| Course | NU650 AGACNP Introduction to Acute Care Management I |
|---|---|
| Unit | Unit 9 |
| Paper type | Code status summary |
| Length | About 770 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 9
Code Status Summary: No Intubation, No Compressions, and a Defined Trial of Noninvasive Ventilation for a 77-Year-Old With Idiopathic Pulmonary Fibrosis
[Student Name]
Purdue University Global
NU650: AGACNP Introduction to Acute Care Management I
Unit 9 Code Status Summary
[Instructor Name]
[Date]
The patient is composite; dates, times and oxygen settings are bracketed, and her words are paraphrased except where quoted.
Header
Date and time: [Day 2], [19:40] to [20:25]. Present: the patient; her son, [M.], her named health care agent; her bedside nurse; the author, AGACNP student with the attending hospitalist. Setting: private room on the step-down unit, with the patient on high-flow nasal cannula at [40] liters and [60] percent oxygen, saturation [90] to [92] percent.
Capacity
She was able to describe her illness in her own words, understood the choices offered and their likely consequences, reasoned about them in relation to her own values, and expressed a clear and consistent choice across the conversation. These are the four abilities used to assess decision-making capacity (Appelbaum, 2007). She was alert and oriented, and her oxygen level was stable throughout. Capacity for this decision: present.
Her Understanding and Values
Mrs. [W.] said she has known for [four] years that her lungs are "scarring and won't heal," and that her breathing had been worse for [two] weeks before this admission. She understands this episode may be an acute worsening of her fibrosis. In her words: "I've watched this coming. I don't want a tube, and I don't want to be kept alive by a machine I can't get off." She said what matters most is being comfortable, being awake enough to talk with her son and grandchildren, and not dying in an ICU if she can avoid it. She would accept treatment that might help her get home, if it did not mean a breathing tube.
Recommendation Offered
We recommended against intubation and chest compressions. For most patients with respiratory failure caused by idiopathic pulmonary fibrosis, the international guideline advises against mechanical ventilation, because outcomes are poor and survival to discharge is uncommon (Raghu et al., 2011), and reviews of ventilated patients with the disease describe high hospital mortality (Mallick, 2008). We said this plainly and explained that chest compressions and a breathing tube would be unlikely to return her to the life she described. We recommended continuing high-flow oxygen, treating any reversible contributor, and offering a time-limited trial of noninvasive ventilation if her breathing worsened, with the aim of getting her home. She and her son agreed. The recommendation was given as a recommendation, with its reasons, not as a list of options for her to sort through alone.
Decisions, Each on Its Own Line
1. Chest compressions (CPR): no.
2. Defibrillation: no.
3. Endotracheal intubation and mechanical ventilation: no.
4. Noninvasive ventilation (bilevel): yes, as a time-limited trial, described below.
5. High-flow nasal oxygen: yes.
6. Vasopressors: no.
7. Transfer to the ICU: only if needed to deliver the noninvasive ventilation trial; not for intubation or vasopressors.
8. Antibiotics and corticosteroids for a possible reversible cause: yes.
9. Blood draws and imaging: yes, when results would change care.
10. Comfort medications, including opioids for breathlessness: yes, at any point, and not withheld to prolong the trial.
Trial of Noninvasive Ventilation
Purpose: to support her breathing through a possibly reversible worsening, so she can return to high-flow oxygen and, if possible, home. Start: if her respiratory rate rises above [32] for more than [30] minutes or her saturation stays below [85] percent on maximal high flow. Duration: up to [48] hours. Signs the trial is failing: rising carbon dioxide with drowsiness, inability to tolerate the mask for more than [two] hours at a time, or no improvement in oxygen needs after [24] hours. If the trial fails: stop noninvasive ventilation and focus fully on comfort, as she requested. She said she does not want the mask "to become the tube I said no to."
Follow-Up
1. Code status order entered as "Do not resuscitate, do not intubate; noninvasive ventilation trial per note" at [20:35].
2. Palliative care consultation requested for the morning, for symptom support and discussion of home hospice if she improves.
3. Her son will bring her existing advance directive, and a portable medical order form will be completed before discharge.
4. The decision will be revisited if she asks, if her condition changes substantially, or at the end of the trial.
The conversation followed a structured approach to serious illness communication, which asks about understanding, information preferences, goals, fears and trade-offs before making a recommendation (Bernacki & Block, 2014).
