| Course | NR 304 Health Assessment II |
|---|---|
| Week | 5 |
| Paper type | Case study analysis |
| Length | About 1,220 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 304 Week 5
Case Study Analysis: Ranking Seven Findings in an 82-Year-Old Admitted After a Fall, When Her Own Baselines and a Beta-Blocker Change What Each Reading Means
Student Name
College of Nursing, Chamberlain University
NR 304: Health Assessment II
Instructor Name
Month Day, Year
Case Study Analysis: Ranking Seven Findings in an 82-Year-Old Admitted After a Fall, When Her Own Baselines and a Beta-Blocker Change What Each Reading Means
What the Case Gives
Mrs. A. is an 82-year-old woman brought from her assisted living apartment to the emergency department and admitted to a medical unit after staff found her on the bathroom floor at 0630. The case separates cleanly into two lists, and the analysis uses them differently: the findings are what gets ranked, and the background is what they are ranked by.
Findings, at 1000 on the Unit
1. Oral temperature 37.6 degrees Celsius.
2. Heart rate 94, regular.
3. Respiratory rate 22.
4. Blood pressure 108/64, lying.
5. Her daughter says she is "not herself": slow to answer, unsure of the day; she scored 2 of 3 on orientation (name and place, not date).
6. Dark, cloudy urine, 150 milliliters in the four hours since admission.
7. A 6 by 4 centimeter purple bruise over the outer left hip; she can move the leg and bear weight with help, and the emergency department hip X-ray showed no fracture.
Background
Usual temperature: 36.1 to 36.3 degrees Celsius, from the assisted living monthly records.
Usual blood pressure: about 142/80.
Usual heart rate: 60 to 66.
Medicines: metoprolol 50 milligrams twice daily, for high blood pressure; last dose last evening.
Usual mental state: fully oriented, does her own crossword every morning, manages her own medicines with a weekly pill box, per her daughter and the facility nurse.
Other: mild chronic kidney disease; a urinary tract infection in the spring.
Each Finding Read Against the History
Temperature. A temperature of 37.6 degrees would not raise concern in a younger adult. In Mrs. A. it is about 1.4 degrees above her own usual range. Norman (2000) describes a smaller fever response in older adults and recommends judging temperature against the person's own baseline, using lower thresholds than those applied to younger patients. Read that way, this is a real rise, and it moves up the list.
Heart rate. A rate of 94 is within the adult range printed on the form. Mrs. A.'s usual rate is in the low 60s, and she takes metoprolol, a medicine that slows the heart and can hold back the rise in rate that usually comes with fever, pain or low blood pressure. A rate of 94 through a beta-blocker is therefore a larger change than the number suggests.
Respiratory rate. A rate of 22 is at the upper edge of normal. It gains weight because it appears alongside the change in mental state, and together they meet two of the three quick bedside criteria that Seymour et al. (2016) found were associated with a higher risk of death among adults with suspected infection outside intensive care: a respiratory rate of 22 or more, altered mental state, and a systolic blood pressure of 100 or less.
Blood pressure. At 108/64, her systolic reading has not crossed the threshold of 100, but it is 34 points below her usual level, and she still received metoprolol last evening. A reading that looks acceptable on a form is a fall of about a quarter for her.
Change in mental state. New confusion in a woman who completes her own crossword and manages her own pill box is a large change from her baseline, and it comes from the person who knows her best. It is also the finding most easily dismissed as normal for her age, which is why the history is so important here.
Urine. Dark, cloudy urine at about 37 milliliters an hour is near the lower edge of the output usually expected in an adult, and the dark color suggests it is concentrated. With mild kidney disease and a spring urinary infection in her history, it is both a possible source and a sign that fluid intake or circulation may be reduced.
Bruise. The hip bruise is important for her comfort and for fall prevention, but the X-ray has already answered the most serious question it raised, and she can bear weight with help. The history makes it less urgent, not unimportant.
The Ranking
First: change in mental state. Largest departure from her own baseline, reported by the person who knows her, and one of the two criteria she meets.
Second: blood pressure. Below her own baseline by about a quarter, while on a medicine that lowers pressure and slows the heart; the next reading decides whether it is falling.
Third: respiratory rate. The second criterion she meets; needs a full-minute count repeated within the hour.
Fourth: heart rate. Modest on paper, significant through a beta-blocker; ranked below the others because it is less specific on its own.
Fifth: temperature. A real rise for her, and ranked here because it points to a cause rather than to how unwell she is right now.
Sixth: urine. Borderline output and its appearance support a possible source and possible dehydration; ranked sixth because the fluid balance over the next hours will say more than a single four-hour total.
Seventh: hip bruise. Kept in the list, marked lower priority because the fracture has been ruled out and she can bear weight; needs pain assessment and a fall-prevention plan.
What Would Move the Order
A repeat blood pressure below 100 systolic would move blood pressure to first place, because it would complete the third bedside criterion and point to a problem with circulation. A return to full orientation after fluids and a meal would move the change in mental state down, though it would still be recorded and watched. If the hip pain rose sharply or she could no longer bear weight, the bruise would move up, because a hip fracture can be missed on a first X-ray. A temperature above 38 degrees would not change the order much, because the analysis has already treated her 37.6 as a real rise.
