NU475's Unit 2 analysis draws Lynn and Adamson's organ failure and cancer trajectories for two composite patients, using Palliative Performance Scale scores, and argues the transitions each produces. Searches like "nu 475 unit 2 assignment example", "nu475 unit 2 sample" and "nu475 unit 2 example" land here.
Steps Down and a Cliff: Two Illness Trajectories, Cirrhosis and Gastric Cancer, Drawn on One Set of Axes
[Student Name]
Purdue University Global
NU475: Providing Transition Care - Chronic Disease and Palliative/Hospice Spheres
Unit 2 Assignment
[Instructor Name]
[Date]
Composite patients written as a model document. Scores and dates are illustrative and bracketed.
Two Patients, Described by Function
Both patients are described first by what they could do at home, at four points in time, so that the curves come from observation rather than from expectations attached to a diagnosis. Function is scored on the Palliative Performance Scale, which rates ambulation, activity and evidence of disease, self-care, intake and level of consciousness in 11 steps from 0 to 100 percent (Anderson et al., 1996).
The retired mail carrier, 72, lives with his wife in a small town [50] miles from the regional liver center.
Month 0: walks to the post office for coffee each morning, tends his tomato beds, drives. PPS [70] percent, reduced by fatigue and visible ascites.
Month 5, after his first admission for bleeding varices: walks around the block with rests, no longer drives. PPS [60] percent.
Month 9, after a second admission for spontaneous bacterial peritonitis: walks in the house, needs help with bathing. PPS [50] percent.
Month 14, after a first episode of hepatic encephalopathy: spends most of the day in a chair, eats small amounts. PPS [40] percent.
The retired bank teller, 66, lives with her daughter.
Month 0: cares for two grandchildren after school, drives to church. PPS [80] percent.
Month 3, on chemotherapy: some fatigue, same activities. PPS [80] percent.
Month 5: stops the school pickups, eating less. PPS [60] percent.
Month 7, about [70] days after progression of liver metastases: in bed most of the day. PPS [30] percent.
The Figure
Figure 1 plots both patients on the same axes: PPS percentage on the vertical axis and months since diagnosis of advanced disease on the horizontal. His line drops sharply at each of three admissions, rises partway after each, and settles lower than before. Her line runs nearly flat near 80 percent for five months and then falls steeply to 30 percent.
Placing Each Case on a Trajectory
Lynn and Adamson (2003) described three typical courses of decline near the end of life, and Murray et al. (2005) argued that each calls for palliative care organized in a different way.
The first is the course typical of cancer: a long period of relatively good function followed by a short, evident decline, usually over weeks to months. The bank teller's line fits it closely. Her function held while the cancer was treated, then fell once her liver metastases progressed.
The second is the course of organ failure, such as heart, lung or liver failure: long-term limitation with intermittent acute episodes, each of which may be survived but leaves the person weaker. The mail carrier's line fits it. His MELD-Na score, a sodium-adjusted form of the Model for End-Stage Liver Disease score first developed to estimate short-term survival in advanced liver disease (Kamath et al., 2001), rose from [14] to [19] over the 14 months, and each admission left him at a lower baseline.
The third course, prolonged dwindling, is typical of frailty and dementia: a low starting level and a slow, steady decline over years. Neither patient fits it, and it is set aside here, though it will matter for many older adults with cirrhosis who are also frail.
What Each Shape Means for Palliative Care
The mail carrier's pattern makes prognosis unreliable, because any exacerbation might be the last and most are not. Clinicians waiting for a clear survival estimate before raising palliative care may wait until after he has died. Murray et al. (2005) make this point about organ failure in general: death often comes suddenly during an exacerbation, at a time that is hard to predict.
For this pattern, palliative need is better identified by other means. The surprise question puts one thing to the clinician: would his death within a year come as a surprise? A systematic review found its accuracy modest, performing better in some settings than others (Downar et al., 2017), so it works better as a prompt to start a conversation than as a prognosis. The Supportive and Palliative Care Indicators Tool (SPICT) adds general signs of declining health and disease-specific indicators (Highet et al., 2014). For liver disease, these include complications such as ascites that persists despite diuretics and hepatic encephalopathy. The mail carrier met both by month 14, and the SPICT would have flagged him after his second admission. Palliative care for him should run alongside disease treatment, with plans for each future emergency agreed in advance.
The bank teller's course is predictable enough that the transition can be anticipated. Her oncologist could say with some confidence, once her metastases progressed, that she likely had months rather than years. The Medicare hospice benefit, which requires that a physician certify a prognosis of six months or less if the disease runs its usual course, fits her trajectory comfortably. For her, the task is to recognize the turn when it comes and to make the move to hospice smooth.
