| Course | NR 325 Adult Health II |
|---|---|
| Week | 7 |
| Paper type | Handover report with rationale |
| Length | About 1,200 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 7
Handover Report at 1900: New Atrial Fibrillation on a Diltiazem Infusion in a 71-Year-Old Retired Librarian, and the Echocardiogram Nobody Has Read Yet
Student Name
College of Nursing, Chamberlain University
NR 325: Adult Health II
Instructor Name
Month Day, Year
Handover Report at 1900: New Atrial Fibrillation on a Diltiazem Infusion in a 71-Year-Old Retired Librarian, and the Echocardiogram Nobody Has Read Yet
The Case Behind the Report
Mrs. A. is 71, a retired school librarian with type 2 diabetes and long-standing hypertension. She came to the emergency department at 0600 with palpitations and breathlessness on stairs and was found to be in new atrial fibrillation with a ventricular rate of 146. After a bolus of diltiazem she was started on an infusion at 10 mg an hour and admitted to the telemetry unit. I cared for her from 0700. At 1900 I hand her over to the night nurse, who has five other patients and will hear this report standing at the desk.
The case asks for the report as it would be spoken, and then for the reasoning behind what went in and what was left out. The report below is about 200 words and takes a little over a minute to say aloud. It is followed by the reasons for its order, which is the order of the I-PASS model: how sick the patient is, a short summary, the actions due, what could go wrong and what to do about it, and a read-back by the receiver. Starmer et al. (2014) introduced this structure across nine hospitals and counted 18.8 medical errors per 100 admissions afterward against 24.5 before, and 3.3 preventable adverse events per 100 against 4.7, while spoken handovers stayed about 2.5 minutes a patient. The structure did not make handover longer. It changed what was in it.
The Report as Spoken
"Mrs. A. in bed 12, 71, watcher status. New atrial fibrillation since this morning, rate 146 on arrival, now 96 to 104 on diltiazem at 10 mg an hour since 1400. Her pressure has come down with it, 128 over 74 at noon to 108 over 66 at 1800.
Background that matters tonight: diabetic on metformin, held; her home lisinopril was held at 1700 for a pressure of 104 and can be given if she is above 110 before 2200, otherwise hold and tell the provider.
Due: vitals every hour while the drip runs, next at 2000; glucose at 2100; first apixaban was given at 1800, next at 0600.
Outstanding: thyroid result not back, lab is running it; echocardiogram done at 1600, not yet read; magnesium 1.7, replacement ordered, not yet hung.
Come back if her rate is over 120 for ten minutes, her systolic is under 95, or her saturation drops below 92 or she says she is more breathless lying flat.
What I could not settle: her BNP is 610 and she has faint crackles at the bases. If the echo shows a weak heart, diltiazem may be the wrong drug, and the night provider needs to know that when the read comes back."
Why the Change Comes First, Once
The report opens with the change and does not return to it. The night nurse needs to know in the first ten seconds that this patient has a new rhythm, a drug running against it and a pressure falling with the rate. If the report had started at admission with the story of the palpitations and the emergency department, the change would have arrived at the end, after the listener's attention had gone to the patient in bed 14 whose call light was on. I gave the rate at three points, arrival, now and the time the infusion reached its present dose, and the pressure at two, because the fall in pressure is the part most likely to decide something tonight.
I also labeled her as a watcher, which is the illness-severity category in I-PASS between stable and unstable. It tells the receiving nurse where to put her in the order of first rounds without my having to argue for it.
Background Only Where It Alters Something
Mrs. A. has a long history: a cholecystectomy in her fifties, cataract surgery, knee pain, a sister with breast cancer. None of it changes the next twelve hours, so none of it is in the report. What stayed in are two facts that do. Her diabetes matters because she is fasting for a possible cardioversion tomorrow and her metformin was held, so the 2100 glucose is not routine. Her held lisinopril matters because it is a decision passed to the night nurse with a number attached. A held dose handed over with no release condition becomes a dose nobody gives and nobody records as held.
Due, Outstanding and the Numbers That Bring Someone Back
Every item due has a time. Every item outstanding has an owner or a state: the laboratory is running the thyroid test, the echocardiogram is done but unread, the magnesium is ordered but not hung. Those three are the items most likely to disappear at a change of staff, because each one is already in motion and belongs to no single person. Saying "not yet hung" is what makes the night nurse go and hang it.
The figures that should bring the night nurse back are given as numbers rather than adjectives. A rate over 120 for ten minutes means the infusion is no longer controlling the rhythm. A systolic under 95 means the drug that is slowing her heart is now lowering her pressure more than she can tolerate. Breathlessness when lying flat is included even though it is something she says rather than something a monitor shows, because in a woman with crackles and a raised BNP, it may be the first sign that her heart is failing under a drug that weakens its squeeze.
The Thing I Could Not Settle
The last line of the report is the most important one. The joint 2023 guideline on atrial fibrillation issued by the ACC, AHA, ACCP and HRS advises against diltiazem and verapamil for rate control in patients with a reduced ejection fraction, because these drugs weaken the heart's contraction (Joglar et al., 2024). Mrs. A. has not had heart failure diagnosed. She has, however, a BNP of 610, crackles at both bases and breathlessness on exertion, and her echocardiogram was done three hours ago and has not been read. If it shows an ejection fraction below 40%, the provider may change her to a different drug, and the time between the read and the change is time she spends on the wrong one.
