| Course | NR 500NP Foundational Concepts and Advanced Practice Roles |
|---|---|
| Week | 5 |
| Paper type | Case-based application paper |
| Length | About 1,100 words, 3 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NR 500NP Week 5
Case-Based Application Paper: Watchful Waiting for a 3-Year-Old With an Ear Infection, a Decision Taken, Held and Covered for the Hours the Clinic Is Closed
Student Name
College of Nursing, Chamberlain University
NR 500NP: Foundational Concepts and Advanced Practice Roles
Instructor Name
Month Day, Year
Case-Based Application Paper: Watchful Waiting for a 3-Year-Old With an Ear Infection, a Decision Taken, Held and Covered for the Hours the Clinic Is Closed
The Case, in Its Working Facts
Mia is 3 years old and is brought to a rural family practice clinic on a Friday at 1600 by her father. She has had a cold for four days and started pulling at her right ear and crying last night. Her temperature is 38.4 C. On examination, her right eardrum bulges and is red and cloudy; her left is normal. She is drinking, playing in the waiting room and has no other illness. She has had one ear infection before, at 18 months, treated with amoxicillin without problems, and has no allergies. The clinic is closed on weekends, and the nearest emergency department is 40 minutes away. Details are composite.
These are the facts that will do work below: her age, a single ear, pain for less than 48 hours, a temperature below 39 C, a well-appearing child, a Friday afternoon and a 40-minute drive.
The Decision
The decision is to diagnose acute otitis media of the right ear and to offer the family observation for 48 to 72 hours without starting an antibiotic, with pain treated now and a safety-net plan for starting an antibiotic if she does not improve. The American Academy of Pediatrics guideline allows either antibiotic treatment or observation with close follow-up for children 24 months or older with non-severe acute otitis media, whether one ear or both, where non-severe means mild ear pain for less than 48 hours and a temperature below 39 C; the choice is made jointly with the parent, and follow-up must be arranged so that an antibiotic can be started if the child worsens or fails to improve within 48 to 72 hours (Lieberthal et al., 2013). Mia meets the conditions: she is over two, has one affected ear, pain for less than a day, a temperature of 38.4 C and looks well.
What is being treated is her pain: weight-based ibuprofen every six to eight hours as needed, with the dose written on the sheet for her weight today of 14.5 kilograms. What is being watched is the ear infection itself, which in many children clears without antibiotics.
The Alternatives That Lost
Starting amoxicillin today was a reasonable alternative, and the guideline allows it. It lost for three reasons: Mia meets every condition for observation, observation spares her the diarrhea and rash that antibiotics sometimes cause, and it avoids an antibiotic that may not be needed. It would have won if her father had preferred it after hearing both options, if she had looked unwell, if her temperature had been 39 C or higher, or if her pain had lasted more than two days. A third option, referring her to the emergency department, lost because nothing in her presentation calls for emergency care, and a 40-minute drive on a Friday evening would add burden without benefit.
Her father chose observation after hearing both options.
He said he would rather wait.
An Interval, Written Down
Observation is only safe if the interval is explicit. Her father is told, and the visit summary says, that the plan is to watch for 48 to 72 hours, that is, until Sunday afternoon or Monday morning at the latest. The clinic will call on Monday morning to ask how she is. If she is better, with less pain and a normal temperature, no antibiotic is needed and a recheck is offered in two to three weeks only if there are new concerns. If she is not better by Sunday afternoon, the safety-net plan below starts.
The Findings That Bring Them Back
Her father was given, in writing, the findings that change the plan:
Start the antibiotic prescription: ear pain that is worse or not better after 48 hours; a temperature of 39 C or higher at any point; pain in both ears.
Emergency department now, or 911: swelling, redness or tenderness behind the ear, or the ear pushed forward; a stiff neck, unusual sleepiness or a child who is hard to wake; a child who will not drink or has no wet diaper for eight hours.
He repeated these back, and he pointed out that he would be the one watching her on Saturday, because her mother works weekends.
Cover for the Hours You Are Away
The part most plans leave out is the weekend. The clinic is closed Saturday and Sunday, so the plan cannot depend on a phone call to the clinic. Instead, following the guideline's allowance for a safety-net prescription, an amoxicillin prescription dosed for her weight is sent to the family's pharmacy with instructions to fill it only if she meets the start criteria above. Her father is also given the number of the practice's after-hours nurse line, which is staffed through the weekend, and told that the nurse can help him decide whether the criteria are met. This arrangement means that the decision to observe does not leave the family alone for the two days when the clinic cannot be reached.
As a future nurse practitioner, this is the piece I most need to learn to write routinely. As an emergency nurse, I have seen many children return on Sunday night because a plan made on Friday had no cover for the weekend.
