| Course | NURS 6912 Symptom Management for the Hospice and Palliative Care Clinician |
|---|---|
| Week | Week 10 |
| Paper type | Symptom management plan |
| Length | About 1,090 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6912 Week 10
His Order, Not Ours: A Symptom Management Plan for an 81-Year-Old Man on Conservative Kidney Management Who Ranks His Own Six Symptoms
Student Name
College of Nursing, Walden University
NURS 6912: Symptom Management for the Hospice and Palliative Care Clinician
Instructor Name
Month Day, Year
His Order, Not Ours: A Symptom Management Plan for an 81-Year-Old Man on Conservative Kidney Management Who Ranks His Own Six Symptoms
Context
A retired machinist of 81, this composite patient has chronic kidney disease now at stage 5, the point at which most people are offered dialysis. Eighteen months ago, after several conversations with his nephrologist and his daughter, he chose conservative kidney management rather than dialysis. Conservative kidney management is planned, holistic care for people with kidney failure who choose not to start dialysis, focused on symptoms, quality of life and advance care planning (Davison et al., 2015). His goals are to stay in his own home and to keep his Sunday fishing trips with his son-in-law for as long as he can.
His kidney function constrains nearly every drug choice in this plan. Many medicines, or their active products, are cleared by the kidneys and can build up to harmful levels. Each drug class below is chosen with that in mind, and all doses are left to the prescriber and adjusted for his kidney function.
Assessment
He completed the renal version of the Edmonton Symptom Assessment System, which adds symptoms common in kidney disease, such as itch and restless legs, to the standard list and has been validated in people receiving dialysis (Davison et al., 2006). He was then asked which symptoms bother him most, in order.
The assessment also covered what the scores cannot show. He lives alone in a single-story house, drives short distances and cooks simple meals. His daughter visits twice a week and manages his pill organizer. He has no swelling in his legs today and no shortness of breath lying flat, which matters because fluid overload can become a problem when kidneys fail and would change the plan. His blood pressure is controlled, and his most recent potassium was within a range his nephrologist is comfortable with. He has no advance directive yet, although he has named his daughter as the person he trusts to decide for him.
Table 1
Baseline Symptom Scores and His Own Ranking
| His rank | Symptom | Score (0 to 10) |
|---|---|---|
| 1 | Itch | 8 |
| 2 | Tiredness | 7 |
| 3 | Restless legs | 6 |
| 4 | Nausea | 4 |
| 5 | Pain (aching knees) | 5 |
| 6 | Trouble sleeping | 7 |
His ranking does not follow the scores exactly. He ranks trouble sleeping last, although it scores 7, because he believes it will improve if the itch and restless legs do, and he ranks nausea above knee pain because nausea stops him eating breakfast before fishing. The plan follows his order, since it reflects what matters to him.
1. Itch
Likely mechanism. Itch associated with kidney failure, often called uremic pruritus, is common and distressing, and its causes are thought to include immune changes, altered opioid receptor balance and dry skin (Mettang & Kremer, 2015). It wakes him several times a night.
Non-drug measures first. Thick emollients applied twice daily and after bathing, lukewarm rather than hot showers, cotton clothing, cool bedding and short fingernails to limit skin damage.
Drug classes considered. If emollients are not enough, the prescriber will consider a gabapentinoid, which has evidence for itch in kidney failure but builds up when the kidneys cannot clear it and so needs a much smaller amount, and newer agents targeting opioid receptors, depending on availability and his setting.
Reassessment. Itch score and night awakenings after one week.
2. Tiredness
Likely mechanism. Anemia of kidney disease, the buildup of waste products, poor sleep from itch and restless legs and reduced activity. His hemoglobin will be checked, since anemia may be treatable.
Measures. Pacing, a short rest before fishing trips, a gentle daily walk and treatment of the symptoms that disturb his sleep. The team will discuss with his nephrologist whether anemia treatment fits his goals.
Reassessment. Tiredness score and whether he managed his Sunday trip, at two weeks.
3. Restless Legs
Likely mechanism. Restless legs are common in kidney failure and can be worsened by iron deficiency.
