NU654 Unit 6 Integrated Plan, Endocarditis Example

Course	NU654 AGACNP Acute Care Diagnosis and Management III
Unit	Unit 6
Paper type	Integrated assessment and plan
Length	About 890 words, 6 pages double-spaced
Format	APA 7 student paper
School	Purdue University Global
Program	MSN
Updated	September 2026

Free sample paper for NU654 Unit 6

One Infected Valve, Five Problems: An Integrated Assessment and Plan for Enterococcal Endocarditis With Acute Mitral Regurgitation and Kidney Injury

[Student Name]

Purdue University Global

NU654: AGACNP Acute Care Diagnosis and Management III

Unit 6 Integrated Assessment and Plan

[Instructor Name]

[Date]

The patient is composite; values, doses and sizes are bracketed.

What this part is doingThe strategy is stated before the problem list, because it governs every entry below it.

Strategy

One process drives this admission: an infected mitral valve. It produces three threats, ranked by what can be fixed soonest. First, acute severe mitral regurgitation is causing pulmonary edema, and surgery can correct it; delay risks shock. Second, the infection must be cured with antibiotics that do not worsen his kidneys. Third, his kidney injury limits both the antibiotics and the fluid removal his lungs need. The plan therefore asks cardiac surgery to evaluate him today, chooses an antibiotic combination that spares the kidneys, and accepts some further rise in creatinine as the cost of diuresis for his lungs.

Problem 1: Acute Severe Mitral Regurgitation With Pulmonary Edema

Transesophageal echocardiography on [Day 2] showed a [12] mm vegetation on the anterior mitral leaflet with a perforation and severe regurgitation. He is on [4] liters of oxygen with crackles to the mid-lung fields and a pressure of [104/62]. Plan: cardiac surgery consultation today. The ESC endocarditis guideline recommends urgent surgery for heart failure caused by severe valve regurgitation, and emergency surgery when there is cardiogenic shock or pulmonary edema that does not respond to treatment (Delgado et al., 2023). Furosemide [40 mg] intravenously twice daily with a target negative balance of [1] liter a day. Affects problem 3: diuresis will likely raise his creatinine further; accepted, with limits set in problem 3. Affects problem 2: surgery during active infection is not delayed for a full course of antibiotics when heart failure is the indication.

Problem 2: Enterococcus faecalis Endocarditis

Four of four blood culture bottles grew Enterococcus faecalis, sensitive to ampicillin, with high-level aminoglycoside resistance not tested yet. Definite endocarditis by the modified Duke criteria. Plan: ampicillin [2 g] every [four] hours with ceftriaxone [2 g] every [12] hours, for [six] weeks. The combination is chosen as much for his kidneys as for the organism. Ampicillin with ceftriaxone was as effective as ampicillin with gentamicin for Enterococcus faecalis endocarditis in a large observational study, with no difference in mortality or relapse, and with virtually no risk of kidney failure (Fernández-Hidalgo et al., 2013). The AHA statement also supports the combination (Baddour et al., 2015). Repeat blood cultures every [48] hours until negative. Colonoscopy after recovery, since Enterococcus faecalis endocarditis may start from a colonic source. Affects problem 3: gentamicin is avoided because of nephrotoxicity. Affects problem 1: the surgical team will send the valve for culture.

What this part is doingEach antibiotic choice names the problem it protects, so the entry cannot be read in isolation.

Problem 3: Acute Kidney Injury

Creatinine [2.1] mg/dL, up from [1.0] three days ago. Likely causes: poor forward flow from the regurgitation, immune complex glomerulonephritis from endocarditis and contrast from a CT on admission. Urinalysis shows [2+] protein and red cells. Plan: avoid nephrotoxins, including gentamicin, nonsteroidal anti-inflammatory drugs and further contrast unless essential for surgery; dose ampicillin for kidney function; daily creatinine and potassium. Accept a creatinine up to [2.8] during diuresis if urine output is maintained and potassium stays below [5.5]; beyond that, discuss with nephrology. Affects problem 1: the diuresis target may be slowed if these limits are reached. Affects problem 2: antibiotic doses change with kidney function.

