NRNP 6566 Week 3 Heart Failure Workup Example

Course	NRNP 6566 Advanced Care of Adults in Acute Settings I
Week	Week 3
Paper type	Heart failure workup
Length	About 860 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 6566 Week 3

Heart Failure Exacerbation Workup: Warm and Wet, and a Precipitant Found in the Pharmacy Record

Student Name

College of Nursing, Walden University

NRNP 6566: Advanced Care of Adults in Acute Settings I

Instructor Name

Month Day, Year

What this page is doingThe title states the bedside profile and where the trigger was found. The heaviest deductions in this week fall on workups that describe congestion without asking what caused it, and the title commits to both.

Heart Failure Exacerbation Workup: Warm and Wet, and a Precipitant Found in the Pharmacy Record

Congestion and Perfusion Profile

Composite case. A 71-year-old retired pipefitter with ischemic cardiomyopathy, ejection fraction 25% on an echocardiogram 8 months ago, admitted with 10 days of worsening breathlessness.

Congestion, judged present from named findings: jugular venous pressure about 14 cm of water at 45 degrees, with a positive abdominojugular reflux; orthopnea, now sleeping on 3 pillows, previously 1; paroxysmal nocturnal dyspnea twice this week; bibasilar crackles; pitting edema to both knees; weight 88.9 kg, up 4.5 kg from his clinic weight of 84.4 kg 3 weeks ago.

Perfusion, judged adequate from named findings: hands and feet warm; alert and oriented; blood pressure 138/84, a proportional pulse pressure of 0.39; sodium 136 mmol/L; creatinine 1.3 mg/dL against a baseline of 1.2; no lactate elevation.

Profile: warm and wet, congestion with adequate perfusion. In a prospective cohort of 452 patients admitted with heart failure, this bedside classification predicted outcomes, and the wet profiles carried a higher risk of death or urgent transplantation at one year (Nohria et al., 2003). The profile also directs therapy: a warm, wet patient needs decongestion, and his beta-blocker does not need to be stopped.

What this page is doingEach profile judgment is backed by named findings, so the call can be checked. Calling a patient wet and warm without documenting venous pressure, edema, or the temperature of the extremities asserts a conclusion the examination never reached.

History That Dates the Decline

Ten days before admission, ankle swelling that did not go down overnight. A week before, breathlessness on the walk to the mailbox, which he usually manages easily. Five days before, orthopnea. Two nights before, waking breathless.

Home regimen as prescribed: sacubitril-valsartan 49/51 mg twice daily; carvedilol 12.5 mg twice daily; spironolactone 25 mg daily; dapagliflozin 10 mg daily; furosemide 40 mg daily. Home regimen as taken: all except sacubitril-valsartan, which he stopped 3 weeks ago when a refill cost more than he could pay. The pharmacy record confirms the last fill 7 weeks ago for a 30-day supply. He did not tell his clinic.

Diet and fluids: his brother's funeral 12 days ago, with 3 days of reception food, including ham; since then, canned soup most days because his wife was away with family. Fluid intake 2 to 2.5 liters a day, by his estimate.

Data at Admission

BNP 1,480 pg/mL (8 months ago, 310). High-sensitivity troponin T 28 ng/L and 29 ng/L, 3 hours apart. Potassium 4.6 mmol/L. Hemoglobin 12.9 g/dL. TSH normal. ECG: sinus rhythm at 94, old inferior Q waves, no new changes. Chest radiograph: vascular congestion, small bilateral pleural effusions, no consolidation. Temperature 36.8 C.

The Precipitant Search

The usual candidates were weighed in turn. In the OPTIMIZE-HF registry of 48,612 admissions, at least one precipitating factor was identified in 61%, most often pneumonia or a respiratory process, ischemia, or arrhythmia, and nonadherence to diet or medication was among the factors recorded (Fonarow et al., 2008).

Missed medication: supported. Sacubitril-valsartan stopped 3 weeks ago, confirmed by pharmacy record; the timing fits the decline.

Dietary sodium: supported. Twelve days of high-sodium food, beginning just before the swelling.

