| Course | N420 Adult Health IV |
|---|---|
| Module | Module 1 |
| Paper type | Nursing care paper |
| Length | About 1,072 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Pre-licensure BSN |
| Updated | September 2026 |
Free sample paper for N420 Module 1
Sixteen Hours Face Down: Nursing Care of a Woman Whose Pancreatitis Turned Into Acute Respiratory Distress Syndrome
Student Name
Pre-licensure BSN Program, Aspen University
N420: Adult Health IV
Instructor Name
Month Day, Year
Sixteen Hours Face Down: Nursing Care of a Woman Whose Pancreatitis Turned Into Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) often begins outside the lungs. Mrs. S., a composite 44-year-old woman, was admitted to intensive care with severe gallstone pancreatitis. On her third day her breathing rate climbed to 34, her oxygen saturation fell to 86% on a nonrebreather mask, and she was intubated. This paper describes the nursing care of an adult with ARDS, from recognizing it to ventilation, prone positioning, sedation, fluids and family support, and explains the evidence behind each part. Mrs. S. is an illustrative composite.
Recognizing ARDS
The Berlin definition requires onset within a week of a known insult, bilateral opacities on imaging not explained by effusions or collapse, breathing failure that cardiac causes or excess fluid cannot fully account for, and a ratio of arterial oxygen to inspired oxygen of 300 or less on at least 5 cm of water of positive end-expiratory pressure (PEEP). A ratio of 200 or less marks moderate ARDS and 100 or less severe (ARDS Definition Task Force, 2012). After intubation, Mrs. S. had an arterial oxygen of 88 mm Hg on 80% oxygen, a ratio of 110, with PEEP of 12 and bilateral infiltrates, which placed her in the moderate range, close to severe. Heart failure had to be excluded, and a bedside echocardiogram showed normal left ventricular function, which supported the diagnosis.
Why Pancreatitis Injures the Lungs
Pancreatitis is an indirect cause of ARDS. Enzymes and inflammatory mediators released from the inflamed pancreas travel in the blood and damage the membrane between the alveoli and capillaries. Protein-rich fluid floods the alveoli, surfactant is lost, and many alveoli collapse, leaving a smaller amount of functioning lung, sometimes called the baby lung. The practical meaning for nursing is that normal breaths delivered to a small lung overstretch it, which is why ventilation must be gentle (Harding et al., 2023).
Lung-Protective Ventilation and the Nurse's Role
In the landmark trial, ventilating patients with breaths of 6 mL for each kilogram of predicted body weight and a plateau pressure of 30 cm of water or less lowered deaths to 31.0%, against 39.8% among patients given 12 mL per kilogram (Acute Respiratory Distress Syndrome Network, 2000). Predicted body weight comes from height and sex, not actual weight. At 165 centimeters, Mrs. S.'s predicted weight is about 57 kilograms, so her target tidal volume is about 340 mL, much smaller than her actual weight of 92 kilograms would suggest. The nurse's role is to confirm that the measured height was used, check plateau pressure with the respiratory therapist, recognize that a higher carbon dioxide level is an accepted cost of small breaths, and report plateau pressures above the limit.
Prone Positioning
When Mrs. S.'s ratio fell to 96 on her fifth day despite a PEEP of 14, the team placed her prone. In a multicenter trial of 466 patients with severe ARDS, sessions of at least 16 hours prone cut deaths at 28 days roughly in half, to 16.0% against 32.8% in patients left supine (Guerin et al., 2013). Proning is a nursing procedure as much as a medical order. At least five staff are needed, with one person at the head responsible only for the airway. Before the turn, the nurse secures the endotracheal tube, empties drainage bags, protects the eyes with lubricant and closure, and removes chest electrodes to reapply on the back. After the turn, the nurse checks tube position, ventilation and blood pressure, and positions the arms to avoid nerve injury.
