| Course | NU655 AGACNP Acute Care Diagnosis and Management Clinical III |
|---|---|
| Unit | Unit 5 |
| Paper type | Seminar reflection |
| Length | About 810 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 5
Bleeding Side Down: A Seminar Reflection on the First Hour of Massive Hemoptysis and a Plan That Put the Scan First
[Student Name]
Purdue University Global
NU655: AGACNP Acute Care Diagnosis and Management Clinical III
Unit 5 Seminar Reflection
[Instructor Name]
[Date]
The case and seminar are composite; volumes, times and values are bracketed, and classmates are described by role.
The Case as I Brought It
Mr. [J.] is a [57]-year-old man with bronchiectasis and a cavity in the left upper lobe on a CT from [March]. He takes apixaban for atrial fibrillation. On the ward he coughed up about [250] mL of bright red blood in [twenty] minutes. His saturation fell from [95] to [87] percent, his pulse rose to [118] and his hemoglobin was [11.9] g/dL.
My plan, as I presented it: "Sit him upright, oxygen by mask, hold apixaban, send a type and crossmatch, and get a CT angiogram of the chest to find the source."
The Challenges
The first question came from a classmate who works in an intensive care unit: "Which way should he lie?" I answered that sitting up would help him cough the blood out. She explained that in massive hemoptysis the danger is not blood loss but drowning, and that a patient with a known left-sided source should lie on his left side, bleeding side down, so that blood pools in the lung that is already damaged rather than spilling into the healthy right lung (Davidson & Shojaee, 2020). I had positioned him to clear the blood and had not thought about where it would go.
The second question came from the facilitator: "What is the plan for his airway if the next [200] mL comes in the next ten minutes?" I said the anesthesia team would intubate him. The facilitator asked what size of tube, and whether they would intubate one lung. I did not know. The answer is a large tube, at least [8.0] mm, so a therapeutic bronchoscope can pass through it, and, if bleeding continues, advancing the tube into the right mainstem bronchus to protect the good lung (Kathuria et al., 2020).
The third question was about the CT. A classmate asked who would take a desaturating patient who was coughing blood to the scanner, and who would be with him there. I said the transport nurse. That answer is the one I now consider wrong, because the CT was my first step and it was the step most likely to put him somewhere without the people and equipment he might need. Imaging is useful to locate the source and plan embolization once the patient is stable, but it does not come first when he is not.
I also noticed why I reached for the CT. It was the step I knew how to order and could defend, and it promised an answer. Positioning and airway planning felt like someone else's work, the nurse's and the anesthesiologist's, and I did not think of them as mine to decide. The seminar made the point that in the first minutes, deciding which way the patient lies and who is called is exactly the work of the clinician in the room.
What Changed
The seminar reordered my plan by what would kill him soonest. Drowning comes first, so position and airway come first. Bleeding comes next, so the call to interventional radiology for bronchial artery embolization, the definitive treatment for most massive hemoptysis, goes out early, along with reversal of his anticoagulant if bleeding continues. Localization by CT or bronchoscopy follows, guided by his stability.
My revised first hour:
1. Left side down; high-flow oxygen; suction at the bedside.
2. Call the rapid response team, anesthesia and interventional radiology now.
3. Hold apixaban; discuss reversal with hematology given the volume.
4. Large-bore access, type and crossmatch, hemoglobin and coagulation tests.
5. If he is stable: CT angiography to locate the source and map the bronchial arteries for embolization. If he is not: intubation with a large tube and bronchoscopy at the bedside.
I also asked about tranexamic acid. A randomized trial found that inhaled tranexamic acid reduced bleeding and led to faster resolution in patients with hemoptysis (Wand et al., 2018), but those patients did not have massive bleeding, so it would be an adjunct here at most, not a reason to delay the steps above.
What I Will Take Forward
I had ordered the plan by what I wanted to know, not by what would harm him first. When I prepare for a patient who is actively bleeding into the airway, I will ask three questions in order: where will the blood go, who will manage the airway if it gets worse, and who stops the bleeding. The scan answers a fourth question, and it can wait until the first three are answered.
