NRNP 6566 Week 6 Upper GI Bleed Admission Note Example

Course	NRNP 6566 Advanced Care of Adults in Acute Settings I
Week	Week 6
Paper type	Upper GI bleed admission note
Length	About 800 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 6566 Week 6

Upper GI Bleed Admission Note: Melena in a 79-Year-Old on Apixaban, With Ibuprofen and Sertraline Found by Asking

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 names the anticoagulant and the two over-the-counter and prescription drugs that changed the picture. A thin medication history is where this note most often loses points, and the title shows it was taken.

Upper GI Bleed Admission Note: Melena in a 79-Year-Old on Apixaban, With Ibuprofen and Sertraline Found by Asking

Present Illness

Composite case. A 79-year-old retired church organist, admitted from the emergency department. Two days ago she noticed her first black, tarry stool; there have been four since, the last this morning. No vomiting, no blood or coffee-ground material brought up. This morning, standing up from the toilet, she felt the room go gray and sat back down; she did not lose consciousness. Mild upper abdominal discomfort for 2 weeks, which she blamed on her back pain medicine. No weight loss, no change in bowel habit before this, no bright red blood.

Postural Signs Up Front

Lying: heart rate 92, blood pressure 118/70. Standing for 1 minute: heart rate 118, blood pressure 96/60, lightheaded, returned to the bed. Seated on arrival: heart rate 102, blood pressure 104/64. Breathing 18 times a minute with a room-air saturation of 97%; temperature 36.6 C. Capillary refill 3 seconds; hands cool. She is not stable in the sense the word usually implies, and the plan below does not treat her as if she were.

What this page is doingPostural vital signs are recorded before anything else, so no later sentence can call her stable without evidence. Stability asserted without these numbers is the most common deduction on this note.

Medications That Change Everything

Prescribed: apixaban 5 mg twice daily for atrial fibrillation, last dose 20:00 yesterday; sertraline 50 mg daily for depression, for 3 years; amlodipine 5 mg daily; atorvastatin 20 mg nightly.

Over the counter, asked about by name: ibuprofen, 2 tablets of 200 mg three times a day for 2 weeks for low back pain after moving furniture, which she did not mention until asked whether she took Advil, Motrin, or Aleve; no aspirin; no naproxen; no bismuth, which can darken stools; no iron.

Each drug on this list changes the plan. Apixaban raises bleeding severity and must be held. Ibuprofen is the likely cause of an ulcer. Sertraline reduces platelet serotonin and adds to bleeding risk, particularly with an NSAID.

Past History

No previous ulcer or gastrointestinal bleeding. No known liver disease; drinks a glass of wine on Sundays; no hepatitis history. Atrial fibrillation for 4 years; no stroke. Weight 57 kg.

Examination and Admission Data

Pale conjunctivae. Abdomen soft, mild epigastric tenderness, no guarding, no masses. Rectal examination: black, tarry stool, no bright red blood. Stigmata of chronic liver disease looked for and absent: no jaundice, spider angiomas, palmar erythema, ascites, caput medusae, or asterixis. Irregularly irregular rhythm at about 100.

Hemoglobin 8.1 g/dL (12.6 six months ago). Platelets 210 x 10^9/L. INR 1.3. Blood urea nitrogen 52 mg/dL; creatinine 1.2 mg/dL; ratio 43. Type and crossmatch sent.

Localizing the Source

Upper source favored, by weighing the clues. Melena seen on rectal examination carried a likelihood ratio of about 25 for an upper source in a systematic review of bedside findings, and a urea nitrogen to creatinine ratio above 30 also raised the likelihood of an upper source; clots in the stool make an upper source much less likely (Srygley et al., 2012). She has melena on exam, a ratio of 43, and no clots. Against an upper source: no hematemesis, which does not argue strongly either way. A brisk right colon bleed can occasionally produce dark stool, but with this ratio, NSAID use, and epigastric discomfort, a peptic ulcer is the leading cause.

Risk Before the Procedure

Glasgow-Blatchford score, shown by component: urea 18.6 mmol/L, 4; hemoglobin below 10 g/dL in a woman, 6; systolic pressure 100 to 109, 1; pulse 100 or higher, 1; melena, 1; syncope, 0, since she did not lose consciousness; liver disease, 0; heart failure, 0. Total 13, far above the very-low-risk range of 0 to 1 that the ACG guideline suggests could be managed as an outpatient (Laine et al., 2021). She needs admission and endoscopy.

Plan, Safety First

1. Circulation: two large-bore intravenous lines; balanced crystalloid bolus; transfuse red cells for hemoglobin below 7 g/dL, the threshold the ACG guideline suggests for upper gastrointestinal bleeding (Laine et al., 2021), since she has no coronary disease; recheck hemoglobin every 6 hours.

2. Anticoagulation: hold apixaban. No reversal agent or prothrombin complex concentrate, since the ACG-CAG guideline suggests against them for DOAC-associated gastrointestinal bleeding (Abraham et al., 2022); her last dose was 13 hours ago and her kidney function is preserved.

3. Acid suppression: intravenous proton pump inhibitor now; high-dose therapy continued after endoscopy if a high-risk lesion is treated.

