| Course | NU655 AGACNP Acute Care Diagnosis and Management Clinical III |
|---|---|
| Unit | Unit 2 |
| Paper type | Integrated case presentation script |
| Length | About 660 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU655 Unit 2
One Sentence Joins Four Emergencies: A Five-Minute Integrated Case Presentation of Myxedema Coma in a 76-Year-Old Woman
[Student Name]
Purdue University Global
NU655: AGACNP Acute Care Diagnosis and Management Clinical III
Unit 2 Integrated Case Presentation
[Instructor Name]
[Date]
The patient is composite; values, doses and times are bracketed. Timing marks show where the five minutes go.
Script
[0:00 to 0:30] Mrs. [K.] is a [76]-year-old woman whose untreated hypothyroidism has progressed to myxedema coma, likely precipitated by a urinary infection, and it is driving her low temperature, slow heart rate, low sodium and rising carbon dioxide; the aim for the next [six] hours is intravenous thyroid hormone with steroid cover, and airway protection if her carbon dioxide keeps rising.
[0:30 to 1:00] Background: hypothyroidism for [20] years on levothyroxine [100] mcg daily, which ran out in [April] when her pharmacy closed. Her daughter found her drowsy and cold at home this morning. She has had [two] weeks of slowed speech and constipation.
[1:00 to 2:00] Breathing first, because it will fail soonest. Respiratory rate [9], pCO2 [66], pH [7.26]. Thyroid hormone deficiency blunts the brain's drive to breathe and weakens the respiratory muscles, so she retains carbon dioxide. She is on bilevel noninvasive ventilation; if her pCO2 rises above [75] or she cannot protect her airway, she will be intubated, with vasopressors ready, because her heart tolerates induction poorly.
[2:00 to 2:45] Circulation. Pulse [44], blood pressure [88/50], a small pericardial effusion without tamponade on bedside echo. Hypothyroidism slows the heart and weakens its contraction. Fluids are cautious, since she retains water, and norepinephrine is ready. Heart rhythm will improve with thyroid hormone, not with atropine alone.
[2:45 to 3:30] Temperature and brain. Temperature [33.8]; drowsy but rousable, Glasgow Coma Scale [11]. Passive rewarming with blankets only; active external warming can drop her pressure by dilating vessels. Glucose [64]: dextrose given.
[3:30 to 4:10] Sodium [119] mEq/L. Hypothyroidism reduces the kidney's ability to excrete water. She has no seizures, so the plan is fluid restriction and slow correction, no more than [8] mEq/L in [24] hours, with sodium every [four] hours.
[4:10 to 4:40] Trigger. Urine is cloudy with many white cells; ceftriaxone started after cultures. Her temperature is low, so infection may not produce fever.
[4:40 to 5:00] Treatment. Hydrocortisone [100 mg] intravenously every [eight] hours, given first, because adrenal insufficiency can coexist and thyroid hormone can precipitate an adrenal crisis. Then levothyroxine [200] mcg intravenously as a loading dose, followed by a daily intravenous dose. The ATA guideline recommends intravenous thyroid hormone with glucocorticoids until adrenal insufficiency is excluded (Jonklaas et al., 2014). Intensive care admission.
Margin Notes on Why the Order Holds
Breathing leads because hypercapnic failure can end in arrest within hours, and the plan for intubation has to be ready before it is needed. Circulation follows because hypotension and bradycardia limit every other treatment. Temperature, glucose and sodium come next, because each can be corrected slowly once breathing and circulation are safe. The trigger and the definitive treatment close the script, so the listener leaves with the thing that will fix all four abnormalities.
Four abnormal numbers are one disease with four signs, and the presentation earns that claim by linking each sign to the thyroid in its first sentence.
Prepared Answers
How dangerous is this? In a Japanese national inpatient database, in-hospital mortality from myxedema coma was about 30 percent, and patients needing vasopressors or ventilation did worse (Ono et al., 2017).
Why not a high dose of liothyronine? It acts faster, but it carries more cardiac risk in an older woman with a slow heart, and treatment reviews describe levothyroxine as the usual base, with liothyronine added cautiously if at all (Wartofsky, 2006).
Why steroids first? Because giving thyroid hormone to someone with unrecognized adrenal insufficiency increases cortisol clearance and can cause an adrenal crisis. A random cortisol was drawn before the first dose.
