NU652 Unit 8 Asthma Escalation Plan Example

Course	NU652 AGACNP Acute Care Diagnosis and Management II
Unit	Unit 8
Paper type	Escalation plan
Length	About 900 words, 6 pages double-spaced
Format	APA 7 student paper
School	Purdue University Global
Program	MSN
Updated	September 2026

Free sample paper for NU652 Unit 8

A Ladder With Numbers on Every Rung: An Escalation Plan for Acute Asthma in a 46-Year-Old Who Was Intubated Six Years Ago

[Student Name]

Purdue University Global

NU652: AGACNP Acute Care Diagnosis and Management II

Unit 8 Escalation Plan

[Instructor Name]

[Date]

The patient is composite; peak flows, doses and times are bracketed.

What this part is doingRisk is set out before the ladder, because a prior intubation changes how early each rung should be climbed.

Risk Before the Ladder

Ms. [L.] is a [46]-year-old woman with asthma since childhood, admitted after [two] days of worsening wheeze following a cold. On arrival her peak flow was [35] percent of predicted, her saturation [91] percent without oxygen and she could speak in phrases. After [three] doses of albuterol with ipratropium and oral prednisone, her peak flow reached [55] percent and she could speak in sentences. Her venous carbon dioxide was [41] mmHg.

Her history changes the plan. She was intubated for asthma [six] years ago and has had [two] emergency visits in the past year, and she stopped her inhaled corticosteroid [three] months ago because of cost. A history of intubation for asthma is among the strongest markers of risk for a fatal attack, as are recent emergency care and not using inhaled corticosteroids (Global Initiative for Asthma, 2024). She looks like a ward patient by her peak flow and like an intensive care patient by her history, so the plan is built to move her quickly in either direction.

Level One: Medical Ward

Entry: peak flow at or above [50] percent of predicted after initial treatment, speaking in sentences, saturation at or above [93] percent on no more than [2] liters. Actions: albuterol [2.5 mg] with ipratropium [0.5 mg] by nebulizer every [four] hours and as needed for [24] hours; prednisone [50 mg] daily; oxygen titrated to a saturation of [93 to 95] percent; peak flow before and after each scheduled nebulizer; vital signs every [two] hours for the first night. Notification: the covering clinician is told of any as-needed nebulizer. Exit to level two: see below. Exit to discharge planning: peak flow above [70] percent and nebulizers needed no more than every [four] hours for [12] hours.

Level Two: Step-Down Unit

Entry, any one of these: peak flow below [50] percent of predicted, or a fall of more than [15] percentage points from her best; bronchodilators needed more often than every hour; saturation below [92] percent on [4] liters; respiratory rate above [28]. Actions: continuous cardiac monitoring; albuterol by continuous or back-to-back nebulizer for up to [one] hour; intravenous magnesium sulfate [2 g] over [20] minutes; repeat venous gas at [one] hour. Intravenous magnesium reduced hospital admissions in adults with acute asthma, by about seven per hundred treated, in a Cochrane review (Kew et al., 2014). Notification: covering clinician at the bedside within [15] minutes; attending informed. Exit to level one: peak flow above [50] percent and no continuous nebulizer for [six] hours.

What this part is doingEvery entry trigger is a number or an observable event; an adjective such as worse appears nowhere in the ladder.

Level Three: Intensive Care

Entry, any one of these: a rising carbon dioxide, with a venous value above [45] mmHg or an increase of [5] or more from the last gas; drowsiness or confusion; speech reduced to single words; silent chest; saturation below [90] percent on high-flow oxygen; peak flow below [33] percent or too breathless to perform it. Actions: intensive care team at the bedside; preparation for noninvasive ventilation or intubation by the most experienced airway clinician available; intravenous corticosteroid; continuous bronchodilator. Notification: rapid response call, attending and intensive care attending. Exit to level two: normal and falling carbon dioxide, peak flow above [40] percent, no ventilatory support for [12] hours.

Why Carbon Dioxide Is a Trigger

In a severe asthma attack, a patient breathing fast should blow off carbon dioxide, and a normal value can mean she is tiring. A rising value is a sign of impending respiratory failure and is the reason carbon dioxide appears as an intensive care trigger even when saturation looks acceptable. It is also why oxygen is titrated rather than given at high flow: in a randomized trial of severe asthma, high-concentration oxygen raised transcutaneous carbon dioxide by 4 mmHg or more in 44 percent of patients, against 19 percent with oxygen titrated to 93 to 95 percent (Perrin et al., 2011).

What this part is doingThe carbon dioxide trigger is argued rather than asserted, since it is the rung a busy team is most likely to question.

How the Night Team Uses the Ladder

The ladder is printed at the bedside and in the chart, and the first line of every nursing handoff states her current rung. Because each trigger is a number, the night nurse does not need to page to ask whether a finding matters; she checks the trigger and acts on it. Two rules apply to every rung. First, moving up never waits for the next scheduled assessment: a trigger met at [02:00] is acted on at [02:00]. Second, moving down requires the exit trigger to hold for the stated time, so that a single good peak flow after a nebulizer does not send her back to the ward prematurely. The plan is reviewed with her at the start, because she knows her own attacks and can often tell before the numbers do when she is getting worse.

