| Course | NR 571 Complex Diagnosis and Management in Acute Care Practicum |
|---|---|
| Week | 6 |
| Paper type | Goals of care record |
| Length | About 930 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 6
Goals of Care Record, Hospital Day 2: A Conversation About Breathing Support for a Patient With Myasthenia Gravis Whose Strength Is Falling During Pneumonia
Student Name
College of Nursing, Chamberlain University
NR 571: Complex Diagnosis and Management in Acute Care Practicum
Instructor Name
Month Day, Year
Goals of Care Record, Hospital Day 2: A Conversation About Breathing Support for a Patient With Myasthenia Gravis Whose Strength Is Falling During Pneumonia
Date, Time and Setting
Hospital day 2, 14:30, in the patient's room on the acute care unit. Conversation lasted about 35 minutes. The patient was seated upright and able to speak in full sentences throughout, with mild nasal quality to the voice.
Why the Conversation Was Held Now
The patient has generalized myasthenia gravis and was admitted with pneumonia. Its bedside breathing measures have dropped since admission: a count on one breath of 17 where it was 22, and a vital capacity of 1.5 liters where it was 1.9. Immune globulin started this morning. If the weakness continues, breathing support may be needed within days, and the team wanted the patient's wishes known before any emergency.
Participants
The patient, who has decision-making capacity for this discussion, assessed by the attending physician before the conversation began. The patient's spouse of 44 years, present at the patient's request. The patient's daughter, present by video call, named by the patient as the health care agent on a document signed three years ago; a copy is now in the chart. The attending physician, who led the conversation. The acute care nurse practitioner student, who recorded this note. The bedside nurse, present for the first 15 minutes.
What the Patient Understood Before We Began
Asked what the patient knew about the current situation, the patient said: "The pneumonia's made my myasthenia act up. My eyelids are bad and I'm coughing on water. They said my breathing numbers are down."
The Question, as It Was Put
The attending physician said: "Sometimes when myasthenia gets worse, the breathing muscles get too weak for a while. If that happened, we could help with a mask that pushes air in, or with a breathing tube and a machine until the medicines work, often a week or two. Some people want that, and some don't. If your breathing got that weak, what would matter most to you?"
The Patient's Answer, in the Patient's Words
"I'd take the tube for a while if it gets me back to my garden. I've seen what that medicine can do; I had a bad spell the year I was diagnosed and I came all the way back. But if it's the end of the road, if I'm not going to come back to myself, then no. I don't want to be kept going on a machine."
Asked what "come back to myself" meant: "Walking around the yard. Knowing my grandkids. Eating at my own table."
Asked about the heart stopping: "If my heart stops, let it. That's different. That's not the myasthenia, that's just the end."
Options Discussed
Mask ventilation through the nose and mouth, noninvasive. Accepted. Reason given: "If it helps me avoid the tube, yes."
A breathing tube and mechanical ventilation for myasthenic crisis. Accepted, as a time-limited trial. Reason given: the patient recovered from a previous episode and expects to recover again.
Tracheostomy if ventilation became prolonged. Set aside for now. Reason given: "Ask me again if it comes to that, and ask my daughter if I can't answer."
A gastrostomy tube for long-term feeding. Declined. Reason given: "Not unless there's a real chance I'll eat on my own again. I don't want to live on a tube."
Cardiopulmonary resuscitation if the heart stops. Declined. Reason given: the patient sees cardiac arrest as separate from the myasthenia and as the natural end of life.
What the Family Said
The spouse said the patient's account matched past conversations. The daughter agreed to act as the health care agent and asked that, if a decision about tracheostomy arose while the patient could not speak, the team call her first. Neither raised a disagreement.
Decision Recorded
Code status: do not attempt resuscitation; intubation and mechanical ventilation are acceptable for myasthenic crisis or respiratory failure; noninvasive ventilation acceptable. The order was entered at 15:20 as "DNR, okay to intubate," with the explanation copied to the order comments. The health care agent document is scanned to the chart.
Review Points
Revisit if: the patient is intubated for more than 10 days without clear improvement; a tracheostomy or long-term feeding tube is being considered; the patient's capacity changes; or the patient asks to talk again. The next routine review is at discharge, when the outpatient neurologist and the primary care clinician will receive this record. Research on serious illness conversations supports revisiting goals as the illness changes rather than treating one conversation as final (Bernacki & Block, 2014).
Sources Used to Shape the Conversation
The structure of the conversation, beginning with what the patient understood, then asking about goals and what mattered most before discussing specific treatments, follows the serious illness communication practices reviewed by Bernacki and Block (2014). The description of crisis as a usually reversible event, from which most patients recover with treatment, follows a review of myasthenia gravis (Gilhus, 2016). The importance of recording a time-limited trial, rather than a simple yes or no to intubation, reflects the guiding principles for the care of older adults with several conditions, which emphasize patient preferences and prognosis in decisions (American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity, 2012).
