| Course | NU651 AGACNP Introduction to Acute Care Management Clinical I |
|---|---|
| Unit | Unit 3 |
| Paper type | Daily progress note |
| Length | About 650 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU651 Unit 3
Daily Progress Note, Hospital Day Two: Sickle Cell Pain Crisis in a 26-Year-Old Woman, Recording Only What Moved
[Student Name]
Purdue University Global
NU651: AGACNP Introduction to Acute Care Management Clinical I
Unit 3 Daily Progress Note
[Instructor Name]
[Date]
The patient is composite; scores, doses and values are bracketed.
Subjective
Hospital day [2]. See the admission note of [Day 0] for history. Overnight she slept in stretches of [two to three] hours, which she says is better than the first night. Pain is [6] out of 10 this morning, down from [9] on admission and [7] at midnight, now mostly in the lower back and both thighs; the pain in her arms has settled. She has no chest pain, cough or shortness of breath. She compares this crisis to her last one in [March], which lasted [five] days, and says this one "is turning faster." She is eating about half of each meal and drinking well. No fever or chills.
Objective
Vital signs, past [24] hours: temperature [36.8 to 37.4] degrees Celsius; pulse [84 to 102]; blood pressure [108 to 122] over [64 to 76]; respiratory rate [16 to 20]; saturation [96 to 98] percent without oxygen.
Patient-controlled analgesia, hydromorphone: [41] demands and [24] deliveries in the past [24] hours, against [86] demands and [30] deliveries the day before; total dose [7.2] mg against [9.0] mg. Scheduled acetaminophen continued.
Incentive spirometer: [ten] breaths every [two] hours while awake, recorded by nursing, with a best volume of [1,750] mL.
Examination: comfortable at rest, moving slowly. Chest clear to the bases on both sides, no dullness, no added sounds. Heart regular with a soft flow murmur, unchanged. Abdomen soft without tenderness; spleen not palpable, as before. Lower back and both thighs tender without swelling or redness. Alert, no focal deficit.
Laboratory results, today against admission:
1. Hemoglobin [7.9] g/dL, against [8.3] on admission and her baseline of [8.2].
2. Reticulocytes [11.2] percent, against [10.4].
3. Total bilirubin [3.4] mg/dL, against [3.9].
4. Lactate dehydrogenase [412] U/L, against [468].
5. White cell count [11.8], against [13.1]. Creatinine [0.6], unchanged.
Assessment and Plan
Pain is improving by the numbers that matter for dosing: fewer demands, fewer deliveries and a lower total dose, with better sleep. Hemoglobin is near her baseline, and the hemolysis markers are stable to improving, which argues against a new hemolytic or sequestration process.
1. Vaso-occlusive pain crisis, improving. Continue hydromorphone PCA at the current settings today, with no change to the demand dose or lockout. The ASH guideline supports individualized, rapidly started opioid therapy with patient-controlled analgesia where appropriate (Brandow et al., 2020). Plan to convert to an oral regimen when her demands fall below [20] in [24] hours, probably tomorrow. Continue scheduled acetaminophen. No corticosteroids, which the guideline suggests against for acute pain. Encourage walking in the hall twice today.
2. Acute chest syndrome, not present; risk remains. Nothing points to it this morning: no chest pain, no fever, clear chest and a stable saturation. It stays on the problem list because acute chest syndrome often develops after admission for a pain crisis, in the second or third day, and in adults it runs a more severe course (Vichinsky et al., 2000). Continue incentive spirometry, which reduced pulmonary complications in patients admitted with chest or back pain in a randomized trial (Bellet et al., 1995). Chest radiograph and a call to the team for any new chest pain, cough, fever above [38.0] or a saturation below [94] percent.
3. Anemia, at baseline. No transfusion indicated. Repeat complete blood count and reticulocyte count tomorrow.
4. Opioid-related constipation risk. Continue senna and polyethylene glycol; last bowel movement [Day 1].
5. Venous thromboembolism prophylaxis. Enoxaparin continued; walking encouraged.
6. Disposition. Anticipate discharge on [Day 3 or 4] once pain is controlled on oral medication, with hematology follow-up within [one] week and her individualized pain plan updated.
