| Course | NR 283 Pathophysiology |
|---|---|
| Week | 7 |
| Paper type | Patient scenario write-up |
| Length | About 1,090 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 283 Week 7
Patient Scenario Write-Up: Alcohol Withdrawal Over Three Days in a 51-Year-Old Man Admitted for a Broken Wrist, Each Change Graded for Urgency
Student Name
College of Nursing, Chamberlain University
NR 283: Pathophysiology
Instructor Name
Month Day, Year
Patient Scenario Write-Up: Alcohol Withdrawal Over Three Days in a 51-Year-Old Man Admitted for a Broken Wrist, Each Change Graded for Urgency
The Scenario as It Stands
Mr. P. is 51, admitted to an orthopedic unit at 1900 on day zero for surgical repair of a wrist fracture after a fall at home. On admission he says he drinks "a few beers" a night; his wife later tells the nurse it is closer to a 12-pack daily, with his last drink at about 1600 before the fall. He has high blood pressure. Surgery is planned for the next morning. Details are composite.
The pathophysiology behind what follows is a nervous system that has adapted to alcohol. Alcohol enhances the calming effect of the brain's main inhibitory signal, GABA, and dampens the effect of the main excitatory signal, glutamate. With daily heavy drinking, the brain adjusts by reducing inhibition and increasing excitation, so that it functions normally in the presence of alcohol. When alcohol is suddenly stopped, that adjustment is left unopposed, and the brain and the sympathetic nervous system become overexcited. Each change below is taken in the same way: what altered, what would produce it, and what it means for the person on shift.
Change 1: 12 Hours, Day One at 0400
What altered: Mr. P. is awake, sweating, with a fine tremor of both hands when he holds them out. Heart rate 104, blood pressure 156/96, temperature 37.4 C. He is anxious and asks repeatedly when he can go home. On the CIWA-Ar, the ten-item withdrawal scale nurses score at the bedside, he rates 14.
What would produce it: sympathetic overactivity as the brain's unopposed excitation drives up heart rate, blood pressure and sweating, with tremor from the same overexcited nervous system. Sullivan et al. (1989) developed the revised scale to measure the severity of withdrawal from observed and reported symptoms, so that treatment could be matched to severity.
Urgency: moderate. This is the expected early course, but it is not minor. The nurse gives the withdrawal medicine ordered on the symptom-triggered protocol, rechecks the score in one hour, and tells the charge nurse and the surgical resident, because withdrawal will affect his surgery and anesthesia. Recorded and called.
Change 2: 30 Hours, Day One at 2200
What altered: after his wrist surgery, which went ahead with the anesthesia team aware of his withdrawal, Mr. P. tells the nurse there are "bugs on the wall" and points at them. He knows he is in the hospital and knows the date. Heart rate 112, blood pressure 150/92. CIWA-Ar score 18.
What would produce it: visual hallucinations with a clear sense of where he is can occur in the first two days of withdrawal and reflect the same overexcited brain. What matters is that his orientation is intact: he is seeing things but knows where and when he is.
Urgency: higher. His score has risen despite treatment, and hallucinations are a step beyond tremor. The nurse gives the protocol dose for the higher score, places him in a room near the station with a low bed and fall precautions, since his wrist is in a splint and he may try to get up, and calls the covering provider to report that the protocol is not controlling his symptoms. Called, not only recorded.
Change 3: 54 Hours, Day Two at 2200
What altered: Mr. P. does not know where he is and thinks the nurse is his brother. He is pulling at his IV and trying to climb over the bed rail. Temperature 38.4 C, heart rate 132, blood pressure 172/104, breathing 26, heavy sweating. CIWA-Ar cannot be completed because he cannot answer the questions.
What would produce it: these findings together, confusion, fever, a racing heart and very high blood pressure, two to four days after the last drink, fit delirium tremens, the most severe form of withdrawal. The brain's overexcitation has now reached the point of global confusion and loss of temperature and cardiovascular control. It can be fatal without intensive treatment. Infection must also be considered, since he has a fever and a fresh surgical wound.
Urgency: emergency. The nurse stays with him, calls the rapid response team, and asks the charge nurse to bring help to keep him safe. The findings are given in one sentence: "Mr. P., day two of alcohol withdrawal, now disoriented, temp 38.4, heart rate 132, pressure 172 over 104, pulling at his IV."
Named by Role, and the Record Against the Call
Each finding went to a specific role. The early tremor and sweating went to the charge nurse and the surgical team, because it affected the plan for surgery. The rising score with hallucinations went to the covering provider, because the protocol was not working and needed review. The confusion with fever and a heart rate of 132 went to the rapid response team, because it needed more than the unit could provide.
What separates recording from calling is change against the expected course and the response to treatment. A score of 14 at 12 hours in a heavy drinker is expected and is treated by protocol; it is recorded and reported, not escalated. A score that rises despite two protocol doses is a sign that the plan is failing, which needs a provider. And any disorientation with abnormal vital signs is outside what the unit protocol covers.
