| Course | NU655 AGACNP Acute Care Diagnosis and Management Clinical III |
|---|---|
| Unit | Unit 1 |
| Paper type | Discussion board post with two replies |
| Length | About 550 words, 3 pages double-spaced |
| Format | APA 7 discussion post |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU655 Unit 1
A Sepsis Workup That Missed the Arthritis Tablets: Re-Ranking a Confused, Breathless 78-Year-Old Once Her Salicylate Level Came Back
NU655 · Unit 1 Discussion Board Post
Posted by [Student Name]
The patient is composite; values and times are bracketed.
Initial Post
The sickest patient I have presented so far was a [78]-year-old woman whose son brought her in after [two] days in which she had been confused and breathing fast. My first presentation went like this: "Older woman with fever of [38.3], confusion and a respiratory rate of [32]. Concern for sepsis, possibly meningitis. Cultures, a lumbar puncture and broad antibiotics are ordered." That was a reasonable first reading. Fever with confusion in an older adult should raise infection, and I was right to start antibiotics while I looked.
What reframed it came in the next [40] minutes. Her arterial gas showed a pH of [7.46], a pCO2 of [22] mmHg and a bicarbonate of [15], with an anion gap of [24]: a respiratory alkalosis and a metabolic acidosis at the same time. Her son then brought in a bag from her kitchen containing extra-strength aspirin, which she took [six to eight] times a day for knee pain, and a bottle of bismuth subsalicylate for diarrhea. Her salicylate level was [62] mg/dL. The mixed acid-base pattern was the clue I had not known how to read, and the kitchen bag was the history I had not asked for.
My second presentation led with the poisoning: "Chronic salicylate toxicity with altered mental status; the priorities are alkalinizing her blood and urine, correcting her glucose in the brain, and dialysis." Chronic toxicity in older adults is often mistaken for sepsis or delirium, and its levels can look modest while the brain is already affected (Palmer & Clegg, 2020). The EXTRIP workgroup recommends extracorporeal treatment for any patient with altered mental status from salicylate poisoning, whatever the level (Juurlink et al., 2015). She had dialysis within [three] hours and was talking with her son by the next morning.
I kept the cultures and one dose of antibiotics until they returned negative, so the sepsis plan was not abandoned, only moved down the list.
My question for the group: have you had a patient whose first presentation was reasonable but whose priorities flipped within an hour, and what finding did it?
Reply to a Classmate Who Asked About Intubation
You asked whether she should have been intubated for her confusion. That was discussed and avoided. Patients with salicylate toxicity breathe fast to offset the acid, and if intubation lowers their ventilation even briefly, the blood becomes more acidic and more salicylate moves into the brain. If intubation had been needed, the plan was to set a high minute ventilation and to have dialysis ready. Keeping her breathing on her own, with close watching, was safer.
Reply to a Classmate Who Missed a Similar History
You described an older man whose confusion turned out to come from a sleeping tablet his wife had given him. I think our cases share a lesson: medications bought at a pharmacy counter often never reach the medication list, because people rarely count them when asked what they take. Asking a family member to bring every bottle from home found the answer in both of our cases.
References
Juurlink, D. N., Gosselin, S., Kielstein, J. T., Ghannoum, M., Lavergne, V., Nolin, T. D., Hoffman, R. S., Anseeuw, K., Bhalla, A., Burdmann, E. A., Calello, D. P., Dargan, P. I., Decker, B. S., Goldfarb, D. S., Galvão, T., Hoegberg, L. C., Laliberté, M., Li, Y., Liu, K. D., . . . Yates, C. (2015). Extracorporeal treatment for salicylate poisoning: Systematic review and recommendations from the EXTRIP workgroup. Annals of Emergency Medicine, 66(2), 165-181. https://doi.org/10.1016/j.annemergmed.2015.03.031
Palmer, B. F., & Clegg, D. J. (2020). Salicylate toxicity. New England Journal of Medicine, 382(26), 2544-2555. https://doi.org/10.1056/NEJMra2010852
The Purdue Global NU655 Unit 1 instructions
The opening NU655 discussion asks you to describe the sickest patient you have presented so far and how your presentation changed as the picture became clearer. Most prompts want the first presentation described fairly, the finding that changed it, the new priorities and the evidence behind them. You are expected to invite classmates to share similar reversals. Expect about 400 words for the first post, a pair of scholarly citations, and replies to two classmates later in the unit; a composite woman stands in for any real patient. Posts that quote both versions of the presentation let classmates see exactly what moved, which is usually what the prompt is after. Say why the first reading was reasonable before you correct it.
