NU263CL Unit 9 Post-Laparotomy COPD Plan of Care Example

Course	NU263CL Medical-Surgical Nursing III Clinical
Unit	Unit 9
Paper type	Plan of care
Length	About 870 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 9

The Epidural That Lets Him Cough Also Drops His Pressure When He Stands: A Plan of Care for a Composite 72-Year-Old Man With COPD After Laparotomy, Writing His Day as Priorities That Trade Places by the Hour, With a Conflict Note Wherever One Goal Works Against Another

[Student Name]

Purdue University Global

NU263CL: Medical-Surgical Nursing III Clinical

Unit 9 Plan of Care

[Instructor Name]

[Date]

The patient is composite; values, doses and settings are bracketed where illustrative, and all orders, including epidural management, are the providers' and the anesthesia team's.

What this part is doingConflict notes make visible where two good goals compete, which is what this unit's plan is graded on.

Assessment Summary

[Mr. S.], composite, 72, open sigmoid colectomy on [day 0] for a perforated diverticulum. COPD with an FEV1 of about [45] percent of predicted, two exacerbations last year, home inhalers. Thoracic epidural infusing local anesthetic with a low-dose opioid as ordered. Day 2 findings: pain [3] at rest, [5] with coughing; saturation [90] percent on [1] L; diminished breath sounds at both bases; blood pressure [124/70] lying, [98/58] after one minute sitting at the edge of the bed, with lightheadedness. Potassium [3.3]. On prednisone [40] mg daily for a COPD flare that began before surgery. Glucose [186] to [240].

The Priority Strip

[0700]: breathing first (deep breathing, cough, saturation), then potassium. [0900]: potassium replaced; blood pressure checks lying and sitting. [1000]: first walk with physical therapy, if potassium and pressure criteria met. [1300]: breathing again after lunch; glucose. [1600]: second walk; wound and drain check. [2000]: breathing, glucose and sleep. The order changes because each problem has its own clock.

Problem 1: Impaired Gas Exchange

Goal: saturation [88] to [92] percent on no more than [2] L, clear breath sounds at the bases by day [4]. Interventions and reasons: incentive spirometry and coughing with a splinting pillow every hour while awake, because the epidural makes deep breathing possible; oxygen titrated to [88] to [92] percent, the target recommended for patients at risk of carbon dioxide retention, rather than higher (O'Driscoll et al., 2017); inhalers and nebulizers as ordered; head of bed raised. Conflict note: more oxygen would make his saturation look better but could raise his carbon dioxide; the target is held deliberately.

Problem 2: Risk for Falls and Low Pressure When Upright

Goal: walks [30] meters twice a day by day [3] without dizziness or a fall. Interventions and reasons: check pressure lying, sitting and standing before each walk; sit at the edge of the bed for two minutes first; walk with two staff and a walker; report a systolic below [90] or dizziness that does not settle. Conflict note: the epidural that allows coughing also widens blood vessels and lowers pressure on standing. Reducing the epidural would help his pressure but worsen his pain and breathing. Thoracic epidurals give better pain relief than IV opioids after major abdominal surgery (Block et al., 2003), so the plan asks the anesthesia team to adjust the rate rather than stop it.

Every goal on his list helps one system and pushes against another, so the plan writes the trade-offs down instead of pretending they are not there.

How the Strip Is Used at Handoff

At each handoff the strip is read aloud, so the next nurse knows which priority is on top at that hour and why. A conflict note travels with the strip; for example, the evening nurse is told that his oxygen target is intentionally low and that his epidural rate was adjusted, not stopped, after the morning's dizziness.

What this part is doingThe strip is designed for handoff, so the conflicts are passed on rather than rediscovered each shift.

Problem 3: Electrolyte Imbalance, Low Potassium

Goal: potassium at or above [3.8] before the first walk. Interventions and reasons: replace potassium as ordered and recheck before [1000]; low potassium can cause muscle weakness and rhythm problems, both risky during a first walk. Conflict note: potassium is a priority because of the walk, not on its own; if the walk is delayed, so is the urgency.

What this part is doingPotassium is placed in the strip according to what depends on it, showing priorities set by the day's events rather than by a fixed list.

Problem 4: Risk for Impaired Healing and High Glucose

Goal: glucose below [180] most readings; incision clean and closed. Interventions and reasons: correction insulin as ordered; wound checks each shift. Conflict note, steroids on both sides: prednisone helps his COPD flare and his breathing but raises his glucose and can slow wound healing. The plan does not stop the steroid; it treats the glucose and watches the wound, and flags the conflict for the team to weigh as his lungs improve (Harding et al., 2023).

What He Said About His Day

Asked what mattered most to him, Mr. S. said, "Being able to breathe without that tight feeling." That put the breathing goal first in his own words and supported the choice to keep the epidural running despite the dizziness. When the dizziness came, he asked whether he could skip the walk. The physical therapist explained why walking helps his lungs too, and he agreed to try again in the afternoon after sitting longer first.

