| Course | NSG 223 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 1 |
| Paper type | Comorbidity interaction study |
| Length | About 500 words, 4 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 223 Unit 1
Diabetes and Kidney Failure in One Admission for a Foot Infection: What Each Condition Asks For, and Six Places Where the Two Requests Collide
Student Name
Department of Nursing, Herzing University
NSG 223: Medical-Surgical Nursing II
Instructor Name
January 15, 2026
Diabetes and Kidney Failure in One Admission for a Foot Infection: What Each Condition Asks For, and Six Places Where the Two Requests Collide
Patient Picture
Composite man, age band 60 to 65, retired city bus driver. Type 2 diabetes for 22 years, treated with basal and mealtime insulin; kidney failure for 3 years, treated with in-center hemodialysis on Monday, Wednesday, and Friday through a fistula in the left forearm. He makes almost no urine. Admitted on a Tuesday with an infected ulcer on the ball of the right foot, present for six weeks, now red, swollen, and draining, with bone felt when the wound is probed, which raises concern for infection of the bone. Temperature 38.2 °C, glucose 286 mg/dL on arrival, potassium 5.6 mmol/L, weight 2.4 kg above his usual post-dialysis weight.
Paired Care, With the Interactions Between
The left column lists care the diabetes ordinarily calls for; the right, care the kidney failure calls for; the middle, the interaction sentence saying which measure helps one and complicates the other.
| Diabetes asks for | Interaction | Kidney failure asks for |
|---|---|---|
| Glucose kept near target to support wound healing and fight infection | Insulin is partly cleared by the kidneys, so with kidney failure each dose lasts longer and lowers glucose more; tight control therefore carries a higher risk of hypoglycemia, and guidance for people with diabetes and advanced kidney disease favors individualized, less strict targets (Rossing et al., 2022) | Avoidance of hypoglycemia, which is more frequent and prolonged when kidneys cannot clear insulin |
| Generous protein and calories for wound healing | Protein needs are actually higher on dialysis, because dialysis removes amino acids; the conflict is with phosphorus and potassium in protein-rich foods, not with protein itself (Ikizler et al., 2020) | Limits on potassium, phosphorus, and fluid between dialysis sessions |
| Fluids for fever and infection | He makes almost no urine, so any fluid given stays in his body until dialysis removes it; he arrived already 2.4 kg over his usual weight | Strict fluid limits between sessions |
| Antibiotics that reach bone | Many antibiotics are cleared by the kidneys; doses and timing must be set around dialysis, and some drug levels are measured before sessions | Medicines dosed for kidney failure and timed with dialysis |
| Foot checks and offloading pressure from the ulcer | Poor circulation from diabetes and vessel changes common in kidney failure both slow healing and hide pulses | Protection of the fistula arm: no blood pressure cuffs, blood draws, or intravenous lines on the left arm |
| Surgical debridement if the bone is infected | Surgery must be scheduled around dialysis, and heparin used during dialysis affects bleeding risk on the day of surgery | Dialysis on schedule, with potassium controlled before any anesthetic |
Which Interactions Matter Most on This Admission
Two of the six interactions demand action on the first day. The first is glucose. His arrival glucose of 286 mg/dL is high, and infection will keep it high, but the correction insulin that would be routine in a person with working kidneys can cause a delayed low in him. The nursing response is more frequent glucose checks, including overnight, and prompt reporting of any value trending down after correction doses.
The second is fluid. Fever and infection would normally call for generous fluids, but he is already above his usual weight and produces almost no urine. He is on the Tuesday of a Monday-Wednesday-Friday schedule, so the next routine dialysis is a day away. The nursing response is daily weights, strict intake and output, listening to the lungs every shift, and reporting any increase in breathlessness, which would argue for an extra dialysis session rather than holding fluids.
The antibiotic and surgical interactions matter on days 2 and 3, once the team decides on bone biopsy and debridement. Guidance for diabetes-related foot infections recommends that suspected bone infection be confirmed and that surgical options be considered alongside antibiotics (Senneville et al., 2023).
What the Study Changes in Nursing Care
Without the interaction column, a nurse could follow the diabetes plan and the kidney plan separately and harm him with each: tight glucose correction causing a low at 0300, or generous fluids for fever leading to fluid in the lungs before Wednesday's dialysis. The paired layout makes the collisions visible before they happen. The course text describes care of patients with diabetes and kidney failure in the same terms (Hinkle et al., 2022). The study will be revisited on day 3, when the surgical plan is known, because two new interactions will then need adding: anesthesia and pain medicines, many of which are cleared by the kidneys, and the timing of the first dialysis after surgery. The patient is a composite.
References
Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.