Transitions Each Line Generates
The mail carrier's line generates many transitions, each a point where care can be lost:
Each admission and discharge, with medication changes and new instructions.
Moves between the local hospital and the liver center, [50] miles away.
The transplant evaluation and its result, which changes the whole goal of care.
Shifts in caregiving as he loses function, with his wife taking on more.
The eventual move to hospice, which may come abruptly during an admission.
The most likely to miss these are the clinicians who see him only during one admission and his primary care office, which may not hear of an admission until after discharge.
The bank teller's line generates fewer, larger transitions:
The end of chemotherapy.
The move to hospice.
The move from managing at home with her daughter to needing help at night.
The most likely to miss these is the oncology team if chemotherapy continues past its benefit, delaying hospice.
Conclusion
Illness trajectories are not predictions for any one person, and both patients could depart from their typical courses. But the shapes are useful. They tell the nurse whether to wait for a clear turn in the disease or to begin palliative care alongside treatment now. For the mail carrier, the answer is now. That means a palliative care visit at his next hepatology appointment, not at the moment a clinician finally feels sure of his prognosis, and a written plan for his next emergency admission.
References
Anderson, F., Downing, G. M., Hill, J., Casorso, L., & Lerch, N. (1996). Palliative Performance Scale (PPS): A new tool. Journal of Palliative Care, 12(1), 5-11.
Downar, J., Goldman, R., Pinto, R., Englesakis, M., & Adhikari, N. K. J. (2017). The "surprise question" for predicting death in seriously ill patients: A systematic review and meta-analysis. Canadian Medical Association Journal, 189(13), E484-E493. https://doi.org/10.1503/cmaj.160775
Highet, G., Crawford, D., Murray, S. A., & Boyd, K. (2014). Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): A mixed-methods study. BMJ Supportive & Palliative Care, 4(3), 285-290. https://doi.org/10.1136/bmjspcare-2013-000488
Kamath, P. S., Wiesner, R. H., Malinchoc, M., Kremers, W., Therneau, T. M., Kosberg, C. L., D'Amico, G., Dickson, E. R., & Kim, W. R. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 33(2), 464-470. https://doi.org/10.1053/jhep.2001.22172
Lynn, J., & Adamson, D. M. (2003). Living well at the end of life: Adapting health care to serious chronic illness in old age. RAND Corporation.
Murray, S. A., Kendall, M., Boyd, K., & Sheikh, A. (2005). Illness trajectories and palliative care. BMJ, 330(7498), 1007-1011. https://doi.org/10.1136/bmj.330.7498.1007
How this NU475 Unit 2 example is structured
Two cases, one frame, then consequences. The opening section describes each patient in function terms only, what each could do at home at four points in time, so the curves come from observations rather than labels. Next, each case is placed on a trajectory with the evidence for the placement: his MELD-Na score rising from 14 to 19 and each admission leaving a lower baseline, her performance status holding until the liver metastases progressed. The central argument follows. His pattern makes prognosis unreliable, since any exacerbation might be the last and most are not, which is why palliative need is identified with the surprise question and the SPICT tool rather than by waiting for a survival estimate. Hers is predictable enough that the hospice benefit fits it comfortably. Transitions close the paper, one set per curve.
Get an NU475 Unit 2 example written to your instructions
Two composite patients or one, whichever the prompt calls for. The desk needs the assignment text, the rubric and any required trajectory model; from those, a trajectory analysis with a labeled figure comes back inside 24-48h, and the first one costs nothing. Where a section prefers a different framework, name it and the paper follows that instead. 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.
NU475 Unit 2 questions, answered
Which trajectory model do instructors expect?
Lynn and Adamson's three trajectories are the most commonly cited, often alongside the 2005 BMJ paper by Murray and colleagues, which applies them to palliative care planning. Some prompts name the Corbin and Strauss chronic illness trajectory framework instead, which works through phases rather than curves. Check your instructions; the sample can be rebuilt on either, and the figure changes accordingly.
Does the analysis need a figure?
Not every rubric requires one, but a figure makes the argument faster than any paragraph can. A simple line chart, with function on one axis and time on the other, lets a marker see the steps and the slide at a glance. Label the axes, cite the source of the shape, and keep plotted values illustrative when the patients are composites, as the sample does.
Can the analysis cover a patient with dementia instead?
Yes, and the frailty and dementia pattern is a strong choice because it is so often mistaken for ordinary aging. The comparison then sets a long, gradual dwindling against whichever second pattern your prompt asks for. Send the case you have in mind, composite or supplied by the course, and the sample will plot that trajectory and argue the transitions it produces.