| Course | NU144CL Medical-Surgical Nursing II Clinical |
|---|---|
| Unit | Unit 7 |
| Paper type | Case study analysis |
| Length | About 980 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 7
Held Together to Walk and Cough: A Case Study Analysis of the Evidence for an Elastic Abdominal Binder in a Composite 76-Year-Old Man With Mild COPD on Day One After Open Colectomy Through a Midline Incision
[Student Name]
Purdue University Global
NU144CL: Medical-Surgical Nursing II Clinical
Unit 7 Case Study Analysis
[Instructor Name]
[Date]
The patient is composite; values and times are bracketed where illustrative, and a binder is applied only with the surgeon's order and the unit's fitting guidance.
The Patient
[Mr. P.], composite, 76, retired bus driver, underwent open removal of the right colon for a tumor of the cecum on [day 0] through a [20] cm midline incision. He has mild COPD, uses an inhaler daily and quit smoking ten years ago. On day one at [0800] his pain is [7] of 10 when he coughs or sits up and [4] at rest. He holds his breath instead of coughing, and his cough produces little. Saturation is [93] percent on [2] L. He walked to the door with physical therapy and stopped, saying it felt "like it would come apart." He is on an enhanced recovery pathway with scheduled acetaminophen and an opioid as needed.
The Clinical Question
In adults after abdominal surgery through an open incision (P), does an elastic abdominal binder (I), compared with no binder (C), reduce pain and improve walking without harming lung function (O)?
Source One: A Systematic Review and Meta-Analysis
Watanabe et al. (2025) pooled 27 randomized trials with 2,741 participants after abdominal surgery. On the first day after surgery, binders reduced pain (21 trials, moderate certainty) and improved a six-minute walk by about [9] meters (5 trials, high certainty). By day seven, the pain benefit was larger and the walking gain was about [42] meters, both with moderate certainty, from fewer trials. Patients with binders also had fewer surgical site infections in seven trials. Level and quality: a recent meta-analysis graded with a formal certainty system, the strongest kind of source for this question. Its limits: the trials covered many different abdominal operations, binders cannot be hidden from patients, and the day-seven results rest on only two to four trials. Fit to Mr. P.: broad. He belongs to the population, but the pooled patients were not selected for age, open incisions or lung disease.
Source Two: A Nursing Trial After Major Abdominal Surgery
Arici et al. (2016) randomized 84 patients after major abdominal surgery to a binder or none. Binder users walked farther on days four and seven and reported lower pain scores on days one, four and seven. Bowel and lung function did not differ between groups. Level and quality: a single randomized trial, modest in size, not blinded. Fit to Mr. P.: closer, since it studied major open procedures like his and measured walking, his main problem.
Source Three: A Trial That Measured the Lungs
Clay et al. (2014) randomized 48 patients after midline laparotomy to an individually fitted elastic girdle or none. Lung function fell by about a third after surgery whether or not a girdle was worn, and abdominal pressure and wound healing were the same. Pain was lower in the girdle group on day five. Level and quality: small, single center, but it answers a specific safety question. Fit to Mr. P.: the closest on safety. His COPD makes the worry that a binder could restrict breathing a real one, and this trial measured exactly that.
The smallest trial fits him best on the one question that could make the binder harmful: whether it squeezes the breath out of a man with lung disease.
What the Sources Mean Together
The meta-analysis shows the binder generally reduces pain and helps walking. The nursing trial shows the same in open major surgery. The girdle trial suggests it does not reduce lung function, which is the concern most specific to him. Together they support offering a binder, while being honest that no trial studied older men with COPD after colectomy, and that his response cannot be predicted from averages. The binder adds to the recovery pathway; it does not replace pain control, early walking or coughing exercises (Harding et al., 2023).
Applying It at the Bedside
1. Ask the surgeon whether a binder may be used; with an order, measure his abdomen and choose the size per the product guidance.
2. Apply it while he lies on his back, centered over the incision and dressing, snug enough to support but loose enough to slide a flat hand beneath.
3. Before and after the first application, check his breathing rate, saturation and ability to take a deep breath.
4. Teach him to press his hands or a pillow over the binder when he coughs, and pair the binder with deep breathing and coughing every hour while awake.
5. Remove it at least once a shift to inspect the skin and incision, and keep it off when it slips above the ribs or below the hips.
Signs a Nurse Can Chart
Pain at rest and with coughing, before and an hour after applying the binder. Distance walked each time, in meters or room lengths. Breathing rate, saturation and cough strength each shift. Skin under the binder and edges for redness. Incision appearance. Whether he chose to keep the binder on. Charting walking distance as a number, not "ambulated in hall," lets the team see change (Potter et al., 2023).
