| Course | NR 571 Complex Diagnosis and Management in Acute Care Practicum |
|---|---|
| Week | 3 |
| Paper type | Problem list prioritization |
| Length | About 920 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 571 Week 3
Problem List Prioritization on Hospital Day 2: Eight Entries for a Patient With Myasthenia Gravis and Pneumonia, Each With Its Place, Its Warrant and the Finding That Would Move It
Student Name
College of Nursing, Chamberlain University
NR 571: Complex Diagnosis and Management in Acute Care Practicum
Instructor Name
Month Day, Year
Problem List Prioritization on Hospital Day 2: Eight Entries for a Patient With Myasthenia Gravis and Pneumonia, Each With Its Place, Its Warrant and the Finding That Would Move It
How the List Is Built
This list was written at 09:00 on hospital day 2 for the 72-year-old with myasthenia gravis admitted with right lower lobe pneumonia. Active problems sit above carried problems. A carried problem is marked inactive rather than deleted, because it still shapes decisions. Each entry gives its rank, a sentence explaining why it sits there for this patient, and the finding that would move it up or down. Severity alone does not set a place; what matters is how much harm the problem can do in the next two days and how much the plan for it constrains the plan for everything else.
Active Problems
1. Myasthenia gravis, worsening, at risk of crisis.
Warrant: the patient now counts to 17 on one breath, against 22 last evening, and forced vital capacity has dropped by 0.4 liters to 1.5; the evening eyelid droop is now present by noon; respiratory failure would arrive faster than any other harm on this list.
Would move it: a vital capacity below about 1.2 liters, a single-breath count below 15 or a weaker cough would send the patient to intensive care; three stable sets of numbers after immune globulin would move it below the pneumonia.
2. Community-acquired pneumonia, right lower lobe, on ceftriaxone and doxycycline.
Warrant: it is the trigger for the myasthenic worsening, and the antibiotic regimen is a substitute for the guideline's preferred combinations, which cannot be used here (Metlay et al., 2019).
Would move it: a positive Legionella urinary antigen or no fall in fever by 48 hours would move it to first and reopen the antibiotic choice; defervescence and falling oxygen needs would move it down.
3. Swallowing difficulty with aspiration risk.
Warrant: coughing on thin liquids links problems 1 and 2, since aspiration would worsen the pneumonia and the swallow itself is a measure of the myasthenia.
Would move it: the speech-language pathology assessment this afternoon; a safe swallow for thickened liquids would move it down.
4. Atrial fibrillation with rapid rate, on home metoprolol and apixaban.
Warrant: the rate was 118 on arrival and 104 this morning, driven by fever; the plan deliberately avoids extra beta blocker doses because of the myasthenia (Sheikh et al., 2021).
Would move it: a rate above 130 or hypotension would move it up and force a choice among rate control drugs.
5. Hyperglycemia from infection on daily prednisone, metformin held.
Warrant: glucose ran from 198 to 262 overnight; it matters because high glucose slows infection control, but it is managed by insulin without affecting the other plans.
Would move it: any rise in the prednisone dose would move it up.
Holding Pattern
6. Chronic kidney disease, stage 3a, estimated filtration rate 52.
Warrant: it shapes doses and the choice of immune globulin product but is not itself changing; creatinine is stable at 1.2.
Would move it: a rise in creatinine after immune globulin, since products containing sucrose and large volumes are linked to kidney injury (Orbach et al., 2005).
7. Osteoporosis, alendronate held.
Warrant: the drug cannot be taken safely with impaired swallowing, and holding it for a few weeks carries little risk compared with the burden of giving it now; this is a deliberate hold, recorded so that it is not mistaken for an oversight.
Would move it: a normal swallow assessment, after which it returns before discharge or at the first clinic visit.
Carried and Inactive
8. Long-term prednisone use, inactive as a separate problem.
Warrant: the dose is unchanged at 10 mg daily, and its effects are captured under problems 1, 5 and 7.
Would move it: a decision by neurology to raise the dose would make it active again, with consequences for glucose and bone.
What Changed Since Admission
The order on the admission evening placed the pneumonia first and the myasthenia second. Overnight the bedside numbers fell, and this morning the order reversed. The pneumonia did not become less important; the myasthenia became more urgent, because its worst outcome is now closer than the pneumonia's. Both are being treated at once, but the order tells the team which set of numbers to watch first, and which consult answers first if both call.
Why Severity Alone Does Not Set the Order
If the list were ordered by how serious each disease is in general, atrial fibrillation with a history of stroke prevention might rank above the swallowing difficulty. It does not here, because the swallowing problem connects the two top problems and could turn a manageable pneumonia into an aspiration within hours, while the rate is improving with treatment of the fever. The guiding principles for older adults with several conditions ask clinicians to consider the interactions between conditions and treatments when setting priorities, not only each condition's severity, and that is the basis of this order (American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity, 2012). The order will be rewritten tomorrow morning with the same four elements, whatever the numbers show.