References
Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. https://doi.org/10.1056/NEJMcp074045
Bernacki, R. E., & Block, S. D. (2014). Communication about serious illness care goals: A review and synthesis of best practices. JAMA Internal Medicine, 174(12), 1994-2003. https://doi.org/10.1001/jamainternmed.2014.5271
Mallick, S. (2008). Outcome of patients with idiopathic pulmonary fibrosis (IPF) ventilated in intensive care unit. Respiratory Medicine, 102(10), 1355-1359. https://doi.org/10.1016/j.rmed.2008.06.003
Raghu, G., Collard, H. R., Egan, J. J., Martinez, F. J., Behr, J., Brown, K. K., Colby, T. V., Cordier, J.-F., Flaherty, K. R., Lasky, J. A., Lynch, D. A., Ryu, J. H., Swigris, J. J., Wells, A. U., Ancochea, J., Bouros, D., Carvalho, C., Costabel, U., Ebina, M., . . . Schünemann, H. J. (2011). An official ATS/ERS/JRS/ALAT statement: Idiopathic pulmonary fibrosis: Evidence-based guidelines for diagnosis and management. American Journal of Respiratory and Critical Care Medicine, 183(6), 788-824. https://doi.org/10.1164/rccm.2009-040GL
NU650 Unit 9 instructions, in plain terms
The Unit 9 assignment asks you to document a code status conversation with a seriously ill hospitalized patient, written as a note the team will rely on overnight. You record the participants, assess and document decision-making capacity, summarize the patient's understanding and values, state the recommendation you offered and why, list each decision about resuscitation and escalation, and plan follow-up. Many prompts include a time-limited trial, which must be defined clearly. The note is usually one to two pages. It should be specific enough that a cross-covering clinician at night can act on it without calling anyone. Where the patient has a named health care agent, record who that is and whether they took part.
Inside the NU650 Unit 9 example
The example is laid out as a chart note with a header giving date, time, participants and her oxygen settings. The capacity section names four abilities and states the finding rather than simply writing capable. Her understanding and values come next, partly in her own words, before the recommendation, as in the conversation itself. The recommendation cites the international IPF guideline and a review of ventilated patients. A numbered list gives each intervention its own answer. The trial of noninvasive ventilation has a purpose, a start trigger, a duration, failure signs and a plan if it fails. The note ends with the order entered and four follow-up items.
Where the points sit in the NU650 Unit 9 rubric
The Unit 9 rubric looks at documentation of capacity, representation of the patient's values, the clinical recommendation, clarity of the decisions, the definition of any trial and follow-up. Capacity earns full points when the abilities assessed are named. Values count when they appear in the patient's own words and connect to the decisions. The recommendation is judged on whether it is given as a recommendation with evidence rather than a menu. Clarity is weighted heavily, since vague code status notes cause harm at night. A trial must have measurable limits. Follow-up earns credit when it includes palliative care and portable orders. A note that a night clinician could act on without paging anyone is the standard to aim for.
NU650 Unit 9 help from the desk
The most common error is writing a single DNR line and leaving the team to guess about noninvasive ventilation, vasopressors or transfer. Another is recording capacity as present without saying how it was assessed. Students often present every option as equally reasonable instead of making a recommendation. Trials of noninvasive ventilation are frequently left open-ended, with no duration or failure criteria. Some notes forget comfort medications, which should be allowed at any point. The patient's own words are often paraphrased away. And many notes omit the surrogate's role, which matters if the patient later loses capacity. Read the note as the night team would, at four in the morning, and fix anything that needs a phone call to interpret.
Get an NU650 Unit 9 example written to your instructions
Scenario details, including any surrogate or family members, and the NU650 Unit 9 rubric are what the model summary needs. It is free the first time and takes 24-48h, pairing a composite conversation with an intervention table, a capacity statement and trial terms clear enough for a cross-covering clinician to follow at 4 a.m. without a phone call. 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 9 questions, answered
Is a code status summary the same as a goals-of-care note?
They overlap. A goals-of-care note records values and the conversation broadly; a code status summary turns that conversation into specific decisions about resuscitation and escalation that the team can act on. Many hospitals combine them. The sample leads with the decisions and keeps the conversation summary short enough to support them without burying the table.
What if the patient lacks capacity?
Then the summary identifies the surrogate and the legal basis for that role, records what the surrogate reports the patient was known to want, and uses substituted judgment where possible. The capacity section states which elements were missing. A prompt with an incapacitated patient would get that structure, with the surrogate's reasoning documented instead of the patient's.
Should the summary include a POLST form?
POLST forms record portable medical orders for seriously ill patients and are usually completed near discharge rather than during an acute admission. The sample lists POLST as a follow-up item. State rules on POLST and similar forms vary, so a sample written for a particular site follows that site's forms and whatever the prompt specifies.
Where can I find a free NU650 Unit 9 sample paper?
This page holds the complete NU650 Unit 9 code status summary, with capacity, values, the recommendation, ten decisions each on its own line and a defined trial. A free sample written around your own patient and conversation can be requested.
Should a code status note make a recommendation in NU650 Unit 9?
Yes. The sample gives a clear recommendation against intubation and compressions, with its reasons and the guideline behind it, after recording what the patient values. Leaving a seriously ill patient to sort through a list of options alone is not what the rubric rewards.