The student's analysis ends with a request: that the primary nurse repeat the blood pressure and a full-minute respiratory count within 30 minutes, start strict intake and output, and discuss with the provider whether urine and blood tests for infection are indicated. The student does not name a diagnosis. The reasoning in this analysis is that several modest changes, each read against Mrs. A.'s own history, add up to a woman who is sicker than any single number on the form suggests.
Reflection
Without the background, the findings in this case read as a mild temperature, a normal heart rate, a normal blood pressure and some confusion in an older woman. The history turned three of those four into concerns. The student's first draft listed the findings in the order the case gave them and then retold the background in a separate section, and neither section used the other. Rewriting each paragraph to name the piece of history that changed the reading was the whole assignment. Jarvis and Eckhardt (2024) describe the value of a person's baseline in older adults, and this case showed that without the baseline, three abnormal findings looked normal.
References
Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.
Norman, D. C. (2000). Fever in the elderly. Clinical Infectious Diseases, 31(1), 148-151. https://doi.org/10.1086/313896
Seymour, C. W., Liu, V. X., Iwashyna, T. J., Brunkhorst, F. M., Rea, T. D., Scherag, A., Rubenfeld, G., Kahn, J. M., Shankar-Hari, M., Singer, M., Deutschman, C. S., Escobar, G. J., & Angus, D. C. (2016). Assessment of clinical criteria for sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8), 762-774. https://doi.org/10.1001/jama.2016.0288
Reading the NR 304 Week 5 instructions
The Week 5 assignment gives you a case with a list of findings and a patient history, and asks you to analyze and prioritize the findings. Expect the instructions to want each finding interpreted in light of the history, a ranked list with reasons and what you would do or recommend next, in APA with sources. Keep the findings and the background separate at the start so you can show which piece of history changes which reading. Compare values with the person's own baseline, not only the printed adult range. Give every position in the ranking a reason. Keep low-priority findings in the list rather than dropping them. Say what new information would change the order.
Inside the NR 304 Week 5 example
The analysis opens by splitting the case into findings at 1000 and background. Seven findings are listed with values, from a temperature of 37.6 to a 6 by 4 centimeter hip bruise. Background lists her usual temperature, blood pressure and heart rate, metoprolol twice daily and her daily crossword. Each finding is then read against that history: the temperature as a real rise for her, with Norman (2000); the heart rate as blunted by metoprolol; the respiratory rate and confusion meeting two criteria from Seymour et al. (2016). The ranking places mental status first and the bruise last. A section names what would move items, and a request closes the analysis.
Where the points sit in the NR 304 Week 5 rubric
Case analysis rubrics typically grade accurate interpretation of each finding, use of the patient's history, logical prioritization with rationale, use of evidence, recommendations and APA. Use of history carries the largest share, which is why each paragraph names the piece of background that changes the reading. Prioritization scores when every position has a reason and ties are avoided. Evidence earns credit when sources support specific claims about older adults' fever response and bedside sepsis criteria. Recommendations are graded on being specific and within scope, such as a repeat blood pressure within 30 minutes. Naming what would move the order shows that the ranking is reasoning, not a fixed list.
Common NR 304 Week 5 mistakes, and how to avoid them
The worst analysis retells the case for two pages with the findings scattered through it and no ranking. Close behind is history that is quoted at the start and never used. A ranking with no reasons, findings dropped instead of ranked low, claims without a source where one was required, two findings tied with no way to tell them apart and an analysis that ends in a named condition all lose points. Use all the history the case gives, even if some of it confirms rather than changes a reading. You are not expected to reach a diagnosis. Quote only the values you interpret. Forward the findings and history exactly as the case lists them, and a ranked analysis can be written from that material.
Get a NR 304 Week 5 example written to your instructions
Send the Week 5 case as your section published it, together with the assignment instructions and any required headings, and a custom analysis comes back written to them inside 24 to 48 hours. The first one is free. Send it exactly as printed even where the classroom shortened it, since the ranking has to rest on what your own version contains.
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NR 304 Week 5 questions, answered
The case gives history that does not seem to affect anything. Do I use it?
Say so explicitly and move on. An analysis that names a piece of background, states plainly that it does not change the order, and gives one line of reasoning has shown the marker it was considered. Silently omitting it looks identical to missing it. Cases in this week often include one or two details that exist purely to see whether you will claim relevance where there is none.
Am I supposed to reach a diagnosis by the end?
No, and analyses that do usually lose the marks the ordering was carrying. What the assignment wants is a defended order of attention plus what each item raises. Naming a condition ends the argument early and tends to make the remaining findings look like supporting evidence rather than items that were independently weighed. Stop at what you would look at first, and why, and what would change it.
How much of the case can I quote?
Enough to anchor each finding and no more, which in practice is a phrase rather than a sentence. Long quotation eats the word count the reasoning needs and gives a marker no evidence that you understood the material. If your section publishes a limit, follow it. Where the case wording is genuinely load-bearing, quote it once and refer back to it afterward by the finding's name.
Where can I find a free NR 304 Week 5 sample paper?
The full Week 5 case analysis ranking Mrs. A.'s seven findings against her own baselines and her beta-blocker is reproduced on this page with margin notes.
Why is a heart rate of 94 significant in the NR 304 Week 5 case?
Mrs. A.'s usual rate is 60 to 66 and she takes metoprolol, which holds back the usual rise in heart rate, so 94 is a meaningful change for her even though it sits in the adult range.