| Course | NR 570 Common Diagnosis and Management in Acute Care Practicum |
|---|---|
| Week | 4 |
| Paper type | Admission note critique |
| Length | About 1,170 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 4
Admission Note Critique: Quoting Each Block of a Night Team's Note for Bowel Obstruction and Writing the Line That Should Replace It
Student Name
College of Nursing, Chamberlain University
NR 570: Common Diagnosis and Management in Acute Care Practicum
Instructor Name
Month Day, Year
Admission Note Critique: Quoting Each Block of a Night Team's Note for Bowel Obstruction and Writing the Line That Should Replace It
The Note and the Method
The note under review was written at 23:30 by the night admitting team for a 74-year-old with an adhesive small bowel obstruction. It is a composite drawn from notes I read during my placement, and nothing here identifies a patient or a clinician. I take the note block by block in its own order. For each block I quote the line as it stands, say in a sentence what a reader looks for there, and give a replacement. Where a block is complete, I say so.
Chief Complaint
As written: "Abdominal pain, N/V."
What a reader looks for: the complaint in time, so the urgency is visible.
Replacement: "Crampy periumbilical pain for 30 hours, bilious vomiting since last evening, no flatus for 20 hours."
History of Present Illness
As written: "74 y/o with h/o HTN, DM presenting with abd pain and vomiting x1 day. Pain is crampy. Has not had BM. CT shows SBO."
What a reader looks for: onset, the last flatus and stool, and the prior operations that make adhesions likely.
This block contradicts itself elsewhere. The assessment later says vomiting for two days, and the emergency note says it began the previous evening. A reader cannot tell which is right. The surgeries that explain the diagnosis are not mentioned at all.
Replacement: "Pain began about 30 hours before arrival, around the navel, in waves every few minutes. Vomiting started the same evening, six episodes, bilious by morning. Last stool 36 hours ago; no flatus for about 20 hours. No hematemesis, fever or new medicines. Prior abdominal surgery: appendectomy at 19; hysterectomy at 39, open, lower midline cut."
Medications
As written: a list of three home medicines, each followed by "continue."
What a reader looks for: a decision on each medicine for a patient who cannot eat and has kidney injury.
Replacement: "Lisinopril 20 mg daily: hold, acute kidney injury. Metformin 500 mg twice daily: hold, kidney injury, intravenous contrast and nothing by mouth. Ibuprofen 400 mg most days, over the counter: stop, kidney injury; discuss knee pain plan before discharge." The ibuprofen was not on the original list; it came from asking the patient directly. A copied list with "continue" beside every drug is the kind of entry that copy-and-paste practices are meant to catch (Tsou et al., 2017).
Social and Functional History
As written: "Lives alone. Independent."
What a reader looks for: what the person could actually do two weeks ago, in activities.
Replacement: "Lives alone, second-floor apartment, no elevator. Most mornings walks roughly a mile; drives; sets up own weekly pillbox. Neighbor checks in most evenings. Former smoker, quit at 50; no alcohol." The smoking history also matters later, because it changes the follow-up of the lung nodule. The function line is what a later reader will measure decline against, and older adults often leave the hospital less able than they arrived (Covinsky et al., 2003).
Examination
As written: "Abd distended, TTP, no rebound. Hernia neg."
What a reader looks for: findings that rule strangulation in or out, and where a hernia was sought.
This block is mostly complete. "No rebound" is the key negative, and "hernia neg" records a search. The replacement only adds where: "Distended and tympanic, high-pitched bowel sounds, mild diffuse tenderness without guarding, rebound or rigidity. Healed lower midline scar. No hernia at the umbilicus, either groin or the incision."
Data
As written: "Labs reviewed. CT: SBO."
What a reader looks for: the values that drive decisions, and the CT details that determine whether surgery is needed.
Replacement: "Creatinine 1.6 (baseline 1.0 in the spring), potassium 3.3, bicarbonate 29, white count 11.2, glucose 188; lactate not drawn in the emergency department, ordered. CT: small bowel dilated to 3.6 cm, transition point right lower quadrant, normal wall enhancement, small interloop fluid, no free air or pneumatosis. Incidental 7 mm solid nodule, right lower lobe." The CT line as written could describe any obstruction; the features that rule out strangulation are what justify nonoperative care.
Assessment and Plan
As written: "SBO. NPO, NGT, IVF, surgery consult. DM: SSI. HTN: continue home meds."
What a reader looks for: internal agreement with the rest of the note, and a plan that knows what would change it.
This block conflicts with the medication block, which was itself wrong, and with the patient's kidney injury. "Continue home meds" for blood pressure would restart lisinopril. The plan also has no point at which the approach would change.
Replacement: "1. Adhesive small bowel obstruction without signs of strangulation: nothing by mouth, nasogastric tube to low intermittent suction, balanced crystalloid, surgery consulted tonight; water-soluble contrast challenge after decompression; reassess for surgery if no improvement by about 72 hours or any sign of strangulation (ten Broek et al., 2018). 2. Acute kidney injury, prerenal with ibuprofen and lisinopril: hold both, fluids, recheck in the morning. 3. Hypokalemia: replace intravenously, recheck in 6 hours. 4. Type 2 diabetes: metformin held, glucose every 6 hours with correction insulin. 5. Incidental lung nodule: for discharge summary and follow-up."
