| Course | NR 579 Palliative Care in Adult-Gerontology Across the Spectrum |
|---|---|
| Week | 2 |
| Paper type | Symptom management plan |
| Length | About 1,140 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Adult-Gerontology Primary Care NP (AGPCNP) |
| Updated | October 2026 |
Free sample paper for NR 579 Week 2
Symptom Management Plan for a 66-Year-Old With ALS: Five Symptoms, Each in the Patient's Word, With Today's Figure, the Treatment and Where the Figure Should Be by a Stated Date
Student Name
College of Nursing, Chamberlain University
NR 579: Palliative Care in Adult-Gerontology Across the Spectrum
Instructor Name
Month Day, Year
Symptom Management Plan for a 66-Year-Old With ALS: Five Symptoms, Each in the Patient's Word, With Today's Figure, the Treatment and Where the Figure Should Be by a Stated Date
The Patient and the Limit on What Relief May Cost
The patient is a composite, 66, almost two years into amyotrophic lateral sclerosis, on riluzole and noninvasive ventilation for about ten hours a night, communicating by typing on a tablet with one hand. Forced vital capacity is 38% of predicted. Swallowing is slow; tablets are crushed or given as liquids. The patient set one limit for this plan, typed at the visit: "Nothing that makes me too sleepy to talk to the kids after dinner." That limit applies to every block below, and any treatment that breaks it will be changed.
Symptom 1: "The Drool"
Today: two hand towels soaked a day, by the spouse's count; patient rates it 8 of 10 for how much it bothers.
Treatment: glycopyrrolate oral solution, 1 mg three times a day, before meals. A portable suction device at the table. If not enough after two weeks, referral for botulinum toxin injections to the salivary glands, which the neurology practice parameter supports for this problem (Miller et al., 2009b).
Target by day 14: one towel a day or fewer; rating 4 or less. Watch for thick secretions that are harder to clear, which would mean the dose is too high.
Symptom 2: "Shoulder Pain"
Today: right shoulder, worst at night and when the arm is moved; 6 of 10 at rest, 8 with movement. Pain is common in ALS, much of it from muscles and joints that no longer move normally (Chiò et al., 2017).
Treatment: acetaminophen liquid, 650 mg at 08:00, 14:00 and 20:00, standing. Rescue: oxycodone oral solution 2.5 mg, up to every four hours as needed. Physical therapy for range-of-motion exercises, and a pillow support for the arm at night.
Counting rule: the spouse writes the time of every rescue dose on the chart. If more than three rescue doses are needed in 24 hours on two days running, the clinic is called the next morning to reconsider the standing plan rather than adding more rescues.
Target by day 14: 3 of 10 at rest, 5 with movement; no more than two rescues a day.
Symptom 3: "Short of Breath at Night"
Today: wakes two or three times a night breathless, even with the mask on; rates it 6 of 10.
Treatment: check the mask fit and pressures with the respiratory therapist this week. Morphine oral solution 2.5 mg as needed for breathlessness not relieved by repositioning and the mask, no more than every four hours. A Cochrane review found low-quality evidence that opioids may reduce breathlessness in advanced disease (Barnes et al., 2016). A fan directed at the face as a first step.
Target by day 14: one waking a night or fewer; rating 3 or less.
Symptom 4: Constipation, Prevented
Today: bowels open every second day, soft; no complaint.
Treatment, started today with the opioids: senna, 8.6 mg at night, and polyethylene glycol powder 17 g in the morning thickened drink, adjusted to a soft stool every one to two days. Opioids slow the bowel in nearly everyone who takes them, and immobility adds to it, so this is prescribed before the problem appears.
Target: soft stool at least every two days throughout.
Symptom 5: "Laughing When I Want to Cry"
Today: sudden laughing or crying spells several times a day that do not match the patient's mood, which the patient finds humiliating with visitors.
Treatment: dextromethorphan with quinidine, one capsule daily for a week then twice daily, which the neurology practice parameter supports for this symptom in ALS (Miller et al., 2009b). Explanation given to the family that these spells are part of the disease, not distress.
Target by day 28: spells fewer than once a day.
How the Limit Is Protected
Oxycodone and morphine are both sedating. The plan limits them to small rescue doses and asks the spouse to note whether the patient was drowsy at 19:00 on any day a rescue was taken after 15:00. If yes on two days, rescues after 15:00 are reduced and the standing acetaminophen and positioning are relied on in the evening.
What the Patient and Spouse Were Told
The plan was read through with the patient and spouse at the visit. The spouse asked whether the oxycodone would make the patient addicted; I explained that the doses are small, used for pain and breathlessness, and watched by the clinic, and that the bigger risk is constipation, which the plan prevents. The patient typed one question: "Will the drool stop completely?" The honest answer was that it would probably be less but not gone, and that botulinum injections could be added if needed. The patient agreed to start with the liquid medicine.
How the Plan Will Be Reviewed
Each symptom has a target and a date. On day 14, the palliative care nurse practitioner reviews the chart against each target. A symptom that meets its target stays on the same plan. A symptom that misses it gets one change, chosen from the options already named in its block. A symptom that has improved but at the cost of evening drowsiness is changed in favor of the patient's limit, even if the score rises slightly.
What Is Not in This Plan
No sleeping medicine, because it would add to the drowsiness the patient wants to avoid and could weaken breathing further. No antidepressant yet; mood will be screened at the day 14 visit, and the laughing and crying spells are being treated separately. No change to riluzole or the ventilation settings, which belong to the neurology clinic and the respiratory therapist. The two plans are reviewed together on the same clinic day so that one does not undo the other.
Where Each Medicine Is Kept
All liquids are kept on one shelf in the kitchen, labeled with the symptom they treat in large print, because the spouse said the bottle names were hard to tell apart. The oxycodone and morphine solutions are kept in a locked box, with the key on the spouse's key ring, and the chart sits next to the box.
