NR 602 Week 8 i-Human Case Study: Avery Brook | 10-Year-Old
Slipping Grades & ADHD Complete Solution Guide & SOAP Note
(Chamberlain 2026)
,1. PATIENT BIODATA & REASON FOR ENCOUNTER
Category Information
Patient Name Avery Brook
Age 10 years
Sex Female
Ethnicity Caucasian
Height 4'7" (140 cm)
Weight 80.0 lbs (36.4 kg)
BMI 18.5 kg/m² (50th percentile)
Setting Outpatient Pediatric Clinic
Source Patient and Mother
Grade 5th Grade
Reason for Encounter "Slipping grades" and decline in academic performance over the past 4-5 months
2. CASE INTRODUCTION
Avery Brook is a 10-year-old female who presents to the outpatient pediatric clinic accompanied by her
mother with a chief complaint of declining academic performance. Avery, who was previously an A/B
student, has experienced a progressive drop in her grades over the past 4-5 months, now receiving Cs
and Ds in core subjects .
The mother reports that Avery seems "foggy" and frequently receives notes from teachers regarding her
inability to stay on task or complete assignments during class. Avery herself describes feeling "tired all
the time" and struggling to concentrate, stating she feels like she is "in a cloud" and often needs a nap as
soon as she gets home from school .
What makes this case particularly significant is the presence of associated symptoms including loud
snoring at night, mouth breathing, and witnessed gasping episodes during sleep, as reported by the
,mother . This constellation of symptoms—academic decline, daytime somnolence, and nocturnal
respiratory disturbances—necessitates a comprehensive evaluation that goes beyond a simple ADHD
workup.
The case requires the advanced practice nurse to consider multiple etiologies, including
neurodevelopmental disorders (ADHD), sleep-disordered breathing (Obstructive Sleep Apnea), and
endocrine dysfunction (Hypothyroidism), each of which can present with overlapping symptoms of
inattention, fatigue, and cognitive impairment .
3. CHIEF COMPLAINT
"Slipping grades" – Mother reports: "My daughter's grades are slipping" as the primary reason for the
visit .
Patient Statement: "I'm just really tired all the time and I can't focus on my schoolwork like I used to."
4. QUESTIONS AND ANSWERS DURING FULL HISTORY
A. HISTORY OF PRESENT ILLNESS (HPI) QUESTIONS
Clinician Question Patient/Mother Response
"What brings you in today?" Mother: "My daughter's grades are slipping. She used to be an A/B
student, but now she's getting Cs and Ds."
"When did you first notice the decline in grades?" Mother: "It started about 4-5 months ago, right
after winter break. It's been getting progressively worse."
"Which subjects are most affected?" Mother: "Math and reading. She struggles with assignments that
have multiple steps."
"Can you describe what happens in class?" Avery: "I stare at the board but the words don't make
sense. I feel like I'm in a cloud."
"Do you have trouble concentrating?" Avery: "Yes. It feels like my brain is a radio and someone keeps
changing the stations. I hear a bird outside or someone's pencil and I forget what I was doing."
, "Do you forget instructions or homework?" Mother: "Yes. She forgets what she's supposed to do and
loses her homework all the time."
"Have teachers reported behavioral changes?" Mother: "Her teacher says she's daydreaming a lot and
doesn't follow instructions. She doesn't finish her work in class."
"How do you feel about your grades dropping?" Avery: "It makes me feel sad and frustrated. I want to do
well, but I just get distracted by everything around me."
"Has there been any recent stress at home or school?" Mother: "No. We have a stable home. She has
friends at school."
"Any problems with bullying?" Mother: "No, she gets along well with other kids."
"What treatments have you tried?" Mother: "We tried extra tutoring and limiting TV time. Nothing
helped."
B. SLEEP HISTORY QUESTIONS
Clinician Question Patient/Mother Response
"How does Avery sleep at night?" Mother: "She snores really loudly—you can hear it from the
hallway. She also breathes through her mouth at night."
"Have you noticed pauses in her breathing?" Mother: "Yes. Sometimes she gasps or seems to
struggle for breath while sleeping."
"Does she wake up feeling rested?" Avery: "No. I wake up tired even after sleeping 10 hours."
"Does she have trouble falling asleep?" Mother: "She has a hard time falling asleep because her 'brain
won't turn off.' We started giving her melatonin 1 mg at night about a month ago."
"Does she have morning headaches?" Avery: "Sometimes. Usually they go away after I wake up."
"Does she wet the bed?"Mother: "No, she doesn't have that problem."
"Has her snoring changed recently?" Mother: "It's gotten louder over the last year. She used to not
snore at all."
C. REVIEW OF SYSTEMS (ROS) QUESTIONS
System Clinician Question Patient Response
Constitutional "Have you had any fever, chills, or weight changes?" "No fever or chills. I've gained
about 6 pounds lately even though I haven't changed what I eat."
