| Course | NRNP 6557 Adult Acute Care: Comprehensive Patient Management II |
|---|---|
| Week | Week 5 |
| Paper type | Medication reconciliation write-up |
| Length | About 930 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 6557 Week 5
Medication Reconciliation at Transfer, Day 3: Four Sources, Eleven Drugs, and the Diuretic Nobody in the Hospital Knew About
Student Name
College of Nursing, Walden University
NRNP 6557: Adult Acute Care: Comprehensive Patient Management II
Instructor Name
Month Day, Year
Medication Reconciliation at Transfer, Day 3: Four Sources, Eleven Drugs, and the Diuretic Nobody in the Hospital Knew About
The Reconciliation Table
Composite case, the same 67-year-old man followed since week 1: duodenal ulcer bleeding five weeks after a coronary stent, now on hospital day 3 and moving from the step-down unit to the medical floor. Four sources were compared: the cardiology discharge summary from five weeks ago (DC), the outpatient pharmacy fill history for the past 90 days (Rx), the patient and his wife interviewed together at the bedside (Pt), and the step-down transfer orders (TO).
Aspirin 81 mg oral daily. DC yes, Rx yes, Pt yes, TO yes. Status: continued.
Ticagrelor 90 mg oral twice daily. DC yes, Rx yes, Pt yes, TO held. Status: held, documented; restart planned at 72 hours with cardiology.
Atorvastatin 80 mg oral nightly. DC yes, Rx yes, Pt yes, TO absent. Status: unexplained omission.
Metoprolol succinate 50 mg oral daily. DC yes, Rx yes, Pt yes, TO 25 mg daily. Status: changed, documented on day 2 for blood pressure.
Lisinopril 20 mg oral daily. DC yes, Rx no (last fill 7 weeks ago), Pt "my blood pressure pill," TO held. Status: held, documented for kidney injury; source conflict, see below.
Lisinopril-hydrochlorothiazide 20/12.5 mg oral daily. DC no, Rx yes (filled 3 weeks ago), Pt yes when shown the bottle photo, TO absent. Status: unexplained; not known to the admitting team.
Metformin 1,000 mg oral twice daily. DC yes, Rx yes, Pt yes, TO held. Status: held, documented for kidney injury.
Insulin glargine. DC 24 units nightly, Rx consistent with either dose, Pt 30 units, TO 17 units. Status: changed; the 17 units is 70% of 24, not of the dose he actually takes.
Naproxen 220 mg tablets, two tablets twice daily, over the counter. DC no, Rx no, Pt yes, TO absent. Status: stopped permanently; recorded as a home drug.
Fish oil 2 g oral daily, over the counter. DC no, Rx no, Pt yes, TO absent. Status: held.
Famotidine 20 mg intravenous twice daily, started in the emergency department. TO yes, alongside a pantoprazole infusion. Status: duplication.
Omissions and Duplications
Omission: atorvastatin dropped out of the transfer orders when he was made nothing by mouth for endoscopy and was never restarted. After a recent myocardial infarction, high-intensity statin therapy is one of the drugs that should not lapse. Action: restart tonight.
Omission from every clinical list: naproxen and fish oil, both over the counter, found only by asking him. Naproxen is addressed in its own section below. Fish oil is recorded, held while he is on dual antiplatelet therapy with a healing ulcer, and flagged as low priority.
Duplication: famotidine and a high-dose pantoprazole infusion, two acid suppressants acting through different mechanisms, with no benefit from combining them in this setting; the recommended acid suppression after endoscopic hemostasis is a high-dose proton pump inhibitor alone for 3 days (Laine et al., 2021). Action: stop famotidine.
Undocumented Changes
Insulin glargine: the discharge summary says 24 units; he says 30, because his primary care clinician increased it by phone three weeks ago. The transfer dose of 17 units was calculated from the wrong baseline. His glucose has run 180 to 240 mg/dL, which fits under-dosing. Action: recalculate from 30 units as he starts eating.
Lisinopril: the discharge summary lists lisinopril alone, but the pharmacy record shows that three weeks ago his primary care clinician switched him to a lisinopril-hydrochlorothiazide combination tablet. Nobody in the hospital knew he was taking a diuretic.
The Working-Against Finding
Three drugs on his home list, each chosen for a separate problem, combined to work against his kidneys. Naproxen for knee pain blocks prostaglandins that keep the afferent arteriole open; lisinopril for blood pressure relaxes the efferent arteriole; hydrochlorothiazide lowers circulating volume. Together they reduce the pressure that drives filtration at the moment he lost blood. In a nested case-control study of 487,372 users of antihypertensive drugs, adding an NSAID to a diuretic plus an ACE inhibitor or angiotensin receptor blocker raised the rate of acute kidney injury by about a third (rate ratio 1.31), and the risk was highest in the first 30 days of the combination (rate ratio 1.82) (Lapi et al., 2013). He started the diuretic three weeks ago and the naproxen a month ago; both fall inside that window.
That explains part of his kidney injury that blood loss alone did not: his creatinine rose from 1.4 to 1.9 mg/dL, more than his modest hypotension would predict. It also changes the restart plan: when his blood pressure medicine is resumed, it should be lisinopril without the thiazide at first, and naproxen should not return at all.
The other discrepancies are real but smaller. The statin omission would matter over weeks; the insulin error is causing hyperglycemia now but is easily corrected; the famotidine duplication adds cost, not harm. The diuretic finding matters most because it changes both the explanation of his kidney injury and his discharge plan.
