| Course | NSG 223 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 3 |
| Paper type | Chronic and acute overlap paper |
| Length | About 590 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 223 Unit 3
Measured Against His Own Normal: A Man on Hemodialysis With Diabetes, His Ordinary Baseline, and the Acute Changes a Foot Infection Laid on Top
Student Name
Department of Nursing, Herzing University
NSG 223: Medical-Surgical Nursing II
Instructor Name
January 29, 2026
Measured Against His Own Normal: A Man on Hemodialysis With Diabetes, His Ordinary Baseline, and the Acute Changes a Foot Infection Laid on Top
Baseline: His Ordinary Day
Before this admission, the composite man from Units 1 and 2 lived an ordinary week built around dialysis. On Monday, Wednesday, and Friday mornings he drove himself to the dialysis center for four-hour sessions and came home tired. Between sessions he gained about 2 kg of fluid, which his team considers acceptable. His blood tests before dialysis routinely showed creatinine around 8 mg/dL, urea nitrogen in the 50s, potassium 5.0 to 5.3 mmol/L, and hemoglobin near 10.5 g/dL on an erythropoiesis-stimulating medicine. His blood pressure before dialysis ran about 150/85. He could not feel his feet below the ankles because of diabetic nerve damage, and the pulses at his ankles had not been palpable for years. His fasting glucose ran 140 to 180 mg/dL on insulin. He walked two blocks to the store and back.
Almost every one of these values would be abnormal in a healthy adult. For him they are normal, and treating them as new problems would lead to unnecessary alarm and, worse, to missing the changes that really are new.
The Acute Layer, Measured Against That Baseline
Each acute change is paired with the baseline it departs from.
| Measure | His baseline | On admission and day 1 | What the change means |
|---|---|---|---|
| Temperature | 36.6 °C | 38.2 to 38.6 °C | Fever; a clear departure, since people on dialysis often run slightly lower temperatures |
| Blood pressure | About 150/85 before dialysis | 92/54 on the evening of day 1 | A fall of nearly 60 mm Hg systolic from his usual; alarming for him even though 92 would be low-normal for some healthy adults |
| Potassium | 5.0 to 5.3 before dialysis | 5.6 on Tuesday | Higher than his usual, and on a non-dialysis day; infection and tissue breakdown can add potassium |
| Glucose | 140 to 180 fasting | 286 on arrival | Infection raising glucose above his usual range |
| Weight between sessions | About 2 kg gain | 2.4 kg on a Tuesday | Near his usual; the concern is what fluid given now will add |
| Hemoglobin | Near 10.5 | 9.6 | A small fall; infection and blood draws can both contribute; watched rather than acted on alone |
| Foot sensation | Absent below the ankles | Absent | No change, but it explains why a deep infection developed without pain |
| Mental state | Alert and conversational | Alert, slower to answer on the evening of day 1 | A subtle change for him, recorded because his family noticed it first |
Where the Baseline Came From
The baseline was not guessed. It came from three sources: the dialysis center's flow sheet for the previous month, faxed on admission, which gave his usual pre- and post-dialysis weights, blood pressures, and laboratory values; his own account of an ordinary week; and his wife's description of how he usually talks and moves. Where the sources disagreed, the written record was preferred for numbers and the family's account for behavior. Asking for the dialysis flow sheet is a routine step for patients on hemodialysis because hospital reference ranges say nothing about what is normal for them.
What the Baseline Changes in Nursing Judgment
Three judgments depend on knowing his normal. First, blood pressure. On a general ward, 92/54 might be recorded as low-normal and rechecked later. Against a baseline of 150 before dialysis, it is a fall that signals his circulation is under strain, and it was reported at once, which led to the fluid decisions in Unit 2.
Second, pain. A foot infection this deep would cause severe pain in someone with normal sensation. His absence of pain is a feature of his baseline neuropathy, not reassurance, and it is why the ulcer reached the bone before he sought help. Guidance on diabetes-related foot infections notes that the usual signs of infection can be blunted in people with neuropathy and poor circulation (Senneville et al., 2023). Pain, if it appeared, would be a new and important finding.
Third, laboratory values. His creatinine of 8 is not acute kidney injury; it is his dialysis baseline. His potassium of 5.6, by contrast, is above his usual range on a day when he would not normally be dialyzed, which makes it a genuine acute concern that argues for checking it again before Wednesday.