How the NU 655 Unit 1 example is put together
The example quotes the first presentation in full and calls it reasonable, since fever and confusion in an older adult rightly raise infection. A paragraph then gives the two findings that reframed the case: a mixed acid-base pattern and the bag from the kitchen. A highlighted sentence names what the author had not known how to read and what the author had not asked. The second presentation is quoted, with evidence that chronic salicylate toxicity is often mistaken for sepsis and that altered mental status is an indication for dialysis. A line explains that the sepsis plan was moved down rather than abandoned. The replies address intubation and hidden medicines. Both replies stay under two hundred words.
Where the points sit in the NU655 Unit 1 rubric
Unit 1 grading usually spreads points across clinical accuracy, reasoning, evidence, peer engagement and writing mechanics. Accuracy earns full credit when the acid-base pattern and its meaning are described correctly. Reasoning points depend on explaining the cause of the reversal, not merely reporting it. Evidence counts when it supports the new plan, such as the EXTRIP indications for extracorporeal treatment. Replies should add something, like the danger of intubating a patient who is compensating by breathing fast. Writing is scored on clarity and APA citations. Posts that treat the first presentation fairly usually score better than those that disown it.
NU655 Unit 1 help: mistakes that cost points
A frequent mistake is describing the first presentation as a careless error, which misses the point that it was reasonable at the time. Another is naming a toxic level without saying what it changes in treatment. Students often forget to ask what the patient takes from the pharmacy counter. Some posts suggest intubating a patient with salicylate toxicity without addressing ventilation, which can worsen acidosis. Replies may repeat the original post. And a post that drops the sepsis workup entirely, rather than moving it down, leaves an infection untreated if the new diagnosis turns out to be only part of the story.
Get an NU655 Unit 1 example written to your instructions
The patient who stretched your presentation most belongs to your own clinical days and stays there. Describe the pattern in general terms, with no identifiers, and send the posting rules; a composite post built on that pattern costs nothing and is ready inside 24-48h, its corrected opening sentence where a reader meets it first. 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 NU655 papers and MSN samples
- NU655 Unit 2: Integrated Case Presentation
- NU655 Unit 3: Priority Defense Memo
- NU655 Unit 4: Escalation Handoff Note
- NU655 Unit 5: Seminar Reflection
- NU655 Unit 6: Family Meeting Summary
- NU655 Unit 7: Code Debrief
- NU655 Unit 8: Transfer Summary
- NU655 Unit 9: End-of-life Reflection
- NU655 Unit 10: Acute Care Synthesis Paper
- NU654 Unit 1: Stroke and Pulmonary Edema BP Post
- NU653 Unit 1: Re-Presenting a Changed Diagnosis
- NU652 Unit 1: Persistent Fever Discussion Post
- NU651 Unit 1: Pre-Rounding Discussion Post
NU655 Unit 1 questions, answered
Can the post describe a real patient from my rotation?
Your own post should draw on a patient you actually presented, with every identifier removed and any details your program requires changed. A sample written by someone outside the rotation can only offer a composite on a similar pattern, which shows the structure and the reflection without borrowing anyone's clinical record, including your own.
What if my sickest patient had a straightforward diagnosis?
The post can still work. Sickness and diagnostic difficulty are different things, and many prompts care more about how the presentation held several failing systems together. A composite built on a patient with a clear diagnosis would shift its focus to ranking and linking those systems, rather than to correcting an opening sentence.
Where can I find a free NU655 Unit 1 sample paper?
This page holds the complete NU655 Unit 1 discussion post and both replies, with both presentations quoted and the treatment priorities explained. If your sickest patient had a different reversal, the desk can prepare a free post around your case.
When is dialysis needed for salicylate toxicity in NU655 Unit 1?
The EXTRIP workgroup recommends extracorporeal treatment for any patient with altered mental status from salicylate poisoning, for new hypoxemia requiring oxygen, when standard therapy is failing, and above certain levels regardless of symptoms. The sample's patient was confused, so she had dialysis.
Why can salicylate toxicity look like sepsis in NU655 Unit 1?
Chronic toxicity in older adults causes fever, confusion and fast breathing, all of which also suggest infection. The mixed acid-base pattern on the blood gas and a history of aspirin or bismuth use are the clues that separate them.