| Course | NSG 233 Medical-Surgical Nursing III |
|---|---|
| Unit | Unit 1 |
| Paper type | Deterioration recognition record |
| Length | About 770 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 233 Unit 1
Twelve Observations Over Thirty Hours, and What I Made of Each at the Time: A Deterioration Recognition Record for a 79-Year-Old With Pneumonia and Diabetes
Student Name
Department of Nursing, Herzing University
NSG 233: Medical-Surgical Nursing III
Instructor Name
January 16, 2026
Twelve Observations Over Thirty Hours, and What I Made of Each at the Time: A Deterioration Recognition Record for a 79-Year-Old With Pneumonia and Diabetes
Context
The patient is a composite 79-year-old woman admitted from an assisted-living residence with pneumonia. She has type 2 diabetes, usually treated with two oral medicines that were held on admission, and mild memory impairment; she normally recognizes staff, knows the month, and walks with a cane. On the floor she was given intravenous antibiotics, maintenance fluids at a modest rate, and correction insulin by a sliding scale, with glucose checks before meals. The numbered observations below were made by a nursing student across two day shifts and a handoff. Each gives the time, what was seen, heard, or reported, and one line on what I made of it then, including where that reading was wrong.
The Record
1. Day 1, 1100. Glucose 238 mg/dL before lunch. My reading: expected with infection and oral medicines held; correction insulin given per scale. Reasonable.
2. Day 1, 1500. She drank half of one cup of water all afternoon; said, "I'm not thirsty, honey." My reading: poor appetite from pneumonia. Partly wrong: older adults often lose the thirst signal, and her intake was far below her losses.
3. Day 1, 1700. Glucose 312. My reading: higher than I liked; correction dose given. I did not notice that the dose was the scale's maximum.
4. Day 1, 1900. Handed off: "Pleasant, a little sleepy, sugars high-ish." My reading at the time: an adequate summary. Wrong: "high-ish" hid a rise of 74 in six hours.
5. Day 2, 0730. Night nurse: voided large amounts overnight, three times; sheets changed twice. My reading: the fluids running. Wrong: at her modest fluid rate, large urine volumes with high glucose suggest glucose pulling water into the urine.
6. Day 2, 0800. Glucose 396. Temperature 37.6 °C, heart rate 104, blood pressure 118/64 (her usual about 140/80). My reading: pneumonia still active. Partly right; the heart rate and lower pressure also fit fluid loss.
7. Day 2, 0830. Did not know the month when asked; said it was "summer." My reading: her usual memory problem. Wrong: her baseline, from the residence's note, was that she knows the month.
8. Day 2, 0900. Tongue dry and furrowed; skin on the forearm slow to flatten. My reading: dehydrated. Right, though skin turgor is unreliable in older adults.
9. Day 2, 1100. Ate two spoonfuls of breakfast. Glucose before lunch 488. My reading: this is not right. The first moment I put observations 2 to 9 together.
10. Day 2, 1130. Morning chemistry, resulted at 0900 but not yet reviewed: sodium 147, urea nitrogen 44 (was 22 on admission), creatinine 1.6 (was 1.0). My reading: kidneys affected by fluid loss.
11. Day 2, 1135. Reported to the primary nurse, who called the provider. Serum glucose drawn: 612 mg/dL. No ketones in the urine.
12. Day 2, 1200. Harder to rouse; opened her eyes to her name, then drifted off. My reading: the most serious finding of the two days. A rapid response call was made at 1205.
What the Record Shows
The deterioration was a hyperglycemic hyperosmolar state developing over about 30 hours: very high glucose, heavy urine output, dehydration, rising kidney values, and worsening confusion, without the ketoacidosis more typical of type 1 diabetes. Older adults with type 2 diabetes and an infection are the group in which it usually develops, often over days rather than hours (Pasquel & Umpierrez, 2014). The current consensus report defines it by a glucose at or above 600 mg/dL, a high serum osmolality, and the absence of significant ketoacidosis, and it lists infection as the most common trigger (Umpierrez et al., 2024).
Three of my wrong readings share a pattern: I explained each finding with the diagnosis already on the chart. Poor drinking was the pneumonia; confusion was her memory problem; heavy urine was the fluids. Each explanation was plausible alone. Only observation 9 made me stop explaining and start adding. The earliest point where the pieces were available together was the morning of day 2, observations 5 to 8, about four hours before I reported.
What would have caught it sooner: comparing her mental state with the residence's written baseline rather than the word "dementia"; recording her intake as a number; and reading the morning chemistry when it resulted rather than at lunch. The course text makes the same point about altered mental status in older adults, which should be treated as new until shown otherwise (Hinkle 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.