Problem 4: Embolic Risk

A mobile vegetation larger than [10] mm raises the risk of embolism, including stroke. His neurological examination is normal. Plan: brain MRI before surgery, since a silent embolic stroke or hemorrhage changes surgical timing. No anticoagulation for the valve. Affects problem 1: the MRI result may change when surgery can safely happen.

Problem 5: Source and Prevention

Enterococcus faecalis in a [58]-year-old man raises the question of a colonic lesion. He had a colonoscopy [eight] years ago. Plan: colonoscopy once he has recovered from surgery. Dental review before discharge. Affects problem 2: a colonic source could explain a relapse if found later.

Communication and Consent

Mr. [E.] and his wife were told on [Day 2] that the infection has damaged a heart valve, that the damage is causing fluid in his lungs, and that surgery to repair or replace the valve is likely to be needed within days rather than weeks. The antibiotic plan, six weeks of treatment through a central line, was explained, including why the team chose drugs that are gentler on his kidneys. He asked whether surgery could wait until the infection was cleared. The answer given was that the guideline supports earlier surgery when the valve is causing heart failure, because waiting can let the heart failure worsen, and that the surgeon would discuss timing with him today. His questions and the answers are recorded so that the surgical team starts from the same understanding.

What this part is doingThe patient's own question about timing is recorded with the answer, since it is the question the surgeon will hear next.

How the Problems Were Ordered

Heart failure from regurgitation is first because it is the most dangerous and the most fixable. The infection is second because its treatment takes weeks and is already under way. The kidneys are third because they limit the first two rather than threatening life on their own. Embolism and the source follow because they change timing and prevention rather than today's orders. Writing each problem with its effect on the others is what makes this an integrated plan rather than a list.

References

Baddour, L. M., Wilson, W. R., Bayer, A. S., Fowler, V. G., Jr., Tleyjeh, I. M., Rybak, M. J., Barsic, B., Lockhart, P. B., Gewitz, M. H., Levison, M. E., Bolger, A. F., Steckelberg, J. M., Baltimore, R. S., Fink, A. M., O'Gara, P., & Taubert, K. A. (2015). Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: A scientific statement for healthcare professionals from the American Heart Association. Circulation, 132(15), 1435-1486. https://doi.org/10.1161/CIR.0000000000000296

Delgado, V., Ajmone Marsan, N., de Waha, S., Bonaros, N., Brida, M., Burri, H., Caselli, S., Doenst, T., Ederhy, S., Erba, P. A., Foldager, D., Fosbøl, E. L., Kovac, J., Mestres, C. A., Miller, O. I., Miro, J. M., Pazdernik, M., Pizzi, M. N., Quintana, E., . . . Borger, M. A. (2023). 2023 ESC guidelines for the management of endocarditis. European Heart Journal, 44(39), 3948-4042. https://doi.org/10.1093/eurheartj/ehad193

Fernández-Hidalgo, N., Almirante, B., Gavaldà, J., Gurgui, M., Peña, C., de Alarcón, A., Ruiz, J., Vilacosta, I., Montejo, M., Vallejo, N., López-Medrano, F., Plata, A., López, J., Hidalgo-Tenorio, C., Gálvez, J., Sáez, C., Lomas, J. M., Falcone, M., de la Torre, J., . . . Pahissa, A. (2013). Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating Enterococcus faecalis infective endocarditis. Clinical Infectious Diseases, 56(9), 1261-1268. https://doi.org/10.1093/cid/cit052

What the NU654 Unit 6 assignment asks for

The Unit 6 assignment asks you to write an assessment and plan for a patient whose problems are linked, so that treating one affects the others. You state an overall strategy first, then list problems in priority order, each with its assessment, plan and effect on the other problems. Most prompts expect about six pages. The plan should make clear which problem drives the others and why the order was chosen. Guidelines and primary studies should support major decisions, such as the timing of surgery and the choice of antibiotics, and communication with the patient belongs in the plan. Include what the patient was told, since consent for surgery depends on it.

