NU657 Unit 3 Rounds Script, Near-Fatal Asthma Example

Reviewed by Elspeth Marlowe, MSN, RN AGACNP Critical Care Management Clinical Purdue University Global Free custom sample in 24 to 48h

This NU657 Unit 3 sample is a rounds presentation script for a 29-year-old woman on day two of mechanical ventilation for near-fatal asthma, timed at about two minutes of speech. It was written for Purdue Global NU 657, AGACNP Critical Care Management Clinical, in the MSN acute care nurse practitioner program. A one-sentence identifier gives her age, history and admission pH of 7.12. Overnight events follow, then every system in a fixed order, with the respiratory line carrying the passed awakening trial, the passed breathing trial and an auto-PEEP that fell from 11 to 3. The script closes by asking the attending whether to extubate this morning, and states the author's proposal and its reasons.

CourseNU657 AGACNP Critical Care Management Clinical
UnitUnit 3
Paper typeRounds presentation script
LengthAbout 590 words, 5 pages double-spaced
FormatAPA 7 student paper
SchoolPurdue University Global
ProgramMSN
UpdatedSeptember 2026

Free sample paper for NU657 Unit 3

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Two Minutes, Ten Systems, One Question: A Rounds Presentation Script for Day Two of Near-Fatal Asthma in a 29-Year-Old Woman

[Student Name]

Purdue University Global

NU657: AGACNP Critical Care Management Clinical

Unit 3 Rounds Presentation Script

[Instructor Name]

[Date]

The patient is composite; values, doses and times are bracketed. Timing marks show where the two minutes go.

What this part is doingThe identifier line tells the attending in one breath who the patient is and where she is in her illness.
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Script

[0:00 to 0:15] Ms. [F.] is a [29]-year-old woman with asthma, one prior intubation at age [19], intubated [36] hours ago for near-fatal asthma with a pH of [7.12] and a PaCO2 of [88], now on hospital day [two].

[0:15 to 0:30] Overnight: ketamine was weaned off at [01:00], her auto-PEEP fell from [11] to [3], and she has had no further episodes of high peak pressure. No new events.

[0:30 to 0:45] Neurologic: off propofol since [05:30] for her awakening trial; she opened her eyes, followed commands and was calm, Richmond score [0]. CAM-ICU negative.

[0:45 to 1:15] Respiratory, the reason for today's question. Overnight on volume control at a rate of [12] with a long expiratory time; plateau [22], peak [34] from [52] yesterday. At [06:15] she passed a [30]-minute spontaneous breathing trial on pressure support [5] and PEEP [5]: respiratory rate [22], tidal volume [380] mL, rapid shallow breathing index [58], saturation [96] percent on [35] percent oxygen. Wheeze is faint and end-expiratory only. Last gas: pH [7.38], PaCO2 [44].

[1:15 to 1:30] Cardiovascular: off norepinephrine since yesterday afternoon; pressure [118/70], heart rate [96] on albuterol. Renal: creatinine [0.7], urine adequate, potassium [3.6] after replacement.

[1:30 to 1:40] Infectious: afebrile, viral panel positive for rhinovirus, no antibiotics. GI and nutrition: tube feeds at goal. Endocrine: glucose up to [210] on methylprednisolone, sliding scale.

[1:40 to 1:50] Lines: right radial arterial line, two peripheral lines, no central line. Prophylaxis: enoxaparin, famotidine.

[1:50 to 2:05] My question: should we extubate her this morning? I propose yes, now, to high-flow oxygen, with continuous albuterol ready, because she passed both trials and her auto-PEEP is down to [3]. Waiting a day adds sedation and ventilator time without a clear gain.

What this part is doingEvery system gets one or two sentences, and the respiratory system gets four because it carries today's decision.
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Margin Notes on What Was Left Out

Normal values that do not change the plan were dropped: her magnesium, liver tests and white count were not spoken, though they are in the chart. System order never varies, so the attending can interrupt at any heading and return to the same place. Two spoken minutes force selection, and the test for each value is whether it changes something today.

The overnight line reports auto-PEEP, not only the peak pressure, because air trapping is the danger in ventilated asthma. Slowing the rate to lengthen expiration lowered plateau pressure in ventilated patients with status asthmaticus, though the gain was modest once minute ventilation was already low, because little air is still flowing late in expiration (Leatherman et al., 2004). A fall from [11] to [3] shows that the trapped air is leaving.

Prepared Answers

Why not wait a day? The paired awakening and breathing trial approach shortened time on the ventilator and improved survival in a randomized trial (Girard et al., 2008). She has passed both trials, and each extra day of sedation carries its own risk of delirium and weakness.

What if she reintubates? The risk is real, and the plan names the signs: rising respiratory rate above [30], a PaCO2 climbing on a repeat gas at [one] hour, or silent chest on examination. The airway team is aware, and she will stay in the unit for at least [24] hours after extubation.

