| Course | NSG 223 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 2 |
| Paper type | Competing treatment write-up |
| Length | About 780 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 223 Unit 2
The Circulation Wants Fluid and the Lungs Do Not: A Competing Treatment Write-Up for a Man on Hemodialysis Whose Blood Pressure Falls With Sepsis
Student Name
Department of Nursing, Herzing University
NSG 223: Medical-Surgical Nursing II
Instructor Name
January 22, 2026
The Circulation Wants Fluid and the Lungs Do Not: A Competing Treatment Write-Up for a Man on Hemodialysis Whose Blood Pressure Falls With Sepsis
Clinical Summary
The composite man from Unit 1: diabetes for 22 years, kidney failure on hemodialysis Monday, Wednesday, and Friday, admitted Tuesday with an infected foot ulcer and likely bone infection. He makes almost no urine. At 1900 on the day of admission, after his first antibiotic doses, his blood pressure fell from 128/74 to 92/54, heart rate rose to 108, respiratory rate 22, temperature 38.6 °C, oxygen saturation 93% on room air, with fine crackles at both lung bases that were present on admission. Lactate 2.6 mmol/L. He is still carrying the extra 2.4 kg found on arrival. What the record already shows about the two organ systems involved: his heart and lungs are carrying extra fluid he cannot excrete, and his circulation is now showing signs of the widening of blood vessels that sepsis causes.
The Competition
His circulation would prefer the fluid balance to move up. Sepsis makes blood vessels leak and widen, so the space the blood has to fill grows while the volume in it does not; giving fluid is the first step guidelines recommend for sepsis with low blood pressure or signs of poor perfusion, with at least 30 mL/kg of crystalloid suggested within the first three hours (Evans et al., 2021). For him that would be over 2 liters. His lungs would prefer the balance to move down. He has no kidneys to remove extra fluid, is already above his usual weight, has crackles at both bases, and his saturation is already lower than normal. Every milliliter given stays in his body until the next dialysis, and extra fluid in the lungs could tip him into respiratory failure. These directions cannot both be satisfied with a single fixed volume, and the conflict is real: in a study of septic patients on hemodialysis, clinicians gave the full recommended volume far less often than in other patients, 23% compared with 60%, reflecting exactly this fear, although in that study those who received the full volume did not have more intubations (Rajdev et al., 2020).
How the Team Resolved It, and Nursing's Part
The team chose a middle course: fluid given 500 mL at a time, with a full reassessment between portions, with a plan to start a vasopressor through a central line if blood pressure did not respond, and to contact nephrology about dialysis with fluid removal once his blood pressure could tolerate it. The decisions belong to the provider and nephrologist; the nursing role is to supply the findings that decide each next step.
Why Neither Extreme Was Chosen
Withholding fluid entirely would have protected his lungs but left a septic circulation underfilled, risking poor blood flow to the brain, heart, and the infected foot the antibiotics need to reach. Giving the full weight-based volume at once would have followed the general sepsis guidance but ignored the fact that he cannot excrete any of it until dialysis. Smaller portions with reassessment keep both risks in view and turn the decision into a series of small tests, each answered by the findings below. This approach depends entirely on the frequency and quality of the observations between portions, which is why the monitoring line is the longest part of the plan.
Findings That Decide Each Next Step
Signs the fluid is helping the circulation: mean arterial pressure rising toward 65 mm Hg or above, heart rate falling, skin warmer, mental state clear, lactate falling on the repeat test.
Signs the lungs are paying for it: respiratory rate climbing, saturation falling, crackles rising higher up the back, new use of neck muscles to breathe, or the patient needing to sit bolt upright.
Each bolus is judged by both sets together. A rising blood pressure with stable breathing supports another bolus. Any worsening in the lung findings stops further fluid and is reported at once, even if the blood pressure is still low, because that combination points toward a vasopressor rather than more volume.
Monitoring Line
Pressure and pulse at quarter-hour intervals while each bolus runs and for 30 minutes after; respiratory rate, saturation, and breath sounds at the bases before and after each bolus; mental state hourly; lactate repeated as ordered; weight at 0600; strict intake of every fluid, including antibiotic infusions and flushes, since in a patient who makes no urine every line counts. The fistula arm is never used for blood pressure or blood draws. The course text describes this dual monitoring in patients with kidney failure and acute illness (Hinkle et al., 2022). The patient is a composite.
References
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., ... Levy, M. (2021). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Critical Care Medicine, 49(11), e1063-e1143. https://doi.org/10.1097/CCM.0000000000005337
Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.
