| Course | NR 304 Health Assessment II |
|---|---|
| Week | 7 |
| Paper type | Risk assessment write-up |
| Length | About 1,170 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 7
Risk Assessment Write-Up: Three Sets of Readings Across Eight Hours in a 57-Year-Old Admitted With a Cat Bite Infection of the Hand
Student Name
College of Nursing, Chamberlain University
NR 304: Health Assessment II
Instructor Name
Month Day, Year
Risk Assessment Write-Up: Three Sets of Readings Across Eight Hours in a 57-Year-Old Admitted With a Cat Bite Infection of the Hand
Parameters in Force
Mr. M., a 57-year-old postal sorting clerk, was admitted at 0700 for intravenous antibiotics after a cat bite to the back of his right hand two days ago became red, swollen and painful. He has type 2 diabetes. The admitting provider wrote the following call parameters in the orders, and every reading below is judged against them, quoted from the order sheet rather than from memory:
Notify the provider for heart rate above 120 or below 50; systolic blood pressure below 90; respiratory rate above 26 or below 10; oxygen saturation below 92 percent; temperature above 38.5 degrees Celsius; urine output below 30 milliliters per hour for 2 consecutive hours; any new confusion; or redness extending beyond the marked border by more than 2 centimeters.
The unit's rapid response team may also be called by any nurse who is worried about a patient, whether or not a parameter has been crossed.
The Readings, Each With the Two Before It
Heart rate: 0800, 92; 1200, 104; 1600, 116.
Systolic blood pressure, right arm, lying: 0800, 132; 1200, 118; 1600, 102.
Respiratory rate, one full minute: 0800, 16; 1200, 20; 1600, 24.
Oxygen saturation, room air: 0800, 97 percent; 1200, 96 percent; 1600, 96 percent.
Temperature, oral: 0800, 38.2 degrees Celsius; 1200, 38.4; 1600, 38.7.
Urine output: 1300 to 1400, 45 milliliters; 1400 to 1500, 35 milliliters; 1500 to 1600, 28 milliliters.
Orientation: 0800, 1200 and 1600, oriented to person, place, date and reason for admission.
Redness on the right forearm, measured from the skin-marker border drawn at 0800: 1200, 1 centimeter beyond the line; 1600, 3.5 centimeters beyond the line, on the inner forearm.
Fingerstick glucose: 0730, 182; 1130, 236; 1530, 264 milligrams per deciliter.
Crossed
Temperature, 38.7 degrees at 1600: above the 38.5 parameter; rising at each reading.
Redness, 3.5 centimeters beyond the marked border: above the 2-centimeter parameter; it was 1 centimeter at 1200, so it spread 2.5 centimeters in 4 hours.
Approaching
This is the group that most needs judgment, because none of these readings has crossed its parameter, and each would look acceptable on its own.
Heart rate has risen by 12 at each reading, from 92 to 116. It is 4 below the parameter. At this pace it would pass 120 before the next scheduled check at 2000.
Systolic blood pressure has fallen by 14 and then 16, from 132 to 102. It is 12 above the parameter of 90, and the fall has not slowed.
Respiratory rate has risen by 4 at each reading, from 16 to 24, and is 2 below the parameter. Cretikos et al. (2008) describe respiratory rate as one of the most useful early signs of a patient getting worse and one of the least often measured properly, which is why each of these counts was taken for a full minute.
Urine output has fallen for three hours in a row and dropped below 30 for the most recent hour. The parameter requires two consecutive hours below 30, so it has not been crossed, but the next hour will decide it.
Taken one at a time, each of these is inside its range. Taken together, four readings are moving in the direction of the same kind of trouble, and they are moving at the same time as a fever that has crossed its line and an infection that is spreading. Churpek et al. (2013) review methods for identifying ward patients at risk of deterioration and describe how combining several vital signs, and following their trends, identifies risk better than any single reading does.
Steady
Oxygen saturation: 97, 96, 96 percent; well above 92.
Orientation: unchanged and complete at all three checks.
Glucose: rising, 182 to 264; no parameter is written for glucose in the call orders, and the sliding-scale insulin order covers these readings. Recorded here, and included in the report because it is rising, but not treated as a reason for escalation on its own.
Escalation
1610, to the primary nurse and the charge nurse, in person: all readings above, with their trends, and the two crossed parameters.
1615, to the admitting provider, by phone, from the primary nurse with the student present: temperature 38.7 and redness 3.5 centimeters beyond the border, both crossed; heart rate, blood pressure, respiratory rate and urine output all approaching their limits and moving steadily in the same direction. Request: that the provider see the patient within 30 minutes, and consideration of blood cultures, a lactate level and a fluid bolus.
1615, agreed with the charge nurse: if the provider cannot come within 30 minutes, or if any approaching reading crosses before then, the charge nurse will call the rapid response team.
1615, plan agreed: vital signs every 30 minutes and hourly urine output until the provider has reviewed; a new skin-marker border drawn at 1605 with the time and date.
Not Escalated, and Why
Oxygen saturation: steady and well inside its parameter; will be rechecked with each set.
Orientation: unchanged; any new confusion would move it to the crossed group at once, per the orders.
Glucose: managed by the existing insulin order; included in the report as context rather than as a separate escalation.