The course text asks nurses to compare findings with a patient's own baseline when chronic disease has reset what is normal (Hinkle et al., 2022). For this man, doing so turned an apparently stable admission into one that needed close watching from the first evening. His glucose targets during the admission follow the individualized approach recommended for people with diabetes and kidney disease (Rossing et al., 2022). 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.
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
The Herzing NSG 223 Unit 3 instructions
Unit 3 asks you to compare a patient's acute presentation with his chronic baseline. Expect to describe the baseline, pair each acute change with the baseline it departs from, explain where the baseline came from and show how it changes nursing judgment. Students often ask where to find baseline data and how many changes to include. Patients with chronic illness often live with values outside textbook ranges that are normal for them. A change from baseline can matter more than a value outside a printed range. Gather baseline from records, the patient and family, and say which source gave which value. Explain how knowing the baseline changes decisions about blood pressure, confusion or potassium.
How the NSG 223 Unit 3 example is put together
The paper opens with the patient's ordinary week, including dialysis days, usual blood pressure, glucose, weight between sessions and activity. A table pairs each acute finding with its baseline value, so the size of each change is visible. The sources section names where each baseline came from, which makes the comparison trustworthy. The judgment section takes three areas and shows how the baseline changes interpretation, such as a blood pressure that looks fine but signals shock for him, or mild confusion that his wife says is new. Throughout, the baseline is handled as clinical data rather than background, which is the lesson the unit is built around.
NSG 223 Unit 3 rubric: what full points look like
Herzing's rubric for a chronic and acute overlap paper usually covers the baseline, paired changes, sources, effect on judgment and writing. The pairing of each acute finding with its baseline, and the decisions that follow, carry most of the marks. Baseline points reward specific usual values rather than general statements such as usually stable. Source criteria look for dialysis records, primary care notes and family accounts. Judgment points go to decisions changed by the baseline, such as treating a normal-looking pressure as low. Timing around dialysis, when values swing, is often credited. A table helps the reader see each change at once. Plain language is expected. Hinkle and Cheever and KDIGO guidance support the paper.
NSG 223 Unit 3 help: mistakes that cost points
Overlap papers in Unit 3 commonly lose points by judging values against textbook ranges only. Another frequent problem is a baseline guessed rather than sourced. Students often skip how the baseline changes decisions. Changes are not paired with specific baseline values. Family accounts are ignored, though a spouse often notices mental changes first. Dialysis timing is forgotten, though potassium and weight swing around it. Glucose baseline is left out, though his usual range shapes insulin decisions. The baseline section runs long and the acute section is thin. Finally, show a decision the baseline changed, because graders reward a paper where knowing the patient's normal leads to a different action.
Get a NSG 223 Unit 3 example written to your instructions
Send the Unit 3 instructions with your NSG 223 rubric and the case if the assignment names one. Your example returns with the baseline paragraph, the acute layer written as difference, the pairing table, the earliest-signal argument and the section admitting overlap. First custom sample free, back in 24 to 48 hours.
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NSG 223 Unit 3 questions, answered
What counts as a baseline for this paper?
The adult's own usual state, described in enough detail that departures from it can be measured. That includes findings which would look abnormal in a healthy person and are ordinary for someone carrying this condition for years. Instructions sometimes supply the baseline inside the case; where they do not, compose one and say plainly that it was composed.
How early is early enough?
Early enough that a reasonable reader could still argue with you. If the change you name is the one nobody could miss, the recognition criterion has nothing to weigh, and if you name something the record cannot support, the paper is guessing. Aim for the first entry a careful nurse could defend, then defend it from the pairings you built.
Should the paper say what is done about the acute layer?
Most sections want the constructed scenario carried a step further, written as what happened in the case rather than as direction to a reader. Keep decisions belonging to a prescriber attributed to one. The graded weight in this unit usually sits on the recognition and the comparison behind it, not on the response that follows it.
Where can I find a free NSG 223 Unit 3 sample paper?
This page shows the whole NSG 223 Unit 3 overlap paper for free, acute changes measured against one man's own normal. Your own patient's baseline can anchor a custom paper.
Why compare a patient's vital signs with their own baseline?
Because a value that looks normal can be a big change for someone whose usual is different. This sample shows a blood pressure of 118/70 signaling trouble for a man whose usual is much higher.