Encephalopathy, coagulopathy and a pH of [7.28] earn him the ICU bed in this NU657 admission note for staggered acetaminophen liver failure, with transplant criteria tracked from hour one. Searches like "nu 657 unit 2 assignment example", "nu657 unit 2 sample" and "nu657 unit 2 example" land here.
What a finished NU657 Unit 2 ICU admission note looks like
Five pages in admission order, headed by a bold line: reason for ICU admission. That line names grade [2] encephalopathy, the risk of hypoglycemia needing hourly checks and early transplant evaluation. The present illness gives the ingestion as a daily timeline, [bracketed] grams per day across [four] days, and states why the Rumack-Matthew nomogram does not apply to a staggered pattern. Examination records asterixis and a West Haven grade. Data sit in a table: ALT [6,800], AST [5,200], bilirubin [3.9] mg/dL, INR [3.1], lactate [3.8] mmol/L, arterial pH [7.28], creatinine [2.4] mg/dL, glucose [62] mg/dL. A ranked differential follows, then a problem list, then a separate block for code status, surrogate and transplant center contact. Sources are the 2011 AASLD position paper on acute liver failure (Lee and colleagues) and the King's College criteria.
How a NU657 Unit 2 example is structured
Justification leads because it answers the first question any intensivist asks about a new admission. The note then separates two decisions the case invites: whether he needs the ICU, which the encephalopathy and glucose monitoring settle, and whether he may need a new liver, which depends on criteria tracked over hours. The history is timed by ingestion day because staggered overdose behaves differently from one large ingestion, and a nomogram level would mislead. The differential is ranked, not listed: acetaminophen first, then ischemic hepatitis, viral hepatitis, other drug injury, autoimmune disease and Budd-Chiari syndrome, each with the test that would settle it. Problems are ordered by threat: liver failure with N-acetylcysteine regardless of level, encephalopathy with airway thresholds, hypoglycemia, coagulopathy managed without plasma unless bleeding, and kidney injury. The block beneath names full treatment as his stated choice and his wife as surrogate.
One sentence that earns the bed
Grade [2] encephalopathy, a glucose of [62] needing hourly checks and a pH below [7.30] are named together. A covering clinician reading only that line would know why he is in a unit bed and what could change overnight.
A timeline instead of a level
Doses by day, with times where known, replace a single ingestion time. The note explains in two sentences why a staggered pattern makes the nomogram unusable and why N-acetylcysteine starts anyway.
A ranked differential, each with its test
Acetaminophen leads on history and enzyme pattern. Ischemic injury, hepatitis A, B and E, herpes simplex, autoimmune disease and hepatic vein thrombosis follow, each paired with a serology, an ultrasound or a level that would confirm or exclude it.
Criteria watched by the hour
King's College criteria for acetaminophen are listed with his current values: a pH of [7.28], to be rechecked after fluids, and INR, creatinine and encephalopathy grade below the combined thresholds. The transplant center was called at [21:40] and the call is recorded.
Code status where it can be found
Full treatment, including transplant evaluation, is recorded as discussed with him and with his wife, who is named as surrogate should his encephalopathy deepen. The block sits directly under the problem list, not buried in the social history.
Where marks go in NU657 Unit 2
The bed justification is read first, and a note without one leaves reviewers to infer why a man who is talking needs intensive care. Applying the nomogram to a staggered ingestion is the classic error here, and it draws a correction at once. The differential is judged on ranking and on whether each entry has a deciding test; a list of every liver disease reads as recall. Problem order matters: hypoglycemia buried below chronic issues, or plasma given for a high INR without bleeding, suggests the author is treating numbers rather than threats. The King's College criteria should appear with the patient's own values beside them, including the condition attached to pH. Code status and the surrogate's name are checked for placement as well as content, since a night clinician needs them in seconds.
Get a 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.
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.