| Course | NU263CL Medical-Surgical Nursing III Clinical |
|---|---|
| Unit | Unit 6 |
| Paper type | SBAR handoff write-up |
| Length | About 900 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BSN (prelicensure) |
| Updated | October 2026 |
Free sample paper for NU263CL Unit 6
A Night That Built Toward One Concern: An SBAR Handoff Write-Up Opening With Suspected Pulmonary Embolism in a Composite 67-Year-Old Woman Three Days After Knee Replacement, Leaving Her Surgery for the Background and Ending With Numbers That Trigger a Call
[Student Name]
Purdue University Global
NU263CL: Medical-Surgical Nursing III Clinical
Unit 6 SBAR Handoff Write-Up
[Instructor Name]
[Date]
The patient is composite; values and times are bracketed where illustrative, and diagnosis and treatment belong to the provider. The student prepared the handoff with the night nurse.
The Night, as a Table
[2300]: heart rate [88], respirations [16], saturation [96] percent on room air, blood pressure [134/78], temperature [37.2] C. Sleeping. [0200]: heart rate [96], respirations [18], saturation [95] percent. Woke to use the bathroom. [0400]: pulse now [104], breathing [22] a minute, saturation [93] percent. Said she felt "uneasy." [0530]: heart rate [108], respirations [24], saturation [91] percent on room air. New sharp pain on the right side of her chest when breathing in. Left calf [3] cm larger than the right, warm, tender. [0545]: night nurse notified the provider; oxygen [2] L started as ordered; saturation [94] percent. Imaging ordered.
Why Pulmonary Embolism First
Patients after knee or hip replacement are at high risk of blood clots in the legs, which can travel to the lungs. Clot prevention after orthopedic surgery is standard for this reason (Falck-Ytter et al., 2012). She was on enoxaparin, but the evening dose on day two was held for a procedure and given late. A swollen, warm calf with a rising heart rate, faster breathing, falling saturation and pleuritic chest pain is the pattern of a clot in the leg that has moved to the lungs.
No single number was alarming at 0200; together, by 0530, they told one story, and the calf told where it started.
A Differential Kept Open
The handoff names other possibilities so they are not forgotten: atelectasis from shallow breathing, pneumonia, a heart problem and pain or anxiety. Atelectasis usually brings a low-grade temperature and improves with deep breathing; it does not explain the calf. A heart attack is less likely without crushing pain but is checked with an ECG and troponin as ordered. Keeping the list open protects her if the scan is negative.
The Handoff, Word for Word
Situation: "Mrs. M. in 14 may have a pulmonary embolism. Since 2300 her pulse has gone from 88 to 108, breathing from 16 to 24, and saturation fell to 91 on room air. At 0530 she developed sharp right-sided chest pain on breathing in, and her left calf is swollen, warm and tender." Background: "She is 67, day three after a left total knee replacement. On enoxaparin for clot prevention; last night's dose was held for a procedure and given late." Assessment: "I think this is a clot from her calf to her lungs. Atelectasis is possible but doesn't explain the leg. ECG shows sinus tachycardia only. The provider was called at 0545, oxygen started at 2 liters, and a CT scan of her chest is ordered for 0730." Recommendation: "Please make sure the scan happens on time, keep her on oxygen and the monitor, and call the provider if any of these happen." (Haig et al., 2006)
Triggers in Numbers
Call the provider at once if: saturation below [90] percent on [2] L; heart rate above [120]; systolic pressure below [100] or a drop of [20] from baseline; respiratory rate above [28]; new confusion, fainting or worsening chest pain. Call the rapid response team if systolic falls below [90].
What Could Have Been Noticed Earlier
Looking back at the table, the trend started at [0200], when her heart rate had risen by eight beats and her breathing by two. Neither change alone would prompt a call. At [0400], with three values moving the same way and her saying she felt uneasy, a call would have been reasonable. Her own sense of unease was a finding, and on another night it might be the first one. The night nurse said she would have called at [0400] if she had seen all the values side by side, which is exactly what the table shows.
Her Own Words
At [0530], when asked how she felt, Mrs. M. said, "Something is wrong, I can't get a full breath." That sentence went into the handoff word for word, because a patient's own sense of alarm is part of the assessment. She was also told, in plain terms, that the team was checking for a clot and that the scan would show it.
What the Day Nurse Should Watch
Besides the triggers, the day nurse should watch her left calf for increasing swelling, her right chest pain for any change in character, and her anxiety, which may rise while waiting for the scan. If a clot is confirmed, the provider will choose treatment, and her bleeding risk from the recent surgery will be part of that decision.
