| Course | NR 575 Acute Care Practicum II |
|---|---|
| Week | 3 |
| Paper type | Continuity case narrative |
| 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 575 Week 3
Continuity Case Narrative: A 34-Year-Old Ventilated for Status Asthmaticus, Followed From the Second Day of Admission to Transfer, With Each Fact Labeled by How I Came to Know It
Student Name
College of Nursing, Chamberlain University
NR 575: Acute Care Practicum II
Instructor Name
Month Day, Year
Continuity Case Narrative: A 34-Year-Old Ventilated for Status Asthmaticus, Followed From the Second Day of Admission to Transfer, With Each Fact Labeled by How I Came to Know It
Where I Came In
I met the patient on a Monday at 07:00, the second day of the admission. By then a great deal had already happened, and I learned it from the chart and from the night nurse practitioner's handover rather than by seeing it. This patient is a composite, assembled from the medical intensive care unit where I am placed this term; no identifying details are included. In what follows, [watched] marks what I saw myself, [chart] what I read in the record and [handover] what I was told by a colleague.
Before I Arrived, Sunday
[chart] The patient, 34, with asthma since childhood and two previous admissions without intubation, arrived in the emergency department on Sunday afternoon after two days of worsening wheeze and a cold. Despite continuous nebulized albuterol, ipratropium, intravenous methylprednisolone and 2 g of intravenous magnesium, the patient tired, became drowsy, and had a venous carbon dioxide of 78 with a pH of 7.12. Intubation was performed at 18:40. The record shows no trial of noninvasive ventilation; the European and American guideline on noninvasive ventilation makes no recommendation for or against it in acute asthma because the evidence is too uncertain (Rochwerg et al., 2017).
[handover] The night nurse practitioner told me that the first hour on the ventilator had been difficult: the blood pressure fell to the 70s soon after intubation, and it recovered when the ventilator rate was lowered and the patient was briefly disconnected to let trapped air out.
Monday, Day 2
[watched] At 07:30 I stood with my preceptor at the ventilator. The patient was deeply sedated on propofol and a ketamine infusion. Settings were volume control, tidal volume 420 mL, rate 12, inspiratory flow 80 L per minute and positive end-expiratory pressure of 0. My preceptor performed an end-expiratory hold, which showed an intrinsic pressure of 9 cm of water, and an end-inspiratory hold, which showed a plateau pressure of 29.
[chart] The morning gas showed a pH of 7.21 and a carbon dioxide of 68. The team's note described this as accepted hypercapnia, with the aim of limiting hyperinflation rather than correcting the carbon dioxide.
[watched] On rounds the intensivist asked me why the rate was 12 rather than higher, given the carbon dioxide. I answered that a higher rate would shorten the time to breathe out and trap more air. That approach, accepting a high carbon dioxide to avoid dangerous hyperinflation, is the preferred strategy for ventilated patients with severe asthma (Leatherman, 2015).
Monday Afternoon
[watched] At 15:00 the patient's partner arrived. My preceptor explained, in the family room, that the patient was very sick but that most people ventilated for asthma survive the admission, and that the next two days would show which way things were going. I listened and did not speak. The partner asked whether the cold had caused this; my preceptor said a viral infection is a common trigger.
[handover] At 18:30 my preceptor told the night nurse practitioner that the partner would stay overnight and wanted a call if anything changed.
Tuesday, Day 3
[watched] At 08:00 the intrinsic pressure on the hold was 4 and the plateau 24. Wheeze was quieter. The pH was 7.30 with a carbon dioxide of 55. The ketamine infusion was reduced.
[watched] At 14:00 my preceptor asked me to write the ventilator plan for the next 24 hours: keep the rate and flow, reduce sedation in the evening and assess for a spontaneous breathing trial in the morning if the plateau stayed below 25 and the patient could follow commands. My preceptor cosigned the note with one change: check for intrinsic pressure again before any rate increase overnight.
Wednesday and Thursday, Days 4 and 5: Not There
I was not on placement on Wednesday or Thursday. What follows is from the record and from my preceptor's handover on Friday morning.
[chart] Wednesday: sedation was lightened, the patient became agitated at 10:00 and needed a brief increase in propofol. A spontaneous breathing trial was not done.
[chart] Thursday: spontaneous breathing trial at 09:00 on pressure support of 5, passed after 30 minutes. Extubated at 10:15 to nasal cannula at 2 L.
[handover] My preceptor said the extubation was the right call but that the patient had panicked for about ten minutes afterward and needed reassurance, not medication.
Friday, Day 6
[watched] At 08:30 the patient was sitting up, speaking in full sentences, with soft expiratory wheeze at both bases and a saturation of 95% on 1 L. The patient asked me how close they had come to dying. I said I had not been there on Sunday and that the doctors who had been there would be better placed to answer, and I asked my preceptor to come back and talk with the patient later that morning.
[watched] Later that morning my preceptor sat with the patient for ten minutes and answered the question; I was in the room and did not speak; the answer was not mine to give.
[chart] Transfer to the intermediate care unit at 15:00, on oral prednisone, inhaled budesonide with formoterol and a plan for pulmonary follow-up.
What I Can and Cannot Say About This Patient
I can describe the ventilator strategy on days 2 and 3 because I watched it and wrote part of it. I cannot describe the agitation on Wednesday or the extubation on Thursday from my own observation. The narrative would read more smoothly if I wrote all six days evenly, but it would claim a continuity I did not have.
