| Course | NU655 AGACNP Acute Care Diagnosis and Management Clinical III |
|---|---|
| Unit | Unit 7 |
| Paper type | Code debrief |
| Length | About 1,090 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU655 Unit 7
Twenty-One Minutes and Three Findings: A Code Debrief of Ventricular Fibrillation Two Days After Laparoscopic Cholecystectomy
[Student Name]
Purdue University Global
NU655: AGACNP Acute Care Diagnosis and Management Clinical III
Unit 7 Code Debrief
[Instructor Name]
[Date]
The patient and all staff are composite and identified by role; times, doses and values are bracketed.
Timeline
1. [04:10]. Finding: patient reports pressure in the upper abdomen and lower chest, "different from the incision." Who noticed: night nurse. Action: pain score [7]; covering clinician paged for analgesia.
2. [04:14]. Finding: none new. Who: covering clinician by phone. Action: oxycodone [5 mg] ordered and given for incisional pain.
3. [04:22]. Finding: ST elevation in lead II on the monitor. Who: telemetry technician. Action: alert paged to the day-team clinician, whose pager was still assigned to the patient after the evening handoff.
4. [04:26]. Finding: patient sweaty and pale, pressure unchanged. Who: night nurse. Action: vital signs, pulse [58], blood pressure [102/64]; nurse decides to obtain a 12-lead ECG.
5. [04:28]. Finding: 12-lead ECG shows ST elevation in II, III and aVF with ST depression in I and aVL. Who: ECG machine interpretation reads "consider acute inferior infarct." Action: ECG placed in the chart holder; nurse pages the covering clinician again.
6. [04:31]. Finding: ventricular fibrillation. Who: night nurse at the bedside. Action: code called; compressions started within [ten] seconds.
7. [04:32]. Defibrillation at [200] joules.
8. [04:34]. Second shock; epinephrine [1 mg].
9. [04:36]. Return of spontaneous circulation.
10. [04:41]. Repeat 12-lead ECG read by the covering clinician: inferior ST elevation myocardial infarction.
11. [04:52]. Cardiac catheterization laboratory activated; cardiology on the phone.
Reading the Record: Delays in Doing
Once the rhythm changed, the response followed the adult advanced life support algorithm closely: compressions began within seconds, the first shock was delivered in about a minute, and epinephrine was given after the second shock, as the AHA guidance for shockable rhythms describes (Panchal et al., 2020). Circulation returned within five minutes. There was no delay in doing.
Reading the Record: Delays in Thinking
The delay lay in the [21] minutes before the arrest, and it was a delay in putting three findings together. Each of the three findings that pointed to a heart attack sat with a different person, and none of them had all three.
The first finding was the patient's own description at [04:10]: pressure, not pain, and different from the incision. The covering clinician heard "pain two days after surgery" and prescribed for the incision. Postoperative chest or epigastric symptoms can come from the heart, and myocardial injury after noncardiac surgery is common and often silent or atypical, which is why the perioperative guideline asks clinicians to consider it in patients at risk (Thompson et al., 2024). He had hypertension, diabetes and was a smoker.
The second finding was the telemetry alert at [04:22]. It went to a clinician who had left at [19:00], because the pager assignment was not changed at handoff. The technician did not receive an acknowledgment and did not escalate within the unit's [five]-minute rule.
The third finding was the 12-lead ECG at [04:28]. It was obtained by the night nurse on her own judgment, which was correct, but it was placed in the chart holder while she paged again. The machine's interpretation named the infarct.
What Twenty-One Minutes Could Have Changed
If the three findings had come together at [04:22], the likely sequence would have been an immediate 12-lead ECG read by a clinician, aspirin, a call to cardiology and activation of the catheterization laboratory before the arrest rather than after it. Ventricular fibrillation early in an inferior infarct is not always preventable, and the debrief does not claim it was here. What earlier recognition would have changed is the setting: a patient on a monitor with pads applied, a clinician at the bedside and a laboratory preparing, instead of a nurse alone at the moment the rhythm changed. The time from first symptom to the laboratory's activation was [42] minutes; half of that time passed before anyone who could act on an infarct knew about it.
How the Debrief Was Run
The debrief took place at [07:30], before the night staff left, and included the night nurse, the telemetry technician, the covering clinician, the rapid response nurse and the unit's charge nurse. It began with the facts of the timeline, read aloud without comment, and each person was asked to add what they saw and when. The telemetry technician described the six other alerts and the pager that never answered, which no one else had known. The covering clinician said that the word pain in the first page had framed everything that followed. Hearing those two accounts side by side was what turned a story about one missed diagnosis into a story about three people each holding a piece of it.
Contributing Factors
1. Anchoring on the surgical diagnosis: symptoms after surgery were assumed to come from the surgery.
2. Pager assignment: the telemetry system routed alerts by an assignment that was not updated at handoff.
3. Alarm burden: the technician reported [six] other active alerts at the time; alarm fatigue is a recognized safety problem in monitored units, where most alerts are not actionable and important ones can be missed (Sendelbach & Funk, 2013).
4. No rule for an abnormal 12-lead ECG: the unit had no standard that an ECG showing possible infarction must be shown to a clinician in person or read to one by phone within minutes.
Recommendations
1. Update telemetry pager assignments automatically from the handoff list at every shift change.
2. An unacknowledged ST-elevation alert escalates to the charge nurse and the rapid response team after [three] minutes.
3. Any 12-lead ECG with a machine reading of possible acute infarction is read aloud to the covering clinician immediately and triggers a rapid response call if the clinician cannot come within [five] minutes.
4. Teach covering clinicians to ask one question for any new postoperative chest or upper abdominal symptom: could this be the heart, and has an ECG been done?
