| Course | NRNP 6540 Advanced Practice Care of Older Adults |
|---|---|
| Week | Week 9 |
| Paper type | Multimorbidity prioritization note |
| Length | About 780 words, 5 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NRNP 6540 Week 9
Multimorbidity Prioritization Note: Five Conditions, Eleven Medications, and Saturday Mornings Fishing With His Grandson
Student Name
College of Nursing, Walden University
NRNP 6540: Advanced Nurse Practice in Primary Care Adult Gerontology II
Instructor Name
Month Day, Year
Multimorbidity Prioritization Note: Five Conditions, Eleven Medications, and Saturday Mornings Fishing With His Grandson
Problem List With Every Active Recommendation
D.C., a composite 81-year-old retired highway maintenance worker, lives alone in a small house near a lake. His problems and the recommendations currently attached to each:
Heart failure with reduced ejection fraction: four guideline medicines, daily weights, a sodium limit, a cardiology visit every three months.
COPD: a twice-daily inhaler, a rescue inhaler, pulmonary rehabilitation (not attended).
Type 2 diabetes: metformin and a sulfonylurea, glucose checks twice daily, an A1c target below 7 percent set years ago, an endocrinology visit twice a year.
Chronic kidney disease stage 3b: nephrology visits twice a year, avoidance of nonsteroidal anti-inflammatory drugs.
Knee osteoarthritis: an orthopedic referral for injections.
Eleven medications in total, taken at four times of day, and five specialists.
Where the Plans Conflict
Diabetes and living alone: tighter glucose control with a sulfonylurea raises the risk of hypoglycemia, and he lives alone; a low glucose while driving to the lake or at night could be dangerous. His last two A1c values were 6.6 and 6.8 percent, lower than current guidance suggests for an older adult with multiple chronic conditions and limited remaining life expectancy (American Diabetes Association Professional Practice Committee [ADA], 2024).
Knee pain and kidneys: the most effective oral pain relievers for his knees, nonsteroidal anti-inflammatory drugs, are unsafe for his kidneys and heart failure.
Heart failure and COPD: the sodium and fluid limits he follows for his heart make him thirsty, while his COPD inhaler dries his mouth; he has stopped the inhaler because of it.
Visits and energy: five specialists mean one or two appointments nearly every week in some months, each a 40-minute drive.
His Priority, in His Words
"I want to keep fishing with my grandson on Saturday mornings. That's the best part of my week. I don't care about the numbers if I can still do that." He also wants fewer appointments. Asking about priorities and aligning care to them is the approach recommended for older adults with multiple chronic conditions (American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity, 2012), and in a clinical trial, patient priorities-aligned care was associated with reduced treatment burden (Tinetti et al., 2019).
Each Recommendation Against His Goal and Time to Benefit
Heart failure medicines: continue. They reduce breathlessness and hospitalization within months, which protects his Saturdays directly.
COPD inhaler: continue, but switch to a once-daily device with less mouth dryness, since breathing on the dock matters to him.
Sulfonylurea: stop. Its main benefit, lower microvascular risk from tight glucose control, takes years to appear, while its main harm, hypoglycemia, could happen this Saturday in a boat. Relax his A1c target to below 8 percent, continue metformin at a dose adjusted for his kidneys, and reduce glucose checks to once daily.
Knee pain: topical diclofenac, which has little kidney effect at recommended doses, and acetaminophen; a knee injection is reasonable if pain limits walking to the lake.
Visits: combine cardiology and nephrology follow-up into alternating visits where possible, and ask endocrinology to hand diabetes care back to primary care given the simplified plan.
Pulmonary rehabilitation: offered again in a form he might accept, a home exercise program, since stamina for fishing is a direct payoff.
Communicating the Changes
Each change was explained to him in terms of Saturday mornings rather than in terms of guidelines. Stopping the sulfonylurea was described as removing the medicine most likely to make him shaky or confused on the water. Relaxing the glucose target was described honestly: slightly higher sugars carry a small long-term risk, but the risk of a dangerous low is more immediate, and he agreed that trade was worth it. His specialists will each receive a letter explaining the priority-based plan, so that the next visit does not quietly restore what was simplified. The note records one thing deliberately not changed: his daily weights, which he finds tedious but which give early warning of fluid buildup that would keep him off the dock for weeks.
Treatment Burden
Before these changes, a typical week of his care meant 11 medications at four times of day, 14 glucose checks, 7 weight checks, and one or two drives to appointments, roughly six hours a week spent on being a patient. After the changes: 9 medications at two times of day, 7 glucose checks, 7 weight checks, and about half the visits. The plan was reviewed with him and his daughter, who agreed to fill his pill organizer weekly. Follow-up: one month, and the measure of success he chose: whether he is still on the dock every Saturday.
