| Course | NR 325 Adult Health II |
|---|---|
| Week | 6 |
| Paper type | Treatment safety analysis |
| Length | About 1,320 words, 7 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 325 Week 6
Treatment Safety Analysis: A Continuous Insulin Infusion for Diabetic Ketoacidosis in a 38-Year-Old Bus Driver, Before, During and When It Stops
Student Name
College of Nursing, Chamberlain University
NR 325: Adult Health II
Instructor Name
Month Day, Year
Treatment Safety Analysis: A Continuous Insulin Infusion for Diabetic Ketoacidosis in a 38-Year-Old Bus Driver, Before, During and When It Stops
The Therapy and the Question
Mr. J. is 38, a city bus driver with type 1 diabetes since age 15. He stopped taking his long-acting insulin three days ago when a stomach virus left him unable to eat, reasoning that no food meant no insulin. He arrived with a glucose of 486 mg/dL, a venous pH of 7.18, a bicarbonate of 11 mmol/L, a potassium of 4.6 mmol/L, and ketones in his blood. He weighs 82 kilograms. After a liter of saline in the emergency department he was started on a regular insulin infusion at 0.1 units per kilogram an hour, 8.2 units an hour, and moved to the step-down unit.
Nobody doubts that the infusion works. Insulin will bring his glucose down and switch off the ketone production that is making his blood acidic. The question this analysis answers is the second one: what the infusion itself can do to Mr. J. while it runs, what the nurse checks and how often, and which readings hold or stop it. Umpierrez et al. (2024), in the current consensus report on hyperglycemic crises in adults, list low blood glucose and low potassium among the most frequent complications of treatment, which means the two most likely harms in this case are caused by the therapy rather than the illness. The analysis is ordered by time, because that is the order in which the checks happen at the bedside.
Before the Infusion Starts
Three things are checked before the first unit runs, and each one has a value that permits the start and a value that holds it. The first is potassium. Insulin drives potassium from the blood into the cells, and a man who has been vomiting and passing large amounts of glucose-heavy urine for three days has lost potassium from his body even when his blood level looks normal, because acidosis pushes potassium out of the cells. The unit protocol in the case holds insulin if the potassium is below 3.5 mmol/L and replaces it first. At 4.6, Mr. J. may start, and the protocol adds 20 mEq of potassium to each liter of maintenance fluid while his level stays between 3.5 and 5.0.
The second check is urine. Potassium is not added to fluids for a patient who is not making urine, because the kidneys are the only way it leaves. Mr. J. passed 400 mL in the emergency department, which permits the potassium. The third check is the line itself. The insulin runs on a dedicated pump channel, the tubing is primed and flushed with the insulin solution because insulin binds to new plastic and the first milliliters would otherwise carry less than ordered, and a second nurse independently checks the concentration, the rate in units an hour and the rate in milliliters an hour. Intravenous insulin is on the list of high-alert medications for acute care (Institute for Safe Medication Practices [ISMP], 2024), and the double check is where a decimal error is caught before it reaches the patient rather than after.
While It Runs: What Is Watched, and How Often
Monitoring written without an interval says nothing, so Table 1 gives each check with its frequency and the reason for it.
Table 1
Monitoring During the Insulin Infusion
| What is checked | How often | Why at that interval |
|---|---|---|
| Capillary glucose | Every hour | The rate is adjusted hourly by the protocol, and glucose can fall 50 to 75 mg/dL in an hour |
| Potassium | Every 2 hours for the first 6 hours, then every 4 hours | The steepest fall comes early, as insulin and fluid take effect together |
| Venous pH, bicarbonate and ketones | Every 4 hours | These decide when the ketoacidosis has resolved, which glucose alone cannot show |
| Heart rhythm | Continuous | Low potassium shows first as flattened T waves and extra beats |
| Neurological check and symptoms | Every hour with the glucose | Sweating, shaking or confusion may precede the next meter reading |
| Intake and output | Every hour | Urine permits the potassium; falling output changes the fluid plan |
Note. Frequencies are those set in the unit protocol given in the case.
The most important moment during the infusion is not a low reading but a falling one. The protocol adds 5% dextrose to the fluids when glucose falls below 250 mg/dL and keeps the insulin running, because the goal is to clear the ketones, not to reach a normal glucose. A nurse who sees 240 mg/dL and simply lowers or stops the insulin has corrected the number and left the acidosis in place. The case gives the fourth hourly reading as 252, so the dextrose bag should be in the room before the fifth.
The earliest sign of harm is often something Mr. J. says rather than something the monitor shows. Low glucose may begin as hunger, a racing heart, sweating, or a feeling he may describe as being shaky; low potassium may begin as weakness in his legs or cramping. He should be told on arrival that these sensations matter and that he should press the call light rather than wait for the next check. He has managed his own diabetes for 23 years and will often recognize low glucose before the meter does.
When the Infusion Stops, and What Stops It
Some readings stop the infusion at once. A glucose below 70 mg/dL stops it, and the nurse gives dextrose by the route and dose the protocol names, rechecks glucose in 15 minutes, and calls the provider. A potassium below 3.5 mmol/L holds the insulin while potassium is replaced, because continuing would push the level lower. New ventricular extra beats or a run of rhythm change with a low potassium is a reason to call the rapid response team, not simply the provider. In each case, the reversal is not an antidote kept in a pharmacy but the dextrose bag and the potassium on the unit, which is why the analysis names where each is kept: 50% dextrose in the unit's hypoglycemia kit in the medication room, and premixed potassium chloride in the automated dispensing cabinet under the provider's order.