What this part is doingThe prepared answers take both sides of the question, which is what the attending is weighing.
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References

Girard, T. D., Kress, J. P., Fuchs, B. D., Thomason, J. W. W., Schweickert, W. D., Pun, B. T., Taichman, D. B., Dunn, J. G., Pohlman, A. S., Kinniry, P. A., Jackson, J. C., Canonico, A. E., Light, R. W., Shintani, A. K., Thompson, J. L., Gordon, S. M., Hall, J. B., Dittus, R. S., Bernard, G. R., & Ely, E. W. (2008). Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): A randomised controlled trial. The Lancet, 371(9607), 126-134. https://doi.org/10.1016/S0140-6736(08)60105-1

Leatherman, J. W., McArthur, C., & Shapiro, R. S. (2004). Effect of prolongation of expiratory time on dynamic hyperinflation in mechanically ventilated patients with severe asthma. Critical Care Medicine, 32(7), 1542-1545. https://doi.org/10.1097/01.CCM.0000130993.43076.20

Reading the NU 657 Unit 3 instructions

For Unit 3 you prepare a spoken presentation of one of your ICU patients for morning rounds, usually with a strict time limit of two to three minutes. The prompt expects a brief identifier, overnight events, each system in a consistent order with the values that matter and a plan, and a clear question or proposal for the attending at the end. Most versions ask for the script to be submitted in writing with timing marks, and some want a short rationale explaining what was left out and why. The skill being graded is selection: keeping what changes today's decisions and cutting what does not. Build the script around the one decision the team needs to make that morning.

How the NU 657 Unit 3 example is put together

Timing marks break the script into blocks of 10 to 30 seconds. The identifier fits her history and the severity of her admission into one sentence. Overnight events report the ketamine wean and the fall in auto-PEEP. Neurologic status gives her Richmond score and delirium screen. The respiratory block is the longest, with plateau and peak pressures, the breathing trial settings, the rapid shallow breathing index and the last gas. Cardiovascular, renal, infectious, nutrition, endocrine, lines and prophylaxis take a sentence or two each. The closing question and proposal take 15 seconds. Margin notes explain what was cut and why auto-PEEP was reported, citing Leatherman, and two prepared answers cover waiting and reintubation.

Where the points sit in the NU657 Unit 3 rubric

Points for a rounds script usually go to organization, clinical accuracy, selection of data, the clarity of the question or proposal, and timing. Organization earns full credit when the system order never varies and overnight events come first. Accuracy is judged on correct values and correct interpretation, such as reading auto-PEEP as a measure of air trapping. The selection row rewards leaving out stable, irrelevant values rather than reciting the chart. A proposal scores well when it is specific and supported, with the Girard trial here backing the case for paired trials. Timing is judged against the stated limit, so extra detail that pushes the script past two minutes costs points rather than earning them.

NU657 Unit 3 help from the desk

The most common problem is reading every value from the chart, which buries the decision the team needs to make. Another is presenting the systems in a different order each day, so the attending cannot interrupt and rejoin. Students often report peak pressure in a ventilated asthmatic without plateau or auto-PEEP, which misses the real danger. Some end the presentation without a question, leaving the attending to guess what the student thinks. Others propose extubation without the trial results that justify it. And a script that has never been read aloud against a clock almost always runs over, so rehearse it with a timer at least twice before rounds.

Get an NU657 Unit 3 example written to your instructions

Give the patient's overnight data, the NU657 Unit 3 time limit and the rubric, and mention the order your preceptor rounds in. Back to you in 24-48h, the first one without charge: a script written for the ear, timed in the margin, running every system in order and closing on one decision with a proposal attached. 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 3 questions, answered

Should the written script include citations?

Written versions often do, beneath the script, because the grader wants to see the evidence behind a plan. Spoken aloud, a citation costs seconds and rarely helps. The sample keeps the guideline and trial references in a note below the spoken text, and the script itself mentions only the decision they support.

Can the script describe a patient from my own rounds?

Many programs expect it once identifying details are stripped out, and choosing that patient falls to you. The sample uses an invented man with bracketed values. What you present at the site, the hours you spend there and whatever your preceptor records about your performance remain yours; the sample models structure and timing only.

Where can I find a free NU657 Unit 3 sample paper?

This page shows the full NU657 Unit 3 rounds presentation script, with timing marks, every system, the closing question, margin notes on what was left out and two prepared answers, plus two references. A script for your own patient can be requested below.

What does the NU657 Unit 3 script propose?

Extubation this morning to high-flow oxygen with continuous albuterol ready. The patient passed both an awakening trial and a 30-minute breathing trial, her auto-PEEP fell to 3, and the paired-trial approach shortened ventilation in a randomized trial.

How long is the NU657 Unit 3 script?

It is written to take about two minutes to say aloud, with a timing mark at each block. The respiratory system takes the most time because it carries the day's decision, while stable systems get a sentence each.