| Course | NU 611 Clinical Decision-Making |
|---|---|
| Unit | Unit 5 |
| Paper type | Problem-based management plan |
| Length | About 1,100 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 611 Unit 5
Management Plan for New Type 2 Diabetes With Stage 3a Chronic Kidney Disease in a 64-Year-Old Woman
Student Name
Department of Nursing, Herzing University
NU 611: Clinical Decision-Making
Instructor Name
February 17, 2026
Management Plan for New Type 2 Diabetes With Stage 3a Chronic Kidney Disease in a 64-Year-Old Woman
Patient Summary and Problem List
Mrs. L. is a composite 64-year-old retired librarian seen in primary care after routine laboratory work. Her hemoglobin A1C is 8.4%, confirmed on repeat, and she has no symptoms of hyperglycemia. Two kidney function results taken three months apart both show an eGFR of 52, and a spot urine sample shows an albumin-to-creatinine ratio of 180 mg/g. Blood pressure averages 146/88 on home readings. Body mass index is 32. She takes amlodipine 5 mg daily and no other prescription medications. She lives alone on a fixed income, drives, and manages her own medications reliably. She has no history of heart failure, pancreatitis, or genital infections.
Problems, in the order the plan addresses them: (1) type 2 diabetes, newly diagnosed, above goal; (2) chronic kidney disease stage G3a with moderately increased albuminuria (A2); (3) hypertension, above goal on a single agent; (4) obesity; (5) cardiovascular risk reduction. The kidney problem is listed second rather than as a complication because it changes the treatment of the first and third problems.
Problem 1: Type 2 Diabetes
Goal: A1C below 7.0%, individualized for a healthy 64-year-old without hypoglycemia risk factors. Intervention: metformin extended release 500 mg by mouth once daily with the evening meal for one week, then 1,000 mg once daily, increasing to 1,500 mg daily at week four if tolerated. Metformin remains the usual starting agent, and at an eGFR of 52 it can be used at full dose with kidney function monitored at least every three to six months (American Diabetes Association Professional Practice Committee, 2024). The extended-release form was chosen because gastrointestinal side effects are the most common reason patients stop metformin.
Second agent: empagliflozin 10 mg by mouth once daily, started at the same visit rather than added later. When diabetes coexists with reduced kidney function and the eGFR is 20 or above, a sodium-glucose cotransporter 2 inhibitor is recommended for kidney and cardiovascular protection, independent of the A1C (Kidney Disease: Improving Global Outcomes [KDIGO] Diabetes Work Group, 2022). Its glucose-lowering effect is modest at her level of kidney function, but that is not why it is being given.
Rejected alternative: a sulfonylurea such as glipizide. It is inexpensive, which matters on her income, and it lowers A1C effectively, but it carries a risk of hypoglycemia in a woman who lives alone and drives, and it does nothing to protect her kidneys or heart. Semaglutide, or another agent in the GLP-1 receptor agonist class, came up as well and was deferred rather than rejected; it would support weight loss and has cardiovascular benefit, but she prefers to avoid injections at this stage and the cost under her plan is high. It remains the next step if A1C is above goal at three months.
Patient factors that decided the choice: her kidney function made the kidney-protective agent a priority; her living situation made hypoglycemia risk decisive against a sulfonylurea; her cost concerns were addressed by confirming her plan covers empagliflozin with a manageable copay before prescribing. Education, in her words: "The metformin is for your sugar. The second pill protects your kidneys and heart as well as lowering sugar. It makes you pass more urine, so drink water through the day, and keep the genital area clean and dry because it can cause yeast infections. If you are ever sick with vomiting or can't eat or drink, skip both pills that day and call us."
