NU657 Unit 2 ICU Admission Note, Pulmonary-Renal Example

Course	NU657 AGACNP Critical Care Management Clinical
Unit	Unit 2
Paper type	ICU admission note
Length	About 990 words, 6 pages double-spaced
Format	APA 7 student paper
School	Purdue University Global
Program	MSN
Updated	September 2026

Free sample paper for NU657 Unit 2

Blood in the Lungs and the Urine: An ICU Admission Note for Pulmonary-Renal Syndrome in a 56-Year-Old Woman With Three Weeks of Sinus Symptoms

[Student Name]

Purdue University Global

NU657: AGACNP Critical Care Management Clinical

Unit 2 ICU Admission Note

[Instructor Name]

[Date]

The patient is composite; values, doses and times are bracketed.

What this part is doingThe reason for admission comes first because it is the question every intensivist asks before reading anything else.

Reason for ICU Admission

Hypoxemic respiratory failure from probable diffuse alveolar hemorrhage, needing high-flow oxygen at an FiO2 of [0.60] with a rising requirement, together with rapidly progressive kidney failure, in a patient who needs urgent immunosuppression, may need plasma exchange and intubation within hours, and cannot be monitored safely on a ward.

History of Present Illness

Mrs. [H.] is a [56]-year-old office manager with hypothyroidism who was well until [three] weeks ago, when she developed nasal congestion with bloody crusts, pain over her cheeks and fatigue. Two courses of oral antibiotics from urgent care did not help. Over [four] days she has had a dry cough, then streaks of blood, and since this morning she has coughed up about [two] tablespoons of blood at a time. She reports dark urine for a week and aching in her knees. She has lost [4] kg. She has no fever, rash or chest pain. She does not smoke and takes no anticoagulants or new medications.

In the emergency department at [16:20], her saturation was [86] percent on [four] liters by nasal cannula. Heated high flow was set at [50] liters per minute with [60] percent oxygen; her saturation rose to [91] percent, and she was breathing [28] times a minute.

Examination

Temperature [37.4] C, blood pressure [168/94], heart rate [104]. Alert and oriented; speaking in short sentences. Crusting and a small septal ulcer in the left nostril. Diffuse inspiratory crackles on both sides. No edema, no rash, no joint swelling. Jugular venous pressure not raised.

Data

1. Hemoglobin [8.1] g/dL, down from [10.2] on arrival [six] hours ago; white count [12,600]; platelets [388,000].

2. Creatinine [3.9] mg/dL (baseline [0.8] one year ago); potassium [5.2] mEq/L; bicarbonate [19] mEq/L.

3. Urinalysis: blood [3+], protein [2+]; microscopy with dysmorphic red cells and [two] red cell casts.

4. INR [1.1]; lactate [1.4] mmol/L.

5. CT of the chest without contrast: bilateral patchy ground-glass opacities, central more than peripheral, no nodules or cavities.

6. Echocardiogram at the bedside: normal left ventricular function, no effusion.

7. Sent and pending: ANCA with PR3 and MPO specificity, anti-GBM antibody, antinuclear antibody, complement, blood and sputum cultures, respiratory viral panel.

What this part is doingA falling hemoglobin with new infiltrates and no bleeding elsewhere is the finding that makes alveolar hemorrhage the working diagnosis.

Assessment and Ranked Differential

Mrs. [H.] has a pulmonary-renal syndrome: probable diffuse alveolar hemorrhage, shown by hemoptysis, new infiltrates and a fall in hemoglobin of [2.1] g/dL, together with glomerulonephritis, shown by red cell casts and a rapidly rising creatinine. The combination of blood in the lungs and red cell casts in the urine is a vasculitis until proven otherwise, and treatment cannot wait for the serology.

1. ANCA-associated vasculitis, most likely granulomatosis with polyangiitis. Sinus disease with crusting and a septal ulcer, alveolar hemorrhage and glomerulonephritis are the classic triad of the upper airway, lung and kidney involvement described in the Chapel Hill nomenclature (Jennette et al., 2013). The ANCA result will confirm the type. A kidney biopsy will be sought once her oxygen and bleeding allow it.

2. Anti-glomerular basement membrane disease. It produces the same combination and can coexist with ANCA; a positive result would change the plan, because plasma exchange is standard treatment for it. The result is requested as urgent.

3. Systemic lupus erythematosus. Less likely without rash or serositis; antinuclear antibody and complement are pending.

4. Pneumonia with kidney injury from sepsis. Afebrile, with normal lactate and no consolidation; cultures sent, and one dose of antibiotics given until they are back.

