| Course | NR 325 Adult Health II |
|---|---|
| Week | 5 |
| Paper type | Concept map with narrative |
| Length | About 1,500 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 325 Week 5
Concept Map: The Bleed and the Treatment in a 56-Year-Old Man With Cirrhosis After Variceal Banding, Drawn as Two Chains That Meet
Student Name
College of Nursing, Chamberlain University
NR 325: Adult Health II
Instructor Name
Month Day, Year
Concept Map: The Bleed and the Treatment in a 56-Year-Old Man With Cirrhosis After Variceal Banding, Drawn as Two Chains That Meet
The Patient and the Two Heads
Mr. R. is 56, a warehouse supervisor with cirrhosis from alcohol, graded Child-Pugh class B at his last clinic visit. He came to the emergency department at 2200 after vomiting bright red blood twice at home. On arrival his blood pressure was 96/58, his pulse 118, and his hemoglobin 7.4 g/dL against 11.0 three months ago. He was started on an octreotide infusion and intravenous ceftriaxone, given one unit of packed red cells, and had two varices banded at endoscopy at 0300. He arrived on the medical unit at 0500 with the octreotide running at 50 micrograms an hour, lactulose ordered three times a day, and a hemoglobin target of 7 to 8 g/dL written in the orders.
Before drawing anything else I fixed the two heads of the map. The first head is the illness: pressure in the portal vein high enough to open and then rupture a varix in the esophagus. The second head is the therapy given against it, which is not one thing but four: octreotide to lower blood flow into the portal system, a restrictive transfusion target, lactulose to clear the protein load of swallowed blood, and a prophylactic antibiotic. Fixing both heads first kept the map from becoming a drawing of cirrhosis with a treatment box pinned to the bottom. It also forced a question I would otherwise have skipped: what does each of these four treatments do to this man besides the thing it was ordered for?
Chain One: The Bleed, Carried Down to the Chart
Every box on the illness chain holds a change with a direction, and every line ends at something a nurse writes down. Table 1 shows the chain as it appears on the map, read from left to right.
Table 1
The Illness Chain, From Portal Pressure to the Observation Chart
| Starting change | What follows in the body | Where it reaches the chart |
|---|---|---|
| Portal pressure stays high after banding | A banded varix or a new one bleeds again | Fresh hematemesis; tarry stool; hemoglobin falling |
| Circulating volume falls | Heart rate rises, then blood pressure falls, kidneys conserve water | Pulse above 100; systolic below 100; urine below 30 mL an hour |
| Blood sits in the gut | Digested protein raises ammonia the scarred liver cannot clear | Day-night reversal; slowed answers; flapping tremor of the outstretched hands |
| Bleeding cirrhosis weakens defenses | Gut bacteria cross into the blood or the abdominal fluid | Temperature rising; new abdominal tenderness; confusion that worsens |
Note. Each row is one line on the map. The right-hand column is the lowest box of that line.
Chain Two: Each Treatment and What It Costs This Patient
The therapy chain is built the same way, and it is the half of the map a first draft usually leaves out. Octreotide constricts the blood vessels that feed the portal system, which is its purpose, but it also raises blood glucose and can slow the heart. Mr. R. is not diabetic, but his glucose on arrival was 168 mg/dL, so the map carries a line from octreotide to a rising glucose and a second line to a pulse that falls faster than his volume status would explain.
The transfusion target carries its own line. Villanueva et al. (2013) randomized 921 patients with acute upper gastrointestinal bleeding to transfusion at a hemoglobin below 7 or below 9 g/dL. Six-week survival was higher with the restrictive strategy (95% against 91%), further bleeding was less common (10% against 16%), and in the patients with cirrhosis the pressure gradient across the liver rose in the first five days only in the liberal group. On the map, the line from transfusion therefore runs in two directions: too little blood and the illness chain continues, too much and portal pressure rises toward another bleed. A third line runs from each unit of blood to the lungs, because a man whose kidneys are already holding salt can be overloaded by volume given quickly.
Lactulose produces two to three soft stools a day when it is working and many more when it is not. The map carries a line from lactulose to fluid loss and a falling potassium, and from there to a pulse that rises and a patient who becomes more confused, since low potassium itself worsens encephalopathy. Ceftriaxone carries a short line to diarrhea and a longer one to allergy, which his record does not show but which I still placed as a box with nothing below it but the first dose time. De Franchis et al. (2022) recommend both the antibiotic and the vasoactive drug in acute variceal bleeding, which is why neither can simply be stopped when its side effect appears; the map has to show the nurse what to report, not what to discontinue.
