| Course | NU144 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 9 |
| Paper type | Comfort care plan |
| Length | About 860 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 9
Every Symptom With a Measure and a Reason: A Comfort Care Plan for a Composite 84-Year-Old Man With End-Stage Heart Failure and an Implanted Defibrillator Who Has Chosen, With His Wife, Care Aimed at Comfort
[Student Name]
Purdue University Global
NU144: Medical-Surgical Nursing II
Unit 9 Comfort Care Plan
[Instructor Name]
[Date]
The patient and family are composite; values and doses are bracketed where illustrative, and orders are the provider's.
The Patient and His Goals
[Mr. H.], composite, 84, a retired carpenter, now has a heart that pumps out only about [15] percent of its volume per beat despite full treatment. He has been admitted three times in two months. He and his wife, married sixty years, decided with his cardiologist to stop aiming at prolonging life and to focus on comfort, at home if possible. He has an implanted cardioverter-defibrillator. His stated goals: to breathe easier, to sleep, and to not be shocked.
Symptom One: Breathlessness
Measure: his own rating from 0 to 10 every [four] hours and with activity; breathing rate; ability to speak in full sentences. Interventions: sitting upright with pillows or in a recliner; a fan directed at his face; low-dose oral morphine as ordered, which reduces the sensation of breathlessness, with sedation checked after doses (Pasero & McCaffery, 2011); continuing diuretic as ordered if it eases his breathing without causing distress; oxygen only if it helps him, not to reach a saturation number. Reason: in advanced heart failure, low-dose opioids and simple measures such as a fan ease breathlessness, and comfort, not numbers, is the goal. Evaluation: rating from [8] to [4] within a day.
Symptom Two: Edema and Skin
Measure: leg swelling, skin integrity and his discomfort. Interventions: legs elevated on pillows, gentle skin care, pressure-relieving mattress, loose socks. Reason: swollen skin breaks down easily and becomes painful.
Symptom Three: Anxiety and Sleep
Measure: his report and his wife's observation of restlessness; hours slept. Interventions: a quiet room, his wife allowed to stay overnight, familiar music, reassurance; a low dose of an anti-anxiety medicine as ordered if needed. Reason: anxiety worsens breathlessness, and breathlessness worsens anxiety.
The Defibrillator
An implanted defibrillator delivers shocks to stop dangerous rhythms. In someone dying of heart failure, it can deliver repeated painful shocks in the last days without changing the outcome. Turning off the shock function does not cause death and does not stop the heart; it prevents an intervention that no longer serves his goals. Studies found that deactivation was often not discussed with patients near the end of life and that many patients received shocks in their final days (Goldstein et al., 2004). His cardiologist discussed it with him and his wife, they chose deactivation, and the device clinic turned off the shock therapy, documented in the chart.
Turning off the shock function did not end his life; it removed the possibility that his last minutes would include being shocked.
Symptom Four: Fatigue, Appetite and Mouth Comfort
Measure: his report of tiredness and what he wants to eat; mouth dryness. Interventions: food and drink of his choosing in small amounts, without pressure to finish; frequent mouth care with swabs and lip balm; grouping care so he can rest. Reason: appetite falls in advanced heart failure, and forced eating adds distress without benefit; a dry mouth from breathing through it and from medicines is a common, easily relieved discomfort.
Anticipating the Last Days
The plan also prepares for symptoms likely near death so they can be treated quickly at home: noisy breathing from secretions, which is eased by repositioning and, if ordered, medicine to dry secretions; restlessness, which is assessed for a full bladder or pain before medicine is given; and increasing breathlessness, for which the morphine dose can be adjusted by the hospice team. His wife is told that noisy breathing is usually more distressing to watch than to experience, and that she can call the hospice nurse at any time. Mr. H. asked for his pastor to visit, and the visit was arranged for the next morning.
Stopping What No Longer Helps
Daily blood draws, routine vital signs every four hours at night and strict fluid limits were reviewed with the team. Blood draws were stopped, vital signs reduced to what guides comfort, and fluid limits relaxed so he could drink when thirsty. Each change was explained to him and his wife, so that stopping a routine would not feel like being forgotten.
Supporting His Wife
She was afraid that stopping treatment meant giving up on him. The nurse explained that comfort care is active care, focused on what matters to him now. She was shown how to help him sit up, how to use the fan and how to give liquid morphine at home, and she was told what changes to expect as he nears death and whom to call at any hour.