Internal Agreement Across Blocks
Three conflicts run between blocks, and none of them is visible if each block is read alone. The history gives one day of vomiting while the assessment gives two. The medication block continues lisinopril while the data block reports a creatinine of 1.6. The plan orders correction insulin while the medication block continues metformin. A reader trying to act on this note at 03:00 would have to decide which block to believe. The replacement wording above removes all three, but the general fix is a habit: read the assessment and plan last, against every block above it, before signing. In a note written at the end of a long admitting shift, that check takes about a minute and catches the conflicts that matter most.
What the Note Already Does Well
The examination block is close to complete and records the most important negatives. The surgical consult was placed on the night of admission, which is early and correct. The note is short, which is not a fault in itself; the problem is what was left out, not the length.
Ranked Closing
If the writer could fix only three things, in this order: first, add the prior abdominal surgeries, because they are the basis of the diagnosis; second, replace "continue" with a decision on each medicine, because one of them was harming the kidneys; third, add the point at which the nonoperative plan would be reconsidered. Contradictory timelines and a one-word functional history follow. These are documentation fixes; this critique makes no claim about the care itself, which went well.
References
Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L., Kresevic, D., Burant, C. J., & Landefeld, C. S. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. Journal of the American Geriatrics Society, 51(4), 451-458. https://doi.org/10.1046/j.1532-5415.2003.51152.x
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
Tsou, A. Y., Lehmann, C. U., Michel, J., Solomon, R., Possanza, L., & Gandhi, T. (2017). Safe practices for copy and paste in the EHR: Systematic review, recommendations, and novel model for health IT collaboration. Applied Clinical Informatics, 8(1), 12-34. https://doi.org/10.4338/ACI-2016-09-R-0150
NR 570 Week 4 instructions, in plain terms
The Week 4 critique asks you to review an admission note, usually supplied by your section or taken from your rotation with identifiers removed. Expect five to seven pages organized by the note's own blocks, not by the rubric. For each block, quote the line as written, explain briefly what a reader needs from that block and give a replacement specific enough to use. Prompts often stress that missing information matters more than poor wording. Most rubrics also ask whether the blocks agree with each other, what the note does well and which fixes matter most. Comments on the clinical care itself usually fall outside the assignment.
Inside the NR 570 Week 4 example
The example states its method, then works through chief complaint, history, medications, social and functional history, examination, data and the assessment and plan. Each block quotes the original, gives one sentence on what a reader looks for and offers replacement wording. The history block finds the operations that explain the diagnosis missing. The medication block finds "continue" beside drugs that were harming the kidneys, and the functional block replaces "independent" with activities. A separate section lists three conflicts between blocks. The examination block is called nearly complete. The ranked closing names the three fixes that matter most and notes that the care itself went well.
NR 570 Week 4 rubric: what full points look like
In this critique, marks follow the replacements. A page of adjectives with no new wording earns little, because the writer has nothing to act on. Absences are worth more than errors, so the missing surgeries and the missing ibuprofen are the heaviest findings here. Quotations must reproduce the note exactly for the findings to stand. Agreement between blocks is often its own criterion, and the separate section on three conflicts meets it. Credit for balance goes to saying what the note does well. A ranked closing earns the final row, and staying with documentation rather than clinical judgment keeps the critique inside its boundary. Specific wording that could be pasted in is what separates a strong critique from a weak one.
NR 570 Week 4 help from the desk
Critiques for NR 570 Week 4 most often rate each block without offering replacement wording. Another frequent problem is finding what is wrong and missing what is absent, which is the smaller half of the job. Some critiques drift into judging the clinical decisions rather than the record. Paraphrasing the note instead of quoting it weakens every finding. A critique with no positives reads as rushed. An unranked list of faults leaves the reader unsure where to start. If your section supplies a different note, send it with any template you were given; a critique can be prepared that quotes each block, replaces it and ranks the fixes. Quote first, then replace.
Get a NR 570 Week 4 example written to your instructions
Attach the note your classroom supplied, or list the blocks it contains, along with the rubric and the word count. A custom critique comes back inside 24-48h with quoted lines, replacement wording underneath each one and a ranked closing list. The first is free, and if your section publishes a critique form the example is built inside it.
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 3: Guideline Concordance Write-Up
- 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 4: Discriminating Feature Brief
- NR 567 Week 4: Septic Shock Vasopressor Write-Up
NR 570 Week 4 questions, answered
Do I critique the care or the documentation?
The documentation. This assignment is about a record and whether it carries what its next reader needs, so comments about what should have been done clinically fall outside the rubric rows and often cost marks. Where the content raises a documentation question, such as a plan item appearing with no assessment behind it, write it up as a documentation finding.
The note we were given looks fine to me.
Then the assignment is working as intended. Notes supplied for critique are usually competent and under-written in two or three specific places, which is what makes finding the gaps a marked skill. Work block by block against what each one is supposed to contain, and the thin spots turn up in the fields nobody enjoys filling.
Can I critique a note I wrote myself?
Some sections allow it and some supply the document, so check before you start. If you use your own, treat it on the page as though somebody else wrote it: quote it, find its absences and write the replacement lines without defending the original. Strip identifiers first, and keep comment about the visit itself out of the critique.
Where can I find a free NR 570 Week 4 sample paper?
Read the full critique of the bowel obstruction admission note here, block by block, with each original line and its replacement.
What is the most important finding in the NR 570 Week 4 critique?
The missing prior abdominal surgeries, because they are the basis of the adhesive obstruction diagnosis, followed by a medicine list that continued drugs harming the kidneys.