| Course | NU142 Medical-Surgical Nursing I |
|---|---|
| Unit | Unit 6 |
| Paper type | Handoff report |
| Length | About 620 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BSN (prelicensure) |
| Updated | October 2026 |
Free sample paper for NU142 Unit 6
Glucose 820 at Admission, 412 at Handoff: An SBAR Report Handing Over a Composite 72-Year-Old Woman With Hyperosmolar Hyperglycemic State on the Evening of Her First Day, Written So the Night Nurse Can Act on It
[Student Name]
Purdue University Global
NU142: Medical-Surgical Nursing I
Unit 6 Handoff Report
[Instructor Name]
[Date]
The patient is composite; values and orders are bracketed where illustrative, and the facility's protocol governs insulin and fluid management.
Situation
[Mrs. D.], a composite 72-year-old woman, room [12]. Admitted at [0900] with hyperosmolar hyperglycemic state. Glucose was [820] mg/dL on arrival and is [412] at the [1800] check, falling about [50] per hour, which is the target rate. She is more alert than this morning but still slow to answer.
Background
Type 2 diabetes on metformin; lives alone; found confused by her son after several days of vomiting and drinking little. Serum osmolality on admission [342] mOsm/kg; sodium [134] measured, which corrects to a higher value given the glucose; potassium [4.4]; creatinine [2.1], baseline [1.0]. No ketones of significance. She has received [4.5] L of IV fluid since arrival. Hyperosmolar hyperglycemic state develops over days of high glucose and fluid loss through urine, producing severe dehydration and high osmolality with little or no ketosis, unlike diabetic ketoacidosis (Kitabchi et al., 2009).
Assessment
Neuro: oriented to person and place, not date; moves all limbs; no seizure activity. Cardiovascular: heart rate [98], down from [124]; blood pressure [124/70]. Respiratory: clear lungs, saturation [96] percent on room air. Renal: urine output [60] to [80] mL per hour for the last three hours. IV: normal saline at [250] mL per hour per protocol; insulin infusion at [6] units per hour. Skin dry, mucous membranes improving. Fall risk high.
The glucose is falling at the right speed; the danger overnight is that it falls too fast, or that her potassium falls with it.
Recommendations and What to Watch Overnight
1. Hourly glucose. When glucose reaches [300], the protocol calls for adding dextrose to the IV fluids and adjusting the insulin rate, to avoid dropping glucose and osmolality too quickly, which can cause brain swelling.
2. Potassium is due at [2000] and every [four] hours. Insulin moves potassium into cells, so it can fall quickly. Protocol replaces it if below [4.0]. Hold the insulin and call if potassium is below [3.3].
3. Sodium and osmolality with the next lab draw; a rapid fall in osmolality should be reported.
4. Neurological checks every [two] hours. Call if she becomes more confused, has a headache or a seizure.
5. Urine output: call if it stays under [30] mL an hour across two consecutive hours; her kidney injury is improving and should continue to.
6. Lung sounds every [four] hours; she has received a large volume of fluid, and crackles or a falling saturation would suggest overload.
7. Metformin is held because of her kidney injury.
8. Fall precautions: bed alarm on, low bed; she tries to get up to use the bathroom.
Call the provider for: glucose below [100] or falling more than [100] per hour; potassium below [3.3]; new neurological change; urine under [30] mL an hour for two hours running; signs of fluid overload.
Why the Report Is Built This Way
SBAR gives both nurses the same structure, so information is less likely to be lost at the shift change (Haig et al., 2006). The recommendations section is the longest because it is what the night nurse will use: trends with targets, timed labs and call parameters, rather than a narrative of the day. The plan follows the medical-surgical text's emphasis on gradual correction of glucose and osmolality and close potassium monitoring in hyperglycemic crises (Harding et al., 2023).
References
Haig, K. M., Sutton, S., & Whittington, J. (2006). SBAR: A shared mental model for improving communication between clinicians. The Joint Commission Journal on Quality and Patient Safety, 32(3), 167-175. https://doi.org/10.1016/S1553-7250(06)32022-3
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.
Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009). Hyperglycemic crises in adult patients with diabetes. Diabetes Care, 32(7), 1335-1343. https://doi.org/10.2337/dc09-9032
NU142 Unit 6 instructions, in plain terms
Unit 6 commonly ends a gastrointestinal or endocrine case with a written handoff rather than an essay, graded on what the next nurse can act on. Prompts usually want a structured report such as SBAR, covering the patient's current situation, relevant background, a focused assessment and recommendations for the next shift. Instructors look for trends with targets rather than isolated numbers, timed tasks the next nurse must complete, specific risks to watch and explicit criteria for calling the provider. The recommendations section is often the longest, since it is what the receiving nurse uses. A brief explanation of the condition helps when its management differs from a similar condition the next nurse might assume.
How the NU 142 Unit 6 example is put together
The report opens with the situation: the patient, her diagnosis and the glucose trend against its target. Background covers her history, admission values, fluid given and how this condition differs from ketoacidosis. The assessment section moves system by system, including current infusion rates, with the highlighted line naming the overnight danger. Eight numbered recommendations follow, from the dextrose switch to fall precautions, then a list of numeric call criteria, with a margin note explaining why numbers replace judgment calls. A closing section explains why SBAR was used and why recommendations dominate, citing the communication model and the medical-surgical text on gradual correction. Each recommendation is numbered so it can be checked off overnight.
NU142 Unit 6 rubric: what earns full points
Handoff reports in NU 142 are assessed on structure, relevance, actionable recommendations and safety. Structure earns credit for a recognized format followed consistently. Relevance points go to including what the next nurse needs and leaving out narrative that does not change care. Actionable recommendations carry the most weight: timed tasks, targets, thresholds and the next steps in the protocol. Safety points require clear call criteria and attention to complications specific to the condition, such as falling potassium during insulin therapy or overly rapid correction. Citing the communication model and clinical guidance in APA 7 supports the choices, and conciseness is valued because handoffs happen under time pressure. A report the next nurse could follow without asking a single question meets the standard.
Common NU142 Unit 6 mistakes, and how to avoid them
Handoff reports often retell the shift in order, leaving the receiving nurse to dig out what matters. Another common gap is giving current values without trends or targets, so the next nurse cannot tell whether things are improving. Some reports say to monitor potassium without giving the threshold for action. Many omit when to call the provider. Lead with the situation and trend, keep background to what explains the plan, assess by system, write recommendations as timed tasks with targets, list protocol steps that come next, name the complications to watch overnight and give numeric call criteria the next nurse can apply without guessing.
Get an NU142 Unit 6 example written to your instructions
Some Unit 6 handoffs follow SBAR, others I-PASS or a unit's own form. Name the format, forward the case and the rubric, and the report follows that format item for item, rationale paragraph included whenever the prompt calls for it. A first custom sample is free of charge. Turnaround runs 24-48h in most cases. 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.
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NU142 Unit 6 questions, answered
Where can I find a free NU142 Unit 6 sample paper?
This page holds the full NU142 Unit 6 SBAR handoff for hyperosmolar hyperglycemic state, with situation, background, assessment, eight recommendations and numeric call criteria, citing three sources. We can write a handoff for the patient in your assignment.
How is hyperosmolar hyperglycemic state different from DKA?
It develops over days of high glucose and fluid loss, producing severe dehydration and high osmolality with little or no ketosis. Diabetic ketoacidosis features significant ketones and acidosis.
Why switch to dextrose-containing fluids at a glucose of 300?
To avoid lowering glucose and osmolality too quickly, which can cause brain swelling. The insulin continues to correct the underlying problem while dextrose slows the fall.
Why watch potassium during insulin therapy?
Insulin moves potassium into cells, so serum potassium can fall quickly. The report sets replacement below 4.0 and a hold-and-call threshold below 3.3.
What makes a handoff actionable in NU142 Unit 6?
Trends with targets, timed tasks such as the next lab draw, specific risks to watch and numeric criteria for calling the provider, so the night nurse knows what to do without interpreting a narrative.