Who Does What
The spouse gives all medicines and keeps the chart. The home health nurse visits weekly. The clinic calls on day 7. The palliative care nurse practitioner reviews the whole plan on day 14 in the ALS clinic, alongside the neurology visit.
References
Barnes, H., McDonald, J., Smallwood, N., & Manser, R. (2016). Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness. Cochrane Database of Systematic Reviews, (3), Article CD011008. https://doi.org/10.1002/14651858.CD011008.pub2
Chiò, A., Mora, G., & Lauria, G. (2017). Pain in amyotrophic lateral sclerosis. Lancet Neurology, 16(2), 144-157. https://doi.org/10.1016/S1474-4422(16)30358-1
Miller, R. G., Jackson, C. E., Kasarskis, E. J., England, J. D., Forshew, D., Johnston, W., Kalra, S., Katz, J. S., Mitsumoto, H., Rosenfeld, J., Shoesmith, C., Strong, M. J., & Woolley, S. C. (2009b). Practice parameter update: The care of the patient with amyotrophic lateral sclerosis: Multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 73(15), 1227-1233. https://doi.org/10.1212/WNL.0b013e3181bc01a4
Reading the NR 579 Week 2 instructions
The Week 2 plan should be usable by someone who cannot phone you. Give each symptom a short block of its own: the word the patient uses for it, a figure recorded today, what is being given and where the figure should be by a stated point. Pain needs a standing dose and a rescue dose with a rule for counting the rescues. Constipation should be prevented when an opioid starts, not treated after it appears. Most rubrics also look for a stated limit on what relief may cost the patient, such as sedation, and a way of protecting it. Non-drug measures belong inside the relevant blocks.
How the NR 579 Week 2 example is put together
The plan begins with the patient's typed limit: nothing that causes sleepiness after dinner. Five blocks follow. Drooling has a towel count, a liquid medicine before meals, suction at the table and a botulinum option. Shoulder pain has standing acetaminophen, a small oxycodone rescue, therapy and a counting rule. Night breathlessness has a mask check, a fan and a small morphine rescue with the evidence stated. Constipation is prevented from day one. Pseudobulbar spells have a specific medicine and an explanation to the family. Sections cover how the limit is protected, what the family was told, how targets will be reviewed, storage and what is left out.
Where the points sit in the NR 579 Week 2 rubric
Relief prescribed with no stated limit on what it may cost forfeits the most, because it can sedate a patient who wanted to stay awake for visitors; this plan states the limit first and checks it at 19:00. Almost as expensive is an opioid ordered without bowel care, which graders read as a knowledge gap, so constipation is prevented from the start. A rescue dose with no counting rule comes next, and the plan sets one. Targets without dates leave nothing to review. Each symptom's block names the patient's own word, which earns the patient-centered row, and the review method shows the plan will be used. Writing each symptom in the patient's own word also shows whose plan this is.
NR 579 Week 2 help: mistakes that cost points
The most common NR 579 Week 2 problem is a plan that lists drugs without targets or dates. Another is an opioid with no bowel care. Many plans give rescue doses with no way of noticing when they are overused. Some ignore the patient's own limit, so the plan works on paper and fails at the dinner table. Symptoms are often named in clinical terms the family cannot use. If your patient has different symptoms, send the patient's words for each and any limit they set; a plan can be laid out with a block, a figure and a date for every symptom. Start with the patient's limit, then give every symptom a word, a figure, a treatment and a date.
Get a NR 579 Week 2 example written to your instructions
Send your own assignment file and the rubric, plus whatever case your classroom supplied, and a custom symptom management plan written for that patient returns to you in 24-48h, with nothing to pay on the first one. Where your section uses a fixed grid, send the blank and the example arrives already filled into it.
More NR 579 papers and AGPCNP samples
- NR 579 Week 1: Palliative Timing Discussion Post
- NR 579 Week 3: Goals of Care Write-up
- NR 579 Week 4: Advance Care Planning Note
- NR 579 Week 5: Family Meeting Summary
- NR 579 Week 6: Pain Management Case Analysis
- NR 579 Week 7: Ethical Dilemma Write-up
- NR 579 Week 8: Narrative Reflection
- NR 578 Week 2: Functional Assessment Write-Up
- NR 568 Week 2: Medication List Review
- NR 577 Week 2: Adolescent Visit Note
- NR 576 Week 2: Problem List Review
NR 579 Week 2 questions, answered
Does the plan need doses, or is a strategy enough?
Doses, routes and intervals, in most sections. A plan describing an approach to pain without a number is the commonest way this assignment gives up points, because the rubric row is usually built around prescribing rather than around principles. Where a classroom asks for a non-prescriptive version, the same structure holds and each number is replaced by a stated target.
How many symptoms should the example cover?
Three or four handled properly beat seven listed. Rubrics here reward depth inside each block, and a plan naming every complaint in the vignette without prescribing for any of them reads as a summary of the case rather than a response to it. Take the ones the patient ranked highest, treat those completely, and say briefly what else is being watched.
Where does non-drug management go?
Inside the symptom block it belongs to, written as an instruction somebody could carry out. A fan directed at the face for breathlessness, a repositioning schedule, a smaller plate: each carries who does it and how often. Gathered at the end under a general heading, these read as decoration, and markers treat them that way.
Where can I find a free NR 579 Week 2 sample paper?
The full symptom plan for the patient with ALS, with five symptom blocks, a rescue counting rule and the patient's limit, is published on this page.
What is the rescue counting rule in the NR 579 Week 2 plan?
Every rescue is charted with its time; more than three in 24 hours on two days running prompts a call to change the standing plan rather than adding more rescues.