| Course | NU144 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 10 |
| Paper type | Final case study |
| Length | About 870 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BSN (prelicensure) |
| Updated | October 2026 |
Free sample paper for NU144 Unit 10
One Shift, Four Problems in Sequence: A Final Case Study Following a Composite 79-Year-Old Man With Urosepsis From the First Check of the Day to the Evening Handoff, Through Delirium, Hypotension, Kidney Injury and New Atrial Fibrillation
[Student Name]
Purdue University Global
NU144: Medical-Surgical Nursing II
Unit 10 Final Case Study
[Instructor Name]
[Date]
The patient is composite; values and times are bracketed where illustrative, and medical orders are the providers'.
07:00: First Check
[Mr. L.], composite, 79, with type 2 diabetes and an enlarged prostate, was admitted at [0200] with fever and burning urination. Antibiotics started at [0300]. At [0700] he is restless, pulling at his gown, and does not know the date; his daughter says he is normally sharp. Temperature [38.4] C, heart rate [104], blood pressure [118/66], respirations [22], saturation [95] percent. Priority: delirium, a sign of acute brain dysfunction that in an older adult with infection often signals worsening sepsis (Inouye et al., 2014). Actions: a delirium screen, glucose check ([186]), report to the provider, fall precautions, his daughter invited to stay.
10:00: Falling Pressure
Blood pressure [92/50], mean about [64], heart rate [118], lactate [3.1]. Priority shifts to perfusion. The provider is called to the bedside; a [30] mL per kilogram fluid bolus is started, blood cultures were already drawn, and antibiotics are confirmed on time (Cecconi et al., 2018).
Each problem that arrived was a different face of the same infection, and the plan had to change shape four times in one shift.
12:00: Kidneys
Urine output since [0800] totals [60] mL through his catheter. Creatinine [2.1], up from [1.2] at admission. Priority: protecting the kidneys by restoring perfusion; holding metformin and his lisinopril; avoiding contrast and nephrotoxic drugs; hourly urine output. His blood pressure improves to a mean of [70] after fluid, and output rises to [30] mL an hour by [1400].
15:00: A New Rhythm
On the monitor his rhythm becomes irregular at a rate of [148]: new atrial fibrillation, common in sepsis because of inflammation, fever and stress hormones. Blood pressure [98/56]. Priority: rate and its effect on pressure. A 12-lead ECG is obtained, the provider notified, electrolytes checked (potassium [3.4], replaced as ordered), and the fever treated. The rate falls to [112] with these measures and a small dose of a rate-controlling drug chosen with his pressure in mind (Harding et al., 2023).
Communicating With His Daughter
His daughter arrived at [0730] frightened to find her father confused. The nurse explained that sudden confusion is common in older adults with infection, that it usually improves as the infection is treated, and that her presence helps, because a familiar face and voice reduce delirium. She was shown how to reorient him gently, bring his glasses and hearing aid from home and avoid arguing when he was mistaken. At [1000], when his pressure fell and staff gathered at the bedside, one nurse stepped aside to tell her what was happening. At [1500], when the monitor alarmed for the new rhythm, she was told before she had to ask. Keeping her informed at each turn kept her an ally rather than a bystander.
What Was Prevented
None of the four problems became a crisis, and the reason was timing. Because the confusion at [0700] was reported as a sign of worsening infection rather than accepted as normal for his age, the provider saw him early and his lactate was checked. That meant the fall in pressure at [1000] was met by a team already watching. Hourly urine output, started at [1000], showed the kidney injury before his creatinine came back. Continuous monitoring caught the rhythm change within minutes. Each early finding shortened the time to the next response.
Ranking Through the Shift
At [0700], mental status and safety; at [1000], circulation; at [1200], circulation with kidney protection; at [1500], circulation with rhythm. Throughout: infection treated with antibiotics on time. The order changed, but each step followed the same rule: the problem that most threatened perfusion came first.
19:00: Handoff
Situation: urosepsis day one with delirium, hypotension responsive to fluid, kidney injury and new atrial fibrillation, now rate [108] and mean pressure [68]. Background and assessment as above. Recommendations: hourly urine output, call if below [30] mL for two hours; recheck lactate and creatinine at [2200]; continuous monitoring for rhythm; call for mean pressure below [65]; delirium measures overnight, including lights low, glasses on, daughter staying; repeat potassium at midnight.
The Next Morning
By [0700] the next day his temperature was [37.4] C, he knew where he was and his rhythm had returned to normal on its own. His creatinine had fallen to [1.6] and his urine output was steady. His culture grew an organism sensitive to his antibiotic, so no change was needed. The plan turned to recovery: walking with help, restarting home medicines once his kidneys allowed, and teaching him and his daughter the signs of another infection, especially since his enlarged prostate makes infections more likely.
What the Shift Shows
Sepsis rarely presents as one problem. The nurse who recognized new confusion as a warning at [0700] set up the early response that kept the next three problems from becoming a crisis.