5. Heart failure with pulmonary edema. Excluded by normal left ventricular function and a normal jugular pressure.

Problem List and Plan

1. Hypoxemic respiratory failure from probable alveolar hemorrhage. High-flow oxygen with saturation target [92 to 96] percent. Criteria for intubation: FiO2 above [0.80], respiratory rate above [35] sustained, rising carbon dioxide or massive hemoptysis. Anesthesia aware; airway cart at the bedside. Bronchoscopy with lavage in the morning if she remains stable, to confirm hemorrhage and exclude infection.

2. Suspected ANCA vasculitis with alveolar hemorrhage and rapidly progressive glomerulonephritis. Methylprednisolone [500] mg intravenously tonight, daily for [three] days, after discussion with rheumatology and nephrology. Rituximab for induction once infection is reasonably excluded; rituximab was not inferior to cyclophosphamide for inducing remission in a randomized trial (Stone et al., 2010). Plasma exchange: in PEXIVAS, adding plasma exchange did not reduce death or end-stage kidney disease in severe ANCA vasculitis (Walsh et al., 2020), but the 2024 KDIGO guideline suggests that it may still be considered in selected patients, including those with alveolar hemorrhage and hypoxemia (Floege et al., 2024). Nephrology will place a dialysis catheter tonight so that plasma exchange can begin at once if the anti-GBM antibody is positive or if her oxygen need keeps rising.

3. Acute kidney injury, KDIGO stage 3 by creatinine. No urgent dialysis indication now; potassium [5.2], no fluid overload. Dialysis thresholds: potassium above [6.0] despite treatment, pH below [7.20], or fluid overload affecting oxygenation.

4. Anemia from blood loss. Transfuse for hemoglobin below [7] g/dL or active massive hemoptysis; type and cross [two] units.

5. Hypertension. Target below [160/90]; amlodipine if persistent.

6. Prophylaxis. Pantoprazole while on high-dose steroids; mechanical compression for venous thrombosis, no heparin while bleeding; trimethoprim-sulfamethoxazole for Pneumocystis once the kidney dose is agreed with pharmacy.

Code Status, Surrogate and Contacts

Full code, confirmed with the patient, who has capacity, at [18:40] in the presence of her husband. She agrees to intubation, plasma exchange and dialysis if needed. Surrogate if she loses capacity: her husband, Mr. [H.], [phone on the chart]. Rheumatology (Dr. [R.]) and nephrology (Dr. [N.]) have seen her; plasma exchange team on call tonight: [extension]. Next review of the oxygen requirement and hemoglobin at [22:00].

What this part is doingCode status and contacts sit in their own block at the end, where a clinician called at night will look first.

References

Floege, J., Jayne, D. R. W., Sanders, J.-S. F., Tesar, V., & Rovin, B. H. (2024). KDIGO 2024 clinical practice guideline for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Kidney International, 105(3S), S71-S116. https://doi.org/10.1016/j.kint.2023.10.008

Jennette, J. C., Falk, R. J., Bacon, P. A., Basu, N., Cid, M. C., Ferrario, F., Flores-Suarez, L. F., Gross, W. L., Guillevin, L., Hagen, E. C., Hoffman, G. S., Jayne, D. R., Kallenberg, C. G. M., Lamprecht, P., Langford, C. A., Luqmani, R. A., Mahr, A. D., Matteson, E. L., Merkel, P. A., . . . Watts, R. A. (2013). 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Arthritis & Rheumatism, 65(1), 1-11. https://doi.org/10.1002/art.37715

Stone, J. H., Merkel, P. A., Spiera, R., Seo, P., Langford, C. A., Hoffman, G. S., Kallenberg, C. G. M., St. Clair, E. W., Turkiewicz, A., Tchao, N. K., Webber, L., Ding, L., Sejismundo, L. P., Mieras, K., Weitzenkamp, D., Ikle, D., Seyfert-Margolis, V., Mueller, M., Brunetta, P., . . . Specks, U. (2010). Rituximab versus cyclophosphamide for ANCA-associated vasculitis. New England Journal of Medicine, 363(3), 221-232. https://doi.org/10.1056/NEJMoa0909905

