| Course | NRNP 6557 Adult Acute Care: Comprehensive Patient Management II |
|---|---|
| Week | Week 2 |
| Paper type | Ranked problem list |
| Length | About 790 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 6557 Week 2
Ranked Problem List, Hospital Day 2: Duodenal Ulcer Bleeding in a Man With a Five-Week-Old Coronary Stent
Student Name
College of Nursing, Walden University
NRNP 6557: Adult Acute Care: Comprehensive Patient Management II
Instructor Name
Month Day, Year
Ranked Problem List, Hospital Day 2: Duodenal Ulcer Bleeding in a Man With a Five-Week-Old Coronary Stent
The Patient on Day 2
Composite case, continued from the week 1 discussion: a 67-year-old retired commercial fisherman admitted yesterday with melena and syncope, five weeks after a drug-eluting stent was placed for a non-ST-elevation myocardial infarction. Received 2 units of red cells overnight. Endoscopy this morning: a 1.5 cm ulcer in the duodenal bulb with a nonbleeding visible vessel, treated with epinephrine injection and two clips; biopsies taken for Helicobacter pylori. On a high-dose proton pump inhibitor infusion. Aspirin continued; ticagrelor held since admission, 30 hours ago.
Active Block
1. Duodenal ulcer bleeding, after endoscopic therapy of a nonbleeding visible vessel. Onset: 2 days before admission. Status: hemostasis achieved today; highest rebleeding risk in the next 72 hours. Justification: still ranked first because rebleeding in the next three days would threaten his life faster than any other entry, and because nothing else on the list can be managed safely until it is controlled. Competes with: entry 2, since every day of bleeding control is a day without full antiplatelet therapy.
2. Recent drug-eluting stent in the left anterior descending artery, on dual antiplatelet therapy with ticagrelor held. Onset: 5 weeks ago. Status: aspirin continued; ticagrelor held 30 hours; no chest pain; ECG unchanged from discharge; troponin flat. Justification: a close second because stent thrombosis is uncommon but often catastrophic, and the risk is highest in the first months after placement. It constrains entry 1 by limiting how long the ticagrelor can stay off. Competes with: entry 1.
3. Acute blood loss anemia. Onset: day 0. Status: hemoglobin 7.4 on admission, 8.3 after 2 units, 8.1 this afternoon. Justification: ranked third because it is a consequence of entry 1 and a strain on entry 2; a heart with a recent infarction tolerates anemia less well. What it constrains: the transfusion threshold, which is debated separately this week.
4. Acute kidney injury on chronic kidney disease stage 3a. Onset: day 0. Status: creatinine 1.9 on admission, 1.6 today (baseline 1.4); urea falling. Justification: most likely prerenal from blood loss and urea from digested blood; improving with volume. It constrains drug choices: metformin held, lisinopril held, contrast avoided.
5. Type 2 diabetes on insulin. Status: glucose 180 to 240 mg/dL on basal insulin at 70% of home dose while taking nothing by mouth. Justification: active because his usual regimen has been changed and he is about to start eating.
6. Naproxen use, stopped. Onset: 1 month before admission. Status: discontinued on admission. Justification: listed as active, not historical, because the ulcer most likely began with it, and his knee pain still needs a plan that does not include it.
7. Hypertension, home medications held. Status: blood pressure 118/70 today; lisinopril held for kidney injury; metoprolol resumed at half dose this morning once heart rate and pressure allowed. Justification: active because a held beta-blocker in a man with a recent infarction needs a restart plan.
Background Block
8. Knee osteoarthritis, bilateral. Kept on the list because the pain is what led to naproxen, and without a replacement plan he may restart it.
9. Hyperlipidemia on high-intensity atorvastatin, continued. Listed because stopping it after a recent infarction would be an error of omission.
10. Helicobacter pylori status pending. Kept visible because a positive biopsy changes treatment and his long-term risk of recurrent ulcer bleeding.
The Top Three as a Set
The first three positions are relational rather than independent. Bleeding control ranks first because the proton pump inhibitor infusion and endoscopic therapy work only if the ulcer is not re-exposed to a full antiplatelet load in the first days, when rebleeding after endoscopic therapy is most likely (Lau et al., 2000). The stent ranks second, not lower, because aspirin has been kept and the question of when to restart ticagrelor is being decided actively rather than deferred. Guidance on antiplatelet management during acute bleeding supports continuing aspirin for secondary prevention (Abraham et al., 2022), which is why entry 2 is managed rather than merely watched. Anemia ranks third because it links the two: more blood loss worsens both, and a lower hemoglobin reduces oxygen delivery to a heart that is still healing.
The Reorder Trigger
Entry 2 moves to first place if he develops chest pain, new ST-segment changes, or a rising troponin: at that point stent thrombosis is the greater threat and the ticagrelor decision becomes urgent regardless of the ulcer. Entry 1 stays first if he rebleeds, marked by new melena or hematemesis, a drop in hemoglobin by 2 g/dL or further, or a heart rate rising above 100, and repeat endoscopy is suggested for recurrent bleeding (Laine et al., 2021).
