| Course | NU656 AGACNP Critical Care Management |
|---|---|
| Unit | Unit 10 |
| Paper type | Goals of care summary note |
| Length | About 870 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU656 Unit 10
Goals of Care Summary: Day Three After a Deep Intracerebral Hemorrhage on Apixaban in an 81-Year-Old Woman With a Written Living Will
[Student Name]
Purdue University Global
NU656: AGACNP Critical Care Management
Unit 10 Goals of Care Summary
[Instructor Name]
[Date]
The patient and family are composite; names, values and times are bracketed.
Meeting Details
Date and time: [day 3], [14:00 to 15:05], family room, neurocritical care unit.
Participants: Mr. [G.], husband and named health care agent; Ms. [A.] and Mr. [P.], daughter and son; Dr. [S.], neurocritical care attending; [J.], bedside nurse; the author, acute care nurse practitioner student under the attending's supervision; Rev. [M.], chaplain, at the family's request.
Capacity: the patient cannot take part. She has a Glasgow Coma Scale of [5] and has not followed a command since admission.
Clinical Summary in Plain Words
Mrs. [G.] had a bleed deep in the left side of her brain on [day 1] while taking apixaban for atrial fibrillation. The blood clot measured about [52] mL and had spread into the fluid spaces of the brain. Her blood thinner was reversed within [two] hours of arrival, her blood pressure was lowered to the guideline target, and a drain was placed to relieve pressure from fluid building up in her brain. The repeat scan on [day 2] showed that the bleed had not grown.
Despite all of this, she has not woken. On [day 3] off sedation she opens her eyes only to pain, makes no words and bends her arm abnormally to pain. Her right pupil is slower than the left.
For clinicians: ICH score [4] (Glasgow Coma Scale 5 to 12, 1 point; volume 30 mL or more, 1; intraventricular extension, 1; infratentorial origin, 0; age 80 or older, 1). In the cohort that produced the score, 30-day mortality was 97 percent at a score of 4 (Hemphill et al., 2001).
The team did not use the score alone to guide this meeting. The 2022 AHA/ASA guideline cautions that severity scores should not be the only basis for limiting life-sustaining treatment, and that decisions made too early can create the poor outcome they predict (Greenberg et al., 2022). For that reason full treatment was given for the first [48] hours, and this meeting was held after the team had observed her course.
What Could Help and What Could Not
Treatments that could help:
1. Continuing the ventilator, drain and blood pressure control may keep her alive while the swelling peaks over the next few days.
2. Tracheostomy and a feeding tube could support her for weeks or months if she survives the first phase.
3. Rehabilitation could help if she regained consciousness, although her husband was told, gently, that the team expects severe disability at best: she would most likely need full care for every daily task.
Treatments that could not help:
1. Surgery to remove the clot. The bleed is deep, and in a large randomized trial early surgery for bleeds in this part of the brain did not improve outcomes compared with initial medical treatment (Mendelow et al., 2005).
2. Cardiopulmonary resuscitation if her heart stopped. The team expects that it would not restore her brain function and could cause harm.
3. More reversal treatment. Her blood thinner has already been reversed; the bleed is stable.
The team separated what could keep her alive from what could bring her back, and said plainly that nothing on the list could do the second.
Her Own Words
Her husband brought the living will she signed in [2019]. It says that if she had an injury from which she was not expected to regain the ability to recognize her family, she would not want to be kept alive by machines or a feeding tube. Her daughter added that after caring for her own mother in a nursing home, Mrs. [G.] said more than once that she "never wanted to live like that." Her son agreed that the document matches what she told him.
Decision and Recommendation
The attending recommended that care focus on comfort, based on the injury, the course over [48] hours and her written wishes. After questions and a pause requested by the family, her husband, as her agent, agreed with the family's support.
1. Do not attempt resuscitation, effective now.
2. No tracheostomy, feeding tube or surgery.
3. Current care continues until [day 4], [12:00], so that her grandson can arrive from [Denver].
4. Then the ventilator will be removed with medications for comfort, in the presence of family who wish to be there, with chaplaincy and palliative care involved.
When disagreement about treatment arises between families and clinicians, an official multisociety statement advises communication and a fair process before any unilateral decision (Bosslet et al., 2015). No such conflict arose here; the family and the team agreed.
Follow-Up
The bedside nurse and the author will update the family at [18:00] today. Palliative care will see the family tomorrow at [09:00] to plan the time of extubation and symptom control. Social work will help with travel and bereavement support. The attending will review this plan tomorrow morning, and any change in her examination will be reported to her husband at once.
