| Course | NR 570 Common Diagnosis and Management in Acute Care Practicum |
|---|---|
| Week | 3 |
| Paper type | Guideline concordance write-up |
| Length | About 1,240 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Adult-Gerontology Acute Care NP (AGACNP) |
| Updated | October 2026 |
Free sample paper for NR 570 Week 3
Guideline Concordance Write-Up: One Admission for Adhesive Small Bowel Obstruction Measured, Element by Element, Against the 2017 Bologna Guidelines
Student Name
College of Nursing, Chamberlain University
NR 570: Common Diagnosis and Management in Acute Care Practicum
Instructor Name
Month Day, Year
Guideline Concordance Write-Up: One Admission for Adhesive Small Bowel Obstruction Measured, Element by Element, Against the 2017 Bologna Guidelines
Pinning the Source
The source for this write-up is the 2017 update of the Bologna guidelines for adhesive small bowel obstruction, written by a working group of the World Society of Emergency Surgery and published in 2018 (ten Broek et al., 2018). It addresses adults with obstruction caused by adhesions, which are almost always the result of earlier abdominal surgery. It does not address obstruction from hernia, tumor or inflammatory bowel disease, and its recommendations on prevention apply to patients having an operation. I used the published update rather than the 2013 version, because the update added sections on special patient groups and revised the evidence grading.
The guideline is written for surgeons, but most patients with this condition on our service are admitted under hospital medicine with a surgical consult, so its recommendations reach the record we write. This write-up asks what the record shows against those recommendations. It does not ask whether any clinician was right.
How the Rows Were Chosen
The guideline contains more recommendations than this table shows. I selected the nine that apply to a patient managed without surgery from presentation to discharge, and left out those on operative technique, on adhesion barriers and on special groups such as pregnant patients, which do not apply here. Each selected row was read against three documents: the emergency department note, the admission note and the progress notes for days 2 to 4. A row was marked matched only if the action appeared in at least one of them with a time; partly if the action appeared but late or incomplete; and not raised if no document mentioned it at all.
The Case, Briefly
A 74-year-old whose abdomen was opened twice decades ago, for the appendix and later for a hysterectomy, was admitted with 30 hours of crampy pain, vomiting and no flatus. CT showed dilated small bowel narrowing to a transition zone low on the right side, with normal wall enhancement. The patient was managed without surgery, received a water-soluble contrast challenge on day 2 and went home on day 4.
The Table
Table 1
Record Compared With Selected Recommendations of the 2017 Bologna Guidelines
| Guideline element | What the record shows | Match | Reason where they differ |
|---|---|---|---|
| CT when the cause is uncertain or strangulation is possible | CT with intravenous contrast 3 hours after arrival; transition point, normal wall enhancement, no free air | Matched | |
| Check for signs of strangulation or peritonitis before choosing nonoperative care | Temperature, pulse, white count and abdominal examination in the first note; lactate added 5 hours after arrival | Partly | The emergency note did not include lactate; it was added by the admitting team |
| Nothing by mouth with nasogastric decompression | Ordered on arrival; 1,100 mL drained in 6 hours | Matched | |
| Intravenous fluids and electrolytes | Balanced crystalloid; potassium replaced and rechecked | Matched | The guideline names no fluid; the record's choice of a balanced solution rests on separate trial evidence |
| Water-soluble contrast as a diagnostic and therapeutic step | Diatrizoate given on day 2 at 06:00; film at 8 hours showed contrast in the colon | Matched | |
| Surgical assessment early in the course | Surgery consulted on the night of admission | Matched | |
| A limit on how long nonoperative care runs before surgery is reconsidered | Not stated anywhere in the record | Not raised | The obstruction resolved on day 2, so the question never became urgent, but no note named the limit in advance |
| Nutritional support if oral intake is delayed | Not applicable; diet resumed on day 3 | Not raised | |
| Advice on recurrence risk | Discharge instructions list return symptoms; no note mentions recurrence risk | Not raised |
The Third Category
The column most often missing from a concordance table is the one for elements the record never raised. A two-column table forces each row into matched or unmatched, and a silent record ends up in whichever column the writer prefers. Here three rows fall into the third category. The clearest is the time limit on nonoperative care. The guideline's working group advises that a trial without surgery should not run on indefinitely in the absence of improvement, and gives a window of about three days. Our record never named that window. The patient improved within 36 hours, so nothing went wrong, but if the contrast had stayed in the small bowel, the record offered no shared point at which the plan would change.