Reflection
The student's first draft said only that the temperature and redness had crossed their parameters and that the patient should be watched. That draft was accurate and missed the main point. It reported each reading on its own and never set it next to the two before it, so the steady fall in blood pressure and rise in heart rate were invisible. Writing each finding with its two earlier readings, and then sorting them into crossed, approaching and steady, made the pattern obvious. Jarvis and Eckhardt (2024) note that a single set of vital signs is a snapshot and that trends carry more information, and this case was a clear example. The hardest part was deciding that four readings inside their ranges were worth a phone call. The parameters exist to make that decision easier, but they do not make it for the nurse. What made the call defensible was not a feeling that he looked unwell but a page that showed, for each reading, the limit, the current figure, the two before it and the distance left. A provider who disagreed with the request could argue with those numbers, and that is the point of writing them down that way. The student also learned to write the time of the next reading into the plan, because an approaching finding is only useful if someone is going to look at it again before it crosses.
References
Churpek, M. M., Yuen, T. C., & Edelson, D. P. (2013). Risk stratification of hospitalized patients on the wards. Chest, 143(6), 1758-1765. https://doi.org/10.1378/chest.12-1605
Cretikos, M. A., Bellomo, R., Hillman, K., Chen, J., Finfer, S., & Flabouris, A. (2008). Respiratory rate: The neglected vital sign. Medical Journal of Australia, 188(11), 657-659. https://doi.org/10.5694/j.1326-5377.2008.tb01825.x
Jarvis, C., & Eckhardt, A. (2024). Physical examination and health assessment (9th ed.). Elsevier.
NR 304 Week 7 instructions, in plain terms
The Week 7 assignment asks you to assess a patient's risk of deterioration using a series of readings and the parameters in force. Expect the instructions to want the parameters, the trend of each finding, which have crossed, which are approaching and what you would escalate, to whom and when, in APA with sources. Quote the parameters from the case before judging any reading. Show each finding with the readings before it so its direction is visible. Readings moving steadily toward a limit deserve as much attention as ones already past it. Name the person you escalate to, the time and what you ask for, plus a fallback. Explain any finding you chose not to escalate.
How the NR 304 Week 7 example is put together
The write-up opens with Mr. M., his diabetes and the call parameters quoted from the orders, including the nurse's option to call the rapid response team. Readings follow with the two before each: heart rate 92, 104, 116; systolic pressure 132, 118, 102; respiratory rate 16, 20, 24; temperature rising to 38.7; and redness 3.5 centimeters past the marked border. A crossed section lists temperature and redness. An approaching section gives each figure's distance from its limit and direction, citing Cretikos et al. (2008). Steady items follow. Escalation is logged at 1610 and 1615 with a 30-minute fallback. A section explains why oxygen, orientation and glucose were not escalated.
NR 304 Week 7 rubric: what full points look like
Deterioration rubrics commonly reward accurate use of parameters, trend recognition, prioritization, timely and specific escalation, safety planning and APA. Seeing the direction of each reading is where most marks sit, so every reading appears with the two before it. Using parameters accurately scores when they are quoted from the orders, not remembered. Prioritization earns credit through the crossed, approaching and steady groups. Escalation is graded on naming the recipient, time and request, and the fallback meets the safety criterion. Explaining items not escalated shows judgment rather than oversight. Evidence on respiratory rate and ward risk stratification supports the attention given to approaching readings. Clear, time-stamped entries make the trend easy to audit later.
NR 304 Week 7 help: mistakes that cost points
First to cost you is a concern with no parameter behind it, which a grader cannot agree or disagree with. Behind it is a single reading judged alone, its direction invisible. Escalation with no recipient, timeframes like soon, items dismissed without reason, approaching readings treated as safe and parameters quoted from memory all lose points. A concern raised for the first time in the final sentence also costs marks. If the case gives no parameters, use your facility's early warning criteria and say so. A reading moving toward a limit is worth reporting. Share your case's readings and orders, and an NR 304 risk write-up can be drafted with trends shown.
Get a NR 304 Week 7 example written to your instructions
Send the Week 7 instructions along with the case and any parameter sheet your section supplies, and a custom example is written to them and returned inside 24 to 48 hours. The first one is free. Where your prompt leaves the parameters open, say so when you send it and the example will state its own and show the reasoning that follows from them.
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NR 304 Week 7 questions, answered
What if the case gives me no parameters to work from?
State the ones you are using and where they came from, then reason inside them. A classroom text or the form your section issues will carry ordinary ranges, and naming your source converts an assumption into something a marker can check. The write-up that goes wrong is the one applying limits it never wrote down, because every judgment in it then rests on a standard the reader cannot see.
Is a reading that has not crossed a limit still worth reporting?
Often it is the most valuable line in the document. A figure moving steadily toward a limit across three entries is a different situation from one sitting quietly in the same place, even though both are inside the range. Showing the earlier entries is what makes that argument, and this is usually the item a rubric is watching for, since it is the judgment that cannot be made from a single row.
How do I decide what goes to somebody senior and what waits?
By what the reading crossed, how fast it is moving, and what the case says about how long you have. Write those three out for each item rather than announcing a conclusion, and the sorting justifies itself. A marker will accept a different judgment from their own when the reasoning is visible, and will not accept the right judgment with nothing underneath it.
Where can I find a free NR 304 Week 7 sample paper?
The full Week 7 risk assessment on Mr. M.'s three sets of readings, with crossed, approaching and steady findings and the logged escalation, is posted on this page.
Which readings are approaching limits in the NR 304 Week 7 example?
Heart rate at 116 against a limit of 120, systolic pressure at 102 against 90, respiratory rate at 24 against 26 and urine output dropping below 30 milliliters for one hour.