Rajdev, K., Leifer, L., Sandhu, G., Mann, B., Pervaiz, S., Habib, S., Siddiqui, A. H., Joseph, B., Demissie, S., & El-Sayegh, S. (2020). Fluid resuscitation in patients with end-stage renal disease on hemodialysis presenting with severe sepsis or septic shock: A case control study. Journal of Critical Care, 55, 157-162. https://doi.org/10.1016/j.jcrc.2019.10.008
What the NSG 223 Unit 2 instructions ask for
Unit 2 centers on a situation where two treatment needs pull against each other. Expect to summarize the case, explain the competition and its mechanisms, describe how the team resolved it, explain nursing's part, say why extremes were rejected and list findings that decide each next step. Sections differ on how much physiology to include and how detailed the monitoring plan should be. Explain why each side needs what it needs, in plain terms a classmate could follow. A middle course with reassessment points is common in practice. Nursing's role is often the reassessment itself, done at the bedside between boluses. List the specific findings that show benefit and those that show harm. Set a monitoring schedule with intervals and thresholds rather than a general instruction to watch closely.
Inside the NSG 223 Unit 2 example
The write-up opens with the clinical summary, including vital signs, oxygen needs and fluid status. The competition section explains both sides in plain language. The resolution section describes small boluses with reassessment and the nurse's role in each check. The extremes section explains why withholding fluid would leave the circulation failing and why large volumes would flood the lungs. The findings section lists signs the fluid is helping and signs it is harming, with thresholds. The monitoring line gives intervals for each measure. The write-up shows clinical judgment working inside a conflict, which is the unit's aim.
Reading the NSG 223 Unit 2 rubric
Herzing's rubric for a competing treatment write-up typically covers the clinical summary, explanation of the competition, the resolution, nursing's role, rejection of extremes, decision findings and monitoring. Two parts are read most closely: the plain explanation of why each side needs what it needs, and the findings that decide each next step. Summary points reward vital signs, oxygen needs and fluid status at the start. Resolution criteria look for a reasoned middle course rather than a guess. Nursing role points go to the reassessment the nurse performs between boluses. Decision findings should carry thresholds, such as a mean arterial pressure target. Monitoring earns credit for intervals tied to each bolus. Dialysis as a way to remove fluid later is often credited. Evans's 2021 Surviving Sepsis guideline supports the plan.
NSG 223 Unit 2 help before you submit
Competing treatment write-ups in Unit 2 often slip by choosing one side without explaining the other. Another frequent problem is describing the conflict without mechanisms, so the reader cannot see why fluid helps one system and harms another. Students often skip nursing's role. Decision findings lack thresholds. Monitoring is vague, such as monitor closely. Extremes are not discussed, so the middle course looks arbitrary. Dialysis as a tool to remove fluid is forgotten. Oxygen saturation, breathing rate and breath sounds are not linked to fluid overload. Urine output is used as a guide even though he makes little urine. Finally, list the findings that decide each next step, because graders reward a write-up that shows how the nurse would know whether the middle course is working.
Get a NSG 223 Unit 2 example written to your instructions
Send us the Unit 2 instructions and your NSG 223 rubric, plus the scenario if one is given. The example comes back with a trimmed summary, the competition written as a paragraph, one grouped findings list covering both organs, and a monitoring close. First custom sample free, delivered in 24 to 48 hours.
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NSG 223 Unit 2 questions, answered
Does the write-up have to choose a side?
Most rubrics want a position and the reasoning behind it rather than a balanced shrug. State which way the constructed plan leans, say what it costs the other organ, and record what would be watched because of that cost. Leave any decision belonging to a prescriber attributed to a prescriber, and keep the whole document describing the built case.
Where do the values in the example come from?
From you. We write the example so that every figure sits in a sentence naming its source, whether that is your textbook, the materials your instructor posted, or the constructed chart itself. We supply no thresholds or ranges of our own, partly because they vary between facilities and partly because a defended number is what this rubric is actually looking at.
Can two organs really be the whole assignment?
Often that is exactly the point. Medical-surgical II moves you off single-problem thinking, so a paper that manages one organ well and mentions the second in passing has answered the previous course instead. Keep both present in the summary, in the findings list and in the close, and the competition stays visible the whole way through.
Where can I find a free NSG 223 Unit 2 sample paper?
Read the complete NSG 223 Unit 2 competing treatment write-up here at no charge, the fluid conflict explained with decision findings. A write-up on a different conflict can be prepared on request.
How is fluid given to a septic patient on dialysis?
Often in small boluses with reassessment after each, watching blood pressure for benefit and oxygen and breathing for harm. This sample explains that middle course and the findings that decide each next step.