| Course | NU144 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 5 |
| Paper type | Escalation report (SBAR) |
| Length | About 600 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BSN (prelicensure) |
| Updated | October 2026 |
Free sample paper for NU144 Unit 5
Breathless Ninety Minutes Into the Second Unit, Pressure Rising: An Escalation Report Scripting the Call for a Composite 81-Year-Old Woman With Suspected Transfusion-Associated Circulatory Overload, So the Listener Knows Within a Minute What Is Asked
[Student Name]
Purdue University Global
NU144: Medical-Surgical Nursing II
Unit 5 Escalation Report
[Instructor Name]
[Date]
The patient is composite; values are bracketed where illustrative, and the facility's transfusion reaction policy governs.
Before the Call
[Mrs. O.], composite, 81, whose heart failure leaves her pumping about [35] percent per beat, was receiving two units of red cells for a hemoglobin of [6.9] after a slow gastrointestinal bleed. The first unit ran over three hours without problems. Ninety minutes into the second, she said she could not catch her breath. The nurse stopped the transfusion, kept the IV line open with saline per policy, sat her upright, raised her oxygen as ordered and checked her vital signs: respirations [30], heart rate [108], blood pressure [172/94] up from [138/76] before the transfusion, saturation [87] percent on [4] L, temperature [37.1] C, unchanged. Crackles were heard at both bases, and her neck veins were full.
The Call, Word for Word
Situation: "This is [name], nurse on 5 West, calling about Mrs. O. in room 12. She's acutely short of breath ninety minutes into her second unit of red cells. I've stopped the transfusion. Her sats are 87 on 4 liters, respirations 30, and her pressure has gone up to 172 over 94." Background: "She's 81, heart failure with an EF of 35. Hemoglobin was 6.9 from a slow GI bleed. The first unit went in over three hours with no problems. She's had about 1,500 mL of IV fluid and blood since yesterday." Assessment: "She has new crackles at both bases and distended neck veins. No fever, no rash, no hives. I think this is fluid overload from the transfusion, transfusion-associated circulatory overload." Recommendation: "Please come to the bedside now, and I'm asking whether you want to give IV furosemide. I've started the transfusion reaction workup per policy and kept the bag."
Her pressure went up, not down, and that single direction separated overload from the lung injury and allergic reactions that usually lower it.
Why the Words Were Chosen
The situation names the problem, the timing and the most worrying numbers in the first sentence. The background gives only what explains the problem: heart failure, the volume already given and the first unit's uneventful course. The assessment states the nurse's conclusion and the findings that support it, including what was absent, fever and rash, which argue against other reactions. The recommendation asks for two specific things, a bedside review and a decision on a diuretic. Structured communication gives both clinicians the same frame and reduces the chance that the request is lost (Haig et al., 2006).
Why Overload Was Suspected
Transfusion-associated circulatory overload causes breathlessness, crackles, rising blood pressure and full neck veins from too much volume, and older patients with heart failure are at highest risk. Transfusion-related acute lung injury causes similar breathing problems but usually with fever and low blood pressure, and allergic reactions bring hives or wheezing (Semple et al., 2019).
Outcome
The provider came within five minutes, ordered furosemide [40] mg IV and a chest X-ray. Within an hour her saturation was [94] percent on [3] L. The rest of the second unit was not given that night, and future units were ordered at a slower rate with a diuretic between them, a common prevention approach for patients at risk (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.
Semple, J. W., Rebetz, J., & Kapur, R. (2019). Transfusion-associated circulatory overload and transfusion-related acute lung injury. Blood, 133(17), 1840-1853. https://doi.org/10.1182/blood-2018-10-860809
What the NU144 Unit 5 assignment asks for
Unit 5 commonly asks students to write an escalation or handoff in a structured format, usually SBAR, for a patient who has changed suddenly. The prompt typically wants the actions taken before calling, the exact wording of each section and a short defense of every detail kept in or cut. Instructors expect the situation to state the problem and the most concerning numbers in the opening sentence, a background limited to relevant history, an assessment that gives the nurse's conclusion and a recommendation that asks for something specific. Many prompts also ask students to explain the clinical reasoning behind the conclusion. The written part is short, often two to three pages. Sources should support both the communication tool and the clinical problem.
How this NU144 Unit 5 example is built
The report opens with what happened before the call: the transfusion stopped, the line kept open with saline, Mrs. O. sat upright and oxygen raised, with her vital signs and exam. The call follows as four labeled lines in the nurse's own words, ending with a request for a bedside review and a decision on furosemide. A highlighted sentence points to the direction of the blood pressure as the deciding clue. The next section explains why each part of the call was worded the way it was, citing the SBAR paper. A short section separates overload from other reactions using the Blood review. The outcome reports the response to furosemide and the prevention plan.
NU144 Unit 5 rubric: what earns full points
Communication assignments in NU 144 are generally scored on structure, clinical accuracy, prioritization of information, clarity of the request and supporting rationale. Structure points depend on all four SBAR parts in order. Clinical accuracy rewards correct values and a defensible conclusion about the cause. Prioritization is graded on whether the most urgent information comes first and whether irrelevant history has been left out. The recommendation earns points when it asks for a specific action and time frame. Rationale points go to explaining choices with sources in APA 7. Including pertinent negatives, such as no fever and no rash, usually lifts the assessment score. Brevity counts in this unit as much as completeness does.
NU144 Unit 5 help: mistakes that cost points
Escalation reports often lose points with an opening that gives the room number and diagnosis but not the problem. Another frequent mistake is a background that recites the whole history, burying the details that matter. Some students leave the assessment vague, saying the patient "doesn't look good" without a conclusion. Others end without a request, leaving the listener to decide what is wanted. Stop the transfusion and stabilize first, then write the situation in one sentence with the worst numbers, keep background to what explains the problem, state what you think is happening and ask for something specific. Read it aloud and time it. A good call is understood in under a minute.
Get an NU144 Unit 5 example written to your instructions
The Unit 5 escalation in your section may concern a transfusion, a bleed after surgery, a falling level of consciousness or failing breathing. Forward that scenario with the reporting format the course names, ISBAR, SBAR or its own, and the marking rubric; script and note are then built to that format. First custom sample, no charge; typical return 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 5 questions, answered
Where can I find a free NU144 Unit 5 sample paper?
A complete NU144 Unit 5 escalation report sits on this page, scripting an SBAR call for suspected transfusion overload in a composite 81-year-old woman, with the actions before the call, the reasoning and three sources. Your own scenario can be scripted the same way on request.
What should a nurse do first in a suspected transfusion reaction?
Stop the transfusion, keep the IV line open with saline, check vital signs and assess the patient, then notify the provider and follow the facility's reaction policy, keeping the bag and tubing.
How is circulatory overload told apart from lung injury?
Overload usually raises blood pressure and fills the neck veins, while lung injury from a transfusion more often brings fever and low blood pressure. Allergic reactions bring hives or wheezing.
Why include negative findings in the NU144 Unit 5 SBAR?
Stating that there was no fever, rash or hives lets the listener see why other reactions are less likely, so the nurse's conclusion can be weighed quickly.
How long should an SBAR call take?
Usually under a minute for the first part. The listener should know the problem, why it matters and what is being asked before any details are discussed.