| Course | NR 341 Complex Adult Health |
|---|---|
| Week | 4 |
| Paper type | Shock case response |
| Length | About 1,150 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 4
Shock Case Response: Ten Minutes With a 74-Year-Old Woman in Septic Shock From Cholangitis, Two Nurses and One Bag of Fluid at a Time
Student Name
College of Nursing, Chamberlain University
NR 341: Complex Adult Health
Instructor Name
Month Day, Year
Shock Case Response: Ten Minutes With a 74-Year-Old Woman in Septic Shock From Cholangitis, Two Nurses and One Bag of Fluid at a Time
Two Sets of Readings
Mrs. P. is 74 and was admitted at 0200 with fever, right upper abdominal pain and jaundice; ultrasound shows a stone blocking her common bile duct, and she is waiting for an endoscopic procedure to drain it. She weighs 60 kilograms. The case gives two sets of readings; details are composite.
At 0600: blood pressure 108/62, mean arterial pressure 77, heart rate 104, temperature 38.6 C, breathing 20, saturation 95% on room air, urine 45 mL in the previous hour, alert and oriented.
At 0900, when the case opens: blood pressure 82/46, mean arterial pressure 58, heart rate 124, temperature 39.4 C, breathing 26, saturation 93% on 2 L, urine 15 mL in the previous hour and 20 in the hour before. Capillary refill 4 seconds at the fingertip. Mottling over both knees. She answers questions but asks twice what day it is. Her lactate, drawn at 0845, is 4.2 mmol/L.
Between the two sets she has moved from sepsis to shock. Her mean pressure has slipped below 65, her lactate is above 4, and her skin, kidneys and brain are all showing reduced blood flow. She received her first dose of piperacillin-tazobactam at 0300 and 1 liter of fluid overnight.
The First Ten Minutes
There are two nurses: me, her assigned nurse, and the charge nurse, who arrives at 0902. The rapid response team is called at 0901 and arrives at 0906.
0900, me. Press the call light for help, lay her flat with her legs raised on a pillow, and increase oxygen to keep saturation at 94% or above. Confirm her intravenous line is working, flushing it while watching the site.
0901, me. Call the rapid response team from the bedside phone: "Room 12, septic shock from cholangitis, MAP 58, lactate 4.2, new confusion."
0902, charge nurse. Brings the bag of balanced crystalloid and starts the first 500 mL bolus on a pressure bag under the standing sepsis order, then places a second large-bore line in the other arm.
0903 to 0906, me. Continuous monitoring on, pressure every 5 minutes, bladder catheter placed to measure urine hourly, repeat blood cultures and lactate drawn from the new line.
0906, the team arrives. I give the report in one breath: the two sets of readings, the time of her last antibiotic dose, the fluid given since 0200, and that she has a blocked bile duct waiting for drainage.
0908, charge nurse leaves the room to call pharmacy for the next antibiotic dose to be moved earlier and to tell the gastroenterology team that the drainage has become urgent, then returns at 0912.
Who Left the Room, and Why
Only one person left the room in the first ten minutes, and only after the rapid response team had arrived. The charge nurse's two calls could not be made from the bedside and both mattered: the source of the infection, a blocked duct full of infected bile, will not be controlled by antibiotics or fluid alone. The Surviving Sepsis Campaign guideline recommends that the source of infection be controlled as soon as is practical (Evans et al., 2021), and in Mrs. P.'s case that means an endoscopic drainage that was scheduled for later in the day. Moving it earlier may do more for her pressure than any single bag of fluid. I stayed at the bedside because the monitoring and the fluid needed a nurse's hands.
Volume, With Its Stopping Condition
The same guideline suggests at least 30 mL per kilogram of crystalloid within the first 3 hours for sepsis-induced low blood pressure, with further fluid guided by frequent reassessment (Evans et al., 2021). For Mrs. P., 30 mL/kg is 1,800 mL. She had 1 liter overnight, so the order is for further boluses of 500 mL, each followed by reassessment.
Every bag carries a stopping condition, because she is 74 and her lungs can fill. Before each bolus and after it, I listen to her lung bases, check her saturation and breathing rate, and look at her neck veins. The fluid stops, and the team is told, if any of these appear: new crackles, a saturation that falls on the same oxygen, a breathing rate that climbs rather than falls, or no rise in blood pressure after a bolus. That last one is a stopping condition too: a bolus that does nothing is a sign that more fluid is unlikely to help, and that a medicine to raise her pressure should come sooner.
Reading the Response Honestly
At 0930, after two 500 mL boluses, her pressure is 92/52 with a mean of 65, her heart rate 116, capillary refill 3 seconds, urine 20 mL in the half hour, saturation 94% on 4 L, and her lungs have a few new crackles at the right base. Her repeat lactate is 3.6.
It is tempting to call this improvement, and part of it is: her mean pressure reached 65 and her lactate fell. But she needed 4 liters of oxygen to hold 94% instead of 2, and new crackles have appeared. Her heart rate is still above 110. She is not out of shock; she has been moved to its edge by volume, and her lungs are telling me the volume is nearly spent. I report it that way: "MAP 65 after a liter, lactate down to 3.6, but new crackles at the right base and oxygen up to 4 liters. I don't think she'll tolerate much more fluid." The team starts norepinephrine through a central line, which the guideline recommends as the first-line medicine to raise pressure (Evans et al., 2021), and targets a mean pressure of 65. The endoscopy team takes her at 1030.
