| Course | NSG 123 Medical-Surgical Nursing I |
|---|---|
| Unit | Unit 8 |
| Paper type | System-focused case study |
| Length | About 890 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 123 Unit 8
Five Systems, Three Conflicts, One Order: A System-Focused Case Study of the Second Day After Sigmoid Colectomy for Complicated Diverticulitis
Student Name
Department of Nursing, Herzing University
NSG 123: Medical-Surgical Nursing I
Instructor Name
March 6, 2026
Five Systems, Three Conflicts, One Order: A System-Focused Case Study of the Second Day After Sigmoid Colectomy for Complicated Diverticulitis
The Case on Postoperative Day 2
The composite 58-year-old dispatcher had a laparoscopic sigmoid colectomy with the bowel rejoined, after complicated diverticulitis with an abscess. Overnight into day 2, her heart rate rose to 112, urine fell below 20 mL an hour, and pain spread across the lower abdomen. After a 1-liter fluid bolus, urine rose to 45 mL an hour and heart rate settled to 96. Lactate was 2.1 mmol/L and hemoglobin stable at 11.4 g/dL. A CT scan in the early morning showed no leak at the join and no collection, but dilated loops of small bowel and colon. By midmorning she has not passed flatus, her abdomen is distended, she is nauseated and vomited 200 mL once, and she has used her opioid pump 14 times in 12 hours. Temperature 37.9 °C. She has walked only once since yesterday afternoon.
First Movement: System by System
Each system follows the same pattern: what the case shows, the process behind it, what a nurse assesses, and what nursing does.
Gastrointestinal
Shows: no flatus on day 2, distension, nausea, vomiting, dilated bowel on CT without a leak. Process: postoperative ileus, a temporary loss of coordinated bowel movement after abdominal surgery, driven by handling of the bowel, inflammation, opioids, and immobility. Definitions vary, but many clinicians treat failure to pass flatus or stool and to tolerate oral intake beyond about the fourth day as prolonged ileus (Vather et al., 2013); on day 2 she is within the expected window but moving the wrong way. Assess: bowel sounds, distension measured at the umbilicus with a tape, flatus, nausea, vomit volume. Nursing does: holds oral intake if ordered, reports vomiting, encourages walking, and assists with nasogastric tube insertion if ordered.
Renal and Fluid
Shows: low urine overnight that responded to fluid; vomiting now adds loss; home lisinopril on hold. Process: reduced circulating volume after surgery, fluid moving into the swollen bowel and its wall, and ongoing losses. Assess: hourly urine, daily weight, intake and output including vomit. Nursing does: records and reports output below the ordered threshold, gives fluids as ordered.
Respiratory
Shows: low-grade fever of 37.9 °C, shallow breathing because coughing hurts, a distended abdomen pushing up on the diaphragm. Process: small airways close at the lung bases, atelectasis, when breaths stay shallow. Assess: respiratory rate, oxygen saturation, breath sounds at the bases. Nursing does: deep breathing and supported coughing each hour while awake, head of bed raised, walking.
Pain and Sedation
Shows: 14 pump doses in 12 hours, pain 6 on coughing. Process: surgical pain, now with pain from distension. Assess: pain at rest and on movement, sedation level, respiratory rate. Nursing does: gives scheduled non-opioid analgesics as ordered, uses the pump safely, repositions, and reports if pain control is inadequate.
Mobility and Clot Prevention
Shows: one walk since yesterday afternoon; compression devices on. Process: immobility slows the bowel, weakens breathing, and raises clot risk. Assess: distance walked, dizziness, calves. Nursing does: plans walks at least three times a day around pain relief.
Second Movement: How the Plans Interact
Conflict 1: pain control against bowel function. Her opioid use is high, and opioids slow the bowel. Easing pain with more opioid would help her breathe and walk but deepen the ileus. The enhanced recovery guideline recommends multimodal analgesia that limits opioids after colorectal surgery (Gustafsson et al., 2019), and a postoperative pain guideline recommends scheduled non-opioid medicines as the base of the regimen (Chou et al., 2016). Nursing cannot change the regimen, but it can report the pattern, pump use rising while pain on coughing stays high, and ask the team to review it. This conflict is named, not resolved by nursing alone.
Conflict 2: fluids for the kidneys against fluid in the bowel. Fluid restored her urine overnight, but too much fluid can worsen swelling of the bowel wall and prolong ileus, a concern in enhanced recovery pathways that aim for balanced fluid rather than liberal fluid (Gustafsson et al., 2019). The nursing response is precise measurement, hourly urine and a daily weight, so that the team can give as much as needed and no more.
Conflict 3: walking against pain and nausea. Walking is the one action that helps three systems at once, the bowel, the lungs, and clot prevention, yet she avoids it because it hurts and she feels sick. The resolution is timing: walks planned 30 minutes after a scheduled analgesic dose and after an antiemetic if one is ordered.
The Order That Results
1. Fluid and renal status, because falling urine overnight was the first sign of instability and vomiting has resumed. 2. The gastrointestinal problem, because the ileus drives the vomiting, the distension, and part of the pain. 3. Pain and sedation, because the regimen is feeding the ileus and needs review. 4. Respiratory, because the fever and shallow breathing will improve if pain and distension improve. 5. Mobility, placed last because it depends on the three above; yet it is the single action most likely to help all of them, so it is scheduled first thing after each pain dose even though it is ranked last. The patient is a composite, and the systems approach follows the course text (Hinkle et al., 2022).