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
Bernacki, R. E., & Block, S. D. (2014). Communication about serious illness care goals: A review and synthesis of best practices. JAMA Internal Medicine, 174(12), 1994-2003. https://doi.org/10.1001/jamainternmed.2014.5271
Gilhus, N. E. (2016). Myasthenia gravis. New England Journal of Medicine, 375(26), 2570-2581. https://doi.org/10.1056/NEJMra1602678
Reading the NR 571 Week 6 instructions
The Week 6 assignment asks you to record a goals of care conversation in note form, with short labeled blocks. Participants are listed by role and relationship, and any surrogate is identified as such. The question put to the patient should be reproduced as it was asked, because the answer depends on its wording. The patient's position belongs in the patient's own vocabulary, not translated into clinical terms. Options discussed, including those set aside, should be listed with the reason given for each. Most rubrics also want the decision recorded, any orders entered and the circumstances that would prompt a review.
How the NR 571 Week 6 example is put together
The sample opens with date, time, place and why the conversation was held now, based on falling breathing numbers. Participants include the patient with capacity, the spouse, the daughter as named agent, the attending, the student and the nurse. The patient's understanding comes first in the patient's words. The question appears in full as asked. The answer about the garden, the grandchildren and the family table is kept verbatim. Five options are listed with reasons, from mask ventilation to resuscitation. The family's view, the recorded decision and the order wording follow, and review points close the note with sources for the approach.
Where the points sit in the NR 571 Week 6 rubric
Credit is concentrated on fidelity: the question and the answer reproduced rather than summarized. A record that translates the patient's words into clinical phrases loses its most important row. Listing participants with roles and the surrogate's status satisfies the documentation criterion. Options set aside need their reasons, and this sample gives one for each. A decision recorded in the patient's own terms, here a time-limited trial accepted and resuscitation declined, scores higher than a code status alone. Review points that name specific circumstances fill the final criterion. Note form, not essay form, is often marked as part of professional documentation. Including how capacity was assessed, and by whom, protects the record if the decision is questioned later.
NR 571 Week 6 help: mistakes that cost points
Weak NR 571 Week 6 records read like reflections about how the conversation felt. Others summarize the question, so the answer loses its meaning. Many translate the patient's words into clinical terms, which removes the evidence. Records often list only the chosen option, without the ones set aside. Some give a code status with no explanation, which later readers may misread as refusing all treatment. If you have notes from a real or simulated conversation, send them with the participants' roles; a record can be formatted with each block answering one question. Record who was present and in what role, and identify the surrogate clearly. Write the order wording exactly as entered, so it can be matched to the chart.
Get a NR 571 Week 6 example written to your instructions
Forward the documentation form your section uses, or the case the assignment supplies, and an example written into that form arrives inside 24-48h, free the first time. Say which problems are already on the list and the sample will show the closing block doing its work on them.
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 3: Problem List Prioritization
- NR 571 Week 4: Competing Treatment Analysis
- NR 571 Week 5: Comorbidity Conflict Brief
- NR 571 Week 7: Rounds Case Brief
- NR 571 Week 8: Concurrent Problem Synthesis
- NR 570 Week 6: Discharge Summary Draft
- NR 569 Week 6: Clinical Reasoning Journal
- NR 567 Week 6: Empiric Antibiotic Rationale
NR 571 Week 6 questions, answered
Is a goals of care record a reflection?
No, and writing it as one is the commonest structural mistake this week. A reflection is about the writer; this document is about what was said and what follows from it. Where your section attaches a short reflective piece, keep it separate and underneath, so the record itself stays readable as documentation by somebody who was not present.
The patient did not decide anything. Is that a problem?
Not at all, and an undecided record is often the more interesting document. What gets written is what was asked, what the patient wanted to think about, who else they wanted in the conversation, and when it resumes. An assignment marking this week is looking for the exchange and its consequences, not for a resolution that did not occur.
Does the record need a formal decision-making framework?
Only where the assignment names one. Left open, the four blocks carry the marks by themselves: who was present, what was put, what came back, what changes. A framework imported for effect tends to push the patient's own words into a category heading, which is the opposite of what this week is built to reward.
Where can I find a free NR 571 Week 6 sample paper?
The full goals of care record for the patient with myasthenia gravis, with the question as asked and the answer in the patient's own words, is on this page.
What code status is recorded in the NR 571 Week 6 example?
Do not attempt resuscitation, with intubation and noninvasive ventilation acceptable for a myasthenic crisis, entered as DNR, okay to intubate, with the reason in the comments.