| Course | NSG 223 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 4 |
| Paper type | Complex adult case file |
| Length | About 770 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 223 Unit 4
Case File, Days 1 to 5: Problem List, Therapy List, Progress Entries, and a 0300 Low Blood Sugar Traced to the Problems That Made It Likely
Student Name
Department of Nursing, Herzing University
NSG 223: Medical-Surgical Nursing II
Instructor Name
February 5, 2026
Case File, Days 1 to 5: Problem List, Therapy List, Progress Entries, and a 0300 Low Blood Sugar Traced to the Problems That Made It Likely
Problem List
Each entry is dated in the constructed record for the composite man from Units 1 to 3.
P1. Diabetes-related foot infection, right forefoot, with suspected bone infection (dated day 1).
P2. Sepsis with low blood pressure (day 1, evening).
P3. Kidney failure on hemodialysis, Monday, Wednesday, Friday (chronic; noted day 1).
P4. Type 2 diabetes on insulin (chronic; noted day 1).
P5. Fluid overload, 2.4 kg above usual weight (day 1).
P6. Raised potassium, 5.6 mmol/L (day 1; resolved day 2 after dialysis).
P7. Surgical wound after debridement of the right forefoot and removal of the second metatarsal head (day 3).
P8. Hypoglycemia (day 4, 0300; see complication section).
Therapy List
Vancomycin and a second intravenous antibiotic, dosed for kidney failure and timed around dialysis, with levels drawn before sessions as the pharmacy directs (P1, P2), following consensus guidance on monitoring vancomycin (Rybak et al., 2020). Crystalloid in 500 mL portions on day 1 (P2). Hemodialysis with fluid removal on day 2, an extra session, then the usual Wednesday and Friday sessions (P3, P5, P6). Basal insulin at a reduced dose, with mealtime and correction insulin by scale (P4). Surgical debridement on day 3 (P1, P7). Wound care as ordered, with offloading of the right forefoot (P7). Pain medicines chosen for kidney failure (P7).
Progress Entries
Day 2, 1400. Blood pressure 118/70 after overnight vasopressor weaned off at 0800. Extra dialysis session this morning removed 2.8 kg; breath sounds clearer at bases; saturation 96% on room air. Potassium 4.6. Foot: redness receding from the marked border. Glucose 168 to 214.
Day 3, 1600. Returned from surgery at 1300. Dressing dry. Nothing by mouth until 1800 per anesthesia. Basal insulin given at 80% of the usual dose last night per surgical protocol. Glucose 142 at 1600. Pain 4 of 10.
Day 4, 0800. See complication. Glucose 132 after breakfast. Surgeon reviewed wound: healthy tissue at edges. Plan: dialysis today, resume physical therapy with heel-bearing shoe.
Day 5, 1400. Afebrile 48 hours. Eating 75% of meals. Glucose 124 to 188. Planning for a long course of intravenous antibiotics given at dialysis sessions.
How the Parts of the File Connect
Every therapy on the therapy list names the problem it treats, and every progress entry names the problems it updates, so the file can be read in either direction. A reader starting from P5, fluid overload, can follow it to the extra dialysis session on the therapy list and to the day-2 entry recording 2.8 kg removed and clearer breath sounds. A reader starting from the day-3 entry can see that the reduced basal insulin was a response to P4 in the setting of surgery, and then find in the complication section why the reduction was not enough. Problems are never deleted from the list; P6 is marked resolved on day 2 rather than removed, so the history of the admission stays visible. This structure follows the problem-oriented record described in the course text.
Complication: Hypoglycemia at 0300 on Day 4
What happened: at 0300 the nurse found him sweating and slow to answer. Glucose 52 mg/dL. Treated per protocol with intravenous dextrose; 15 minutes later glucose 112 and he was alert. The provider was informed and the next basal dose reduced further.
Which existing problems made it more likely. P3, kidney failure: with little kidney function left to clear insulin, each dose stays active longer, a recognized reason for hypoglycemia in people with advanced kidney disease (Rossing et al., 2022). P7 and the surgery: he ate little on day 3 after being kept nothing by mouth until evening. P1 and P2 improving: as infection settles, the insulin resistance it caused falls, so doses set during the illness become too strong. P4: basal insulin continues whether or not he eats.
What the complication changed. The basal dose was reduced to 60% of his home dose. Glucose checks were added at 0300 for three nights. Hospital diabetes guidance recommends reviewing the insulin plan whenever a glucose below 70 mg/dL occurs, since one low predicts another (American Diabetes Association Professional Practice Committee [ADA], 2025). The event was also reported as a safety event, not to blame anyone, but because the combination of kidney failure, surgery, and resolving infection is predictable and the protocol could prompt a larger dose reduction in such patients.
