NRNP 6537 Week 4 Septic Shock Case Example

Course	NRNP 6537 Adult Acute Care: Comprehensive Patient Management I
Week	Week 4
Paper type	Case write-up paper
Length	About 1,070 words, 6 pages
Format	APA 7 student paper
School	Walden University
Program	MSN Adult-Gerontology Acute Care Nurse Practitioner (AGACNP)
Updated	October 2026

Free sample paper for NRNP 6537 Week 4

Septic Shock From an Obstructed Urinary Source in a 74-Year-Old Woman: Recognition Timeline, Shock Differential, and Guideline-Based Management

Student Name

College of Nursing, Walden University

NRNP 6537: Advanced Nurse Practice in Adult/Gerontology Acute Care I

Instructor Name

Month Day, Year

What this page is doingThe title names the source as obstructed, which is the detail that makes source control a problem in its own right, and it names the three parts of the write-up. A septic shock case is graded on recognition and reasoning more than on the list of bundle elements, and the title promises both.

Septic Shock From an Obstructed Urinary Source in a 74-Year-Old Woman: Recognition Timeline, Shock Differential, and Guideline-Based Management

Recognition Timeline

Arrival (0 minutes): M.R., a 74-year-old retired seamstress who exists only for this case, is brought from home by her son for two days of confusion, poor oral intake, and fever. Triage vital signs: temperature 102.6 F, heart rate 118, respiratory rate 24, blood pressure 96/58, oxygen saturation 95 percent on room air.

20 minutes: infection suspected. She has right flank tenderness, and her son reports she had kidney stones in the past and has complained of burning on urination. A qSOFA assessment is positive: respiratory rate of 22 or more, altered mentation, and systolic pressure of 100 or less. Current Surviving Sepsis Campaign guidance recommends against using qSOFA alone as a screening tool compared with other measures, because it misses many patients with sepsis; here it served as the bedside prompt that raised concern, alongside clinical judgment (Evans et al., 2021).

50 minutes: organ dysfunction documented. Lactate 4.6 mmol/L, creatinine 2.4 mg/dL from a baseline of 0.9, platelets 96,000, bilirubin 1.8 mg/dL, and a Glasgow Coma Scale score of 13.

2 hours 10 minutes: shock recognized. After initial fluid resuscitation, blood pressure remains low and a vasopressor is required to maintain perfusion, with lactate still elevated on repeat. Under the Sepsis-3 definitions, sepsis means organ dysfunction that threatens life and arises from the body's dysregulated response to an infection, and septic shock is sepsis with vasopressor requirement to maintain mean arterial pressure and an elevated lactate despite adequate fluid resuscitation (Singer et al., 2016).

What this page is doingThe timeline records each step as elapsed time from arrival: infection suspected, organ dysfunction documented, shock recognized. It uses qSOFA as the prompt it actually was while noting the guideline's caution against relying on it alone, which is the kind of precision graders reward.

Organ Dysfunction by System (SOFA)

The Sequential Organ Failure Assessment was used after recognition to document which systems were failing, not as a screening tool (Singer et al., 2016). Renal: creatinine rise to more than twice baseline, with falling urine output. Coagulation: thrombocytopenia. Hepatic: mildly elevated bilirubin. Central nervous system: reduced Glasgow Coma Scale score. Cardiovascular: hypotension requiring a vasopressor. Respiratory: oxygenation preserved at this stage. Her SOFA score rose by well over two points from an assumed normal baseline, confirming sepsis, and five of six systems show dysfunction.

Shock Differential, Ranked

1. Distributive shock from sepsis, leading. Fever, a clear urinary source, warm extremities early on, a widened pulse pressure, and a rising lactate despite fluids fit vasodilatory shock from infection.

2. Hypovolemic contribution, weighed rather than dismissed. Two days of poor intake, fever-related losses, and a concentrated urine mean she arrived volume depleted. This component responds to fluid, and her initial improvement in heart rate after fluids shows it was present.

3. Cardiogenic contribution, weighed rather than dismissed. Sepsis can depress myocardial function, and at 74 she may have unrecognized heart disease. A bedside echocardiogram showed a normal-sized left ventricle with preserved function and a collapsing inferior vena cava before fluids, which argues against a primary cardiogenic cause; the finding is rechecked if she fails to respond to vasopressors or develops pulmonary edema.