The Cost of Proning: Pressure Injury
Proning shifts pressure to the face, chest, knees and other bony prominences. In the same trial, new pressure injuries of stage 2 or higher occurred at 13.92 per 1,000 intensive care days in the prone group compared with 7.72 in the supine group, and older age and higher body mass index added risk (Girard et al., 2014). Mrs. S. had both of the latter risks at 92 kilograms. Nursing care includes foam dressings on the forehead, chin, chest and knees, a head position changed every two hours with the airway secured, and a full skin inspection at each return to the supine position.
Sedation, Paralysis and Comfort
Deep sedation is usually needed while prone, and a current guideline suggests neuromuscular blockers for patients with early severe ARDS (Qadir et al., 2024). A paralyzed patient cannot show pain or awareness, so the nurse confirms adequate sedation before paralysis begins, uses eye protection, turns and positions the patient, and explains procedures aloud because hearing may remain. The same guideline also suggests corticosteroids for ARDS, and the nurse monitors glucose closely when they are given.
Fluids and Nutrition
Pancreatitis needs early fluids, but once shock resolves, extra fluid worsens lung edema. The nurse tracks intake and output, daily weight and signs of overload, and reports when fluid balance runs strongly positive. Tube feeding is continued while she is prone, with the whole bed tilted head up, and the nurse watches for vomiting and abdominal distension.
Supporting the Family
Mrs. S.'s husband saw her face down for the first time on the fifth morning and asked if she had died. Families need to be prepared before they see a prone patient, told why her face is swollen and given a way to touch her hand. Short daily updates from the same nurse, where possible, help them follow a long course. He was also given a short written sheet explaining proning, so he could explain it to his children at home.
Care Summary
The table summarizes the main problems, actions and evaluation.
| Problem | Key nursing actions | Evaluation |
|---|---|---|
| Impaired gas exchange | Protective volumes by predicted weight; plateau checks; prone sessions of 16 hours or more | Ratio above 150 in supine position; plateau 30 or less |
| Risk for pressure injury | Foam dressings; head repositioning every two hours; skin checks at each turn | No new stage 2 injury |
| Risk for airway loss during turns | Airway-only team member; tube secured and position checked | No unplanned extubation |
| Family distress | Preparation before visits; daily updates | Family states understanding of plan |
Conclusion
Mrs. S.'s ARDS began in her pancreas and was treated in her lungs. The evidence shows that small breaths and long prone sessions save lives, and both depend on precise nursing: using the right weight, turning safely, protecting skin and eyes, monitoring a patient who cannot speak and preparing a frightened family.
References
Acute Respiratory Distress Syndrome Network. (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. New England Journal of Medicine, 342(18), 1301-1308. https://doi.org/10.1056/NEJM200005043421801
ARDS Definition Task Force. (2012). Acute respiratory distress syndrome: The Berlin definition. JAMA, 307(23), 2526-2533. https://doi.org/10.1001/jama.2012.5669
Girard, R., Baboi, L., Ayzac, L., Richard, J.-C., & Guerin, C. (2014). The impact of patient positioning on pressure ulcers in patients with severe ARDS: Results from a multicentre randomised controlled trial on prone positioning. Intensive Care Medicine, 40(3), 397-403. https://doi.org/10.1007/s00134-013-3188-1
Guerin, C., Reignier, J., Richard, J.-C., Beuret, P., Gacouin, A., Boulain, T., Mercier, E., Badet, M., Mercat, A., Baudin, O., Clavel, M., Chatellier, D., Jaber, S., Rosselli, S., Mancebo, J., Sirodot, M., Hilbert, G., Bengler, C., Richecoeur, J., ... Ayzac, L. (2013). Prone positioning in severe acute respiratory distress syndrome. New England Journal of Medicine, 368(23), 2159-2168. https://doi.org/10.1056/NEJMoa1214103
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.