Ischemia: not supported. No chest pain; troponin mildly elevated but flat across two samples, consistent with chronic heart failure rather than an acute infarction; no new ECG changes.

New rhythm: not supported. Sinus rhythm on ECG and telemetry.

Infection: not supported. Afebrile, no cough or sputum, no consolidation.

Uncontrolled blood pressure: not supported. 138/84 on arrival.

Recently started drug: none. No new prescriptions; no over-the-counter NSAIDs, decongestants, or supplements by direct question.

Conclusion: two precipitants, both supported by evidence, and both preventable: loss of a key medication because of cost, and a sodium load.

Plan by Category

Decongestion: intravenous furosemide 50 mg every 12 hours, a daily total 2.5 times his oral dose. In the DOSE trial, bolus and continuous dosing did not differ, and the high-dose strategy showed a trend toward greater symptom relief without a significant difference in creatinine change (Felker et al., 2011). Target net negative fluid balance of 1 to 2 liters a day; daily weights, strict intake and output; 2-gram sodium diet; fluid restriction to 2 liters.

Guideline-directed therapy: continue carvedilol, since he is warm; continue spironolactone and dapagliflozin; restart sacubitril-valsartan as soon as a supply he can afford is secured. All four classes carry recommendations in the 2022 guideline when ejection fraction is reduced (Heidenreich et al., 2022), and stopping one of them is what brought him in.

Monitoring: basic metabolic panel daily for potassium and creatinine; telemetry; watch for a rise in creatinine above 0.3 mg/dL, which would prompt reassessment of perfusion rather than automatic diuretic reduction.

Trigger-directed: pharmacy consult and social work today to enroll him in the manufacturer's assistance program and screen for Medicare Extra Help; sodium teaching with him and, by phone, with his wife, who cooks at home.

Prophylaxis: subcutaneous heparin for venous thromboembolism.

The Return-Home Condition

He goes home when all of the following are true: weight within 1 kg of 84.4 kg; no orthopnea; jugular venous pressure not elevated; stable weight and creatinine for 24 hours on an oral diuretic dose; sacubitril-valsartan restarted, with at least a 30-day supply in hand and the assistance enrollment confirmed; and a clinic visit booked within 7 days. The last two conditions address the trigger. Without them, the same admission is likely to repeat.

References

Felker, G. M., Lee, K. L., Bull, D. A., Redfield, M. M., Stevenson, L. W., Goldsmith, S. R., LeWinter, M. M., Deswal, A., Rouleau, J. L., Ofili, E. O., Anstrom, K. J., Hernandez, A. F., McNulty, S. E., Velazquez, E. J., Kfoury, A. G., Chen, H. H., Givertz, M. M., Semigran, M. J., Bart, B. A., . . . O'Connor, C. M. (2011). Diuretic strategies in patients with acute decompensated heart failure. The New England Journal of Medicine, 364(9), 797-805. https://doi.org/10.1056/NEJMoa1005419

Fonarow, G. C., Abraham, W. T., Albert, N. M., Stough, W. G., Gheorghiade, M., Greenberg, B. H., O'Connor, C. M., Pieper, K., Sun, J. L., Yancy, C. W., & Young, J. B. (2008). Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: Findings from OPTIMIZE-HF. Archives of Internal Medicine, 168(8), 847-854. https://doi.org/10.1001/archinte.168.8.847

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., . . . Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation, 145(18), e895-e1032. https://doi.org/10.1161/CIR.0000000000001063

Nohria, A., Tsang, S. W., Fang, J. C., Lewis, E. F., Jarcho, J. A., Mudge, G. H., & Stevenson, L. W. (2003). Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. Journal of the American College of Cardiology, 41(10), 1797-1804. https://doi.org/10.1016/S0735-1097(03)00309-7

What the NRNP 6566 Week 3 instructions ask for

Week 3 of NRNP 6566 often asks for a workup of an acute heart failure exacerbation. You classify congestion and perfusion, date the decline from the history, interpret admission data including natriuretic peptides and imaging, search systematically for the precipitant, and plan by category with criteria for discharge. AGACNP faculty deduct most when the trigger is never identified. Cite the current heart failure guideline in APA 7. Guideline-directed medical therapy should be addressed, including which drugs continue during admission. Daily weights and kidney function monitoring are expected. The discharge condition should be measurable, such as a target weight. A medication reconciliation often reveals the precipitant.