Slipping Grades & ADHD Complete Solution Guide & SOAP Note
(Chamberlain 2026)
,1. PATIENT BIODATA & REASON FOR ENCOUNTER
Category Information
Patient Name Avery Brook
Age 10 years
Sex Female
Ethnicity Caucasian
Height 4'7" (140 cm)
Weight 80.0 lbs (36.4 kg)
BMI 18.5 kg/m² (50th percentile)
Setting Outpatient Pediatric Clinic
Source Patient and Mother
Grade 5th Grade
Reason for Encounter "Slipping grades" and decline in academic performance over the past 4-5 months
2. CASE INTRODUCTION
Avery Brook is a 10-year-old female who presents to the outpatient pediatric clinic accompanied by her
mother with a chief complaint of declining academic performance. Avery, who was previously an A/B
student, has experienced a progressive drop in her grades over the past 4-5 months, now receiving Cs
and Ds in core subjects .
The mother reports that Avery seems "foggy" and frequently receives notes from teachers regarding her
inability to stay on task or complete assignments during class. Avery herself describes feeling "tired all
the time" and struggling to concentrate, stating she feels like she is "in a cloud" and often needs a nap as
soon as she gets home from school .
What makes this case particularly significant is the presence of associated symptoms including loud
snoring at night, mouth breathing, and witnessed gasping episodes during sleep, as reported by the
,mother . This constellation of symptoms—academic decline, daytime somnolence, and nocturnal
respiratory disturbances—necessitates a comprehensive evaluation that goes beyond a simple ADHD
workup.
The case requires the advanced practice nurse to consider multiple etiologies, including
neurodevelopmental disorders (ADHD), sleep-disordered breathing (Obstructive Sleep Apnea), and
endocrine dysfunction (Hypothyroidism), each of which can present with overlapping symptoms of
inattention, fatigue, and cognitive impairment .
3. CHIEF COMPLAINT
"Slipping grades" – Mother reports: "My daughter's grades are slipping" as the primary reason for the
visit .
Patient Statement: "I'm just really tired all the time and I can't focus on my schoolwork like I used to."
4. QUESTIONS AND ANSWERS DURING FULL HISTORY
A. HISTORY OF PRESENT ILLNESS (HPI) QUESTIONS
Clinician Question Patient/Mother Response
"What brings you in today?" Mother: "My daughter's grades are slipping. She used to be an A/B
student, but now she's getting Cs and Ds."
"When did you first notice the decline in grades?" Mother: "It started about 4-5 months ago, right
after winter break. It's been getting progressively worse."
"Which subjects are most affected?" Mother: "Math and reading. She struggles with assignments that
have multiple steps."
"Can you describe what happens in class?" Avery: "I stare at the board but the words don't make
sense. I feel like I'm in a cloud."
"Do you have trouble concentrating?" Avery: "Yes. It feels like my brain is a radio and someone keeps
changing the stations. I hear a bird outside or someone's pencil and I forget what I was doing."
, "Do you forget instructions or homework?" Mother: "Yes. She forgets what she's supposed to do and
loses her homework all the time."
"Have teachers reported behavioral changes?" Mother: "Her teacher says she's daydreaming a lot and
doesn't follow instructions. She doesn't finish her work in class."
"How do you feel about your grades dropping?" Avery: "It makes me feel sad and frustrated. I want to do
well, but I just get distracted by everything around me."
"Has there been any recent stress at home or school?" Mother: "No. We have a stable home. She has
friends at school."
"Any problems with bullying?" Mother: "No, she gets along well with other kids."
"What treatments have you tried?" Mother: "We tried extra tutoring and limiting TV time. Nothing
helped."
B. SLEEP HISTORY QUESTIONS
Clinician Question Patient/Mother Response
"How does Avery sleep at night?" Mother: "She snores really loudly—you can hear it from the
hallway. She also breathes through her mouth at night."
"Have you noticed pauses in her breathing?" Mother: "Yes. Sometimes she gasps or seems to
struggle for breath while sleeping."
"Does she wake up feeling rested?" Avery: "No. I wake up tired even after sleeping 10 hours."
"Does she have trouble falling asleep?" Mother: "She has a hard time falling asleep because her 'brain
won't turn off.' We started giving her melatonin 1 mg at night about a month ago."
"Does she have morning headaches?" Avery: "Sometimes. Usually they go away after I wake up."
"Does she wet the bed?"Mother: "No, she doesn't have that problem."
"Has her snoring changed recently?" Mother: "It's gotten louder over the last year. She used to not
snore at all."
C. REVIEW OF SYSTEMS (ROS) QUESTIONS
System Clinician Question Patient Response
Constitutional "Have you had any fever, chills, or weight changes?" "No fever or chills. I've gained
about 6 pounds lately even though I haven't changed what I eat."
