| Course | NU 611 Clinical Decision-Making |
|---|---|
| Unit | Unit 6 |
| Paper type | Oral-style case presentation |
| Length | About 880 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 6
Case Presentation: Fever and Productive Cough in a 71-Year-Old Man, With a Question About Admission
Student Name
Department of Nursing, Herzing University
NU 611: Clinical Decision-Making
Instructor Name
February 24, 2026
Case Presentation: Fever and Productive Cough in a 71-Year-Old Man, With a Question About Admission
One-Line Summary
Mr. H. is a 71-year-old man with well-controlled type 2 diabetes and no lung disease who presents with three days of fever and productive cough, has a right lower lobe infiltrate on chest radiograph, and scores 2 on CURB-65; I think this is community-acquired pneumonia, and I am asking whether you agree he can be treated at home.
History, Selected
He was well until three days ago, when he developed fever to 101.8 F at home, chills, and a cough productive of yellow-green sputum. Since yesterday, coughing or a deep breath has brought on pain along the right side of his chest. He is more tired than usual and has been eating less, but he is drinking fluids and passing urine normally. He denies confusion, and his wife, who is with him, agrees he has been himself. He has not been hospitalized or taken antibiotics in the past 90 days, which matters for the choice of antibiotic. He has no history of MRSA or Pseudomonas. He does not smoke, and he has no chronic lung, heart, liver, or kidney disease.
Pertinent negatives I want you to hear: no blood in the sputum, no leg swelling or calf pain, no recent travel, and no known sick contacts with influenza or COVID-19. His metformin and lisinopril are his only medications, and he is allergic to nothing.
I have left out his remote knee surgery, his well-controlled cholesterol, and the details of his diabetes management apart from a recent A1C of 6.9%, because none of them changes where he should be treated or what he should receive.
Examination and Results, Selected
Temperature 101.2 F, heart rate 98, respiratory rate 24, blood pressure 128/74, and oxygen saturation 93% on room air, rising to 96% on 2 liters by nasal cannula in clinic. He is alert and oriented, speaks in full sentences, and sits comfortably. Over the right lower posterior chest there are crackles, increased tactile fremitus, and dullness to percussion; the left lung is clear. Heart rhythm is regular, and there is no edema. Mucous membranes are slightly dry.
The chest radiograph shows a right lower lobe consolidation without effusion. Point-of-care testing shows glucose 212 mg/dL and a negative rapid influenza and COVID-19 test. The serum blood urea nitrogen, sent this morning, is 22 mg/dL, which is just above the CURB-65 threshold of 19 mg/dL (7 mmol/L).
Assessment and Alternatives
My impression is a probably bacterial community-acquired pneumonia involving the right lower lobe. The combination of fever, productive cough, pleuritic pain, focal crackles with dullness and increased fremitus, and a new infiltrate on radiograph makes this the leading diagnosis by a wide margin; no single bedside finding is reliable alone, but the combination is (Metlay et al., 1997).
Two alternatives sit lower. Pulmonary embolism with infarction can cause pleuritic pain, fever, and an infiltrate; I rank it low because of the productive purulent cough, the absence of leg symptoms or risk factors, and the lobar consolidation with dullness. Viral pneumonia from influenza or SARS-CoV-2 is less likely with negative rapid tests, although the tests are not perfect.
Severity is the real question. His CURB-65 score is 2: one point for age 65 or older and one point for blood urea nitrogen above threshold. He has no confusion, his respiratory rate is below 30, and his blood pressure is normal. In the derivation study, a score of 2 carried intermediate mortality, and the authors suggested that such patients be considered for short inpatient treatment or closely supervised outpatient care (Lim et al., 2003). The current guideline recommends a validated severity tool plus clinical judgment rather than a score alone (Metlay et al., 2019).
Plan, by Problem
Pneumonia: if he goes home, amoxicillin 1 g by mouth three times daily plus doxycycline 100 mg by mouth twice daily for five days, because he has a comorbidity and the guideline recommends combination therapy or a respiratory fluoroquinolone for outpatients with comorbidities (Metlay et al., 2019). I chose this over levofloxacin to avoid fluoroquinolone adverse effects in an older adult. If he is admitted, ceftriaxone plus azithromycin per the inpatient recommendation.
Hypoxemia: his saturation of 93% on room air is the finding I am least comfortable with. At home he would need a pulse oximeter and a clear threshold of 92% for return.
Diabetes: hold metformin while he is eating poorly and acutely unwell, check glucose twice daily, and resume when he is eating normally.
Follow-up: a phone call tomorrow, a visit in 48 hours, and return precautions for breathlessness, confusion, chest pain at rest, or inability to keep fluids down. Chest radiograph follow-up is not routinely needed if he recovers fully.
The Ask
My question is whether you agree with outpatient treatment. In favor: he is alert, his vital signs apart from oxygen saturation are reassuring, he has a capable wife at home, and he can return quickly. Against: CURB-65 of 2, age 71, a saturation of 93% on room air, and a comorbidity. The weakest link in my plan is the oxygen saturation. If you think 93% should push him to a short observation stay, I would accept that, and I would like to know which finding you weigh most.
