| Course | NU650 AGACNP Introduction to Acute Care Management I |
|---|---|
| Unit | Unit 3 |
| Paper type | Level-of-care justification |
| Length | About 800 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU650 Unit 3
Progressive Care, Not the Floor and Not the ICU: A Level-of-Care Justification for Severe Alcohol Withdrawal in a 66-Year-Old With a Prior Seizure
[Student Name]
Purdue University Global
NU650: AGACNP Introduction to Acute Care Management I
Unit 3 Level-of-Care Justification
[Instructor Name]
[Date]
The patient is composite; scores, doses and times are bracketed.
Recommendation
Admit Mr. [K.] to a progressive care (step-down) bed as an inpatient. The bed is chosen for the frequency of reassessment and the dose of medication he is likely to need; the status is chosen because his care is expected to span more than two midnights. These are separate questions and are answered separately below.
Case Summary
Mr. [K.] is a [66]-year-old man who drinks about [a pint] of vodka daily and stopped [36] hours ago when he ran out of money. He had a withdrawal seizure [three] years ago during an earlier attempt to stop. Over the past [three] hours his CIWA-Ar scores have been [14], [17] and [19], with tremor, sweating, anxiety and intermittent visual disturbances he recognizes as not real. His heart rate is [118], blood pressure [168/98], temperature [37.9] degrees Celsius. He is oriented and protecting his airway. He has received lorazepam [2 mg] three times in [three] hours. His Prediction of Alcohol Withdrawal Severity Scale (PAWSS) score is [6]; scores of 4 or more identify patients at high risk of complicated withdrawal (Maldonado et al., 2015). Magnesium is [1.5] mg/dL and potassium [3.4] mEq/L; liver enzymes are mildly raised.
Why This Bed
Each factor below could point to a different unit. Placement follows what he needs to be safe, which is the principle the critical care admission guidance sets out: the unit should match the monitoring and interventions the patient requires, not the diagnosis (Nates et al., 2016).
1. Reassessment frequency. A CIWA-Ar of [19] with a rising trend calls for reassessment about every hour and symptom-triggered dosing. A medical floor with a [one]-to-[five] nurse ratio cannot reliably reassess hourly. Points to: progressive care.
2. Benzodiazepine requirement. He needed [6 mg] of lorazepam in [three] hours. That is substantial but not escalating toward a continuous infusion. Points to: progressive care, not intensive care.
3. Seizure history. A prior withdrawal seizure is one of the strongest predictors of complicated withdrawal, and the ASAM guideline treats it as a reason for inpatient management with close monitoring (American Society of Addiction Medicine, 2020). Points against: the floor.
4. Autonomic instability. Heart rate [118] and pressure [168/98] need continuous cardiac monitoring while doses are adjusted. Points to: a monitored bed.
5. Airway and mental status. He is oriented and protecting his airway, with no sign of delirium. Points against: intensive care.
6. Electrolytes and comorbidity. Low magnesium and potassium need replacement and rechecks, which a progressive care unit handles routinely. Neutral.
Taken together, the seizure history rules out the floor and the intact airway rules out the ICU, which leaves the one bed built for hourly reassessment without intubation.
What Would Move Him
Up to intensive care, if any of these occur:
1. A requirement for more than [lorazepam 8 mg, or equivalent,] in any hour, or for a continuous infusion or phenobarbital loading beyond the unit's protocol.
2. A seizure, or delirium with agitation that endangers him or staff.
3. Failure to protect his airway, or oxygen needs rising above [4] liters.
4. Hemodynamic instability not corrected by treating withdrawal.
Down to the medical floor, when all of these are true for [12] hours:
1. CIWA-Ar below [10] on consecutive checks.
2. No benzodiazepine requirement above [2 mg] of lorazepam in [four] hours.
3. Heart rate below [100] and no new neurologic symptoms.
Naming the thresholds in advance lets the night team act without reopening the placement argument.
Why Inpatient Status
Status is a different decision from bed type. It answers a regulatory and billing question: whether the admitting practitioner expects him to need hospital care that crosses at least two midnights. Under the Medicare rule, inpatient admission is generally appropriate when that expectation is reasonable and documented (Admissions, 42 C.F.R. § 412.3, 2024). For Mr. [K.], it is. Severe withdrawal with a seizure history usually peaks between [48] and [72] hours after the last drink, and he is at [36] hours, so his highest risk is still ahead. He will need symptom-triggered dosing and monitoring for at least [two to three] more days, then a taper and addiction medicine consultation. Observation status would understate what he needs and would not match the care he will receive.
Documentation will state the expected length of stay, the reasons for it (severity, seizure history, the timing of the withdrawal peak) and the plan for treatment and discharge, including a referral for medication treatment of alcohol use disorder before he leaves.
References
Admissions, 42 C.F.R. § 412.3 (2024).
