| Course | NSG 123 Medical-Surgical Nursing I |
|---|---|
| Unit | Unit 4 |
| Paper type | Condition change case study |
| Length | About 710 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 123 Unit 4
When the Drain Went Quiet: A Twenty-Hour Record of a Returning Abscess, Read Once at Each Point and Once With the Whole Series in View
Student Name
Department of Nursing, Herzing University
NSG 123: Medical-Surgical Nursing I
Instructor Name
February 6, 2026
When the Drain Went Quiet: A Twenty-Hour Record of a Returning Abscess, Read Once at Each Point and Once With the Whole Series in View
The Record
The composite dispatcher from the earlier units, on hospital days 3 and 4. She had improved after the abscess was drained on day 2: temperature 37.2 °C and pain 4 of 10 by the evening of day 2. Observations below are as charted, with her own words where recorded.
| Time | Temp (°C) | HR | BP | RR | Pain (0-10) | Drain output since last check | Other findings and her words |
|---|---|---|---|---|---|---|---|
| Day 3, 0800 | 37.3 | 84 | 122/74 | 16 | 3 | 20 mL, thin, tan | "Best I've felt." Walked the hallway. |
| Day 3, 1200 | 37.4 | 86 | 120/72 | 16 | 3 | 5 mL | Drain site dry. Tolerating clear liquids. |
| Day 3, 1600 | 37.8 | 92 | 118/70 | 18 | 4 | 0 mL | "A bit achy." Mild burning when passing urine. |
| Day 3, 2000 | 38.0 | 98 | 116/70 | 18 | 5 | 0 mL | Declined evening walk: "tired." Left forearm IV site slightly pink. |
| Day 4, 0000 | 38.4 | 104 | 112/68 | 20 | 6 | 0 mL | Shivering briefly. Pain "deeper, same place as before." |
| Day 4, 0400 | 38.7 | 110 | 108/66 | 22 | 7 | 0 mL | Abdomen tender left lower, guarding. Drain tubing kinked under the dressing when examined. |
First Reading: How It Looked at Each Point
At 0800 and 1200 on day 3 everything pointed to recovery. A fall in drain output looked like the abscess emptying, which was the expected course.
At 1600 there were three small changes: a temperature of 37.8 °C, a heart rate of 92, and pain up by one point. Each on its own was within a range seen earlier in her stay. She also reported burning on urination, which offered a different explanation for a low fever.
At 2000 the temperature reached 38.0 °C and the heart rate 98. She was tired and declined to walk. A slightly pink intravenous site offered yet another possible source of fever. Read at that moment, the picture contained three competing explanations: the abscess, a urinary infection, and the intravenous site.
By 0000 the fever was 38.4 °C with shivering, and she described the pain as "deeper, same place as before." At 0400 she had guarding in the left lower abdomen and the drain tubing was found kinked.
Second Reading: With the Whole Series in View
Read as a series, the record shows five measures moving in the same direction for twelve hours: temperature, heart rate, respiratory rate, and pain all rising, and blood pressure slowly falling. Drain output fell to zero at 1600 and never recovered, and zero began at the same check where the vital signs first moved. A draining abscess that stops draining while fever returns is more likely blocked than empty. Her description at midnight, pain in the same place as the original problem, points to the abscess rather than to the bladder or the arm.
Early warning scores are built on exactly this idea: several modest changes together carry more weight than any single value (Subbe et al., 2001). Scored across the series, her total climbed steadily from 1600 onward.
When the Change Should Reasonably Have Been Identified
The point is 2000 on day 3, not 0400 on day 4. The record supports this without hindsight: by 2000 there were two consecutive checks with rising temperature and heart rate, a second consecutive zero drain output after a steady decline, and a patient who declined activity she had enjoyed that morning. A nurse at 2000 would not have known the tubing was kinked, but checking the drain for patency is a standard step when output stops unexpectedly (Hinkle et al., 2022), and doing so at 2000 would likely have found the kink six to eight hours earlier. The 1600 check is too early to name: one set of small changes with a plausible alternative explanation.
The findings that pointed elsewhere are kept in the record because they were real. The urinary burning and the pink intravenous site each deserved their own check: a urine sample and removal of the intravenous line if the site worsened. But they explained the fever less well than the abscess did, because neither explained the drain falling silent or the pain returning to the original site. Guidelines for complicated diverticulitis treat worsening after drainage as a reason to reassess drainage and consider surgery (Hall et al., 2020), which is where this record led.