Before Discharge

Ms. [L.] will restart an inhaled corticosteroid, with the pharmacy team looking for a lower-cost option before she leaves, and receive a written action plan with her peak flow zones, a spacer, teaching on inhaler technique and a follow-up visit within [one] week. Her risk will be restated in the discharge summary, because the next clinician may meet her on a good day.

References

Global Initiative for Asthma. (2024). Global strategy for asthma management and prevention: 2024 update. https://ginasthma.org/2024-report/

Kew, K. M., Kirtchuk, L., Michell, C. I., & Griffiths, B. (2014). Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database of Systematic Reviews, 2014(5), Article CD010909. https://doi.org/10.1002/14651858.CD010909.pub2

Perrin, K., Wijesinghe, M., Healy, B., Wadsworth, K., Bowditch, R., Bibby, S., Baker, T., Weatherall, M., & Beasley, R. (2011). Randomised controlled trial of high concentration versus titrated oxygen therapy in severe exacerbations of asthma. Thorax, 66(11), 937-941. https://doi.org/10.1136/thx.2010.155259

What the NU652 Unit 8 assignment asks for

The Unit 8 assignment asks you to write an escalation plan for an acutely ill patient admitted to a general ward. You assess the patient's risk, define levels of care with clear entry and exit criteria, specify treatments and monitoring at each level, and state who is notified and when. Most prompts expect triggers that a bedside nurse can check quickly, such as vital signs, peak flow or gas values. The plan is usually three to four pages, often laid out as a table or ladder. Evidence is expected for the key treatments and for the risk factors that shape how early to escalate. State the exit criteria for each level as clearly as the entry criteria.

How the NU 652 Unit 8 example is put together

The example begins with the patient's presentation and response to treatment, then sets out why her history of intubation, recent emergency visits and stopped inhaled steroid raise her risk, citing the GINA report. Each of three levels has the same parts: entry, actions, notification and exit. Every trigger is a number or an observable event. Magnesium appears at level two with the Cochrane review's absolute effect. A section explains why carbon dioxide is an intensive care trigger and why oxygen is titrated, citing a randomized trial. A paragraph describes how the night team uses the ladder, and a final section covers discharge. Each level ends with its exit rule so the plan works in both directions.

Where the points sit in the NU652 Unit 8 rubric

The Unit 8 rubric generally scores risk assessment, the clarity of triggers, the appropriateness of treatments at each level, communication and discharge planning. Risk assessment earns full credit when it identifies factors that change the timing of escalation. Triggers are weighted heavily; they must be measurable and quick to check. Treatments are judged against current guidance, such as the GINA oxygen target and magnesium for severe attacks. Communication counts when each level names who is told and how fast. Discharge planning should address the cause of the admission, here an inhaled steroid stopped for cost. A short paragraph on how the ladder is used overnight usually earns credit for communication.

Common NU652 Unit 8 mistakes, and how to avoid them

The most common mistake is writing triggers as adjectives, such as worsening distress, that a night nurse cannot act on. Another is giving high-flow oxygen by default, which can raise carbon dioxide. Students often omit the exit criteria, so patients stay at the highest level longer than needed. Some plans escalate on peak flow alone and ignore a rising carbon dioxide with normal saturation. Magnesium is sometimes left out or given without a stated trigger. Discharge sections often miss the reason the patient came in. And a plan that ignores a prior intubation understates her risk from the start. Check that doses match the guideline you cite.

Get an NU652 Unit 8 example written to your instructions

Escalation plans in this unit might cover an asthma attack, a bleed, respiratory failure or delirium, whichever the case supplies. Forward the scenario along with the grading criteria and any template. There is no charge for the first plan, returned within 24-48h, and each rung in it is entered and left on a stated number. 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.

More NU652 papers and MSN samples

NU652 Unit 8 questions, answered

Can the escalation plan include specific doses?

Yes, in brackets, with a source for each. Bronchodilator frequency, steroid dose and the magnesium dose vary with weight, institution and the guideline used, so the sample shows where a dose belongs and which reference supports it without presenting one figure as universal. Your own plan should follow your course's required references and any protocol the prompt provides.

Why does the plan include a way to step down?

Because staying on the highest level has costs of its own: monitored beds are scarce, frequent nebulizers cause tremor and low potassium, and patients sleep poorly. A plan that describes only escalation tends to keep people there longer than needed. The sample gives each rung an exit criterion, a sign to any grader that the writer is thinking about the whole admission.

Does every escalation plan need an intensive care level?

Not always, but most acute care cases benefit from naming the point at which the ward is no longer the right place. The sample's top rung lists the findings that require transfer, such as drowsiness or a rising PaCO2. For a lower-risk case, your plan may stop at a closer-monitoring level and explain why that is enough.

Where can I find a free NU652 Unit 8 sample paper?

The complete NU652 Unit 8 escalation plan is on this page, with the risk assessment, three levels with triggers and exits, the carbon dioxide argument and discharge. For a patient with a different condition, a free escalation plan can be written from your case.

Why is carbon dioxide an ICU trigger in NU652 Unit 8?

In a severe asthma attack, fast breathing should lower carbon dioxide, so a normal or rising value can mean the patient is tiring. The sample moves her to intensive care if venous carbon dioxide passes 45 or rises by 5 or more.