Every gap between four home sources and one set of discharge orders is sorted as documented, unexplained or unintentional in the NU475 Unit 3 reconciliation shown here. Searches like "nu 475 unit 3 assignment example", "nu475 unit 3 sample" and "nu475 unit 3 example" land here.
Four Lists, No Two Alike: Reconciling Fourteen Medicines for a Retired Mail Carrier After His First Hepatic Encephalopathy
[Student Name]
Purdue University Global
NU475: Providing Transition Care - Chronic Disease and Palliative/Hospice Spheres
Unit 3 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Every drug name and dose is bracketed; nothing here is a prescribing instruction.
Sources
Four sources were compared against the discharge orders: the bottles his wife brought in a grocery bag, the pharmacy's 90-day fill history, her handwritten list kept on the refrigerator, and the primary care medication list. Unintended discrepancies at hospital transitions are common; in one prospective study, more than half of adults on a medical ward had at least one at admission (Cornish et al., 2005).
Reconciliation Table
Each row gives the drug, what the sources show, the discharge order, the discrepancy type and the action with an owner.
1. [Spironolactone]. Bottles, pharmacy and wife: [25 mg] daily. Discharge summary: [100 mg] daily. Electronic prescription received by the pharmacy: [25 mg]. Type: unintentional. Action: prescriber corrects the e-prescription today; nurse confirms with the pharmacy before he leaves.
2. [Furosemide] [40 mg] daily. All sources agree with the order. Type: none.
3. [Lactulose], titrated to two to three soft stools a day. New. Type: none; teaching needed. Owner: nurse.
4. [Rifaximin] [550 mg] twice daily. New. Type: none; supply at risk. Owner: case manager, prior authorization.
5. [Lisinopril] [10 mg] daily. All four home sources: taking. Discharge orders: absent, with no stop reason. Type: intentional but undocumented. Action: prescriber writes the stop reason; letter to primary care.
6. [Propranolol] [20 mg] twice daily. All sources agree. Type: none.
7. [Trimethoprim-sulfamethoxazole], daily prophylaxis after peritonitis. All sources agree. Type: none.
8. [Omeprazole] [20 mg] daily, filled since [2019]. No indication recorded anywhere. Type: continued without indication. Action: question sent to hepatology.
9. [Tamsulosin] [0.4 mg] nightly. All sources agree. Type: none.
10. Nighttime pain reliever, [diphenhydramine] with [acetaminophen]. Bottles only. Type: unrecorded over-the-counter use. Action: stop; nurse teaches wife.
11. [Ibuprofen] [400 mg], most days. Wife's list only. Type: unrecorded over-the-counter use. Action: stop; nurse teaches both.
12. [Vitamin D] [1,000 units] daily. All sources agree. Type: none.
13. Multivitamin. Bottles and wife's list; not in primary care record. Type: unrecorded, low risk. Action: add to list.
14. [Milk thistle]. Bottles only. Type: unrecorded supplement. Action: record; hepatology to advise.
Discussion, in Order of Harm
The discussion follows the order of harm, not the order of the table.
The spironolactone mismatch comes first because it is the only unintentional discrepancy, and it reaches him through the pharmacy regardless of what anyone teaches. The discharge summary raises his dose to [100 mg] with [furosemide] at [40 mg], the ratio liver guidance suggests for ascites (Biggins et al., 2021), but the electronic prescription still says [25 mg]. At a dose four times lower than intended, ascites could reaccumulate within days and bring him back for another paracentesis. Nothing on the discharge paperwork would warn his wife, because the paper list and the bottle would disagree only after the pharmacy filled the old dose.
The over-the-counter findings come next, as a pair. The nighttime pain reliever combines [acetaminophen] with [diphenhydramine], a first-generation antihistamine with strong anticholinergic effects that the Beers Criteria advise avoiding in older adults (American Geriatrics Society Beers Criteria Update Expert Panel, 2023). In a man just treated for hepatic encephalopathy, a sedating drug can worsen confusion; guidance on encephalopathy lists sedatives among the common precipitants (Vilstrup et al., 2014). The hidden [acetaminophen] also adds to his daily total, which his hepatology team limits. The [ibuprofen] is the second threat. NSAIDs can reduce kidney blood flow and blunt diuretic response in patients with ascites, and liver guidance advises avoiding them (Biggins et al., 2021). His wife said he took it "for his knees, like everybody does." Both are stopped, with teaching aimed at her, since she buys the household's medicines.