The second is recurrence. The guideline points out that patients with one adhesive obstruction are at risk of another. The discharge instructions told the patient what symptoms should bring a call, but no note recorded a conversation about why it might happen again. The third, nutrition, did not apply because eating resumed on day 3; I list it so a reader can see it was considered and judged irrelevant, not overlooked.
Reasons, Not Ratings
The partial row deserves a reason rather than a mark. The emergency team examined the abdomen and recorded the temperature, pulse and white count, which are the signs the guideline lists. They did not draw a lactate. Lactate is one of the markers a CT reading and examination are weighed against, and in a patient with kidney injury and vomiting it can rise for other reasons, so its absence was not a failure of care. It was a gap in the record, filled five hours later. The reason belongs in the table because without it the row would read as a judgment on the clinicians, which is outside what this assignment asks.
What the Rows Show Together
One row goes further than the guideline asks. The guideline calls for fluids and electrolytes without naming a solution; the record chose a balanced crystalloid, which a trial in adults outside intensive care supports over saline for kidney outcomes (Self et al., 2018). I note it to show that matching a guideline and exceeding it are different findings.
Taken as a whole, the record matches the guideline closely on the actions that happen in the first six hours: imaging, decompression, fluids, contrast and early surgical involvement. It is thinner on the elements that only matter if the case goes badly or recurs: a stated time limit, and a conversation about future risk. That pattern makes sense for a record written by clinicians attending to the immediate problem, and it is also the pattern most likely to cause trouble on the occasional admission that does not resolve quickly. The contrast challenge itself is well supported; a meta-analysis found that it predicted which patients would avoid surgery with high accuracy and shortened the stay (Ceresoli et al., 2016).
What the Write-Up Is Not
This is not a review of whether the patient received good care; by every measure in the record, the patient did well. It does not cover recommendations on surgical technique, adhesion barriers or laparoscopy, which apply only when an operation is performed. And it does not recommend care for this patient now that the admission is over. Its purpose is narrower: to show where a published statement and a written record meet, where they part, and where the record says nothing at all.
References
Ceresoli, M., Coccolini, F., Catena, F., Montori, G., Di Saverio, S., Sartelli, M., & Ansaloni, L. (2016). Water-soluble contrast agent in adhesive small bowel obstruction: A systematic review and meta-analysis of diagnostic and therapeutic value. American Journal of Surgery, 211(6), 1114-1125. https://doi.org/10.1016/j.amjsurg.2015.06.012
Self, W. H., Semler, M. W., Wanderer, J. P., Wang, L., Byrne, D. W., Collins, S. P., Slovis, C. M., Lindsell, C. J., Ehrenfeld, J. M., Siew, E. D., Shaw, A. D., Bernard, G. R., & Rice, T. W. (2018). Balanced crystalloids versus saline in noncritically ill adults. New England Journal of Medicine, 378(9), 819-828. https://doi.org/10.1056/NEJMoa1711586
ten Broek, R. P. G., Krielen, P., Di Saverio, S., Coccolini, F., Biffl, W. L., Ansaloni, L., Velmahos, G. C., Sartelli, M., Fraga, G. P., Kelly, M. D., Moore, F. A., Peitzman, A. B., Leppaniemi, A., Moore, E. E., Jeekel, J., Kluger, Y., Sugrue, M., Balogh, Z. J., Bendinelli, C., . . . van Goor, H. (2018). Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the World Society of Emergency Surgery ASBO working group. World Journal of Emergency Surgery, 13, Article 24. https://doi.org/10.1186/s13017-018-0185-2
Reading the NR 570 Week 3 instructions
The Week 3 write-up asks you to compare a real or composite admission with a named clinical guideline. Expect six to eight pages, with a table at the center. The source needs to be pinned precisely: issuing body, year or edition, and the population it covers. A brief case summary follows, just enough to support the rows. The table typically lists each recommended element against what the record shows, whether they agree, and why not where they differ. Many rubrics also ask for a category for elements the record never mentions. The closing section should describe the overall pattern rather than repeat each row, and most sections forbid recommending further care.