Where the Chains Join, and What Tells Them Apart
Three findings sit on both chains, and I drew them last. Each join carries a label saying what would tell the two causes apart, because a shared finding with no label only records confusion. Table 2 sets them out.
Table 2
The Joins Between the Illness Chain and the Therapy Chain
| Shared finding | From the illness | From the therapy | What tells them apart |
|---|---|---|---|
| Loose dark stools | Rebleeding: black, tarry, sticky, with a strong smell | Lactulose: brown or green, watery, expected two to three a day | Color and consistency; hemoglobin; pulse and blood pressure over the same hours |
| A heart rate that is not rising | Volume holding steady after banding | Octreotide slowing the heart and hiding a rise | Urine output and blood pressure; a pulse can be falsely calm, urine cannot |
| Faster breathing, lower saturation | Blood aspirated during vomiting or endoscopy | Too much volume from transfusion | Timing within hours of a unit; crackles at both bases; blood pressure rising rather than falling |
Note. A join is drawn as a line between the two chains with the right-hand column written on it.
The second join is the one I would not have seen without drawing the therapy chain. On paper, a steady pulse of 92 overnight reads as reassurance. On a map that includes octreotide, the same pulse reads as a finding with two possible causes, one of them reassuring and one of them the drug. The label on the join sends the reader to the urine bag and the blood pressure, which octreotide does not disguise in the same way.
The Bottom Row: A Reading and a Word
The bottom row of the map is different from the rest. Every box holds a reading and one of three words: hold, stop or tell.
Tell: pulse above 110, systolic pressure below 90, or urine below 30 mL an hour for two hours; any fresh blood in vomit; a black, tarry stool.
Tell: hemoglobin below 7 g/dL on the 6-hourly count, and ask whether a unit is ordered.
Hold and tell: a second unit of blood when the last hemoglobin is already 8 or above, because the order sets a target, not a number of units.
Stop and tell: a transfusion running when breathing rises above 24 or saturation falls below 92%, with new crackles.
Hold and tell: the next lactulose dose after more than four stools in 24 hours, or a potassium below 3.5 mmol/L.
Tell: a glucose above 200 mg/dL, or a pulse below 55 on octreotide.
Tell: a temperature of 38 C or above, or confusion that is worse than at the last check.
Why the Map Is Drawn as Two Chains
My first draft had one head, cirrhosis, and it spread in every direction: jaundice, ascites, clotting, encephalopathy, varices. It was accurate and it would have been the same map for any patient with cirrhosis. It also had no octreotide, no blood and no lactulose in it, which meant nothing on it would have helped the nurse caring for Mr. R. at 0500. Starting again from two heads left out most of what I know about cirrhosis and kept only what could change in the next 48 hours.
The map also has limits worth saying. It does not decide whether confusion on the second day is encephalopathy or alcohol withdrawal, which is a third chain belonging to a separate head; I marked it as a box off to the side with an arrow to the timing of his last drink. And it does not tell anyone how to adjust the octreotide or the transfusion, which are the provider's decisions. What it does is make sure that each treatment arrives on the page with its cost attached, so the nurse knows which readings to bring to the provider and in what words.
References
de Franchis, R., Bosch, J., Garcia-Tsao, G., Reiberger, T., Ripoll, C., Abraldes, J. G., Albillos, A., Baiges, A., Bajaj, J., Bañares, R., Barrufet, M., Benajiba, L., Berzigotti, A., Bureau, C., Calvaruso, V., Cardenas, A., D'Amico, G., De Gottardi, A., Dell'Era, A., . . . Yoshiji, H. (2022). Baveno VII: Renewing consensus in portal hypertension. Journal of Hepatology, 76(4), 959-974. https://doi.org/10.1016/j.jhep.2021.12.022
Villanueva, C., Colomo, A., Bosch, A., Concepción, M., Hernandez-Gea, V., Aracil, C., Graupera, I., Poca, M., Alvarez-Urturi, C., Gordillo, J., Guarner-Argente, C., Santaló, M., Muñiz, E., & Guarner, C. (2013). Transfusion strategies for acute upper gastrointestinal bleeding. New England Journal of Medicine, 368(1), 11-21. https://doi.org/10.1056/NEJMoa1211801
The Chamberlain NR 325 Week 5 instructions
For Week 5 you map both a patient's condition and the treatment given for it, then explain the map in writing. The prompt usually lists the pathophysiology, the therapies, their effects and hazards, nursing assessments and links between them, with sources. Draw the treatment as its own chain, not just the illness. For each therapy, include its intended effect and the harm it can bring this patient, with the earliest sign of that harm. Where a finding could come from either chain, draw the join and label what tells the causes apart. End the map at the observation chart with figures and actions. Keep the page readable.
