| Course | NR 325 Adult Health II |
|---|---|
| Week | 1 |
| Paper type | Discussion post with one reply |
| Length | About 530 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 325 Week 1
Week 1 Discussion: Same Numbers, Different Patients
Two Blood Pressures of 108/66 at 2000, and the 1600 Column Underneath
Initial Post
At 2000 on my clinical unit last week, two patients in neighboring rooms had nearly identical vital signs: blood pressure 108/66, pulse 94 to 96, breathing 18, oxygen saturation 96% on room air, temperature normal. Read from that one column, both look acceptable, and on a busy evening both would likely be charted and left until the next round.
The 1600 column tells a different story. The first patient, a woman of 72 with chronic heart failure, on a diuretic and a beta-blocker, was 110/64 with a pulse of 92 at 1600, and her chart shows she runs in the low 100s to 110s systolic every day. Nothing moved. The second patient, a 58-year-old man on the first day after a total hip replacement, was 136/82 with a pulse of 76 at 1600, and 142/84 at 0800. Over four hours his systolic pressure fell by 28 points while his pulse rose by 20 to hold the pressure where it is now. His numbers at 2000 look like hers, but his body is working to keep them there.
That difference is what I would act on. His falling pressure and climbing pulse after surgery raise the question of blood loss, and the ratio of his pulse to his systolic pressure, the shock index, has gone from about 0.56 to about 0.89. Olaussen et al. (2014) reviewed the shock index in trauma patients and found that the cut-off most often suggested for predicting critical bleeding was 0.9 or higher. He is not a trauma patient and the index is not a diagnosis, but he is close to that line and moving toward it.
What I would do, and when: tell the charge nurse and the surgical team now, not at the next scheduled check; look at his dressing and drain, check the hemoglobin from this morning against the one before surgery, recheck his vital signs in 30 minutes, and ask whether a repeat blood count is wanted tonight. For the woman with heart failure, I would chart the 2000 set and recheck at the usual time.
Brekke et al. (2019) searched for studies of vital sign trends in patients monitored intermittently on general wards and found very few, but both included studies suggested that trends improved detection of deterioration compared with single values. That matches what I saw: neither patient's 2000 column alone would have told me who needed a phone call.
My question for the board: does your unit's flowsheet show the previous set beside the current one, or do you have to click back to find it?
Reply to a Classmate
Your comparison of two patients with a saturation of 93% made the same point from the other side: one had been 93% since admission with long-standing lung disease, and the other had dropped from 98% over the shift. One thing I would add is the oxygen they were on. If the second patient's oxygen was turned up during the shift, the 93% hides an even larger fall. Did the flowsheet record the oxygen flow beside each saturation?
References
Brekke, I. J., Puntervoll, L. H., Pedersen, P. B., Kellett, J., & Brabrand, M. (2019). The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review. PLOS ONE, 14(1), Article e0210875. https://doi.org/10.1371/journal.pone.0210875
Olaussen, A., Blackburn, T., Mitra, B., & Fitzgerald, M. (2014). Review article: Shock index for prediction of critical bleeding post-trauma: A systematic review. Emergency Medicine Australasia, 26(3), 223-228. https://doi.org/10.1111/1742-6723.12232
NR 325 Week 1 instructions, in plain terms
The opening NR 325 discussion asks you to show how earlier readings change the meaning of current vital signs. Expect a prompt asking you to compare two patients or two moments, explain what the difference means and say what you would do, with a scholarly source and a reply. Do not judge any patient from one column. Put an earlier set beside the current one and compare each person with their own usual values. Keep biology short and tie it to the bedside. When something is moving, say who you would tell and when you would look again, instead of writing further observation. Replies should add a measurement or comparator the classmate left out.
How the NR 325 Week 1 example is put together
The post opens at 2000 with two neighboring patients whose vital signs look nearly identical. The 1600 column follows: the woman with heart failure was 110/64 and runs low on her diuretic and beta-blocker, while the surgical patient was 124/78 with a pulse of 70 and is now 108/66 with 96. His shock index rising from about 0.56 to 0.89 is set against Olaussen et al. (2014). The action paragraph names the charge nurse and surgical team now, the dressing, drain and hemoglobin checks and a recheck in 30 minutes. Brekke et al. (2019) support trends over single values. The reply adds oxygen flow to a classmate's saturation comparison.
Reading the NR 325 Week 1 grading rubric
The NR 325 discussion rubric generally weighs clinical reasoning, use of evidence, specific nursing action, the reply and writing. Clinical reasoning carries the most points, so the post refuses to judge either patient until the earlier column is beside the current one. Evidence earns credit when the shock index source is applied to one patient's numbers. Nursing action scores when it names who is told, what is checked and when the next look happens. The reply is credited for adding a missing comparator that changes how a classmate's trend reads. A question about how flowsheets display earlier sets invites real responses. Two complete references with DOIs protect the APA row.
NR 325 Week 1 help from the desk
The costliest post in this week reads one column and calls the quieter patient stable, the exact error the assignment catches. Next is spotting movement and closing on further observation with nobody told. Textbook ranges with nothing about the person's usual values, compensation explained as biology with no bedside link, urgency by adjective when a figure and an hour were available and arguing from information nobody had at 2000 all cost points. Replies that endorse a classmate without adding a measurement earn little. Keep the biology to a sentence or two. Both patients need not be unwell. Bring the vital signs you plan to compare, and an NR 325 post can be built around the earlier column.
Get a NR 325 Week 1 example written to your instructions
Send the Week 1 prompt as your classroom posts it, the discussion rubric, and the two patients or the scenario your section handed out. A custom example is written to those instructions, replies included, and comes back inside 24 to 48 hours. The first one is free, and it arrives as something to read your own draft beside.
More NR 325 papers and pre-licensure samples
- NR 325 Week 2: Case Study Analysis
- NR 325 Week 3: Laboratory Trend Write-up
- NR 325 Week 4: Cardiac Case Response
- NR 325 Week 5: Concept Map
- NR 325 Week 6: Treatment Safety Analysis
- NR 325 Week 7: Handover Report
- NR 325 Week 8: Deterioration Case Paper
- NR 326 Week 1: Discussion Post
- NR 324 Week 1: Chronic Condition Management Post
- NR 327 Week 1: Discussion Post
- NR 304 Week 1: Symptom Timing Question Post
NR 325 Week 1 questions, answered
How much biology belongs in a post this short?
Less than the first draft usually carries. One clause on why a pulse rises when a pressure starts to give is enough to make everything after it defensible, and the room saved goes to the comparison. A paragraph of physiology with no person attached to it reads as material carried forward from an earlier course, and this week is not marking it.
Do both patients have to be unwell?
No, and the post is usually stronger when one of them is not. The pair exists so a reader can see what an ordinary set of figures looks like beside a set that has been traveling. Where your section supplies only one patient, the second half of the comparison can come from that same person earlier in the day, which does the same job.
Can I just say the quiet patient is the one worrying me?
That is the post, so say it early and then make it survive the figures: which measurement you are following, what it did across the afternoon, and what you expect it to read in another hour. Worry stated without those three is an impression, and an impression is the first thing a marker in this course discounts.
Where can I find a free NR 325 Week 1 sample paper?
The complete Week 1 post comparing two patients at 108/66, with the 1600 readings, the shock index and the reply about oxygen flow, is shown on this page.
Which patient worries the NR 325 Week 1 writer, and why?
The postoperative man, because his pressure fell from 124/78 and his pulse rose from 70 since 1600, moving his shock index from about 0.56 to 0.89, while the other patient always runs low.