pain on coughing or hopping, fever, a raised white count and neutrophilia; the higher the total, the greater the risk.

What imaging is first for suspected appendicitis in children?

Ultrasound is preferred first because it avoids radiation; CT or MRI may follow when ultrasound is inconclusive.

How much is the DNP 641 problem-focused note worth?

It is worth 30 points and is due in Week 11, during the module on assessment of the cardiovascular system and abdomen.