| Course | NR 325 Adult Health II |
|---|---|
| Week | 3 |
| Paper type | Laboratory trend write-up |
| Length | About 1,110 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 325 Week 3
Laboratory Trend Write-Up: Six Mornings of Creatinine and Potassium in a 67-Year-Old Man on Vancomycin and Piperacillin-Tazobactam
Student Name
College of Nursing, Chamberlain University
NR 325: Adult Health II
Instructor Name
Month Day, Year
Laboratory Trend Write-Up: Six Mornings of Creatinine and Potassium in a 67-Year-Old Man on Vancomycin and Piperacillin-Tazobactam
The Patient and the Tests Followed
Mr. H. is a 67-year-old retired electrician admitted with pneumonia that developed after a week in a rehabilitation facility following a knee replacement. He has been on intravenous vancomycin and piperacillin-tazobactam since admission. His creatinine before admission, from a clinic visit last month, was 0.9 milligrams per deciliter. He weighs 82 kilograms. His fever resolved on day 3, and his breathing is better. This write-up follows two tests, creatinine and potassium, over six mornings. His other results, the white cell count, sodium and glucose, were stable across the same days and are noted once, at the end, rather than reported daily. Every value below was drawn at 0500 unless stated.
Table 1
Creatinine, Potassium and Urine Output Over Six Days
| Day | Creatinine (mg/dL) | Change from previous | Potassium (mmol/L) | Urine output, previous 24 hours |
|---|---|---|---|---|
| 1 | 0.9 | 4.1 | 1,650 mL | |
| 2 | 0.9 | 0.0 | 4.3 | 1,500 mL |
| 3 | 1.0 | +0.1 | 4.4 | 1,400 mL |
| 4 (drawn at 1400) | 1.2 | +0.2 | 4.7 | 1,200 mL |
| 5 | 1.5 | +0.3 | 5.0 | 950 mL |
| 6 | 1.9 | +0.4 | 5.3 | 780 mL |
Note. Day 4 was drawn in the afternoon because the morning sample hemolyzed; it was nine hours later than the others.
The Shape of the Creatinine
No single day in Table 1 would have prompted a phone call. A creatinine of 1.2 on day 4 is inside many laboratories' printed range for men, and 1.5 on day 5 is only slightly above it. Read as a series, though, the creatinine is not just rising, it is rising faster. The steps have been 0.1, then 0.2, then 0.3, then 0.4, each larger than the one before. If the next step is 0.5, the creatinine would be 2.4 on day 7, more than two and a half times his baseline. The shape is an accelerating curve, not a line.
The standard definition of acute kidney injury uses exactly this kind of change rather than a single threshold. The Kidney Disease: Improving Global Outcomes criteria define it as a rise of 0.3 milligrams per deciliter or more within 48 hours, or a rise to 1.5 times baseline or more within seven days, and stage it by how far the creatinine has risen (Kellum & Lameire, 2013). Mr. H. met the first criterion by day 5, when his creatinine had risen by 0.5 since day 3. By day 6 it was 2.1 times his clinic baseline, which places him in stage 2. On the printed reference range, he had been flagged as high only once, on day 6.
The Potassium Moving With It
His potassium has risen every day, from 4.1 to 5.3, in steps of 0.2 to 0.3 until the last two days, when they were 0.3 each. It is now above the upper limit of normal for the first time. The kidneys excrete most of the body's potassium, so a potassium that rises in step with creatinine is expected. The rate matters: at 0.3 a day, it would reach 5.6 on day 7 and 5.9 on day 8, the range at which heart rhythm changes become a concern. He is not taking a potassium supplement or a medicine known to raise potassium, which makes the kidney trend the most likely explanation.
Urine Output Confirms the Direction
His urine output over 24 hours fell from 1,650 milliliters on day 1 to 780 on day 6, about 0.4 milliliters per kilogram per hour. The fall began before the creatinine was flagged, on day 4, and has been steady. Together, rising creatinine, rising potassium and falling urine output describe kidneys that are doing less each day.
The Time of Day Caveat
The day 4 sample was drawn at 1400, nine hours later than the others, because the morning sample hemolyzed. Hemolysis would have falsely raised the potassium, which is why it was repeated. A later draw on the same day would not change the creatinine trend meaningfully, but it is noted so that anyone comparing the day 4 value is aware it came from a different time.
What the Trend Points To
The most likely cause, given what changed on admission, is the antibiotic combination. Luther et al. (2018) pooled studies of adults receiving vancomycin with piperacillin-tazobactam and found acute kidney injury in 22.2% of them, against 12.9% with comparator regimens, with higher odds than vancomycin alone or vancomycin with cefepime or a carbapenem. Other contributors cannot be excluded: contrast for a CT scan on day 2, and his fluid intake falling as he felt better and drank less. The write-up does not decide the cause. It reports that the trend began on day 3, has accelerated since, and now meets a formal definition of kidney injury.
What Was Done With It
Day 5, 0800: the student and primary nurse reported the day 3 to day 5 rise of 0.5 to the team, with the urine output trend, before rounds.
Day 5: the team requested a vancomycin level and pharmacy review of dosing; the level came back high, and the dose was held.
Day 6: the team changed piperacillin-tazobactam to cefepime, started strict intake and output, and ordered repeat creatinine and potassium in the evening as well as the morning.