American Society of Addiction Medicine. (2020). The ASAM clinical practice guideline on alcohol withdrawal management. Journal of Addiction Medicine, 14(3S), 1-72. https://doi.org/10.1097/ADM.0000000000000668
Maldonado, J. R., Sher, Y., Das, S., Hills-Evans, K., Frenklach, A., Lolak, S., Talley, R., & Neri, E. (2015). Prospective validation study of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in medically ill inpatients: A new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol and Alcoholism, 50(5), 509-518. https://doi.org/10.1093/alcalc/agv043
Nates, J. L., Nunnally, M., Kleinpell, R., Blosser, S., Goldner, J., Birriel, B., Fowler, C. S., Byrum, D., Miles, W. S., Bailey, H., & Sprung, C. L. (2016). ICU admission, discharge, and triage guidelines: A framework to enhance clinical operations, development of institutional policies, and further research. Critical Care Medicine, 44(8), 1553-1602. https://doi.org/10.1097/CCM.0000000000001856
NU650 Unit 3 instructions, in plain terms
The Unit 3 assignment gives you an acutely ill patient and asks where in the hospital that patient belongs, with a written justification. You summarize the case, apply criteria for placement, compare the options, state the thresholds that would change the placement and address admission status. Most prompts expect you to use validated scores where they exist, such as CIWA-Ar and PAWSS for alcohol withdrawal, and to cite guidance on placement. Status and bed type should be discussed separately, because one is about monitoring need and the other about expected length of hospital care. Two to four pages is typical, and the recommendation should appear first. The best papers also say which factor they weighed most heavily and why.
How the NU 650 Unit 3 example is put together
The example states its recommendation in the opening line and then separates the two decisions it contains. A case summary gives the drinking history, the seizure, the CIWA-Ar trend over three hours and the PAWSS score of 6. The heart of the paper is a list of six factors, each ending with the unit it points toward, so a reader sees that the seizure history rules out the floor while the intact airway rules out intensive care. Thresholds for moving up or down are written as numbered conditions. The status section cites the federal admissions regulation and argues from timing, since withdrawal usually peaks after the point he has reached.
NU650 Unit 3 rubric: what earns full points
The Unit 3 rubric weighs the accuracy of the case summary, the use of criteria, the reasoning behind the placement, the escalation and de-escalation plan and the discussion of status. Criteria earn full credit when validated scores are used and interpreted correctly, including the PAWSS threshold of 4. Reasoning is judged on whether competing factors are acknowledged; a paper that lists only the reasons for its choice looks one-sided. The escalation plan counts when thresholds are specific enough for a night team to act on. Status earns points when it is treated as a separate question with its own basis. Clear writing and correct APA references complete the rubric.
NU650 Unit 3 help from the desk
Students often argue for intensive care because withdrawal feels dangerous, without showing a need the progressive care unit cannot meet. The reverse error, sending a patient with a seizure history to a floor that cannot reassess hourly, is just as common. Many papers mix bed type and status into one decision. Some quote proprietary utilization criteria that cannot be cited publicly. Thresholds are often vague, such as worsening symptoms, rather than a dose or a score. And a surprising number of papers forget low magnesium and potassium, which need replacement and rechecks and support the choice of a monitored bed. Finally, read the recommendation line again at the end; it should still match the table you built.
Get an NU650 Unit 3 example written to your instructions
For the Unit 3 sample, the NU650 case and rubric are enough, plus the name of any triage framework the section prefers. Expect the paper in 24-48h at no cost for a first request, with placement criteria tabled, both escalation directions stated and admission status argued on its own under whatever payer the case names. 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 3 questions, answered
What is the difference between level of care and admission status?
Level of care is where the patient is treated: floor, progressive care or intensive care, chosen by monitoring and nursing need. Status is inpatient or observation, a coverage determination that for Medicare depends on whether hospital care is expected to span at least two midnights. A patient can be inpatient on the floor or under observation on telemetry.
Can the paper quote InterQual or MCG criteria?
Generally not. Both are licensed products, and their detailed content is not public, so the sample names them as the tools utilization review commonly applies and argues from published clinical sources instead. If a section supplies criteria of its own, the paper cites those. The status decision itself belongs to the hospital's process, which the sample acknowledges.
Why not simply place a seizure-risk patient in intensive care?
Because intensive care is justified by what the patient needs now, and this composite man is protecting his airway and responding to intermittent doses. The paper argues that progressive care supplies hourly scoring and closer nursing, and it writes explicit triggers for transfer. A sicker presentation, such as delirium or an infusion requirement, would change the answer.
Where can I find a free NU650 Unit 3 sample paper?
This page contains the complete NU650 Unit 3 level-of-care justification, with the case summary, six placement factors, escalation thresholds and the status argument. A justification for a patient with sepsis, a GI bleed or another diagnosis can be drafted free from your prompt.
What PAWSS score means high risk in NU650 Unit 3?
A PAWSS score of 4 or more identifies patients at high risk of complicated alcohol withdrawal, the threshold reported in the validation study by Maldonado and colleagues. The sample's patient scores 6, and a prior withdrawal seizure adds to that risk.