4. Obstructive shock, briefly considered. No signs of tension pneumothorax, tamponade on echocardiography, or massive pulmonary embolism.

Management, With Guideline Rationale

Source control is the problem most specific to this case. A renal ultrasound shows right hydronephrosis with an obstructing ureteral stone. An infected, obstructed kidney will not clear with antibiotics alone, because pus under pressure cannot drain, and the guidelines recommend identifying a source requiring control and performing the intervention as soon as medically and logistically practical (Evans et al., 2021). Urology is consulted for emergent decompression by ureteral stent or percutaneous nephrostomy.

Cultures: two sets of blood cultures and a urine culture are obtained before antibiotics, because identifying the organism and its susceptibilities will guide later narrowing of therapy, but cultures must not delay antibiotics.

Antimicrobial timing: in patients with probable septic shock, the guideline recommends administering antimicrobials immediately, ideally within one hour of recognition, because each hour of delay in shock is associated with higher mortality (Evans et al., 2021). Broad-spectrum coverage appropriate for a complicated urinary source and her recent health care exposure is started within the hour and will be narrowed when culture results return.

Fluid reassessment: initial crystalloid resuscitation is given, then additional fluid is guided by repeated assessment of perfusion rather than given as a fixed volume: capillary refill, mental status, urine output, lactate trend, and dynamic measures such as the change in stroke volume with passive leg raising, a reversible fluid challenge that tests responsiveness without giving any fluid (Monnet & Teboul, 2015). The guideline favors dynamic measures of fluid responsiveness over static ones, and fluids are stopped when she no longer responds, to avoid overload.

Vasopressor reasoning: when hypotension persists despite fluid, a vasopressor is started rather than giving more fluid to a patient who is no longer fluid responsive. Norepinephrine is the first-line agent recommended by the guideline; vasopressin is added if higher doses of norepinephrine are needed, and corticosteroids are considered for ongoing vasopressor requirement. She is started through a peripheral line while central access is obtained, which the guideline permits to avoid delay.

Level of care: admission to the intensive care unit after decompression.

Reassessment

At six hours, after nephrostomy drainage of purulent urine, her lactate is falling, her mental status is improving, and her vasopressor requirement is decreasing. The reassessment plan names what would change the course: a rising lactate or vasopressor need, which would prompt a search for another source or a missed complication; new hypoxemia, which would prompt reassessment of fluid balance and of acute respiratory distress syndrome; and a worsening creatinine or oliguria despite restored perfusion, which would bring in nephrology.

Communication and Goals of Care

Her son was updated in the emergency department and again after the nephrostomy, in plain terms: a serious blood infection from a blocked kidney, a procedure to drain it, and medicines to support her blood pressure in intensive care. Her advance directive, which he brought, requests full treatment for reversible conditions, and this was confirmed with him and documented. The handoff to the intensive care team records the recognition times, the source and the drainage procedure, culture sites and timing, the antibiotic start time, the fluid response assessments, and the current vasopressor requirement, so that the receiving team can judge her trajectory rather than a single snapshot. De-escalation of antibiotics will be reviewed daily against culture results, and the need for the vasopressor, the central line, and the nephrostomy will be reassessed every day as she improves.

References

Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., . . . Levy, M. (2021). Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Critical Care Medicine, 49(11), e1063-e1143. https://doi.org/10.1097/CCM.0000000000005337

Monnet, X., & Teboul, J.-L. (2015). Passive leg raising: Five rules, not a drop of fluid! Critical Care, 19, 18. https://doi.org/10.1186/s13054-014-0708-5

Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J.-D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., van der Poll, T., Vincent, J.-L., & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 315(8), 801-810. https://doi.org/10.1001/jama.2016.0287

What the NRNP 6537 Week 4 instructions ask for

The fourth week of NRNP 6537 usually asks for a case write-up on sepsis or shock. You present the case with a timeline, score organ dysfunction, rank the shock differential, and describe management with guideline rationale, reassessment and communication with the family. Faculty want to see when sepsis was recognized and how quickly key steps happened. Plan on four to six pages for NRNP 6537, citing Sepsis-3 and the Surviving Sepsis Campaign in APA 7. Source control should be addressed specifically. Some sections omit fluid volumes and vasopressor doses to keep the focus on reasoning. Goals of care belong in the paper for an older patient. NRNP 6537 sections often ask for the qSOFA or SOFA calculation shown in full. Antibiotic timing from recognition should be stated in minutes. Include lactate and its repeat. A family conversation about goals is expected for an older adult in shock.