Evaluation
By the evening of [day 1], his pain with coughing was [5] and his cough was stronger. On [day 2] he walked to the nurses' station and back twice, about [60] meters, and his saturation rose to [95] percent on [1] L. He said the binder made him "feel held together." Whether the binder caused the change cannot be known for one patient, but nothing suggested harm to his breathing.
References
Arici, E., Tastan, S., & Can, M. F. (2016). The effect of using an abdominal binder on postoperative gastrointestinal function, mobilization, pulmonary function, and pain in patients undergoing major abdominal surgery: A randomized controlled trial. International Journal of Nursing Studies, 62, 108-117. https://doi.org/10.1016/j.ijnurstu.2016.07.017
Clay, L., Gunnarsson, U., Franklin, K. A., & Strigård, K. (2014). Effect of an elastic girdle on lung function, intra-abdominal pressure, and pain after midline laparotomy: A randomized controlled trial. International Journal of Colorectal Disease, 29(6), 715-721. https://doi.org/10.1007/s00384-014-1834-x
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.
Watanabe, J., Kasahara, N., Kiyasu, Y., Yamaguchi, H., & Sata, N. (2025). Abdominal binders after abdominal surgery: A systematic review and meta-analysis. The American Journal of Surgery, 247, Article 116451. https://doi.org/10.1016/j.amjsurg.2025.116451
NU144CL Unit 7 instructions, in plain terms
Unit 7 commonly asks students to choose one nursing intervention for a patient from their clinical assignment and analyze the evidence behind it. Prompts usually want a brief patient summary, a PICO question, two or more sources appraised for level and quality, an explanation of how well each fits the patient, and an application plan with outcomes to monitor. Instructors look for appraisal that goes beyond summarizing, including the limits of each study, and for honesty about where the evidence does not reach. The patient should take a small share of the paper and the evidence the larger share. Papers run four to six pages, with every source cited in APA 7.
How this NU144CL Unit 7 example is built
The analysis gives the patient one section: his surgery, COPD, pain with coughing and reluctance to walk. A PICO question follows. Each of three sources then gets three short parts: findings, level and quality, and fit to him. The meta-analysis is the strongest but broadest, the nursing trial fits his open surgery and walking, and the small girdle trial answers the safety question about his lungs, a contrast stated in a highlighted line. A synthesis section explains what the sources mean together and names the gap in the evidence. Five bedside steps, a list of chartable signs and an evaluation over two days complete the paper.
Reading the NU144CL Unit 7 grading rubric
Evidence analyses in NU 144CL are typically scored on the clinical question, search and selection of sources, appraisal, application to the patient, evaluation and APA writing. Question points depend on a PICO that matches the patient's problem. Source points reward relevant, credible studies with at least one recent. Appraisal points go to stating level, quality and specific limits rather than general praise. Application points are earned by steps tied to the evidence and safe for this patient, including the check of breathing after applying the binder. Evaluation points require measurable outcomes, such as distance walked. Separating a study's strength from its fit to the patient usually scores in the top band.
NU144CL Unit 7 help from the desk
Evidence papers often lose points by summarizing studies without appraising them. Another common problem is treating the strongest study as automatically the most relevant, even when its patients differ from the one in the case. Some students overstate what the evidence shows, or skip the safety concern most specific to their patient, here his lungs. Others list outcomes that cannot be measured. Write a PICO, describe each source's findings, rate its level and limits, judge its fit to your patient separately, say plainly where the evidence stops and give outcomes in numbers. Ask the provider before applying the intervention, and check the patient afterward. If the patient cannot tolerate it, say so in the evaluation rather than reporting only the successes.
Get an NU144CL Unit 7 example written to your instructions
Whatever intervention was chosen for your assigned patient, name it and sketch that patient broadly, with identifiers removed. List the evidence levels your section accepts and its publication window, with the rubric attached. A composite patient then carries the question, the sources and their appraisal. The first custom sample is free, 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.
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NU144CL Unit 7 questions, answered
Where can I find a free NU144CL Unit 7 sample paper?
The full NU144CL Unit 7 case study analysis is on this page, appraising three sources on abdominal binders for a composite man after open colectomy, with fit to the patient, bedside steps, chartable signs and five references. Bring us your own intervention and we can help appraise it.
Do abdominal binders reduce pain after surgery?
A 2025 meta-analysis of 27 randomized trials found less pain on the first day after abdominal surgery with a binder, with moderate certainty, and better walking distances.
Can a binder affect breathing?
That was the concern for a man with COPD. A trial after midline laparotomy found lung function fell equally with or without a fitted girdle, so it did not appear to restrict breathing.
What does fit to the patient mean in NU144CL Unit 7?
How closely a study's patients and setting match the one in the case. A smaller study can fit better than a large review that pools many different operations.
What should a nurse chart after applying a binder?
Pain at rest and with coughing, distance walked, breathing rate, saturation, cough strength, skin under the binder and the incision, each with a time.