References
Bosslet, G. T., Pope, T. M., Rubenfeld, G. D., Lo, B., Truog, R. D., Rushton, C. H., Curtis, J. R., Ford, D. W., Osborne, M., Misak, C., Au, D. H., Azoulay, E., Brody, B., Fahy, B. G., Hall, J. B., Kesecioglu, J., Kon, A. A., Lindell, K. O., & White, D. B. (2015). An official ATS/AACN/ACCP/ESICM/SCCM policy statement: Responding to requests for potentially inappropriate treatments in intensive care units. American Journal of Respiratory and Critical Care Medicine, 191(11), 1318-1330. https://doi.org/10.1164/rccm.201505-0924ST
Greenberg, S. M., Ziai, W. C., Cordonnier, C., Dowlatshahi, D., Francis, B., Goldstein, J. N., Hemphill, J. C., III, Johnson, R., Keigher, K. M., Mack, W. J., Mocco, J., Newton, E. J., Ruff, I. M., Sansing, L. H., Schulman, S., Selim, M. H., Sheth, K. N., Sprigg, N., & Sunnerhagen, K. S. (2022). 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association. Stroke, 53(7), e282-e361. https://doi.org/10.1161/STR.0000000000000407
Hemphill, J. C., III, Bonovich, D. C., Besmertis, L., Manley, G. T., & Johnston, S. C. (2001). The ICH score: A simple, reliable grading scale for intracerebral hemorrhage. Stroke, 32(4), 891-897. https://doi.org/10.1161/01.STR.32.4.891
Mendelow, A. D., Gregson, B. A., Fernandes, H. M., Murray, G. D., Teasdale, G. M., Hope, D. T., Karimi, A., Shaw, M. D. M., & Barer, D. H. (2005). Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): A randomised trial. The Lancet, 365(9457), 387-397. https://doi.org/10.1016/S0140-6736(05)17826-X
What the NU656 Unit 10 assignment asks for
The final unit of NU656 asks you to document a goals of care discussion for a critically ill patient who cannot speak for themselves. Prompts usually require the participants and their roles, a statement on capacity, a clinical summary the family could understand, the options discussed with their likely effects, the patient's known values, the decision and the follow-up plan. Two to three pages in chart note form is typical, with sources for any prognostic tool and for the ethical framework used. The note should be usable by a clinician who was not in the room. Most rubrics also look for how the team handled uncertainty, so explain when the meeting was held and why that timing was chosen rather than an earlier one.
How the NU 656 Unit 10 example is put together
The note opens with the date, time, room and participants, including the chaplain the family asked for. A capacity line follows. The clinical summary explains the bleed, the reversal, the drain and the stable repeat scan in plain words, then gives the ICH score with its components for clinicians and the 97 percent mortality from Hemphill's cohort. The next paragraph explains, citing the 2022 AHA/ASA guideline, why full treatment continued for 48 hours before the meeting. Two numbered lists follow: treatments that could help and treatments that could not, with STICH cited for surgery. Her living will and her daughter's memory are quoted. The decision is written as four numbered orders, and the follow-up names who acts next.
Reading the NU656 Unit 10 grading rubric
Rubric rows for a goals of care note usually include documentation completeness, clinical accuracy, communication quality, ethical and legal reasoning, and the plan. Completeness requires participants, roles, capacity and the legal decision maker. Accuracy is judged on whether the prognosis is stated with its evidence and its limits, not as a certainty. Communication points go to plain language, a clear separation of what treatment can and cannot achieve, and the patient's values in her own words. The ethical row rewards correct use of substituted judgment and awareness of guidance on early limitation of care. The plan should name who does what and when, so it survives a shift change without depending on memory.
NU656 Unit 10 help from the desk
Notes often report a prognostic score as if it settles the question, which the 2022 guideline warns against. Another frequent error is presenting options as a menu for the family to choose from, instead of making a recommendation grounded in the patient's values. Some notes skip the capacity statement or fail to name the legal decision maker. Others use clinical shorthand the family would not understand in the summary meant for them. Students sometimes record the decision but not the reasons, which leaves the next clinician unable to answer questions. And a follow-up line such as "palliative care to see" without a time or a person gives the team nothing to act on.
Get an 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. 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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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.
Where can I find a free NU656 Unit 10 sample paper?
The complete NU656 Unit 10 goals of care summary is on this page, with the meeting details, plain-language summary, the ICH score and its limits, the two lists of treatments, her living will, the decision and four references. A note for your own case can be requested below.
Why was the ICH score not used alone in the NU656 Unit 10 note?
The 2022 AHA/ASA guideline cautions that severity scores should not be the sole basis for limiting life-sustaining treatment, since early decisions can create the outcome they predict. The team gave full treatment for 48 hours and met after watching her course.
What does the NU656 Unit 10 note say about surgery?
Surgery to remove the clot was listed among treatments that could not help. The bleed was deep, and in the STICH trial early surgery for supratentorial hemorrhage did not improve outcomes compared with initial medical treatment.
Is the family in the NU656 Unit 10 note real?
No. The patient, her husband, her children and every value are composites and bracketed on the page. The note models how to record a meeting for coursework; a summary written in clinical hours belongs to that record, and any case you use needs to be de-identified.