References
Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., Carter, T., Cassidy, C. L., Chittenden, E. H., Degenhardt, E., Griffith, S., Manworren, R., McCarberg, B., Montgomery, R., Murphy, J., Perkal, M. F., Suresh, S., Sluka, K., Strassels, S., ... Wu, C. L. (2016). Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The Journal of Pain, 17(2), 131-157. https://doi.org/10.1016/j.jpain.2015.12.008
Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., Rockall, T. A., Young-Fadok, T. M., Hill, A. G., Soop, M., de Boer, H. D., Urman, R. D., Chang, G. J., Fichera, A., Kessler, H., Grass, F., Whang, E. E., Fawcett, W. J., Carli, F., ... Ljungqvist, O. (2019). Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: 2018. World Journal of Surgery, 43(3), 659-695. https://doi.org/10.1007/s00268-018-4844-y
Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.
Vather, R., Trivedi, S., & Bissett, I. (2013). Defining postoperative ileus: Results of a systematic review and global survey. Journal of Gastrointestinal Surgery, 17(5), 962-972. https://doi.org/10.1007/s11605-013-2148-y
What the NSG 123 Unit 8 instructions ask for
Unit 8 asks you to analyze one patient system by system and then show how the plans interact. Expect to present the case, assess each system with what it shows, the process behind it and the plan, identify conflicts between plans and set a final order. Many versions ask how many systems to include and how to handle competing plans. Five systems is a common number. Using the same structure for each system makes comparison easier. Conflicts are the integration point, such as opioids for pain slowing the bowel. The final order should follow from the analysis rather than from habit. Keep the patient consistent with earlier units, since this is the closing case.
How the NSG 123 Unit 8 example is put together
The case study opens with the patient on day 2, with key findings. The first movement takes five systems in turn, each with what the case shows, the process and the plan. The second movement names three conflicts, such as pain control against bowel recovery, and explains how each is resolved. The order section ranks the systems with reasons. The two movements show separate analysis followed by integration, which is what the unit asks for. Each plan draws on enhanced recovery evidence, such as early walking and limiting opioids. Findings from earlier units, such as the low potassium, reappear where they matter.
NSG 123 Unit 8 rubric: what full points look like
Herzing's rubric for a system-focused case study typically covers the case summary, analysis of each system, identification of conflicts, resolution, the final order and integration. Conflicts and their resolution carry the most weight, because that is where separate system plans become one plan. System points reward findings, processes and plans for each, in a consistent format. Order criteria look for a ranking that follows from the analysis, with fluid and renal status first here because falling urine was the earliest warning. Integration earns credit when earlier units, such as the electrolyte study, are used. Enhanced recovery evidence is often credited. Clot prevention included as its own system is usually expected. Clear headings help. Gustafsson's ERAS guideline supports the plan. A short note on what would change the order tomorrow is often credited.
Common NSG 123 Unit 8 mistakes, and how to avoid them
System-focused case studies in Unit 8 commonly lose points by analyzing systems separately without showing how plans interact. Another frequent problem is missing conflicts such as opioids and bowel function, or fluids and lung status. Students often rank systems without reasons. The process behind findings is skipped. Plans are generic. Earlier units are not used. Clot prevention is forgotten. Low-grade fever on day 2 is not explained, though shallow breathing offers a likely cause. The final order does not match the analysis. Finally, show how the plans conflict and resolve, because graders reward a case study where the parts come together into one coherent order.
Get a NSG 123 Unit 8 example written to your instructions
Send the Unit 8 instructions and the rubric from your NSG 123 classroom, along with the case the assignment builds on. We write a custom example that works each system to one pattern, keeps those sections short enough for the integration, settles the interactions before the ordering and names the conflicts between plans. First custom sample free, returned in 24 to 48 hours.
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NSG 123 Unit 8 questions, answered
How many systems should the study cover?
However many the case gives, and where you choose, two or three worked properly beat five that each get a paragraph. The integration is graded on what it can connect, so every system you add has to earn its place by interacting with the others. Where your instructions fix a number, that number settles it.
How do I keep the system sections from repeating each other?
Write them to one pattern and resist reaching across while you are inside one, since that is where repetition starts. Anything involving two systems belongs to the integration and can be left with a short marker in the section. The second movement then has material to work with rather than a summary of what was already said.
Is this the same as the ranking assignment from Unit 1?
It uses the same reasoning at a larger size, and your instructions will say how much of it to show. The earlier paper ranks problems within one picture, while this study builds each problem up first and then orders the set. Expect the interactions between them to carry weight the earlier assignment did not ask for.
Where can I find a free NSG 123 Unit 8 sample paper?
This page holds the whole NSG 123 Unit 8 system case study free, five systems, three conflicts and the resulting order. A case study for a different patient can be prepared on request.
How do pain medicines affect bowel recovery after surgery?
Opioids slow the bowel and can delay return of function, which conflicts with the need for pain control. This sample resolves the conflict with multimodal analgesia, walking and limiting opioids.