| Course | NR 573 Advanced Acute Care Management Lab |
|---|---|
| Week | 5 |
| Paper type | Scenario decision log |
| 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 573 Week 5
Scenario Decision Log: A Ventilated Patient Whose Peak Airway Pressure Doubled 40 Minutes After a Subclavian Line, From Suctioning to Needle Decompression
Student Name
College of Nursing, Chamberlain University
NR 573: Advanced Acute Care Management Lab
Instructor Name
Month Day, Year
Scenario Decision Log: A Ventilated Patient Whose Peak Airway Pressure Doubled 40 Minutes After a Subclavian Line, From Suctioning to Needle Decompression
Setup
Lab session 5 in the simulation center. Stem: a 64-year-old, 82 kg, intubated on day 2 for pneumonia, on volume-control ventilation with a tidal volume of 450 mL. A left subclavian central line was placed 40 minutes before the scenario begins. The team was four students; I was the leader. Times are from the simulator log.
Entry 1, 00:00
Information: high-pressure alarm. Peak airway pressure 42 cm H2O, up from 26 at the last check an hour ago. Saturation 88% on 50% oxygen. Heart rate 118. Pressure 104/66. The patient is moving and coughing.
Options open: suction the tube for a mucus plug; increase oxygen; sedate for ventilator dyssynchrony; disconnect and bag by hand; listen to the chest.
Taken: suction through the closed system and increase oxygen to 100%.
Refused: deeper sedation, because the patient's movement may be a response to the problem rather than its cause, and sedation could hide the sign. Refused also: changing ventilator settings, since the cause was not yet known and a setting change could mask it.
Would reverse: no fall in peak pressure within one minute of suctioning.
Entry 2, 00:50
Information: suction catheter passed easily to full depth with a small amount of thin secretion. Peak pressure still 44. Saturation 85%. The bedside nurse asks whether breath sounds are "a bit quiet on the left." I had not yet listened.
Options open: bag by hand to feel the compliance; listen to the chest; call for a chest radiograph; consider tube displacement.
Taken: disconnect from the ventilator and bag by hand with 100% oxygen while I listen.
Refused: waiting for a radiograph, because the pressure and saturation are moving faster than a film can be done.
Would reverse: easy bagging and normal breath sounds, which would point back to the ventilator.
Entry 3, 01:10
Information: bagging is stiff. Breath sounds absent on the left, present on the right. Peak pressure on reconnection 46. Saturation 82%. Pressure 86/52. Heart rate 132. Tube at 23 cm at the teeth, unchanged from the morning.
Correction to entry 1: the obstruction explanation behind the suction no longer fits. Suction was reasonable at 00:00 with the information I had, but the cause is in the chest, not the tube. A left subclavian line placed 40 minutes ago, a sudden pressure rise and absent left breath sounds point to a pneumothorax, and the falling blood pressure suggests it is under tension.
Options open: needle decompression now; immediate chest tube; ultrasound to look for lung sliding; radiograph.
Taken: needle decompression on the left.
Refused: radiograph and ultrasound first, because a tension pneumothorax with falling pressure is a clinical diagnosis and imaging would delay treatment. Chest tube first, because it takes longer to set up than a needle.
Would reverse: no rush of air and no improvement in pressure after decompression, which would send me back to the tube and the ventilator.
Entry 4, 01:40
Information: decompression catheter placed at the left fifth intercostal space, anterior to the midaxillary line. Rush of air heard. At 02:20, peak pressure 30, saturation 89%, pressure 102/64.
Options open: chest tube now; observe the catheter.
Taken: chest tube requested; faculty in the role of the surgical team informed. Catheter left in place and watched.
Refused: removing the decompression catheter before the chest tube is in, because the pneumothorax will reaccumulate.
Would reverse: catheter kinks or blocks and pressure rises again, which would mean a second decompression.
Note for the next reader: the catheter is a temporary measure; a chest tube is the definitive treatment, and the time of decompression is written on the dressing.
Entry 5, 03:00
Information: peak pressure 28, saturation 93%, heart rate 104. Faculty ends the scenario.
Taken: handoff to the simulated surgical team with a statement that the left subclavian line is the likely cause and the line's position needs to be confirmed on the chest film after the tube.
Review, Written After the Scenario Ended
This section was written at 03:30, after the scenario ended, and is kept separate from the log. Entry 1 was a reasonable choice on what I knew at 00:00, but I made it without listening to the chest, which would have taken 15 seconds. The nurse's question at 00:50 contained the most important finding of the scenario and was asked as a question; I should have treated it as a statement. A recent central line placed through the subclavian approach is a known cause of pneumothorax, and in ventilated patients positive pressure can turn a small leak into tension quickly (Yarmus & Feller-Kopman, 2012).
The early entries look wrong when read from the end, and they are left in place on purpose. A log in which every early decision happened to be correct would tell a reader it was written after the fact.
What the Log Shows About Speed
The log runs three minutes. The decision that cost the most time was not a wrong treatment but a missing examination: listening to the chest took 15 seconds and was done at 01:10 rather than at 00:00. Every entry after that moved quickly, because each one was made with better information. Reading the entries in order shows how a single early omission shapes the next minute more than any later choice does. If I had listened at 00:00, entry 1 would have read differently, and the needle would probably have been in by about 00:45 instead of 01:40. The other entries would have looked much the same, only earlier.
