| Course | NSG 223 Medical-Surgical Nursing II |
|---|---|
| Unit | Unit 7 |
| Paper type | Multi-problem patient record |
| Length | About 810 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 223 Unit 7
Six Active Problems, Five Fields Each: A Record for Day 5 That a Nurse Could Pick Up Halfway Through the Shift
Student Name
Department of Nursing, Herzing University
NSG 223: Medical-Surgical Nursing II
Instructor Name
February 26, 2026
Six Active Problems, Five Fields Each: A Record for Day 5 That a Nurse Could Pick Up Halfway Through the Shift
How the Record Works
The patient is the composite man on hemodialysis with diabetes, now on day 5 after admission for a foot infection and day 2 after debridement. Each block below holds the same five fields: the problem; the parameters watched; where the values come from; what a change would mean; and who would be told. The values given are the most recent at 1400.
Problems that have resolved during the admission, such as the raised potassium on day 1 and the low blood pressure on the first evening, are not given blocks; they appear in the case file's problem list as resolved. The record holds only what is active now, which is what makes it usable mid-shift.
Block 1: Foot Infection and Surgical Wound
Problem: infection of the right forefoot and bone, debrided on day 3.
Watched: wound edges, drainage amount and color, the redness border marked on day 1, temperature, white cell count.
Values from: dressing change at 1000 (edges pink, small serous drainage, redness 1 cm inside the marked line); temperature 36.9 °C at 1200; morning laboratory results, white count 9.8, down from 15.2.
A change would mean: redness spreading past the line, purulent drainage, or new fever would suggest the infection is not controlled or has spread (Senneville et al., 2023).
Told: surgical team for wound changes; primary provider for fever.
Block 2: Glucose and Insulin
Problem: type 2 diabetes on insulin, with a low glucose on day 4.
Watched: glucose before meals, at bedtime, and at 0300; meal intake; insulin doses given.
Values from: meter readings 142, 176, 158 today; 0300 reading 118; ate 75% of breakfast and lunch.
A change would mean: any value under 70 mg/dL, or two over 250, would call for a review of the insulin plan, as hospital diabetes guidance advises (American Diabetes Association Professional Practice Committee [ADA], 2025).
Told: primary provider; diabetes educator for discharge teaching.
Block 3: Kidney Failure, Fluid, and Potassium
Problem: kidney failure on hemodialysis; dialysis due Friday (tomorrow).
Watched: weight, fluid intake, breath sounds, ankles, blood pressure, potassium.
Values from: 0600 weight 1.1 kg above target; intake 700 mL so far today against a 1,000 mL limit; breath sounds clear; potassium 4.8 this morning.
A change would mean: new crackles, weight more than 2 kg above target before Friday, or potassium above 5.5 would suggest fluid or potassium building up faster than planned.
Told: nephrology and the dialysis unit.
Block 4: Pain and Sedation
Problem: surgical pain, treated with an opioid chosen for kidney failure.
Watched: pain score at rest and when walking, sedation level, respiratory rate.
Values from: pain 2 at rest, 4 when walking; alert; respiratory rate 16; last as-needed dose at 0900.
A change would mean: increasing drowsiness would suggest the medicine is accumulating, which is a known risk with some opioids in kidney failure (Dean, 2004); a sudden rise in pain would suggest a wound problem.
Told: primary provider; surgical team if pain rises suddenly.
Block 5: Mobility and Falls
Problem: impaired mobility after forefoot surgery, with offloading shoe required.
Watched: use of the shoe, walking distance, dizziness, night-time trips to the bathroom.
Values from: walked 30 m twice with physical therapy; shoe worn each time; no dizziness.
A change would mean: walking without the shoe risks the wound; dizziness after dialysis tomorrow would raise falls risk.
Told: physical therapy; charge nurse if a fall occurs.
Block 6: Nutrition
Problem: increased protein needs for wound healing within a renal diet.
Watched: percent of meals eaten, protein supplement taken, phosphate binder given with meals.
Values from: meal trays; dietitian's note on day 4.
A change would mean: eating less than half of meals for two days would slow healing and affect insulin needs.
Told: dietitian; primary provider.
The block structure follows the problem-oriented approach in the course text (Hinkle et al., 2022). The patient is a composite.
How the Blocks Relate
The blocks are separate so that each can be read on its own, but several share a parameter, and those shared values are where a single change affects more than one problem. Meal intake appears in Blocks 2 and 6: a poor lunch changes both the next insulin dose and the healing plan. Dizziness appears in Blocks 3 and 5: a fall in blood pressure after tomorrow's dialysis is both a fluid finding and a falls risk. Drowsiness appears in Blocks 2 and 4: it could be a low glucose or an opioid effect, and the first step is always a glucose check, because that cause is quickest to find and to treat. Writing these links once, at the end, keeps the blocks short while making sure a nurse reading one block knows which others to check.
