| Course | NRNP 6557 Adult Acute Care: Comprehensive Patient Management II |
|---|---|
| Week | Week 9 |
| Paper type | Care transition plan |
| Length | About 990 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 9
Care Transition Plan: Discharge on Day 6 After Ulcer Bleeding and a Type 2 Infarction, With One Weak Link Named
Student Name
College of Nursing, Walden University
NRNP 6557: Adult Acute Care: Comprehensive Patient Management II
Instructor Name
Month Day, Year
Care Transition Plan: Discharge on Day 6 After Ulcer Bleeding and a Type 2 Infarction, With One Weak Link Named
Problem by Problem Handoff
Composite case, the patient followed through this course: 67 years old, retired commercial fisherman, admitted when a duodenal ulcer bled in the fifth week after his coronary stent, course complicated on day 3 by a type 2 myocardial infarction. Discharge is on hospital day 6 to home with his wife, 40 minutes from town.
Duodenal ulcer, clipped visible vessel. Continued by: his primary care nurse practitioner, with gastroenterology clinic. Interval: primary care in 7 days; gastroenterology clinic in 6 weeks, which is the clinic's current wait. Watching: black stools, vomiting blood, dizziness on standing. Fallback: if the gastroenterology appointment is not confirmed by the primary care visit, the primary care clinic calls the scheduler that day.
Helicobacter pylori, biopsy positive on day 4. Continued by: primary care. Interval: start bismuth quadruple therapy for 14 days on discharge, the preferred first regimen when antibiotic susceptibility is unknown; a test of cure is recommended after treatment for everyone treated (Chey et al., 2024), so a breath or stool test is ordered for at least 4 weeks after the antibiotics finish, with his acid suppressant paused for the 2 weeks before it. Watching: adherence to four drugs, four times a day. Fallback: pharmacy telephone check on day 3 of therapy.
Recent stent and type 2 infarction. Continued by: his cardiologist. Interval: 7 days, booked before discharge for next Tuesday. Watching: chest pressure, breathlessness walking, bleeding on ticagrelor. Fallback: if the appointment is missed, the cardiology nurse calls within 24 hours. Referral to cardiac rehabilitation placed.
Anemia, hemoglobin 9.8 g/dL at discharge. Continued by: primary care. Interval: complete blood count at the 7-day visit. Watching: fatigue, heart rate at rest over 100. Fallback: laboratory order is placed now so it can be drawn locally even if the visit slips.
Kidney injury, creatinine 1.5 mg/dL at discharge (baseline 1.4), lisinopril restarted at 5 mg on day 5. Continued by: primary care. Interval: basic metabolic panel at 7 days. Watching: potassium, creatinine. Fallback: same standing order as above.
Type 2 diabetes. Continued by: primary care. Interval: glucose log reviewed at 7 days. Metformin stays held until the 7-day creatinine is back.
Medications at Transition
Continued unchanged: aspirin 81 mg daily; atorvastatin 80 mg nightly; insulin glargine 30 units nightly.
Restarted: ticagrelor 90 mg twice daily (resumed hospital day 3).
Changed: metoprolol succinate, now 25 mg daily (was 50 mg); lisinopril, now 5 mg daily alone (was lisinopril-hydrochlorothiazide 20/12.5 mg).
New: pantoprazole 40 mg twice daily, which also serves as the acid suppressant in the 14-day bismuth regimen, then once daily while he remains on two antiplatelet drugs; bismuth subcitrate, metronidazole, and tetracycline for 14 days; acetaminophen for knee pain, 650 mg up to every 6 hours, with a ceiling of 3,000 mg in 24 hours.
Stopped: naproxen, permanently; hydrochlorothiazide; fish oil.
Held: metformin, until the 7-day kidney test.
The Patient-Facing Summary
You were in the hospital because a sore in your gut, called an ulcer, was bleeding. The doctors closed the bleeding spot with small clips. The ulcer was caused by naproxen (Aleve) and a germ in your stomach. While you were here, your heart did not get enough blood for a short time because you had lost blood. You got blood, and your heart is better now.
What to do: Take the new germ medicines four times a day for 14 days. Take both blood thinners, aspirin and ticagrelor, every day. Do not stop them unless your heart doctor tells you to. Never take Aleve, Advil, or ibuprofen again. For knee pain, use Tylenol.
Call 911 if you have chest pain or pressure, or you throw up blood. Call the clinic the same day if your stool is black or you feel dizzy when you stand up.
Your visits: heart doctor next Tuesday; your regular clinic in 7 days, with blood tests; stomach clinic in 6 weeks.
Education and Its Check
Education was given to him and his wife together on day 5 and repeated on day 6, using the pill bottles themselves rather than a printed list. Understanding was checked by teach-back: each was asked to explain in their own words which pills were new, which were stopped, and what would make them call 911. In a study of primary care visits with patients who had low health literacy, clinicians rarely checked understanding, but when they did, their patients' hemoglobin A1c was more often below the study mean (Schillinger et al., 2003). He correctly named the two blood thinners and why not to stop them; he first said "the stomach pills" were the blood thinners, which was corrected and checked again. His wife correctly named all 911 signs.
Barriers and the Weak Link
Barriers: distance, 40 minutes each way, and his wife does not drive at night; a four-drug antibiotic regimen taken four times a day, which is hard to keep; his wish to return to fishing, which involves heavy lifting, before cardiac rehabilitation. Coaching patients and caregivers to take an active role during the transition, with a single person following them across settings, reduced rehospitalization in a randomized trial of older adults (Coleman et al., 2006); the clinic's care coordinator will call him on day 2 and day 7.
