| Course | NU653 AGACNP Acute Care Diagnosis and Management Clinical II |
|---|---|
| Unit | Unit 2 |
| Paper type | Serial progress notes |
| Length | About 610 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU653 Unit 2
Serial Progress Notes, Days One to Three: From Suspected Bacterial Meningitis to Herpes Simplex Encephalitis in a 58-Year-Old Man
[Student Name]
Purdue University Global
NU653: AGACNP Acute Care Diagnosis and Management Clinical II
Unit 2 Serial Progress Notes
[Instructor Name]
[Date]
The patient is composite; values, doses and times are bracketed. Each note is written to stand alone.
Hospital Day 1
Problem-oriented progress note, [18:30]. Summary: [58]-year-old man with hypertension, admitted with [one] day of fever, severe headache and neck stiffness. Objective: temperature [102.4] F, pulse [104], blood pressure [142/84]. Neck stiffness present; oriented but slow to answer. No rash, no focal deficit. Head CT without contrast normal. Lumbar puncture at [15:10]: opening pressure [24] cm H2O; fluid clear; cell count, protein, glucose, Gram stain and culture sent; HSV PCR sent with the other tests. Assessment and plan:
1. Suspected bacterial meningitis. Dexamethasone [10 mg] intravenously given [15] minutes before the first antibiotic doses, then every [six] hours, since adjunctive dexamethasone reduced unfavorable outcomes and death in adults with bacterial meningitis (de Gans & van de Beek, 2002). Empirical vancomycin, ceftriaxone and, because he is over 50, ampicillin for Listeria, as the IDSA meningitis guideline advises (Tunkel et al., 2004).
2. Encephalitis not yet suspected: mental status slowed but no focal findings.
Pending: fluid cell count and chemistry, Gram stain, culture, HSV PCR, blood cultures. Drugs today: dexamethasone, vancomycin, ceftriaxone, ampicillin.
Hospital Day 2
Interval: at [02:15] he had a focal seizure, jerking of the right hand and face for about [90] seconds, with word-finding difficulty afterward that persists this morning. Objective: temperature [101.6] F. Oriented to person only; names objects slowly and substitutes words. No weakness. Spinal fluid: white cells [180] per microliter, [88] percent lymphocytes; red cells [240]; protein [96] mg/dL; glucose [62] mg/dL with serum [118]. Gram stain negative. MRI brain at [08:00]: increased signal in the left medial temporal lobe and insula. Assessment and plan:
1. Herpes simplex encephalitis, now the leading diagnosis, replacing bacterial meningitis. A lymphocytic fluid with a normal glucose, red cells in an atraumatic tap, a focal seizure, a language deficit and a temporal lobe signal on MRI point to the brain tissue, and to herpes, rather than to bacteria in the meninges. Start acyclovir [10 mg/kg] intravenously every [eight] hours now; the IDSA encephalitis guideline recommends acyclovir for all patients with suspected encephalitis while results are pending (Tunkel et al., 2008). Dose adjusted to his creatinine of [1.0]; intravenous fluid to protect the kidneys.
2. Bacterial meningitis, now less likely. Continue vancomycin, ceftriaxone, ampicillin and dexamethasone until cultures at [48] hours and HSV PCR return.
3. Focal seizure. Levetiracetam [1,000 mg] twice daily; EEG today; seizure precautions.
Pending: HSV PCR, fluid and blood cultures, EEG. Drugs today: acyclovir and levetiracetam added; dexamethasone, vancomycin, ceftriaxone and ampicillin continued.
Hospital Day 3
Interval: no further seizures. Word-finding somewhat better. Temperature maximum [100.8] F. Objective: HSV-1 PCR positive in spinal fluid. Fluid and blood cultures with no growth at [48] hours. EEG: left temporal slowing with periodic discharges, no ongoing seizures. Assessment and plan:
1. Herpes simplex encephalitis, confirmed. Continue acyclovir for a total of [14 to 21] days; check creatinine every [two] days for acyclovir nephrotoxicity; speech-language therapy assessment.
2. Bacterial meningitis, excluded. Stop vancomycin, ceftriaxone, ampicillin and dexamethasone today. Dexamethasone is not continued, since its benefit in meningitis applies to pneumococcal disease and its use in herpes encephalitis is not established.
3. Seizure. Continue levetiracetam; neurology to advise on duration.
4. Disposition: expect a prolonged stay; rehabilitation assessment next week.
Pending: repeat creatinine tomorrow. Drugs today: acyclovir and levetiracetam continued; dexamethasone, vancomycin, ceftriaxone and ampicillin stopped.