How the NR 325 Week 5 example is put together
The paper opens with Mr. R., Child-Pugh class B, vomiting blood at 2200, and fixes two heads: portal pressure rupturing a varix and the four parts of therapy. Table 1 shows the illness chain from portal pressure to fresh hematemesis, falling volume and the chart. The therapy chain follows octreotide, transfusion argued from Villanueva et al. (2013) and lactulose, each with its harm. Table 2 sets out three joins, such as loose dark stools from rebleeding or lactulose, with what tells them apart. A bottom row lists readings with hold, stop or tell. The closing section explains the single-head first draft and names confusion as a third chain beyond scope, citing de Franchis et al. (2022).
Where the points sit in the NR 325 Week 5 rubric
Concept map rubrics in this course commonly reward complete and accurate pathophysiology, inclusion of therapies and their hazards, meaningful links, clinical findings at the chart, a written rationale and readability. Inclusion of the therapy chain carries particular weight, since it is the half most maps leave out. Links earn credit when every line has a direction and ends in something recorded. Joins between chains score when they are labeled with what distinguishes the causes. The bottom row is credited for turning hazards into figures with action words. Evidence from a transfusion trial and the Baveno consensus supports specific choices. Admitting what the map leaves out keeps nursing scope honest.
NR 325 Week 5 help: mistakes that cost points
Most lost marks sit in a map that stops at the illness and contains no therapy. Next is a therapy box linked only to its purpose, with nothing about the harm it brings this patient. Hazards with no earliest sign, shared findings drawn twice with no join, boxes holding subject headings, a bottom row of vague instructions and a page too crowded to follow all cost points. Two or three hazards per therapy is usually enough. When a finding could come from either chain, label the join. Most sections want a written piece with the map. Bring the patient's condition and treatments, and an NR 325 map with both chains can be drafted.
Get a NR 325 Week 5 example written to your instructions
Send the mapping prompt from your classroom, the rubric, the case, and whatever software or file format your instructor requires. We build a custom map with both chains carried down and the joins argued, plus the written piece where your section asks for one, and it comes back inside 24 to 48 hours. The first one is free.
More NR 325 papers and pre-licensure samples
- NR 325 Week 1: Vital Sign Trend Discussion Post
- NR 325 Week 2: Postoperative Trend Case Analysis
- NR 325 Week 3: Lab Trend Write-Up
- NR 325 Week 4: Heart Failure Case Response
- NR 325 Week 6: Treatment Safety Analysis
- NR 325 Week 7: Handover Report
- NR 325 Week 8: Deterioration Case Paper
- NR 326 Week 5: Risk Assessment Write-up
- NR 324 Week 5: Home PICC Antibiotic Teaching Plan
- NR 327 Week 5: Postpartum Assessment Write-up
- NR 304 Week 5: Older Adult Findings Ranking Case
NR 325 Week 5 questions, answered
How many hazards should the therapy chain carry?
Three or four worked through to a recordable finding beat a dozen named. The marks are in the descent rather than in the list, so a hazard earns its place by carrying what it would do, what would show first, and what figure would stop the treatment. Anything you cannot take that far is decoration, and markers tend to read a crowded page as a hedge.
What if the same finding could come from either chain?
That is the part of the map worth most, so draw the join and label it. A falling count can belong to the illness or to the drug given for it, and the label says what else would be true in each case. Maps that quietly hand every finding to whichever chain the writer understood better give away the reasoning this week was set to test.
Does the map need a written piece with it?
Most sections ask for something short alongside, and the useful thing to spend it on is the joins rather than the chains. A descent from a therapy to its hazard is visible in the drawing, while the reason two findings can be told apart is not, and that is the argument a marker cannot check from a diagram on its own.
Where can I find a free NR 325 Week 5 sample paper?
The complete Week 5 two-chain concept map for Mr. R.'s variceal bleed, with the joins table and the bottom row of hold, stop and tell readings, is shown on this page.
How does the NR 325 Week 5 map tell rebleeding from lactulose?
By stool color and consistency, black and tarry against brown or green and watery, together with the hemoglobin and the trend in pulse and blood pressure.