| Course | NU144 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 2 |
| Paper type | Case study analysis |
| Length | About 840 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 2
Coping at Arrival, Running Out at Three Hours: A Case Study Analysis of Septic Shock From a Perforated Sigmoid Diverticulum in a Composite 71-Year-Old Woman, Read Before and After Fluid Resuscitation
[Student Name]
Purdue University Global
NU144: Medical-Surgical Nursing II
Unit 2 Case Study Analysis
[Instructor Name]
[Date]
The patient is composite; values are bracketed where illustrative, and treatment decisions belong to the medical and surgical teams.
The Patient at Arrival
[Mrs. G.], composite, 71, has had left lower abdominal pain for three days, worse today, with fever and vomiting. Her abdomen is rigid. Arrival findings: temperature [38.9] C, heart rate [118], respirations [26], blood pressure [102/64], mean arterial pressure about [77], saturation [94] percent on room air. Skin warm and flushed. Alert but anxious. Lactate [3.4] mmol/L, white count [19,800]. A scan shows free air and fluid near a perforated sigmoid diverticulum.
Reading Her as Compensated
At arrival her body is coping. Infection releases mediators that dilate blood vessels and make them leak, so blood pools and fluid shifts out of the circulation. Her body compensates: the sympathetic nervous system raises her heart rate and breathing, and the kidneys and hormones work to hold pressure. Her blood pressure is still acceptable because of that effort, but her raised lactate shows tissues are already short of oxygen. This is sepsis with signs of organ stress, and she meets common criteria for sepsis-related organ dysfunction (Cecconi et al., 2018).
The First Three Hours
Blood cultures were drawn and broad-spectrum antibiotics started within the first hour. She received [30] mL per kilogram of balanced crystalloid, about [2] L, over three hours, with surgery consulted for source control.
Reading Her at Three Hours
Heart rate [128], respirations [30], blood pressure [84/50], mean arterial pressure about [61], saturation [91] percent on [3] L. Urine output [15] mL over the last hour. She is now confused, asking where she is. Skin mottled at the knees. Lactate [4.6].
The fluid went in and the pressure went down; that is the moment compensation ran out.
Her pressure has fallen below a mean of 65 despite adequate fluid, her lactate has risen, her urine output has dropped and her mental status has changed. These findings define septic shock: low blood pressure requiring vasopressors to keep a mean arterial pressure of at least 65, with a raised lactate despite fluid (Cecconi et al., 2018). Her compensatory responses can no longer keep up with the vasodilation and leak. An early warning score at this point would be in its highest band, a level associated with sharply higher short-term risk (Smith et al., 2013).
Why Fluid Alone Was Not Enough
Fluid replaces lost volume, but in septic shock the vessels stay dilated and leaky, so much of the fluid leaves the circulation. Continuing to give fluid without a response risks overload, especially in an older woman; her falling saturation suggests fluid may already be reaching her lungs. At this point vasopressors to restore vessel tone become the priority, usually through a central line or a large, well-functioning peripheral line with close monitoring.
Nursing Actions at Three Hours
Call for urgent bedside review and escalate per protocol. Prepare and start norepinephrine as ordered, titrated to a mean arterial pressure of at least 65. Monitor blood pressure continuously or every few minutes, urine output hourly with a catheter and mental status frequently. Reassess lung sounds before any more fluid. Prepare her for urgent surgery to control the source. Keep her and her daughter informed in short, clear terms, and make sure her daughter knows where to wait during surgery and who will update her (Harding et al., 2023).
What the Nurse Watched Between the Two Readings
The three hours between arrival and decompensation were not a waiting period. The nurse recorded vital signs every fifteen minutes during the fluid boluses, listened to her lungs after each liter, placed a urinary catheter to measure output hourly and checked her mental status with each set. The trend was visible before the three-hour mark: her heart rate rose from [118] to [124] after the first liter instead of falling, and her urine output stayed under [20] mL an hour. A patient who responds to fluid usually shows a falling heart rate and rising urine output within the first liter. Her lack of response was itself a finding, and reporting it at the second hour, rather than waiting for the planned reassessment, allowed vasopressors to be prepared before her pressure dropped further.
Priorities
Circulation and perfusion first, through vasopressors and source control; then breathing, watching for fluid in the lungs; then infection, with antibiotics on time; then her confusion and safety.
Outcome
After norepinephrine and emergency removal of the perforated segment with a temporary colostomy, followed by a night in intensive care, her mean arterial pressure reached [70], her lactate fell to [2.1] by the next morning and her confusion cleared over two days. She returned to the surgical unit on day three, where the plan shifted to stoma teaching, mobility and preventing a second infection.
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.