What Follows
Orders: restart atorvastatin; stop famotidine; recalculate insulin glargine from 30 units; document naproxen and fish oil as home drugs, naproxen stopped permanently. Kidney: creatinine daily; resume lisinopril alone once creatinine is within 0.3 mg/dL of baseline and blood pressure allows; no thiazide until a follow-up visit. Communication: a message to his primary care clinician, who made the change to the combination tablet, so the outpatient list and the hospital list agree. Pharmacist-led reconciliation has consistently reduced medication discrepancies in hospital studies (Mueller et al., 2012), so a pharmacist will repeat this reconciliation at discharge.
References
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
Lapi, F., Azoulay, L., Yin, H., Nessim, S. J., & Suissa, S. (2013). Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: Nested case-control study. BMJ, 346, Article e8525. https://doi.org/10.1136/bmj.e8525
Mueller, S. K., Sponsler, K. C., Kripalani, S., & Schnipper, J. L. (2012). Hospital-based medication reconciliation practices: A systematic review. Archives of Internal Medicine, 172(14), 1057-1069. https://doi.org/10.1001/archinternmed.2012.2246
The Walden NRNP 6557 Week 5 instructions
In Week 5, NRNP 6557 usually asks for a medication reconciliation at a transition point in the hospital stay. You compare several sources, build a table with a source column for each entry, identify omissions, duplications and undocumented changes, find drugs working against the current plan, and recommend actions. Faculty want reasoning, not a table alone. Cite reconciliation standards in APA 7. Over-the-counter products and supplements belong in the table. Each discrepancy should have an action and an owner. Connection to the ongoing case should be clear. NRNP 6557 faculty want four sources compared and named in the table. Each discrepancy should have an action and an owner. Explain the drug working against the plan in its own paragraph. Note how the reconciliation changes the problem list.
How the NRNP 6557 Week 5 example is put together
Two artifacts sit in one file. The table lists every medication against its sources, home list, transfer paperwork and patient report among them, with dose, route, frequency and a status column reading continued, held, changed or unexplained. Beneath it, the narrative works through the discrepancies by type rather than one drug at a time: omissions, duplications, dose changes with no documented reason, and the class of finding this week is built around, where a drug appropriate for one problem aggravates another on the same list. That finding gets its own short section with the mechanism stated and a source behind it. The composite patient's identifying detail is absent, and nothing here reproduces a real chart.
NRNP 6557 Week 5 rubric: what earns full marks
A table submitted alone loses the larger share, since the reconciliation is the reasoning and not the grid. Rows without a source column are the next problem: a list of drugs with no indication of where each one came from cannot show a discrepancy at all. Third, write-ups flagging every difference with equal weight read as undiscriminating, and the rubric in most sections rewards a clear statement of which finding actually matters for this patient. The interaction finding loses points when stated without a mechanism, since asserting that two drugs conflict is not the same as showing why. Cosmetic issues, inconsistent units and drug names alternating between brand and generic, cost less individually but accumulate quickly across thirty rows.
NRNP 6557 Week 5 help: mistakes that cost marks
Reconciliations lose the larger share when a table is submitted with no explanation. Write what each discrepancy means and what you will do. Another common gap is rows without a source column, so nobody can trace where a drug came from. Add it. Writers also miss the outpatient drug that never reached the hospital list, here the diuretic. Compare the bottles. Avoid listing over-the-counter products as an afterthought; naproxen matters in this case. Give each action an owner. Keep doses consistent across sources. Close with who will update the list at discharge. Writers also forget to ask the patient what he actually takes, which is often different from every list. Ask and record it. Another frequent slip is leaving the cardiology summary unreconciled with the pharmacy. Compare them line by line.
Get a NRNP 6557 Week 5 example written to your instructions
Send the Week 5 prompt and any reconciliation template the classroom supplies, and the desk returns a filled example with the narrative written against it. The first custom sample is free, delivered in 24 to 48 hours. Medication records tied to your own patients stay out of it entirely; the example runs on a case composed for the purpose.
More NRNP 6557 papers and AGACNP samples
- NRNP 6557 Week 1: Discussion Post
- NRNP 6557 Week 2: Problem List
- NRNP 6557 Week 3: Case Management Paper
- NRNP 6557 Week 4: Discussion Post
- NRNP 6557 Week 6: Complex case analysis
- NRNP 6557 Week 7: Evidence appraisal
- NRNP 6557 Week 8: Discussion post
- NRNP 6557 Week 9: Care transition plan
- NRNP 6557 Week 10: Case presentation
- NRNP 6557 Week 11: Reflection
- NRNP 6559 Week 5: STI and partner care note
- NRNP 6549 Week 5: Acute Illness SOAP Note
- NRNP 6566 Week 5: Pneumonia admission plan
- NRNP 6547 Week 5: Literature Matrix
NRNP 6557 Week 5 questions, answered
Does the example use a real drug list?
It uses real medications in a fabricated arrangement, built so the discrepancies are the ones these assignments usually test. No part of it is taken from a chart. That is also the safer posture for the graded version, since a reconciliation drawn from a real encounter carries identifying detail with no business in a classroom submission.
Should the table include over-the-counter products?
In the sample, yes, along with supplements, and one discrepancy turns on an item a patient would not think to report. Prompts vary on this and yours governs. Where a template has no row for them, the example mentions them in the narrative instead, since leaving them out entirely is a common way to miss the interaction this week is built around.
How does this connect to the rest of the course?
The reconciliation feeds the ordering work. A drug aggravating a second problem changes what can be treated first, so the closing paragraph of the sample states which position on the problem list moves as a result. Sections grading holistically tend to reward that link explicitly, and it costs two sentences to make.
Where can I find a free NRNP 6557 Week 5 sample paper?
The day 3 reconciliation is printed here with the four-source table, omissions and duplications, undocumented changes and the hidden diuretic.
Should over-the-counter drugs be in an NRNP 6557 Week 5 reconciliation?
Yes. The example includes naproxen and supplements because they can cause or worsen the problems being treated, such as bleeding and kidney injury.