What the Response Leaves Out
This response does not cover the drainage procedure, her care in the ICU, or her antibiotic choice, all of which belong to other people or other shifts. It covers the ten minutes in which several correct things had to be done by two nurses in one room, and the half hour after, when the honest reading of her numbers decided the next step.
It also leaves out her family. Her son had been called at 0915 by the charge nurse, after the first ten minutes, and told that his mother was very unwell and being moved to intensive care. Calling earlier would have taken a pair of hands from the room when both were needed; calling later would have left him to learn it from an empty bed.
References
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., . . . Levy, M. (2021). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Critical Care Medicine, 49(11), e1063-e1143. https://doi.org/10.1097/CCM.0000000000005337
The Chamberlain NR 341 Week 4 instructions
The Week 4 case presents a patient in shock and asks you to recognize it and respond. The usual list includes identifying the type of shock from the data, prioritized interventions, team communication, monitoring of the response and evidence in APA. Show the change in figures before any action. Lay out the first minutes by time and by person, so no nurse is in two places at once. Give each fluid bolus a condition for stopping, especially in an older patient. Report the response honestly, including signs that are getting worse. Say who left the room and why. Keep decisions that belong to other teams, such as antibiotic choice or drainage, out of your plan.
Inside the NR 341 Week 4 example
The paper opens with the two sets of readings, 0600 and 0900, and explains that her mean pressure under 65, lactate above 4 and confusion mark shock. The first ten minutes follow by minute: call light, flat with legs raised and oxygen at 0900; the rapid response call at 0901; the charge nurse starting a 500 mL bolus at 0902; monitoring and cultures by 0906; the report to the team; and the charge nurse's calls to pharmacy and gastroenterology. A short section explains why she was the only one who left. The volume section applies Evans and colleagues' 30 mL per kilogram with lung checks before each bag. The 0930 readings are weighed honestly, and the last section covers what is left out, including the family.
Reading the NR 341 Week 4 grading rubric
Shock case rubrics usually award points for recognizing shock from the data, prioritizing interventions, communication and teamwork, monitoring the response, safe fluid management, evidence and APA. Prioritization and teamwork weigh heavily, and they are earned when the first ten minutes are assigned by person and time, so the plan is physically possible. Recognition is credited for comparing two sets of readings with named thresholds. Fluid management scores when each bolus has a stopping condition based on lungs, breathing and neck veins. Monitoring earns points for reading the 0930 response honestly, including the higher oxygen need. Communication is met by the one-breath report to the rapid response team. The Surviving Sepsis guideline supports the evidence row.
NR 341 Week 4 help from the desk
The most expensive mistake is a response in which one nurse performs six actions at once in three places. Fluid given with no condition for stopping costs the next most points, especially in an older patient. Students also call the 0930 readings improvement because the mean pressure reached 65, missing the new crackles and rising oxygen need. Long sections on the pathophysiology of sepsis leave little room for the actions. Choosing antibiotics or planning the drainage procedure strays outside the nursing role. Forgetting the family entirely is a smaller but common loss. If your case is cardiogenic or hypovolemic shock, send it and an NR 341 response can be laid out minute by minute for that patient.
Get a NR 341 Week 4 example written to your instructions
Send the Week 4 instructions and the scenario your classroom issued, along with any rubric it publishes, and a custom example is written against them and returned inside 24 to 48 hours. The first is free. It comes back as a worked response to set beside your own draft, rather than as anything to submit.
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- NR 452 Week 4: Evidence Appraisal
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NR 341 Week 4 questions, answered
How much pathophysiology belongs in it?
Enough to justify the actions and no more. Most drafts arrive with a page of mechanism and three lines of nursing, which inverts what this week rewards. Put the physiology inside the sentence defending a decision, so a reader meets the mechanism at the moment it earns its place, and let the rest of it go without regret.
Does the type of shock have to be named?
Usually yes, and many prompts ask for it, but treat it as one line rather than as the destination. The nursing response across the first ten minutes overlaps heavily between the types, and the paper is marked on the sequence and on what it traded. Where the case is genuinely ambiguous, say which one your actions are covering and how the plan changes if it proves to be the other.
What if the patient does not improve in the scenario?
That is often the better case to be handed. A paper describing a patient who responds to the first bolus never has to say what it would let go of next, and that sentence is where the higher credit sits. If your scenario does improve, extend it: state the reading that would have told you it had not, and what your next action would then have been.
Where can I find a free NR 341 Week 4 sample paper?
This page has the complete Week 4 shock response for Mrs. P., the two sets of readings, the minute-by-minute first ten minutes, the fluid stopping conditions, the 0930 review and the guideline reference.
What does the NR 341 Week 4 response check before each fluid bolus?
Her lung bases, saturation, breathing rate and neck veins, before and after every bag, because at 74 her lungs can fill, and new crackles or rising oxygen need are reasons to stop.