| Course | NR 574 Acute Care Practicum I |
|---|---|
| Week | 4 |
| Paper type | Weekly practicum journal |
| Length | About 670 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 574 Week 4
Weekly Practicum Journal, Week 4: The Morning I Called a Carbon Dioxide of 62 Acute and Planned to Raise the Ventilator Settings, and Why the Patient's Bicarbonate Said Otherwise
Student Name
College of Nursing, Chamberlain University
NR 574: Acute Care Practicum I
Instructor Name
Month Day, Year
Weekly Practicum Journal, Week 4: The Morning I Called a Carbon Dioxide of 62 Acute and Planned to Raise the Ventilator Settings, and Why the Patient's Bicarbonate Said Otherwise
The Incident
On Tuesday at 07:40, pre-rounding before the hallway rounds, I looked at a venous gas for a 71-year-old admitted two days earlier with a COPD exacerbation and on bilevel ventilation overnight. The carbon dioxide was 62. I wrote "worsening hypercapnia, increase inspiratory pressure" on my sheet and planned to present that on rounds. At 08:10 my preceptor looked at my sheet and asked one question: "What was the pH?" It was 7.37. The bicarbonate was 36. The admission gas, two days earlier, had shown a carbon dioxide of 74 and a pH of 7.26.
What the Preceptor Did
My preceptor did not correct the plan. The question about the pH was the whole intervention, asked quietly at the workstation before rounds, not in the hallway. When I looked again and said the gas was improving, my preceptor asked me to present it that way on rounds and to say why the earlier number mattered. I did, and the respiratory therapist added the patient's carbon dioxide from the last admission, which was 58.
What I Believed at the Time
I believed the carbon dioxide was the number that told me whether the patient's breathing was failing. A value above the normal range, in a patient on noninvasive ventilation, meant to me that the ventilation was not enough. I read it alone and stopped.
What Turned Out to Be True
The patient's carbon dioxide had fallen from 74 to 62, and the pH had moved from acidemic to normal. The bicarbonate of 36 showed a kidney that had been compensating for a long time; this patient has severe COPD and lives with a raised carbon dioxide. The 62 was an improvement toward the patient's usual baseline, not a deterioration. The right plan was to continue the current settings and try time off the machine during the day, which the team agreed on rounds. In acid-base assessment, the pH and the expected compensation have to be read with the carbon dioxide, not after it (Berend et al., 2014). The noninvasive ventilation guideline also frames its recommendations around acidemia, not around a carbon dioxide value alone (Rochwerg et al., 2017).
Where the Difference Came From
The difference came from reading one number in isolation, and from a habit I did not know I had: I look for the abnormal value first and build the story around it. On the unit, the abnormal value is often the patient's normal. I also did not look at the earlier gas, which would have shown the direction of travel. Reflection tends to change practice when it is tied to a specific experience like this one rather than to a week in general (Mann et al., 2009). Neither of those is a knowledge gap; I know how to interpret a gas when I sit down with one. It was a reading order under time pressure at 07:40, with twelve patients to pre-round.
What I Will Do Next Week
For every gas I review before rounds next week, I will write three things on my sheet before I write any plan: the pH, whether the bicarbonate fits a chronic or acute pattern, and the previous gas for comparison. Next week's entry will report how many gases I reviewed, and on how many I wrote all three before a plan. If the number is below all of them, I will say which ones I skipped and why. I will also note whether the order changed any plan I would have presented, since that is the real test of whether the habit matters.
