Aspiration or early pneumonia in a composite resident, written up in NU585's Unit 3 visit note so that evening staff hold numbered thresholds, named responses and a POLST-consistent limit. Searches like "nu 585 unit 3 assignment example", "nu585 unit 3 sample" and "nu585 unit 3 example" land here.
Nursing Facility Visit Note at 19:00: Coughing After Meals in an 84-Year-Old With Dementia, Written for the People Still in the Building
[Student Name]
Purdue University Global
NU585: AGNP II Clinical - Frail Elderly Focus
Unit 3 Nursing Facility Visit Note
[Instructor Name]
[Date]
The resident is a composite; vital signs, thresholds and the state form name are bracketed.
Visit
Type: acute visit at nursing request. Requested by: [charge nurse name], day shift. Code status and treatment limits: POLST, [State] form, selective treatment: hospital transfer for treatment that can return him to the facility; no intubation; DNR. Health care agent: his son.
Interval History, by Source
Charge nurse: coughing and throat clearing during and after lunch and dinner for three days; no cough between meals; eating more slowly. Medication administration record: [two] evening doses refused this week, both at dinner. Intake record: averaging [40] percent of meals, down from [75] percent. Resident: says he is "all right"; denies pain. Moderate dementia limits his history.
Examination
Temperature [37.8] C; heart rate [96]; respiratory rate [22]; blood pressure [132/74]; oxygen saturation [93] percent on room air, from a baseline of [96]. Alert, at his baseline per the nurse. Crackles at the right lung base. Wet, gurgly voice after a sip of water. No use of accessory muscles.
Assessment
Suspected aspiration, with aspiration pneumonitis or early aspiration pneumonia at the right base. Symptoms tied to meals, a low fever, a small drop in saturation and localized right basal crackles fit aspiration, which favors the right lower lobe because of the right main bronchus's angle (Mandell & Niederman, 2019). He does not yet meet minimum criteria for starting antibiotics in a long-term care resident, so none begins tonight, and the watch list defines exactly when one would. For a resident whose temperature is above 37.9 C but not above 38.9 C, the Loeb criteria call for a cough together with at least one further sign: a pulse above 100, new delirium, rigors or a respiratory rate above 24 (Loeb et al., 2001). At 37.8 C, with a pulse of 96, no new delirium and a respiratory rate of 22, he sits just below those lines tonight. Fever in frail older adults is often blunted, so a rise of more than 1.1 C above his baseline would also count as fever (High et al., 2009); his usual temperature is [36.6] C, so tonight's reading is a rise of 1.2 C, and the nurse is asked to watch it closely.
Plan for the Next 48 Hours
1. Diet: hold thin liquids; offer mildly thick liquids and soft foods until speech-language pathology evaluates; sit fully upright for meals and 30 minutes after. Who: nursing and dietary.
2. Vital signs: every four hours, including oxygen saturation and respiratory rate. Who: nursing.
3. Call the on-call provider if: saturation below [90] percent on two readings; respiratory rate above [28]; temperature 38.0 C or higher; new confusion; refusal of all fluids. The on-call provider may start [amoxicillin-clavulanate] from the emergency kit.
4. Transfer if: saturation below [88] percent despite oxygen, or signs of respiratory distress, consistent with his POLST choice of selective treatment. Not for intubation or CPR, which he and his son have declined.
5. Portable chest radiograph: requested for the morning.
6. Speech-language pathology referral: bedside swallow evaluation tomorrow.
7. Oral care: twice daily with a soft brush, since oral bacteria contribute to aspiration pneumonia.
8. Notify his son tonight of the change and the plan. Who: charge nurse.
Why Not Send Him Out Tonight
He is stable, alert at his baseline, and his POLST favors treatment in the facility where possible. An evening transfer to the emergency department for a resident with dementia carries its own harms, delirium, falls and a night on a stretcher, and the facility can monitor him and start an antibiotic from its kit if he crosses a threshold. The plan keeps him in the building with clear lines for when that changes.
Follow-Up
Visit within [24 to 48] hours, after the radiograph and swallow evaluation, to decide on antibiotics and a diet plan.
References
High, K. P., Bradley, S. F., Gravenstein, S., Mehr, D. R., Quagliarello, V. J., Richards, C., & Yoshikawa, T. T. (2009). Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 48(2), 149-171. https://doi.org/10.1086/595683
Loeb, M., Bentley, D. W., Bradley, S., Crossley, K., Garibaldi, R., Gantz, N., McGeer, A., Muder, R. R., Mylotte, J., Nicolle, L. E., Nurse, B., Paton, S., Simor, A. E., Smith, P., & Strausbaugh, L. (2001). Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: Results of a consensus conference. Infection Control and Hospital Epidemiology, 22(2), 120-124. https://doi.org/10.1086/501875
Mandell, L. A., & Niederman, M. S. (2019). Aspiration pneumonia. New England Journal of Medicine, 380(7), 651-663. https://doi.org/10.1056/NEJMra1714562
How this NU585 Unit 3 example is structured
The note is written backward from its reader. That reader is a nurse on the evening shift with thirty residents, no clinician on site until morning, and an emergency medication kit, so the plan section carries the most words and the fewest abbreviations. Assessment still explains its reasoning briefly: symptoms tied to meals, a low fever and localized crackles fit aspiration, and the Loeb minimum criteria for starting antibiotics in long-term care (2001) are cited to show why no antibiotic begins tonight. Monitoring follows as threshold lines: vital signs every four hours; if saturation stays below 90 percent or respiratory rate rises above 28, call the on-call provider, who may start [amoxicillin-clavulanate] from the kit. Transfer triggers match the POLST, and the note states plainly what the resident and his agent have declined. Follow-up names the next visit and its purpose.
Get an NU585 Unit 3 example written to your instructions
Send the call or change in condition your Unit 3 case starts from, what the facility can and cannot do after hours if the prompt says, and the rubric. Our note puts reasoning in the assessment and numbers in the plan, with every drug bracketed. A first request is free, back 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.
NU585 Unit 3 questions, answered
What format should a nursing facility visit note use?
Your site's, if it has one, and many facilities use a problem-focused template close to SOAP. Whatever the headings, the plan should be readable by the nurse who will act on it tonight. Some sections want a note that shows the elements of medical decision-making, and the prompt usually says so. The sample follows a problem-focused layout with a separate watch list.
What are the Loeb minimum criteria?
A consensus set published in 2001 describing the minimum signs and symptoms that justify starting antibiotics in long-term care residents, organized by suspected site: urinary, respiratory, skin and soft tissue, and fever without a focus. They help facilities avoid treating nonspecific change as infection. Cite them with the year, apply them to the findings, and say plainly whether they are met.
Should the note include orders for the nurse?
In a student paper, write them as recommendations for the supervising clinician, with any drug bracketed. The note can still be precise: a threshold, an action and a person responsible. Real orders in a facility are entered and signed by a licensed prescriber under the site's policies, and a sample shows only how such instructions read, never a signature.