| Course | NR 324 Adult Health I |
|---|---|
| Week | 3 |
| Paper type | Case study analysis |
| Length | About 1,140 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 324 Week 3
Case Study Analysis: A Broken Ankle in a 59-Year-Old Man Whose Diabetes Decides Most of What Happens Next
Student Name
College of Nursing, Chamberlain University
NR 324: Adult Health I
Instructor Name
Month Day, Year
Case Study Analysis: A Broken Ankle in a 59-Year-Old Man Whose Diabetes Decides Most of What Happens Next
The Case
Mr. K. is a 59-year-old warehouse supervisor admitted from the emergency department after stepping off a curb and breaking his right ankle, a fracture of both the inner and outer ankle bones that needs surgical repair with a plate and screws. He has had type 2 diabetes for 15 years. His A1c on admission is 9.4%. His home regimen is glipizide 10 milligrams each morning plus metformin, 1,000 milligrams at breakfast and again at supper. On examination he could not feel a 10-gram monofilament at four of five sites on either sole, and his dorsalis pedis pulse is faint on the left and cannot be felt on the right because of the swelling. His fingerstick glucose was 238 milligrams per deciliter on arrival at 1500. Surgery is planned for tomorrow at 1100, and he will be kept nothing by mouth from midnight.
Mr. K. was admitted for the ankle. The analysis below argues that the diabetes decides most of what happens to him while he is here and after he leaves: how the wound heals, how infection is watched for, what his medicines can be around surgery, and what he must manage at home.
What Fifteen Years of Diabetes Have Already Cost
The A1c of 9.4% describes the last two to three months, not today. It tells me that his glucose has been running high for a long time, which means the damage the case describes is not new. The monofilament result means he has lost protective sensation in both feet; he would not feel a blister, a tight cast or a pressure spot on his heel. Boulton et al. (2008) describe inability to feel the 10-gram monofilament as loss of protective sensation, one of the main risk factors for foot ulcers in people with diabetes. The faint pedal pulse raises the question of reduced blood flow to the feet. Wukich et al. (2011) compared operatively treated ankle fractures in patients whose diabetes had damaged the nerves, kidneys or blood vessels with those whose diabetes had not, and found that the first group had 3.8 times the risk of complications overall and 5 times the likelihood of needing revision surgery. Mr. K. belongs in the first group. That single fact changes nearly every decision below.
Decision 1: Glucose Around Surgery
Glipizide makes the pancreas release insulin regardless of whether he is eating. If he takes it tomorrow morning while fasting for surgery, he could become dangerously hypoglycemic before 1100. Metformin is also usually held in hospital, particularly around procedures and while kidney function and contrast exposure are uncertain. The Endocrine Society guideline for non-critical care patients recommends stopping oral diabetes medicines on admission for most patients and using scheduled insulin with a basal component rather than correction-scale insulin alone, with premeal glucose targets below 140 and random values below 180 milligrams per deciliter (Umpierrez et al., 2012). The nursing implications are specific: confirm that glipizide and metformin are held, check glucose before meals and at bedtime tonight and every 4 hours while he is fasting, and know that a reading below 70 means treating it and calling. His 238 on arrival is above target and will be reported with the evening values if it stays there.
Decision 2: The Wound and the Skin Around It
Because Mr. K. cannot feel his feet, the ordinary warning that a splint or cast is too tight, pain, will not come. The skin checks that other patients report for themselves must be done for him. Every 4 hours, the nurse checks the toes for color, warmth and capillary refill, and looks at every visible edge of the splint for pressure. The left heel, the one without the fracture, lies on the mattress all day and night and needs the same attention, with a pillow under the calf so the heel floats. After surgery, the incision will be watched for redness spreading beyond the edges, drainage and new warmth, because a slow-healing wound in a man with diabetes and possibly reduced blood flow can become infected before he feels anything wrong.
Decision 3: Infection Watching
High glucose impairs the body's defenses, and Mr. K.'s surgical site infection risk is higher than a patient without diabetes. Two watch points follow. First, glucose control matters directly: sustained readings above 180 will be reported, not simply documented. Second, the usual sign of infection, pain, may be muted in a foot without sensation, so the nurse relies on what can be seen and measured: temperature, the appearance of the incision and any new swelling. A temperature above 38.0 degrees Celsius after the first postoperative day, or redness spreading beyond the incision edge, is reported the same shift.
Decision 4: Nutrition and the Fasting Period
Fasting from midnight for an 1100 surgery means 11 hours without food, and possibly longer if the operating room is delayed. With glipizide held and glucose checked every 4 hours, the risk shifts from hypoglycemia to hyperglycemia from the stress of injury and surgery. If surgery is delayed past midday, the nurse asks whether dextrose-containing fluid and a basal insulin adjustment are needed. After surgery, the first meal is the point at which his scheduled insulin is matched to what he actually eats, which the nurse records carefully.
Decision 5: Going Home
Mr. K. will go home unable to bear weight on his right leg for about six weeks, with a splint or cast, and with feet he cannot feel. What he must manage alone is the part that matters most. He needs to look at both feet every day, including the heel he cannot easily see, using a mirror or a family member; his wife works days, so the plan is an evening check together. He needs to know that pain is not a reliable warning for him, and that any new swelling, a smell from the cast, or fever means calling the surgeon's office the same day. His diabetes regimen at discharge will likely differ from what he came in on, and the change needs to be explained, not just listed.
Summary
Mr. K. was admitted for a broken ankle, but his diabetes decides the medicine plan around surgery, the way his skin and wound must be checked, how infection will show itself, what fasting does to his glucose, and what he must do at home for the next six weeks. The case shows why a history of diabetes cannot be filed as background. Every nursing decision in this admission is different because of it.
