NU 636 Unit 5 DQ 2: 77-year-old with irregular heartbeat
An abbreviated SOAP note on a 77-year-old man with dizziness, breathlessness and an irregularly irregular pulse of 123, with the plan structured as Therapeutics, Educational and Consultation/Collaboration. This guide covers the duration detail that decides the plan, the stroke risk score the vignette lets you calculate exactly, and the N/A clause most submissions skim past.
Editorial process
Last reviewed · August 6, 2026
The pulse names the rhythm; the duration names the plan
Two numbers in this scenario do most of the work, and one of them is not a vital sign. The pulse is 123 and irregularly irregular, which names the rhythm. And the episodes used to last about a day; this one has run for about three.
That second detail is the one the vignette goes out of its way to supply, and it decides the plan. Duration is the hinge in atrial fibrillation management: an episode under forty-eight hours is managed differently from one that has passed that mark or whose onset is uncertain, because restoring sinus rhythm in a heart that has been fibrillating long enough to form thrombus carries an embolic risk. At three days he is clearly on the far side of that line, and the history of prior self-limiting episodes tells you the pattern has changed from paroxysmal to persistent. A plan that reaches for rhythm control without acknowledging the duration has skipped the reasoning the scenario was built to test. It also changes the urgency question: a man in his seventies who has been in a rapid rhythm for three days is a different disposition problem from one who arrived within hours of onset.
His stroke risk is not a matter of judgement here — the scenario supplies exactly the variables the standard score is built from, so it can be calculated rather than described. He is seventy-seven, which scores two on age alone. He has hypertension, diagnosed fifteen years ago and currently uncontrolled at 172 over 100. He has type 2 diabetes of twenty years' standing. Nothing in the vignette indicates heart failure, prior stroke or vascular disease, and he is male. That totals four, comfortably past the threshold at which anticoagulation is recommended rather than considered. Showing the arithmetic in the assessment is worth more than asserting that he is high risk, because it demonstrates the reasoning is reproducible. Two of those four points come from conditions he is already being treated for, which is worth saying, because it makes the score a summary of his history rather than a new finding.
The plan has a mandated shape and a clause that is easy to skim past. It must be structured as Therapeutics, Educational, and Consultation/Collaboration — and the brief says that if any of the three does not apply, you still use the heading and write N/A after the colon. That is a free instruction: all three headings appear in every submission that read it. Therapeutics has to handle rate control, anticoagulation and the uncontrolled blood pressure, and it should say what is being added to lisinopril and metformin rather than prescribing into a vacuum. Educational is where the anticoagulation conversation lives — bleeding, adherence, what to do about a missed dose, when to seek help. Consultation/Collaboration is where cardiology referral and any advanced care planning belong. Writing N/A costs a line and demonstrates that the format was read, which is exactly the kind of mark that gets left on the table.
The subjective and objective split is worth doing carefully because the scenario deliberately mixes them. Dizziness, breathlessness, fatigue and the sensation of skipped beats are what he reports, along with the year-long history and the three-day duration; the vital signs, the skin findings and the auscultation are what you observed. The grey cast to warm, pale skin belongs in objective and is not decoration — it is a perfusion observation in a man whose ventricle is filling poorly at 123 beats a minute. Equally, the note should say what is missing rather than pretend completeness: no electrocardiogram has been recorded, no thyroid function, no renal function, and renal function is what the anticoagulant dose depends on. Naming the gaps is not a hedge here; it is part of the plan, because the therapeutics cannot be finalised without them.
Scenario detail | Where it belongs | What it decides |
|---|---|---|
Dizzy, short of breath, fatigued, skipping beats | Subjective | The symptom set that brought him in |
Episodes for a year, each about a day; this one three days | Subjective | Paroxysmal has become persistent; past the 48-hour line |
P 123, irregularly irregular | Objective | Names the rhythm and the rapid ventricular response |
BP 172/100 | Objective | Uncontrolled hypertension; also one point on the risk score |
Age 77, type 2 diabetes, hypertension | Objective / history | Four points on the score — anticoagulation recommended |
Warm, pale skin with a slight grey cast | Objective | Perfusion, in a ventricle filling poorly at 123 |
Lisinopril 20 mg, metformin 1000 mg | Objective | What new therapy is being added to, and a renal-function prompt |
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Recognise a rhythm from the descriptive term used for the pulse.
- 02Treat episode duration as a management decision point rather than as background history.
