| Course | NSG 233 Medical-Surgical Nursing III |
|---|---|
| Unit | Unit 2 |
| Paper type | Emergency response walkthrough |
| Length | About 780 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 233 Unit 2
One Decision at 1205: Why the First Action for a Drowsy Woman With a Glucose of 612 Was a Rapid Response Call and Not More Insulin
Student Name
Department of Nursing, Herzing University
NSG 233: Medical-Surgical Nursing III
Instructor Name
January 23, 2026
One Decision at 1205: Why the First Action for a Drowsy Woman With a Glucose of 612 Was a Rapid Response Call and Not More Insulin
The Situation at 1205, With Nothing Added Later
Composite 79-year-old woman, day 2 of admission for pneumonia, type 2 diabetes with oral medicines held. Serum glucose 612 mg/dL, resulted at 1150; urine negative for ketones. Sodium 147, urea nitrogen 44, creatinine 1.6. Heart rate 108, blood pressure 108/60, respiratory rate 22, oxygen saturation 94% on 2 L. Opens her eyes to her name, then drifts off; earlier this morning she was talking. The provider was paged at 1135 and has not yet called back. A correction insulin scale is on the chart.
The First Action
Call the rapid response team now, and while waiting, check her airway and breathing, raise the head of the bed, turn her slightly onto her side, and stay at the bedside.
What in the Record Pointed There
Her level of consciousness had fallen within a few hours, from talking to barely rousable. That single change moved the situation from an abnormal laboratory value to a threat to her airway and brain. Rapid response systems exist for exactly this: acute deterioration on a general ward that cannot wait for the usual chain of calls (Jones et al., 2011), and a fall in consciousness is among the standard calling criteria. The provider had been paged 30 minutes earlier with no reply, so the ordinary route had already been tried and was too slow. The combination of findings, very high glucose, no ketones, dehydration, and rising kidney values, fit a hyperglycemic hyperosmolar state, which carries a substantial risk of death and needs treatment in a monitored setting (Umpierrez et al., 2024).
What Was Said on the Call
The call to the rapid response line at 1205 took about 30 seconds: "Rapid response to room 412. Seventy-nine-year-old woman with pneumonia and type 2 diabetes. She was talking this morning and now barely opens her eyes to her name. Serum glucose 612, no urine ketones, sodium 147, creatinine up from 1.0 to 1.6. Heart rate 108, pressure 108 over 60. Provider paged at 1135, no answer yet. I think this is a hyperosmolar crisis and she needs fluids and a higher level of care." The last sentence matters most. It gives the team a working concern and a request, not only a list of numbers. The primary nurse stayed with the patient while the student made the call, so she was never left alone. Once the team arrived, the student's role changed to recording times and reporting findings as they were asked for, which kept the handover of information clear.
The Alternatives, Taken Seriously
Give the maximum correction insulin on the scale. This is the most tempting option, because the glucose is the most striking number and an order already exists. It was set aside because in this condition the main problem is severe fluid loss, and insulin moves glucose, and with it water, out of the blood into cells. Given before fluids, insulin can lower circulating volume further and drop her blood pressure. The consensus report puts fluid replacement first and starts insulin as a continuous infusion once fluid resuscitation is under way (Umpierrez et al., 2024). The sliding scale was written for a stable patient, not for this.
Start a fluid bolus on my own. Fluid is the right first treatment, but it needs an order, and the rate matters: too fast in a frail older adult can overload the heart and lungs. The rapid response team can give the order within minutes, so calling first is the faster route to the right fluid.
Page the provider again and wait. Waiting another 15 to 30 minutes for a callback, while her consciousness was falling, would have been the slowest option, and the pneumonia had already shown the ordinary chain was busy.
Recheck the glucose by meter before calling. The serum value was already known. A meter often reads only up to a limit, and a second number would not have changed the decision.
What Happened Next, and What the Decision Did Not Solve
The team arrived at 1211, started intravenous fluid, sent a blood gas and serum osmolality, and arranged transfer to the step-down unit, where an insulin infusion was started after the first liter. The decision to call did not solve the four hours of missed signs recorded in Unit 1; it only prevented the next hour from being missed as well. The course text lists decreased responsiveness as a reason for immediate escalation regardless of diagnosis (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.
