| Course | NU682 Childbearing Family |
|---|---|
| Unit | Unit 3 |
| Paper type | Prenatal screening counseling note |
| Length | About 710 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NU682 Unit 3
A Screen Is Not a Diagnosis: A Unit 3 Prenatal Counseling Note After a High-Risk Cell-Free DNA Result for Trisomy 18
[Student Name]
Purdue University Global
NU682: Childbearing Family
Unit 3 Prenatal Screening Counseling Note
[Instructor Name]
[Date]
The patient, couple and results are composite and illustrative; the sources cited are real.
Subjective
Mrs. Okoro, gravida 2 para 1, is at 11 weeks 5 days by first-trimester ultrasound. Her first child, now three, is healthy. She chose cell-free DNA screening at her last visit. The laboratory report was released to the portal before a clinician could call. She and her husband, Mr. Okoro, read online that trisomy 18 is often fatal and ask whether they should "start preparing." They want to understand how certain the result is.
Objective
Cell-free DNA report: high risk for trisomy 18; low risk for trisomies 21 and 13 and sex chromosome aneuploidy; fetal fraction adequate. Today's ultrasound: single intrauterine pregnancy, size consistent with dates, normal nuchal translucency on a limited view; no structural abnormality seen, although detailed anatomy cannot be assessed at this gestation.
Assessment
High-risk cell-free DNA screen for trisomy 18 in a 26-year-old with no other risk factors; diagnosis not established.
Cell-free DNA screening analyzes fragments of DNA in the mother's blood, most of which come from the placenta. It is a screening test, and ACOG and the Society for Maternal-Fetal Medicine state that a positive result should be confirmed by diagnostic testing before any irreversible decision about the pregnancy (American College of Obstetricians and Gynecologists [ACOG], 2020). The test performs far better than older screening. In a study of nearly 16,000 women in a general obstetric population, a positive cell-free DNA result for trisomy 21 was a true positive about 81 percent of the time, compared with about 3 percent for standard screening (Norton et al., 2015). Even so, a meaningful share of positives are false, and the chance of a true positive is lower when the condition is rarer, as trisomy 18 is in a woman of 26.
The report tells them a closer look is needed; it does not tell them what the closer look will find.
Two features of her situation matter. Her first-trimester ultrasound shows no structural findings, though it is too early to rule them out. And because cell-free DNA comes largely from the placenta, a result can reflect a chromosomal difference confined to the placenta rather than the fetus. An audit of more than 52,000 chorionic villus samples traced some discordant screening results to exactly this kind of placental mosaicism and concluded that the biology rules out a perfectly accurate screen (Grati et al., 2014).
Plan and Counseling
The couple was told that the result is a screening result, that many families in their position receive a normal diagnostic result, and that nothing should be decided on the screen alone. Two diagnostic tests were explained.
Chorionic villus sampling at 11 to 13 weeks samples the placenta and gives an earlier answer. Because the placenta is the same tissue that produced the cell-free DNA, a positive result could reflect placental mosaicism, and amniocentesis might still be needed to confirm a fetal diagnosis (ACOG, 2020).
Amniocentesis from 15 weeks samples fluid containing fetal cells. It answers the question directly but requires waiting about three more weeks.
A detailed ultrasound at 18 to 22 weeks, or earlier with maternal-fetal medicine, would look for structural findings associated with trisomy 18.
The couple chose amniocentesis at 15 weeks 2 days, saying they would rather wait for an answer about the baby than risk a second procedure. A referral to genetic counseling was placed for this week, and a maternal-fetal medicine ultrasound was booked for 15 weeks to coincide with the procedure.
Process Note
The portal released the result before a clinician could explain it. With the couple's permission, this was reported through the practice's quality process with a recommendation that high-risk screening results be held for a clinician's call.
Follow-Up
Genetic counseling within one week. Amniocentesis with rapid results for the common trisomies, followed by a full karyotype or microarray. A call from this clinician the day results return, regardless of outcome. The couple was given a direct number and told to call with questions before then.
