NRNP 6537 Week 9 ICU Progress Note Example

Course	NRNP 6537 Adult Acute Care: Comprehensive Patient Management I
Week	Week 9
Paper type	ICU progress note
Length	About 770 words, 5 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 9

ICU Progress Note, Day 4: Pneumonia With Respiratory Failure in a 70-Year-Old Woman, With Conflicting System Priorities and Two Drug Interactions

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 doingA progress note's title should orient the next reader quickly: the hospital day, the principal problem, and what needs attention today. Naming the conflicting priorities and the drug interactions tells the team where the note's judgment is concentrated.

ICU Progress Note, Day 4: Pneumonia With Respiratory Failure in a 70-Year-Old Woman, With Conflicting System Priorities and Two Drug Interactions

Overnight Summary

S.T., a composite 70-year-old retired pharmacist, is on intensive care day 4 for right lower lobe pneumonia with acute hypoxemic respiratory failure, intubated on day 1. Overnight she had one episode of agitation with ventilator dyssynchrony at 02:00 that required an extra sedative dose, and her oxygen requirement fell slightly by morning. She remained on a low-dose vasopressor, which was weaned off at 05:00. Urine output was adequate. No new fever.

Respiratory

Data: on volume-assist control ventilation with modest oxygen and positive end-expiratory pressure, both reduced over 24 hours; this morning's arterial gas shows adequate oxygenation and a normal pH. Secretions thinner. Chest film unchanged to slightly improved. Interpretation: pneumonia is responding to antibiotics, and she is approaching readiness for a spontaneous breathing trial. Plan: daily awakening and breathing trial this morning if she meets screening criteria; continue antibiotics, day 4 of the planned course.

Cardiovascular

Data: off vasopressor since 05:00, blood pressure stable, heart rate 92 in sinus rhythm; electrocardiogram this morning shows a corrected QT interval of 488 milliseconds, up from 452 on admission. Interpretation: shock has resolved; the QT prolongation is new and likely drug-related (see the medication section). Plan: continuous telemetry, daily electrocardiogram, and potassium and magnesium kept in the high normal range.

Gastrointestinal and Nutrition

Data: tube feeds at goal since yesterday, tolerated without high residuals; one loose stool; recurrent nausea episodes treated with an antiemetic. Interpretation: adequate enteral nutrition established. Plan: continue feeds; review antiemetic choice (see the medication section); stress ulcer prophylaxis continued while ventilated.

Metabolic

Data: glucose 140 to 190 mg/dL on insulin; sodium normal; potassium 3.6 mmol/L; magnesium 1.8 mg/dL; creatinine back to baseline. Interpretation: stable metabolic status; potassium and magnesium are low normal, which matters given the QT prolongation. Plan: replete potassium and magnesium; continue insulin protocol.

Pain and Sedation

Data: on a continuous opioid infusion for analgesia and a continuous benzodiazepine infusion for sedation; sedation scale this morning deeper than the unit's target, possibly related to the overnight bolus. Interpretation: analgesia-first sedation is appropriate, but benzodiazepine use increases delirium risk, and current guidance favors propofol or dexmedetomidine over benzodiazepines for sedation of mechanically ventilated adults (Devlin et al., 2018). Plan: switch sedation from the benzodiazepine to propofol, titrate to a lighter target, and screen for delirium each shift.

Where Two Systems Pull in Opposite Directions

Conflict: the respiratory plan needs her lightly sedated and awake enough for a breathing trial today, while the overnight dyssynchrony and agitation pull toward deeper sedation for comfort and ventilator synchrony. Priority today: the respiratory plan wins. A breathing trial is the step that leads to extubation, and deeper sedation would delay it and increase delirium risk. The agitation will be managed by treating pain first and by lighter, more titratable sedation rather than more benzodiazepine. What would reverse this: if she fails the breathing trial with severe distress or dangerous dyssynchrony that threatens oxygenation, sedation would be deepened temporarily and the trial repeated tomorrow.

What this page is doingThe boxed conflict line is the most useful part of a multisystem note. It names the competing priorities, says which wins today and why, and states the finding that would reverse the decision, so the plans in different systems do not contradict each other silently.

Medication Review

Every active order was reviewed against the others. Two interactions were flagged.

1. Opioid plus benzodiazepine infusions: both depress respiratory drive and consciousness, and the combination compounds respiratory depression and deepens sedation. The FDA has warned about serious risks, including respiratory depression and death, when opioids and benzodiazepines are combined (U.S. Food and Drug Administration [FDA], 2016). While she is ventilated, the respiratory risk is partly managed by the ventilator, but it will matter at extubation, and the combination contributes to oversedation now. Action: replace the benzodiazepine with propofol as above.

2. Ondansetron plus her home citalopram, restarted on day 2: both prolong the QT interval, and her corrected QT has risen to 488 milliseconds with low-normal potassium and magnesium, raising the risk of torsades de pointes (Roden, 2004). Action: change the antiemetic to one without significant QT effect, hold citalopram temporarily after discussion with the team, and recheck the electrocardiogram after electrolyte repletion.

Other orders reviewed without concern: antibiotics, insulin, stress ulcer prophylaxis, and venous thromboembolism prophylaxis.

