| Course | NSG 223 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 5 |
| Paper type | Treatment trade-off brief |
| Length | About 510 words, 4 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 223 Unit 5
Seven Treatments, Four Columns Each, and the Two That Argue: A Trade-Off Brief for the Day After Foot Surgery in a Man on Hemodialysis
Student Name
Department of Nursing, Herzing University
NSG 223: Medical-Surgical Nursing II
Instructor Name
February 12, 2026
Seven Treatments, Four Columns Each, and the Two That Argue: A Trade-Off Brief for the Day After Foot Surgery in a Man on Hemodialysis
The Grid
Each row runs across all four columns. The patient is the same composite dialysis patient, now on day 4, the day after debridement of his right forefoot and a scheduled dialysis day.
| Treatment | Given for | Expected effect | Precaution the effect requires | Finding documented if the precaution were ignored |
|---|---|---|---|---|
| Vancomycin, dosed for kidney failure | Foot and bone infection | Infection controlled | Levels drawn before dialysis as directed; dose given after dialysis, since dialysis removes some of the drug (Rybak et al., 2020) | Dose given before dialysis; level low the next session; fever returning |
| Basal and correction insulin | Diabetes | Glucose in target | Reduced dose after the day-4 low; glucose at 0300; meal intake checked before mealtime doses | Glucose below 70 overnight; sweating or confusion |
| Hemodialysis with fluid removal | Kidney failure, extra fluid, potassium | Weight back to target; potassium lowered | Blood pressure checked before and during; fluid removal limited if pressure falls | Pressure below 90 during the session; cramping; dizziness after |
| Heparin during dialysis | Keeps the dialysis circuit from clotting | Circuit stays open | Dose reduced or omitted the day after surgery by the dialysis team; dressing checked after the session | Fresh blood soaking the foot dressing after dialysis |
| Hydromorphone as needed | Surgical pain | Pain low enough to rest and use the heel-bearing shoe | Chosen over morphine because morphine's active products build up in kidney failure (Dean, 2004); sedation and breathing checked after each dose | Hard to rouse; slow breathing; confusion |
| Heel-bearing offloading shoe | Surgical wound on the forefoot | Pressure kept off the wound while walking | Used for every step, including to the bathroom at night | Walking barefoot; new redness at wound edges |
| Phosphate binder with meals | High phosphate from kidney failure | Phosphate controlled | Given with meals, not between; held when he is not eating | Given at 0800 with no breakfast eaten |
The Two Rows That Argue
Heparin during dialysis and the fresh surgical wound pull against each other. Dialysis needs an anticoagulant to keep the circuit open; a wound less than a day old needs blood to clot. If the usual heparin dose is given, the wound may bleed; if none is given, the circuit may clot, the session may be cut short, and he may leave with fluid and potassium not fully removed. The resolution belongs to the dialysis team, who may reduce the heparin dose, flush the circuit with saline instead, or delay the session. The nursing contribution is to make sure the dialysis team knows the surgery date and time, to check the dressing before and after the session, and to report both a bleeding wound and a shortened session.
A second pair argues more quietly: hydromorphone and the offloading shoe. Pain control lets him walk, which prevents clots and weakness, but any sedation increases the chance that he gets up at night without the shoe, or falls. The response is timing: pain doses early in the evening, a night check that includes whether the shoe is at the bedside, and a call light within reach.
Rows Considered and Left Out
Two treatments were considered for the grid and left out, with reasons. The erythropoiesis-stimulating medicine he receives at dialysis for anemia was left out because it is given and monitored by the dialysis unit on its usual schedule and did not change during the admission. Deep vein thrombosis prophylaxis was left out as a separate row because on dialysis days the circuit heparin, discussed above, and on other days the ordered prophylaxis, raise the same bleeding question for the fresh wound; it is covered in the heparin row's precaution column. Leaving a row out is recorded so that a reader can see it was considered, not forgotten.
Why the Grid Is Built This Way
A list of treatments tells a reader what the patient receives. The four columns tell a reader what could go wrong with each and how anyone would know. For a man with kidney failure, almost every treatment needs a precaution that would not apply to someone with working kidneys, which is why no row could be left partly empty. The approach mirrors the course text's emphasis on anticipating complications in patients with several chronic conditions (Hinkle et al., 2022).
The grid also shows the timing of the day. Vancomycin comes after dialysis, the binder with meals, the heparin decision before dialysis, and the extra glucose check at 0300. Laid out in rows, those times become a plan for the shift rather than a set of separate orders. The patient is a composite.
References
Dean, M. (2004). Opioids in renal failure and dialysis patients. Journal of Pain and Symptom Management, 28(5), 497-504. https://doi.org/10.1016/j.jpainsymman.2004.02.021
Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.
