| Course | NR 325 Adult Health II |
|---|---|
| Week | 2 |
| Paper type | Case study analysis |
| Length | About 1,130 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 325 Week 2
Case Study Analysis: Three Columns on the First Day After an Abdominal Hysterectomy, Read as One Movement
Student Name
College of Nursing, Chamberlain University
NR 325: Adult Health II
Instructor Name
Month Day, Year
Case Study Analysis: Three Columns on the First Day After an Abdominal Hysterectomy, Read as One Movement
The Case and the Three Columns
Ms. D. is a 46-year-old office manager on the first day after an open abdominal hysterectomy for large fibroids, done yesterday afternoon. She has no other medical problems. She has a patient-controlled analgesia pump with morphine, a urinary catheter, and a low horizontal incision with a dressing. The case gives three sets of observations on the day after surgery, reproduced in Table 1 so the columns can be read side by side.
Table 1
Observations on Postoperative Day 1
| Measure | 0800 | 1200 | 1600 |
|---|---|---|---|
| Blood pressure | 128/76 | 118/72 | 104/66 |
| Heart rate | 84 | 98 | 112 |
| Respiratory rate | 16 | 18 | 22 |
| Oxygen saturation (room air) | 97% | 97% | 96% |
| Temperature | 37.2 C | 37.3 C | 37.2 C |
| Urine output, previous 4 hours | 240 mL | 160 mL | 90 mL |
| Pain, 0 to 10, at rest | 4 | 4 | 5 |
| Morphine used, previous 4 hours | 6 mg | 5 mg | 6 mg |
| Dressing | Dry | Small spot, 2 cm | Dry spot unchanged |
Note. Urine output is the total for the 4 hours before each time. Morphine is the total patient-controlled dose for the same interval.
What Moved, How Far, and Over How Long
Four measures moved in the eight hours of the case, and they moved together. Her systolic blood pressure fell by 24 points, from 128 to 104, in two steps of about 10 and 14. Her heart rate rose by 28 beats a minute, from 84 to 112, in two steps of 14 each. Her respiratory rate rose by 6 breaths, from 16 to 22, most of it in the last four hours. Her urine output fell by nearly two thirds, from 240 milliliters in four hours, about 60 an hour, to 90 milliliters, about 22 an hour. By 1600 her output is below the 0.5 milliliters per kilogram per hour usually used as a floor for an adult of her weight, which the case gives as 70 kilograms.
Dividing each pulse by its systolic pressure gives a shock index that has moved from 0.66 at 0800 to 0.83 at 1200 and 1.08 at 1600. In the trauma studies reviewed by Olaussen et al. (2014), a value of 0.9 or above was the threshold proposed most often as a warning of major bleeding. Ms. D. crossed that line between the second and third columns. No single column told me that. At 1200, each value was within its printed range.
What Held Still, and What That Rules Out
Three things did not move, and they narrow what could be happening. Her temperature stayed between 37.2 and 37.3 degrees Celsius, which makes infection an unlikely explanation for the rising heart rate this early. Her oxygen saturation stayed at 96 to 97% on room air, and her lungs are not described as changed, which makes a clot in the lungs less likely to be driving the picture, although a rising breathing rate keeps it on the list. Her pain and her morphine use were steady, so the rising heart rate is not explained by uncontrolled pain, and falling blood pressure is not explained by a sudden increase in opioid. The dressing shows only a small unchanged spot, but bleeding after a hysterectomy can collect inside the abdomen or pelvis without appearing on the dressing at all.
What the Difference Between the Columns Means
Read as one movement, the three columns describe a woman whose body is compensating for a falling circulating volume. Her heart is beating faster to hold a blood pressure that is still falling, her kidneys are making less urine, and her breathing is speeding up. In a patient on the first day after major pelvic surgery with steady temperature and pain, the most likely explanation is bleeding, possibly into the abdomen, with dehydration from limited intake as a less likely alternative. The analysis does not decide between them; that is the surgical team's job, with a blood count and an examination. What the analysis does decide is that this is not a stable patient with mildly low urine output, which is what the 1600 column would suggest if it were read alone.
Brekke et al. (2019) found in their review that the research on vital sign trends in intermittently monitored ward patients is thin, but that the studies available suggested trends added value beyond single readings. This case is an example of why. Every single reading in Table 1 could be called acceptable by someone looking at one column. The pattern could not.
What Would Change This Reading
Two pieces of information would change the analysis. If the stat hemoglobin came back close to her preoperative 12.4, bleeding would become less likely and dehydration more likely; the case says she drank little overnight because of nausea and has had maintenance fluid at only 75 milliliters an hour. In that situation, a fluid bolus might restore her pressure, pulse and urine output within an hour, and the response itself would be informative. If instead the hemoglobin had fallen to 9 or below, the trend would read as blood loss, and the question would become how fast and from where.