What I Learned Preparing It
The story was in the trend, not the latest numbers. Writing the table made the pattern obvious in a way that reading the flowsheet one value at a time did not. I also learned to put the most important sentence first: the scan time and triggers matter more to the day nurse than the details of the surgery (Harding et al., 2023).
References
Falck-Ytter, Y., Francis, C. W., Johanson, N. A., Curley, C., Dahl, O. E., Schulman, S., Ortel, T. L., Pauker, S. G., & Colwell, C. W. (2012). Prevention of VTE in orthopedic surgery patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2 Suppl), e278S-e325S. https://doi.org/10.1378/chest.11-2404
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.
What the NU263CL Unit 6 assignment asks for
Unit 6 usually asks students to write up a handoff or escalation in SBAR format for a patient whose condition changed during a shift. Prompts commonly want the trend that led to the concern, the SBAR wording, the reasoning behind the main suspicion, alternatives considered and clear instructions for the next nurse. Instructors look for the concern stated first, background limited to what matters, a differential that keeps alternatives in view and specific numeric triggers rather than "monitor closely." The write-up should also reflect on when the change could have been noticed earlier. A length of three or four pages is usual, citing the SBAR source and relevant clinical guidance in APA 7.
How the NU 263CL Unit 6 example is put together
The write-up sets out the night as a timed table from 2300 to 0545. A section explains why pulmonary embolism leads, citing guidance on clot prevention after orthopedic surgery, with the highlighted sentence about the calf. A differential keeps atelectasis, pneumonia, a heart problem and anxiety in view, with a margin note. The handoff is given word for word in four labeled parts, citing the SBAR paper. Numeric triggers follow, with a margin note. Sections on what could have been noticed earlier, her own words and what the day nurse should watch precede a closing reflection on why the table made the pattern obvious. Every value in the table is bracketed as illustrative.
NU263CL Unit 6 rubric: what earns full points
Handoff rubrics in NU 263CL tend to reward recognition of the trend, a clear leading concern, accurate background, a reasoned differential, specific recommendations and reflection. Trend credit depends on values shown over time rather than one set. Concern credit goes to stating the suspicion in the first sentence. Background credit is earned by including only what bears on the concern, here the surgery and the late anticoagulant dose. Differential credit rewards alternatives named with reasons. Recommendation credit requires numeric triggers and actions. Reflection credit goes to identifying the earliest point a call was justified. Handoffs that include the patient's own words about feeling wrong often show a fuller assessment.
NU263CL Unit 6 help from the desk
SBAR write-ups often lose credit by opening with the patient's name, age and surgery and burying the concern several sentences later. Another common weakness is listing the latest vital signs without the trend that gives them meaning. Some students commit to one diagnosis and drop the alternatives. Others end with "keep monitoring" instead of numbers that prompt a call. Build a timed table, put the suspicion first, include only background that explains it, name alternatives with reasons, give clear numeric triggers and look back at when you first had enough to call. Record the patient's own description of how she feels. Keep the handoff itself short enough to say aloud in under two minutes.
Get an NU263CL Unit 6 example written to your instructions
First custom sample free, returned within 24-48h, and written in whichever handoff tool the course requires, whether SBAR, I-PASS or a form the unit designed itself. Include the Unit 6 prompt, the scenario if one is supplied and the rubric, plus who the handoff is addressed to. The worry leads, and every value is bracketed. 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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NU263CL Unit 6 questions, answered
Where can I find a free NU263CL Unit 6 sample paper?
The complete NU263CL Unit 6 SBAR handoff write-up is here, building toward suspected pulmonary embolism after knee replacement in a composite 67-year-old, with triggers and three sources. Your own handoff can be structured the same way if you send us the night's details.
Why lead with the suspicion in an SBAR handoff?
The listener needs the most important fact first, so the concern, here possible pulmonary embolism, comes before background.
What are signs of pulmonary embolism after knee replacement in NU263CL Unit 6?
A rising heart rate, faster breathing, falling saturation, sharp chest pain on breathing in, anxiety and often a swollen, warm calf.
Why keep a differential open?
If the scan is negative, other causes such as atelectasis, pneumonia or a heart problem still need attention, so the next nurse watches for them.
What are numeric call triggers?
Specific values, such as saturation below 90 percent or heart rate above 120, that tell the next nurse exactly when to call.