References
de Gans, J., & van de Beek, D. (2002). Dexamethasone in adults with bacterial meningitis. New England Journal of Medicine, 347(20), 1549-1556. https://doi.org/10.1056/NEJMoa021334
Tunkel, A. R., Glaser, C. A., Bloch, K. C., Sejvar, J. J., Marra, C. M., Roos, K. L., Hartman, B. J., Kaplan, S. L., Scheld, W. M., & Whitley, R. J. (2008). The management of encephalitis: Clinical practice guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases, 47(3), 303-327. https://doi.org/10.1086/589747
Tunkel, A. R., Hartman, B. J., Kaplan, S. L., Kaufman, B. A., Roos, K. L., Scheld, W. M., & Whitley, R. J. (2004). Practice guidelines for the management of bacterial meningitis. Clinical Infectious Diseases, 39(9), 1267-1284. https://doi.org/10.1086/425368
The Purdue Global NU653 Unit 2 instructions
The Unit 2 assignment asks for consecutive daily progress notes on one patient whose picture changes during the admission. You write each note in problem-oriented form, record the interval events first, show new data, revise the assessment when the data require it and update the plan, including what is started, continued and stopped. Each note should stand on its own, because a covering clinician may read only one. Most prompts expect three notes of about a page each, with current guidelines cited for the main decisions. The revision of the diagnosis should be written out, not implied by a new order.
How the NU 653 Unit 2 example is put together
The example gives three dated notes in the same structure. Day one sets out the empirical plan with its reasons, including why dexamethasone comes before the antibiotics and why ampicillin is added for his age. Day two opens with the interval seizure, then the spinal fluid results and MRI, and moves herpes encephalitis to the top of the problem list with a highlighted sentence explaining the findings. The encephalitis guideline supports starting acyclovir before results return. Day three records the PCR and cultures and stops four drugs, with a reason for stopping dexamethasone. Each note ends with the same drug line, so changes are easy to see.
Reading the NU653 Unit 2 grading rubric
The Unit 2 rubric generally looks at the accuracy of each note, the quality of the interval documentation, the revision of the assessment, the plan and documentation standards. Accuracy earns full credit when data are complete and correctly interpreted. Interval documentation counts when the overnight events come first. The revision is weighted heavily; the rubric rewards stating the new diagnosis and the findings behind it. Plans are judged on specificity: doses, what continues and what stops. Documentation standards include dates, times and problem-oriented structure. Notes that could each be read alone by a covering clinician score higher than notes that refer back. Consistent headings across all three notes also make the revision easier to follow.
NU653 Unit 2 help: mistakes that cost points
A frequent mistake is carrying the original diagnosis forward after the data have changed, adding acyclovir without saying why. Another is writing notes that depend on the previous day's note to make sense. Students often forget to stop the drugs that were started for the excluded diagnosis. Dexamethasone is sometimes continued without a reason once bacterial meningitis is excluded. Kidney monitoring for acyclovir is often left out. And spinal fluid results are sometimes listed without interpretation, when the pattern is what points to encephalitis. Give the acyclovir dose with the kidney function it was based on, since graders check that link. And make sure the day three note records what was stopped as clearly as what continued, because stopped drugs are the ones most often missed on the next shift.
Get an NU653 Unit 2 example written to your instructions
Formats for these notes vary: SOAP, problem-oriented or the template a rotation site uses. Say which one applies, describe the composite course over three days, and include the rubric. Free on a first request and ready within 24-48h, the set opens each note on the interval events and gives every discontinued drug its own line. 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 NU653 papers and MSN samples
- NU653 Unit 1: Re-Presenting a Changed Diagnosis
- NU653 Unit 3: Revised Case Presentation
- NU653 Unit 4: Written Plan Defense
- NU653 Unit 5: Seminar Reflection
- NU653 Unit 6: Family Update Summary
- NU653 Unit 7: Case Conference Review
- NU653 Unit 8: Consultation Note
- NU653 Unit 9: Reflective Narrative
- NU653 Unit 10: Learning Objectives Update
- NU652 Unit 2: Failed Therapy Analysis, Kidney Injury
- NU651 Unit 2: Rounds Presentation Script
- NU650 Unit 2: Admission H&P, Rhabdomyolysis Case
- NU648 Unit 2: Dosing Weight Worksheet
NU653 Unit 2 questions, answered
Can the sample use my real patient's course?
Only as a pattern. The notes you write in a patient's actual chart during the rotation are your own clinical work and stay that way. The sample is a written exercise on a composite: the clinical arc can resemble what you saw, but ages, dates and identifying details are invented, under whatever privacy rules the program applies.
Why does each note repeat information from the one before?
Because notes are read singly. A covering clinician at night, a consultant or a coder may open only one of them, and each has to explain the current diagnosis and plan on its own. The sample restates essentials concisely rather than copying text forward, which is the balance most instructors reward.
Should acyclovir have started on day one?
Many clinicians start it at once when encephalitis is possible, and some sections would expect that. The sample's patient had no confusion or focal signs on arrival, which is why day one covered bacteria alone, and the note says so. If your case presents differently, the sample reflects that timing and cites the guideline's advice on empiric therapy.
Where can I find a free NU653 Unit 2 sample paper?
This page contains the complete NU653 Unit 2 serial progress notes, days one to three, with the revision from meningitis to encephalitis and every drug change. A free set of notes for your own patient's course can be written from your details.
When should acyclovir start in NU653 Unit 2?
As soon as encephalitis is suspected. The IDSA encephalitis guideline recommends acyclovir for all patients with suspected encephalitis while results are pending. In the sample it starts on day two, when a focal seizure and the spinal fluid pattern raise the suspicion.