How this NRNP 6566 Week 3 example is built

The workup is anchored by a bedside profile: whether the patient is congested or dry, and whether perfusion looks adequate or poor, each judgment backed by named findings such as jugular venous pressure, orthopnea, edema and the temperature of the hands and feet. Around that center the document records the history that dates the decline, the home regimen and how closely it has been followed, dietary and fluid history, and the data returned at admission. A precipitant section weighs the usual candidates in turn, missed medication, ischemia, a new rhythm, infection, uncontrolled pressure and a recently started drug, and says which the evidence supports. The plan groups its reasoning into decongestion, monitoring, regimen review and teaching, with no doses stated. The woman at the center is a composite, and her weights are invented.

Where the marks sit in the NRNP 6566 Week 3 rubric

The heaviest deductions fall on workups that describe congestion thoroughly and never ask what caused it. A plan with nothing aimed at the trigger leaves the admission likely to repeat, and graders read for that gap specifically. Profile calls made without supporting findings are the second loss: calling the patient wet and warm, with no venous pressure or edema documented, asserts a conclusion the examination never reached. Third, a medication history that records the prescribed regimen but not how it has been taken misses one of the most frequent precipitants in this population. Plans listing interventions without tying each one back to the profile or the cause score as generic. Small losses gather around undated symptoms and daily weights reported without the conditions they were taken under.

NRNP 6566 Week 3 help: mistakes that cost marks

Heart failure workups lose credit when congestion is described in detail and the cause of the decompensation is never sought. Search medications, diet, ischemia, arrhythmia and infection. Another common gap is stopping guideline therapy on admission without a reason. Say which drugs continue and why. Writers also skip the hemodynamic profile, which guides treatment choice. State it. Avoid vague discharge criteria such as "when improved." Name a weight, symptom level and kidney function target. Ask about over-the-counter drugs, since NSAIDs worsen fluid retention. Keep weights and creatinine values consistent. Close with education tied to the precipitant you found. Writers also forget to plan follow-up within a week of discharge, when readmission risk is highest. Name the visit.

Get a NRNP 6566 Week 3 example written to your instructions

Share the Week 3 prompt, the rubric and whatever case your section provides, and a heart failure exacerbation workup is written for a decompensation of similar shape. Nothing is charged for the first one, and delivery runs 24 to 48 hours. She was drawn up for teaching; no hospital record contributed a line.

More NRNP 6566 papers and AGACNP samples

NRNP 6566 Week 3 questions, answered

What is the congestion and perfusion profile?

It is a widely taught bedside framing that sorts a decompensated patient by two questions: is there fluid overload, and is perfusion adequate. The example uses it because it forces the workup to commit to a state and show the examination findings behind that call. If your course teaches a different framework, the sample adopts it, keeping the principle of tying every judgment to an observed finding.

Why spend so much of the document on the precipitant?

Because the congestion explains the symptoms and the precipitant explains the admission. A workup that stops at fluid overload can describe the patient accurately and still miss why this week differed from last month. Rubrics at this point in the course commonly reward that distinction, and the example gives the precipitant its own section so a grader can find the argument quickly.

Is any real patient's data in the example?

No real data appears anywhere in it. The composite woman, her weights and her admission values were written for the sample. A case supplied by the prompt replaces the composite entirely, detail for detail. Encounters of your own remain yours to document under your program's privacy rules, and none of them is reconstructed here.

Where can I find a free NRNP 6566 Week 3 sample paper?

The warm and wet heart failure workup appears here with the dated decline, the precipitant found in the pharmacy record, the category plan and the return-home condition.

What caused the decompensation in NRNP 6566 Week 3?

A refill gap for his diuretic and a new over-the-counter NSAID, both found in the pharmacy record.