What Happened After 0400
The kink was straightened and the drain flushed as ordered by the radiology team, which returned 60 mL of cloudy fluid. The surgical team was paged at 0415, a repeat CT was ordered, and blood cultures were drawn. By 1000 on day 4 her temperature was 38.1 °C and her heart rate 98, better but not settled, which is the course that later led the team to discuss surgery with her. The outcome is recorded here only to close the record; the case study's judgment about 2000 rests on what was charted before the outcome was known. The patient is a composite.
References
Hall, J., Hardiman, K., Lee, S., Lightner, A., Stocchi, L., Paquette, I. M., Steele, S. R., Feingold, D. L., & Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. (2020). The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Diseases of the Colon & Rectum, 63(6), 728-747. https://doi.org/10.1097/DCR.0000000000001679
Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.
Subbe, C. P., Kruger, M., Rutherford, P., & Gemmel, L. (2001). Validation of a modified Early Warning Score in medical admissions. QJM, 94(10), 521-526. https://doi.org/10.1093/qjmed/94.10.521
The Herzing NSG 123 Unit 4 instructions
Unit 4 asks you to analyze a case where a patient's condition changed and identify when the change should have been recognized. Expect to present the record, read it point by point as it appeared at the time, read it again as a series, argue when the change was identifiable and describe what happened next. Many versions ask how to avoid hindsight bias and whether to use an early warning score. NEWS2 or another early warning score may be required. Reading twice shows why each point looked reassuring alone and alarming together. Argue for a specific time with the evidence available then. Be fair to the nurses involved; the lesson is about trend recognition, not blame.
How the NSG 123 Unit 4 example is put together
The case study opens with the record in a table, times down the side and measures across. The first reading walks through each time point, explaining why each looked acceptable in isolation. The second reading highlights five measures trending together, which is the case study's key insight. The identification section names 2000 on day 3 and explains which combination was visible then. The aftermath section records the kinked drain and the response. The structure demonstrates hindsight bias and how to counter it, which is the unit's lesson. Early warning scoring is mentioned as a tool that would have flagged the trend, and the score at each time point is calculated.
Where the points sit in the NSG 123 Unit 4 rubric
Herzing's rubric for a condition change case study typically covers the record, the point-by-point reading, the series reading, the argument for when change was identifiable and the response. The series reading and the argument for timing carry the most weight, since graders want a specific time defended with data available then. Record points reward a clear table. Point-by-point criteria look for fair explanation of why each value seemed acceptable. Response points go to accurate description of what happened next. Early warning score use is often credited. Fairness to the staff involved is expected. Clear times help. Jones and colleagues' rapid response review and the NEWS2 report support the analysis.
Common NSG 123 Unit 4 mistakes, and how to avoid them
Condition change case studies in Unit 4 commonly lose points by reading the record only with hindsight, which hides why staff missed the change. Another frequent problem is naming a time without showing what data supported it. Students often focus on one value, missing the pattern across several. Early warning scores are ignored. Blame replaces analysis. The response is not described. Times are missing from the record. Drain output falling is read as improvement without asking whether the drain still works. Pain trends are left out. Finally, read the record twice, because graders reward a study that shows both why each moment looked fine and why the series did not.
Get a NSG 123 Unit 4 example written to your instructions
Send the Unit 4 instructions and the rubric from your NSG 123 classroom, with the case or the record the assignment supplies. We write a custom example that keeps the entries at their times, reads the period twice, names the earliest defensible recognition point and holds on to the findings that pointed elsewhere. First custom sample free, returned in 24 to 48 hours.
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NSG 123 Unit 4 questions, answered
How obvious should the change be?
Obvious in the second reading and arguable in the first, which is what makes the study worth writing. If the record shows something nobody could miss, the paper has nothing to argue, and if nothing in it moves, there is no recognition to defend. Your instructions often fix the case, and then the work sits in the reading rather than the design.
Can I write about something I saw on placement?
No. Build the case from patterns that recur across many admissions and say in a line that it was constructed. What you saw belongs to that patient and that setting, and using it puts you in difficulty for reasons unrelated to the grade. A built case also lets you place the entries your argument actually needs.
Does the study have to say what the nurse did?
Most sections want the scenario carried through to what followed, written as case detail. Keep it as a record of the constructed situation rather than as guidance, and leave decisions belonging to a prescriber where they are. The graded part is almost always the recognition and the defense of it rather than the response.
Where can I find a free NSG 123 Unit 4 sample paper?
The complete NSG 123 Unit 4 returning abscess case study is posted here free, the record read point by point and as a series. A case study of your own record can be prepared on request.
Why can a falling drain output be a warning sign?
If the drain is blocked or kinked, output falls while the abscess refills. In this sample, falling output alongside rising heart rate, temperature and pain signaled the abscess returning rather than healing.