| Course | NUR-3220 Fundamentals of Nursing |
|---|---|
| Module | Module 5 |
| Paper type | Nursing paper: vital signs and early warning scores |
| Length | About 1,002 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 3220 Module 5
Sixteen, Twenty, Twenty-Six: A Breathing Rate Trend and the Early Warning Score on a Paterson Medical Unit
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-3220: Fundamentals of Nursing
Mentor Name
Month Day, Year
Sixteen, Twenty, Twenty-Six: A Breathing Rate Trend and the Early Warning Score on a Paterson Medical Unit
The Patient
The patient and the hospital are invented. Mr. Okafor, 67, was admitted to a medical unit in Paterson with a urinary tract infection and a history of diabetes and heart failure. His 0800 vital signs were a temperature of 37.9 Celsius, a heart rate of 92, a blood pressure of 128/76, a breathing rate of 16 and an oxygen saturation of 95 percent without supplemental oxygen. He was alert, talking and eating breakfast. The student was assigned to him under her instructor's supervision.
At 1200, his breathing rate was 20 and heart rate 102. At 1500, his breathing rate was 26, heart rate 112, blood pressure 104/62, oxygen saturation 92 percent and temperature 38.6. He said he felt tired and asked the student to let him sleep. Each number alone did not seem alarming to the student, but together they made her uneasy.
Warning Signs Before Arrest
Schein et al. (1990) reviewed the records of patients who had a cardiopulmonary arrest in a hospital, most on general wards. In 84 percent of cases, there was documented evidence of clinical deterioration or new complaints within the eight hours before the arrest. Changes in breathing and in mental status were common. The authors concluded that many arrests are preceded by signs that could be recognized and acted on, and that the problem is often a failure to respond rather than a lack of information.
The National Early Warning Score
Guidance on the National Early Warning Score 2 (Royal College of Physicians, 2017) assigns points to seven observations: how fast the patient breathes, oxygen saturation, whether oxygen is being given, systolic pressure, heart rate, alertness (new confusion counts) and temperature. Each parameter is scored from 0 to 3 according to how far it is from normal, and the points are added. An urgent response follows a total of 5 or more, or 3 points on any single observation, and should come from a clinician experienced with acutely ill patients, and at 7 points or higher the guidance asks for an emergency team. The score gives nurses a shared language and a threshold for action.
Does the Score Work?
Smith et al. (2013) tested the National Early Warning Score on a large set of vital sign observations from a hospital. The score was good at identifying patients who would have a cardiac arrest, an unanticipated admission to intensive care or death within 24 hours, with the best discrimination for death. It performed as well as or better than many other early warning scores. The authors supported its use as a common standard.
| Source | Finding | Meaning for Mr. Okafor |
|---|---|---|
| Schein et al. (1990) | 84 percent of arrests preceded by documented deterioration | His trend is the kind of warning that precedes arrests |
| NEWS2 guidance (2017) | Points for seven parameters; 5 or more calls for urgent response | Calculate his score and act on the threshold |
| Smith et al. (2013) | Score identifies risk of death within 24 hours | The score is worth trusting |
Calculating the Score
At 1500, the student calculated Mr. Okafor's score with her instructor: breathing rate 26 scores 2 points; oxygen saturation 92 percent on room air scores 2; no supplemental oxygen scores 0; systolic blood pressure 104 scores 1; pulse 112 scores 2; alert scores 0; temperature 38.6 scores 1. The total was 8, in the range calling for an emergency response. At 0800, the same calculation gave a score of 1.
Escalating
The student told the assigned nurse, who agreed and called the rapid response team. The student prepared a report using SBAR: situation, Mr. Okafor's score of 8 with rising breathing and heart rates and falling blood pressure; background, admitted with a urinary tract infection, history of diabetes and heart failure; assessment, she was worried about sepsis; recommendation, she asked the team to assess him now. The team arrived within ten minutes, drew blood cultures and a lactate, gave fluids carefully because of his heart failure and started intravenous antibiotics. He was transferred to a step-down unit and recovered.
Why the Trend Mattered
Mr. Okafor's request to sleep might have suggested he was simply tired. The student learned that fatigue and drowsiness can be early signs of deterioration and that a rising breathing rate is one of the earliest and most often missed signs. Counting the breathing rate for a full minute, rather than estimating it, made the trend visible.
Respecting the Patient's Wishes
Mr. Okafor had asked to be left to sleep, and the student worried about disturbing him. She learned that a patient's wish for rest can be respected while still checking on him: she told him she would let him rest after one quick assessment, explained why she was concerned and stayed with him until the team arrived. He later thanked her for not letting him sleep through it.
