| Course | NU656 AGACNP Critical Care Management |
|---|---|
| Unit | Unit 9 |
| Paper type | Systems-based ICU plan |
| Length | About 930 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 9
The Brain Sets the Pace: A Systems-Based ICU Plan for the First Day After Out-of-Hospital Ventricular Fibrillation Arrest in a 61-Year-Old Man
[Student Name]
Purdue University Global
NU656: AGACNP Critical Care Management
Unit 9 Systems-Based ICU Plan
[Instructor Name]
[Date]
The patient is composite; values, targets and times are bracketed.
Summary
[61]-year-old man, witnessed collapse at a gym at [07:15], bystander compressions within [one] minute, ventricular fibrillation on the first rhythm, [two] shocks, return of spontaneous circulation at [14] minutes. The post-return ECG shows no ST elevation. On arrival he has a Glasgow Coma Scale of [3] off sedation with reactive pupils. History of hypertension and hyperlipidemia; no known heart disease.
Rounding order sets the headings of this plan, but priority sets their length, and the brain comes first on both counts today.
Neurologic
Status: comatose after [14] minutes of low flow; pupils reactive; no seizures seen. Plan: active prevention of fever, keeping his core temperature at or below [37.7] C for at least [72] hours using a surface device with a feedback loop. In the TTM2 trial, targeted hypothermia at 33 C did not lower six-month mortality compared with normothermia and early treatment of fever (Dankiewicz et al., 2021), and the 2021 post-resuscitation guideline recommends preventing fever for at least 72 hours in patients who remain comatose (Nolan et al., 2021). Sedation with propofol and fentanyl to a Richmond score of [minus 3 to minus 4] while the ventilator and fever device are in use, with a daily assessment off sedation.
Continuous EEG from [12:00] today, since seizures after arrest are common and may be seen only on the EEG. Myoclonus, if it appears, will be described and correlated with the EEG rather than taken as a sign of a poor outcome. Prognosis will not be discussed as settled before [72] hours after return of circulation, and later only with several tests that agree, such as examination, EEG, a blood marker of neuron injury and imaging, because the guideline advises a multimodal approach and early predictions can drive decisions that make them come true (Nolan et al., 2021). Recheck: neurologic examination off sedation each morning at [08:00].
Cardiovascular
Status: mean arterial pressure [68] on norepinephrine [0.06] mcg/kg per minute; sinus rhythm at [92]; troponin rising. Plan: perfusion is judged by three markers together: a mean pressure over [65] mmHg, at least [37] mL of urine each hour, and a lactate that keeps falling. Bedside echocardiogram this morning to look for a regional wall motion abnormality or a low ejection fraction.
Coronary angiography is deferred. In the COACT trial, patients resuscitated from a shockable rhythm without ST elevation had similar 90-day survival with immediate or delayed angiography (Lemkes et al., 2019). He will go to the catheterization laboratory urgently if ST elevation appears, if he develops new shock that suggests an ongoing coronary occlusion, or if ventricular arrhythmia recurs. Potassium is kept at [4.0] or higher and magnesium at [2.0] or higher to lower the risk of another arrhythmia. Recheck: echo result and lactate at [13:00].
Pulmonary
Status: intubated in the field; chest radiograph with mild left lower lobe opacity, likely aspiration. Plan: oxygen saturation [94 to 98] percent to avoid both hypoxemia and excess oxygen, and PaCO2 [35 to 45] mmHg, since both high and low carbon dioxide change blood flow to the brain (Nolan et al., 2021). Tidal volume [6 to 8] mL/kg of predicted body weight: at [178] cm, predicted body weight is 50 + 0.91 x (178 minus 152.4) = [73.3] kg, giving [440 to 586] mL. Head of the bed at [30] degrees. Recheck: arterial gas [one] hour after any ventilator change and at [16:00].
