NR 545 Week 7 Two-Condition Case Study Example

Course	NR 545 Pharmacology, Physical Assessment, and Pathophysiology Nurse Practitioner graduate placement
Week	7
Paper type	Case study analysis
Length	About 1,240 words, 2 pages
Format	APA 7 student paper
School	Chamberlain University
Program	MSN, nurse practitioner core
Updated	September 2026

Free sample paper for NR 545 Week 7

Case Study Analysis: Heart Failure With Reduced Ejection Fraction and Diabetic Kidney Disease in the Same 64-Year-Old Patient, Where a Potassium of 5.2 Sits Between the Two and One Plan Has to Serve Both

Student Name

College of Nursing, Chamberlain University

NR 545: Pharmacology, Physical Assessment, and Pathophysiology

Instructor Name

Month Day, Year

What this page is doingThe title keeps both conditions in view from the first line and names the value where they collide, which prevents the second diagnosis from becoming an appendix. Student APA 7 title page.

The Whole Patient

The patient is 64, a retired machinist, living with two conditions that now shape each other: heart failure with reduced ejection fraction, diagnosed ten weeks ago with an ejection fraction of 30% and a nonischemic, probably hypertensive cause; and type 2 diabetes of nine years with chronic kidney disease. Current medications are sacubitril/valsartan 24/26 mg twice daily (switched from lisinopril three weeks ago after a 36-hour gap), carvedilol 12.5 mg twice daily, dapagliflozin 10 mg once each morning, furosemide 40 mg as needed by weight and metformin 1,000 mg twice daily.

At today's visit the patient reports good exercise tolerance on the flat, sleeps flat, and has needed furosemide twice in four weeks. Fatigue in the afternoons is the main complaint, along with getting up twice a night to urinate. Blood pressure is 118/72 mmHg seated, 112/70 standing without symptoms. Heart rate 64. Weight 86.2 kg. Jugular venous pressure normal. Lungs clear. No edema. Feet warm, with reduced monofilament sensation at both great toes and intact pulses.

Laboratory results: creatinine 1.66 mg/dL, eGFR 44 mL/min/1.73 m², potassium 5.2 mmol/L, sodium 139 mmol/L, bicarbonate 22 mmol/L, hemoglobin 12.2 g/dL, HbA1c 7.1%, urine albumin-to-creatinine ratio 210 mg/g. A year ago, eGFR was 58 and the albumin ratio 90 mg/g.

Two Mechanisms, Sized to the Case

Heart failure. The mechanism was set out earlier in the course: a weakened left ventricle, compensated by sympathetic and renin-angiotensin-aldosterone activation that retains sodium and water and drives remodeling. Therapy blocks that activation at several points. What matters here is that three of the four recommended drug classes act on the kidney or on potassium handling.

Diabetic kidney disease. Chronic hyperglycemia damages the glomerulus through several routes, including hyperfiltration driven by increased proximal sodium-glucose reabsorption and by angiotensin II constricting the efferent arteriole. Rising albuminuria is a marker of that damage and of progression. The loss of eGFR from 58 to 44 in a year, with albuminuria more than doubling, indicates active progression. Hypertension adds its own injury. Kidney disease in turn reduces potassium excretion, particularly when aldosterone is blocked.

Where the Two Interfere

The two conditions touch at three points, and each changes the plan.

Potassium. Heart failure therapy calls for a mineralocorticoid receptor antagonist, spironolactone, which lowers mortality in reduced ejection fraction (Pitt et al., 1999). Kidney disease reduces potassium excretion, and the patient already takes a drug that blocks angiotensin, which lowers aldosterone. A potassium of 5.2 mmol/L sits exactly where the two collide. Guidelines advise starting a mineralocorticoid antagonist only when serum potassium is under 5.0 mmol/L and kidney function exceeds an eGFR of 30 (Heidenreich et al., 2022).

The kidney's filtration pressure. Blocking angiotensin and inhibiting sodium-glucose cotransporter 2 both lower glomerular pressure. That protects the diabetic kidney over years but causes an early, expected fall in eGFR. Part of the fall from 50 to 44 since diagnosis probably reflects these intended hemodynamic effects rather than new injury, which is reassuring but makes the true rate of disease progression harder to read.

Glucose drugs and the heart. Some glucose-lowering agents worsen heart failure. Thiazolidinediones cause fluid retention. Saxagliptin, a dipeptidyl peptidase-4 inhibitor, increased hospitalization for heart failure in a large cardiovascular outcomes trial in patients with type 2 diabetes (Scirica et al., 2013). Metformin is safe in stable heart failure but is cleared by the kidney, and its dose depends on eGFR.