How the NRNP 6537 Week 4 example is put together

Six pages in a problem-oriented layout, with a short recognition timeline on the first page. The timeline records when infection was suspected, when organ dysfunction was documented, and when shock was recognized, each as elapsed time from arrival. qSOFA appears as the bedside prompt that raised concern, with a sentence noting that current campaign guidance cautions against using it alone as a screen; SOFA is used afterward to document which organ systems were failing. A ranked shock differential follows, distributive leading, with hypovolemic and cardiogenic contributions each weighed rather than dismissed. The plan runs through source control, cultures, antimicrobial timing, fluid reassessment and vasopressor reasoning, every element tied to its guideline rationale and none carrying a dose or a target. The patient and the emergency department are both composites.

NRNP 6537 Week 4 rubric: what earns full marks

Timing is where these write-ups are won. A document that describes excellent treatment without saying when sepsis was suspected, or how long the patient waited for antimicrobials, leaves the recognition criteria unanswered, and faculty read for the dates first. Score use is the next concentration: qSOFA presented as a diagnostic test, rather than a prompt, signals a misreading the campaign itself has warned against. Third, a shock differential collapsed to one word, septic, skips the weighing of mixed physiology the course expects in unstable patients. Plan elements cited to the guideline as a block, with no rationale per element, read as a bundle recited from memory. Write-ups that stop at the plan, with no failure signals, miss the deterioration loop that most 6537 rubrics carry in one form or another.

NRNP 6537 Week 4 help from the desk

Sepsis write-ups lose credit when they describe good treatment without saying when sepsis was suspected or how long the patient waited for antibiotics. Put times on every step. Another common gap is missing source control, which here means relieving the obstruction. Writers also rank the shock differential without explaining why cardiogenic or hypovolemic causes are less likely. Give reasons. Avoid listing every bundle element without linking it to this patient. Score SOFA by system and show the numbers. Include reassessment after fluids. Close with the conversation about goals of care. Students also forget to name the imaging that found the obstruction and who decompressed it. Say both. Another frequent gap is not stating when vasopressors were started relative to fluids. Give the time. Check that the SOFA total matches its components.

Get a NRNP 6537 Week 4 example written to your instructions

Share the Week 4 case prompt and its rubric, naming the guideline edition your faculty expects where the prompt specifies one, and the septic shock write-up is built against it. Free the first time and returned in 24-48h, recognition timeline included and the plan argued without volumes.

More NRNP 6537 papers and AGACNP samples

NRNP 6537 Week 4 questions, answered

Why does the write-up spend so long on recognition?

Because recognition is where sepsis care most often goes wrong and where many rubrics place their heaviest weighting. A well-argued plan attached to an undated recognition gives no way to tell whether the patient waited. The sample gives recognition its own timeline so the delay, or its absence, can be read at a glance before the treatment argument begins.

Does it include fluid volumes or vasopressor targets?

No figure of either kind appears. The plan explains why fluids are given and reassessed, and when vasopressor support becomes the argument, citing the Surviving Sepsis Campaign for the reasoning. Volumes, targets and doses belong to current guidance and to the prescriber. Leaving them out keeps the sample a model of argument rather than a treatment protocol anyone might copy.

My case has a different source of infection. Does that matter?

Only in the source control section, which changes most with the source. A biliary or soft tissue source raises different questions about timing and procedure than a urinary one does. Recognition, the score discussion, the shock differential and the failure signals keep their shape. Send the case your section provides and the example is rebuilt around its actual source.

Where can I find a free NRNP 6537 Week 4 sample paper?

M.R.'s septic shock case is shown in full here, including the recognition timeline, SOFA scoring, the ranked shock differential and goals of care.

Which scoring system appears in NRNP 6537 Week 4?

SOFA, used to score organ dysfunction system by system as the patient moves from sepsis to shock.