Ikizler, T. A., Burrowes, J. D., Byham-Gray, L. D., Campbell, K. L., Carrero, J.-J., Chan, W., Fouque, D., Friedman, A. N., Ghaddar, S., Goldstein-Fuchs, D. J., Kaysen, G. A., Kopple, J. D., Teta, D., Yee-Moon Wang, A., & Cuppari, L. (2020). KDOQI clinical practice guideline for nutrition in CKD: 2020 update. American Journal of Kidney Diseases, 76(3, Suppl. 1), S1-S107. https://doi.org/10.1053/j.ajkd.2020.05.006
Rossing, P., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., Sadusky, T., Tandon, N., Tuttle, K. R., Wanner, C., Wilkens, K. G., Zoungas, S., & de Boer, I. H. (2022). KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney International, 102(5, Suppl.), S1-S127. https://doi.org/10.1016/j.kint.2022.06.008
Senneville, É., Albalawi, Z., van Asten, S. A., Abbas, Z. G., Allison, G., Aragón-Sánchez, J., Embil, J. M., Lavery, L. A., Alhasan, M., Oz, O., Uçkay, I., Urbančič-Rovan, V., Xu, Z.-R., & Peters, E. J. G. (2023). IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Clinical Infectious Diseases. Advance online publication. https://doi.org/10.1093/cid/ciad527
NSG 223 Unit 1 instructions, in plain terms
Unit 1 asks you to study how two chronic conditions interact during one admission. Expect to describe the patient, list the usual care each condition calls for, identify where they interact, judge which interactions matter most now and explain what changes in nursing care. Many versions ask how many interactions to find and whether to include medications. Check whether your section names the conditions. Medications are often where interactions show first, such as insulin lasting longer when kidneys clear it slowly. Fluid, diet and potassium rules can clash too. Rank interactions by urgency on this admission. Show how a nurse would do something differently because of each. Use current guidelines for both conditions, and keep the patient composite.
How this NSG 223 Unit 1 example is built
The study opens with the patient picture, giving history, treatments and the reason for admission. A two-column table lists diabetes care on the left and kidney care on the right, with interactions noted between them. Six interactions are named, including insulin clearance, contrast dye, dietary potassium, fluid limits and antibiotic dosing. The urgency section picks two that need action on day one and explains why. The final section shows what changes: a nurse following the diabetes plan alone might give a full insulin dose and cause low glucose overnight. Each interaction is tied to guidance from the ADA or KDIGO, so the study rests on standards. The table makes it easy to see where the two plans collide.
NSG 223 Unit 1 rubric: what full points look like
Herzing's rubric for a comorbidity interaction study usually covers the patient picture, care for each condition, identification of interactions, prioritization and nursing implications. Identification of interactions carries the largest share, because the unit exists to show where caring for one condition alters care for the other. Patient points reward history, treatments and current problems. Care criteria look for accurate standards for each condition. Prioritization earns credit when interactions are ranked by urgency on this admission. Nursing implication points go to specific changes in what the nurse does. Medication interactions are usually expected. A paired table helps the reader. Current ADA Standards of Care and KDIGO guidance underpin the analysis.
NSG 223 Unit 1 help: mistakes that cost points
A Unit 1 comorbidity study often falls short by treating each condition separately without finding where they interact. Another frequent problem is listing interactions without ranking them for this admission. Students often miss insulin's longer action in kidney failure, the classic interaction. Contrast dye risk is forgotten. Diet rules are combined without noting conflicts, such as fruit for glucose control versus potassium limits. Nursing implications are generic. Guidelines are outdated. The patient picture lacks dialysis days, which shape timing. Antibiotic dosing around dialysis is left out. Finally, say what the nurse would do differently, because graders reward a study that changes care rather than one that describes two diseases side by side.
Get a NSG 223 Unit 1 example written to your instructions
Send the Unit 1 instructions and the rubric from your NSG 223 classroom, along with any case the assignment supplies. We return a custom example with the patient picture, the paired columns, sourced interaction sentences and the findings that would show a cost appearing. First custom sample free, back in 24 to 48 hours.
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NSG 223 Unit 1 questions, answered
Do both conditions have to be chronic?
Not usually. Many sections set one long-standing problem against something acute the adult was admitted for, which gives the write-up a sharper collision than two stable diagnoses would. Read your instructions first, since some fix the pair for you. Where the choice is yours, pick two conditions whose ordinary care you can source, because an interaction you cannot cite is one you cannot defend.
How many interactions should the study name?
Fewer, argued properly, beats a list. Two or three interaction sentences with sourced care on both sides and the findings that would reveal the cost will fill the space most rubrics allow. A page of one-line collisions with nothing underneath them reads as coverage, and coverage is not what this criterion is asking you for.
Can I use a patient from my clinical unit?
No. Invent the adult, give it the two diagnoses your argument needs, and note in one line that the case was built for the assignment. The care you gave belongs to that person and to the facility that employed you, and reusing it in a graded document creates a problem no grade is worth having.
Where can I find a free NSG 223 Unit 1 sample paper?
The full NSG 223 Unit 1 diabetes and kidney failure study is free on this page, paired care with six interactions ranked. A study of a different pair of conditions can be written on request.
Why does insulin cause more low blood sugar in kidney failure?
The kidneys help clear insulin, so when they fail, insulin lasts longer and doses that were safe before can cause low glucose. This sample flags that interaction as a day-one priority for a man on dialysis.