| Course | NR 341 Complex Adult Health |
|---|---|
| Week | 2 |
| Paper type | Priority-setting case analysis |
| Length | About 1,120 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | BSN (pre-licensure) |
| Updated | October 2026 |
Free sample paper for NR 341 Week 2
Priority-Setting Case: Four Patients at 0715 on a Step-Down Unit, Each With a Clock, and the One Placement Worth Arguing
Student Name
College of Nursing, Chamberlain University
NR 341: Complex Adult Health
Instructor Name
Month Day, Year
Priority-Setting Case: Four Patients at 0715 on a Step-Down Unit, Each With a Clock, and the One Placement Worth Arguing
The Assignment at 0715
I take report at 0700 on four patients on a step-down unit, with one nursing assistant shared with another nurse. The case supplies the following at 0715; details are composite.
Room 1, Mr. A., 68, day 2 after coronary bypass surgery. Chest tube draining 40 to 60 mL an hour overnight, serous. Heart rate 88 in sinus rhythm. Pain 6 of 10 on coughing. Due: 0800 medications, including metoprolol, and walking with physical therapy at 0900.
Room 2, Mrs. B., 74, admitted with heart failure. Furosemide 40 mg IV due at 0800. Her 0500 potassium, just resulted, is 3.1 mmol/L. Weight down 1.2 kg from yesterday. Breathing 20, saturation 94% on 2 L.
Room 3, Mr. C., 59, diabetic ketoacidosis resolving. Insulin infusion running; his hourly glucose at 0700 was 148, and his bicarbonate at 0500 was 19. The team plans to switch him to injected insulin this morning; his breakfast tray arrives at 0730.
Room 4, Ms. D., 81, admitted overnight with a urinary infection and new confusion. Found at 0655 trying to climb over the bed rails. Blood pressure 102/60, heart rate 104, temperature 38.2 C. Last set at 0300: 118/70, 92, 37.6.
Each problem below carries what it is doing now in figures, the nursing response, and how many minutes that response takes, because an order is a claim about time.
Every Problem With a Clock on It
Table 1 sets out each problem with its response and the time I estimate it will take.
Table 1
Problems, Responses and Estimated Times at 0715
| Problem | Now | Nursing response | Minutes |
|---|---|---|---|
| Room 4: possible sepsis with falls risk | Pressure falling, pulse and temperature rising since 0300; climbing out of bed | Full set of vitals, assess, call provider, bed alarm and low bed | 15 |
| Room 3: insulin transition before breakfast | Glucose 148 on the drip; tray at 0730 | Clarify the plan with the provider; give basal insulin 1 to 2 hours before the drip stops; mealtime dose with the tray | 10 |
| Room 2: potassium 3.1 before a diuretic | Furosemide due at 0800 will lower potassium further | Hold the 0800 dose until potassium is replaced or the provider decides; call for a replacement order | 5 |
| Room 1: pain before walking | Pain 6 on coughing; walk at 0900 | Give ordered analgesia by 0830; check chest tube and drainage; give metoprolol after heart rate and pressure | 15 |
| All: 0800 medications and assessments | Due within an hour | Routine assessment and medications | 40 |
Note. Times are my estimates for this shift. They total 85 minutes of work that is due before 0900.
The Order, and Why
1. Room 4, 0715 to 0730. Her pressure has fallen by 16 points and her heart rate risen by 12 in four hours, with a rising temperature and new confusion. If she is becoming septic, each hour of delay in fluids and antibiotics matters, and she is also about to fall. Nothing else on the list gets worse as fast.
2. Room 3, 0730 to 0740. His breakfast arrives at 0730. If the basal insulin is not given before the drip is stopped, his ketones can return within hours, and if he eats without a mealtime dose his glucose will climb. The window is set by the tray, which is why he comes before the potassium.
3. Room 2, 0740 to 0745. Her furosemide is not due until 0800, so there are 15 minutes to hold it and get a replacement order. A phone call does it. If it were missed, she would receive a diuretic with a low potassium, but the timing allows it to wait until third.
4. Room 1, 0745 to 0800 and again at 0830. His pain matters because it will stop him walking and coughing, but its deadline is the 0900 walk. Giving analgesia by 0830 meets it.
5. Routine 0800 medications and assessments, fitted around the four.
The Placement Worth Arguing About
The one I would defend in front of the class is placing Room 3 above Room 2. The potassium looks more dangerous on paper: 3.1 is low, and a diuretic will make it lower. But Mrs. B. is not on the monitor with extra beats, her furosemide is not due for 45 minutes, and holding a dose takes one phone call. Mr. C.'s problem has a fixed deadline set by a meal tray, and a mistake in the insulin transition is one of the most common ways a resolving ketoacidosis restarts. If her potassium had been 2.8, or she had been having extra beats, the order would flip.
Delegation That Changes the Sum
Eighty-five minutes of work before 0900 does not fit in 105 minutes when interruptions are counted, and the assistant changes the sum. The national delegation guidelines describe the right task, circumstance, person, directions and supervision (National Council of State Boards of Nursing [NCSBN], 2016). Three tasks meet them. The assistant takes routine vital signs on Rooms 1 and 2 at 0730, with the instruction to tell me at once if Mrs. B.'s heart rate is under 60 or over 110, or her saturation falls below 92%. The assistant sets up Ms. D.'s bed alarm and low bed while I assess her. And the assistant walks with Mr. A. to the bathroom before physical therapy arrives. That returns about 20 minutes. Nothing that needs assessment, judgment or medication is delegated.