References
Davidson, K., & Shojaee, S. (2020). Managing massive hemoptysis. Chest, 157(1), 77-88. https://doi.org/10.1016/j.chest.2019.07.012
Kathuria, H., Hollingsworth, H. M., Vilvendhan, R., & Reardon, C. (2020). Management of life-threatening hemoptysis. Journal of Intensive Care, 8, Article 23. https://doi.org/10.1186/s40560-020-00441-8
Wand, O., Guber, E., Guber, A., Epstein Shochet, G., Israeli-Shani, L., & Shitrit, D. (2018). Inhaled tranexamic acid for hemoptysis treatment: A randomized controlled trial. Chest, 154(6), 1379-1384. https://doi.org/10.1016/j.chest.2018.09.026
The Purdue Global NU655 Unit 5 instructions
In Unit 5 you look back at a plan you took into seminar and at how the room reshaped it. You describe the case briefly, quote your plan, record each challenge with the answer you gave at the time, explain what changed and why, and set out your next steps. Write it as yourself, in the first person. Most sections set 700 to 800 words with two or more sources. Being honest about which of your answers you now think wrong is part of what the rubric rewards. Classmates are described by their role or background rather than by name. Report your own answers at the time, even the ones you would change.
How the NU 655 Unit 5 example is put together
One paragraph holds the case, and the author's plan appears word for word. Each challenge appears as the question that was asked, followed by the author's answer at the time, then the explanation from the seminar with its source. A highlighted sentence marks the answer the author now considers wrong. A paragraph explains why the CT felt like the right first step. The revised first hour is a numbered list ordered by what would harm him first. A paragraph on inhaled tranexamic acid notes that its trial did not include massive bleeding. Three questions for the next similar patient close the reflection. Its last lines give three questions for the next patient.
Where the points sit in the NU655 Unit 5 rubric
The Unit 5 rubric tends to look at honesty and depth of reflection, integration of evidence, the quality of the revised plan and writing. Depth earns full points when the original plan is quoted and each change is traced to a specific challenge. Evidence counts when it supports each change, such as positioning bleeding side down to protect the healthy lung. The revised plan is judged on its order and specificity. Writing is scored on organization and first-person clarity. Reflections that identify which of their own answers were wrong usually score higher than those that report only what others said. Accurate sources for each change also count.
NU655 Unit 5 help: mistakes that cost points
A common mistake is paraphrasing the original plan, which hides the order that was wrong. Another is reporting the seminar's corrections without the author's own answers at the time. Students often treat massive hemoptysis as a bleeding problem first, when the immediate danger is drowning. Some reflections cite evidence from non-massive bleeding as if it applied. The revised plan is sometimes a list without an order. And ending without three concrete questions for the next bleeding patient leaves the reflection unfinished. Also check each change against its source, since a reflection's evidence should be as accurate as a paper's. Finally, keep the case to one paragraph so the reflection has room.
Get an NU655 Unit 5 example written to your instructions
Is your seminar reflection due after the live hour or in place of it? Either way, describe the patient discussed and the questions raised, or paste the written prompt, and add the rubric. A free first reflection follows within 24-48h, quoting the original plan whole and timing the revision step by step. 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 5 questions, answered
Is the author's first plan made deliberately wrong?
It is made plausible. Sitting a breathless patient up and ordering a scan is a common instinct, and the reflection only works if the first plan sounds like something a capable student might propose. The seminar's challenges then show why the order matters, which is the learning the unit is built around.
Why lie the patient bleeding side down?
Because the immediate danger in massive hemoptysis is blood spilling into the healthy lung and preventing oxygen exchange. Lying with the bleeding side down uses gravity to keep the good lung clear while the airway is secured and the source is found. The reflection explains this briefly because a classmate raised it in the session.
Does the sample work for a written seminar alternative?
Yes. Sections that let students write instead of attending the live hour usually set the same case. The sample's structure, with the original plan, the challenges and the revised sequence, suits either form. Share the written prompt and its rubric, and the reflection follows its specific questions.
Where can I find a free NU655 Unit 5 sample paper?
This page holds the complete NU655 Unit 5 seminar reflection, with the quoted plan, three challenges, the author's answers and the revised first hour. Share the hemoptysis or bleeding case from your own seminar and the desk will draft a free reflection that tracks it.
Why lie the patient bleeding side down in NU655 Unit 5?
Because the immediate danger in massive hemoptysis is blood spilling into the healthy lung. Lying on the side of the bleeding keeps the blood in the lung that is already damaged and protects the other for breathing.