References
American Diabetes Association Professional Practice Committee. (2024). 13. Older adults: Standards of care in diabetes 2024. Diabetes Care, 47(Suppl. 1), S244-S257. https://doi.org/10.2337/dc24-S013
American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. (2012). Patient-centered care for older adults with multiple chronic conditions: A stepwise approach from the American Geriatrics Society. Journal of the American Geriatrics Society, 60(10), 1957-1968. https://doi.org/10.1111/j.1532-5415.2012.04187.x
Tinetti, M. E., Naik, A. D., Dindo, L., Costello, D. M., Esterson, J., Geda, M., Rosen, J., Hernandez-Bigos, K., Smith, C. D., Ouellet, G. M., Kang, G., Lee, Y., & Blaum, C. (2019). Association of patient priorities-aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: A nonrandomized clinical trial. JAMA Internal Medicine, 179(12), 1688-1697. https://doi.org/10.1001/jamainternmed.2019.4235
NRNP 6540 Week 9 instructions, in plain terms
Week 9 of NRNP 6540 often asks for a note that prioritizes care for an older adult with several chronic conditions. You list each condition and its recommendations, identify conflicts, elicit the patient's goals, weigh each recommendation against those goals and time to benefit, and plan changes with attention to treatment burden. Faculty question single-disease thinking. Cite the AGS guiding principles and time to benefit research in APA 7. Deprescribing or relaxing targets can be acceptable when justified. Communication with the patient and other clinicians belongs in the note. The patient's goal should appear in his own words. NRNP 6540 faculty want every active recommendation listed with its source before any is changed. Show the conflicts plainly, such as a blood pressure target that worsens dizziness. Explain how each change fits his fishing goal.
How the NRNP 6540 Week 9 example is put together
The problem list comes first with every active recommendation attached: heart failure, COPD, type 2 diabetes, kidney disease, and knee osteoarthritis, eleven medications, several daily inhaler and glucose routines, and five specialists. A conflicts section follows, showing where one condition's plan works against another's, such as tighter glucose control raising the risk of lows in a man who lives alone, or pain relief options narrowed by his kidneys. Then his priority, in his words: he wants to keep fishing with his grandson on Saturday mornings. Each recommendation is set against that goal and against time to benefit, and the note records which will continue, which will be simplified, and which will be stopped. A treatment burden paragraph counts what a week of his care actually demands.
NRNP 6540 Week 9 rubric: what earns full marks
Single-disease thinking is what this week is designed to question, and a note that manages five conditions in five separate paragraphs, each to its guideline target, applies exactly that approach. This example shows the conflicts and resolves them with the patient's priority. Credit goes to the time-to-benefit reasoning, which requires recognizing that some preventive treatments pay off over a horizon longer than an older adult's goals may extend. Graders check that stopped recommendations carry reasons and that the goal came from him. Weaker notes present de-intensification as neglect, never count the burden of care, or cite the AGS principles without applying them to any decision. The decision table is what makes the prioritization auditable, since every verdict sits beside the argument behind it.
Common NRNP 6540 Week 9 mistakes, and how to avoid them
Multimorbidity notes lose credit when five conditions are managed in five paragraphs, each to its own guideline target. Show the conflicts and decide. Another common gap is never asking what the patient wants. Record his goal and use it. Writers also ignore time to benefit, keeping drugs that will not help within his likely horizon. Weigh it. Avoid stopping treatments without explaining why. Count treatment burden, such as pills and visits. Keep the medication list consistent. Close with how changes will be communicated. Writers also forget to involve his other clinicians before relaxing their targets. Name who you will contact. Another frequent slip is ignoring the cost and effort of eleven medications. Count pills and doses per day. Check that each stopped drug has a reason recorded.
Get a NRNP 6540 Week 9 example written to your instructions
Share the Week 9 prompt, rubric, and the list of conditions you were given. The desk answers with a prioritization note that lists every recommendation, shows where they conflict, and decides each against a goal the patient states. Its conflicts come from the conditions actually listed in your case. Free as a first custom sample, and delivered in 24-48 hours.
More NRNP 6540 papers and MSN samples
- NRNP 6540 Week 1: Geriatric Assessment
- NRNP 6540 Week 2: Memory Complaint Note
- NRNP 6540 Week 3: Post-Fall Evaluation Note
- NRNP 6540 Week 4: Polypharmacy Review
- NRNP 6540 Week 5: Atypical Presentation Note
- NRNP 6540 Week 6: Incontinence Visit Note
- NRNP 6540 Week 7: Weight Loss Workup
- NRNP 6540 Week 8: Dementia Behavior Plan
- NRNP 6540 Week 10: Goals of Care Note
- NRNP 6540 Week 11: Transition Visit Note
- NRNP 6547 Week 9: Caregiver Support Plan
- NRNP 6539 Week 9: Health Maintenance Plan
- NRNP 6549 Week 9: Confidential Adolescent Visit
- NRNP 6537 Week 9: ICU Progress Note
NRNP 6540 Week 9 questions, answered
What does time to benefit mean here?
The interval between starting a treatment and the point when its benefit typically appears. Some preventive therapies help over years, others within weeks. For an older adult with limited life expectancy or near-term goals, a treatment whose benefit lies well beyond that horizon may add burden without meaningful gain. The example weighs each recommendation this way without inventing numerical estimates.
Is stopping recommended treatments acceptable in a graded note?
When it is reasoned and tied to the patient's goals, yes, and in a multimorbidity week it is often the point. The example records a reason for every change and cites the AGS guiding principles on care of older adults with multiple conditions. What loses credit is de-intensifying without explanation or without the patient's involvement in the decision.
Where does his goal come from?
From a direct question about what he wants his days to allow, recorded in his own words. The example deliberately avoids a goal set by the clinician on his behalf. The fishing trips, the grandson, and the rest of his life story are composite, created to show how a concrete personal priority can order a complicated plan.
Where can I find a free NRNP 6540 Week 9 sample paper?
D.C.'s prioritization note is reproduced here with the recommendation list, the conflicts, his fishing goal, the time to benefit weighing and treatment burden.
What is the patient's priority in NRNP 6540 Week 9?
Fishing with his grandson on Saturday mornings, against which each recommendation and its time to benefit is weighed.