I cannot settle that question and the night nurse cannot either. What the report can do is make sure the question arrives with the patient instead of being found at 0300 when her pressure falls. The last step of I-PASS is the receiver's synthesis, and I ask the night nurse to say back the three return figures and the echocardiogram question before I leave. If the numbers come back and the question does not, the report has not worked, and I say it again.
References
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., Gorenek, B., Hess, P. L., Hlatky, M., Hogan, G., Ibeh, C., Indik, J. H., Kido, K., Kusumoto, F., Link, M. S., . . . Van Wagoner, D. R. (2024). 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 149(1), e1-e156. https://doi.org/10.1161/CIR.0000000000001193
Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., Noble, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O'Toole, J. K., Solan, L. G., Aylor, M., . . . Landrigan, C. P. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803-1812. https://doi.org/10.1056/NEJMsa1405556
NR 325 Week 7 instructions, in plain terms
The Week 7 assignment asks for a shift handover report on a changing patient, written as it would be spoken, with a rationale for what was included and left out. Most sections name the handover tool to use, I-PASS or a similar structure, and want sources behind the rationale. Lead with the change, once, with its figures and time. Include background only where it alters the next shift. Give every task due a time and every outstanding item an owner or status. State the readings that should bring the receiver back as numbers. Name what you could not settle. Ask for a read-back. Keep the spoken report short enough to hold attention.
How this NR 325 Week 7 example is built
The paper briefly sets the case: Mrs. A. in new atrial fibrillation at 146, now 96 to 104 on diltiazem since 1400, with her pressure falling. The report is quoted as spoken: watcher status, the change and its figures, background on held metformin and lisinopril, items due with times, outstanding thyroid, echo and magnesium, return thresholds as numbers and the unsettled question. Rationale sections follow: why the change leads, using Starmer et al. (2014); why her long history was cut; why owners and times matter; and why the last line matters most, citing Joglar et al. (2024) on avoiding diltiazem with a weak heart. The read-back closes the loop.
NR 325 Week 7 rubric: what full points look like
Handover rubrics generally grade use of a structured format, prioritization of information, clarity and brevity, actionable content, safety concerns and the written rationale. The order of information decides much of the grade, so the change is stated first with its figures and not repeated. Actionable content earns credit when each item due has a time and each outstanding item a status. Safety scores when return thresholds are numbers and the unsettled echo question is named. Brevity is credited for a report that takes about a minute aloud. The rationale earns points when it defends each inclusion and omission with the format and guideline evidence. A read-back step shows the receiver's synthesis. A report that stays near a minute aloud shows the brevity the format asks for.
NR 325 Week 7 help: mistakes that cost points
What costs most is a report that starts at admission and reaches the change in its last sentence. Next is describing the change and handing over nothing to do. Items with no owner, a held dose with no release condition, the change repeated in three places, figures with no time and background longer than the next two hours need all cost points. Use the format your section names; I-PASS and SBAR both work. Aim for one to two minutes aloud. Include what you already did only where it affects what comes next. Tell us the patient's situation at shift change, and an NR 325 handover can be scripted around it.
Get a NR 325 Week 7 example written to your instructions
Send the Week 7 prompt with the handover form or structured format your classroom uses, and the case or observation record you were given. A custom example is written into that format and returned inside 24 to 48 hours, the first one free. Use it as a finished report to compare against your own rather than as anything to submit.
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 5: Variceal Bleed Concept Map
- NR 325 Week 6: Insulin Infusion Safety Analysis
- NR 325 Week 8: Deterioration Case Paper
- NR 326 Week 7: Therapeutic Milieu Brief
- NR 324 Week 7: Medication Management Case
- NR 327 Week 7: Concept Map
- NR 304 Week 7: Deterioration Risk Assessment Write-Up
NR 325 Week 7 questions, answered
Which handover format should the example use?
Whichever your section prints, and the choice matters less than what goes into the boxes. Every one of these formats can be completed accurately and still hand over nothing, if each field holds a summary instead of an instruction. Fill the fields with what the next two hours require and the format looks after itself.
How long should a handover report be?
Short enough to say aloud in about a minute, which is what these assignments test even when they are submitted in writing. Length is not really the measure, though. Ask instead whether anything in it would still be needed if the patient improved by lunchtime, and cut what would not. Most drafts run long because the history went in whole.
Does the report include what I have already done?
Only where the next person has to know it, and always with what it achieved. A dose given at two o'clock matters because of what the figure did afterward, not because it appears on the chart. Actions listed without their results turn a handover into an account of your shift, when the person taking over needs a direction instead.
Where can I find a free NR 325 Week 7 sample paper?
The complete Week 7 handover report on Mrs. A., spoken in about a minute, with the rationale for every inclusion and the unread echo, appears on this page.
Why is the unread echocardiogram the key line in the NR 325 Week 7 report?
If it shows a reduced ejection fraction, diltiazem may be the wrong drug, since the 2023 guideline advises against it in a weak heart, so the night team must know when the read arrives.