| Course | NU 623 Adult Healthcare |
|---|---|
| Unit | Unit 3 |
| Paper type | Multimorbidity management plan |
| Length | About 1,010 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 623 Unit 3
Managing Heart Failure, Type 2 Diabetes, COPD, and Knee Osteoarthritis Together in a 71-Year-Old Man
Student Name
Department of Nursing, Herzing University
NU 623: Adult Healthcare
Instructor Name
February 5, 2026
Managing Heart Failure, Type 2 Diabetes, COPD, and Knee Osteoarthritis Together in a 71-Year-Old Man
Conditions and Current Control
Mr. F., a composite 71-year-old retired electrician, lives with his wife and manages his own medications. Heart failure with reduced ejection fraction, diagnosed three years ago, ejection fraction 35%, New York Heart Association class II, no admissions in the past year. Type 2 diabetes for 12 years, A1C 7.6%, one episode of symptomatic low blood sugar last month. Chronic obstructive pulmonary disease, moderate, one exacerbation treated with prednisone last winter. Knee osteoarthritis, bilateral, worse on the right, limiting his walking to about two blocks. His estimated glomerular filtration rate is 58. Current medications: metoprolol succinate 50 mg daily, lisinopril 10 mg daily, furosemide 40 mg daily, metformin 1,000 mg morning and evening, glipizide 10 mg morning and evening, tiotropium inhaler daily, albuterol as needed, and over-the-counter ibuprofen, 400 mg on most days and often more, for his knees.
Targets, Adjusted for This Patient
Heart failure: guideline-directed therapy at target or maximally tolerated doses, no admissions, and stable weight (Heidenreich et al., 2022). Diabetes: A1C below 8.0% rather than 7.0%, because he is over 70, has established cardiovascular disease, and has had hypoglycemia; a tighter target would increase hypoglycemia and falls without a clear gain in the time he has. COPD: no exacerbations and preserved daily activity. Osteoarthritis: walking at least 20 minutes a day with pain he rates as acceptable. Each target was checked against the others before being set, which is the step that single-disease guidelines do not take for him (Boyd et al., 2005).
Where the Conditions Collide
Collision one: knee pain treatment versus heart failure and kidneys. Ibuprofen is the most effective analgesic he has tried, but nonsteroidal anti-inflammatory drugs cause sodium and water retention, blunt the effect of diuretics and angiotensin-converting enzyme inhibitors, and raise the risk of heart failure decompensation and kidney injury. The heart failure guideline recommends avoiding them (Heidenreich et al., 2022). Resolution: stop oral ibuprofen; use topical diclofenac gel to both knees four times daily, which gives meaningful relief in knee osteoarthritis with far lower systemic exposure, plus scheduled acetaminophen 1,000 mg twice daily; refer to physical therapy for quadriceps strengthening, which also supports his heart failure activity goals. This is the conflict he minds most, and it is discussed below.
Collision two: beta blockade for heart failure versus COPD. Beta blockers reduce mortality in reduced ejection fraction heart failure, and there is a common fear that they worsen bronchospasm. Cardioselective beta blockers, which include metoprolol succinate and bisoprolol, do not produce clinically significant adverse respiratory effects in people with COPD (Salpeter et al., 2005). Resolution: continue metoprolol succinate and titrate toward the target dose of 200 mg as heart rate and blood pressure allow. Nonselective agents such as carvedilol are avoided in him.
Collision three: glucose lowering versus heart failure and hypoglycemia. Glipizide is the likely cause of last month's low, and hypoglycemia can itself provoke arrhythmia. At the same time, a sodium-glucose cotransporter 2 inhibitor treats both of his conditions: it lowers glucose modestly and reduces heart failure hospitalization and cardiovascular death in reduced ejection fraction heart failure, with or without diabetes (Heidenreich et al., 2022). Resolution: stop glipizide, start empagliflozin 10 mg daily, and reduce furosemide to 20 mg daily when empagliflozin starts, because both increase urinary sodium and water loss and together could cause dehydration and dizziness. Metformin continues at his kidney function.
Collision four: steroids for COPD exacerbations versus diabetes and heart failure. Prednisone raises glucose and causes fluid retention. Resolution: this is anticipated rather than solved; a written exacerbation plan tells him to check glucose twice daily during any steroid course and to weigh himself daily, with thresholds for calling.
Priorities
Clinically, the first priority is stopping ibuprofen, because it threatens both his heart and his kidneys and costs nothing to change; the second is stopping glipizide and starting empagliflozin, because it removes a hypoglycemia risk and adds heart failure benefit in one step. Mr. F.'s own first priority is different: he wants to walk to the park with his grandson without stopping. That goal is recorded in his words and placed at the center of the osteoarthritis plan, and he is told that stopping ibuprofen serves it indirectly by keeping his heart failure stable enough to exercise. The disagreement is acknowledged rather than overridden.
The Regimen as He Will Experience It
Morning: metoprolol succinate, lisinopril, furosemide, empagliflozin, metformin, tiotropium, and acetaminophen, seven items. Evening: metformin and acetaminophen. Diclofenac gel four times daily. Albuterol as needed. That is nine scheduled oral doses a day across seven prescriptions, down from eleven doses before glipizide and ibuprofen were removed. All are available as generics except empagliflozin and tiotropium; his Medicare Part D plan covers empagliflozin at a copay he says he can manage, which was confirmed before it was prescribed. His wife fills a weekly pill organizer, and both of them were shown the new list side by side with the old one.