Smith, G. B., Prytherch, D. R., Meredith, P., Schmidt, P. E., & Featherstone, P. I. (2013). The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation, 84(4), 465-470. https://doi.org/10.1016/j.resuscitation.2012.12.016
What the NU144 Unit 2 assignment asks for
Unit 2 centers on shock, and the case usually asks students to classify it, explain the physiology, separate compensated from decompensated stages and set nursing priorities with interventions. Students are given a patient at more than one point in time and asked what changed and why. Questions often require the nurse's response to a patient who does not respond to fluid, the criteria that define septic shock and the order of priorities. Instructors want physiology explained in the student's own words rather than copied definitions. Each claim about diagnosis or treatment needs a current source. A short outcome or evaluation section is commonly expected. Answers are normally written under headings that follow the case questions, and length often runs four to six pages.
Inside the NU144 Unit 2 example
The analysis begins with Mrs. G. at arrival, giving her vital signs, lactate, white count and scan result. A section reads her as compensated, explaining vasodilation and capillary leak and naming the raised lactate as the hidden cost. The first three hours are summarized next, with cultures, antibiotics and a weight-based fluid bolus. Her three-hour findings follow, with the highlighted line that the fluid went in and the pressure went down. A separate section explains why fluid alone could not restore her pressure. Nursing actions, priorities and outcome come after, and a closing section describes how the nurse noticed her poor response to the first liter. Three sources support the reasoning, including the Lancet review of sepsis.
NU144 Unit 2 rubric: what earns full points
Case study rubrics in this course usually award points for accurate identification of the problem, explanation of physiology, prioritization, appropriate interventions, evaluation and APA format. Identification points here depend on applying the definition of septic shock correctly, with both the vasopressor requirement and the lactate. Physiology points go to linking each finding to a failing compensation rather than listing symptoms. Prioritization is graded on a clear order with reasons, and interventions must match those priorities, including monitoring frequency. Evaluation credit comes from expected changes in measurable values. Writing and citation points reward clear headings and correctly formatted references. Instructors also reward attention to the family. The strongest papers show their reasoning at each step.
NU144 Unit 2 help: mistakes that cost points
Shock analyses often lose points by naming the type of shock without explaining why the body reached it. Another common mistake is recommending more fluid after the patient has failed to respond, which ignores the risk of fluid in the lungs. Some students describe warm, flushed skin as a good sign, when in early sepsis it reflects dilated vessels. Others omit the lactate or misstate the septic shock definition. Read the case at each time point separately, list what each body system is doing to compensate, identify the moment compensation fails and set priorities from there. Use measurable targets, such as a mean arterial pressure of 65, for every intervention. Check that each reference is current enough for the course.
Get an NU144 Unit 2 example written to your instructions
Sepsis cases differ by source: urine, lungs, skin, a line, an abdomen. Whatever source drives the case your section posted, it can be forwarded as it stands, numbered questions and rubric too, with the edition of the sepsis guideline the course cites. Every figure in the analysis then comes from that patient. The first custom sample carries no charge and arrives 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 3: Concept Map
- NU144 Unit 4: Care Plan
- NU144 Unit 5: Escalation Report
- NU144 Unit 6: Case Study Analysis
- NU144 Unit 7: Ethics Case Analysis
- NU144 Unit 8: Seminar Reflection
- NU144 Unit 9: Comfort Care Plan
- NU144 Unit 10: Final Case Study
- NU143CL Unit 2: Observation Analysis
- NU143 Unit 2: Case Study Analysis
- NU142CL Unit 2: Patient Workup
- NU142 Unit 2: Case Study Analysis
NU144 Unit 2 questions, answered
Where can I find a free NU144 Unit 2 sample paper?
This page shows a complete NU144 Unit 2 case study analysis of septic shock, comparing a composite patient at arrival and after three hours of fluid, with priorities, actions, outcome and three sources. We can walk through your own case questions with you.
When did Mrs. G. move from sepsis to septic shock?
At three hours, after about 30 mL per kilogram of fluid, her mean pressure sat near 61 and her lactate had climbed to 4.6. Needing a vasopressor to reach a mean of 65 despite that volume is what marks the shift.
Why does fluid not fix septic shock?
Infection leaves blood vessels dilated and leaky, so much of the fluid moves into tissues. After the first liters, vessel tone is restored with vasopressors rather than more volume.
What does a rising lactate mean in NU144 Unit 2?
It shows tissues are short of oxygen and switching to less efficient energy production. A lactate that rises despite treatment signals that perfusion is still failing.
What did the nurse notice before the patient decompensated?
Her heart rate rose instead of falling after the first liter, and her urine output stayed low. A patient who responds to fluid usually shows the opposite.