| Course | NR 328 Pediatric Nursing |
|---|---|
| Week | 5 |
| Paper type | Respiratory case response |
| Length | About 1,090 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 328 Week 5
Respiratory Case Response: A Wheezing 2-Year-Old Whose Saturation Held at 94% While Her Chest Did the Work
Student Name
College of Nursing, Chamberlain University
NR 328: Pediatric Nursing
Instructor Name
Month Day, Year
Respiratory Case Response: A Wheezing 2-Year-Old Whose Saturation Held at 94% While Her Chest Did the Work
Part 1, 1900: On Arrival to the Unit
Sofia is 25 months old, admitted from the emergency department with her second episode of wheezing with a cold; details have been changed. She had three albuterol treatments and a dose of oral steroid there. Her mother says she has been coughing for two days and "breathing fast since lunchtime," and that she drank half a cup of milk this afternoon, much less than usual.
Effort, as seen. Sofia is sitting upright on her mother's lap, leaning forward with both hands on her mother's knees. Her nostrils flare with each breath. The skin between her ribs and just below her breastbone pulls in with each breath in. She has a wheeze on breathing out that can be heard without a stethoscope. She says single words, "Mama," "no," but not the short phrases her mother says she normally uses. She pushes the oxygen saturation probe away.
Numbers, against her age. Respiratory rate 48, heart rate 156, oxygen saturation 94% on room air, temperature 37.9 C. Fleming et al. (2011), who built centile charts from studies of healthy children, report median values at 2 years of 26 breaths and 113 beats a minute. Sofia's breathing rate is nearly twice the median for her age and her heart rate is more than 40 beats above it. Her albuterol can raise her heart rate, so that part of the number is shared with the treatment.
What this means. The saturation of 94% is acceptable. It is being held there by work: a fast rate, extra muscles and a posture she has chosen because it helps. That is the finding I would act on, not the saturation, because a child can spend reserve for hours to keep that number steady and then stop being able to.
Actions at 1900, Ranked
First, let her stay upright on her mother's lap. Moving her to the bed to lie down would cost her the posture she is using to breathe, and separating her from her mother would add crying, which uses breath. Second, tell the provider now that she is still working hard after three treatments, and ask for the next albuterol order and whether to start continuous monitoring. Third, apply the saturation probe to her toe, where she is less able to pull it off, and count her breathing for a full minute every hour, or sooner if anything changes. Fourth, offer fluids in small sips from her own cup; she is breathing too fast to drink much at once.
Part 2, 2130: Two and a Half Hours Later
After two more albuterol treatments, Sofia's rate is 36, her heart rate 150, and her saturation 95%. The flaring has stopped. The pulling in between her ribs is still present but shallower, and she is saying "Mama, up" and pointing at the cup. She drank 90 mL of juice.
Reading it. The numbers have moved a little. The effort has moved more: two-word phrases, a stop to the flaring and interest in drinking are the most reliable signs that she is spending less reserve. I would record this as improving, with the pulling in still watched, and continue the plan.
Part 3, 0215: The Child Who Stopped Fighting
At 0200 her mother calls the nurse because Sofia "finally settled." At 0215, Sofia is lying on the bed, eyes half closed, not reaching for her mother and not pushing away the probe. Her breathing rate is 28, her heart rate 118, and her saturation 91%. The wheeze is quieter than at 2130. Her mother is relieved.
Reading it. Every one of those changes could be read as improvement, and together they describe the opposite. A child who was fighting the probe and has stopped, with a slower rate, a lower heart rate and a quieter chest, but whose saturation has fallen from 95 to 91, is not resting. She may be tiring. A quieter wheeze with less air movement can mean that less air is getting through, not that the airway has opened. The falling saturation is the number that settles it: it has finally moved, and it moved after the effort changed.
Actions, ranked. Wake her fully and listen to the whole chest for air entry on both sides. Call the provider and the rapid response team at once, with the change stated in one sentence: "Sofia, 25 months, admitted wheezing, was working hard at 2130 and is now drowsy, rate 28, sat 91, quiet chest; I think she's tiring." Give oxygen as ordered to bring her saturation up while they come. Sit her upright. A heart rate that keeps falling in a child in respiratory distress is a warning sign, not reassurance; the current pediatric resuscitation guideline directs the team to start compressions if the heart rate falls below 60 with poor perfusion despite support for breathing (Topjian et al., 2020). Sofia is far from that at 118, but the direction matters, and it is the reason the call does not wait.
Threshold, Time and Person, Written in Advance
Had the plan been written at 1900, it would have said:
Call the provider within 15 minutes: respiratory rate above 50, or pulling in between the ribs that is deeper than at the last check, or refusal of all fluids for four hours.
Call the rapid response team now: drowsiness or a child who stops protesting while still working to breathe; saturation below 92% despite treatment; a quiet chest with poor air entry; a heart rate that falls while effort continues.
Ask the mother: to call the nurse immediately if Sofia seems to stop fighting, not only if she seems worse, because the change from struggling to still is easy to mistake for relief.