References
Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., & Sawka, A. M. (2014). Guidelines for the treatment of hypothyroidism: Prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid, 24(12), 1670-1751. https://doi.org/10.1089/thy.2014.0028
Ono, Y., Ono, S., Yasunaga, H., Matsui, H., Fushimi, K., & Tanaka, Y. (2017). Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan. Journal of Epidemiology, 27(3), 117-122. https://doi.org/10.1016/j.je.2016.04.002
Wartofsky, L. (2006). Myxedema coma. Endocrinology and Metabolism Clinics of North America, 35(4), 687-698. https://doi.org/10.1016/j.ecl.2006.09.003
Reading the NU 655 Unit 2 instructions
The Unit 2 assignment asks you to present a patient with several abnormal systems as one integrated case. You open with a sentence that names the unifying process, its trigger, the systems it affects and the immediate priority, then present each system in order of danger, linking each back to the unifying process, and close with the definitive treatment. Most prompts set a five-minute limit and a script of about 600 words. The presentation should show integration in its structure, not only claim it. Sources are expected for the diagnosis and treatment, and a few prepared answers to likely questions usually earn credit. Put the treatment order in the last block so the listener leaves with it.
How the NU 655 Unit 2 example is put together
Timing marks divide the script into blocks of seconds. Its first sentence carries the whole case. Background takes one short block. Breathing comes first, with the intubation plan ready, then circulation, temperature and glucose, sodium, and the precipitating infection. Each block opens by linking its abnormality to the thyroid. The treatment block gives the order of hydrocortisone and levothyroxine and cites the ATA guideline. Margin notes explain the order, a highlighted sentence restates the integration claim, and three prepared answers address mortality, the choice against liothyronine and the reason steroids come first. Every value in the script is bracketed as a placeholder.
Reading the NU655 Unit 2 grading rubric
The Unit 2 rubric generally scores integration, prioritization, clinical accuracy, treatment reasoning and delivery. Integration earns full points when every system is tied to the unifying diagnosis, not just listed. Prioritization is judged on whether the order follows immediate danger rather than head to toe. Accuracy counts when values and their meaning are correct. Treatment reasoning should include the sequence of drugs and why. Delivery is judged against the time limit. Presenters who have prepared answers to the obvious questions, such as why steroids come first, often earn extra credit for anticipating the attending. Scripts that tie each system to the thyroid in their first words make the integration easy to see.
NU655 Unit 2 help: mistakes that cost points
The most common mistake is presenting four emergencies separately, which leaves the listener to discover the unifying diagnosis. Another is warming a hypothermic, hypotensive patient too actively. Students often give thyroid hormone before steroids, which risks an adrenal crisis. Rapid correction of sodium is another frequent error. Some scripts leave out the precipitating infection, which may not cause fever in a patient this cold. And presenting systems head to toe, instead of by danger, puts the airway plan in the middle of the talk where a listener may miss it. Rehearse the opening sentence until it can be said in one breath, since everything else hangs on it. And check the sodium plan against a stated ceiling.
Get an NU655 Unit 2 example written to your instructions
Built around a patient someone actually followed, an integrated presentation cannot be borrowed, but its architecture can. Outline the systems involved, the time limit and the rubric, and a composite script with a comparable web of problems comes back free within 24-48h: one joining sentence up front, a margin note on every 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.
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NU655 Unit 2 questions, answered
How long should the integrating first sentence be?
Long enough to name the cause, the systems it drives and the priority, and short enough to say in one breath. The sample's runs to about 48 words, which is near the upper limit. Preceptors tend to accept a longer sentence that genuinely integrates over a shorter one that only says the patient is complex.
Why give hydrocortisone before thyroid hormone?
Because a patient in myxedema coma may also have adrenal insufficiency, and replacing thyroid hormone first can raise cortisol demand and precipitate an adrenal crisis. Guidelines therefore recommend stress-dose steroid until adrenal function is known. The presentation states that reasoning briefly because a preceptor is likely to ask about it.
Does my presentation have to use a patient I followed?
Yes. The script you submit should be built on someone you cared for during the rotation, with identifiers removed. The sample is a composite and shows the structure: an integrating first sentence, systems in order of threat and a plan with triggers. Your own patient's details, and what your preceptor observed, remain yours.
Where can I find a free NU655 Unit 2 sample paper?
The full NU655 Unit 2 integrated case presentation is on this page, with the timed script, margin notes and prepared answers. For a different multi-system patient, a free script can be written from your case.
What dose of levothyroxine is used in NU655 Unit 2?
The sample gives 200 mcg intravenously as a loading dose, then a daily intravenous dose, after hydrocortisone. The ATA guideline recommends intravenous thyroid hormone with glucocorticoids until adrenal insufficiency is excluded.