What the Student Learned
Before this shift, the student saw vital signs as tasks to complete on time. She now looks at each set beside the last, calculates the score and asks what has changed. She also learned that escalating is part of a nurse's role, even for a student, and that a clear report gets a faster response.
Limits
Early warning scores miss some patients and can over-alert in others, such as those with chronic lung disease and low baseline saturation, for whom NEWS2 offers a separate oxygen scale. Schein's study is decades old and from one hospital. One patient's story shows how the score can help, not how often it does.
Conclusion
Mr. Okafor's breathing rate rose from 16 to 26 over a shift, and his early warning score rose from 1 to 8. Schein's study showed that most arrests are preceded by signs like these, the NEWS2 guidance gave a threshold for action and Smith's study showed that the score identifies patients at risk. Calculating the score and escalating with a clear report led to treatment before he became sicker.
References
Royal College of Physicians. (2017). National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Royal College of Physicians.
Schein, R. M. H., Hazday, N., Pena, M., Ruben, B. H., & Sprung, C. L. (1990). Clinical antecedents to in-hospital cardiopulmonary arrest. Chest, 98(6), 1388-1392. https://doi.org/10.1378/chest.98.6.1388
Smith, G. B., Prytherch, D. R., Meredith, P., Schmidt, P. E., & Featherstone, P. I. (2013). The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation, 84(4), 465-470. https://doi.org/10.1016/j.resuscitation.2012.12.016
NUR 3220 Module 5 instructions, in plain terms
Basic nursing care grounded in evidence, as TESU's catalog paragraph for NUR-3220 describes, includes spotting the patient who is quietly sliding, and since the syllabus is not posted, module five is planned as a paper on vital signs and early warning scores. Your paper should describe a patient whose vital signs changed, review evidence that deterioration is often preceded by warning signs, explain an early warning score and evidence for it, calculate the score at more than one point, describe how the student escalated with a structured report and reflect. Some sections ask for a paper on a specific vital sign, such as respiratory rate, or on the rapid response system. Check which early warning score your clinical site uses, since scoring tables differ, and whether a sample calculation should appear in a table.
How this NUR 3220 Module 5 example is built
An invented 67-year-old man on a Paterson medical unit whose breathing rate rose from 16 to 26 over a shift opens the paper. Schein's finding that 84 percent of arrests were preceded by documented deterioration, the NEWS2 guidance and Smith's evaluation of the score are explained and tied to the patient. The score is calculated at 0800 and 1500, rising from 1 to 8, and the student escalates with an SBAR report. The rapid response, why the trend mattered, the student's learning, limits and conclusion follow. Annotations note evidence linked to a decision and understanding beyond calculation. A short section shows how the student balanced the patient's wish to sleep with her concern.
Where the marks sit in the NUR 3220 Module 5 rubric
Deterioration papers earn their marks with a clear record of how the patient's vital signs changed, with accurate use of evidence on warning signs and early warning scores, correct calculation of the score at more than one time, escalation with a structured report and reflection on what the trend meant. Mentors notice when a student explains why drowsiness and a rising breathing rate matter. Counting respirations for a full minute shows good practice. Mentioning NEWS2's separate oxygen scale for chronic lung disease shows careful reading. Organizational guidance should be cited as a report with its publisher. Balancing respect for the patient's wishes with the duty to act shows professional judgment.
NUR 3220 Module 5 help: mistakes that cost marks
Deterioration papers often list vital signs without trends; compare each set with the last. Another frequent gap is a score calculated without a response. Count the breathing rate for a full minute. Calculate the score each time. Know your unit's thresholds and whom to call. Use SBAR when you escalate. Reflect on what you nearly missed. The desk drafts your own deterioration paper free from your brief, following the Paterson example. Explain your concern to the patient while you check on them. Write the score and the time you escalated in your notes.
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 Thomas Edison State 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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NUR 3220 Module 5 questions, answered
Where can I find a free NUR 3220 Module 5 sample paper?
The early warning score paper about an invented patient on a Paterson medical unit, from the rising breathing rate to the rapid response, is reproduced here in full.
Do patients show warning signs before cardiac arrest?
Schein and colleagues found documented deterioration within eight hours before arrest in 84 percent of cases.
What does the National Early Warning Score 2 measure?
Seven observations: respiratory rate, oxygen saturation, whether oxygen is given, systolic pressure, heart rate, alertness and temperature.
What NEWS2 score calls for an urgent response?
Five points in total, or 3 on any one observation; 7 points or more calls for an emergency team.
Why is breathing rate important?
A rising breathing rate is one of the earliest signs of deterioration and one of the most often missed.