References
American College of Obstetricians and Gynecologists. (2020). Screening for fetal chromosomal abnormalities: ACOG practice bulletin, number 226. Obstetrics & Gynecology, 136(4), e48-e69. https://doi.org/10.1097/AOG.0000000000004084
Grati, F. R., Malvestiti, F., Ferreira, J. C., Bajaj, K., Gaetani, E., Agrati, C., Grimi, B., Dulcetti, F., Ruggeri, A. M., De Toffol, S., Maggi, F., Wapner, R., Gross, S., & Simoni, G. (2014). Fetoplacental mosaicism: Potential implications for false-positive and false-negative noninvasive prenatal screening results. Genetics in Medicine, 16(8), 620-624. https://doi.org/10.1038/gim.2014.3
Norton, M. E., Jacobsson, B., Swamy, G. K., Laurent, L. C., Ranzini, A. C., Brar, H., Tomlinson, M. W., Pereira, L., Spitz, J. L., Hollemon, D., Cuckle, H., Musci, T. J., & Wapner, R. J. (2015). Cell-free DNA analysis for noninvasive examination of trisomy. New England Journal of Medicine, 372(17), 1589-1597. https://doi.org/10.1056/NEJMoa1407349
NU682 Unit 3 instructions, in plain terms
The third unit usually brings a prenatal screening result back to a patient or couple and asks for counseling documentation. Prompts commonly want what the result means and does not mean, the diagnostic options with their timing and tradeoffs, the family's decision and the follow-up plan. A SOAP structure is typical for a note, though some sections ask for a narrative counseling summary. Instructors look for accurate language about screening versus diagnosis, an explanation of predictive value in terms a family can follow, and respect for the family's values in the decision. The note should record who was present and what was offered. A tight note of three or four pages in APA format is usual, citing ACOG's practice bulletin on chromosomal screening and at least one study on test performance. Genetic counseling referral and the plan for communicating results are expected elements.
How this NU682 Unit 3 example is built
The Okoro note's subjective section records how the couple learned the result and what they had read, so the counseling can address it. The objective section lists the report and the first-trimester ultrasound, which shows no structural finding yet. The assessment states the result as a screen with no diagnosis established, cites ACOG on confirmation, and uses Norton and colleagues' predictive values to explain why some positives are false, under a highlighted line about what the report can and cannot say. A paragraph on placental origin, supported by Grati and colleagues, prepares the test choice and is marked by a margin note. The plan compares chorionic villus sampling and amniocentesis on timing and on what each samples, then records the couple's choice. A process note reports the portal release, and follow-up commits to a call on the day results return.
Reading the NU682 Unit 3 grading rubric
Rubrics for this counseling note weigh accurate interpretation, completeness of options, quality of the counseling, documentation and writing. Interpretation credit requires calling the result a screen, explaining predictive value correctly and avoiding language that implies a diagnosis. Options must include both diagnostic tests with their timing and limits; noting that chorionic villus sampling can reflect placental mosaicism shows depth. Counseling is scored on whether the family's understanding and values shaped the decision, and whether nondirective language was used. Documentation criteria look for who was present, what was offered, what was chosen and the follow-up plan, including genetic counseling. Graders also notice systems thinking, such as reporting a result released without explanation. Clear structure, concise wording appropriate to a clinical note and APA references for the practice bulletin and studies complete the criteria in most NU682 sections.
NU682 Unit 3 help: mistakes that cost points
Counseling notes lose points most often by describing a high-risk screen as a positive diagnosis, which can push a family toward decisions before confirmation. Another common gap is offering only one diagnostic test, or omitting timing, so the family cannot weigh an earlier answer against a more direct one. Some notes quote the laboratory's sensitivity without explaining that predictive value depends on how common the condition is. Others record the clinician's recommendation but not the family's choice. Leaving out genetic counseling or the plan for sharing results is a frequent omission. Before drafting, write what the report says in one sentence and what it cannot say in another, then list each diagnostic option with its earliest date for your patient. Keep the language nondirective. Send the report details and your note template, and a counseling note can be drafted around that family.
Get an NU682 Unit 3 example written to your instructions
Send the case, the screening report details and the note instructions with the rubric. A custom note explains what the result does and does not mean, offers diagnostic testing and records the family's decision. Turnaround is 24-48h, with the first one free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
More NU682 papers and MSN samples
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- NU682 Unit 2: Pregnancy Dating Paper
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- NU682 Unit 6: Postpartum Complication Case Analysis
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- NU682 Unit 8: Lactation Consultation Note
- NU682 Unit 9: Family Adaptation Paper
- NU682 Unit 10: Postpartum Family Planning Plan
- MN501 Unit 3: Scope of Practice Review
- NU680 Unit 3: Contraceptive Counseling Plan
- MN502 Unit 3: Grand Theory Review
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NU682 Unit 3 questions, answered
Is a positive cell-free DNA result a diagnosis?
No. It is a screening result, and some positives are false. Diagnostic testing by chorionic villus sampling or amniocentesis is offered before any irreversible decision. A counseling note should say this plainly.
What is positive predictive value in prenatal screening?
It is the chance that a positive screen is a true positive. It depends on how common the condition is in people like the patient, so the same test can be more or less reliable for different patients.
Should the note include the family's decision?
Yes. Documenting what was offered, what the family chose and the follow-up plan is part of the assignment in most sections.
Where can I find a free NU682 Unit 3 sample paper?
This page holds the complete NU682 Unit 3 prenatal screening counseling note. It explains a high-risk cell-free DNA result for trisomy 18 to a composite couple, compares chorionic villus sampling with amniocentesis and records their choice.
Why did the couple in the NU682 Unit 3 note choose amniocentesis?
Cell-free DNA and chorionic villus sampling both reflect the placenta, so a positive villus result could still need amniocentesis to confirm a fetal diagnosis. They preferred to wait three weeks for one direct answer about the baby.