References
Cecconi, M., Evans, L., Levy, M., & Rhodes, A. (2018). Sepsis and septic shock. The Lancet, 392(10141), 75-87. https://doi.org/10.1016/S0140-6736(18)30696-2
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.
Inouye, S. K., Westendorp, R. G. J., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922. https://doi.org/10.1016/S0140-6736(13)60688-1
Reading the NU 144 Unit 10 instructions
Unit 10 usually brings the course together in a case study where a patient changes over time and the student must set and reset priorities. Prompts typically ask for an assessment at each point, the priority problem and why, nursing interventions, collaboration with the provider and a handoff at the end. Many ask students to link several problems to one underlying cause. Instructors expect time-stamped reasoning rather than a single static plan, and they want measurable call criteria in the handoff. Family communication is often part of the case. Papers commonly run five to seven pages under headings for each time point, with current sources in APA 7 and a reference list at the end.
Inside the NU144 Unit 10 example
The case is written in time order. At 07:00, Mr. L.'s new confusion is named as a sign of worsening sepsis, citing the Lancet review of delirium, with a glucose check and a report. At 10:00 his pressure falls and the priority shifts to perfusion, with a highlighted line about the plan changing shape four times. Noon brings the kidney injury, with medicines held and hourly output. At 15:00 new atrial fibrillation is traced to sepsis and corrected through its triggers. Sections then cover his daughter, what was prevented and how priorities ranked across the shift. The 19:00 handoff gives numbers for every call, and the next morning shows his recovery.
Where the points sit in the NU144 Unit 10 rubric
Final case rubrics in NU 144 tend to award points for assessment at each stage, prioritization, interventions, clinical reasoning across problems, communication and handoff, and scholarly writing. Assessment points depend on relevant values at every time point. Prioritization is graded on naming the top problem as it changes and explaining why it changed. Intervention points require actions that match each priority. Reasoning points go to linking delirium, low pressure, kidney injury and the new rhythm to the same infection. Communication points reward the family updates and a handoff with numbers the night nurse can act on. Headings for each time point and an APA reference list take the last few points. Papers that show what early action prevented usually earn the highest marks for reasoning.
NU144 Unit 10 help: mistakes that cost points
Final case studies often lose points when the plan stays the same from morning to evening, missing the reprioritization the unit tests. Another common mistake is treating each problem as separate, without linking them to the underlying infection. Some students accept confusion in an older patient as normal and miss the earliest sign. Others write a handoff with no numbers, leaving the next nurse to decide when to call. Write each time point as its own short assessment, name the priority and the reason, act, and show how the previous step changed what you saw next. End with call criteria for every active problem. Check the times are consistent from start to finish.
Get an NU144 Unit 10 example written to your instructions
Sepsis, a bleed, burns or a long lie like this one: any unstable patient can anchor the closing case. Upload it with the required headings, the page limit and its rubric. Those headings are kept, each reassessment sits where the case supplies new data, and the ranking moves as the patient does. First custom sample free, typically back in 24-48h. 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 NU144 papers and BSN samples
- NU144 Unit 1: Discussion Post
- NU144 Unit 2: Septic Shock Case Study
- NU144 Unit 3: Sepsis Concept Map
- NU144 Unit 4: Hypoventilation Care Plan
- NU144 Unit 5: SBAR Escalation Report
- NU144 Unit 6: Oncologic Emergencies Case Study
- NU144 Unit 7: Dialysis Withdrawal Ethics Case
- NU144 Unit 8: Burn Seminar Reflection
- NU144 Unit 9: Comfort Care Plan
- NU143CL Unit 10: Final Rotation Reflection
- NU143 Unit 10: Final Case Study
- NU142CL Unit 10: Final Case Study
- NU142 Unit 10: Final Case Study
NU144 Unit 10 questions, answered
Where can I find a free NU144 Unit 10 sample paper?
The complete NU144 Unit 10 final case study is on this page, following a composite man with urosepsis through one shift of delirium, low pressure, kidney injury and new atrial fibrillation, with a numeric handoff and four sources. Bring your case timeline and we will rank its priorities with you.
Why is new confusion important in an older adult with infection?
Sudden confusion, or delirium, can be the first sign that infection is affecting the brain and worsening. It should be reported, not assumed to be normal for age.
Why does atrial fibrillation appear in sepsis?
Inflammation, fever, stress hormones and electrolyte changes make the heart irritable. Treating those triggers often slows or ends the rhythm.
Why were metformin and lisinopril held in NU144 Unit 10?
With acute kidney injury, metformin can build up and lisinopril can lower kidney blood flow further. Both were held until his kidneys recovered.
What should a handoff include for an unstable patient?
The current problems, recent changes and specific numbers that should prompt a call, such as urine output below 30 mL an hour or a mean pressure below 65.