Renal and Fluids
Status: creatinine [1.3] mg/dL from an unknown baseline; urine [45] mL per hour. Plan: fluid only for evidence of low preload, avoiding a large positive balance. Recheck: creatinine and potassium at [18:00].
Gastrointestinal and Nutrition
Status: orogastric tube in place. Plan: stress ulcer prophylaxis with pantoprazole while ventilated; enteral feeding at a low rate from tomorrow if he is stable on a low vasopressor dose. Bowel regimen from day two.
Infectious Disease
Status: temperature controlled by the device, so fever cannot be used as a sign of infection; white count [14,800]. Plan: sputum and blood cultures now. No routine antibiotics; the aspiration pattern will be reassessed with the cultures at [48] hours, and treatment will start sooner if his oxygen need rises or a new infiltrate appears.
Hematologic
Status: hemoglobin [13.6] g/dL; platelets normal. Plan: pharmacologic prophylaxis for venous thrombosis once any procedure plans are settled, with mechanical compression until then.
Endocrine
Status: glucose [212] mg/dL on arrival. Plan: insulin infusion to a target of [140 to 180] mg/dL, avoiding hypoglycemia. Recheck: glucose hourly while on infusion.
Lines and Devices
Arterial line in the right radial artery, placed [09:10]; central line in the right internal jugular vein, placed [09:25]; surface temperature device from [09:40]; orogastric tube and urinary catheter. Plan: review the need for each line daily, and remove the urinary catheter when accurate output is no longer needed.
Family and Disposition
His wife, Mrs. [L.], arrived at [09:50]. The attending and the author met her at [10:30] and explained that he survived the arrest, that his heart is being supported and that it is too early to know how his brain has been affected. She agreed to the plan. The next update is set for [18:00] today and daily after that. She is his health care proxy. Chaplaincy and social work have been offered. Disposition: intensive care for at least [72] hours.
References
Dankiewicz, J., Cronberg, T., Lilja, G., Jakobsen, J. C., Levin, H., Ullén, S., Rylander, C., Wise, M. P., Oddo, M., Cariou, A., Bělohlávek, J., Hovdenes, J., Saxena, M., Kirkegaard, H., Young, P. J., Pelosi, P., Storm, C., Taccone, F. S., Joannidis, M., . . . Nielsen, N. (2021). Hypothermia versus normothermia after out-of-hospital cardiac arrest. New England Journal of Medicine, 384(24), 2283-2294. https://doi.org/10.1056/NEJMoa2100591
Lemkes, J. S., Janssens, G. N., van der Hoeven, N. W., Jewbali, L. S. D., Dubois, E. A., Meuwissen, M., Rijpstra, T. A., Bosker, H. A., Blans, M. J., Bleeker, G. B., Baak, R., Vlachojannis, G. J., Eikemans, B. J. W., van der Harst, P., van der Horst, I. C. C., Voskuil, M., van der Heijden, J. J., Beishuizen, A., Stoel, M., . . . van Royen, N. (2019). Coronary angiography after cardiac arrest without ST-segment elevation. New England Journal of Medicine, 380(15), 1397-1407. https://doi.org/10.1056/NEJMoa1816897
Nolan, J. P., Sandroni, C., Böttiger, B. W., Cariou, A., Cronberg, T., Friberg, H., Genbrugge, C., Haywood, K., Lilja, G., Moulaert, V. R. M., Nikolaou, N., Olasveengen, T. M., Skrifvars, M. B., Taccone, F., & Soar, J. (2021). European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: Post-resuscitation care. Intensive Care Medicine, 47(4), 369-421. https://doi.org/10.1007/s00134-021-06368-4
What the NU656 Unit 9 assignment asks for
Unit 9 asks you to write an intensive care plan organized by body system for a newly admitted, critically ill patient. The prompt usually expects a brief summary, then each system in a consistent order with its current status, goals and interventions, supported by current evidence where decisions are contested. Three to five pages is common, and many versions ask you to show priority within the systems format, since rounding order does not tell the reader which problem matters most. Plans are graded as working documents, so each system should end with something checkable, such as a recheck time or a named update. Include the family and disposition, which some students leave out because it is not a body system.
