| Course | NSG 233 Medical-Surgical Nursing III |
|---|---|
| Unit | Unit 3 |
| Paper type | Rapid reassessment log |
| Length | About 790 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BSN |
| Updated | October 2026 |
Free sample paper for NSG 233 Unit 3
Four Passes, Each Pointing to the Next: A Rapid Reassessment Log for the First Four Hours of Treatment for a Hyperosmolar Crisis
Student Name
Department of Nursing, Herzing University
NSG 233: Medical-Surgical Nursing III
Instructor Name
January 30, 2026
Four Passes, Each Pointing to the Next: A Rapid Reassessment Log for the First Four Hours of Treatment for a Hyperosmolar Crisis
Setting
The composite 79-year-old woman from Units 1 and 2 was transferred to a step-down unit at 1240. Orders: intravenous fluid by the team's protocol, potassium checked before insulin, an insulin infusion once potassium is confirmed adequate, glucose hourly, electrolytes every two hours, and neurological checks hourly. Each pass below has four lines: the time, what was reassessed, what was found, and what that finding sent the nurse to check on the next pass. Guidance for hyperglycemic crises stresses fluid first, potassium before insulin, and a gradual rather than rapid fall in glucose and osmolality (Umpierrez et al., 2024).
Pass 1
Time: 1300.
Reassessed: level of consciousness, airway, blood pressure and heart rate, urine output since the catheter was placed at 1245, glucose, and the fluid running.
Found: opens her eyes to voice and says her first name, a small improvement from the ward. Blood pressure 116/64, heart rate 102. Urine 45 mL in 15 minutes. Glucose 568 by laboratory draw. First liter of fluid finishing. Potassium from the 1240 sample 3.8 mmol/L.
Sent to next: potassium was adequate to start insulin, but insulin will move potassium into cells and could drop it quickly. The next pass must recheck potassium and watch the heart monitor after the insulin starts.
Pass 2
Time: 1400.
Reassessed: potassium, heart rhythm, glucose, sodium, mental state.
Found: insulin infusion started 1310. Potassium 3.4 mmol/L, falling as expected; replacement added to the fluid by order. Rhythm sinus, no new changes. Glucose 505. Sodium 149, slightly higher than on the ward, which is expected as glucose falls and water moves back into cells. Knows she is in a hospital.
Sent to next: glucose fell about 60 in an hour; the rate matters, because a fall that is too fast can shift fluid into brain cells. The next pass must track the rate of fall and any headache or new drowsiness.
Pass 3
Time: 1500.
Reassessed: rate of glucose fall, mental state, lungs.
Found: glucose 452, a fall of about 50 in the hour, gradual. More awake, asks for water. Two liters of fluid given since 1215. Breath sounds: fine crackles at the right base, which was the pneumonia side on admission.
Sent to next: are the crackles pneumonia or new fluid? In a frail older adult, two liters in three hours can overload the heart. The next pass compares both bases, oxygen needs, and breathing rate.
Pass 4
Time: 1600.
Reassessed: lungs, oxygen, glucose.
Found: crackles unchanged at the right base only, left clear, saturation 95% on 2 L, respiratory rate 20. Glucose 401. Oriented to place and year.
Sent to next: no sign of fluid overload yet; continue hourly passes, with electrolytes at 1700.
Where the Chain Could Have Turned
Each pass had a finding that would have changed what came next, and naming them shows the chain was a set of decisions rather than a routine.
At Pass 1, a potassium below the protocol's threshold for starting insulin would have meant replacing potassium first and delaying the insulin infusion, with the delay reported to the team. Insulin started on a low potassium can cause dangerous heart rhythms.
At Pass 2, a glucose fall of well over 100 in the hour, or any new headache, vomiting, or drowsiness, would have been reported at once, because a rapid fall in glucose and osmolality is the recognized path to brain swelling during treatment.
At Pass 3, crackles at both bases, a rising breathing rate, or a higher oxygen need would have pointed to fluid overload, and the fluid rate would have been questioned with the team before the next liter was hung.
At Pass 4, a return of confusion after the improvement on the earlier passes would have pointed to a new problem, such as low sodium, low glucose, or a stroke, rather than the original crisis, and would have been escalated as a new change.