References
Abraham, N. S., Barkun, A. N., Sauer, B. G., Douketis, J., Laine, L., Noseworthy, P. A., Telford, J. J., & Leontiadis, G. I. (2022). American College of Gastroenterology-Canadian Association of Gastroenterology clinical practice guideline: Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. The American Journal of Gastroenterology, 117(4), 542-558. https://doi.org/10.14309/ajg.0000000000001627
Laine, L., Barkun, A. N., Saltzman, J. R., Martel, M., & Leontiadis, G. I. (2021). ACG clinical guideline: Upper gastrointestinal and ulcer bleeding. The American Journal of Gastroenterology, 116(5), 899-917. https://doi.org/10.14309/ajg.0000000000001245
Lau, J. Y., Sung, J. J., Lee, K. K., Yung, M. Y., Wong, S. K., Wu, J. C., Chan, F. K., Ng, E. K., You, J. H., Lee, C. W., Chan, A. C., & Chung, S. C. (2000). Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. The New England Journal of Medicine, 343(5), 310-316. https://doi.org/10.1056/NEJM200008033430501
NRNP 6557 Week 2 instructions, in plain terms
The second week of NRNP 6557 often asks for a ranked problem list for a hospitalized patient. You separate active from background problems, rank active problems by priority with a justification for each, consider how the top problems interact, and state what would change the order. Faculty reward the justification column. Cite guidelines that support the ranking in APA 7. Lists are often submitted as a table with brief prose. Grouping by priority usually works better than grouping by system. The number of problems should match the patient, not a template. NRNP 6557 faculty want each active problem to carry a one-line justification. The top three should be discussed together because their plans collide. A reorder trigger should be measurable. Keep the background block short.
Inside the NRNP 6557 Week 2 example
Two columns of work sit in the document. The list proper names six to nine problems for one composite adult patient, active ones above background ones, each with a status and a date of onset where the case supplies it. Beside or beneath each entry runs a justification of a line or two: what makes this problem live, what it constrains, and which other entry it is competing with. Then a short paragraph explains the top three positions as a set rather than one at a time, because the ranking is relational. Chronic conditions appear even when nothing is being done about them, since they narrow what can be done about the acute problem. No hours, no encounter record and no signed clinical form appears anywhere in the file.
NRNP 6557 Week 2 rubric: what earns full marks
The rubric in most sections rewards the reasoning attached to the order, so a clean list with no justification column loses most of what was available. Alphabetical or intake order reads as transcription. Second, background conditions left off entirely cost points twice, once for the omission and once when the plan later ignores a constraint that would have been obvious. Third, justifications that restate the diagnosis in different words say nothing; a line reading uncontrolled because it is uncontrolled is a blank. Duplicated entries, where one problem appears as both a symptom and a diagnosis, suggest the list was built from notes rather than thought through. Formatting alone rarely costs much, though an unreadable table can bury an argument that was actually there.
NRNP 6557 Week 2 help: mistakes that cost marks
Problem lists lose most when they are clean but carry no reasons for the order. Add a justification for each rank. Another common gap is ranking by system or alphabetically, which hides priority. Rank by threat and time. Writers also treat the top problems separately, though the ulcer and the stent pull plans in opposite directions. Discuss them together. Avoid long lists of stable chronic problems in the active block. State a reorder trigger, such as rebleeding or chest pain. Keep values consistent with the earlier case. Close with the plan for the next 24 hours. Writers also forget to state the day of admission and the last hemoglobin, so the list cannot be judged in time. Add them. Another frequent slip is putting anemia and bleeding as separate top problems when one causes the other. Link them.
Get a NRNP 6557 Week 2 example written to your instructions
Give the desk your Week 2 prompt, any template your classroom supplies and the rubric, and a problem list example comes back built on a case of the same shape as yours. First one is free, back within 24 to 48 hours. Anything a supervising clinician has to sign remains entirely your record.
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NRNP 6557 Week 2 questions, answered
Should the list be grouped by system or by priority?
The example ranks by priority and says so in a header line, because the ordering is the graded object. System grouping is common in charting and it hides exactly what Week 2 is asking for. If your prompt explicitly asks for a systems layout, the priority argument moves into the paragraph underneath, where it can still be read and scored.
How many problems belong on it?
The sample carries between six and nine, which is what a single adult case usually supports without padding. Counts are not published by Walden and no number is safe to treat as official. What matters more is that nothing appearing later in the plan is missing from the list, since a plan acting on an unlisted problem is the discrepancy graders catch first.
Can I use my own patient from clinical?
Your encounters are your record and stay that way; the desk never writes them up or reconstructs them. What the example does instead is work from a composite built for the page, and that is the safer route for a graded document too. Strip identifiers, change the incidental detail, and the reasoning you are scored on survives intact.
Where can I find a free NRNP 6557 Week 2 sample paper?
The day 2 ranked problem list is printed here with the active and background blocks, the justification column, the top three as a set and the reorder trigger.
What ranks first on the problem list in NRNP 6557 Week 2?
Duodenal ulcer bleeding, followed by the recent stent on dual antiplatelet therapy, acute kidney injury and anemia.