| Course | NR 226 Fundamentals: Patient Care |
|---|---|
| Week | 6 |
| Paper type | Priority-setting case response |
| Length | About 1,130 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 226 Week 6
Priority-Setting Case: Mr. W.'s Saturation Falls to 89% at 1100 While the Knee Replacement Next Door Asks for Pain Medicine
Student Name
College of Nursing, Chamberlain University
NR 226: Fundamentals: Patient Care
Instructor Name
Month Day, Year
Priority-Setting Case: Mr. W.'s Saturation Falls to 89% at 1100 While the Knee Replacement Next Door Asks for Pain Medicine
The Decision
I go to Mr. W. first. The rest of this response defends that decision, names the rule behind it, keeps the other patient in view, and states what would reverse it.
The Case, Briefly
At 1100, the nursing assistant tells me that Mr. W., 81, on day three of treatment for pneumonia, "doesn't look right" and that the monitor reads 89% on 2 liters of oxygen; at 0800 he was 92%. At the same moment, Mrs. P., 70, in the next room, on the first day after a total knee replacement, presses her call light and says through the intercom, "My knee is killing me, it's an 8, can I have something?" Her last oral oxycodone was at 0700, and it is ordered every four hours as needed. Details are composite.
A Rule, Named Out Loud
The rule I am using is the one taught this week: physiological needs before other needs, and within physiological needs, airway and breathing before circulation, and circulation before comfort. The first part comes from Maslow's (1943) ordering of human needs, in which the most basic physiological needs come first; the second is the nursing priority sequence of airway, breathing and circulation. By that rule, a falling oxygen saturation in a man with pneumonia is a breathing problem, and severe pain after surgery, while real and urgent, is a comfort need in a patient whose breathing and circulation are, as far as I know, stable.
Findings Quoted From the Case
The findings that decide the order are specific. For Mr. W.: saturation 89% on 2 liters, down 3 points in three hours; the assistant's words, "doesn't look right," which I take seriously because she has cared for him for two days and knows his baseline; and his weak cough and thick secretions from the assessment. A fall to 89% could mean a plug of secretions, worsening pneumonia, a displaced nasal cannula, or a probe that is not reading well. Some of those can be fixed in a minute and one of them could need a rapid response.
For Mrs. P.: pain 8 of 10 in the operated knee, due for her next dose, with no mention of chest pain, shortness of breath or calf pain. Nothing in what she said suggests anything other than expected pain on the first day after surgery.
The Other Patient, Still There
Mrs. P. does not disappear because Mr. W. comes first. Severe pain after a knee replacement matters for more than comfort: it will stop her doing her exercises and walking this afternoon, which are the main defenses against stiffness and blood clots. Her dose is due, and waiting 20 minutes for it is a real cost. So before I go into Mr. W.'s room, I answer her through the intercom: "Mrs. P., I hear you, and your medicine is due. I'm needed next door for a few minutes, and I'm asking another nurse to bring it to you now."
What Can Be Handed On
The oral oxycodone cannot be handed to the nursing assistant, because giving medications is outside the assistant's scope. It can be handed to another registered nurse. I ask the nurse across the hall, who has a lighter assignment, to give Mrs. P. her dose, check her pain and her dressing, and ask her about calf pain and breathing. The assistant can reposition Mrs. P.'s leg on its pillow and bring ice while the nurse comes. What cannot be handed on is the assessment of Mr. W.: working out why his saturation fell is my job as his nurse.
In Mr. W.'s room, I check the cannula is in his nose and connected, check the probe and waveform, sit him upright, and coach him to take deep breaths and cough. He coughs up a large amount of thick yellow sputum, and within five minutes his saturation is 93%. I listen to his lungs, count his breathing, and call the provider to report the drop and the response, and to ask whether he needs a chest film.
What the Rule Does Not Settle
The ordering rule is useful, but it does not settle everything in this case, and it is worth being honest about where my judgment filled the gap. The rule says breathing before comfort. It does not say how far a saturation has to fall before breathing outranks severe pain. At 91% with a stable trend, I might reasonably have gone to Mrs. P. first, given her a medication that takes two minutes, and then gone to Mr. W. What moved me was not only the number 89 but the direction, down three points in three hours, and the assistant's sense that he did not look right. Those two things together suggested a change in progress, not a stable low number.
The rule also does not tell me how long Mrs. P. can wait. My answer was that she should not wait at all if another nurse could give the dose, which is why I asked for help before going next door rather than after. Priority setting is not only about who comes first; it is about making sure the person who comes second is not simply left.
Finally, the rule treated Mr. W.'s drop as a breathing problem before I knew its cause. That was correct, because the first minutes of care are the same whatever the cause: check the equipment, sit him up, help him cough. The cause matters for what happens after those minutes, which is why the call to the provider comes once he has stabilized, with the response already known.