How this NR 570 Week 3 example is built
The sample identifies the source as the 2017 Bologna guidelines from a World Society of Emergency Surgery working group, published in 2018, and notes what they do not cover. A short section explains why nine rows were chosen and how each was read against three notes. The case summary is four sentences. The table compares the record with each recommendation and allows three answers: matched, partly or not raised. Three rows land in the third category, including the time limit on nonoperative care. A reason paragraph explains the partial row on lactate without judging anyone. A closing pattern section is followed by a statement of what the write-up is not. Two sources support the rows, and each is cited where it is used.
Where the points sit in the NR 570 Week 3 rubric
Points here go to describing a match rather than grading a clinician; a write-up that judges people loses heavily. Next comes the table's structure: two columns force every silent element into a verdict, so the third category earns marks of its own. Pinning the source by body, year and population fills its own criterion, and this sample also notes which edition it used. Reasons beneath judgments are marked row by row, so the partial row carries a short explanation. The closing section is scored for the pattern it finds, here the difference between early actions and contingency planning. Staying within the record, without recommending further care, meets the boundary criterion.
NR 570 Week 3 help: mistakes that cost points
The most expensive NR 570 Week 3 error is grading the clinician instead of the record. Next is a table with only matched and unmatched columns, leaving no place for what was never discussed. Many write-ups cite a guideline by name with no year or edition, so the reader cannot tell which version was used. Rows with a verdict but no reason lose points across the table. Closings that walk through every row again add nothing. If your section names a different guideline or condition, send it with your case outline; a write-up can be laid out with a pinned source, a three-way table and reasons under each difference.
Get a NR 570 Week 3 example written to your instructions
Name the source your section requires, send the rubric and the assignment, and describe the case in a few lines. A custom write-up arrives inside 24-48h with the element table built to your rubric rows and every citation retrievable, so you can check the version against your classroom. First one free.
More NR 570 papers and AGACNP samples
- NR 570 Week 1: Baseline Function Discussion Post
- NR 570 Week 2: Bowel Obstruction Case Paper
- NR 570 Week 4: Admission Note Critique
- NR 570 Week 5: Progress Note Sequence
- NR 570 Week 6: Discharge Summary Draft
- NR 570 Week 7: Supervised Encounter Write-up
- NR 570 Week 8: Common Case Portfolio Piece
- NR 569 Week 3: Differential Narrowing Memo
- NR 567 Week 3: Nicardipine Titration Plan
NR 570 Week 3 questions, answered
What if the care matched the guideline completely?
That is a perfectly gradeable result and it does not shorten the assignment. A fully concordant record still needs every element listed, every match evidenced from the document, and a closing section on whether anything in the source went unaddressed. Sets with no unmatched rows usually still have unaddressed ones, and turning those up is what the closing rows reward.
Which guideline should the example cite?
The one your section names, if it names one. Where nothing is specified, a sample uses a current national recommendation from a recognized professional body, with the year attached so you can line it up against whatever your classroom expects. Samples are models of the form and are not clinical guidance for anyone.
Do I have to include the patient's real details?
No, and you should not. The rows need a presentation, an age band, the relevant history and what the record contained, none of which requires a name, a birth date or a site. A sample is written around a patient who does not exist, for exactly that reason. Check whether your section also bans direct quotation from a chart, since several do.
Where can I find a free NR 570 Week 3 sample paper?
The complete concordance write-up comparing a bowel obstruction admission with the Bologna guidelines, including the three-answer table, is published on this page.
What is the third category in the NR 570 Week 3 concordance table?
Elements the record never raised, such as a time limit on nonoperative care, which would otherwise be forced into matched or unmatched without evidence.