| Course | NR 570 Common Diagnosis and Management in Acute Care Practicum |
|---|---|
| Week | 5 |
| Paper type | Progress note sequence |
| Length | About 1,140 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 5
Three Progress Notes, Hospital Days 2 to 4: Adhesive Small Bowel Obstruction Resolving After a Contrast Challenge, Written in One Format Each Morning
Student Name
College of Nursing, Chamberlain University
NR 570: Common Diagnosis and Management in Acute Care Practicum
Instructor Name
Month Day, Year
Three Progress Notes, Hospital Days 2 to 4: Adhesive Small Bowel Obstruction Resolving After a Contrast Challenge, Written in One Format Each Morning
Progress Note 1: Hospital Day 2, 08:15
Where this sits: hospital day 2, about 14 hours after admission and 13 hours of nasogastric decompression; contrast challenge given at 06:00 today.
Subjective: The patient slept in short stretches. Pain is now a dull ache, 4 of 10, down from 7 overnight. Still no flatus. Feels thirsty but not nauseated.
Objective: Temperature 37.2 C, pulse 92, pressure 146/84, saturation 96% on room air. Nasogastric output 1,850 mL since insertion, bilious, last 4 hours 300 mL. Urine 640 mL overnight. Abdomen distended, less tense than last evening; tenderness mild and unchanged; no guarding or rebound. Creatinine 1.3, down from 1.6. Potassium 3.6 after replacement. Glucose 132 to 176 overnight. White count 9.4. Unchanged: no fever, no peritoneal signs.
Overnight: one page at 02:10 for a pressure of 194/100 with pain; the tube was found kinked, was flushed and returned 400 mL; repeat reading 162/88 at 03:30.
Assessment: Adhesive small bowel obstruction, improving clinically on decompression, without signs of strangulation. Kidney injury improving with fluid. The overnight rise in pressure to 194/100 was driven by pain and a blocked tube and settled after the tube was flushed; no antihypertensive was given.
Plan: Plain abdominal film at 14:00, eight hours after contrast; contrast reaching the colon predicts that the obstruction will resolve without surgery (Ceresoli et al., 2016). If contrast remains in the small bowel at that film, discuss with surgery today. Continue fluids at the current rate; recheck electrolytes and creatinine tomorrow morning. Lisinopril, metformin and ibuprofen remain held. Walk the hall twice today with the tube clamped. If fever, a rising pulse, constant rather than cramping pain, or tenderness with guarding appears at any point, call surgery at once, since those would suggest strangulation. Next review: after the 14:00 film.
Progress Note 2: Hospital Day 3, 07:50
Where this sits: hospital day 3; 18 hours after contrast was seen in the right colon on the 14:00 film; flatus first passed at 19:30 yesterday.
Subjective: Passed gas several times overnight and a small soft stool at 05:00. Pain 2 of 10. Asking for something to drink.
Objective: Temperature 36.9 C, pulse 84, pressure 152/88, saturation 97% on room air. Nasogastric output 210 mL in the last 12 hours, now clear. Urine 1,400 mL in 24 hours. Abdomen soft, mildly distended, nontender; bowel sounds present at normal pitch. Creatinine 1.1. Potassium 3.9. Glucose 118 to 154. Unchanged: no fever, no tenderness on deep palpation.
Assessment: Adhesive small bowel obstruction, resolving. The contrast challenge was positive in the useful sense, and the clinical course has followed it. Kidney function is back at baseline. Pressure is rising toward the patient's usual range now that pain has eased; still below a level that needs treatment in hospital. The one thing to watch now is tolerance of liquids after the tube comes out; vomiting after removal would mean the obstruction has not fully cleared and the tube may need to go back.
Plan: Remove the nasogastric tube this morning. Clear liquids at noon if no nausea after removal; advance to full liquids this evening if tolerated. Reduce intravenous fluid to a low rate once intake is above 1 liter. Restart lisinopril at the home dose tomorrow if creatinine holds. Walk three times today, unclamped and untethered. Physical therapy to assess before discharge. Glucose checks continue every six hours while intake is liquid, with correction insulin only. Next review: this afternoon, after the first liquids.
Progress Note 3: Hospital Day 4, 08:05
Where this sits: hospital day 4; 24 hours since the nasogastric tube was removed; on full liquids since last evening.
Subjective: No nausea or vomiting since the tube came out. Ate a full liquid dinner and breakfast. Two soft stools. Wants to go home. Walking to the bathroom feels normal; the stairs at home are the patient's main worry.
Objective: Temperature 36.8 C, pulse 80, pressure 156/86, saturation 97% on room air. Intake by mouth 1,600 mL in 24 hours. Abdomen soft, not distended, nontender. Creatinine 1.0. Glucose 122 to 168 on liquids. Physical therapy note from yesterday: walked 150 meters without an aid, managed one flight of stairs with a rail. Unchanged: no fever since admission.
Assessment: Adhesive small bowel obstruction, resolved without surgery. Kidney injury resolved. Function close to the baseline the patient described on admission, with stairs the one activity still slower. Incidental lung nodule from the admission CT not yet addressed.