References
American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. (2012). Guiding principles for the care of older adults with multimorbidity: An approach for clinicians. Journal of the American Geriatrics Society, 60(10), E1-E25. https://doi.org/10.1111/j.1532-5415.2012.04188.x
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia: An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67. https://doi.org/10.1164/rccm.201908-1581ST
Orbach, H., Katz, U., Sherer, Y., & Shoenfeld, Y. (2005). Intravenous immunoglobulin: Adverse effects and safe administration. Clinical Reviews in Allergy & Immunology, 29(3), 173-184. https://doi.org/10.1385/CRIAI:29:3:173
Sheikh, S., Alvi, U., Soliven, B., & Rezania, K. (2021). Drugs that induce or cause deterioration of myasthenia gravis: An update. Journal of Clinical Medicine, 10(7), Article 1537. https://doi.org/10.3390/jcm10071537
Reading the NR 571 Week 3 instructions
The Week 3 assignment asks for a single-page problem list that shows your priorities. Each entry should name a problem rather than a lab value, give its place in the order, offer one sentence of warrant tied to this patient and state the finding that would move it up or down. Active problems sit above carried ones, and carried problems are marked inactive rather than deleted. Entries in a deliberate holding pattern should say so, with the reason. Most rubrics warn that severity alone does not justify a place, so be ready to explain the order in terms of interactions and timing. Some sections supply a table to fill in.
How this NR 571 Week 3 example is built
The sample begins with a short paragraph on how the list was built and what sets the order. Five active problems follow, from worsening myasthenia to hyperglycemia, each with a rank, a one-sentence warrant and a promote or demote finding with numbers. Two problems sit in a holding pattern: kidney disease, which shapes drug choices, and osteoporosis, whose drug is held while swallowing is unsafe. One carried entry, long-term prednisone, is marked inactive with the conditions that would reactivate it. A section explains why the top two swapped overnight, and a final section defends placing atrial fibrillation below the swallowing problem.
Where the points sit in the NR 571 Week 3 rubric
Each entry is marked on its four parts, so a list that names diagnoses without warrants or movement findings loses across every row. Problems named as lab values cost points; this sample names each as a clinical problem. The difference between active, holding and carried entries carries a criterion of its own, and the osteoporosis hold shows it. Most credit is earned by a warrant that belongs to this patient, not to the disease in general. Explaining why severity alone did not set the order answers the question rubrics most often ask, and noting the overnight change shows the list is a working document. A short note on how the order changed since admission shows the list is maintained, not written once.
NR 571 Week 3 help: mistakes that cost points
The most frequent NR 571 Week 3 error is a list of diagnoses in the order they appear in the chart. Another is naming a lab value, such as a low potassium, as a problem. Many lists delete stable problems instead of marking them inactive, which hides why they still matter. Warrants that would fit any patient with that disease lose credit. Lists without movement findings read as fixed rather than working. If your patient's problems differ, send the current list and recent results; a prioritized list can be written for your case, with a warrant and a movement finding for each entry. Write the movement finding as a number or an observable event whenever possible. A list that cannot tell a reader what would change it is a list of labels.
Get a NR 571 Week 3 example written to your instructions
Upload the rubric and whatever list template your classroom posted, and a worked example is built around your own patient's problems and returned inside 24-48h at no cost. Tell us which two problems you think belong at the top and the sample will show the warrant that separates them. Send the week's instructions too if your section wrote its own.
More NR 571 papers and AGACNP samples
- NR 571 Week 1: Multimorbidity Threshold Post
- NR 571 Week 2: Myasthenia and Pneumonia Case Paper
- NR 571 Week 4: Competing Treatment Analysis
- NR 571 Week 5: Comorbidity Conflict Brief
- NR 571 Week 6: Goals of Care Record
- NR 571 Week 7: Rounds Case Brief
- NR 571 Week 8: Concurrent Problem Synthesis
- NR 570 Week 3: Guideline Concordance Write-Up
- NR 569 Week 3: Differential Narrowing Memo
- NR 567 Week 3: Nicardipine Titration Plan
NR 571 Week 3 questions, answered
What goes at the top, the most dangerous problem or the most constraining one?
Both answers can be defended and the marking follows the defense, not the choice. What loses points is picking one and not saying why. If the constraining problem goes first, the warrant says which other managements it is holding up. If the dangerous one goes first, the warrant says what is being accepted elsewhere while it is handled.
How many items belong on the list?
Everything currently active, plus the carried conditions that change what the active ones can be given. Leaving a stable condition off because nothing is being done about it is a common error, since its presence is often the whole reason an item above it is ranked where it is. Length follows the patient rather than a target.
My classroom supplies a table. Does the reasoning still fit?
It fits, and it has to go in the cells rather than after them. A supplied table usually has a justification column that people fill with a phrase, and a phrase is where the marks stop. Write the sentence the column was built for, even where the box looks too small, and let the table grow to hold it.
Where can I find a free NR 571 Week 3 sample paper?
The full prioritized list for the patient with myasthenia and pneumonia, with eight entries and their warrants, is published on this page.
Why is osteoporosis in a holding pattern in the NR 571 Week 3 list?
Alendronate needs a full glass of water and 30 minutes upright, which is unsafe while swallowing is impaired, so it is held on purpose rather than forgotten.