References
Lim, W. S., van der Eerden, M. M., Laing, R., Boersma, W. G., Karalus, N., Town, G. I., Lewis, S. A., & Macfarlane, J. T. (2003). Defining community acquired pneumonia severity on presentation to hospital: An international derivation and validation study. Thorax, 58(5), 377-382. https://doi.org/10.1136/thorax.58.5.377
Metlay, J. P., Kapoor, W. N., & Fine, M. J. (1997). Does this patient have community-acquired pneumonia? Diagnosing pneumonia by history and physical examination. JAMA, 278(17), 1440-1445. https://doi.org/10.1001/jama.1997.03550170070035
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia: An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67. https://doi.org/10.1164/rccm.201908-1581ST
The Herzing NU 611 Unit 6 instructions
The Unit 6 assignment asks you to prepare a case presentation for a preceptor or consultant, usually in written form that mirrors an oral presentation. Expect to begin with a one-line summary that gives age, key history, the main problem and your question. The history and examination should be selected for relevance rather than complete, with pertinent negatives included. An assessment should state the leading diagnosis with alternatives, and the plan should be organized by problem. Many sections require a specific question for the listener, such as whether to admit or which test to order next. A severity score or decision tool may be expected where one applies. Cite guidelines and decision rules in APA 7 format. The rubric sets length, often shorter than a full paper, and the case should be composite, not from your clinical site.
How this NU 611 Unit 6 example is built
The sample opens with a single sentence that tells the listener who the patient is, what was found and what decision is needed. The history section is limited to what bears on pneumonia and its severity: onset three days ago, sputum color, pleuritic pain and well-controlled diabetes. Examination and results give vital signs with oxygen saturation, focal crackles with dullness and increased fremitus, and the right lower lobe infiltrate. The assessment names probable bacterial pneumonia and lists alternatives with brief reasons. The plan gives amoxicillin with doxycycline for five days and explains why combination therapy fits a patient with a comorbidity. The final section, the ask, states the question directly and sets out the factors favoring home treatment against those favoring admission, such as a CURB-65 score of 2 and age over 65.
Where the points sit in the NU 611 Unit 6 rubric
Herzing rubrics for a case presentation usually reward organization, relevance of selected data, clinical reasoning in the assessment, the plan and the clarity of the question. Organization points go to a presentation that follows the expected order and begins with a strong one-line summary. Relevance is often the most closely read criterion, and markers credit the ability to leave out what does not matter while keeping pertinent negatives. The assessment criterion is scored on a supported diagnosis with alternatives considered. Plan points require guideline-based treatment written with full dosing and a reason for the setting of care. A clear, specific question to the listener earns credit in many rubrics because it shows the student knows what decision is pending. Writing points cover concision, correct terms and APA citations for the score and guideline used.
Common NU 611 Unit 6 mistakes, and how to avoid them
The most common loss is presenting everything in the chart, which buries the key findings and shows the student cannot select. Some presentations never ask a question, so the listener does not know why they are being told the case. One-line summaries often run to several sentences or leave out the main problem. Students also forget the severity score or apply it incorrectly, for example missing the age point. Antibiotic plans lose points when the dose, duration or reason for the choice is missing. Alternatives in the assessment are frequently skipped, which suggests premature closure. Finally, a presentation should state your own opinion and its reasoning; asking the preceptor what to do without offering a view misses what the unit is grading.
Get a NU 611 Unit 6 example written to your instructions
Send the Unit 6 instructions and the rubric from your NU 611 classroom, plus the case and any time limit or required format your section set. We write a custom example built as a presentation script, with the one line summary, the selected data and the ask in place, and return it in 24 to 48 hours. The first custom sample is free.
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NU 611 Unit 6 questions, answered
Should a case presentation include everything in the chart?
No, and including everything is the usual reason these score badly. A presentation is an argument delivered under time pressure, so each item earns its place by changing what the listener concludes or does. Stable chronic problems, unremarkable results and background detail belong in the record rather than the presentation. If your instructions set a time limit, treat it as part of the rubric.
Can I present a patient from my clinical rotation?
Where your instructions allow it, yes, with every identifier removed before it leaves your hands. Keep in mind that your clinical hours, your logged encounters and any evaluation your preceptor signs are your own work and are never produced for you. A supplied or constructed case works equally well here, since the criterion is about selection and delivery rather than about provenance.
How is this different from the full write-up at the end of NU 611?
The presentation is selective and built for a listener under time pressure, so its skill is deciding what to leave out. The final write-up is complete and built for a reader who can pause, so its skill is holding a long argument together. The same case supports both, but the presentation that gets compressed from a full paper usually keeps the wrong material.
Where can I find a free NU 611 Unit 6 sample paper?
This page carries the full NU 611 Unit 6 presentation free, from the one-line summary through the ask, with notes on what was trimmed and why. If your section assigned a different patient, ask for a custom presentation on that patient; it costs nothing and is usually back by the second day.
How do you start a case presentation in NU 611?
Open with one sentence giving the patient's age, the key background, the main problem with the most important finding and the decision you need help with. Everything after that sentence should support it, so the listener knows from the start where the presentation is going.