References
Bellet, P. S., Kalinyak, K. A., Shukla, R., Gelfand, M. J., & Rucknagel, D. L. (1995). Incentive spirometry to prevent acute pulmonary complications in sickle cell diseases. New England Journal of Medicine, 333(11), 699-703. https://doi.org/10.1056/NEJM199509143331104
Brandow, A. M., Carroll, C. P., Creary, S., Edwards-Elliott, R., Glassberg, J., Hurley, R. W., Kutlar, A., Seisa, M., Stinson, J., Strouse, J. J., Yusuf, F., Zempsky, W., & Lang, E. (2020). American Society of Hematology 2020 guidelines for sickle cell disease: Management of acute and chronic pain. Blood Advances, 4(12), 2656-2701. https://doi.org/10.1182/bloodadvances.2020001851
Vichinsky, E. P., Neumayr, L. D., Earles, A. N., Williams, R., Lennette, E. T., Dean, D., Nickerson, B., Orringer, E., McKie, V., Bellevue, R., Daeschner, C., & Manci, E. A. (2000). Causes and outcomes of the acute chest syndrome in sickle cell disease. New England Journal of Medicine, 342(25), 1855-1865. https://doi.org/10.1056/NEJM200006223422502
What the NU651 Unit 3 assignment asks for
The Unit 3 assignment asks for a daily progress note on a hospitalized patient, written as it would appear in the chart. You document the interval since the last note, current data and an assessment and plan by problem. The note should not repeat the admission history; it should show what changed and what the team will do today. Most prompts expect SOAP or a problem-based format, objective data with trends rather than single values, and a plan that sets triggers for escalation. A length of a page or so is normal for a stable day two. Sources are expected for the main management decisions, such as analgesia and complication prevention.
Inside the NU651 Unit 3 example
The example refers once to the admission note and then records only new information. The subjective section gives pain scores through the night, sleep, where the pain now sits and her own comparison with an earlier crisis. The objective section reports patient-controlled analgesia as demands, deliveries and total dose against the day before, so the change can be measured. Labs appear as pairs. The assessment opens with one highlighted sentence on why pain is improving. Six problems follow, each with a plan, including acute chest syndrome kept on the list with incentive spirometry and a named threshold for a chest radiograph. The disposition line names the expected discharge day and the hematology follow-up.
Reading the NU651 Unit 3 grading rubric
The Unit 3 rubric looks at the accuracy and relevance of the interval history, the objective data, the assessment, the plan and documentation standards. Interval history earns full credit when it records change rather than repeating the admission. Objective data count when they are trended and quantified. The assessment is judged on whether it interprets the data, for example stating that hemolysis markers argue against a new process. The plan must be specific, with doses, conditions for change and triggers for escalation. Documentation is graded on brevity and clarity, since a progress note that repeats the history is harder to use and scores lower. Graders also look for a disposition line with a day and a follow-up.
NU651 Unit 3 help: mistakes that cost points
The most common mistake is copying the admission note forward, which hides what changed. Another is describing pain as better without the numbers that guide dosing. Students often drop problems that are quiet, such as acute chest syndrome, when those are the problems that need watching. Labs are frequently listed without the admission comparison. Some notes give corticosteroids for acute pain, which the guideline suggests against. Plans often lack the condition for moving from the pump to oral medication. And disposition is left vague when it should name the expected day and the follow-up. Check every value for a unit and a time, since a trend without times cannot be read.
Get an NU651 Unit 3 example written to your instructions
Day-one admission, day-two data and the NU651 rubric: those three inputs are enough for the model note. Returned within 24-48h, with a first note costing nothing, it records only interval change in a composite case, pairs every lab with its earlier value and opens each problem with a status word before its revised plan. 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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NU651 Unit 3 questions, answered
Why keep acute chest syndrome on the list if it has not happened?
Because it is the complication most likely to turn a pain crisis dangerous, and it often develops a day or more into admission. Keeping it listed makes the surveillance visible: the chest exam, spirometer use, temperature and oxygen needs. The note names the finding that would prompt a chest film, so the next clinician knows what to watch for.
What makes a progress note different from an admission note?
An admission note establishes the whole picture; a progress note assumes it and records the interval. The sample drops the history, compares today's data with the admission values, and gives each problem a status and a revised plan. A reader who knows the admission should find nothing repeated and nothing missing.
Do these samples use patients from real rotations?
No. The patient here is a composite with bracketed values, built to show interval documentation. Notes written in a real chart during clinical hours, patient encounters and anything a preceptor co-signs remain with the student and the site. Coursework about rotation patients should strip identifying details, and the sample models that standard throughout.
Where can I find a free NU651 Unit 3 sample paper?
This page contains the full NU651 Unit 3 progress note in SOAP form, with trended analgesia, paired labs and six problems each with a plan. A free progress note written for your own patient and hospital day can be drafted from your prompt.
Why does the NU651 Unit 3 note list acute chest syndrome?
Because it often appears on the second or third day of an admission for a pain crisis and runs a severe course in adults. The sample keeps it listed with incentive spirometry and a clear trigger, even though nothing suggests it yet.