[Lisinopril] is treated as intentional but undocumented. Stopping it is supported, because ACE inhibitors can cause low blood pressure and kidney injury in patients with ascites (Biggins et al., 2021). The problem is that no one wrote down why. Without a stop reason, primary care may see a missing blood pressure medicine and restart it at the next visit. The fix is a one-line stop reason in the discharge summary and a letter to primary care.
[Omeprazole] closes the list. It has been filled since [2019] with no recorded reason, and the Beers Criteria advise against use beyond eight weeks without a clear indication (American Geriatrics Society Beers Criteria Update Expert Panel, 2023). Whether to stop it is a deprescribing question for hepatology rather than a nursing decision, so the nurse sends the question and records it as open.
Distribution
The reconciled list goes to four places before discharge: the prescriber, for signature; the pharmacy, with the corrected [spironolactone] order; the primary care office, with the [lisinopril] stop reason; and his wife, as a printed copy she can put on the refrigerator in place of her old one. The old handwritten list is not thrown away; she keeps it until the new one has been checked against the first refill.
References
American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
Biggins, S. W., Angeli, P., Garcia-Tsao, G., Ginès, P., Ling, S. C., Nadim, M. K., Wong, F., & Kim, W. R. (2021). Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology, 74(2), 1014-1048. https://doi.org/10.1002/hep.31884
Cornish, P. L., Knowles, S. R., Marchesano, R., Tam, V., Shadowitz, S., Juurlink, D. N., & Etchells, E. E. (2005). Unintended medication discrepancies at the time of hospital admission. Archives of Internal Medicine, 165(4), 424-429. https://doi.org/10.1001/archinte.165.4.424
Vilstrup, H., Amodio, P., Bajaj, J., Cordoba, J., Ferenci, P., Mullen, K. D., Weissenborn, K., & Wong, P. (2014). Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology, 60(2), 715-735. https://doi.org/10.1002/hep.27210
How this NU475 Unit 3 example is structured
The discussion follows the table's own order of harm rather than the alphabet. First comes the spironolactone mismatch, the only unintentional discrepancy, because a dose four times lower than intended would let ascites reaccumulate within days, and it reaches him through the pharmacy regardless of what anyone teaches. The over-the-counter findings follow as a pair: the combined sleep product, which adds a sedating anticholinergic and hidden acetaminophen to a brain already prone to encephalopathy, and the ibuprofen, which threatens kidneys and fluid balance in cirrhosis. Lisinopril is treated as intentional but undocumented, and the fix is a written stop reason sent to primary care so it is not restarted at the next visit. Omeprazole closes the list as a deprescribing question for the hepatology team rather than a nursing decision. Distribution of the reconciled list, to prescriber, pharmacy, clinic and wife, is the last paragraph.
Get an NU475 Unit 3 example written to your instructions
Home lists, discharge orders and a patient story are the three pieces the desk works from, and composite versions are fine. Share whichever reconciliation form or template the section provides, plus the rubric that grades it. The reconciliation arrives with every drug and dose bracketed, returned inside 24-48h, and a first request is free. 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 3 questions, answered
Do I need to include over-the-counter drugs and supplements?
Yes. Reconciliation standards cover everything the patient actually takes, and nonprescription products are where many of the dangerous findings sit. In the sample, a nighttime pain reliever carries both a sedating antihistamine and acetaminophen, and neither shows on any clinician's list. Ask about sleep aids, pain relievers, herbal products and anything taken only now and then.
What discrepancy categories should the table use?
Most instructors accept three: intentional and documented, intentional but undocumented, and unintentional. Some prompts use omission, commission and dose or frequency error instead. Use whichever set your course provides, and apply it identically on every row, so a reader can see that each classification follows a rule rather than an impression formed on the spot.
Can the dose values be real?
They can reflect real dosing ranges, but the patient and the list should not be anyone you have cared for. The sample brackets every drug name and dose to mark them as illustrative inputs for a composite case, and your version can do the same. Instructors care about the method and the reasoning far more than the specific numbers.