What this part is doingThe patient's own priority is recorded and used, which keeps the trade-offs connected to what he wants.

Evaluation, Left Partly Open

Day 3: saturation [91] percent on [1] L; breath sounds improved at the left base; walked [25] meters twice with one dizzy episode that settled; potassium [3.9]; glucose [150] to [210]. The breathing and potassium goals are on track. The walking goal is partly met. The glucose goal is not yet met while the steroid continues, and is left open for tomorrow.

References

Block, B. M., Liu, S. S., Rowlingson, A. J., Cowan, A. R., Cowan, J. A., & Wu, C. L. (2003). Efficacy of postoperative epidural analgesia: A meta-analysis. JAMA, 290(18), 2455-2463. https://doi.org/10.1001/jama.290.18.2455

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

O'Driscoll, B. R., Howard, L. S., Earis, J., & Mak, V. (2017). BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax, 72(Suppl 1), ii1-ii90. https://doi.org/10.1136/thoraxjnl-2016-209729

What the NU263CL Unit 9 assignment asks for

In Unit 9 the plan usually covers a complex medical-surgical patient whose problems interact, written in the program's columned format. Prompts usually want an assessment summary, ranked problems, goals with numbers and dates, reasoned interventions and an evaluation, and many ask students to show how priorities change through the day. Instructors look for plans that acknowledge conflicts between goals rather than ignoring them, evidence-based targets such as oxygen ranges for COPD, attention to timing and honest evaluation that leaves unmet goals open. Medical decisions belong to the providers and anesthesia team. Plans typically run five to six pages, citing evidence on oxygen targets and epidural analgesia.

How this NU263CL Unit 9 example is built

The plan opens with an assessment summary covering his surgery, COPD, epidural, standing blood pressure, potassium, prednisone and glucose. A priority strip sets six times of day. Four problems follow in order. Gas exchange carries an oxygen target from the national oxygen guideline and a conflict note. Falls and low standing pressure cite a meta-analysis of epidural analgesia and carry the highlighted sentence. Potassium is tied to the walk, with a margin note. Glucose and healing carry a conflict note about steroids. Sections on using the strip at handoff and on his own priorities, each with a margin note, precede an evaluation that leaves the glucose goal open. The plan reads left to right like the program's columned form, with conflict notes between rows.

NU263CL Unit 9 rubric: what earns full points

Plan of care rubrics in NU 263CL tend to reward assessment, prioritization, measurable goals, evidence-based interventions, recognition of conflicting goals, evaluation and writing. Assessment credit depends on relevant findings, including standing blood pressure and potassium. Prioritization credit goes to showing how order changes through the day. Goal credit requires numbers and dates. Intervention credit is earned by evidence-based choices such as an 88 to 92 percent oxygen target in COPD. Conflict credit rewards naming where one goal works against another and how the plan resolves it. Evaluation credit requires honest reporting, including partly met and unmet goals. Plans that carry the patient's own priority into the trade-offs usually stand out.

Common NU263CL Unit 9 mistakes, and how to avoid them

Complex care plans often lose credit by listing problems as if each could be solved without affecting the others. Another frequent error is setting a high oxygen saturation target for a patient with COPD. Some students recommend stopping an epidural because of low standing pressure, losing the pain control that makes breathing possible. Others report all goals as met. Order problems by time of day, write goals with numbers and dates, choose evidence-based targets, add a conflict note wherever goals compete, ask the patient what matters most to him and leave unmet goals open with a reason. Make sure the plan travels with the patient at each handoff.

Get an NU263CL Unit 9 example written to your instructions

Care plan formats in Unit 9 can range from NANDA-I tables to narrative plans, concept-map hybrids or a facility's own template. Attach the required format, the case or patient type, and the rubric, noting any diagnosis count the course sets. The composite plan will show its priorities moving and argue every conflict between goals. First custom sample free; generally 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 NU263CL papers and BSN samples

NU263CL Unit 9 questions, answered

Where can I find a free NU263CL Unit 9 sample paper?

This page presents the complete NU263CL Unit 9 plan of care for a composite man with COPD after laparotomy, with a priority strip, conflict notes, dated goals and three sources. A patient with competing goals from your own rotation can be planned the same way.

Why keep oxygen at 88 to 92 percent in COPD?

In patients at risk of carbon dioxide retention, higher oxygen can raise carbon dioxide, so a narrower target is recommended.

Why does an epidural lower blood pressure on standing in NU263CL Unit 9?

The local anesthetic widens blood vessels in the lower body, so blood pools when the patient stands and pressure falls.

What is a conflict note?

A short note in the plan wherever one goal works against another, such as an epidural that helps breathing but causes dizziness on standing.

Why replace potassium before the first walk?

Low potassium can cause muscle weakness and rhythm problems, which add risk during the first time out of bed.