The single point of failure is ticagrelor. It is a brand-name drug with a copay he has not yet paid at the pharmacy he uses, it was stopped once in the hospital so he may think stopping is allowed, and stopping it early after a stent is the error in this plan most likely to kill him. Countermeasures: the first 30 days are dispensed from the hospital pharmacy before he leaves, a copay assistance application is completed with him on day 6, and the day 2 call asks specifically whether he has taken it both morning and night.
References
Chey, W. D., Howden, C. W., Moss, S. F., Morgan, D. R., Greer, K. B., Grover, S., & Shah, S. C. (2024). ACG clinical guideline: Treatment of Helicobacter pylori infection. The American Journal of Gastroenterology, 119(9), 1730-1753. https://doi.org/10.14309/ajg.0000000000002968
Coleman, E. A., Parry, C., Chalmers, S., & Min, S.-J. (2006). The care transitions intervention: Results of a randomized controlled trial. Archives of Internal Medicine, 166(17), 1822-1828. https://doi.org/10.1001/archinte.166.17.1822
Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., Leong-Grotz, K., Castro, C., & Bindman, A. B. (2003). Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine, 163(1), 83-90. https://doi.org/10.1001/archinte.163.1.83
What the NRNP 6557 Week 9 instructions ask for
Week 9 of NRNP 6557 commonly asks for a care transition plan at hospital discharge. You hand off each problem with an owner and date, reconcile medications, write a patient-facing summary, check understanding, and identify barriers including the weakest link. Faculty penalize passive phrasing such as "follow up will be arranged." Cite transition models in APA 7. A transition plan differs from a discharge summary by focusing on what happens next. Barriers should have solutions. Pending results need owners. NRNP 6557 faculty want each problem handed off with a named owner and a date. Medications at discharge must match the reconciliation. The patient summary should be in plain language. Teach-back results should be recorded. The weakest link must be named with a fix.
How this NRNP 6557 Week 9 example is built
The plan works as a document people act on, not an essay. Its core is a table or structured list where every active problem carries the person or service continuing it, the interval before that contact, what is being watched, and the fallback if the contact does not occur. Around that core sit four shorter pieces: the medication list as it stands at discharge with the changes flagged, the patient facing summary written in plain language, the education delivered with a note on how understanding was checked, and a barriers section naming what could realistically break the plan. A closing paragraph identifies the single point of failure. The patient is composite, the receiving clinicians are generic roles, and no real handoff document is reproduced.
Where the marks sit in the NRNP 6557 Week 9 rubric
Plans lose points by being written in the passive. Follow up will be arranged names nobody, commits to nothing, and appears in a large share of submitted transition plans. The second gap is timing: problems handed off with no interval, or with an interval ignoring how long the receiving service actually takes to schedule. Third, patient facing sections written at professional reading level fail the part of the rubric asking for accessible language, and the giveaway is usually a drug class name left unexplained. Education described without a check of understanding claims an outcome nobody verified. Barriers reduced to a demographic list, rather than to what specifically would break this plan for this patient, take the last of the available points.
NRNP 6557 Week 9 help from the desk
Transition plans lose points when they are written in the passive voice and name nobody. Each task needs a named person and a deadline. Another common gap is a patient summary full of jargon. Write it in plain language. Writers also skip checking understanding. Use teach-back and record the result. Avoid ignoring practical barriers such as transport. Name the weakest link and a fix. Keep the medication list consistent with reconciliation. Close with who the patient calls first. Writers also forget pending results at discharge, such as biopsy for Helicobacter pylori. Give them an owner. Another frequent slip is leaving the patient's own role unclear. Tell him what to do if he sees black stools again. Close with the first call he should make.
Get a NRNP 6557 Week 9 example written to your instructions
Send the Week 9 prompt and any transition template your classroom uses and the desk fills an example on a case with a comparable set of active problems. It costs nothing the first time and lands within 24 to 48 hours. Real discharge paperwork and anything signed at your site are yours; we work from composed cases only.
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NRNP 6557 Week 9 questions, answered
Is a transition plan the same as a discharge summary?
They overlap and are graded differently. A summary records what happened during the admission; the plan states what happens next and who owns each piece. The sample keeps a short summary section for context but spends its length on ownership and intervals, because that is what Week 9 rubric language in most sections is scored against.
How specific should the owner be?
Specific to a role and a service, not to a named individual, since names change and a plan built on one person breaks when that person is unavailable. The sample writes the primary care practice, the specialty clinic, the home health service. Where a section wants a named contact, a role line still sits beside it so the plan survives the substitution.
What if the patient has no reliable follow-up?
Then the plan says so and works with it, which is the version of this assignment that earns the most. The sample includes a problem where the intended owner is unavailable and responsibility falls back to a service that can absorb it, with the risk of that arrangement stated. Plans assuming ideal access read as templates and score like them.
Where can I find a free NRNP 6557 Week 9 sample paper?
The day 6 transition plan is reproduced here with the problem-by-problem handoff, medications, the patient summary, teach-back and the named weak link.
How specific should owners be in NRNP 6557 Week 9?
Specific enough that a person or role and a date appear for every task, such as the cardiology clinic nurse calling by a set date, never just "follow up arranged."