Evaluation and Transition
By day two his breathlessness was [3] to [4], he slept six hours and his anxiety had eased. He went home with hospice on day three, with medicines, a hospital bed and nightly visits planned (Harding et al., 2023).
References
Goldstein, N. E., Lampert, R., Bradley, E., Lynn, J., & Krumholz, H. M. (2004). Management of implantable cardioverter defibrillators in end-of-life care. Annals of Internal Medicine, 141(11), 835-838. https://doi.org/10.7326/0003-4819-141-11-200412070-00006
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.
Pasero, C., & McCaffery, M. (2011). Pain assessment and pharmacologic management. Mosby.
What the NU144 Unit 9 assignment asks for
Unit 9 typically asks for a plan of care for a patient at the end of life or receiving palliative care, with symptoms assessed, interventions chosen, rationales given and outcomes evaluated. Students are expected to treat comfort with the same rigor as curative care, using measures such as symptom ratings. Many prompts ask students to address the patient's stated goals, family support and decisions about treatments or devices. Instructors look for interventions that include both medicines and nondrug measures, and for evaluation in the patient's own terms. Questions about stopping routine care, and how to explain it, often appear. Any claim about medicines or devices needs a recent source, listed in APA 7 at the end.
Inside the NU144 Unit 9 example
The plan opens with Mr. H., his heart function, his admissions and his three goals in his own words. Breathlessness comes first, with a rating scale, positioning, a fan, low-dose morphine and oxygen only if it helps, supported by the Pasero and McCaffery text. Edema and skin, then anxiety and sleep, follow in the same four-part form. The defibrillator section explains deactivation and cites the Goldstein study, with a highlighted line on what turning off the shocks meant. Fatigue, appetite and mouth comfort are treated next. Sections then anticipate the last days, stop blood draws and night vital signs, and prepare his wife. Evaluation reports his ratings and sleep before discharge.
Where the points sit in the NU144 Unit 9 rubric
Palliative care plans in NU 144 are usually scored on assessment of symptoms, appropriateness of interventions, rationales, attention to patient goals and family, evaluation and writing. Assessment points depend on measures for each symptom, such as a 0 to 10 rating, rather than general statements. Intervention points reward a mix of nondrug and drug measures matched to his symptoms. Rationales are graded on explaining why each measure fits end-stage heart failure. Goal and family points go to plans built around what he and his wife want. Evaluation earns credit when it reports change in his own ratings. Plans that address the defibrillator and stopping routine care usually score in the top band. APA format and references count as well.
Common NU144 Unit 9 mistakes, and how to avoid them
Comfort care plans often lose points when interventions are vague, such as "promote comfort," with no measure or reason. Another common mistake is setting goals by monitor values, such as a saturation target, when the patient's own rating is the outcome that matters. Some students leave out the defibrillator, missing a decision that families often misunderstand. Others forget the family's fears or the routines that should stop. List each symptom, give it a measure, choose drug and nondrug interventions, explain the reason and evaluate against his rating. Address devices and routines directly. Explain each change to the family, so stopping a routine is not mistaken for neglect.
Get an NU144 Unit 9 example written to your instructions
Comfort cases in Unit 9 may involve cancer, lung disease, dementia or failing organs like this one. Forward that case with the plan template and grading criteria, naming any tool the course uses for rating symptoms. The keep, stop and start lists, the ranking and the family section all follow that case. First custom sample free; 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 9 questions, answered
Where can I find a free NU144 Unit 9 sample paper?
This page holds the full NU144 Unit 9 comfort care plan for a composite man with end-stage heart failure, with a measure and reason for each symptom, defibrillator deactivation, family support and four sources. Share your patient's symptoms and a plan can be drafted around them.
Does turning off a defibrillator cause death?
No. It stops the device from delivering shocks but does not stop the heart. It prevents painful shocks near death that would not change the outcome.
Why is morphine used for breathlessness in NU144 Unit 9?
Low doses reduce the sensation of breathlessness in advanced heart failure. Doses are small, and sedation is checked after each one.
Why is oxygen given only if it helps?
In comfort care the goal is relief, not a saturation number. Oxygen is kept if it eases his breathing and stopped if it brings no benefit or bothers him.
Why stop blood draws and night vital signs?
They no longer guide decisions that serve his goals and disturb his rest. Stopping them, with an explanation, lets care focus on comfort.