The planned stop carries its own hazard. When his pH and bicarbonate recover and he can eat, the infusion is replaced by injected long-acting insulin. Because intravenous insulin works for only minutes after it stops, the long-acting dose is given one to two hours before the drip is turned off. If the drip is stopped first, ketones can start to rise again within hours. The nurse's role is to confirm the time of the injection and write it on the handover before touching the pump.
What the Nurse Says First
When a stop condition occurs, the first ten words are the ones the provider acts on. For a low glucose: "Mr. J.'s glucose is 64 on the insulin drip; I've stopped it and given dextrose." For a low potassium: "Mr. J.'s potassium is 3.2 at the 0600 draw; I've held his insulin and need a replacement order." Each sentence gives the number, the therapy, and what has already been done, so the call is about what happens next.
Two limits apply to this analysis. It does not choose the insulin rate or the potassium dose; those belong to the protocol and the provider. And it treats Mr. J. as a first episode with no kidney disease. If his creatinine had been high, the potassium plan would change and the analysis would have to be rewritten, which is the point of doing it for one patient rather than for a class of drugs.
References
Institute for Safe Medication Practices. (2024). ISMP list of high-alert medications in acute care settings. https://www.ismp.org/recommendations/high-alert-medications-acute-list
Umpierrez, G. E., Davis, G. M., ElSayed, N. A., Fadini, G. P., Galindo, R. J., Hirsch, I. B., Klonoff, D. C., McCoy, R. G., Misra, S., Gabbay, R. A., Bannuru, R. R., & Dhatariya, K. K. (2024). Hyperglycemic crises in adults with diabetes: A consensus report. Diabetes Care, 47(8), 1257-1275. https://doi.org/10.2337/dci24-0032
NR 325 Week 6 instructions, in plain terms
For Week 6 you analyze the safety of a high-risk treatment for a specific patient. Expect the instructions to ask what must be checked before it starts, what is monitored while it runs and how often, which readings stop it, what reverses it and how the nurse communicates problems, in APA with sources. Focus on what the treatment can do to the patient, not on how it works. Give every pre-start check a value that permits and a value that holds. Give monitoring a frequency and a reason. Write stop conditions as figures, name the reversal and where it is kept, and include the transition off the treatment. Leave dose decisions to the protocol and provider.
How the NR 325 Week 6 example is put together
The analysis opens with Mr. J., who stopped his long-acting insulin during a stomach virus, and states its question: what the infusion can do to him. Three pre-start checks follow: potassium, urine output and glucose, each with values that allow or hold. Table 1 lists monitoring with frequencies and reasons, from hourly glucose to potassium every 2 hours. A section explains adding dextrose below 250 while insulin continues, citing Umpierrez et al. (2024), and lists what he might report first. Stop conditions are figures, with dextrose for glucose below 70. The transition overlaps long-acting insulin by one to two hours. Scripted first sentences to the provider and ISMP's high-alert list close it.
Where the points sit in the NR 325 Week 6 rubric
Treatment safety rubrics usually grade pre-treatment assessment, monitoring with frequencies, recognition of hazards and early signs, stop conditions and reversal, communication and APA. Monitoring and stop conditions carry the most points, so each has a figure and an interval. Pre-start checks earn credit when each carries permitting and holding values. Hazard recognition scores when the patient's own report is named as an early sign. The dextrose step is credited because it is the decision students most often miss. The transition off the drip earns points as a hazard in its own right. Scripted communication and a consensus source support the analysis. Leaving doses to the provider respects scope.
NR 325 Week 6 help from the desk
The heaviest loss is explaining how the treatment works and never saying what it costs. Right behind is monitoring with no interval. Hazards with no early sign, stop conditions as adjectives when figures were given, a reversal agent with no location or authorization, the patient's own report ignored and a paper that starts prescribing all cost points. Keep mechanism to what explains a hazard. If your case gives no dose, work from the protocol's structure. Recommending a different treatment moves outside the question. Send the treatment and case you were given, and an NR 325 safety analysis can be built around before, during and after.
Get a NR 325 Week 6 example written to your instructions
Send the Week 6 prompt as your classroom posted it, the rubric, and the therapy and patient your section assigned. A custom example is written to those, with the checks, the intervals and the stop conditions carried through, and returned inside 24 to 48 hours. The first one is free, and it is written to be read beside your own draft.
More NR 325 papers and pre-licensure samples
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NR 325 Week 6 questions, answered
Does this week want the mechanism of the drug?
A little, and placed where it does some work. One clause explaining why a therapy that thins the blood makes a fall dangerous justifies the whole monitoring section. A page on receptor binding earns nothing here, because the assignment measures whether you know what to check, how often, and what result would make you stop, none of which the mechanism settles on its own.
What if my case gives no dose or rate?
Write the checks in terms of the parameter instead. Say which value you would want before starting, what would be measured while it ran and how often, and what result would hold the next dose. Sections often supply a therapy without figures precisely to see whether a writer can name the decision points without a number handed to them.
Can the analysis recommend a different treatment?
That is somebody else's decision and the prompt usually says so. Your position here is the person who checks beforehand, watches while it runs and reports what changes, and that is a great deal of judgment without ever choosing the therapy. Where a prompt does invite an alternative, keep it to a line and finish the safety work before you get there.
Where can I find a free NR 325 Week 6 sample paper?
The full Week 6 safety analysis of Mr. J.'s insulin infusion, with pre-start checks, the monitoring table and the stop conditions, is published on this page.
Why is dextrose added without stopping insulin in the NR 325 Week 6 example?
Below 250 mg/dL the goal is still to clear the ketones and resolve the acidosis, so dextrose protects against low glucose while the insulin keeps running.