Walsh, M., Merkel, P. A., Peh, C.-A., Szpirt, W. M., Puéchal, X., Fujimoto, S., Hawley, C. M., Khalidi, N., Floßmann, O., Wald, R., Girard, L. P., Levin, A., Gregorini, G., Harper, L., Clark, W. F., Pagnoux, C., Specks, U., Smyth, L., Tesar, V., . . . Jayne, D. (2020). Plasma exchange and glucocorticoids in severe ANCA-associated vasculitis. New England Journal of Medicine, 382(7), 622-631. https://doi.org/10.1056/NEJMoa1803537

The Purdue Global NU657 Unit 2 instructions

In Unit 2 you write the admission note for a patient you would admit to intensive care. The note is expected to follow the standard history and physical order but to open with a clear statement of why the patient needs the ICU, to present the data in a way a covering clinician can scan, to rank the differential with the test that would settle each entry, and to list problems in order of threat with a plan for each. Code status, surrogate and contacts should be easy to find. Notes of four to five pages are typical, with sources for the key treatment decisions. Many sections ask you to base the note on a patient from your own shifts, with identifiers removed.

How the NU 657 Unit 2 example is put together

A single bolded sentence opens the note with the reason for admission: failing oxygenation from probable alveolar hemorrhage and failing kidneys in a patient who may need plasma exchange or intubation within hours. The history of present illness follows the three weeks in order. Seven numbered data items include a falling hemoglobin, red cell casts, ground-glass opacities and pending serology. The assessment names the syndrome and the highlighted sentence explains why treatment cannot wait for serology. Five differential entries are ranked with reasons, citing the Chapel Hill nomenclature. The plan covers six problems, with RAVE, PEXIVAS and the 2024 KDIGO guideline behind the vasculitis decisions. A separate block records code status, the surrogate and the consultants.

Reading the NU657 Unit 2 grading rubric

Rubrics for an admission note in this course usually cover the justification for ICU care, data presentation, the differential, the problem list and plan, and documentation of code status and communication. Justification earns full credit when it names the specific instability, not simply "critically ill." The data row rewards organization that lets a reader find the decisive values quickly. The differential is scored on ranking and on naming the deciding test for each entry. Plans earn points when each problem has a concrete action and a threshold for escalation. Code status and surrogate should be documented with the time and the people present. Citations for major treatment choices usually count in the evidence row.

Common NU657 Unit 2 mistakes, and how to avoid them

Many admission notes bury the reason for ICU care in the middle of the history, where a covering clinician will not see it. Another common problem is listing the differential without ranking it or saying what would rule each entry out. Students often wait for antibody results before treating a pulmonary-renal syndrome, when the bleeding lung will not wait. Some notes describe plasma exchange as routine without acknowledging the PEXIVAS result. Anticoagulant prophylaxis is sometimes ordered in a patient who is bleeding. And code status written only in the orders, without the time, the capacity assessment and who was present, leaves the night team unsure whether it was truly discussed.

Get an NU657 Unit 2 example written to your instructions

An assigned admission, whatever labs and history it supplies, and the NU657 Unit 2 rubric are the inputs. You receive the note in 24-48h, with nothing to pay the first time: bed justified in its opening line, a ranked differential with deciding tests, problems ordered by threat and code status placed where a covering clinician looks first. 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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NU657 Unit 2 questions, answered

Why does the note begin with the reason for ICU admission?

Because it is the question every receiving intensivist, and every reviewer, asks first. A one-line justification tells a covering clinician what makes the patient unstable and what to watch. The sample names three findings in that line; your own admission would name whatever features of your assigned patient required the unit rather than a monitored floor bed.

What if the site's template orders the sections differently?

The sample follows whatever template the section or site uses. Many ICU admission notes keep the standard history and physical order with a justification line and a code status block added, which is what the sample shows. The reasoning, ranked problems and a deciding test for each differential entry, carries over into any layout.

Can I base the note on a patient I admitted at my site?

Many sections expect exactly that, with identifiers removed, and the case is yours to bring. The sample's patient is invented, his values bracketed. Anything entered in a real chart during clinical hours, and any cosignature it carries, stays with the chart and the preceptor who cosigns it, never with a sample written for coursework.

Where can I find a free NU657 Unit 2 sample paper?

The full NU657 Unit 2 ICU admission note is on this page, from the reason for admission and the ranked differential to the problem list, code status and four references. A new note can be written for the patient in your own prompt.

Does the NU657 Unit 2 note recommend plasma exchange?

It prepares for it without starting it at once. PEXIVAS found no reduction in death or end-stage kidney disease, but the 2024 KDIGO guideline allows it in selected patients, including alveolar hemorrhage with hypoxemia. A catheter is placed so exchange can start if the anti-GBM result is positive.