Pasquel, F. J., & Umpierrez, G. E. (2014). Hyperosmolar hyperglycemic state: A historic review of the clinical presentation, diagnosis, and treatment. Diabetes Care, 37(11), 3124-3131. https://doi.org/10.2337/dc14-0984
Umpierrez, G. E., Davis, G. M., ElSayed, N. A., Fadini, G. P., Galindo, R. J., Hirsch, I. B., Klonoff, D. C., McCoy, R. G., Misra, S., Gabbay, R. A., Bannuru, R. R., & Dhatariya, K. K. (2024). Hyperglycemic crises in adults with diabetes: A consensus report. Diabetes Care, 47(8), 1257-1275. https://doi.org/10.2337/dci24-0032
The Herzing NSG 233 Unit 1 instructions
Unit 1 asks you to record a series of observations and your reading of each at the time, then explain the deterioration they show. Expect to give context, number each observation with time, finding and interpretation, and analyze the pattern afterward. Students often ask how many observations to include and whether to show readings that turned out wrong. Showing earlier readings honestly is the point, since it teaches how decline hides. Include findings from different sources, such as labs, intake records and behavior. Hyperglycemic hyperosmolar state develops over days in older adults and is easy to miss when each value is explained away. Cite guidelines that describe the condition. Keep the patient composite and the times realistic so the slow build is visible across the thirty hours.
How the NSG 233 Unit 1 example is put together
The record opens with the patient and why she was admitted. Twelve numbered entries follow, each with a time, the finding and the nurse's reading at that moment. Early readings are reasonable, such as attributing high glucose to infection. Middle entries add falling fluid intake and urine output that should have prompted more concern. Late entries show drowsiness, which finally signaled the problem. The analysis section names the condition and explains how glucose, fluid loss and mental status built together. The record is honest about readings that missed the pattern, which makes it a useful learning document. Each finding comes from a realistic source, such as the intake record or the glucose log, so the reader can see where information sat on the chart.
Where the points sit in the NSG 233 Unit 1 rubric
Herzing's rubric for a deterioration record usually covers context, the numbered observations, honesty of interpretations, pattern analysis and use of evidence. Pattern analysis carries the most weight, because the unit teaches that decline shows as a series before any single value is alarming. Context points reward history and baseline. Observation criteria look for times, sources and specific values. Honesty earns credit when earlier readings that missed the pattern are kept rather than edited. Evidence points go to accurate description of the condition and its timeline. Fluid intake and output are often credited when linked to rising glucose. Mental status changes should be dated. Plain language helps. Pasquel and Umpierrez's review of hyperglycemic crises supports the analysis.
NSG 233 Unit 1 help: mistakes that cost points
Deterioration records in Unit 1 often slip by editing early readings to look prescient. Another frequent problem is listing observations without interpretations at the time. Students often miss intake and output, which show fluid loss before confusion appears. Glucose values are listed without trend. Drowsiness is attributed to age or tiredness without checking glucose or sodium. The condition is confused with diabetic ketoacidosis, which usually develops faster. Times are missing. Sources are not named. The analysis restates the entries. Finally, keep the readings you made at the time, because graders reward a record that shows how a pattern was missed and what would have caught it sooner.
Get a NSG 233 Unit 1 example written to your instructions
Send the Unit 1 instructions and the rubric from your NSG 233 classroom, with the scenario if one is given. Your example returns as numbered timed observations, thinking recorded as it happened, a late recognition section citing items by number, and reporting written as case detail. First custom sample free, back in 24 to 48 hours.
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NSG 233 Unit 1 questions, answered
Should the record include what I got wrong?
Yes, and it is often the strongest part. A sequence in which every impression was right is a record composed after the fact, and instructors recognize that quickly. Writing one item where the student read a finding as something else, then the item where that reading came apart, shows the reasoning this unit examines rather than the answer it arrived at.
How many observations belong in the record?
Enough to carry a change without padding, which for most built cases means a dozen or so items. The mix matters more: if every item is a measured value, the record has nothing to say about the part of recognition happening before a device agrees with you. Keep several items that are purely what was seen or heard.
Can I use numbers from my textbook?
Use them and show where they came from. The record should attribute any figure to your course materials, your textbook or the built chart, and note where a facility would set its own. We supply no values ourselves, both because they differ between settings and because defensible sourcing of a number is usually part of what your rubric looks at.
Where can I find a free NSG 233 Unit 1 sample paper?
The full NSG 233 Unit 1 deterioration record is free on this page, twelve observations with the readings made at the time and the pattern analysis. Your own observation series can be analyzed the same way on request.
What is hyperglycemic hyperosmolar state?
A serious complication of type 2 diabetes where very high glucose and fluid loss develop over days, often in older adults, leading to dehydration and confusion. This sample shows how it built over 30 hours before drowsiness signaled it.