Sources
The needle site follows advanced trauma life support teaching for adults, which moved the preferred decompression site to the fourth or fifth intercostal space anterior to the midaxillary line; the overall approach of treating suspected tension physiology clinically, without waiting for imaging, follows the review of pneumothorax in critically ill patients (Yarmus & Feller-Kopman, 2012). The habit of treating a colleague's hedged concern as data, rather than as an opinion, is discussed in the communication literature on assertion in teams (Leonard et al., 2004). The central line source is the scenario's left subclavian placement; the central access guideline lists pneumothorax among the complications to monitor after subclavian access (American Society of Anesthesiologists Task Force on Central Venous Access, 2020).
References
American Society of Anesthesiologists Task Force on Central Venous Access. (2020). Practice guidelines for central venous access 2020: An updated report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology, 132(1), 8-43. https://doi.org/10.1097/ALN.0000000000002864
Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(Suppl. 1), i85-i90. https://doi.org/10.1136/qshc.2004.010033
Yarmus, L., & Feller-Kopman, D. (2012). Pneumothorax in the critically ill patient. Chest, 141(4), 1098-1105. https://doi.org/10.1378/chest.11-1691
The Chamberlain NR 573 Week 5 instructions
The Week 5 assignment asks for a decision log from a simulation, written as entries rather than paragraphs. Each entry holds a time, the information available then, the options genuinely open, the option taken, the option refused with a sentence on why, and the sign that would make you reverse the choice. Read in order, the early entries may look wrong, and that is expected, since they were made with less information. Somewhere in the middle an entry should state that newer data contradicts an earlier choice and record the correction openly. A short review at the end, clearly marked as written afterward, is usually allowed and kept separate from the entries.
How this NR 573 Week 5 example is built
The sample states the scenario stem, including the left subclavian line placed 40 minutes earlier. Entry 1 at 00:00 chooses suction and oxygen for a pressure alarm and refuses deeper sedation. Entry 2 at 00:50 bags by hand and listens after a nurse's question. Entry 3 at 01:10 finds absent left breath sounds, states a correction to entry 1 and chooses needle decompression over imaging. Entry 4 records the decompression site, the response and the chest tube request. Entry 5 closes the scenario with a handoff. A section on speed shows how one missed examination shaped the first minute. The review, marked as written afterward, and the sources close the log.
Where the points sit in the NR 573 Week 5 rubric
Marks in this log depend on it being written forward. A log in which every early entry happens to be right tells a marker it was composed afterward, and formatting cannot recover from that; this sample keeps the suction decision in place and corrects it openly. The refused option is the evidence a decision existed, so each entry names one with its reason. Prose instead of entries loses the structure row. Times rounded to the hour, or no times, cost the timing criterion. Reversal signs phrased as being watchful lose points that a specific sign earns. A review clearly marked as later and kept apart from the entries satisfies the honesty criterion.
NR 573 Week 5 help from the desk
The fatal NR 573 Week 5 error is a log written backward, where every early choice is correct. Another is deleting the rejected options, which turns each entry into a report of an action. Many logs drift into paragraphs and lose the entry structure. Times are often rounded or missing. Every line sounds certain, though the case was not. Reversal signs such as monitor closely give a reader nothing to check. Some writers quietly edit the early entries after the outcome is known. If you ran a different scenario, send your notes with the times you have; a log can be shaped with options, refusals and reversal signs for each entry. Write each entry before the next one, even in rough form.
Get a NR 573 Week 5 example written to your instructions
Send the Week 5 instructions, the rubric and whatever log format your classroom supplies, plus the case as it was handed to you. A custom NR 573 decision log is written to that format and returned inside 24-48h, the first one free, with entries built to read as though the outcome was still unknown.
More NR 573 papers and AGACNP samples
- NR 573 Week 1: Procedure Note Line Discussion Post
- NR 573 Week 2: Central Line Procedure Note
- NR 573 Week 3: Simulation Debrief Timeline
- NR 573 Week 4: Complication Write-Up
- NR 573 Week 6: Team Communication Debrief
- NR 573 Week 7: Case Simulation Analysis
- NR 573 Week 8: Competency Reflection
- NR 572 Week 5: Escalation Plan
- NR 571 Week 5: Comorbidity Conflict Brief
- NR 567 Week 5: ICU Sedation and Analgesia Plan
- NR 570 Week 5: Progress Note Sequence
NR 573 Week 5 questions, answered
How many entries does a log need?
Fewer and fuller beats many and thin. What matters is that every entry marks a point where the case could genuinely have gone two ways, so a log of six real decisions outscores twenty rows recording observations. Section instructions sometimes set a minimum, and where they do, that number governs the finished example.
What if an early decision was wrong?
Leave it, and let the log show how it was caught. A wrong choice made reasonably on the information available is exactly what this document exists to display, and correcting it in a later entry demonstrates more than a clean run ever does. Rewriting it removes the only evidence that any thinking happened.
Can the log be written as an essay?
Only if your section asks for prose, and most do not. The entry format is doing work: it forces the same fields onto every decision so a marker can compare them, and it keeps the outcome out of the reasoning. Where a short commentary is also required, it sits after the entries under its own heading.
Where can I find a free NR 573 Week 5 sample paper?
The full five-entry decision log for the ventilator pressure scenario, including the correction in entry 3 and the separate review, is on this page.
Why does the NR 573 Week 5 log keep a wrong early entry?
Suctioning was a reasonable choice at 00:00 with the information available; keeping it and recording the correction at 01:10 shows the log was written forward rather than after the outcome.