- 03Calculate a risk score from the variables a vignette supplies rather than estimating it.
- 04Structure a plan to a mandated format, including the categories that do not apply.
- 05State what data is missing from a clinical picture and why it matters to the plan.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
What the abbreviated SOAP note has to contain
- 01An abbreviated SOAP note covering Subjective, Objective, Assessment and Plan.
- 02A plan structured under Therapeutics, Educational, and Consultation/Collaboration.
- 03Each of the three plan headings present, with N/A after the colon where the category does not apply.
- 04Pharmacologic interventions, new or revised, and consideration of OTC and non-pharmacologic options.
- 05Health information the patient needs, including support for the therapeutics and follow-up care.
- 06Any consultation, referral or advanced care planning considerations.
- 07In-text citations and a full reference list in APA format.
Sorting the scenario, then building the three-part plan
Split the scenario into S and O before writing
Sort what he reported from what was observed, including the timeline in Subjective and the skin findings in Objective.
Assessment — name the rhythm and its duration class
State the working diagnosis, the descriptive finding that supports it, and whether this is paroxysmal or persistent.
Assessment — calculate, do not estimate
Work the stroke risk score from age, hypertension and diabetes, and state the total.
Therapeutics
Address rate control, the anticoagulation decision, and the uncontrolled blood pressure, in relation to his current medications.
Educational
Cover what he needs to understand about the rhythm, the anticoagulation decision, warning signs and follow-up.
Consultation/Collaboration, and the gaps
State referral and collaboration decisions, and name the investigations the plan depends on but does not yet have.
Where the duration rule and the risk score are documented
Recommended databases
- PubMed / NCBI Bookshelf
- Cardiology society guidance
- CINAHL
- Course pharmacology resources
Search sequence
- 1.Confirm how episode duration changes management before writing the plan, since it is the scenario's pivot.
- 2.Look up the stroke risk score components so the calculation is accurate rather than approximate.
- 3.Check the rate-control options and how they interact with existing antihypertensive therapy.
- 4.Check what renal function is needed for anticoagulant dosing, which is also relevant to his metformin.
Sources for rhythm management and stroke risk
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Atrial fibrillation: diagnosis and management
National Institute for Health and Care Excellence, NCBI Bookshelf · 2021
Guideline-level treatment of stroke risk assessment, rate versus rhythm control and anticoagulation thresholds. This is the central reference for both the assessment and the therapeutics heading.
- 02
Inpatient Management of Acute Atrial Fibrillation and Atrial Flutter in Non-Pregnant Hospitalized Adults
Agency for Healthcare Research and Quality, NCBI Bookshelf · 2022
How duration and haemodynamic status change the acute approach. Use it for the reasoning that the three-day history drives, and for when escalation rather than office management is appropriate.
- 03
Hypokalemia
StatPearls, NCBI Bookshelf, US National Library of Medicine · 2023
Electrolyte disturbance as a precipitant and aggravator of arrhythmia. Relevant to the investigations the note should name as missing rather than to the plan itself.
Before the post goes up
Common mistakes
- Treating the three-day duration as background rather than as the detail that determines the approach.
- Describing the patient as high stroke risk instead of calculating the score from the variables given.
- Omitting one of the three plan headings because it seemed not to apply, when the brief says to write N/A.
- Prescribing without saying what is being added to the existing lisinopril and metformin.
- Leaving the uncontrolled blood pressure of 172/100 unaddressed in the plan.
- Putting the vital signs in Subjective or the reported symptoms in Objective.
- Reducing the Educational heading to generic lifestyle advice rather than the anticoagulation conversation.
- Claiming a complete picture when no electrocardiogram, thyroid function or renal function is available.
- Supporting the plan with no scholarly citations, which the brief requires explicitly.
Submission checklist
- The rhythm is named, and the term used in the scenario is identified as the reason.
- The three-day duration appears in the assessment or the plan, not just in the history.
- A stroke risk score is calculated and the components are shown.
- All three plan headings appear, with N/A used rather than omission.
- Therapeutics addresses rate, anticoagulation and blood pressure.
- New agents are placed in relation to the patient's existing medications.
- Educational content covers what the patient needs to know about the anticoagulation decision.
- Missing investigations are named, including renal function before anticoagulant dosing.
- Interventions are supported by scholarly sources with APA in-text citations and a reference list.
Use this guide to plan and review your own work. Follow your institution's rules and read our academic-integrity policy.
Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
Reviewed by
Dr. Nathan Cole
PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.