Kalisch et al. (2009) describe missed nursing care as required care that is omitted or delayed, and name the priority decisions nurses make under pressure as one of its antecedents. Writing durations beside each problem is how this plan tries to see in advance which care would otherwise be missed. On this morning it would have been Mr. A.'s early walk, which is the easiest to postpone and among the most commonly missed.
The Reading That Restarts It
The order holds only until a reading changes it. If Mr. A.'s chest tube drains more than 100 mL in an hour or turns bright red, he moves to first place and the surgeon is called. If Ms. D.'s pressure falls below 90 systolic, a rapid response is called and everything else waits. If Mr. C.'s glucose falls below 100 before breakfast, the drip rate is changed by protocol before anything else. The plan is a set of decisions made at 0715, and each carries the reading that would undo it.
References
Kalisch, B. J., Landstrom, G. L., & Hinshaw, A. S. (2009). Missed nursing care: A concept analysis. Journal of Advanced Nursing, 65(7), 1509-1517. https://doi.org/10.1111/j.1365-2648.2009.05027.x
National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3
Reading the NR 341 Week 2 instructions
The Week 2 case gives you a patient assignment and asks you to set priorities for the start of the shift. Plan on covering each patient's key findings, the nursing response to each, a ranked order with rationale, delegation decisions and support from the literature in APA. Attach figures to every problem so the reader sees what is happening now. Estimate how long each response takes, because an order is a claim about time. Rank by what gets worse and how fast, not by general importance. Pick the placement most readers would dispute and defend it. Show what you hand to the assistant and how that changes the timing. Finish with the findings that would change the order.
How this NR 341 Week 2 example is built
The opening section lists the four rooms with their 0715 data: a bypass patient with steady chest tube drainage and pain of 6, a heart failure patient with a potassium of 3.1, a man with resolving ketoacidosis whose breakfast arrives at 0730, and an 81-year-old woman with a pressure down 16 points and a temperature of 38.2 C. Table 1 assigns responses and minutes, totaling 85. The ranking places Room 4 first, then the insulin change in Room 3, then holding the furosemide in Room 2, then pain relief before the 0900 walk. A section defends Room 3 above Room 2. Delegation follows the national guidelines, and Kalisch and colleagues tie timing to missed care. The final section lists the triggers that restart the order.
Where the points sit in the NR 341 Week 2 rubric
Priority-setting rubrics usually give points for accurate identification of each patient's problem, a justified order, appropriate interventions, correct delegation, use of evidence and APA. The heaviest row is the rationale for the order; this paper meets it because each position says what would worsen and how quickly, which the timed ranking does. Interventions score when they include the minutes they take, so the plan is realistic. Delegation is credited for tasks that fit the assistant's role under the national guidelines and for saying how they change the total. The defended placement of Room 3 above Room 2 shows the depth of reasoning graders look for. The list of readings that would restart the ranking shows ongoing judgment rather than a fixed list.
NR 341 Week 2 help from the desk
The heaviest loss on this case is a ranked list with no time anywhere in it, because nobody can judge whether the order works. Another is ordering by importance alone, so every patient seems urgent and none is placed with a reason. Students also delegate assessment or teaching to the assistant, which is outside the role, or delegate nothing and leave the timing impossible. Ignoring the potassium before a diuretic, or the insulin change before a meal, are the two clinical traps in this case. A plan that never says what would change the order looks rigid. If your case has a different mix of patients, send the assignment and our writers can show how an NR 341 Week 2 ranking would place each one.
Get a NR 341 Week 2 example written to your instructions
Send the Week 2 instructions, the case your section handed out and any rubric posted with it, and a custom example is written to those and returned inside 24 to 48 hours, the first one free. It arrives with the durations and the defense already in place, so you can hold your own ordering up against a worked one.
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NR 341 Week 2 questions, answered
How many problems should the case carry?
Use the number your prompt supplies, and where it leaves that open, four is usually the ceiling for a paper of this length. Beyond four, each entry shrinks to a line and the durations disappear, which removes the only material the ordering can be argued from. Fewer problems handled properly reads as judgment; more problems listed thinly reads as coverage.
Does the order have to match a standard framework?
It has to be defensible, which is not quite the same thing. A framework is a reasonable starting position and many sections expect one to be visible, but the credit comes from the places where this patient's figures push against it and the writer says so on the page. An order that restates a hierarchy in the same sequence every time tells the marker nothing about this case.
What if two of the problems are equally urgent?
Then say that, and break the tie on something concrete: which response is quicker, which can be started and left running, which needs a second person who is not free yet. Ties broken on practical grounds are perfectly markable. What is not markable is a paper that notices the tie and then quietly ranks them anyway without ever mentioning it.
Where can I find a free NR 341 Week 2 sample paper?
This page shows the entire Week 2 priority-setting case, the timed table, the ranked order, the defended placement, the delegation section and the reorder triggers, with two references.
Why does the NR 341 Week 2 case place the insulin change above the low potassium?
Breakfast arrives at 0730, and if basal insulin is not given before the drip stops, ketones can return, while the furosemide is not due until 0800 and can be held with one call in the time left.