Her Mother's Account
Her mother's report that Sofia had been "breathing fast since lunchtime" was the only information about how long the work had lasted. At 1900 that meant about seven hours of effort already spent before any of us saw her, which is part of why the drowsiness at 0215 was read as tiring rather than sleep. The account belongs in the assessment, with its source labeled, because a child's reserve depends on how long she has been spending it.
References
Fleming, S., Thompson, M., Stevens, R., Heneghan, C., Plüddemann, A., Maconochie, I., Tarassenko, L., & Mant, D. (2011). Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: A systematic review of observational studies. The Lancet, 377(9770), 1011-1018. https://doi.org/10.1016/S0140-6736(10)62226-X
Topjian, A. A., Raymond, T. T., Atkins, D., Chan, M., Duff, J. P., Joyner, B. L., Lasa, J. J., Lavonas, E. J., Levy, A., Mahgoub, M., Meckler, G. D., Roberts, K. E., Sutton, R. M., Schexnayder, S. M., Bronicki, R. A., de Caen, A. R., Guerguerian, A. M., Kadlec, K. D., Kleinman, M. E., . . . Zaritsky, A. (2020). Part 4: Pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 142(16, Suppl. 2), S469-S523. https://doi.org/10.1161/CIR.0000000000000901
The Chamberlain NR 328 Week 5 instructions
The Week 5 case follows a child with a respiratory illness over several hours and asks you to assess, prioritize and respond at each stage. The checklist generally covers interpretation of assessment findings for the child's age, prioritized nursing interventions, recognition of deterioration, communication with the team and evidence in APA. Describe the child's effort before quoting any number. Set each vital sign against the normal range for her age. Rank your actions with a reason for each. Read each new set of findings together, not one at a time. Treat a sudden calm in a child who was working hard as a possible warning. Write escalation thresholds with times and roles.
How the NR 328 Week 5 example is put together
Part 1 at 1900 describes Sofia upright on her mother's lap with flaring and retractions, then compares her rate of 48 and heart rate of 156 with medians for her age. The response argues that the 94% saturation is held up by effort, and ranks actions starting with keeping her on her mother's lap. Part 2 at 2130 reads two-word phrases, the end of flaring and interest in drinking as signs of improvement. Part 3 at 0215 finds her drowsy, not resisting the probe, with lower rates and a falling saturation, and reads that as tiring. The escalation call is scripted, citing Topjian and colleagues. A section lists the thresholds the plan should have stated at 1900, and the last discusses her mother's report.
Where the points sit in the NR 328 Week 5 rubric
Pediatric case response rubrics typically score accurate assessment, interpretation of findings against age norms, prioritized interventions, recognition of change, communication and escalation, and evidence with APA. Recognition of deterioration is weighted heavily, and the paper earns it by reading the 0215 picture as exhaustion rather than recovery. Interpretation scores when each rate is compared with Fleming and colleagues' age medians. Prioritization is credited for an ordered list with reasons, such as keeping her upright. Communication earns points through a scripted call stating the change in one sentence. Written thresholds with times and roles show planning beyond the case. The mother's account adds the family perspective that pediatric rubrics expect.
NR 328 Week 5 help: mistakes that cost points
The costliest error in this response is calling a child stable because the saturation is acceptable while the description shows a chest working hard. Another common loss is reducing effort to one phrase, such as "mild distress," with no flaring or retractions described. Students also judge rates by adult ranges, which makes a child's rate look either alarming or reassuring when it is neither. Missing the meaning of a child who stops fighting the probe is the main trap in Part 3. Escalation written as "notify the provider" without timing or a role earns little. Include the parent's report of how long the effort lasted. If your case has a different child or condition, send it and we can show how an NR 328 respiratory response would read each part.
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NR 328 Week 5 questions, answered
How much of the response should be assessment rather than plan?
More than feels comfortable. In this week the ranking is the graded part, and a plan attached to findings that were never sorted reads as a list of interventions looking for a patient. Get the effort described, get the figures placed against the age, argue which of them shows a child still coping, and the plan afterward tends to write itself in a few lines.
The case gives a normal saturation. Can I still call the child unwell?
Yes, and doing it well is most of the mark. Say what is holding the figure up, name the findings showing the effort, and state the point at which it would stop being held. An answer leaning on the one comfortable number while the description above it shows a chest working hard has read the case backwards, which is the failure the week was built to expose.
How specific does escalation have to be?
Specific enough that somebody else could carry it out without asking you anything. A finding, a time and a role: this sign, within this many minutes, to this person. General instructions to notify a provider if the child deteriorates give a marker nothing to award, because they would fit any case in the course and they leave every decision to whoever reads them next.
Where can I find a free NR 328 Week 5 sample paper?
The full Week 5 respiratory case response for Sofia, with all three parts, the ranked actions, the scripted escalation, the written thresholds and the references, is on this page.
What changes at 0215 in the NR 328 Week 5 case?
Sofia is drowsy and still, with a slower breathing rate, a lower heart rate and a falling saturation. The response reads this as a tiring child and calls the provider and rapid response team at once.