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
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.
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 7 instructions
Unit 7 asks you to write a record for a patient with several active problems in a form another nurse could use mid-shift. Expect to organize by problem, give each the same fields, keep status and plan current, name what to watch and when to escalate, and show where problems connect. Students often ask how many problems to include and which fields to use. A common set is problem, status, plan, watch and call. Keep each block short enough to read in under a minute. Shared parameters, such as potassium or glucose, should be cross-referenced rather than repeated. Escalation thresholds should be specific numbers. The record should reflect the latest events, such as an overnight low glucose, rather than admission details. Use the patient from earlier units so the record continues his story.
How this NSG 223 Unit 7 example is built
The record opens with how each block works, so a reader knows where to look. Six blocks follow in the same five fields. The wound block gives dressing status and signs of infection to watch. The glucose block records the day 4 low and the revised insulin plan with a call threshold. The kidney block lists the next dialysis, fluid limits and potassium trend. The pain block names an opioid suited to kidney failure and sedation checks. The mobility block describes the offloading shoe and fall precautions. The nutrition block balances protein needs against potassium and phosphorus limits. The final section maps shared parameters between blocks. A nurse arriving at 1100 could act from this record without asking for a verbal report.
NSG 223 Unit 7 rubric: what full points look like
Herzing's rubric for a multi-problem record usually covers organization by problem, consistent fields, currency, escalation thresholds, cross-references and usability. Escalation thresholds and currency draw the closest reading, because a record that a nurse picks up mid-shift must say what is happening now and when to call. Organization points reward one block per active problem. Field criteria look for the same headings in every block. Cross-reference points go to shared parameters linked rather than repeated. Usability earns credit when each block can be read quickly. Kidney-appropriate drug choices noted in the pain block are often credited. Clear numbering helps. The record follows Weed's problem-oriented format with ADA and KDIGO guidance for thresholds.
Common NSG 223 Unit 7 mistakes, and how to avoid them
Multi-problem records in Unit 7 often slip by writing a narrative that mixes problems together. Another frequent problem is different fields for different blocks, which makes the record hard to scan. Students often give escalation advice without numbers, such as call if glucose is low. Blocks repeat admission history instead of current status. Shared parameters are repeated inconsistently, such as two different potassium values. The overnight low glucose is not reflected in the insulin plan. Pain medication is chosen without regard to kidney function. Fall risk from the offloading shoe is missed. Nutrition ignores the conflict between protein needs and renal limits. Finally, write for a nurse arriving halfway through the shift, because graders reward a record that could be acted on without a verbal handoff.
Get a NSG 223 Unit 7 example written to your instructions
Send the Unit 7 instructions with your NSG 223 rubric and the problem list if the case gives one. We return a custom record with matched blocks for every problem, sources sitting beside their values, an ordering line and the shared-parameter block at the end. First custom sample free, back 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 5: Treatment trade-off brief
- NSG 223 Unit 6: System interaction map
- NSG 223 Unit 8: Conflicting priority resolution
- NSG 221 Unit 7: Condition presentation summary
- NSG 222 Unit 7: Family assessment write-up
- NSG 233 Unit 7: Urgent report script
- NSG 298 Unit 7: Study plan derivation record
NSG 223 Unit 7 questions, answered
What if I cannot find a value for a parameter?
Write the block without it and say so. Parameters a facility sets locally are normal in a record like this, and the honest version names the parameter, states that the figure comes from local policy, and attributes it to the built setting. Inventing a number to fill the field is the version that costs marks, since the source column then holds something nobody can check.
How many problems should the record cover?
Whatever the case gives you, unless your instructions limit it. Three or four problems with matched blocks read better than six with thin ones, and if you are building the adult yourself, choose problems whose parameters you can source. The shared block gets more interesting as problems increase, so two problems often leaves that section with little to say.
Is this the same as a plan?
No, and mixing the two costs marks. A plan proposes what will be done; this record states what is being watched, what movement would mean and who would hear about it. Keep the verbs in the observing and reporting family, leave prescriber decisions attributed, and the document stays inside what your rubric describes.
Where can I find a free NSG 223 Unit 7 sample paper?
The full NSG 223 Unit 7 multi-problem record is free on this page, six problems in five fields with call thresholds. Your own patient's problems can be organized the same way on request.
How do I document a patient with many problems?
Give each active problem its own block with the same fields, such as status, plan, what to watch and when to call, and link shared values such as potassium. This sample does that for a dialysis patient on day 5.