References
Boulton, A. J. M., Armstrong, D. G., Albert, S. F., Frykberg, R. G., Hellman, R., Kirkman, M. S., Lavery, L. A., LeMaster, J. W., Mills, J. L., Sr., Mueller, M. J., Sheehan, P., & Wukich, D. K. (2008). Comprehensive foot examination and risk assessment. Diabetes Care, 31(8), 1679-1685. https://doi.org/10.2337/dc08-9021
Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., Montori, V. M., Seley, J. J., & Van den Berghe, G. (2012). Management of hyperglycemia in hospitalized patients in non-critical care setting: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 97(1), 16-38. https://doi.org/10.1210/jc.2011-2098
Wukich, D. K., Joseph, A., Ryan, M., Ramirez, C., & Irrgang, J. J. (2011). Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes. Foot & Ankle International, 32(2), 120-130. https://doi.org/10.3113/FAI.2011.0120
The Chamberlain NR 324 Week 3 instructions
Week 3 hands you a patient admitted for one problem who also carries a chronic condition that shapes the plan. The prompt typically wants the relevant data, how the chronic condition changes nursing care, priorities, interventions with rationales and discharge considerations, in APA with sources. Read laboratory values for what they mean over time, not just as results. Bring the chronic condition into every decision rather than listing it in the history. Give monitoring a frequency and the value that would prompt action. Remember that usual warning signs may not appear, such as pain from a tight splint. End with what changes in the person's own daily work at home.
How the NR 324 Week 3 example is put together
The analysis opens with Mr. K., his ankle fracture needing a plate and screws and fifteen years of type 2 diabetes. It states its argument: the diabetes decides most of what happens. A section reads the A1c, the afternoon meter reading and the monofilament result for what each means. Five decisions follow: holding glipizide while fasting, per Umpierrez et al. (2012); skin and toe checks every 4 hours because pain will not warn him; reporting sustained glucose above 180 and watching for infection that may not show the usual signs; managing 11 hours of fasting; and daily foot inspection at home, citing Wukich et al. (2011) and Boulton et al. (2008).
Where the points sit in the NR 324 Week 3 rubric
Case analysis rubrics typically reward accurate interpretation of data, integration of the chronic condition into care decisions, prioritization, evidence-based interventions with rationale, discharge planning and APA. Integration carries the most weight, so each decision names what the diabetes changes about it. Interpretation earns credit when the A1c is read as months and the monofilament as lost sensation. Interventions score when monitoring has a frequency and a threshold. Evidence from a hospital glucose guideline and fracture outcome studies supports the decisions. Discharge planning is credited when it says what Mr. K. must do himself. Recognizing that usual warning signs may be missing shows clinical reasoning.
Common NR 324 Week 3 mistakes, and how to avoid them
Nothing costs more than filing the diabetes under history and never using it to change a decision. The reverse, an essay on the chronic condition while the admission sits untouched, also loses points. Care written for someone with normal sensation and healing, glucose watched without frequency or threshold, values quoted with no action and a discharge that says nothing about the person's own work all cost marks. Reading an A1c as a single result instead of a stretch of months is a common slip. The same approach works for other chronic conditions. A priority nursing diagnosis at the end is fine if your section asks for one. Send your case for an analysis that threads the chronic condition through each decision.
Get a NR 324 Week 3 example written to your instructions
Send the Week 3 case exactly as your section published it, the rubric attached to it, and any required headings. Where the case has to come from somebody you looked after on a clinical day, that account stays yours to write and we work from the prompt alone. A custom example returns inside 24 to 48 hours, and the first is free.
More NR 324 papers and pre-licensure samples
- NR 324 Week 1: Chronic Condition Management Post
- NR 324 Week 2: Heart Failure Daily Jobs Concept Map
- NR 324 Week 4: Care Plan
- NR 324 Week 5: Patient Teaching Plan
- NR 324 Week 6: Perioperative Write-up
- NR 324 Week 7: Medication Management Case
- NR 324 Week 8: Discharge Summary Paper
- NR 325 Week 3: Laboratory Trend Write-up
- NR 304 Week 3: Abnormal Findings Report
- NR 326 Week 3: Process Recording
- NR 302 Week 3: Skin Assessment Write-Up
NR 324 Week 3 questions, answered
My case names a different long-term condition. Does the approach change?
The condition changes and the shape does not. Whatever somebody has carried for years is read for what it has already cost this body, then taken into every decision about the reason for admission. Heart failure changes what fluid means, kidney disease changes which medicines are possible, and the paper is organized the same way in each. Send your own case and the example is built on that.
Should the analysis end with a priority nursing diagnosis?
Where your prompt calls for one, yes, and it comes last rather than first. What earns points is the reasoning that arrived there, so a label announced at the top usually leaves the rest of the paper defending a choice instead of working the case. Where your section supplies required headings, the same order fits underneath them.
Does the paper need the complications this patient has not developed yet?
Briefly, and only the ones this person is genuinely near. A list of everything the condition can eventually cause reads as a chapter summary, while two named risks with the earliest change that would show them reads as nursing. The test is whether something you would watch or teach follows from naming it. Where nothing does, leave it out.
Where can I find a free NR 324 Week 3 sample paper?
The whole Week 3 case analysis of Mr. K.'s ankle fracture, with five decisions shaped by his diabetes, is posted further down this page.
Why are skin checks every 4 hours in the NR 324 Week 3 example?
Mr. K. failed the monofilament test and cannot feel his feet, so pain will not warn him that a splint is too tight; the nurse checks toes and skin for him.