Problem 2: Chronic Kidney Disease With Albuminuria
Goal: slow progression, reduce albuminuria, and avoid nephrotoxic exposures. Intervention: lisinopril 10 mg by mouth once daily, which also serves problem 3. A renin-angiotensin system inhibitor titrated to the highest tolerated dose is recommended in people with diabetes, hypertension, and albuminuria (KDIGO Diabetes Work Group, 2022). She is told to stop over-the-counter nonsteroidal anti-inflammatory drugs and use acetaminophen for pain. Monitoring: a basic metabolic panel for potassium and creatinine one to two weeks after starting lisinopril, because a creatinine rise of up to 30% is expected and acceptable, while a larger rise or potassium above 5.5 mmol/L requires review. The urine albumin-to-creatinine ratio is rechecked at three months.
Problem 3: Hypertension
Goal: blood pressure below 130/80 (Whelton et al., 2018). Intervention: lisinopril as above, continuing amlodipine 5 mg. The guideline supports a target below 130/80 for adults with diabetes or chronic kidney disease, and combining a renin-angiotensin system inhibitor with a calcium channel blocker is a standard two-drug regimen. A thiazide-type diuretic was the alternative second agent and was not chosen, because the albuminuria gives the renin-angiotensin system inhibitor a kidney indication the diuretic lacks, and because starting a diuretic together with empagliflozin, which also causes fluid loss, would raise her risk of dizziness and dehydration in the first weeks. Monitoring: home blood pressure twice daily for one week before the four-week visit, with her home cuff checked against the clinic device at that visit.
Problems 4 and 5: Weight and Cardiovascular Risk
Nonpharmacological management is given the same weight as the prescriptions. She is referred to diabetes self-management education and to a registered dietitian, both covered by her plan, with the specific goal of a 5% weight loss over six months. She walks with a friend twice weekly and agrees to add a third walk. For cardiovascular risk, moderate-intensity atorvastatin 20 mg by mouth nightly is started, because adults aged 40 to 75 with diabetes are candidates for statin therapy regardless of calculated risk (American Diabetes Association Professional Practice Committee, 2024). A fasting lipid panel is drawn before starting and rechecked in 8 to 12 weeks.
Monitoring, Follow-Up, and Return Precautions
Laboratory monitoring: basic metabolic panel at 1 to 2 weeks; A1C, eGFR, and urine albumin-to-creatinine ratio at 3 months; lipid panel at 8 to 12 weeks; vitamin B12 annually while on metformin. Follow-up: a visit at four weeks to review tolerance, home blood pressures, and the metabolic panel, because three new medications are starting and adherence problems are most likely early. A three-month visit follows to review A1C and decide on the injectable agent.
Referral thresholds: nephrology if eGFR falls below 30, if the albumin-to-creatinine ratio rises above 300 mg/g despite treatment, or if potassium stays elevated. Return precautions, written for her: call the same day for dizziness when standing, very little urine, vomiting that stops you from drinking, or painful burning with urination; go to the emergency department for rapid breathing, severe belly pain, or confusion, which can signal a rare but serious acid buildup with the kidney pill.
References
American Diabetes Association Professional Practice Committee. (2024). 9. Pharmacologic approaches to glycemic treatment: Standards of care in diabetes-2024. Diabetes Care, 47(Suppl. 1), S158-S178. https://doi.org/10.2337/dc24-S009
Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. (2022). KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney International, 102(5S), S1-S127. https://doi.org/10.1016/j.kint.2022.06.008
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Jr., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Jr., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., Sr., ... Wright, J. T., Jr. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065
NU 611 Unit 5 instructions, in plain terms
The Unit 5 instructions ask for an evidence-based management plan for a patient with one or more chronic conditions, typically from a case in the classroom. Expect to organize the plan by problem, with a measurable goal for each, followed by pharmacologic and nonpharmacologic interventions. Medications should be written with drug, dose, route, frequency and any titration, and the choice should be justified against a current guideline. Education, referrals and lifestyle measures are usually part of the grade. Many sections require a monitoring schedule, including laboratory tests and follow-up timing, plus return precautions. Interactions between problems, such as kidney function limiting a diabetes drug, should be addressed directly. Cite the guidelines you use in APA 7 format. The classroom rubric sets length and may ask for a table, and the case should stay composite rather than a real patient.