How this NU654 Unit 6 example is built

The example opens with a strategy paragraph of three clauses: surgery evaluated today, antibiotics chosen for the kidneys, and fluid removal accepted at a stated renal cost. Each of the five problems has its own entry, ending with lines that name its effect on other problems. The endocarditis entry uses a large observational study to justify ampicillin with ceftriaxone over gentamicin, with a highlighted sentence. The kidney entry sets numeric limits for the diuresis. A section records the conversation with the patient and his question about timing. A closing paragraph explains the order of the problems. Every entry is written so it cannot be read alone.

Where the points sit in the NU654 Unit 6 rubric

The Unit 6 rubric generally looks at integration, prioritization, the quality of each plan, use of evidence and communication. Integration is weighted most heavily; each problem must show its effect on the others. Prioritization earns full credit when the order is explained by what is most dangerous and most fixable. Each plan should be specific, with doses, targets and limits. Evidence counts when it supports a decision in this patient, such as surgery for heart failure caused by valve regurgitation. Communication with the patient and consulting teams is part of the rubric in most sections. Each problem ending with its effect on the others is the clearest way to show integration.

NU654 Unit 6 help: mistakes that cost points

The most common mistake is writing a separate plan for each problem without showing how they interact, which produces conflicting orders. Another is choosing gentamicin for enterococcal endocarditis in a patient with kidney injury when a kidney-sparing option exists. Students often delay surgery until antibiotics are complete, which the guidelines do not require when heart failure is the indication. Diuresis is sometimes ordered without a renal limit. The source of the infection is often forgotten. And a strategy that is never stated leaves the reader to guess why the problems are in that order. State the renal limits for diuresis as numbers. And record the patient's own questions, since the surgeon will hear them next.

Get an NU654 Unit 6 example written to your instructions

Sepsis with bleeding, heart failure with kidney injury, liver failure with infection: integrated plans here pair all sorts of problems, and the strategy paragraph and cross-references carry over to any of them. Share your case, the number of problems expected and the rubric, and the first plan, free, takes 24-48h to arrive. 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 NU654 papers and MSN samples

NU654 Unit 6 questions, answered

How is an integrated plan different from a problem list?

A problem list treats each diagnosis separately. An integrated plan states one strategy first and then writes each problem so that its decisions acknowledge the effect on the others. In the sample, the antibiotic entry refers to the kidney, the kidney entry refers to diuresis, and the rhythm entry refers to surgery. Graders often read for exactly those cross-references.

Why is heart failure ranked above the infection?

Both are serious, but antibiotics are already running, while acute mitral regurgitation is producing pulmonary edema that only surgery can correct. The plan ranks first the threat that delay would worsen most. It keeps the infection central to the strategy, since the infected valve is the single process behind every problem on the list.

Does the sample include a surgical date?

It includes a surgical consultation on the day of the plan and treats the date as pending, because timing depends on the surgeons, brain imaging and the patient's stability. Several decisions are written as conditional on that date. If your case already supplies one, the plan can be rewritten around it and the conditional entries firmed up.

Where can I find a free NU654 Unit 6 sample paper?

The full NU654 Unit 6 integrated assessment and plan is on this page, with the strategy paragraph, five linked problems and the patient conversation. For a patient with a different set of linked problems, a free plan can be written from your case.

Why ampicillin with ceftriaxone in NU654 Unit 6?

Because it was as effective as ampicillin with gentamicin for Enterococcus faecalis endocarditis in a large observational study, with no difference in mortality or relapse, and with virtually no risk of kidney failure, which matters in a patient whose creatinine has doubled.