| Course | NR 572 Advanced Acute Care Management |
|---|---|
| Week | 2 |
| Paper type | Rapid assessment write-up |
| Length | About 1,100 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 572 Week 2
Rapid Assessment Write-Up, 05:44 to 06:02: One Pass Across a Bradycardic, Hypotensive 77-Year-Old on a Medical Ward, With What Was Left Unexamined and Why
Student Name
College of Nursing, Chamberlain University
NR 572: Advanced Acute Care Management
Instructor Name
Month Day, Year
Rapid Assessment Write-Up, 05:44 to 06:02: One Pass Across a Bradycardic, Hypotensive 77-Year-Old on a Medical Ward, With What Was Left Unexamined and Why
Call and Arrival
05:40. Bedside nurse called the night acute care nurse practitioner and me: pulse 34, cuff pressure 76/42, in a 77-year-old admitted the afternoon before with three days of watery diarrhea. The patient is a composite drawn from my placement; no identifying details are included.
05:44. Arrived at the bedside with my preceptor. The nurse had already placed the patient flat, applied the defibrillator pads and called for the crash cart.
Earlier Observations From the Chart, Read at 05:44
22:00: heart rate 60, pressure 102/60, respiratory rate 18, alert.
02:00: heart rate 52, pressure 96/58, respiratory rate 18, "sleeping, rousable." The early warning score at 02:00 was 3; no call was made.
04:00: vital signs not recorded; the nurse notes the patient was asleep and a stool was cleaned at 04:10.
Read together, the rate had fallen by about 26 beats per minute and the systolic pressure by about 26 mm Hg over eight hours before the call. That trend, rather than the 05:40 numbers alone, is what made this a deteriorating patient rather than a patient with a low reading.
Airway, 05:44
Speaking in short sentences, voice clear. No stridor, no gurgling. Airway patent and protected for now.
Breathing, 05:45
Breathing 20 times a minute. Finger probe reading 95% without oxygen, trace clean. Chest rising equally. Breath sounds heard at both bases; fine crackles at the right base only, which the admission note also recorded. No added effort.
Circulation, 05:45 to 05:47
Heart rate 34 on the monitor, regular. In a patient with permanent atrial fibrillation, a slow regular rate means an escape rhythm beneath a blocked node.
Pressure 76/42 by cuff at 05:45; 74/40 on repeat at 05:47.
Hands cool to the wrist. Capillary refill 4 seconds at the fingertip.
One peripheral line, 20 gauge, left forearm, running lactated Ringer's at 75 mL per hour since admission. Second line placed by the nurse at 05:48, 18 gauge, right antecubital.
Urine: 150 mL recorded since 22:00, about 20 mL per hour.
12-lead ECG at 05:46: regular rhythm at 34 with no organized atrial activity, QRS 118 milliseconds, tall narrow T waves in V2 to V4. No ST elevation.
Disability, 05:47
Eyes open to voice. Oriented to name and place, not to time. Moves all four limbs to command. Pupils equal and reactive. Fingerstick glucose 112 mg/dL at 05:47.
Exposure and Medicines, 05:48
Temperature 37.0 C. No rash. Abdomen soft on brief palpation.
Medication record checked at 05:48: metoprolol succinate 100 mg given at 09:00 yesterday; spironolactone 25 mg given at 09:00 yesterday; lisinopril held on admission; furosemide held on admission; apixaban given at 21:00. No digoxin, no diltiazem, no new drugs overnight.
Intake and output: six liquid stools overnight per the nurse's record; oral intake about 300 mL since admission.
Brief History at the Bedside, 05:49 to 05:51
The patient said the lightheadedness started "a while ago, when I got up to the commode," which the nurse placed at about 03:15. No chest pain, no shortness of breath. No awareness of a slow or skipping heartbeat. No new pills, no salt substitute, no herbal products. Last meal: crackers and broth at 18:30. These answers took two minutes and were taken while the first actions were already under way.
First Actions, 05:47 to 05:55
05:47. Atropine 1 mg intravenous push.
05:48. Lactated Ringer's 500 mL bolus through the new line, run in fast.
05:49. Stat chemistry panel, magnesium, venous blood gas, lactate, troponin and complete blood count sent to the central laboratory.
05:50. Heart rate 34, no change after atropine.
05:52. Decision with my preceptor to give calcium before the potassium result, based on the drugs, the kidney injury and the ECG.
05:55. Calcium gluconate, 3 g, given over five minutes through the larger line.
05:56. Rapid response team called.
Deliberately Not Yet Examined
Full abdominal examination, beyond a brief palpation: deferred because the abdomen was the reason for admission, was soft and was not changing the next ten minutes.
Full neurologic examination: deferred beyond the screen above because the patient answered appropriately and moved all limbs; drowsiness was more likely from low flow than from a primary brain problem.
Skin and pressure areas, feet and back: deferred; not relevant to the first actions.
Jugular venous pressure: attempted and not reliably seen with the patient flat; recorded as not assessed rather than normal.
Second Set of Observations, 06:00 to 06:02
06:00. Heart rate 52, regular. Pressure 92/54.
06:01. Patient more alert, now oriented to time. Says "I feel less woozy."
06:02. Hands still cool; capillary refill 3 seconds. Saturation 96% on room air. Bolus 300 mL in.
06:03. Repeat 12-lead ECG: regular rhythm at 52, QRS 104 milliseconds, T waves less tall. Urine: 40 mL since 05:45.
Direction: improving after calcium, with no change after atropine. That pattern, rather than any single number, is the most useful finding of the pass.