Plan: Soft diet at lunch; if tolerated, discharge this afternoon. Restart lisinopril today. Restart metformin tomorrow morning with the creatinine at baseline. No ibuprofen; acetaminophen and a topical anti-inflammatory gel for the knees. Discharge summary to name the owner of the lung nodule follow-up and the kidney recheck. Discharge teaching with the neighbor present, covering the warning signs that mean a return visit. Next review: after lunch, before discharge.
Notes on the Sequence
Two decisions in the sequence depended on carrying a number forward. Lisinopril was held on day 1 because of the creatinine, so each note restates the creatinine and the plan for the drug in the same place, and the restart happens in the note where the value reaches baseline. The contrast challenge was given on day 2, so the eight-hour film is named in note 1 with a time, and its result opens note 2. A reader who skipped note 1 could still follow note 2, because note 2 places itself by the hours since the film rather than by pointing back to the earlier note.
The three notes use the same headings in the same order, and the objective block carries the same items each day: temperature, pulse, pressure, tube output, urine, abdomen, creatinine, potassium and glucose. A reader can run down any one item across the three mornings without searching. The phrase "unchanged" appears in each note, attached to named findings, because a finding left off the page reads as a finding never checked. The problem name changes from "improving" to "resolving" to "resolved" only when the facts underneath it changed. Weed (1968) argued that a record organized by problems lets a reader follow the reasoning, not just the events, and the format here is a small version of that idea. Each note was written fresh; nothing was copied forward from the day before, in line with recommendations on safe use of copy and paste in the electronic record (Tsou et al., 2017).
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
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
Weed, L. L. (1968). Medical records that guide and teach. New England Journal of Medicine, 278(11), 593-600. https://doi.org/10.1056/NEJM196803142781105
What the NR 570 Week 5 assignment asks for
For Week 5, sections usually want a short series of daily progress notes on one patient, about a page each, in the format your section names. Each note should place itself in the episode: hospital day, time into treatment and time since the last change. The objective block should carry the same items each day so a reader can follow them, and items that did not change should be stated, not omitted. The assessment is argued again daily, and the problem name changes only when the facts do. Plans need an interval: what happens today, what is checked next and when. Some sections want a brief note on how the series fits together.
Inside the NR 570 Week 5 example
The sample gives three notes, at 08:15 on day 2, 07:50 on day 3 and 08:05 on day 4. Each begins with a line placing it in time, such as the hours since decompression began or since the contrast film. Subjective and objective blocks follow, with the same nine objective items and an unchanged line naming what was checked and stable. The first note records an overnight page. Assessments move from improving to resolving to resolved as the facts change. Plans give a next review time and specific triggers, such as when to call surgery. A closing section explains the consistent format and how creatinine and the film result were carried forward. Each note stands alone and still reads as part of the series.
NR 570 Week 5 rubric: what full points look like
A middle note that could be removed without loss is the costliest problem, so each note here depends on the one before. Leaving out findings that did not change costs nearly as much, since a marker cannot tell an omission from a stable result; this sample writes unchanged beside named findings. Notes that never place themselves in the episode lose a row, which the opening line in each note answers. Plans without an interval lose points in every note, so each plan here ends with a next review. Consistent problem names earn credit, and the shift from improving to resolved happens only with new facts. The closing section supports the series criterion.
Common NR 570 Week 5 mistakes, and how to avoid them
Weak NR 570 Week 5 submissions copy the same note forward with small edits, so nothing ties one day to the next. Others drop findings that did not change, which reads as never checking them. Many notes carry a date but never say where in the episode they sit. Plans without a time to review are common. Different names for the same problem across days confuse markers. Long subjective sections can crowd out assessment. If your patient's course differs, send the days you need and the format your section uses; a sequence can be written in that format, placing each note in time and carrying the same items forward.
Get a NR 570 Week 5 example written to your instructions
Tell the desk how many notes the week wants, which note format your section uses, and a two-sentence outline of the episode. A custom set comes back inside 24-48h on a constructed patient, each note placed in its own day and readable against the others. Free the first time.
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 4: Admission Note Critique
- 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 5: Diagnostic Test Rationale
- NR 567 Week 5: ICU Sedation and Analgesia Plan
NR 570 Week 5 questions, answered
How many notes does the week want?
Three is common and some sections ask for two or four, so build to what your classroom shows. The count matters less than the relationship between them. A set of four that never refers backward is worth less than a set of two where the second was clearly written after somebody read the first one properly.
Nothing changed on day two. What do I write?
You write that, and you write what you looked at in order to be able to say it. A day without news is ordinary in a frequent presentation and the rubric expects it documented rather than skipped. The failure is an empty note, not a slow day, and a note recording stability by name still earns its row.
Do the notes have to follow the same patient?
Almost always, since the point of a run is one episode carried forward. If your section allows separate patients, the rubric usually shifts toward comparing the quality of each note instead, which is a different assignment with different rows. Tell the desk which version your classroom is running and the example gets built for that one.
Where can I find a free NR 570 Week 5 sample paper?
All three daily notes for the patient with a resolving bowel obstruction are published on this page, along with the section explaining how the series fits together.
Why does the NR 570 Week 5 note write unchanged instead of leaving findings out?
A finding missing from a note looks like a finding never checked, so naming stable items, such as no fever, shows they were examined each morning.