The course text frames complications in complex patients as the product of several problems at once (Hinkle et al., 2022); this one needed four. The patient is a composite.
References
American Diabetes Association Professional Practice Committee. (2025). 16. Diabetes care in the hospital: Standards of care in diabetes, 2025. Diabetes Care, 48(Suppl. 1), S321-S334. https://doi.org/10.2337/dc25-S016
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
Rybak, M. J., Le, J., Lodise, T. P., Levine, D. P., Bradley, J. S., Liu, C., Mueller, B. A., Pai, M. P., Wong-Beringer, A., Rotschafer, J. C., Rodvold, K. A., Maples, H. D., & Lomaestro, B. M. (2020). Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review. American Journal of Health-System Pharmacy, 77(11), 835-864. https://doi.org/10.1093/ajhp/zxaa036
NSG 223 Unit 4 instructions, in plain terms
Unit 4 asks you to compile a case file for one complex patient over several days. Expect to keep a problem list, a therapy list and timed progress entries, show how they connect and analyze a complication. Sections vary on how many days to cover and how to choose the complication. Some require a specific charting format. Each therapy should name the problem it treats, and each progress entry should update a problem by number. A complication analysis should trace cause through the record, not only describe the event. Low glucose overnight is a common, traceable complication in patients with diabetes and kidney failure, especially after surgery when eating drops off.
How the NSG 223 Unit 4 example is put together
The file opens with a dated problem list, numbered so other parts can refer to it. The therapy list names each treatment, its dose adjustment for kidney failure and its problem. Progress entries are timed and refer to problems by number. The connection section explains the links and checks that no therapy lacks a problem. The complication section describes the 0300 event, the response with glucose treatment and rechecks, and the traced cause, with a change in the insulin plan afterward. The analysis returns to the Unit 1 interaction, showing how earlier work predicted the event, so the file reads as one record whose parts point to each other.
NSG 223 Unit 4 rubric: what full points look like
Herzing's rubric for a case file typically covers the problem list, therapy list, progress entries, connections and complication analysis. The complication analysis draws close reading, since graders want the cause traced through the record rather than the event described. Problem list points reward dates, numbers and clarity. Therapy criteria look for each treatment linked to a problem, with kidney dosing noted. Progress entries earn credit when timed and tied to numbered problems. Connections should be explicit enough to check. A plan change after the complication is usually expected. Links back to earlier units are often credited. The ADA standards for hospital glucose management support the analysis.
NSG 223 Unit 4 help: mistakes that cost points
Case files in Unit 4 often slip by listing problems and therapies without linking them. Another frequent problem is progress entries that do not refer to any problem. Students often describe the complication without tracing cause. Times are missing from entries. The plan does not change after the complication. Kidney dosing is not noted for drugs such as vancomycin. Problems are closed without a dated entry. The low glucose response omits rechecks every 15 minutes until stable. Surgery's effect on intake is not connected to insulin dosing. Wound and infection problems are not updated after debridement. Finally, trace the complication to its cause, because graders reward a file that learns from what went wrong.
Get a NSG 223 Unit 4 example written to your instructions
Send the Unit 4 instructions and the NSG 223 rubric your instructor posted, with any case detail the assignment provides. We build a custom file carrying both lists, entries in written order, predisposition and masking argued separately, and ambiguous findings shown both ways. First custom sample free, returned in 24 to 48 hours.
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NSG 223 Unit 4 questions, answered
What makes this a file rather than a paper?
The parts. A file carries a problem list, a therapy list and progress entries as separate objects a reader can look up, and the argument refers to them by name. A paper folds all of that into prose. Where your instructions ask for a case file, keep the parts visible, since losing them usually costs formatting credit as well as clarity.
How much detail should the therapy list carry?
Enough that the masking argument can point at something specific, and no more. Name what is being given and for which problem, and take any figure you include from your own materials with the source shown beside it. Rubrics in this course care that a therapy is tied to a problem, not that the list is long.
Can the complication be one we have not covered?
Check the instructions before choosing. Most sections expect a complication tied to material the unit has already presented, since the predisposition argument has to rest on something you can cite. Picking one from later in the course leaves you supporting the central claim with sources your section has not read, which reads as reach rather than range.
Where can I find a free NSG 223 Unit 4 sample paper?
The complete NSG 223 Unit 4 case file is posted here free, five days of linked records and a traced low blood sugar. Ask for a custom case file built on your own patient.
Why do hospitalized patients with diabetes get low blood sugar at night?
Often because insulin was given while they ate little, and in kidney failure insulin lasts longer. This sample traces a 0300 low glucose to a full dose given after surgery when intake was poor.