Findings That Could Belong to Either

Afternoon fatigue. Heart failure could cause it through low output, but the patient is warm with a normal pulse pressure and good exercise tolerance. Carvedilol, recently increased, commonly causes fatigue. Anemia of kidney disease could contribute, and hemoglobin has fallen from 13.1 to 12.2 g/dL. Hypoglycemia is unlikely on this regimen. I attribute the fatigue mainly to the beta-blocker increase and mild anemia, and will reassess in four weeks before any change, because carvedilol lowers mortality and fatigue often eases with time.

Nocturia. Dapagliflozin increases urine volume. Heart failure causes nocturia as fluid shifts back from the legs at night. Diabetic kidney disease reduces urine concentrating ability. With no edema and normal jugular pressure, the heart failure explanation is weak. I attribute it mainly to dapagliflozin, taken in the morning as advised, and to kidney disease, and would not stop dapagliflozin for it.

Albuminuria. Rising albuminuria could reflect diabetic kidney disease, hypertensive injury or, less likely, congestion raising renal venous pressure. The patient is now euvolemic, and the albumin ratio rose over a year that began before heart failure was diagnosed, which points to diabetic kidney disease. The attribution matters because it confirms the kidney needs protection in its own right.

One Plan, Two Problems

Priority. Heart failure is the condition most likely to cause death or hospitalization in the next year, and its therapies also protect the kidney. The plan therefore keeps every heart failure drug and adjusts around the kidney.

Potassium first. Spironolactone is not started today because potassium is 5.2 mmol/L. The patient's diet is reviewed for high-potassium foods and salt substitutes containing potassium, and potassium is rechecked in one week. If it falls below 5.0, spironolactone 12.5 mg daily will be started, with potassium and creatinine checked at three days and one week. Finerenone, a nonsteroidal mineralocorticoid antagonist, slowed kidney disease progression in type 2 diabetes (Bakris et al., 2020), but that trial excluded patients with symptomatic reduced ejection fraction, and two mineralocorticoid antagonists are not combined. Spironolactone is preferred here because its evidence is in this patient's heart condition. A potassium binder would be an option if potassium stays high and blocks therapy.

Metformin. With eGFR below 45, the metformin dose is reduced to 500 mg twice daily, in line with kidney guideline recommendations for diabetes in chronic kidney disease (Rossing et al., 2022). HbA1c of 7.1% leaves room for this, since tight control adds hypoglycemia risk in a patient with kidney disease and heart failure.

What is avoided. No thiazolidinedione and no saxagliptin. If more glucose lowering is needed, a glucagon-like peptide-1 receptor agonist would be considered.

Unchanged. Sacubitril/valsartan, carvedilol and dapagliflozin continue. Dapagliflozin in particular serves both conditions, having reduced kidney disease progression in a trial that included patients with and without diabetes (Heerspink et al., 2020).

Feet. Reduced monofilament sensation indicates peripheral neuropathy. Foot care education and podiatry referral follow.

Monitoring Both Conditions

Potassium and creatinine at one week, and after any change to spironolactone. Weight daily at home. Blood pressure, heart rate and fatigue at four weeks. Hemoglobin with iron studies at four weeks, since both conditions frequently bring iron deficiency, which can be treated. Urine albumin ratio and HbA1c at three months. Echocardiogram at three months of full therapy to reassess ejection fraction. Each result is read against both conditions: a rise in creatinine is judged against the expected early hemodynamic dip before being called progression, and a rise in potassium is weighed against the value of the drug causing it.

References

Bakris, G. L., Agarwal, R., Anker, S. D., Pitt, B., Ruilope, L. M., Rossing, P., Kolkhof, P., Nowack, C., Schloemer, P., Joseph, A., & Filippatos, G. (2020). Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. New England Journal of Medicine, 383(23), 2219-2229. https://doi.org/10.1056/NEJMoa2025845

Heerspink, H. J. L., Stefánsson, B. V., Correa-Rotter, R., Chertow, G. M., Greene, T., Hou, F.-F., Mann, J. F. E., McMurray, J. J. V., Lindberg, M., Rossing, P., Sjöström, C. D., Toto, R. D., Langkilde, A.-M., & Wheeler, D. C. (2020). Dapagliflozin in patients with chronic kidney disease. New England Journal of Medicine, 383(15), 1436-1446. https://doi.org/10.1056/NEJMoa2024816

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., . . . Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895-e1032. https://doi.org/10.1161/CIR.0000000000001063

Pitt, B., Zannad, F., Remme, W. J., Cody, R., Castaigne, A., Perez, A., Palensky, J., & Wittes, J. (1999). The effect of spironolactone on morbidity and mortality in patients with severe heart failure. New England Journal of Medicine, 341(10), 709-717. https://doi.org/10.1056/NEJM199909023411001

Rossing, P., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., Sadusky, T., Tandon, N., Tuttle, K. R., Wanner, C., Wilkens, K. G., Zoungas, S., & de Boer, I. H. (2022). KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney International, 102(5S), S1-S127. https://doi.org/10.1016/j.kint.2022.06.008

