| Course | NR 570 Common Diagnosis and Management in Acute Care Practicum |
|---|---|
| Week | 6 |
| Paper type | Discharge summary draft |
| 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 6
Discharge Summary Draft for a Four-Day Stay With Adhesive Small Bowel Obstruction: Medication Changes, a Lung Nodule With a Named Owner and the Symptoms That Should Bring the Patient Back
Student Name
College of Nursing, Chamberlain University
NR 570: Common Diagnosis and Management in Acute Care Practicum
Instructor Name
Month Day, Year
Discharge Summary Draft for a Four-Day Stay With Adhesive Small Bowel Obstruction: Medication Changes, a Lung Nodule With a Named Owner and the Symptoms That Should Bring the Patient Back
Admitted With, and How Long
Admitted for four days with an adhesive small bowel obstruction that resolved without surgery. Discharged home on hospital day 4.
Medicines That Changed, and Why
Restarted at home doses: lisinopril 20 mg daily, restarted on day 4 after an acute kidney injury resolved; metformin 500 mg twice daily, to restart the morning after discharge now that creatinine is back to 1.0.
Stopped: ibuprofen 400 mg, taken over the counter on most days for knee pain. It contributed to the kidney injury on admission and should not be resumed.
New: acetaminophen 650 mg as needed for the knees, no more than three doses a day; diclofenac gel to each knee up to four times a day.
Unchanged: no other home medicines.
Items Still Outstanding, and Who Owns Them
1. Lung nodule. The admission CT found a 7 mm solid nodule in the right lower lobe. The patient smoked until age 50, which places the patient in the higher-risk group. For a solid nodule of 6 to 8 mm in a higher-risk patient, the Fleischner Society recommends CT at 6 to 12 months and again at 18 to 24 months (MacMahon et al., 2017). Owner: the primary care clinician, who has been sent this summary and called directly. The patient knows about the nodule and that it is most likely harmless but needs a follow-up scan.
2. Kidney function. Creatinine rose from a spring baseline of 1.0 to 1.6 on admission and returned to 1.0 by discharge. Owner: the primary care clinician, to recheck creatinine and potassium at the 7-day visit, since lisinopril and metformin have just restarted.
3. No laboratory results are pending at discharge. A review of discharge communication found that test results pending at discharge were missing from 65% of summaries (Kripalani et al., 2007), so this line states the absence explicitly.
Problems Addressed During the Stay
Adhesive small bowel obstruction: resolved without surgery; tolerating a soft diet with normal stools at discharge. Acute kidney injury: prerenal, from vomiting with ibuprofen and lisinopril; creatinine 1.6 at its peak, 1.0 at discharge. Low potassium: 3.3 on arrival, replaced, 3.9 by day 3. Type 2 diabetes: metformin held for four days; glucose ranged from 118 to 188 on correction insulin; no low readings. Elevated blood pressure: one overnight reading of 194/100 with pain on day 1, not treated with medicine; 156/86 on the morning of discharge before lisinopril was restarted.
Appointments and Their Purpose
Primary care, within 7 days: recheck creatinine and potassium; review blood pressure on lisinopril; review knee pain on the new plan; arrange the nodule CT.
General surgery clinic, in 3 to 4 weeks: discuss the risk of another adhesive obstruction and what to do if symptoms return. No operation is planned.
Reasons to Come Back
The patient and neighbor were told, and given in writing, to return or call 911 for any of the following: crampy belly pain that comes in waves and does not settle within a few hours, vomiting more than twice, no gas or stool for a day, a swollen or hard belly, fever, or any blood in vomit or stool.
Diet and Activity
Soft, low-fiber foods for the first week, eaten in small portions, then a return to the usual diet. Fluids of at least six to eight cups a day unless told otherwise. Walking is encouraged from today, starting with the usual morning route at a shorter distance and building back up over one to two weeks. Driving can resume once the patient feels steady and is not taking any medicine that causes drowsiness.
Who Was Told What
The patient and the neighbor received the medication changes, the return symptoms and the appointment plan in writing and went over them with the discharging nurse. The primary care office was called on day 4 at 14:10, and the office nurse took a verbal summary including the nodule and the creatinine recheck. The surgical clinic referral was placed electronically. The patient was told that the lung nodule is most likely harmless and that the follow-up scan is a routine precaution.
The Stay, Briefly
The patient arrived after a day and a half of cramping abdominal pain with vomiting and no passage of gas. On CT the small bowel was distended down to a point low in the right abdomen, with no sign of strangulation; the likely cause is adhesions from an appendectomy and an open hysterectomy decades ago. Management was nonoperative: nothing by mouth, nasogastric decompression, intravenous fluid and potassium, and, on day 2, diatrizoate given through the tube, which had reached the colon by the eight-hour film. Surgery was consulted on the night of admission. Flatus returned on day 2, the tube came out on day 3 and a soft diet was tolerated on day 4. On the first night, pressure rose to 194/100 with pain and a blocked tube; it settled after the tube was flushed and no blood pressure medicine was given. The acute kidney injury resolved with fluids and stopping ibuprofen and lisinopril. Diabetes was managed with correction insulin while metformin was held.
Function at Discharge
Before admission the patient lived alone on a second floor, walked about a mile most mornings, drove and managed medicines independently. At discharge the patient walked 150 meters without an aid and climbed one flight of stairs with a rail, slower than usual. Physical therapy did not recommend home services or equipment, and judged the patient safe on the apartment stairs with the rail. The neighbor will check in daily for the first week. Recording both lines lets the next clinician see whether the patient is back to baseline at the 7-day visit; in older adults, a loss of function that is still present a month after discharge often persists (Boyd et al., 2008).