Family Update

Her daughter was updated at 10:00: her mother's pneumonia and blood pressure are improving, the team hopes to test whether she can breathe without the ventilator today, and some medications were adjusted to make her more awake and to protect her heart rhythm. Questions answered; next update after the breathing trial. She asked whether her mother will remember this; she was told that lighter sedation and daily awakening are meant partly to reduce confusion and distressing memories, and that the team screens for delirium every shift.

References

Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., van den Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., . . . Alhazzani, W. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825-e873. https://doi.org/10.1097/CCM.0000000000003299

Roden, D. M. (2004). Drug-induced prolongation of the QT interval. New England Journal of Medicine, 350(10), 1013-1022. https://doi.org/10.1056/NEJMra032426

U.S. Food and Drug Administration. (2016). FDA drug safety communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-about-serious-risks-and-death-when-combining-opioid-pain-or

Reading the NRNP 6537 Week 9 instructions

In Week 9, NRNP 6537 sections typically want one day's progress note on a critically ill patient with several active problems. You summarize overnight events, review each system with assessment and plan, reconcile conflicts between system plans, review medications for interactions and dosing, and document family communication. Faculty look for integration rather than separate lists. The note is structured by system and cites guidelines in APA 7 where they drive a decision. Medication review may or may not include doses depending on the section. Conciseness matters, so avoid restating the whole admission. Sedation and ventilator goals belong in the note. NRNP 6537 instructors expect each system to end with a decision, not just a description. State the ventilator settings and gas results for day 4. Name the sedation scale and target. The family update should say who was present and what they understood.

How the NRNP 6537 Week 9 example is put together

Three pages in the problem-based format intensive care teams use, organized by system with a short overnight summary at the top. Each system entry carries data, interpretation and a plan line: respiratory, cardiovascular, gastrointestinal and nutrition, metabolic, and pain and sedation. Where two systems pull in opposite directions, the note says so in a boxed line rather than letting the plans contradict each other silently, and it states which priority wins today and which finding would reverse it. A medication section reviews every active order against the others and flags two interactions: an opioid combined with a sedative that compounds respiratory depression, and an antiemetic that adds to the QT effect of a home antidepressant. A brief family update line closes the plan. No chart sits behind any value; the patient was made up for the page.

NRNP 6537 Week 9 rubric: what earns full marks

Most of the credit here rides on reconciling the conflicts, which is the part most submissions leave implicit. A respiratory plan asking for fluid removal beside a cardiovascular plan asking for fluid, with no line acknowledging the conflict, reads as two notes stapled together. The next share sits with the medication review: interactions named by class and mechanism earn, while an inventory of orders with no pair ever examined earns little. Third, system entries that report data without interpretation leave the note reading like a flowsheet. Where the reversal finding is missing, the priority chosen cannot be tested, and faculty tend to treat that as untestable reasoning. Oversized notes lose on format as well, since a progress note running to eight pages is no longer usable by the team it is written for.

NRNP 6537 Week 9 help: mistakes that cost marks

Progress notes forfeit the bulk of their credit when the respiratory plan asks for fluid removal and the renal plan asks for fluid, with no section reconciling them. Name the conflict and decide. Another common gap is a medication review that lists drugs without checking interactions or kidney dosing. Writers also skip the family update or write it as a single line. Say what was discussed. Avoid copying yesterday's note forward. Keep ventilator settings and laboratory values current for day 4. Include sedation goals with a scale. Close with the plan for the next 24 hours. Students also forget to reassess antibiotic duration on day 4 with culture results. Add it. Another frequent slip is listing drug interactions without saying what was changed. State the action.

Get a NRNP 6537 Week 9 example written to your instructions

Attach the Week 9 case with the prompt and the rubric, and a multisystem progress note example is organized by system around that patient, every conflict and interaction stated. Your first one is free within 24-48h, and any multisystem patient your faculty chose fits the same layout.

More NRNP 6537 papers and AGACNP samples

NRNP 6537 Week 9 questions, answered

Why pancreatitis for a multisystem note?

Severe acute pancreatitis produces genuine conflicts between systems within a single day, which is what this week's reconciliation work needs. Fluid, oxygenation, pain control and nutrition all compete, and none of them can be managed in isolation. The same note structure carries any multisystem patient, and a section assigning a different case gets the same conflict lines built around its own priorities.

Does the medication review list doses?

It lists active orders by drug and class only. The two interactions are explained by mechanism, compounded respiratory depression and additive QT effect, and the note says what monitoring or substitution the team would consider, without numbers. Dosing belongs to the prescriber and pharmacist, and graders in this course read the reasoning about interactions rather than the amounts.

How long should an ICU progress note run?

Long enough to carry every active problem, short enough that a covering clinician reads it before rounds. At about three pages, the sample suits most prompts. If your section asks for an expanded academic version with citations, the reasoning moves into short paragraphs under each system and the conflict lines stay exactly where they are.

Where can I find a free NRNP 6537 Week 9 sample paper?

The day 4 ICU progress note is printed here with each system, the section on competing priorities, the medication review and the family update.

How should an ICU note handle conflicting system plans in NRNP 6537 Week 9?

Name the conflict in its own section and make a decision. The example balances fluid removal for the lungs against kidney perfusion and states the target.