Monitoring, Consolidated
Daily home weight, and he calls the clinic if the scale rises more than 3 pounds overnight or 5 pounds across any week. Home glucose once daily for four weeks after glipizide stops, then twice weekly. Basic metabolic panel two weeks after starting empagliflozin and reducing furosemide, to check kidney function, potassium, and volume status. A1C in three months. Blood pressure and heart rate at each visit for beta blocker titration. Rather than four separate specialty schedules, these are gathered into one visit every four weeks for three months, then every three months, with laboratory work drawn the week before so results are available at the visit. Spirometry is not repeated routinely unless his symptoms change. The plan will be revisited sooner if any collision resolves differently than expected: if his knees do not improve on topical treatment and therapy within six weeks, an intra-articular steroid injection is the next step rather than a return to oral ibuprofen; if his kidney function falls by more than a third after empagliflozin starts, the furosemide dose is reviewed first.
References
Boyd, C. M., Darer, J., Boult, C., Fried, L. P., Boult, L., & Wu, A. W. (2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: Implications for pay for performance. JAMA, 294(6), 716-724. https://doi.org/10.1001/jama.294.6.716
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., ... Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895-e1032. https://doi.org/10.1161/CIR.0000000000001063
Salpeter, S. R., Ormiston, T. M., & Salpeter, E. E. (2005). Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (4), Article CD003566. https://doi.org/10.1002/14651858.CD003566.pub2
The Herzing NU 623 Unit 3 instructions
The Unit 3 assignment asks for a management plan for an adult with several chronic conditions, showing how the plan accounts for their interaction. Expect to summarize each condition and how well it is controlled, then set targets suited to the patient rather than copying the general guideline target. The central task is usually identifying conflicts, where treatment for one condition harms another, and resolving them. Many sections ask you to prioritize changes, simplify the medication regimen and consolidate monitoring. Patient factors such as age, function, support and preferences should shape the plan. Cite the guidelines for each condition plus evidence on multimorbidity in APA 7, working from the supplied case or an invented one. A table of the regimen or the monitoring schedule is requested in some sections.
How this NU 623 Unit 3 example is built
The plan opens with a condition list showing duration, current treatment and control for each. The targets section adjusts goals to the patient, for example a less strict A1C because of age and hypoglycemia risk. The collisions section is the core: it explains that ibuprofen worsens heart failure and kidney function, that glipizide risks low blood sugar in an older adult, and that some inhaler and heart medications need attention together. The priorities section ranks the changes, putting the free and fast fix first. The regimen section writes out the morning and evening medications as he will take them, counting the items, which shows the pill burden. Monitoring is merged into one plan with daily weight and clear call thresholds, glucose checks after the medication switch and laboratory tests at set intervals.
NU 623 Unit 3 rubric: what full points look like
Herzing rubrics for multimorbidity plans typically score assessment of conditions, individualized targets, identification and resolution of conflicts, prioritization, monitoring and evidence. Assessment points require accurate summaries with control status. Targets are credited when they are adjusted for this patient with a reason. Conflict resolution is the heaviest line in most versions, with credit for specific drug or condition interactions and a clear decision for each. Prioritization earns points when the order of changes is justified by risk and practicality. Monitoring is scored on a consolidated, specific schedule. Evidence points require the condition-specific guidelines and research on applying guidelines in multimorbidity, cited in APA format. Writing points go to organization, readability and a regimen description that a patient and caregiver could actually follow.
NU 623 Unit 3 help before you submit
Multimorbidity plans often lose points by treating each condition in its own section with its own guideline, never addressing how they interact. Students also adopt standard targets, such as an A1C below 7 percent, without considering age or hypoglycemia risk. Over-the-counter drugs like ibuprofen are a commonly missed conflict. Plans frequently add medications without removing any, which raises the pill burden. Another gap is a lack of priorities, leaving the reader with many changes and no order. Monitoring spread across separate sections is hard to follow and often incomplete. Finally, adherence should be addressed without blame; describe barriers and supports rather than calling the patient noncompliant.
Get a NU 623 Unit 3 example written to your instructions
Send the Unit 3 instructions and the rubric from your NU 623 classroom, plus the patient case and the conditions your plan covers. We write a custom example that works through the interactions, defends its priorities and counts the regimen, returned in 24 to 48 hours. The first custom sample is free.
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NU 623 Unit 3 questions, answered
How do I handle conditions whose targets conflict?
Name the conflict, then decide and defend it. Multimorbidity guidelines exist precisely because single-condition guidance was written as though patients had one problem, and faculty are looking for a writer who notices. State which target you would relax, for what reason, over what period, and what you would monitor to know whether the trade was right.
Should I always aim for the guideline target?
Not automatically, and saying why is where the marks are. Guideline targets are derived from populations, and for an individual patient life expectancy, frailty, treatment burden and preference can all justify a different goal. What matters is that any departure is argued from something specific about this patient rather than left as an unexplained looser number.
How do I write about adherence without blaming the patient?
Treat it as an output of the plan. Count the doses, the daily timing points, the monthly cost and what the schedule asks of somebody who works shifts. Those are things you can change. A plan requiring four daily administrations at fixed hours produces poor adherence in almost anybody, and identifying that is clinical reasoning rather than an excuse.
Where can I find a free NU 623 Unit 3 sample paper?
The complete NU 623 Unit 3 plan can be read here for free, including the conflicts between conditions, the ranked priorities, the daily regimen and the merged monitoring schedule. For a different combination of conditions, request a custom plan; it costs nothing and is normally sent within about two days.
How do you manage multiple chronic conditions in one plan?
Summarize each condition, set targets that fit the patient, then look for places where one treatment harms another condition and resolve them. Rank the changes, simplify the regimen and combine monitoring into one schedule the patient can follow.