Other results, stable across all six days: white cell count falling from 14.2 to 9.8; sodium 137 to 139; glucose 110 to 150.
Why Six Correct Readings Were Not Enough
On each of the first five mornings, a nurse looking at that day's result alone would have been right to call it unremarkable. The electronic record flagged nothing until day 6, because the flag is set by the printed range, not by the person's own baseline or by the direction of travel. The one number that made the trend visible early was the clinic creatinine of 0.9 from the month before admission, which is easy to overlook because it sits in a different part of the record. Putting it at the top of the series, and writing the change from the previous day next to every value, is what turned six readings into a finding. The practical lesson is small: when a patient starts a drug combination known to affect the kidneys, write the baseline and the daily difference on the handoff sheet, so that the second rise of 0.2 is noticed as a second rise and not as a first value of 1.2.
References
Kellum, J. A., & Lameire, N. (2013). Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1). Critical Care, 17(1), Article 204. https://doi.org/10.1186/cc11454
Luther, M. K., Timbrook, T. T., Caffrey, A. R., Dosa, D., Lodise, T. P., & LaPlante, K. L. (2018). Vancomycin plus piperacillin-tazobactam and acute kidney injury in adults: A systematic review and meta-analysis. Critical Care Medicine, 46(1), 12-20. https://doi.org/10.1097/CCM.0000000000002769
The Chamberlain NR 325 Week 3 instructions
Week 3 gives you laboratory values from several days to analyze and explain what the trend means for nursing care. Expect the instructions to ask for the values in a table, the direction and size of change, related findings, the likely cause and nursing actions, with sources. Write in differences: how far each step moved and whether steps are growing. Hold each value against what this person ran before admission as well as the printed range. Note the time each sample was drawn and anything that could distort it. Use related findings, such as urine output, to confirm direction. End with what the next value is expected to be and what was done about it.
How the NR 325 Week 3 example is put together
The write-up opens with Mr. H., his pneumonia after rehabilitation and his clinic creatinine of 0.9. Table 1 lists six days of creatinine, change from the previous day, potassium and urine output, with a note on the hemolyzed sample. A section describes the creatinine's shape: steps growing from 0.1 to 0.4, crossing the KDIGO definition from Kellum and Lameire (2013). Potassium rises alongside, and urine output confirms the direction. The time-of-day caveat explains the day 4 draw. The likely cause is weighed with Luther et al. (2018). Actions are listed by day, from the report on day 5 to the antibiotic change on day 6. The close explains why no flag fired until day 6.
Reading the NR 325 Week 3 grading rubric
Lab trend rubrics usually reward accurate presentation of data, interpretation of direction and rate, comparison with baseline and standard definitions, related findings, nursing actions and APA. Interpretation of rate carries the most points, so the write-up measures each step and notes that the steps are growing. Baseline comparison earns credit when the clinic value anchors the series. Standard definitions score when the KDIGO criteria are applied correctly. Related findings, such as urine output, are credited for confirming direction. Noting the timing and hemolysis issue shows attention to sample quality. Nursing actions are graded on timing and specificity, such as reporting before rounds.
Common NR 325 Week 3 mistakes, and how to avoid them
The most expensive write-up interprets each day separately and never says what the week did. A series with no size attached to its steps leaves direction meaningless. Results compared without noting the hour drawn, a value called alarming only because it crossed a printed limit, tiny changes treated as real when they sit within normal variation and an ending on the last figure instead of the expected next one all cost points. Reference ranges help but do not replace the baseline. If a series moves both ways, describe each segment. A graph can work if your section allows it, with the numbers available. Share your results table, and an NR 325 trend write-up can be drafted in differences.
Get a NR 325 Week 3 example written to your instructions
Send the Week 3 results exactly as your classroom published them, with the reference ranges printed on the form and whatever patient details came attached. A custom write-up is built on your own series, day by day, and returned inside 24 to 48 hours, the first one free. It comes back as a finished document to set beside the draft you are working on.
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NR 325 Week 3 questions, answered
Do I need reference ranges for every result?
Use whichever your classroom prints beside the figures, and put them in once rather than repeating them under each day. Ranges matter less here than they do in a single panel, because the argument runs between one day and the next in the same person. A result traveling steadily downward inside its range still needs the passage that says so.
What if the series moves in both directions?
Then the write-up says where it turned and what was happening around that day. A figure that fell for three days and then rose makes a more interesting document than one that fell for six, provided the turn is dated and something is offered for it: a transfusion, a bag of fluid, a medicine started or held. Smoothing the turn away is what loses marks.
Can I use a graph instead of a table?
Where the instructions allow one, a plotted series often reads better than a table and some sections ask for both. What the picture cannot do is the arguing, so the prose still has to name the steps, the turn and the day the writer would have reported it. A graph with no passage under it is treated as an illustration rather than an answer.
Where can I find a free NR 325 Week 3 sample paper?
The full Week 3 trend write-up on Mr. H.'s creatinine and potassium over six mornings, with the KDIGO comparison and the actions taken, is printed on this page.
Why was no flag raised until day 6 in the NR 325 Week 3 example?
The electronic record flags results by the printed range, not by the person's own baseline, so creatinine of 1.2 and 1.5 looked unremarkable alone even though it had risen from 0.9.