How this NU 611 Unit 5 example is built
The plan starts with a summary that gives the confirming A1C, two estimated filtration results and the albumin ratio, so the problem list is supported from the first page. The diabetes section sets an A1C goal below 7.0 percent and explains why that target suits a healthy 64-year-old, then gives metformin extended release with a titration schedule that respects her kidney function. The kidney section adds lisinopril and explains that it also lowers blood pressure, which ties two problems together. The hypertension section names the target and the continuing amlodipine. Weight and cardiovascular risk receive education referrals and a statin decision with the same weight as the prescriptions. The monitoring section lists a metabolic panel in one to two weeks, A1C and kidney tests at three months and yearly vitamin B12 while on metformin, with clear return precautions.
Where the points sit in the NU 611 Unit 5 rubric
Herzing rubrics for management plans commonly score goals, pharmacologic management, nonpharmacologic management, monitoring and follow-up, use of evidence and writing. Goal points require targets that are specific and measurable, such as an A1C or blood pressure value, and suited to the patient. The medication criterion usually carries the most weight and depends on correct drugs, full dosing, attention to kidney function and justification from a current guideline. Nonpharmacologic points go to concrete education, referrals and lifestyle steps rather than general advice. Monitoring is scored on correct laboratory timing and follow-up intervals linked to the drugs started. Evidence points require named guidelines cited in APA format. Writing is assessed for problem-based organization, accurate terminology and a plan another clinician could carry out without asking questions.
NU 611 Unit 5 help before you submit
Plans most often lose points when medications appear without a dose, a titration schedule or a check against kidney function. Students also write goals such as "improve blood sugar" instead of a number. Another common gap is treating each condition in isolation, which misses chances for one drug to serve two problems or creates conflicts between them. Lifestyle sections are frequently a single line about diet and exercise with no referral or measurable step. Monitoring is often left vague, so the reader cannot tell when laboratory tests will be repeated. Guidelines should be current and named; citing an old edition can cost points. Return precautions are easy to forget and are part of patient safety. Finally, check that the plan fits the patient described, including age, insurance coverage and stated preferences.
Get a NU 611 Unit 5 example written to your instructions
Send the Unit 5 instructions and the rubric from your NU 611 classroom, plus the case, the diagnosis you settled on and any guideline your section requires. We write a custom example with named treatment, rejected alternatives, monitoring and return precautions worked through, and return it in 24 to 48 hours. The first custom sample is free.
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NU 611 Unit 5 questions, answered
Do I have to name a specific drug and dose?
In most graduate nursing sections, yes, and the rubric usually says so. Naming a class demonstrates recognition; naming an agent with dose, route, frequency and duration demonstrates a decision. Support the choice with current clinical guidance and state the patient factors behind it. If your instructions restrict prescribing detail for a particular case, follow them and defend the class level choice just as carefully.
Which guidelines should the plan cite?
Current national or specialty guidance for the condition, cited properly, in preference to review articles or summary sites. Use the version in force now rather than one you already have on hand, since recommendations change. Where two credible guidelines disagree, say so and choose one with a reason, which usually reads stronger than presenting a recommendation as though it were uncontested.
How does this differ from the workup earlier in NU 611?
The workup argues what should be investigated and what each result would change, ending before treatment. This deliverable begins after a diagnosis is settled and defends what will now be done about it, including monitoring and follow-up. The habit of justification carries across both, but a plan that spends its length re-arguing test selection loses the treatment criteria it should be earning.
Where can I find a free NU 611 Unit 5 sample paper?
You can read the entire NU 611 Unit 5 plan here at no cost: the problem list, each goal and dosed intervention, and the monitoring schedule, with margin notes. If your case involves other conditions, request a plan written for it and the custom version arrives free within about two days.
How do I write a management plan for NU 611?
Organize by problem. Give each a measurable goal, then medications with full dosing and the guideline that supports them, plus education and referrals. Finish with when labs are repeated, when the patient returns and which symptoms should bring them back sooner.