What the Pass Supports, and What It Does Not
The pass supports a bradycardic, hypotensive state with poor perfusion, unresponsive to atropine and responsive to calcium, in a patient with kidney injury taking a nodal blocker and two drugs that raise potassium. Farkas et al. (2020) describe a moderate potassium rise and an AV nodal drug as amplifying each other, which fits this picture. The guideline on slow heart rhythms directs the search toward exactly these reversible causes (Kusumoto et al., 2019). The pass does not yet support a single explanation. The potassium is not back, the troponin is not back, and the ECG change, though suggestive, is not reliable on its own; the ECG can be normal at dangerous potassium levels and abnormal at modest ones (Montford & Linas, 2017). The decisions that follow are recorded in the stabilization plan.
Two dead ends are recorded because they were real. The second atropine dose my preceptor considered at 05:50 was not given once the first had failed. A brief attempt to see the neck veins was abandoned because the patient could not tolerate lying fully flat for long. A tidier write-up assembled later would leave both out; they belong here because they show what was tried and set aside during the pass, in the order it happened.
References
Farkas, J. D., Long, B., Koyfman, A., & Menson, K. (2020). BRASH syndrome: Bradycardia, renal failure, AV blockade, shock, and hyperkalemia. Journal of Emergency Medicine, 59(2), 216-223. https://doi.org/10.1016/j.jemermed.2020.05.001
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., Lee, R., Marine, J. E., McLeod, C. J., Oken, K. R., Patton, K. K., Pellegrini, C. N., Selzman, K. A., Thompson, A., & Varosy, P. D. (2019). 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Circulation, 140(8), e382-e482. https://doi.org/10.1161/CIR.0000000000000628
Montford, J. R., & Linas, S. (2017). How dangerous is hyperkalemia? Journal of the American Society of Nephrology, 28(11), 3155-3165. https://doi.org/10.1681/ASN.2016121344
The Chamberlain NR 572 Week 2 instructions
For Week 2, sections want one rapid pass across an acutely unwell patient. Expect a short, dense document stamped with times. Findings are recorded in the order they were checked, usually airway, breathing, circulation, disability and exposure, each with a figure and an hour. The write-up is deliberately incomplete: areas not yet examined should be marked as such, with the reason they could wait, instead of being filled in from assumption. A second set of observations at the foot, taken after the first actions, shows direction as well as position. Most prompts want flat language and interpretation kept to a short closing section. Some sections also ask for the earlier chart observations that set the trend.
Inside the NR 572 Week 2 example
This example begins with the 22:00 and 02:00 observations from the chart, which show the rate and pressure falling over eight hours and an early warning score that rose without a call. The pass then runs from airway at 05:44 to exposure at 05:48, with every finding timed, including the ECG, the medication record and the overnight stools. A short bedside history is placed where it happened. First actions are listed minute by minute, from atropine to the rapid response call. A section lists four areas left unexamined and why. The second set at 06:00 to 06:03 shows the rise after calcium, and a final section records two dead ends and states what the pass supports.
Reading the NR 572 Week 2 grading rubric
Points in this write-up gather around times and figures. A document with no times cannot show a trend and therefore cannot support a claim of deterioration, so every observation here carries both. The largest deduction goes to a write-up assembled later, where every finding points neatly at the final answer; this sample keeps its dead ends, the second atropine and the neck veins, to show it was written as it happened. Regions marked as unexamined, with reasons, satisfy the honesty criterion and avoid the penalty for normal values entered against areas nobody checked. The second set of observations earns the direction row. Interpretation is marked separately, and here it is kept to the closing section and limited to what the pass supports.
NR 572 Week 2 help: mistakes that cost points
The costliest NR 572 Week 2 mistake is a smooth narrative written after the fact, with no dead ends and every observation pointing at the diagnosis. Another frequent problem is a write-up with no times, or with times only on some entries. Findings recorded without figures, such as low pressure or fast breathing, lose marks. Many write-ups enter normal findings for regions that were never examined, which markers spot quickly. Plans stacked at the bottom, detached from the observations that produced them, read as an afterthought. Interpretation scattered through the findings blurs what was seen with what was thought. If your rapid assessment came from a different patient, send your timed notes; a write-up can be laid out in the same order with the gaps marked.
Get a NR 572 Week 2 example written to your instructions
Send the Week 2 instructions, the template your classroom uses and whatever scenario you were given, and a custom example is written to them and comes back inside 24 to 48 hours, the first one free. What returns is a model of the finished record, laid out so you can check your own version against it line by line.
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NR 572 Week 2 questions, answered
How incomplete can the write-up be?
Incomplete wherever the tempo made it unavoidable, and explicit about it. A record naming three unexamined regions and the reason each could wait reads as a genuine first pass. One that quietly fills them with normal findings reads as fabrication, and if any of those regions later turns out to matter, the whole document loses its standing with the marker.
Does a working diagnosis belong in it?
A working problem does, phrased physiologically: falling perfusion, rising work of breathing, a widening deficit. A named condition usually does not, because this week is about the record produced before the answer exists. Where your section asks for an impression line, keep it provisional and attach the observation it rests on so the reader can weigh it.
How should the times be handled?
Consistently, and against a single clock. The value of the document is that a reader can lay the observations end to end and see what happened between them. Times written to the minute on the first pass and omitted from the second destroy that, and a repeat set carrying no interval cannot be used to argue anything about direction.
Where can I find a free NR 572 Week 2 sample paper?
This page shows the full timed write-up of the 05:44 pass across the bradycardic patient, including the unexamined areas and the second set of observations.
Why does the NR 572 Week 2 write-up list areas not examined?
A first pass is incomplete by design, so marking what was left and why it could wait is more honest than entering normal values for regions nobody checked.