NU144CL Unit 6 Deterioration Write-Up Example

Course	NU144CL Medical-Surgical Nursing II Clinical
Unit	Unit 6
Paper type	Deterioration write-up
Length	About 920 words, 6 pages double-spaced
Format	APA 7 student paper
School	Purdue University Global
Program	BSN (prelicensure)
Updated	October 2026

Free sample paper for NU144CL Unit 6

His Voice Changed Before Anything Was Measured: A Deterioration Write-Up of a Composite 74-Year-Old Man Developing a Neck Hematoma Five Hours After Carotid Endarterectomy While His Saturation Stayed Normal

[Student Name]

Purdue University Global

NU144CL: Medical-Surgical Nursing II Clinical

Unit 6 Deterioration Write-Up

[Instructor Name]

[Date]

The patient is composite; values and times are bracketed where illustrative, and every medical and surgical decision is attributed to the provider who made it. The student worked under the assigned nurse and instructor.

What this part is doingThe write-up is built on the order of noticing, measuring and telling, which is the sequence this unit grades.

The Patient

[Mr. N.], composite, 74, retired electrician, had a left carotid endarterectomy at [0800] to remove plaque narrowing the artery by about [80] percent after two brief episodes of weakness in his right hand. He arrived on the unit at [1030], with orders for neurological checks, blood pressure kept below [160] systolic, and neck and wound checks every hour. He takes aspirin and a statin, and received heparin during surgery. At [1100] he was talking easily, his neck was flat with a clean dressing and his saturation was [96] percent on room air.

Timed Record, 1300 to 1340

[1300]. Heard: his voice is lower and slightly muffled; he clears his throat twice while asking for water. Measured: saturation [96] percent, respirations [18], blood pressure [148/80], heart rate [82]. Done: I looked at the neck closely and thought the left side was fuller than the right. I asked him to swallow a sip; he said it felt "tight." I marked the edge of the swelling with a skin pen and noted the time beside it. [1310]. Heard: he stops mid-sentence to swallow; his voice is hoarse. Measured: saturation [95] percent, respirations [20], blood pressure [156/84]. Neck: swelling extends past the pen line by about [1] cm; dressing dry. Done: I told my assigned nurse at [1311]: "Mr. N.'s voice has changed and his neck swelling has grown past the mark in ten minutes." [1320]. Heard: a faint high-pitched sound on breathing in when he lies back; he prefers to sit forward. Measured: saturation [95] percent, respirations [24], heart rate [96]; trachea appears shifted slightly to the right. Done: my nurse assessed him, raised the head of the bed fully and called the surgeon and the rapid response team. Oxygen was placed. The staple and suture removal kit, kept at the bedside per unit protocol after neck surgery, was checked. [1340]. Measured: saturation [94] percent, respirations [26]. Done: the surgeon assessed him at the bedside and [decided to return him to the operating room to evacuate a hematoma]; anesthesia was notified to manage the airway.

His oxygen was fine because air was still getting past; the swelling was narrowing the space, and the voice was the first thing to tell us.

Why a Normal Saturation Misled

Oxygen saturation measures how much of the blood's hemoglobin is carrying oxygen. A patient whose airway is narrowing can keep a normal saturation until the narrowing is severe, because he breathes harder and faster to move enough air. The saturation stays reassuring until compensation gives out, and then it can fall quickly. For a patient with a growing neck hematoma, the signs that matter come earlier: changes in voice, difficulty swallowing, a sense of tightness, visible swelling and noisy breathing. A hematoma after carotid surgery can compress the airway and may need urgent return to the operating room (Welling et al., 1989).

What this part is doingThe paragraph explains the physiology of why saturation lags, so the misleading number becomes a lesson rather than a surprise.

What I Noticed First, and Why It Mattered

I heard the change before I measured anything. His voice at [1100] was clear, and at [1300] it was muffled. I almost dismissed the throat clearing as a dry mouth after anesthesia. What made me look was that he cleared his throat twice in one sentence. Marking the edge of the swelling turned an impression into something measurable, so ten minutes later I could say it had grown, rather than "I think it looks bigger." Swallowing and voice are airway findings, not comfort complaints, after neck surgery (Harding et al., 2023).

Why the Report Was Worded the Way It Was

My report to my nurse at [1311] gave the change and the evidence in one sentence: the voice had changed and the swelling had passed the mark within ten minutes. I did not lead with his saturation, because it was normal and would have made the problem sound small. Structured communication helps the listener hear the problem first and the supporting data second (Haig et al., 2006). My nurse said afterward that "past the mark in ten minutes" was what made her come at once.

What this part is doingLeaving the normal saturation out of the first sentence is explained as a choice, which shows judgment about what the listener needs to hear first.