Scirica, B. M., Bhatt, D. L., Braunwald, E., Steg, P. G., Davidson, J., Hirshberg, B., Ohman, P., Frederich, R., Wiviott, S. D., Hoffman, E. B., Cavender, M. A., Udell, J. A., Desai, N. R., Mosenzon, O., McGuire, D. K., Ray, K. K., Leiter, L. A., & Raz, I. (2013). Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. New England Journal of Medicine, 369(14), 1317-1326. https://doi.org/10.1056/NEJMoa1307684

What the NR 545 Week 7 assignment asks for

The seventh week asks you to analyze a patient with more than one condition. Expect the prompt to request the presentation, the pathophysiology of each condition, how they interact, assessment findings, a combined management plan and monitoring. Open with the whole patient rather than a primary diagnosis. Explain each mechanism to the depth your plan will use. Identify where the conditions interfere, such as a shared organ, a competing drug effect or a laboratory value both influence. Attribute ambiguous findings to one condition or the other and argue the attribution. Build one plan, state treatment priority and note agents chosen or avoided because of the second condition. Design monitoring that watches both. Cite guidelines and trials for each condition in APA 7.

Inside the NR 545 Week 7 example

The analysis opens with the patient's two conditions, current regimen, symptoms, examination and laboratory values, including potassium 5.2, eGFR 44 and a rising albumin ratio. Two short mechanism sections follow. The interference section covers potassium and mineralocorticoid antagonists, the expected early eGFR dip from kidney-protective drugs and glucose-lowering agents that worsen heart failure, citing guidelines and a saxagliptin trial. The ambiguous findings section attributes fatigue, nocturia and albuminuria, with reasons. The plan puts heart failure first, postpones spironolactone until potassium falls, explains why finerenone is not added, reduces metformin for the lower eGFR, keeps dapagliflozin for both conditions and refers for foot care. Monitoring reads each result against both conditions.

NR 545 Week 7 rubric: what full points look like

Multi-condition analyses are typically marked on thorough understanding of each condition, clear explanation of their interaction, sound attribution of findings, an integrated plan with stated priorities and monitoring that covers both. Opening with the whole patient prevents the second condition from becoming an appendix, which instructors notice. Identifying specific points of interference shows the analysis is more than two write-ups side by side. Arguing the attribution of ambiguous findings demonstrates careful reasoning. A plan that chooses or avoids agents because of the second condition makes the interaction concrete. Stated priority and monitoring of both conditions show a realistic approach to care. Current guidelines and trials for each condition, cited accurately in APA 7, support the plan.

Common NR 545 Week 7 mistakes, and how to avoid them

Analyses often treat one condition in depth and the second in a paragraph at the end. Give both their due and show where they meet. Another weakness is listing two separate medication plans rather than one plan for the patient. Some students attribute ambiguous findings without explaining why, although the attribution changes management. Argue each one. Avoid recommending a drug for one condition that worsens the other without acknowledging it. Check kidney-based dose adjustments carefully. State which condition takes priority and why. Monitoring should interpret results in light of both conditions; an early creatinine rise, for example, may be expected rather than harmful. Keep the patient's details consistent with earlier weeks if the course uses the same case.

Get a NR 545 Week 7 example written to your instructions

Send the Week 7 case with both conditions, the rubric and the word range, and a custom analysis is written to your instructions and returned inside 24 to 48 hours, the first one free. Say which condition your section treats as primary and the example is built around that ordering.

More NR 545 papers and MSN samples

NR 545 Week 7 questions, answered

Should each condition get its own section?

Separate mechanism sections are fine and often clearer. What cannot be separated is the analysis, because the assignment is the interaction. A reliable test is whether any paragraph in the paper would need rewriting if the second condition were removed. If none would, the two problems are sitting beside each other rather than being reasoned about together.

How do I handle a drug that helps one condition and worsens the other?

That situation is usually the whole point of the case. The paper names the conflict, explains it physiologically instead of only quoting an interaction warning, makes a choice, and says what will be watched to catch the cost of that choice early. A paper avoiding the conflict by picking something neutral loses the reasoning it was set up to show.

How long does a Week 7 analysis usually run?

Longer than the single-problem weeks, though the published word range settles it. The extra length should come from the interaction sections rather than from two full write-ups, so if a draft is running far over, the usual cause is each condition being explained in textbook depth instead of to the depth the argument uses.

Where can I find a free NR 545 Week 7 sample paper?

The heart failure and diabetic kidney disease case study above is the NR 545 Week 7 sample, available without a login. If your patient has another combination of conditions, share the case with us and an analysis building one plan for both can be prepared.

How should the NR 545 Week 7 plan handle two conditions?

As one plan with a stated priority, noting agents chosen or avoided because of the second condition. The sample postpones spironolactone for potassium, reduces metformin for kidney function and avoids saxagliptin.