| Course | NU144 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 4 |
| Paper type | Nursing care plan |
| Length | About 850 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 4
Oxygen Held in a Narrow Band: A Care Plan for a Composite 58-Year-Old Woman With Obesity Hypoventilation Admitted Drowsy With a Carbon Dioxide of 68 and Placed on Bilevel Positive Airway Pressure, Each Intervention Weighed for What It Could Cost
[Student Name]
Purdue University Global
NU144: Medical-Surgical Nursing II
Unit 4 Care Plan
[Instructor Name]
[Date]
The patient is composite; values are bracketed where illustrative, and ventilator and oxygen settings are ordered by the provider and respiratory therapist.
The Patient
[Ms. B.], composite, 58, body mass index [48], admitted after her husband found her hard to wake. Arterial blood gas: pH [7.28], carbon dioxide [68] mm Hg, bicarbonate [32], oxygen [54] mm Hg on room air. Saturation [84] percent. She snores loudly and falls asleep during the day at home. She has never been diagnosed with sleep apnea. Started on bilevel pressure, inspiratory [14] and expiratory [6] cm of water, with oxygen bled in to a target of [88] to [92] percent.
Why Her Carbon Dioxide Is High
In obesity hypoventilation, the weight of the chest wall and abdomen reduces lung volume and makes breathing harder, and the brain's drive to breathe in response to carbon dioxide is blunted. During sleep, especially, breathing becomes too shallow to clear carbon dioxide. Over time the kidneys retain bicarbonate to compensate, which is why her bicarbonate is high, but tonight's acute rise has overwhelmed that compensation and lowered her pH (Masa et al., 2019).
Her low oxygen is real, but the danger tonight is the carbon dioxide, and treating the first carelessly can worsen the second.
Priority One: Impaired Gas Exchange
Goal: pH above [7.35] and carbon dioxide falling, with saturation [88] to [92] percent, within [six] hours. Interventions and their costs:
1. Bilevel pressure as ordered, checking mask fit and leak every hour. Cost if neglected: a large leak reduces the pressure delivered and carbon dioxide stays high. Cost if the mask is overtightened: skin breakdown on the bridge of the nose, a device-related pressure injury (Potter et al., 2023).
2. Oxygen titrated to [88] to [92] percent. Cost if too high: in people whose breathing depends partly on low oxygen and whose ventilation is limited, high oxygen can worsen carbon dioxide retention. Cost if too low: tissue hypoxia.
3. Head of bed at least [30] degrees. Cost if flat: the abdomen pushes up on the diaphragm and worsens ventilation.
4. Repeat blood gas at [one] to [two] hours as ordered. Cost if skipped: no evidence the pressure settings are working.
Priority Two: Risk for Aspiration and Airway Compromise
Interventions: no food or drink by mouth while drowsy on bilevel pressure; watch for vomiting, since a full face mask can trap vomit; keep suction at the bedside. Cost of being too restrictive once she is alert: thirst and distress that make her pull off the mask; a short break for sips, with oxygen in place, may be safer when she is awake.
Priority Three: Risk for Sedation
Avoid sedatives and opioids where possible, since they further blunt her drive to breathe. If she becomes anxious on the mask, coaching and short breaks come before medication. Cost if sedated: carbon dioxide rises and she may stop breathing adequately.
Priority Four: Risk for Skin and Comfort Problems Over Days on the Mask
Bilevel pressure may continue for days, and comfort affects whether she will keep it on. Interventions: humidify the air to prevent dry mouth and nose, rotate between mask types if her skin reddens, provide mouth care every few hours, and plan short supervised breaks for eating once she is alert. Cost if comfort is ignored: she removes the mask at night, her carbon dioxide rises again and the gains of the first day are lost. Cost if breaks are too long or unsupervised: her saturation and ventilation fall while the mask is off. The respiratory therapist and nurse agree on break length and oxygen during breaks, written into the plan so night staff follow the same rules.
Watching for Failure of Noninvasive Support
The plan also names the signs that bilevel pressure is not enough: a rising carbon dioxide or falling pH on the repeat gas, worsening drowsiness, inability to protect her airway or vomiting. Any of these is reported immediately, since intubation may be needed, and delays in recognizing failure worsen outcomes.
Involving Her Husband
Her husband had watched her stop breathing in her sleep for years without knowing it mattered. He was taught how the mask works, why she must not be given sleeping pills, and how to help her keep the mask on when she wakes confused at night. He will be part of the plan at home, where she will likely use bilevel pressure every night.