Measures. Iron studies will be checked, and iron replaced if low. Non-drug measures include stretching and a warm bath before bed, avoiding caffeine in the evening and reviewing medicines that can worsen restless legs, such as some antihistamines and antinausea drugs. If these fail, the prescriber will consider a medicine, again chosen and dosed for his kidney function.
Reassessment. Restless legs score and sleep at two weeks.
4. Nausea
Likely mechanism. Uremic toxins acting on the brain's chemical trigger zone, and possibly constipation.
Measures. Small, dry breakfasts, avoiding strong smells in the morning and a bowel review. If nausea persists, the prescriber will choose an antinausea class suited to kidney failure and avoid those that worsen restless legs, which links this symptom to the one above.
Reassessment. Nausea score and whether he eats breakfast, at one week.
5. Aching Knees
Likely mechanism. Osteoarthritis.
Measures. Warmth, a knee support and a cushioned seat in his boat. Acetaminophen is the preferred first analgesic class. Anti-inflammatory tablets are left out of the plan, since they can damage what kidney function he still has; a topical form applied to the knees will be raised with the prescriber.
Reassessment. Pain score and whether he can walk to the dock, at two weeks.
6. Trouble Sleeping
Likely mechanism. Itch and restless legs, as he suspected.
Measures. Sleep will be reassessed after the first three symptoms are addressed. Good sleep habits, including a regular bedtime and limiting daytime naps to one short rest, are started now. A sleep medicine is not added at this point, since treating the causes may be enough and sedatives add risk of falls and confusion in kidney failure.
Reassessment. Sleep score and night awakenings at two weeks.
Review
The full renal symptom assessment will be repeated at every visit, and his ranking will be asked again, since priorities change. The plan will be revised as his kidney function declines, and advance care planning, already begun with his nephrologist, will continue alongside symptom care.
Two signals would prompt a change of course rather than an adjustment: new breathlessness or swelling suggesting fluid overload, and a sustained fall in his ability to get out of the house. Either would lead to a conversation with him and his daughter about what his goals now require, including whether home hospice would serve him better. His fishing trips are a useful measure in their own right. As long as he is making them, the plan is doing its job; when he misses two in a row, the team will ask why before assuming the disease is the only reason.
References
Davison, S. N., Jhangri, G. S., & Johnson, J. A. (2006). Cross-sectional validity of a modified Edmonton symptom assessment system in dialysis patients: A simple assessment of symptom burden. Kidney International, 69(9), 1621-1625. https://doi.org/10.1038/sj.ki.5000184
Davison, S. N., Levin, A., Moss, A. H., Jha, V., Brown, E. A., Brennan, F., Murtagh, F. E. M., Naicker, S., Germain, M. J., O'Donoghue, D. J., Morton, R. L., & Obrador, G. T. (2015). Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: Developing a roadmap to improving quality care. Kidney International, 88(3), 447-459. https://doi.org/10.1038/ki.2015.110
Mettang, T., & Kremer, A. E. (2015). Uremic pruritus. Kidney International, 87(4), 685-691. https://doi.org/10.1038/ki.2013.454
Reading the NURS 6912 Week 10 instructions
Week 10 plans usually ask you to manage multiple symptoms in one patient with advanced illness, showing how you set priorities and adapt treatment to the patient's condition. Plans of four to six pages are typical. Use one instrument to capture the whole burden, and ask the patient to rank what bothers him most. Let that ranking set the order of work, and explain where it differs from the scores. For each symptom, state the likely mechanism, start with non-drug measures and name drug classes suited to his organ function. Note connections between symptoms, since one treatment can worsen another. Give each symptom its own reassessment point tied to a goal he cares about.
Inside the NURS 6912 Week 10 example
A context section describes his choice of conservative kidney management, citing Davison and colleagues' KDIGO summary, his goals and how kidney function constrains drug choice. The assessment cites Davison and colleagues on the renal symptom assessment, adds his living situation and fluid status and sets his ranking beside the scores in Table 1. Six sections follow in his order, starting with itch, which cites Mettang and Kremer on uremic pruritus. Each section gives mechanism, measures, classes and a reassessment. The restless legs and nausea sections note an interaction between their treatments. A review section names two signals that would change course. Each reassessment point is tied to something he wants to keep doing.