Qadir, N., Sahetya, S., Munshi, L., Summers, C., Abrams, D., Beitler, J., Bellani, G., Brower, R. G., Burry, L., Chen, J.-T., Hodgson, C., Hough, C. L., Lamontagne, F., Law, A., Papazian, L., Pham, T., Rubin, E., Siuba, M., Telias, I., ... Fan, E. (2024). An update on management of adult patients with acute respiratory distress syndrome: An official American Thoracic Society clinical practice guideline. American Journal of Respiratory and Critical Care Medicine, 209(1), 24-36. https://doi.org/10.1164/rccm.202311-2011ST
N420 Module 1 instructions, in plain terms
Aspen's catalog opens its N420 description with complex pulmonary alterations, and this sample follows that description because the actual module directions stay inside the online classroom. Assignments on ARDS usually ask you to explain the pathophysiology, identify priority nursing problems and describe interventions with rationales, sometimes as a care plan and sometimes as an essay. Many instructors expect the Berlin criteria, lung-protective ventilation and prone positioning to appear, with current evidence behind them. Check whether a care table is required, whether you should use a patient from your clinical rotation with details removed, and how many sources are needed. Confirm too whether medical treatments may be described or whether the focus must stay on nursing actions.
Inside the N420 Module 1 example
The sample holds roughly 1,050 words under eleven headings, with one table at the end. It opens by showing how ARDS can start outside the lungs. The recognition section applies each Berlin criterion to the patient's numbers and adds the echocardiogram that ruled out heart failure. A short pathophysiology section explains the baby lung. The ventilation section works the predicted-weight calculation step by step. Prone positioning follows, with the turning procedure, and then a section weighs its pressure injury cost using the trial's own rates. Sedation and paralysis, fluids and nutrition, and family support come next, and the care table and conclusion pull the plan together. Each section is short so the prone procedure can be followed step by step.
Reading the N420 Module 1 grading rubric
Rubrics for N420 care papers commonly reward accurate pathophysiology, prioritized nursing actions, evidence-based rationales and attention to safety. Here the pathophysiology is short but linked directly to why breaths must be small. Evidence is specific: two landmark trials with their mortality figures and a current guideline. The worked tidal volume calculation earns application marks, and a margin note explains why it exposes the danger of using actual weight. Safety appears in the airway role during turns and the pressure injury prevention plan, balanced against benefit with real numbers. Family care shows breadth. Presentation marks come from a readable care table and six correctly formatted APA references. Keeping the focus on nursing actions throughout also helps.
N420 Module 1 help from the desk
Students often describe ARDS in textbook terms and never connect it to a real patient's numbers. Use the ratio, the PEEP and the imaging to classify severity. Another common error is quoting a tidal volume of 6 mL per kilogram without saying the weight is predicted from height, which is the step nurses actually check. Some papers present proning as a medical order and leave out the nursing work of turning, airway protection, eye care and skin care. Include it. Others praise proning without mentioning pressure injuries. Report both benefit and cost. Finally, remember the family, who often see the patient prone with no warning and need preparation before the first visit.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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N420 Module 1 questions, answered
What does N420 Module 1 usually ask for?
Aspen's N420 description begins with complex pulmonary alterations, so a paper on nursing care of a patient with ARDS is a typical first assignment. Check your classroom for the format.
How is predicted body weight calculated for ARDS?
It is based on height and sex. For women, 45.5 plus 0.91 times the height in centimeters minus 152.4; for men the constant is 50. Actual weight is not used.
Why is prone positioning used in severe ARDS?
Lying prone opens collapsed areas at the back of the lungs and spreads ventilation more evenly. A large trial found lower mortality with sessions of at least 16 hours.
Where can I find a free N420 Module 1 sample paper?
The ARDS nursing care paper appears in full on this page, from title page to care table, annotated in the margin and open without registration. It begins the N420 series, which goes on to ventilator care, shock, sepsis, brain injury, burns, code teams and diabetic emergencies.
What should an N420 Module 1 ARDS paper include?
The diagnostic criteria applied to your patient, the cause, lung-protective ventilation with predicted body weight, prone positioning and its nursing care, sedation, fluids and family support, with current evidence for each.