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
Reading the NSG 223 Unit 5 instructions
Unit 5 asks you to compare a patient's treatments by their benefits, risks and monitoring, and to find where they conflict. Expect to build a grid with the same columns for every treatment, identify rows that argue with each other, explain how the conflict is managed, note treatments left out and explain why the format helps. Students often ask how many treatments to include and what columns to use. Common columns are purpose, risk, nursing monitoring and stop criteria. Conflicts often appear between procedures and medications, such as anticoagulation and surgery. Treatments left out should have a stated reason. The grid should help a nurse see trade-offs at a glance rather than read a narrative for each drug. Keep the patient consistent with earlier units so the trade-offs fit his record.
Inside the NSG 223 Unit 5 example
The brief opens with the grid, seven rows across four columns, written for day 4. Each cell is short and specific, such as watch the wound dressing for fresh blood after dialysis. The section on the two rows that argue explains the mechanism of the conflict and the team's compromise, with what the nurse watches during and after dialysis. The left-out section explains two treatments not included and why, which shows the grid was chosen deliberately. The final section explains that a list tells what a patient receives while the columns tell what each treatment asks of the nurse. The grid uses the same patient as earlier units, so its trade-offs fit his record. Stop criteria in the fourth column make the grid usable during a shift, not only as a study tool.
Reading the NSG 223 Unit 5 rubric
Herzing's rubric for a trade-off brief usually covers the grid's completeness, accuracy of each cell, identification of conflicting rows, management of the conflict, judgment about exclusions and explanation of the format. The two rows that argue, and how the conflict is handled, carry the largest share of the marks. Grid points reward the same columns applied to every treatment. Accuracy criteria look for correct purposes, risks and stop criteria for a dialysis patient. Management points go to a compromise with nursing checks attached. Exclusion judgment earns credit when left-out treatments have reasons. Stop criteria are often what lifts a grid into the top band, since they turn it into a working tool. Clear, short cells help. KDIGO guidance and the ADA Standards of Care support the grid.
NSG 223 Unit 5 help before you submit
A Unit 5 trade-off brief often falls short by listing treatments without the risks and stop criteria that make a grid useful. Another frequent problem is missing the conflict between heparin in dialysis and a fresh wound. Students often fill cells with long sentences that hide the comparison. Stop criteria are vague, such as if problems occur. Treatments left out are not explained. Kidney dosing is ignored in the risk column. The nurse's monitoring is generic, such as monitor vital signs. Wound bleeding after dialysis is not linked to the heparin row. Glucose effects of steroids or stress are forgotten in the insulin row. Finally, name the rows that argue and how they are reconciled, because graders reward a brief that shows the trade-off rather than hiding it in a list.
Get a NSG 223 Unit 5 example written to your instructions
Send the Unit 5 instructions and your NSG 223 rubric, together with the therapy list if the case supplies one. The example arrives as a completed grid, all four columns filled for every treatment, with the conflicting rows argued underneath and sources on one line. First custom sample free, returned in 24 to 48 hours.
More NSG 223 papers and BSN samples
- NSG 223 Unit 1: Comorbidity interaction study
- NSG 223 Unit 2: Competing treatment write-up
- NSG 223 Unit 3: Chronic and acute overlap paper
- NSG 223 Unit 4: Complex adult case file
- NSG 223 Unit 6: System interaction map
- NSG 223 Unit 7: Multi problem patient record
- NSG 223 Unit 8: Conflicting priority resolution
- NSG 120 Unit 5: Laboratory value pattern study
- NSG 121 Unit 5: Head to toe rehearsal log
- NSG 122 Unit 5: Patient needs ordering brief
- NSG 123 Unit 5: Preoperative and postoperative record
NSG 223 Unit 5 questions, answered
Is a table acceptable if the instructions say brief?
Usually yes, provided the prose your instructions ask for is present somewhere. Most sections accept a grid plus the paragraph that reasons across it, and some require a particular format outright. Where prose only is specified, keep the four elements in a fixed order inside each paragraph so a grader can still read them as rows.
How many treatments belong in the brief?
As many as the built adult is receiving, unless your instructions cap the number. Rubrics tend to reward complete rows over long grids, so a brief covering four treatments properly usually outscores one covering ten with empty cells. Where the case gives a therapy list, work from that list rather than adding treatments to look fuller.
What if two precautions genuinely conflict?
Then you have found the paragraph this unit wants. Name both rows, say what each precaution protects, and state which one the constructed plan holds first and why. Attribute anything that would be a prescriber decision to the prescriber, and keep the paragraph describing the built case rather than telling a reader what to do.
Where can I find a free NSG 223 Unit 5 sample paper?
The full NSG 223 Unit 5 trade-off brief is free on this page, seven treatments in four columns with the heparin and wound conflict explained. Send your own patient's treatment list for a custom grid.
Can a patient get heparin during dialysis right after surgery?
Often the dose is reduced or heparin is held and saline flushes used, because dialysis needs anticoagulation while a fresh wound needs clotting. This sample explains that compromise and what the nurse watches.