References
Berend, K., de Vries, A. P. J., & Gans, R. O. B. (2014). Physiological approach to assessment of acid-base disturbances. New England Journal of Medicine, 371(15), 1434-1445. https://doi.org/10.1056/NEJMra1003327
Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education, 14(4), 595-621. https://doi.org/10.1007/s10459-007-9090-2
Rochwerg, B., Brochard, L., Elliott, M. W., Hess, D., Hill, N. S., Nava, S., Navalesi, P., Antonelli, M., Brozek, J., Conti, G., Ferrer, M., Guntupalli, K., Jaber, S., Keenan, S., Mancebo, J., Mehta, S., & Raoof, S. (2017). Official ERS/ATS clinical practice guidelines: Noninvasive ventilation for acute respiratory failure. European Respiratory Journal, 50(2), Article 1602426. https://doi.org/10.1183/13993003.02426-2016
Reading the NR 574 Week 4 instructions
The Week 4 journal asks for a short entry, often under a page, about one incident that took a few minutes. Describe it in enough detail for the point where your understanding gave out to be visible, but keep the description the smallest part. Most of the entry is the second movement: what you believed at the time, what turned out to be true and where the difference came from. The entry should end on something specific enough that next week's entry can report whether it happened. Many sections attach a three-row rubric covering description, analysis and the change. The patient is not the subject; your reasoning is.
How the NR 574 Week 4 example is put together
The entry opens at 07:40 with the gas, the plan written on the pre-rounds sheet and the preceptor's question about the pH at 08:10. A short section describes what the preceptor did and did not do. The belief at the time is stated plainly: the carbon dioxide alone signaled failure. What was true follows: the pH had normalized, the bicarbonate showed long-standing compensation and the value was an improvement, with an acid-base review and the ventilation guideline cited. The source of the difference is traced to reading the abnormal value first under time pressure. The closing commits to writing three things before any plan and reporting the count next week.
Reading the NR 574 Week 4 grading rubric
Entries lose the most when the patient becomes the subject, because a workup fills the wrong rubric and leaves the analysis rows empty; this entry keeps the patient in two sentences and spends the rest on the writer's reasoning. A resolution nothing could test, such as reading more, costs the change row; the sample commits to a count. A tour of four events at a sentence each loses depth, and this entry takes one. A difficulty that resolves itself in the final line because the team was supportive earns little. Locating where the difference came from, as a habit rather than a gap in knowledge, earns the analysis marks.
NR 574 Week 4 help from the desk
The most common NR 574 Week 4 problem is an entry that reads like a case presentation, all patient and no reflection. Another is a resolution too vague to check next week. Many entries list the week's events briefly instead of examining one. Some end with praise for the team that dissolves the difficulty. Writers also blame time pressure without saying what they did under it. If a different incident fits your week better, send a short description of it and what you believed at the time; an entry can be shaped around that moment with a testable ending. Keep the entry to one incident and one change, and resist adding a second event.
Get a NR 574 Week 4 example written to your instructions
Send the assignment file, the rubric rows and a sentence about the incident, and a custom NR 574 Week 4 entry is returned inside 24-48h, free the first time. No example ever carries a shift nobody stood, a count on a timesheet, an attestation from a site, or an encounter invented to fill a week. Those come off the term you actually work.
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NR 574 Week 4 questions, answered
Nothing interesting happened this week.
That is usually a definition problem rather than a quiet week. The entries that mark best are rarely dramatic: a question asked badly, an order misread, a moment of not knowing who to ask. Faculty are looking for a limit in the writer's own understanding, and a slow week on a familiar unit produces those as readily as a busy one.
Can an entry say the supervision was unhelpful?
Yes, when it is written as an account rather than a complaint, and most rubrics reward it. What went unanswered, what the writer did next, what would have helped: that is analysis. A judgment on somebody's teaching with no description under it reads as grievance, and the place for a considered verdict on the placement is the closing summary.
How much reading goes into a single entry?
Usually one source, occasionally two, and always aimed at the specific confusion rather than the general subject. An entry about missing a sign in a deteriorating patient cites something on that sign. A broad review article attached to a narrow entry signals that the reading was chosen after the writing, which graders spot quickly.
Where can I find a free NR 574 Week 4 sample paper?
The full journal entry about misreading a carbon dioxide of 62 is on this page, with margin notes showing where each rubric row is earned.
What change does the NR 574 Week 4 journal commit to?
Writing the pH, the compensation pattern and the previous gas before any plan for every gas reviewed next week, and reporting the count in the next entry.