A third possibility deserves mention even though the columns argue against it: a clot in the lungs can cause a fast heart rate and fast breathing after pelvic surgery. Her steady oxygen saturation and the absence of chest pain make it less likely, but if her breathing rate kept rising while her saturation began to fall, it would move up the list. Writing these alternatives down does not delay the phone call. It tells the resident what the nurse has already considered.
What the Nurse Does at 1600
1600: report to the charge nurse and the gynecology resident by phone, stating the trend, not the 1600 value alone: "Her pressure has gone from 128 to 104 since 0800, her heart rate from 84 to 112, and her urine from 60 an hour to about 22. Shock index is now above 1."
Request: that the resident see her within 15 minutes, and a stat hemoglobin, with the preoperative value of 12.4 grams per deciliter from the case for comparison.
While waiting: check her abdomen for new distension or tenderness, check the incision and under her back for blood, confirm her intravenous line is working, lower the head of the bed if she feels faint, and count vital signs every 15 minutes.
Stop: do not increase her analgesia or give a fluid bolus without an order, but ask for one when reporting.
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 2 instructions, in plain terms
For Week 2 you analyze a case with several sets of observations and explain what the changes mean. Expect the instructions to ask what changed, by how much and over what time, what stayed the same, what the pattern suggests, what else could explain it and what the nurse should do, in APA with sources. Read all the columns together instead of focusing on the latest. Give every moving value its size and duration. Use stable values to rule explanations out. Say what information would change your reading. Write as if you were there at each hour, without using the ending. Finish with a report that states the trend and a request with a time.
How this NR 325 Week 2 example is built
The analysis opens with Ms. D., her surgery yesterday afternoon and Table 1 with three columns of nine measures. A section measures movement: systolic down 24 in two steps, heart rate up 28, breathing up to 22 and urine down to 90 milliliters in four hours. The shock index moves from 0.66 to 1.08, set against Olaussen et al. (2014). A section uses steady temperature and saturation to make infection and a lung problem less likely. Another explains the combined meaning as compensation for falling volume, with Brekke et al. (2019). What would change the reading includes the hemoglobin and a clot in the lungs. The close scripts the 1600 call and request.
Reading the NR 325 Week 2 grading rubric
Case analysis rubrics in NR 325 typically reward identification of trends, accurate interpretation, consideration of alternative explanations, prioritized nursing actions and APA. Trend identification carries the most weight, so each moving value has a size and a time span. Interpretation scores when the combined pattern is explained rather than each value alone. Alternatives earn credit when stable values are used to rule them in or out and when the paper says what would change its reading. Nursing actions are graded on a report that states the trend and a request with a time limit. Evidence on shock index and vital sign trends supports the reasoning. Writing without hindsight shows sound judgment.
Common NR 325 Week 2 mistakes, and how to avoid them
Top of the list is an analysis that works only on the latest column. Close behind is describing all three columns and never saying what the difference means. Movement without size or duration, stable values ignored, an action with no reading behind it and a paper written from the ending all cost points. Interventions belong at the end, tied to the trend. Include only the history that explains the pattern. If your three sets barely differ, say so and explain what the stability means. Pass along the observation columns from your case, and an analysis reading them as one movement can be drafted.
Get a NR 325 Week 2 example written to your instructions
Send the Week 2 case as your section published it, the rubric, and any headings your instructor requires. We write a custom example against those three columns, or against whatever observations your own prompt supplies, and return it inside 24 to 48 hours. The first one is free. It arrives as a finished analysis to hold your own draft against.
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NR 325 Week 2 questions, answered
Where do the interventions belong in this document?
Beside the readings that prompted them. A plan collected at the foot of the paper separates every action from its reason and gives a marker no way of telling whether the writer acted on the twelve o'clock set or worked backwards from the four o'clock one. Putting each action under its own figure also makes the timing visible, which is most of what this week rewards.
How much of the patient's history belongs in it?
Only the parts that change how the columns are read. A medicine holding the pulse down matters enormously here, because it removes the rise you would otherwise expect to see, and a page of unrelated background matters not at all. In many sections the vignette is generous with history precisely to see what a writer leaves out of the analysis.
The three sets in my case barely differ. What then?
Then say so and prove it, which is a real finding rather than a failure of the case. Very little movement across a shift in somebody sick enough to be watched hourly is information, and the analysis can name what would have to change before the picture became worrying, and by how much. Classrooms build flat cases deliberately to see whether a writer manufactures direction.
Where can I find a free NR 325 Week 2 sample paper?
The whole Week 2 analysis of Ms. D.'s three columns of observations, with the shock index and the 1600 report, is reproduced further down this page.
What does the NR 325 Week 2 report ask for at 1600?
That the gynecology resident see Ms. D. within 15 minutes and that a stat hemoglobin be drawn for comparison with her preoperative value of 12.4 grams per deciliter.