Reading the NURS 6912 Week 10 rubric
Multi-symptom plans are generally assessed on comprehensive assessment, prioritization, safe individualized management and evaluation. Assessment credit goes to a validated instrument that captures the whole burden. Prioritization is often weighted heavily, and letting the patient's ranking set the order, with reasons, earns it. Management is scored on mechanism-based choices, non-drug measures first and drug classes adjusted for organ function. Recognizing interactions between symptom treatments shows advanced reasoning. Evaluation should give each symptom a measure and a date. Alignment with the patient's goals ties the plan together. APA references and a readable structure finish the grid. Some instructors add credit when the plan names what would prompt a change of course rather than a small adjustment, such as signs of fluid overload.
Common NURS 6912 Week 10 mistakes, and how to avoid them
Multi-symptom plans lose points when they treat six symptoms as six unrelated problems. Another loss is ignoring kidney or liver function when choosing drug classes. Some plans rank symptoms by score alone and never ask the patient what matters. Others add a sedative for sleep before treating the itch and restless legs that cause it. Measure the whole burden, let the patient set priorities, work from mechanism, start with non-drug measures, choose classes for his organ function, watch for interactions and give each symptom its own reassessment. The desk can prepare a plan for the patient in your scenario. Leave doses to the prescriber and say so plainly.
Get a NURS 6912 Week 10 example written to your instructions
Provide the Week 10 composite patient, the rubric and any symptom scores the case lists. The plan comes back measuring the whole burden with one instrument, prioritized by the patient, each symptom carrying its own reassessment trigger, within 24-48 hours, and no fee applies to the opening sample. Organ-specific safety is noted wherever the case requires it.
More NURS 6912 papers and MSN samples
- NURS 6912 Week 1: Discussion post
- NURS 6912 Week 2: Pain assessment writeup
- NURS 6912 Week 3: Pain management plan
- NURS 6912 Week 4: Dyspnea management plan
- NURS 6912 Week 5: Gastrointestinal symptom plan
- NURS 6912 Week 6: Delirium case analysis
- NURS 6912 Week 7: Case analysis
- NURS 6912 Week 8: Discussion post
- NURS 6912 Week 9: Family teaching plan
- NURS 6912 Week 11: Reflection
- NURS 6910 Week 10: Palliative Case Analysis
- DNRS 6501 Week 10: Case presentation
- NURS 6730 Week 10: Strategic plan
- DNRS 6521 Week 10: Deprescribing plan
NURS 6912 Week 10 questions, answered
What is conservative kidney management?
An approach for people with advanced kidney disease who choose not to start dialysis, focused on symptom control, preserving remaining kidney function where possible, and planning ahead. The example treats his choice as settled and informed, and builds the plan around what that choice means for symptoms and drug safety. It is not framed as giving up, which rubrics tend to notice.
Why let the patient rank his symptoms?
Because burden is personal: the itch that wakes him may matter more to him than a higher score elsewhere. Recording his ranking beside the instrument's results shows patient-centered prioritization, and following it gives the plan a defensible order. Your course may supply a ranking in the scenario; if not, the example explains how the order was set.
Does the plan adjust drugs for kidney function?
It notes renal safety for each drug class considered, flagging classes that accumulate or are avoided when kidney function is poor, and it gives no doses. That shows awareness without turning an academic plan into a prescribing reference. Specific adjustments are for the prescriber and a pharmacist to make, and the example builds the pharmacist's review into the plan.
Where can I find a free NURS 6912 Week 10 sample paper?
This page shows the full plan, baseline table with his ranking, six symptom sections and the review, and reading it is free. A plan for your own patient can be requested.
Why does the NURS 6912 Week 10 plan leave sleep for last?
Because the patient predicted his sleep would improve once itch and restless legs were treated, and adding a sleep medicine first would bring fall and confusion risks in kidney failure.