| Course | NU650 AGACNP Introduction to Acute Care Management I |
|---|---|
| Unit | Unit 2 |
| Paper type | Admission history and physical |
| Length | About 990 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU650 Unit 2
Admission History and Physical: Hyperkalemia, Rhabdomyolysis and Acute Kidney Injury After a Sixteen-Hour Lie in a 76-Year-Old Man
[Student Name]
Purdue University Global
NU650: AGACNP Introduction to Acute Care Management I
Unit 2 Admission History and Physical
[Instructor Name]
[Date]
The patient is composite; times, doses and laboratory values are bracketed.
Summary
[76]-year-old man with hypertension and osteoarthritis, found on his bathroom floor after an estimated [16] hours, admitted to a telemetry bed with hyperkalemia and ECG changes, rhabdomyolysis with acute kidney injury, mild hypothermia and a possible syncopal fall.
History of Present Illness
He remembers getting up at about [22:00] to use the bathroom, feeling lightheaded and "gray" for a few seconds, and then waking on the floor. He could not rise because of right hip and thigh pain and could not reach his phone. His son found him at about [14:00] the next day when he did not answer calls. He denies chest pain, palpitations or tongue biting before the fall, and reports no incontinence. He had not eaten or drunk since the evening meal. He has had two similar brief lightheaded spells on standing in the past month, both without falling.
Past History, Medications and Allergies
Past history: hypertension for [12] years; osteoarthritis of both knees; benign prostatic hyperplasia. Home medications: lisinopril [20 mg] daily, hydrochlorothiazide [25 mg] daily, tamsulosin [0.4 mg] nightly, started [five] weeks ago, and ibuprofen [400 mg] two to three times a day for knee pain. Allergies: none known. Social history: widowed, lives alone in a two-story house, retired machinist, drinks [two] beers on weekends, never smoked. Independent in all activities before this event.
Examination
Temperature [35.6] degrees Celsius, pulse [96] and regular, blood pressure [118/70] lying, respiratory rate [20], pulse oximetry [96] percent without oxygen. He is alert, oriented and uncomfortable. Mucous membranes are dry. Heart sounds are regular without murmur. Lungs are clear. The abdomen is soft. The right thigh is swollen, tense but compressible, and tender, with intact distal pulses and sensation; compartment pressures were not measured because the thigh remains compressible and pain is not out of proportion. A stage [2] pressure injury, about [3] by [4] cm, sits over the right greater trochanter. There is no focal neurologic deficit. Orthostatic measurements are deferred until he can stand safely.
Data
Potassium [6.3] mEq/L; sodium [136]; bicarbonate [17]; creatinine [2.7] mg/dL (eight months ago it was [0.9]); blood urea nitrogen [48]. Creatine kinase [21,400] U/L. Calcium [7.9] mg/dL; phosphate [6.1] mg/dL. Urinalysis: large blood by dipstick with [0 to 2] red cells per high-power field, which points to myoglobin. ECG: sinus rhythm at [94], peaked T waves in the precordial leads, PR [210] ms, QRS [100] ms.
Assessment and Plan
The order below follows threat. Hyperkalemia with ECG change can stop the heart within the hour, so it leads; the cause of the fall matters, but it can wait until he is safe.
Problem 1: Hyperkalemia with ECG changes, from muscle breakdown and acute kidney injury, worsened by lisinopril and ibuprofen. The peaked T waves make this an emergency regardless of the exact number, because the ECG shows the heart already responding to the potassium. Plan, following the KDIGO conference summary for emergency hyperkalemia (Lindner et al., 2020): calcium gluconate [10] percent, [30] mL intravenously over [10] minutes to stabilize the membrane, repeated if the ECG does not improve; regular insulin [5 to 10] units intravenously with dextrose [25] g to shift potassium into cells, with glucose checks hourly for [six] hours; nebulized albuterol [10 to 20] mg as an added shift; and removal through restored urine output. A potassium binder is added if the level stays above [6.0] at the [two]-hour recheck. Nephrology is called now, because dialysis is the fallback if potassium rises despite these steps or urine output does not recover. Lisinopril and ibuprofen are held. Continuous cardiac monitoring.
Problem 2: Rhabdomyolysis with acute kidney injury, stage [2], from prolonged immobilization, with volume depletion. Plan: isotonic crystalloid at [300] mL per hour initially, adjusted to a urine output of about [200 to 300] mL per hour, the range recommended to protect the kidney in rhabdomyolysis (Bosch et al., 2009); hourly urine output by bladder scanner and a urinary catheter only if output cannot be measured otherwise; a repeat panel of potassium, creatinine and creatine kinase at [six]-hour intervals; watch for fluid overload given his age. Routine bicarbonate and mannitol are not used, because the evidence for them is weak. Calcium is not replaced unless he has symptoms or ECG changes, since calcium given early can deposit in damaged muscle. Nephrotoxins held, including hydrochlorothiazide.
Problem 3: Fall with possible syncope. The prodrome of lightheadedness on standing, two earlier episodes, a new alpha-blocker [five] weeks ago and a thiazide all point toward orthostatic syncope. An arrhythmia has not been excluded, and his PR interval is mildly prolonged. The syncope guideline supports an initial evaluation of history, examination with orthostatic measurements and an ECG, with cardiac monitoring for patients admitted with a possible arrhythmic cause (Shen et al., 2017). Plan: telemetry, orthostatic vital signs once he can stand, tamsulosin held, echocardiogram only if an abnormal finding appears.
Problem 4: Mild hypothermia, [35.6] degrees Celsius, from environmental exposure on a tile floor. Plan: warm blankets and warmed fluids; recheck temperature hourly; infection considered if it does not correct.