Written for a Stranger
This summary was drafted on day 4 for a primary care clinician who did not see the patient in hospital. The assessment wording was rewritten for discharge rather than copied from the last progress note, so it describes the patient as they are leaving rather than as they were on a particular morning. The headings follow the order a reader at the 7-day visit will need: what changed, what is still open and who owns it, then the story.
References
Boyd, C. M., Landefeld, C. S., Counsell, S. R., Palmer, R. M., Fortinsky, R. H., Kresevic, D., Burant, C., & Covinsky, K. E. (2008). Recovery of activities of daily living in older adults after hospitalization for acute medical illness. Journal of the American Geriatrics Society, 56(12), 2171-2179. https://doi.org/10.1111/j.1532-5415.2008.02023.x
Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., & Baker, D. W. (2007). Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA, 297(8), 831-841. https://doi.org/10.1001/jama.297.8.831
MacMahon, H., Naidich, D. P., Goo, J. M., Lee, K. S., Leung, A. N. C., Mayo, J. R., Mehta, A. C., Ohno, Y., Powell, C. A., Prokop, M., Rubin, G. D., Schaefer-Prokop, C. M., Travis, W. D., Van Schil, P. E., & Bankier, A. A. (2017). Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 284(1), 228-243. https://doi.org/10.1148/radiol.2017161659
NR 570 Week 6 instructions, in plain terms
The Week 6 assignment asks for a draft discharge summary under fixed headings, usually two to four pages. It opens with one line on what the patient was admitted with and how long they stayed. The forward half comes next: medicines that changed and why, results or items still outstanding with the person responsible, appointments with their purpose and the symptoms that should bring the patient back. Only after that does the hospital stay appear, kept short. Rubrics often reward a summary written for someone who never met the patient. Expect to rewrite assessment wording for discharge rather than copying the last progress note. Some sections also want function at discharge compared with the baseline from admission.
Inside the NR 570 Week 6 example
The draft opens with a single sentence on the four-day stay. Medicines follow in four groups, restarted, stopped, new and unchanged, each with its reason, including stopping over-the-counter ibuprofen. The outstanding items section gives the lung nodule a follow-up interval from the Fleischner Society and a named owner, adds a kidney recheck and states that nothing is pending. A problem list gives the status of each issue at discharge. Appointments carry purposes, return symptoms are listed in plain words, and diet and activity follow. The stay is summarized in one paragraph. A function section compares discharge with baseline, and a final section records who was told what.
Reading the NR 570 Week 6 grading rubric
The order of the summary is part of the mark, so a draft that opens with three paragraphs of admission history loses the rows that matter most. Medicines listed without saying which are new, stopped or changed lose the next criterion; this draft groups them with reasons. Every outstanding item needs an owner, and each one here has a named clinician and a time. Appointments need purposes. The summary should describe the patient at discharge rather than repeat earlier notes, which this one states openly. Comparing function at discharge with baseline, and recording who was told what, often earn communication points. Return symptoms in plain words help the patient and are often marked under education.
NR 570 Week 6 help from the desk
The most common NR 570 Week 6 problem is a summary that reads like a shortened admission note, with medicines and follow-up buried at the end. Medication lists without change markers or reasons come next. Outstanding results often appear without a responsible person. Appointment dates are given with no purpose. Many drafts copy the assessment from the last progress note, describing the patient on the wrong day. Return symptoms written in clinical terms may not help the patient. If your patient's discharge was more complex, send the medication changes and pending items; a draft can be organized with the forward half first and owners named.
Get a NR 570 Week 6 example written to your instructions
Send the week's instructions, the summary template your section publishes and a few lines about the episode, including what was still unresolved when it ended. A custom draft arrives inside 24-48h with the forward block built first and the account of the stay sized to fit around it. First one free, revisions included.
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 5: Progress Note Sequence
- NR 570 Week 7: Supervised Encounter Write-up
- NR 570 Week 8: Common Case Portfolio Piece
- NR 569 Week 6: Clinical Reasoning Journal
- NR 567 Week 6: Empiric Antibiotic Rationale
NR 570 Week 6 questions, answered
How much of the admission belongs in the summary?
Less than most drafts include. One line on what brought the person in and a short block on what happened is usually enough, because the rows carrying this document are the ones a reader acts on. Send your template and the example is built to its heading structure, with the proportions set by whichever blocks your rubric weights.
What if things were still unresolved at discharge?
That is the common case and the document is designed for it. Unfinished items get named as unfinished, with who is responsible and when an answer is expected. A summary claiming everything is settled while the record still shows results outstanding loses more than one stating the open items plainly and moving on.
Is a discharge summary different from a transfer note?
Yes, and sections sometimes assign one while naming the other. A transfer document is written for a team continuing active management and keeps more clinical detail. A discharge summary goes to somebody outside, so it carries instructions, changes and the appointment. Say which one your classroom means and the sample matches it.
Where can I find a free NR 570 Week 6 sample paper?
The full discharge summary draft for the bowel obstruction stay, with medication changes, owned follow-up items and return symptoms, is on this page.
Why does the NR 570 Week 6 summary say no results are pending?
Pending results are often missing from discharge summaries, so stating that none remain tells the next clinician the question was checked rather than forgotten.