4. Endoscopy within 24 hours; nothing by mouth from midnight.

5. Stop ibuprofen permanently; hold sertraline for now, with a plan to discuss restarting it with her once bleeding is controlled.

6. Monitoring: vital signs every hour for 4 hours, then every 2 hours; telemetry for her atrial fibrillation; stool charting.

7. Decisions to come: when to restart apixaban after hemostasis, weighed against her stroke risk, and a non-NSAID plan for her back pain.

Code status: full code. Contact: her son, health care proxy.

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

Srygley, F. D., Gerardo, C. J., Tran, T., & Fisher, D. A. (2012). Does this patient have a severe upper gastrointestinal bleed? JAMA, 307(10), 1072-1079. https://doi.org/10.1001/jama.2012.253

The Walden NRNP 6566 Week 6 instructions

The sixth week of NRNP 6566 typically asks for an admission note on upper gastrointestinal bleeding. You document the bleeding history, measure hemodynamic status including postural signs, take a careful medication history including over-the-counter drugs, examine, interpret laboratory data, localize the source, score risk and plan resuscitation, medication changes and endoscopy timing. Faculty deduct for stability asserted without evidence and for missed medications. Cite the ACG guideline and reversal guidance in APA 7. Anticoagulant management needs a clear decision. Transfusion thresholds may be stated or left to the reasoning. Disposition between ward and intensive care should be argued. NRNP 6566 faculty also want the anticoagulant's last dose time recorded, since it guides reversal and endoscopy timing. Include the Glasgow-Blatchford parts.

Inside the NRNP 6566 Week 6 example

The note runs about three pages. Its present illness dates the first dark stool, describes any vomiting and its appearance, and records lightheadedness on standing. The medication history is unusually detailed, since anticoagulants, antiplatelet agents and anti-inflammatory drugs change the whole picture, and over-the-counter use is asked about by name. Past history covers prior ulcer and risk for liver disease. The examination records postural vital signs, perfusion, abdominal findings, and stigmata of chronic liver disease looked for and found absent. Admission data appear as values. A localization paragraph argues an upper against a lower source. The Glasgow-Blatchford score is shown by component and used as a pre-procedure risk estimate. The plan explains, category by category, access and monitoring, transfusion as a threshold decision, acid suppression, consultation timing and medication holds. The man is a composite.

Where the marks sit in the NRNP 6566 Week 6 rubric

Deductions on this note tend to cluster in two places. The first is stability asserted without evidence: a patient described as stable when no postural vital signs were documented leaves the plan resting on a claim nobody checked. The second is a thin medication history, which misses the single most important modifier in many upper bleeds and weakens every later decision. Localization written as a conclusion, with no weighing of the clues, loses the reasoning points. A risk score reported without any link to consultation urgency does little work. Plans that treat transfusion as automatic, rather than as a threshold decision with its reasoning stated, draw comments in most sections. Minor losses come from unquantified descriptions of blood loss and from liver disease never addressed either way.

NRNP 6566 Week 6 help: mistakes that cost marks

Bleed notes lose the most when a patient is called stable without postural vital signs. Measure and record them. Another common gap is a medication list copied from the chart without asking about over-the-counter drugs. Ask directly, as the example did to find ibuprofen. Writers also hold the anticoagulant without deciding on reversal. State whether reversal is needed and why. Avoid scoring risk without showing the parts. Name the endoscopy timing and who is consulted. Keep hemoglobin and blood urea nitrogen values consistent. Close with disposition and the next laboratory check. Writers also forget to plan when apixaban might restart after the bleed is controlled. Give a time frame and who decides. Another frequent slip is leaving the sertraline unaddressed. Note the plan for it.

Get a NRNP 6566 Week 6 example written to your instructions

Send along the Week 6 prompt, its rubric and the case details your section gives, and a bleeding admission note returns written to that presentation. The first request is free and arrives inside 24 to 48 hours. Where your template orders headings differently, the example adopts that order. Invented from the ground up, the case describes no one.

More NRNP 6566 papers and AGACNP samples

NRNP 6566 Week 6 questions, answered

Why is the medication history placed above past medical history?

Because in an upper bleed a drug is often the most important modifier, both of why the bleeding happened and of what the plan can safely do. Moving it up makes that emphasis visible to a grader. If your template fixes the order of headings, the example follows it and signals the emphasis inside the medication section instead.

Does the note state a transfusion threshold?

It does not give a number. It records that transfusion is a threshold decision, names the factors that would shape the threshold for this patient, such as cardiac history, and points to where the evidence sits. Specific values belong to your course materials and current guidance, not to a sample page presenting them as if they applied to anyone.

Is this patient unstable enough for intensive care?

The composite was built to be ward appropriate, and the note says why using the documented postural signs and the risk score. That choice keeps the case inside this course's territory, the common inpatient admission, rather than the critical care course that follows it. A case your section supplies at higher acuity would be written at that acuity instead.

Where can I find a free NRNP 6566 Week 6 sample paper?

The melena on apixaban admission note is reproduced here with postural signs first, the medications found by asking, the risk score and the safety-first plan.

What raises bleeding risk in NRNP 6566 Week 6?

Apixaban plus over-the-counter ibuprofen for her knees and sertraline, found by asking directly.