NU656 · Unit 10

NU656 Unit 10 goals of care summary example

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Dialysis could replace this man's kidneys for a while; nothing on offer could replace his heart. That sentence, said to the wife of a composite [84]-year-old in cardiogenic shock, sits near the center of the NU656 Unit 10 goals of care summary, which records where physiology set the limits and what the family decided inside them.

What this page holds

Written within an hour of the meeting, this NU656 Unit 10 summary separates what could still be offered from what could not, then documents a family's decision and its source. Searches like "nu 656 unit 10 assignment example", "nu656 unit 10 sample" and "nu656 unit 10 example" land here.

What a finished NU656 Unit 10 goals of care summary looks like

Two pages written as a chart note. The header lists the date, the time, the participants and each person's role: the patient's wife as his named health care agent, their two sons, the attending, the bedside nurse and the author. A capacity line explains his absence: low cardiac output with fluctuating confusion. A clinical summary in plain words describes an ejection fraction of [15] percent, two infusions supporting pressure, rising lactate and failing kidneys, with the SCAI stage D label kept in brackets for clinicians. The central section splits into two lists, treatments that could help and treatments that could not, each with a one-line reason. The patient's own words from a prior admission, as his wife reported them, come next. The decision, the recommendation behind it and a follow-up plan close the note.

How a NU656 Unit 10 example is structured

The note is built around a boundary. Physiology comes first because the decision depends on it: without mechanical support or transplant, and with neither suitable at his age and frailty, the heart will not recover. The two lists then separate options by effect rather than by preference. Continuing dobutamine and norepinephrine may buy time; dialysis could replace kidney function but would not change the heart; resuscitation after an arrest would be unlikely to restore lasting circulation. His values follow, because they turn physiology into a decision: after his last admission he told his wife he wanted no machines if his heart could not come back. One recommendation follows, grounded in those words. The ATS multisociety statement on potentially inappropriate treatment (Bosslet and colleagues, AJRCCM, 2015) is cited for how the team framed resuscitation. The follow-up plan names who revisits what, and when.

Who was in the room, and in what role

Five people besides the author are listed with their relationship or title. The wife is identified as the agent named in his health care power of attorney, a copy of which is in the chart, and the sons as family present at her request.

The heart, in plain words

The summary quotes the explanation given: with each beat his heart pushes out about [15] percent of the blood inside it, where a healthy heart manages more than half, and his kidneys are failing because too little blood reaches them.

What could help, what could not

Two short lists carry the boundary. Current infusions and comfort measures sit on one side; mechanical pumps, transplant and dialysis as a route to recovery sit on the other, each with its reason stated in a sentence the family heard.

His own words, reported

After his last admission he said he wanted no machines if his heart could not come back. The note attributes the quotation to his wife, records that both sons recognized it, and treats it as the anchor for substituted judgment.

Decision and next steps

Do not attempt resuscitation, no intubation, no dialysis. Infusions continue until a granddaughter arrives from out of state tomorrow; if pressure falls before then, care shifts to comfort. Palliative care is consulted, and the attending revisits the plan at [10:00].

Where marks go in NU656 Unit 10

Precision about what physiology allows carries most of the credit. A summary that lists every intervention as a family choice, including ones that could not help, shifts an impossible burden onto the surrogate, and instructors tend to point that out. The authority line is checked: naming the wife as next of kin without noting the power of attorney, or recording the sons' views as if they held equal say, misstates who decides. Plain language is graded as a skill; a clinical summary quoting ejection fractions and SCAI stages to a family has documented the wrong conversation. Substituted judgment should rest on the patient's words, attributed to whoever reported them. A recommendation is expected, argued from those words. Notes without a follow-up time, or with the decision buried below the history, draw smaller deductions.

Get a NU656 Unit 10 example written to your instructions

Meeting details, the case's clinical picture and your rubric are the materials the NU656 Unit 10 model is written from. Delivered inside 24-48h, and free the first time, it is a note that separates what can be offered from what cannot, records who holds authority and grounds the decision in what the patient once said.

NU656 Unit 10 questions, answered

Should a goals of care summary list options the team would not offer?

Yes, briefly, with the reason. Families often ask about treatments they have heard of, such as a heart pump or dialysis, and a note that records why each was not offered prevents the next clinician from reopening the question unprepared. The sample keeps those options in a separate list so nobody mistakes them for choices the family declined.

What if family members disagree with the agent's decision?

The summary records each view neutrally and states who holds legal authority, which in this case is the named agent. It notes any support offered, such as a chaplain, palliative care or an ethics consultation. The sample's sons agreed, so the note stays simple; a prompt with disagreement would get a fuller record of each position and the plan for resolving it.

Does the sample reflect a real family meeting?

No. The patient, his wife and his sons are composites, and every clinical value is bracketed. The note models structure and wording for coursework. A summary written during clinical hours belongs to that record and to the team that held the meeting, and your own assignment would draw on a case you de-identify yourself.