5. Recognize the night nurse's decision to obtain the ECG, which placed the diagnosis in the chart before the arrest.
Outcome
Mr. [W.] had a right coronary artery occlusion opened with a stent at [05:40]. He was extubated on [Day 3], discharged on [Day 8] without neurological deficit and enrolled in cardiac rehabilitation. The debrief was held at [07:30] with everyone involved, and the patient and his wife were told what happened, including the delay, on [Day 4].
References
Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., Kudenchuk, P. J., Kurz, M. C., Lavonas, E. J., Morley, P. T., O'Neil, B. J., Peberdy, M. A., Rittenberger, J. C., Rodriguez, A. J., Sawyer, K. N., & Berg, K. M. (2020). Part 3: Adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 142(16 Suppl. 2), S366-S468. https://doi.org/10.1161/CIR.0000000000000916
Sendelbach, S., & Funk, M. (2013). Alarm fatigue: A patient safety concern. AACN Advanced Critical Care, 24(4), 378-386. https://doi.org/10.4037/NCI.0b013e3182a903f9
Thompson, A., Fleischmann, K. E., Smilowitz, N. R., de las Fuentes, L., Mukherjee, D., Aggarwal, N. R., Ahmad, F. S., Allen, R. B., Altin, S. E., Auerbach, A., Berger, J. S., Chow, B., Dakik, H. A., Eisenstein, E. L., Gerhard-Herman, M., Ghadimi, K., Kachulis, B., Leclerc, J., Lee, C. S., . . . Williams, K. A. (2024). 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery. Circulation, 150(19), e351-e442. https://doi.org/10.1161/CIR.0000000000001285
The Purdue Global NU655 Unit 7 instructions
For Unit 7 you reconstruct a cardiac arrest in debrief form, reconstructing who noticed what and when, and separating delays in recognition from delays in response. You build a timeline with roles and times, evaluate the resuscitation against current guidelines, analyze the period before the arrest, identify contributing factors and propose changes, naming staff only by role. Most prompts set about four pages. The debrief should credit what went well, and it should treat system design, such as alarm routing, as seriously as individual decisions. Credit what went well as clearly as what went wrong. Build the timeline from the chart and the monitor record together.
Inside the NU655 Unit 7 example
The example's timeline gives each finding, who noticed it and what was done. A short section judges the resuscitation against the AHA guidance and finds it fast. The longer analysis reads the record for delays in thinking and shows that three findings pointing to an infarct sat with three different people, with a highlighted sentence. The perioperative guideline explains why postoperative symptoms deserve cardiac consideration. A section estimates what earlier recognition could have changed, and another describes how the debrief was run. Contributing factors cite alarm fatigue research, and five recommendations include recognizing the nurse's ECG. The patient's outcome closes the document.
Where the points sit in the NU655 Unit 7 rubric
The Unit 7 rubric usually rewards a precise timeline, fair evaluation of the resuscitation, analysis of recognition, contributing factors, recommendations and professionalism. The timeline is judged on whether roles and times are attached to every finding. The resuscitation is evaluated against current guidelines. Recognition analysis is weighted most heavily, because the pre-arrest period is where most preventable harm lies. Contributing factors should include system design. Recommendations earn credit when they are specific and some are automatic rather than dependent on memory. A tone that avoids blame is expected throughout. Debriefs that describe how the meeting itself was run also show the professionalism graders look for. Recording the outcome completes the analysis.
Common NU655 Unit 7 mistakes, and how to avoid them
The most common mistake is focusing on the resuscitation, which usually went well, and missing the minutes before it. Another is blaming the clinician who prescribed the opioid, when the problem was that no one had all the findings. Students often overlook alarm routing and handoff as causes. Some debriefs forget to credit the nurse who obtained the ECG. Recommendations are often limited to education. And timelines that mix judgment into the entries make it hard for the team to agree on what actually happened. Keep the timeline free of judgment, and put the analysis on its own pages. Also name the specific alarm route that failed, so the recommendation can fix it. Finally, include the patient's outcome and whether the family was told.
Get an NU655 Unit 7 example written to your instructions
Witnessed codes stay with the student who saw them, so the debrief reconstructs a composite event with another cause. Name the kind of event and the debrief format your section uses, remove identifiers and attach the rubric. Every finding in the first debrief, free and back inside 24-48h, carries a role and a time. 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 7 questions, answered
Why does the debrief focus on who noticed what?
Because recognition is often where a code is won or lost, and it is harder to see than the resuscitation itself. Assigning each finding to a role and a time shows how the diagnosis was assembled and where it stalled. That makes the debrief useful for system change rather than a record of tasks completed.
Is the nurse who gave the opioid blamed?
No. Epigastric discomfort after gallbladder surgery is commonly incisional, and treating it as such was reasonable on the information at the bedside. The debrief's concern is why the telemetry finding and the symptom were never joined, which traces to a paging list and an unwritten assumption. People appear only by role, and the analysis stays with the system.
How is a code debrief different from a personal reflection on a code?
A debrief reconstructs the team's actions and the system around them; a personal reflection examines the writer's own thoughts and feelings. The sample is a debrief, so it keeps the writer's role in the background. A prompt that asks about the writer's own experience of the event would call for a reflective structure instead.
Where can I find a free NU655 Unit 7 sample paper?
This page contains the full NU655 Unit 7 code debrief, with its role-by-role timeline, the split between thinking and doing, and five recommendations. A different arrest from your own rotation can become a free debrief built from your notes.
What was the main delay in NU655 Unit 7?
Not the resuscitation, which started within seconds, but the 21 minutes before the arrest, when the patient's description, a telemetry alert and a 12-lead ECG each pointed to an infarct but sat with three different people.