Evaluation at Six Hours
pH [7.34], carbon dioxide [56], saturation [90] percent, alert enough to answer questions. Mask fit good, small red area on the nose padded. The plan continues, with sleep studies and home bilevel pressure discussed before discharge, and a referral for weight management offered in a way that respects her pace (Harding et al., 2023).
References
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.
Masa, J. F., Pépin, J.-L., Borel, J.-C., Mokhlesi, B., Murphy, P. B., & Sánchez-Quiroga, M. Á. (2019). Obesity hypoventilation syndrome. European Respiratory Review, 28(151), Article 180097. https://doi.org/10.1183/16000617.0097-2018
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.
The Purdue Global NU144 Unit 4 instructions
Unit 4 commonly asks for a care plan for a patient with a respiratory problem, including assessment data, prioritized nursing diagnoses, measurable goals, interventions with rationales and evaluation. Students are expected to explain the physiology behind the main problem and justify the order of priorities. Many prompts ask for safety considerations, such as oxygen targets and sedation risks, and for patient or family teaching. Instructors look for goals with a number and a time frame, and for rationales that explain why an intervention works for this patient rather than for patients in general. Evaluation should report whether each goal was met. Sources must be current and cited in APA 7, with the respiratory guidelines or a review included where relevant.
How this NU144 Unit 4 example is built
The plan opens with Ms. B.'s data, including her blood gas, sleep history and starting bilevel settings. A short section explains why her carbon dioxide is high, citing the European Respiratory Review article, with a highlighted line on the danger of treating oxygen carelessly. Priority one, impaired gas exchange, sets a measurable goal and four interventions, each with its cost if neglected or overdone. Priorities two and three cover aspiration and sedation, and priority four covers skin and comfort over several days. A section lists the signs that bilevel support is failing. Her husband's teaching follows, and the six-hour evaluation reports pH, carbon dioxide, saturation and skin, with a plan for discharge.
NU144 Unit 4 rubric: what earns full points
Care plan rubrics in this course usually assign points to assessment data, nursing diagnoses, goals, interventions with rationales, evaluation and APA format. Assessment points need relevant data, such as blood gas values and history, rather than everything known about the patient. Diagnosis points reward priorities in a defensible order. Goal points depend on measurable targets with times, such as a pH above 7.35 within six hours. Interventions and rationales carry the most weight and must be specific to her condition, including why oxygen is limited. Evaluation points go to reporting results against each goal. Plans that consider risks of the interventions themselves usually score higher. Formatting and references count toward the final points.
Common NU144 Unit 4 mistakes, and how to avoid them
Respiratory care plans often lose points by setting oxygen goals at 95 percent or higher for every patient, which is unsafe in hypoventilation. Another frequent error is listing interventions without rationales tied to the patient, such as "monitor vital signs" with no reason or frequency. Some plans ignore the mask itself, missing skin injury and comfort problems that make patients remove it. Others forget to name what would signal that noninvasive support is failing. Begin with the blood gas, explain why it is abnormal, set measurable goals, then write each intervention with its reason and its risk. Include the family when they will continue care at home. Report evaluation against the goals you set at the start.
Get an NU144 Unit 4 example written to your instructions
Respiratory failure cases vary: a flare of chronic lung disease, pneumonia on a ventilator, a patient weaning, a mask like this one. For Unit 4, pass along the case, the column template, any approved diagnosis list and the rubric, after which the plan ranks that patient's own problems. Other formats are followed as given. Free as a first custom sample; 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.
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NU144 Unit 4 questions, answered
Where can I find a free NU144 Unit 4 sample paper?
This page holds the full NU144 Unit 4 care plan for a composite woman with obesity hypoventilation on bilevel pressure, with four priorities, the cost of each intervention, teaching and a six-hour evaluation, citing three sources. Send us your patient's data if you want a plan drafted for it.
Why is oxygen kept at 88 to 92 percent in hypoventilation?
In some patients with limited ventilation, high oxygen can worsen carbon dioxide retention. A narrow target gives enough oxygen while avoiding that rise.
Why is her bicarbonate high?
Her kidneys have retained bicarbonate over time to balance chronically high carbon dioxide. Tonight's sudden rise overwhelmed that compensation, which is why her pH is low.
Why are sedatives avoided in NU144 Unit 4?
Sedatives and opioids blunt the drive to breathe, which is already weak in obesity hypoventilation. Coaching and short breaks come first if she is anxious on the mask.
What are signs that bilevel pressure is failing?
A rising carbon dioxide or falling pH on the repeat gas, increasing drowsiness, vomiting or an inability to protect the airway. These are reported at once because intubation may be needed.