How the NU 656 Unit 9 example is put together
The summary gives the arrest details, the rhythm, the time to return of circulation and the ECG in three lines. A highlighted sentence explains that rounding order sets the headings but priority sets their length. The neurologic entry runs two paragraphs, covering temperature control, sedation targets, EEG, myoclonus and the timing of prognosis. The cardiovascular entry sets perfusion markers, orders an echo and explains the deferred angiography with its triggers. The pulmonary entry sets oxygen and carbon dioxide ranges and works out a predicted weight of 73.3 kg for the tidal volume. Shorter entries follow for renal, nutrition, infection, hematologic, endocrine and lines. The family entry records who was told what, and when the next update falls.
Where the points sit in the NU656 Unit 9 rubric
The rubric for a systems plan in this course tends to cover completeness, prioritization, evidence-based targets, specificity of interventions and communication. Completeness means every system appears, including lines and family, and nothing contradicts across systems. Prioritization earns credit when the most important problem gets the most attention and the plan says why. Evidence rows reward current trials and guidelines for the decisions that are genuinely debated, such as temperature targets and the timing of angiography. Specificity is judged on numbers: target ranges, doses and recheck times rather than "monitor closely." Communication points come from a family entry that records what was said and when the next conversation will happen.
NU656 Unit 9 help: mistakes that cost points
The most common error is giving every system the same weight, which buries the neurologic plan among routine prophylaxis. Another is cooling to 33 C by habit, when TTM2 found no benefit over preventing fever. Students also discuss prognosis on day one, which the guidance warns can lead to decisions that make a poor outcome certain. Some send every patient without ST elevation straight to angiography, missing the COACT evidence. Others write "monitor glucose" without a target, or "wean oxygen" without a saturation range. And a plan that omits the family entry leaves the next team unsure what the family has been told, which causes real harm in the first days after an arrest.
Get an NU656 Unit 9 example written to your instructions
Admission details from the NU656 Unit 9 case and your rubric are enough; say whether the section wants a fixed list of systems. Delivered within 24-48h, the first plan free, it runs organ by organ in rounding order, weights space by what is decided today and closes every entry on a recheck. 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 9 questions, answered
Why does the plan not cool the patient to 33 C?
Because the TTM2 trial found no survival or functional benefit from targeting 33 C compared with normothermia and early treatment of fever. Current European guidance recommends actively preventing fever for at least 72 hours. The sample follows that approach and cites both sources. Units vary in their protocols, and a prompt that specifies a target would be written to it.
When is it appropriate to talk about neurologic prognosis?
Most guidance advises against firm prognostic statements until at least 72 hours after return of circulation, and then only through multimodal assessment: examination, EEG, imaging and biomarkers together. The sample records that the family was told it is too early to know, and it names when the formal assessment will happen, so the message stays consistent across shifts.
Is the post-arrest patient drawn from a real chart?
Nobody's chart supplied him. Every value, dose and time is bracketed, and the man himself is a composite. The plan shows how an ICU admission is organized system by system with priorities and rechecks, the thing this unit commonly grades. Real post-arrest care follows the treating team's protocols, and any patient you describe from your own rotation remains yours to de-identify and present.
Where can I find a free NU656 Unit 9 sample paper?
This page shows the full NU656 Unit 9 systems-based ICU plan, from the three-line summary through ten systems in rounding order to the family entry, with three references. A plan for your own ICU admission can be requested through the form.
What oxygen and carbon dioxide targets does the NU656 Unit 9 plan use?
Saturation between 94 and 98 percent and a PaCO2 of 35 to 45 mmHg, following the 2021 ERC-ESICM post-resuscitation guideline, since both low and high oxygen and carbon dioxide can harm the injured brain.