What the case taught me about continuity is that the most important decision of the admission, extubation, happened on a day I was absent, and the plan I wrote on Tuesday was the bridge to it. Patients who have needed intubation for asthma are at higher risk of dying in later attacks (Leatherman, 2015), and a review of critically ill patients with asthma emphasizes planning follow-up before discharge from the intensive care unit (Louie et al., 2012). The patient's transfer note contained a pulmonary referral; whether the patient will keep that appointment is something I will not see.
References
Leatherman, J. (2015). Mechanical ventilation for severe asthma. Chest, 147(6), 1671-1680. https://doi.org/10.1378/chest.14-1733
Louie, S., Morrissey, B. M., Kenyon, N. J., Albertson, T. E., & Avdalovic, M. (2012). The critically ill asthmatic: From ICU to discharge. Clinical Reviews in Allergy & Immunology, 43(1-2), 30-44. https://doi.org/10.1007/s12016-011-8274-y
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
NR 575 Week 3 instructions, in plain terms
The Week 3 assignment asks for a narrative following one patient across several days of your rotation. It is longer than a case write-up and organized by time rather than by heading. Open at the point you first met the patient, which is rarely the admission, and say plainly what had already happened. Then move in dated steps: what changed, what the team did and how you came to know it. Watching, reading the chart and being told at handover should be labeled differently, so nothing borrowed reads as something seen. Figures belong where they changed a decision. Days you were absent should show, and identifying details stay out.
Inside the NR 575 Week 3 example
The sample states that the writer met the patient on day 2 and introduces three labels for sources. The Sunday section comes from the chart and a handover: the emergency treatment, the gas and the intubation. Monday is watched: the holds, the accepted hypercapnia and a question from the intensivist about the rate. A family conversation follows. Tuesday includes the plan the writer wrote and the preceptor's one change. Wednesday and Thursday are marked as absent days, sourced to the record and the preceptor's account of extubation. Friday is watched again. The closing section says which days the writer can describe and links the case to follow-up after intubation for asthma.
Reading the NR 575 Week 3 grading rubric
The biggest loss is a narrative that turns into an account of the condition, with management paragraphs that could have been written without meeting the patient; this one stays with what happened and how the writer knew it. Next is the evenly covered story, every day covered evenly with no sign the writer was absent, which reads as invention the moment a marker asks how you knew. The labels and the marked absent days answer that directly. Continuity asserted but never shown costs a row, while a plan the writer drafted and a preceptor revised shows it. Naming the unit, dates or people costs points, so details here are composite.
NR 575 Week 3 help: mistakes that cost points
Many NR 575 Week 3 narratives drift into a review of the disease. Others describe every day evenly, including days the writer was not there. Writers often fail to separate what they saw from what they read or were told. Figures appear in long lists with no link to decisions. Some narratives name the hospital or include dates that could identify a patient. A narrative that ends at extubation without saying what remains unknown misses the reflective close. If you followed a different patient, send your notes with a mark beside each fact showing its source; a narrative can be built in dated steps from them. Mark each fact with its source as you write, not afterward, and keep absent days short and clearly sourced.
Get a NR 575 Week 3 example written to your instructions
Forward the week's instructions along with any template your section attaches, and a continuity narrative written to those rows comes back inside 24-48h, the first one free. Name the service and the kind of admission you want it built around and the example will match that setting rather than a generic one.
More NR 575 papers and AGACNP samples
- NR 575 Week 1: Carried-Over Change Discussion Post
- NR 575 Week 2: Objective Revision Memo
- NR 575 Week 4: Competency Evidence Map
- NR 575 Week 5: Practice Readiness Appraisal
- NR 575 Week 6: Transition to Practice Plan
- NR 575 Week 7: Cumulative Portfolio Entry
- NR 575 Week 8: Practicum Closing Memo
- NR 567 Week 3: Nicardipine Titration Plan
- NR 574 Week 3: Practicum Orientation Write-Up
- NR 569 Week 3: Differential Narrowing Memo
- NR 573 Week 3: Simulation Debrief Timeline
NR 575 Week 3 questions, answered
How does this differ from the case write-ups earlier in the sequence?
Those cover one encounter or one problem set and are marked on reasoning. This one is marked on holding a single patient together across days and handovers, including the stretches you were not present for. The medicine matters less than the join: two well reasoned paragraphs with an unexplained two day gap between them score below a plainer piece that accounts for the gap.
Can you write this from a patient I actually looked after?
Send the shape and not the chart. A useful request gives the kind of service, the sort of admission, the rough run of events and the rubric, and the example is built on a case assembled for the purpose. Identifiable material should not leave your unit, and an example does not need any of it to show where the bridging lines go.
What if the patient was discharged before the week ended?
That is a normal ending and easier to write than a transfer. The narrative closes where the stay closed, states what was still unsettled at that point, and gives the last section to what the run of days showed the writer. Sections rarely demand a resolved case, and several rubrics reward an account admitting an unfinished picture.
Where can I find a free NR 575 Week 3 sample paper?
The full continuity narrative following the ventilated patient with severe asthma, with every fact labeled by its source, is published on this page.
Why does the NR 575 Week 3 narrative label facts as watched, chart or handover?
So that nothing the writer learned secondhand reads as something they saw, which matters because the extubation happened on a day the writer was absent.