Jones, D. A., DeVita, M. A., & Bellomo, R. (2011). Rapid-response teams. New England Journal of Medicine, 365(2), 139-146. https://doi.org/10.1056/NEJMra0910926
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
Reading the NSG 233 Unit 2 instructions
Unit 2 asks you to explain the first action you would take in an emergency and defend it. Expect to describe the situation as it was known at the time, state the first action, explain what pointed to it, script any call made, weigh alternatives and describe what happened next. Students often ask how to avoid hindsight and how many alternatives to consider. Describe only what was known at the moment. The first action is often to call for help while supporting airway and breathing. Alternatives deserve fair consideration, especially tempting ones. In hyperglycemic crises, insulin without fluid can drop blood pressure, so fluid and expert help come first. Note what the first action did not solve.
Inside the NSG 233 Unit 2 example
The walkthrough opens with the situation at 1205, deliberately limited to what was known then. The first action section names the call and the bedside steps taken while waiting. The pointing section explains how falling consciousness and the glucose value together signaled a crisis beyond the floor's usual care. The call is scripted with times. The alternatives section considers three other actions and explains why each was not first. The final section records the team's arrival and what remained unsolved, such as the cause of the decline. Every line is anchored to the time it happened, which keeps hindsight out and shows the decision as the nurse faced it.
Reading the NSG 233 Unit 2 rubric
Herzing's rubric for an emergency response walkthrough typically covers the situation as known, the first action, its justification, communication, alternatives and follow-through. Justification and the handling of alternatives draw the closest reading: the first action must be defended against the options a nurse would be tempted to choose. Situation points reward limiting the account to what was known at 1205. Communication criteria look for a scripted call with the key data in the first sentence. Alternative points go to fair, specific consideration of each other option. Follow-through earns credit for what happened next and what remained unsolved. Airway and breathing steps while waiting are usually expected. Exact times help the grader judge speed. The ADA hyperglycemic crisis consensus and Jones's rapid response review support the decision.
NSG 233 Unit 2 help before you submit
A Unit 2 emergency walkthrough often falls short when it is written with hindsight, using findings that only came later. Another frequent problem is choosing insulin first without fluids or expert help. Students often skip what the nurse does while waiting for the team, such as positioning, oxygen and a fresh set of vital signs. The call is summarized rather than scripted. Alternatives are dismissed without reasons. What remained unsolved, such as the cause of the decline, is left out. Times are vague, so the speed of the response cannot be judged. Family notification is forgotten. The record of who arrived and when is missing. Finally, defend the first action against the most tempting alternative, because graders reward a walkthrough that shows why the obvious move was not the right one.
Get a NSG 233 Unit 2 example written to your instructions
Send the Unit 2 instructions and your NSG 233 rubric, along with the scenario the assignment provides. The example arrives with a capped situation, the first action stated up front, each alternative named and weighed, and the condition that would have changed the choice. First custom sample free, delivered in 24 to 48 hours.
More NSG 233 papers and BSN samples
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- NSG 233 Unit 4: Escalation decision record
- NSG 233 Unit 5: Acuity ranking exercise
- NSG 233 Unit 6: High acuity case file
- NSG 233 Unit 7: Urgent report script
- NSG 233 Unit 8: Unstable patient timeline
- NSG 120 Unit 2: Sign and symptom rationale
- NSG 121 Unit 2: Equipment use record
- NSG 122 Unit 2: Patient problem statement set
- NSG 123 Unit 2: Fluid and electrolyte study
NSG 233 Unit 2 questions, answered
Why only one action?
Because a list hides the reasoning. Anyone can produce six sensible things to do in an hour; choosing the one that comes first, and saying what in the record put it there, is the skill this course examines. If your instructions do ask for a sequence, keep the first item argued at full depth and let the remaining ones follow briefly.
What if two actions are equally defensible?
Say so and then pick. A short paragraph acknowledging that two options sit close together, followed by the finding that tipped it, usually scores better than a confident choice with no acknowledgment at all. What loses marks is leaving both open, since the walkthrough then never reaches the decision it exists to defend.
Is this the same as writing a protocol?
No, and keeping them apart matters. A protocol tells any nurse what to do in a class of situations; this document explains one choice inside a built case, using sources you cite. Write it in past tense about the constructed scenario, attribute anything belonging to a prescriber, and it stays a piece of coursework.
Where can I find a free NSG 233 Unit 2 sample paper?
Read the complete NSG 233 Unit 2 emergency walkthrough here at no charge, the 1205 decision, the scripted call and the alternatives. Ask for a custom walkthrough if your emergency differs.
Why not just give insulin for a blood sugar of 600?
In a hyperglycemic crisis the patient is usually very dry, and insulin without fluid can drop blood pressure dangerously. This sample explains why a rapid response call and fluids came first for a drowsy woman with a glucose of 612.