Problem 5: Stage [2] pressure injury over the right hip. Plan: wound nursing consult, pressure redistribution mattress, turning every [two] hours, protein intake once he is eating.
Problem 6: Chronic conditions. Hypertension: all agents held today while he is volume depleted. Osteoarthritis: acetaminophen scheduled, no nonsteroidal anti-inflammatory drugs. Benign prostatic hyperplasia: monitor for retention while tamsulosin is held.
Disposition and code status: telemetry bed; full code, confirmed with the patient. His son is his emergency contact. Physical therapy and home safety evaluation before discharge, since he lives alone and lay for [16] hours without help.
References
Bosch, X., Poch, E., & Grau, J. M. (2009). Rhabdomyolysis and acute kidney injury. New England Journal of Medicine, 361(1), 62-72. https://doi.org/10.1056/NEJMra0801327
Lindner, G., Burdmann, E. A., Clase, C. M., Hemmelgarn, B. R., Herzog, C. A., Małyszko, J., Nagahama, M., Pecoits-Filho, R., Rafique, Z., Rossignol, P., & Singer, A. J. (2020). Acute hyperkalemia in the emergency department: A summary from a Kidney Disease: Improving Global Outcomes conference. European Journal of Emergency Medicine, 27(5), 329-337. https://doi.org/10.1097/MEJ.0000000000000691
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., Olshansky, B., Raj, S. R., Sandhu, R. K., Sorajja, D., Sun, B. C., & Yancy, C. W. (2017). 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope. Circulation, 136(5), e60-e122. https://doi.org/10.1161/CIR.0000000000000499
The Purdue Global NU650 Unit 2 instructions
The Unit 2 assignment asks for a complete admission history and physical on an acutely ill adult, written as it would appear in the hospital record. You give a summary statement, a focused but complete history, medications with doses, allergies, social history, an examination, the admission data and an assessment and plan organized by problem. Most sections want the problems ranked by acuity and each plan to name tests, treatments, monitoring and the point at which it will be rechecked. The note should read like one a hospital team could act on overnight, so clarity matters more than length. Four to five pages is typical, with current sources for the major problems.
How this NU650 Unit 2 example is built
The example opens with a one-sentence summary that gives the two numbers setting the pace and the bed he is going to. The present illness is short and timed, from the lightheaded moment he remembers to the son's arrival. Home medications include the new tamsulosin and the ibuprofen, because both matter later. The examination records the thigh as tense but compressible, which explains why compartment pressures were not measured. The data section pairs each result with the comparison that gives it meaning. The assessment and plan states its ranking rule in one line, then gives hyperkalemia a stepwise plan from the KDIGO conference summary and rhabdomyolysis a urine output target.
Where the points sit in the NU650 Unit 2 rubric
The Unit 2 rubric gives points for the completeness of the history, the accuracy of the examination and data, the prioritization of problems, the quality of each plan and professional documentation. Completeness is judged against what the case needs; a medication list without doses or a social history without living situation loses points. Prioritization is weighted heavily in acute care courses, and a note that leads with the fall rather than the potassium would lose credit. Plans earn full points when each names what is done now, what is monitored and when it is rechecked. Evidence counts when the major problems cite a guideline or review. Documentation style and brevity are graded too.
Common NU650 Unit 2 mistakes, and how to avoid them
The most common error is organizing the assessment by the order the problems were found rather than by threat, so the arrhythmia risk sits under the fall. Another is writing a plan for hyperkalemia that lowers the level without first stabilizing the heart. Students often forget to hold the drugs that caused the problem, here lisinopril, ibuprofen and the thiazide. Some notes give fluids without a target or without watching for overload in an older adult. The cause of a fall is often labeled mechanical without looking at the medication list. And many plans skip the pressure injury and discharge safety, which matter for a man who lives alone.
Get an NU650 Unit 2 example written to your instructions
An emergency department case, whatever labs, vitals and imaging it lists, and the rubric are all the NU650 Unit 2 sample needs. The first one is free and turns around in 24-48h, with an invented patient, bracketed values and problems ranked by danger, each entry carrying its own plan and recheck hour. 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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NU650 Unit 2 questions, answered
Why is the cause of the fall not the first problem?
Because it is not the most dangerous one tonight. A potassium of 6.3 with ECG change can cause an arrhythmia within the hour, and kidney injury from muscle breakdown can worsen fast. The syncope workup still happens and has its own plan, but a threat-ranked list puts tonight's most dangerous problem at the top.
How long should an admission history and physical be?
Long enough to support every problem and no longer. The sample runs about five pages because six problems need assessments and plans, while the history itself is kept short and timed. Sections vary in how much detail they expect, so the prompt and rubric decide, and the sample follows whichever length the instructions set.
Does the sample include real orders and doses?
It includes orders as coursework, with every dose in brackets. The point graded is why each order exists and when it is rechecked. Actual amounts come from the treating team, the hospital's references and the pharmacist, and the patient is a composite, so nothing in the note applies to anyone's real care.
Where can I find a free NU650 Unit 2 sample paper?
The complete NU650 Unit 2 admission history and physical is on this page, with the history, examination, data and six ranked problems each carrying a plan. Admitting a patient with another diagnosis? Send the case and the desk will draft a free note for it.
What goes first in an NU650 Unit 2 assessment and plan?
The problem most likely to cause harm soonest. In the sample, hyperkalemia with ECG changes comes first because it can cause an arrhythmia within the hour, then rhabdomyolysis with kidney injury, then the fall. The note states that ranking rule in one line.