Holding the Decision
The decision is documented in the chart with the reasons: non-severe right acute otitis media in a well-appearing child over 24 months, observation chosen jointly with the father after discussing antibiotic treatment, pain treatment prescribed, safety-net antibiotic sent with criteria, after-hours line provided, and a Monday call scheduled. If the Monday call finds her worse and the antibiotic not started, that is a reason to see her that day, and the chart will show what was planned and why.
Holding the decision also means not quietly reversing it. If her father calls on Saturday morning to say she slept badly but has no fever and is playing, the plan is working as intended, and the right answer is to reassure him and continue, not to tell him to start the antibiotic because he sounds worried. The criteria were written to be applied, and applying them consistently is what makes observation a real choice rather than a delay.
References
Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., Joffe, M. D., Miller, D. T., Rosenfeld, R. M., Sevilla, X. D., Schwartz, R. H., Thomas, P. A., & Tunkel, D. E. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999. https://doi.org/10.1542/peds.2012-3488
What the NR 500NP Week 5 assignment asks for
The Week 5 paper asks you to apply advanced practice concepts to a clinical case. Students are usually asked for the case facts, assessment, a diagnosis, a plan based on evidence, consideration of alternatives, patient education, follow-up and APA. List the facts that will do work in your decision. Commit to a diagnosis and plan in the first lines. Tie each condition of the guideline you use to a fact in the case. Explain why the alternatives lost. Write the interval and the findings that change the plan down for the family. Arrange cover for the hours you are not available. Document the decision with reasons and explain how you would hold it.
How the NR 500NP Week 5 example is put together
The case section gives Mia's age, four days of a cold, right ear pulling, pain under 48 hours, temperature, appearance and the Friday timing. The decision section diagnoses right acute otitis media, offers observation for 48 to 72 hours and doses ibuprofen for 14.5 kilograms. The alternatives section explains why amoxicillin today lost, though the guideline allows it, and records that her father chose observation. The interval section sets watching until Sunday. The return findings list when to start the antibiotic prescription, such as fever of 39 C or worse pain after 48 hours, and when to go to the emergency department. The cover section explains a safety-net prescription and after-hours plan for the closed weekend. The documentation section explains not quietly reversing the plan.
NR 500NP Week 5 rubric: what full points look like
Case application rubrics in NR 500NP generally score accurate assessment, a clear diagnosis and plan, use of guidelines, consideration of alternatives, patient education, follow-up and safety, and APA. The course weighs commitment to a decision above the other rows, and this paper states the diagnosis and plan in its first lines. Guideline use is credited because each condition is matched to a case fact. Alternatives score when amoxicillin is given a fair hearing. Education earns points for written return findings repeated back. Safety is credited through weekend cover, which most plans omit. Holding the decision shows mature reasoning. Lieberthal and colleagues' guideline completes the evidence.
Common NR 500NP Week 5 mistakes, and how to avoid them
The single largest loss on this paper is gathering material and never deciding, with every possibility described and no plan chosen. Another is a plan with no interval or return findings, which is unsafe in a child. Students also ignore the weekend or evening when the clinic is closed, leave out the parent's choice or reverse the plan at the first phone call. Workup detail should be enough to support the decision, not every possible test. If the right decision is referral, the paper should commit to that and arrange it. A diagnosis is expected, not just a plan. Send your case and an NR 500NP application paper can be built around one committed decision.
Get a NR 500NP Week 5 example written to your instructions
Send the Week 5 case or vignette exactly as your classroom posted it, along with the rubric, and a custom example paper is written to that case and returned inside 24-48h, the first one free. If your section lets you bring your own case, send a version with the identifying details removed and the example is built on that.
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NR 500NP Week 5 questions, answered
How much workup detail does the paper need?
Enough that each test named changes what you would do with the answer, and no more. A list of everything available reads as coverage rather than reasoning, and it usually crowds out the plan. For each item, say what a positive result would move and what a negative one would rule out. Anything that changes nothing either way comes out in the second pass.
What if the right decision is to send the patient somewhere else?
That is a decision and it is graded as one, provided it is argued. Say what made the case exceed what you would take on yourself, who receives the patient, how quickly, and what you would do in the meantime, because a referral written as a single line reads as avoidance. The interval and the interim plan separate a considered handoff from a shrug.
Does the paper need a diagnosis, or is a plan enough?
Most prompts want both and they are marked separately. The plan is only defensible once a reader knows what it is treating, and a plan attached to a vague impression cannot be assessed at all. Where the case genuinely does not settle, name the working impression, say what would confirm it, and treat what needs treating meanwhile. That is closer to practice than false certainty.
Where can I find a free NR 500NP Week 5 sample paper?
The complete Week 5 case paper on watchful waiting for Mia's ear infection, with the decision, alternatives, interval, return findings, weekend cover, documentation and the guideline reference, can be read here.
When does the NR 500NP Week 5 plan start the antibiotic?
If ear pain is worse or not better after 48 hours, if she has a temperature of 39 C or higher at any point, or if pain appears in both ears.