The Condition That Flips It
The order would reverse if Mrs. P.'s findings were different. If she had said her chest hurt or she could not catch her breath, a blood clot in her lungs after knee surgery would be possible, and her problem would become a breathing and circulation problem that could be more urgent than Mr. W.'s. The same would be true if her pain were in her calf rather than her knee, with swelling. And the order would also change if Mr. W.'s saturation had been 92% and stable, and the assistant's concern had been something like "he wants to sit up": then Mrs. P.'s due medication would come first, and I would check him right after. The rule decides the order only because of the findings; different findings would give a different answer under the same rule.
References
Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-396. https://doi.org/10.1037/h0054346
NR 226 Week 6 instructions, in plain terms
The Week 6 assignment presents two or more patients with competing needs and asks which you would attend to first and why. Expect the instructions to ask for the decision, the prioritization framework used, the data supporting it, what happens to the other patient and what could be delegated. Sections often ask for three or four APA pages that cite the framework. The prompt rewards a decision stated early and defended with findings from the case, not a general rule alone. Delegation must respect each role's scope; medications cannot go to an assistant. Strong responses also say what would change the order, which shows the reasoning is conditional on the data.
How the NR 226 Week 6 example is put together
The response opens with its decision in one sentence: Mr. W. first. A short case summary follows with both patients. The rule is named: physiological needs first and airway and breathing before comfort, drawn from Maslow (1943). Findings are quoted from the case, a 3-point fall in saturation and an assistant who says he does not look right, set against Mrs. P.'s expected pain of 8 out of 10. A section keeps her in view and explains why her pain matters for walking and clot prevention. The handoff of her dose to another RN is described, then the cough that clears Mr. W.'s secretions. The close states what would flip the order.
Reading the NR 226 Week 6 grading rubric
Priority case rubrics usually grade the decision, the framework and its application, the supporting data, delegation, attention to the other patient and APA. The decision with its rationale carries the most points, and this sample states it in the first line. Applying a framework means using it to sort the findings, as the Maslow and airway ordering does here, rather than naming it and moving on. Supporting data must come from the case. Delegation is graded on scope, so the medication goes to another RN. Keeping the second patient in view earns points many responses miss. Naming the reversing condition shows the conditional thinking these rubrics describe as clinical judgment.
Common NR 226 Week 6 mistakes, and how to avoid them
The lowest scores get the order right and never say why. Another frequent loss is naming a framework at the top and then arguing from how sick each patient sounds. Leaving the second patient off the page entirely costs marks. Retelling the case at length before any decision, using a finding not in the case, hedging until both patients are first and delegating a task outside someone's role all lose points. Most cases have a defensible answer rather than one correct order. Restate only the findings that decide. Send the case exactly as your section wrote it, and a response can be argued from its own findings.
Get a NR 226 Week 6 example written to your instructions
Send the Week 6 case and the prompts your section attached, and a custom response comes back inside 24 to 48 hours with the ordering rule named and applied to the findings the case actually supplies. The first one is free. If your classroom requires a particular framework, tell us which one and that is the one used.
More NR 226 papers and pre-licensure samples
- NR 226 Week 1: Nursing Action Discussion Post
- NR 226 Week 2: Assessment Data Clustering Write-Up
- NR 226 Week 3: Nursing Diagnosis Statements
- NR 226 Week 4: Three Problem Nursing Care Plan
- NR 226 Week 5: Patient Concept Map
- NR 226 Week 7: Discharge Teaching Plan
- NR 226 Week 8: Reflection
- NR 228 Week 6: Patient Teaching Handout
- NR 224 Week 6: Sterile Dressing Change Write-Up
- NR 283 Week 6: Case Study Analysis
- NR 222 Week 6: Community Resource Brief
NR 226 Week 6 questions, answered
Is there a single correct order?
Often there is, and often the marks do not depend on it. Cases are usually built so that one patient is clearly first, but sections awarding most of their points to the justification will pass a defensible wrong order and fail an unexplained right one. Write the reasoning as though the reader disagreed with you, and quote the finding that settled it for you.
Which framework should I use?
Whichever your week teaches, and name it rather than implying it. Maslow turns up frequently in a fundamentals course, and some sections prefer an ordering built on what is unstable, what is urgent and what can wait. The choice matters less than the consistency: a scheme cited in one line and ignored in the next costs more than picking the other one ever would.
How much of the case should I restate?
As little as you can manage. The grader wrote it, and rereading it back to them costs space the argument needs. Pull individual findings in where they do work, quoted or closely reported, and leave the rest alone. A response spending half its length on summary is the commonest way a sound decision ends up looking thin on the page.
Where can I find a free NR 226 Week 6 sample paper?
The full Week 6 priority-setting response, deciding between Mr. W.'s falling saturation and Mrs. P.'s knee pain, with the rule and the reversing condition, is published here.
What would change the order in the NR 226 Week 6 example?
If Mrs. P. reported chest pain or could not catch her breath, a blood clot in her lungs after knee surgery would be possible and her problem would become breathing and circulation first.