Decisions and Who Made Them

I noticed, measured and reported. My assigned nurse assessed him, raised the head of the bed and called the surgeon and rapid response team. The rapid response nurse placed oxygen and prepared for airway problems. The surgeon decided to return him to the operating room, and anesthesia managed his airway there. I stayed with him, kept him sitting up and told him what was happening in short sentences, since he was frightened and talking made his breathing harder.

Outcome

A hematoma was evacuated and a small bleeding point tied off. He returned to the unit that evening with clear speech, and his neurological checks remained normal throughout.

What I Will Do Next Time

Listen to the voice and ask about swallowing at every neck check after neck surgery, not only look at the dressing. Mark any swelling with the time. Report change over time in the first sentence, and never let a normal saturation reassure me when the airway is the concern.

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.

Welling, R. E., Ramadas, H., & Gansmuller, K. J. (1989). Cervical wound hematoma after carotid endarterectomy. Annals of Vascular Surgery, 3(3), 229-231. https://doi.org/10.1016/S0890-5096(07)60029-6

What the NU144CL Unit 6 assignment asks for

Unit 6 often asks students to write up a patient whose condition worsened during a clinical shift, with the order of noticing, measuring, reporting and responding made clear. Prompts usually request a timed account, the early cues, the assessment data that confirmed them, the report and the response, plus reflection on what the student noticed first. Instructors expect students to attribute medical decisions to the provider and to describe their own role accurately. They also look for an explanation of why a normal-looking value can be misleading. Many sections want the report wording included. Papers run three to four pages, written in the first person for the reflective parts, with sources listed in APA 7.

Inside the NU144CL Unit 6 example

First comes Mr. N.: his surgery, his orders and a baseline check at 1100. The timed record follows in four entries, each split into what was heard, measured and done, ending with the surgeon's decision. A highlighted line explains why oxygen stayed normal while the airway narrowed. The next section explains saturation lag and cites a study of neck hematoma after carotid surgery. A section on what was noticed first describes the throat clearing and the pen mark. The report's wording is explained with the SBAR paper. Decisions are attributed to their owners, the outcome is stated briefly and the paper ends with three changes to practice.

Reading the NU144CL Unit 6 grading rubric

Deterioration write-ups in NU 144CL are usually scored on recognition of early cues, quality of assessment, timeliness and clarity of reporting, accurate description of roles, clinical reasoning and writing. Recognition points depend on naming the first cue and when it appeared. Assessment points reward turning an impression into a measurement, such as marking swelling with a time. Reporting points go to a report given promptly and worded so the listener grasps the problem first. Role points require decisions credited to the nurse, surgeon and team accurately. Reasoning points are earned by explaining why normal values misled. Writing points cover organization, the timed format and correct citations.

NU144CL Unit 6 help: mistakes that cost points

Write-ups of a decline often lose points by narrating events without times, which hides how quickly the patient changed. Another common error is presenting medical decisions as the student's own. Some students lead their report with normal vital signs, making the problem sound small, or describe a cue without saying how it was measured. Others skip the physiology of why the monitor stayed reassuring. Record each entry with a time, separate what you heard from what you measured, report change over time first, credit each decision to the person who made it and explain the mechanism behind the misleading number. Finish with changes you will make at the next neck check, and keep the patient's own words where they were the first clue.

Get an NU144CL Unit 6 example written to your instructions

For the Unit 6 write-up, one sentence on how your patient's decline began and who noticed it is enough, with identifiers stripped and the assignment instructions attached. The model tells a composite decline of that kind in timed rows, values bracketed, decisions attributed. Your own sequence of events is yours to record. A first custom sample is free; turnaround 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 NU144CL papers and BSN samples

NU144CL Unit 6 questions, answered

Where can I find a free NU144CL Unit 6 sample paper?

This page holds the full NU144CL Unit 6 deterioration write-up for a composite man with a neck hematoma after carotid surgery, with a timed record, the reasoning behind the report and three sources. We can help you write up the change you saw on your own shift.

Why can oxygen saturation stay normal while an airway narrows?

The patient breathes harder and faster to move enough air, so oxygen levels hold until that effort fails. By the time saturation falls, the airway may be severely narrowed.

What are signs of a neck hematoma after carotid surgery?

Growing neck swelling, a change in voice, difficulty or tightness with swallowing, noisy breathing and, later, a shift of the trachea. These need urgent reporting.

Why mark the edge of swelling in NU144CL Unit 6?

A pen line with a time turns an impression into a measurement, so the nurse can report that swelling grew by a set amount in a set number of minutes.

Why didn't the report start with the saturation?

A normal saturation would have made the problem sound minor. Leading with the voice change and the growing swelling told the nurse what was wrong first.