Why the Passes Got Shorter
Each pass narrowed to what the previous one had raised. Pass 1 checked everything because nothing was yet known about her response. By Pass 4 only three things needed checking, because the others had settled or were on their own schedule. A log that repeated every item at every pass would have been longer and harder to use, and the one new finding, the crackles, would have been easier to miss among unchanged values. Older adults with this condition are especially at risk from both the crisis itself and its treatment, including fluid overload (Pasquel & Umpierrez, 2014). The step-down monitoring follows the course text (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
NSG 233 Unit 3 instructions, in plain terms
Unit 3 asks you to log repeated, focused reassessments of an unstable patient. Expect to set the scene, record each pass with time, findings and what it points to next, identify where the plan could have changed and explain how the passes narrowed. Students often ask how often to reassess and how much to record each time. Hourly passes are common during an insulin infusion. Each pass should name the one or two findings that shape the next. Potassium and glucose fall rate are critical in hyperglycemic crisis care. Note thresholds that would stop or change treatment. Mental status should be tracked because it is the patient-level sign of improvement. The log shows reasoning, not just numbers.
How this NSG 233 Unit 3 example is built
The log opens with the setting and orders. Pass 1 records a full assessment and names what to watch. Pass 2 narrows to the findings pass 1 raised. Pass 3 follows a falling potassium and records the replacement given. Pass 4 checks whether mental status is improving with glucose. Each pass ends with a line pointing to the next, which shows the chain of reasoning. The turning points section names a finding at each pass that would have changed the plan. Why the passes shortened is explained last. Thresholds are stated for every key value, so a reader can see exactly when the plan would have turned.
Where the points sit in the NSG 233 Unit 3 rubric
Herzing's rubric for a rapid reassessment log usually covers the setting, timed passes, focus of each pass, links between passes, turning points and explanation. The links between passes carry the most weight, since the unit is about each check shaping the next rather than repeating a full assessment every hour. Setting points reward orders and starting values. Timing criteria look for regular intervals tied to the infusion. Focus earns credit when each pass narrows sensibly. Turning point points go to thresholds that would change treatment, such as potassium below 3.3 mmol/L holding the insulin. Mental status tracking is usually expected as the patient-level sign of improvement. Glucose fall rate is often credited, since too fast a fall carries its own risk. The ADA hyperglycemic crisis consensus supports the thresholds.
NSG 233 Unit 3 help before you submit
Reassessment logs in Unit 3 often slip by repeating a full assessment every hour without focus. Another frequent problem is passes that do not point to the next. Students often skip potassium, which falls with insulin and can cause arrhythmias. Glucose fall rate is not tracked, though a drop that is too fast is risky in older adults. Turning points are missing, so the reader cannot tell when the plan would have changed. Mental status is recorded once and then dropped. Times are irregular. Fluid balance is left out, though fluid is the main treatment. The infusion rate is not recorded beside each glucose value. Finally, end each pass with what to check next, because graders reward a log where reasoning carries from one hour to the next.
Get a NSG 233 Unit 3 example written to your instructions
Send the Unit 3 instructions with your NSG 233 rubric and the scenario if the assignment includes one. We return a custom log of repeating four-line passes, narrowing as it goes, with times close together and one closing paragraph reading the chain by pass number. First custom sample free, returned in 24 to 48 hours.
More NSG 233 papers and BSN samples
- NSG 233 Unit 1: Deterioration recognition record
- NSG 233 Unit 2: Emergency response walkthrough
- 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 660 Unit 3: Source credibility comparison
- NSG 120 Unit 3: Complication watch list
- NSG 121 Unit 3: Expected versus unexpected findings chart
- NSG 122 Unit 3: Measurable goal and outcome sheet
NSG 233 Unit 3 questions, answered
How many passes should the log have?
Three or four is usually enough to show a chain, unless your instructions set a number. What matters is that consecutive passes differ, since two identical ones tell a grader the log could have stopped after the first. Where the case runs longer, keep later passes brief and let the narrowing show itself.
Do I record everything I would check?
Only on the first pass. After that the log records what the previous finding sent you to, which is the entire point of the format, and listing the full set again each time hides it. If your instructions require a complete set every pass, keep the fourth line anyway so the reasoning between passes stays visible.
What if a pass finds nothing new?
Write it down. A pass showing no change is information, and the fourth line then says what that absence sent the nurse to check next, which is often more interesting than a positive finding. Deleting quiet passes to make the log look eventful removes the part where reasoning had to continue without confirmation.
Where can I find a free NSG 233 Unit 3 sample paper?
The full NSG 233 Unit 3 reassessment log is free on this page, four hourly passes each pointing to the next. A log for a different unstable patient can be built on request.
What should a nurse monitor during an insulin infusion for hyperglycemic crisis?
Hourly glucose and its rate of fall, potassium, fluid balance, mental status and vital signs, with thresholds that would stop insulin. This sample logs four passes and names where each could have changed the plan.