The same logic works in the other direction: once he is transferred, the fall in heart rate and the return of his orientation over the next days are recorded as signs that treatment is working, but a new fever after that improvement would be called at once, because at that point infection is more likely than withdrawal.
What Gets Watched Next
After transfer to the intensive care unit, the watch continues on the findings that would show improvement or danger: orientation, heart rate and blood pressure, temperature and the wound as a possible source of infection, breathing and sedation level as withdrawal medicine is increased, blood sugar, electrolytes, and fall and injury risk. Looking back, the earliest point at which this course could have been anticipated was admission, when his wife's account of his drinking differed from his own. A withdrawal assessment started then, rather than at the first tremor, is the change this case argues for.
References
Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. (1989). Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction, 84(11), 1353-1357. https://doi.org/10.1111/j.1360-0443.1989.tb00737.x
Reading the NR 283 Week 7 instructions
The Week 7 assignment presents a patient whose condition changes over time and asks you to explain the pathophysiology behind each change and judge its urgency. Expect the instructions to want the mechanism, the findings at each stage, which changes require action and who should be told, in an APA paper with sources. Each change should be compared against the expected course and the response to treatment. Urgency needs a reason based on what the finding predicts. Name the role you would report to, not just that someone would be notified. The focus is on recognition and escalation rather than writing full treatment plans, though immediate safety actions belong in the answer.
How this NR 283 Week 7 example is built
The write-up sets the scenario: Mr. P., admitted at 1900 on day zero with a wrist fracture, whose wife reports far more drinking than he did. A short section explains the brain's adaptation to alcohol. Change 1 at 12 hours shows sweating, tremor, a heart rate of 104 and a CIWA-Ar score of 14, graded moderate, with Sullivan et al. (1989) cited. Change 2 at 30 hours adds hallucinations with intact orientation and a rising score, graded higher. Change 3 at 54 hours shows confusion, a temperature of 38.4 and a heart rate of 132, graded an emergency with a rapid response call. A section explains who received each finding and why.
Where the points sit in the NR 283 Week 7 rubric
Scenario write-ups are typically graded on accurate pathophysiology, recognition of changes, appropriate urgency, communication to the right person and APA. Urgency with a reason carries the most marks, so each change is graded and justified by what it predicts. Recognition scores when findings are compared with the expected course, as the score of 14 at 12 hours is. Communication earns credit when a role is named and the message is given. Accuracy depends on the GABA and glutamate mechanism being tied to each sign. Using a validated scale shows measurement rather than impression. Watching for improvement after transfer demonstrates the follow-through many rubrics include. Reading the score trend, not one score, is what earns the recognition row.
NR 283 Week 7 help from the desk
The costliest write-ups describe a patient getting worse and never say anyone would be told. Urgency asserted because a finding sounds serious, without physiology, loses points. Treating everything as urgent shows no more judgment than treating nothing as urgent. Passive sentences about escalation with no role named cost marks. Jumping to treatment the course does not measure, reporting a change with no baseline and retelling the scenario before using it also lose points. Give times as specifically as the scenario allows. If nobody is named on shift, use roles. Send your scenario, and a write-up grading each change can be drafted from it. Keep each change in the same four-part order so a grader can compare them.
Get a NR 283 Week 7 example written to your instructions
Send the Week 7 scenario as your classroom posted it, the rubric, and any reporting form or template your instructor wants used. A custom example is written to that scenario, with every finding sorted by who is told and how fast, and returned inside 24 to 48 hours. The first is free.
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NR 283 Week 7 questions, answered
Does the write-up say what should be done about the findings?
Not beyond reporting them. The course stops at what is happening, what it produces and what a nurse does with that, and the last of those three is noticing, recording and telling somebody. Deciding on treatment sits with other people and other courses. Drafts that reach for it usually get there by stepping over the observation, which is the part actually being marked.
How specific should the timing be?
Specific enough to be checkable and no more. The example uses relative language, before the end of the round, within the hour, immediately, rather than inventing intervals no rubric set. Where a section publishes its own escalation timings, those are what the example is written to. What matters is that every finding carries some statement about how long it can be left.
What if the scenario never says who is on shift?
Then roles are used and the write-up says as much. The charge nurse, the nurse responsible for the patient, the team answering a rapid call: these hold true whatever the staffing looks like. Inventing a name adds nothing a rubric rewards and can make the document read as fiction, where the scenario was set to test sorting rather than storytelling.
Where can I find a free NR 283 Week 7 sample paper?
The full Week 7 write-up of Mr. P.'s alcohol withdrawal, with three changes graded for urgency and the roles each finding went to, is printed on this page.
What made the NR 283 Week 7 change an emergency?
At 54 hours Mr. P. was disoriented, pulling at his IV, febrile at 38.4 C with a heart rate of 132 and blood pressure of 172/104, which fits delirium tremens and calls for a rapid response.