,Table of Contents
NGN Case Study 001: Acute Exacerbation of COPD.............................................................................. 3
NGN Case Study 002: Acute Decompensated Heart Failure (ADHF).................................................... 6
NGN Case Study 003: Diabetic Ketoacidosis (DKA).............................................................................10
NGN Case Study 004: Ischemic Stroke (Acute Cerebrovascular Accident).......................................13
NGN Case Study 005: Sepsis (Progressing Toward Septic Shock).................................................... 17
NGN Case Study 006: Hypertensive Crisis (Emergency)..................................................................... 20
NGN Case Study 007: Acute Asthma Exacerbation..............................................................................24
NGN Case Study 008: Upper Gastrointestinal Bleeding (UGIB).......................................................... 27
NGN Case Study 009: Acute Pancreatitis.............................................................................................. 31
NGN Case Study 010: Sickle Cell Crisis (Vaso-Occlusive Crisis)....................................................... 34
NGN Case Study 011: Hepatic Encephalopathy....................................................................................38
NGN Case Study 012: Pulmonary Embolism.........................................................................................41
NGN Case Study 013: Acute Myocardial Infarction (ST-Elevation MI)................................................ 44
NGN Case Study 014: Acute Kidney Injury (Pre-Renal AKI due to Hypovolemia)............................. 48
NGN Case Study 015: Acute Bacterial Meningitis................................................................................ 51
NGN Case Study 016: Anaphylaxis........................................................................................................ 55
NGN Case Study 017: Severe Hypoglycemia........................................................................................ 58
NGN Case Study 018: Thyroid Storm.....................................................................................................61
NGN Case Study 019: Spinal Cord Injury (Cervical Trauma, C6 Level).............................................. 64
NGN Case Study 020: Heat Stroke......................................................................................................... 68
NGN Case Study 021: Hyperosmolar Hyperglycemic State (HHS)......................................................71
NGN Case Study 022: Tension Pneumothorax......................................................................................74
NGN Case Study 023: Status Epilepticus.............................................................................................. 77
NGN Case Study 024: Small Bowel Obstruction...................................................................................81
NGN Case Study 025: Acute Ischemic Stroke.......................................................................................84
NGN Case Study 026: Acute Respiratory Failure (Type I – Hypoxemic)............................................. 87
NGN Case Study 027: Upper GI Bleed (UGIB) – Suspected Peptic Ulcer........................................... 91
NGN Case Study 028: Acute Pancreatitis.............................................................................................. 94
NGN Case Study 029: Diabetic Ketoacidosis (DKA).............................................................................97
NGN Case Study 030: Bacterial Endocarditis..................................................................................... 100
NGN Case Study 031: Tumor Lysis Syndrome (TLS)..........................................................................104
NGN Case Study 032: Acute Asthma Exacerbation............................................................................107
NGN Case Study 033: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)......................... 110
NGN Case Study 034: Multiple Sclerosis (MS) Exacerbation.............................................................113
NGN Case Study 035: Myasthenic Crisis............................................................................................. 117
NGN Case Study 036: Guillain-Barré Syndrome................................................................................. 120
NGN Case Study 037: Amyotrophic Lateral Sclerosis (ALS).............................................................123
NGN Case Study 038: Neurogenic Shock............................................................................................126
NGN Case Study 039: Sepsis (Secondary to Urinary Tract Infection).............................................. 129
NGN Case Study 040: Anaphylactic Shock......................................................................................... 133
NGN Case Study 042: Acute Pulmonary Embolism (PE)................................................................... 139
NGN Case Study 043: Pediatric Diabetic Ketoacidosis (DKA)...........................................................142
NGN Case Study 044: Cerebral Aneurysm Rupture / Subarachnoid Hemorrhage.......................... 145
NGN Case Study 046: Classic (Non-Exertional) Heat Stroke.............................................................152
,NGN Case Study 047: Status Asthmaticus (Severe Asthma Exacerbation Unresponsive to Initial
Therapy).................................................................................................................................................. 155
NGN Case Study 048: Meningococcal Meningitis...............................................................................158
NGN Case Study 049: Acute Pancreatitis in Pregnancy (Third Trimester).......................................162
NGN Case Study 050: Traumatic Brain Injury (Moderate to Severe).................................................165
NGN Case Study 051: Toxic Shock Syndrome (TSS)..........................................................................168
NGN Case Study 052: Obstetric Hemorrhage – Postpartum Hemorrhage (Uterine Atony)............ 171
NGN Case Study 053: Necrotizing Fasciitis (Rapidly Spreading Soft Tissue Infection)................. 174
NGN Case Study 054: Tumor Lysis Syndrome (Oncologic Emergency).......................................... 178
NGN Case Study 055: Spinal Cord Compression (Secondary to Metastatic Cancer).....................................181
NGN Case Study 056: Acute Upper GI Bleed (Peptic Ulcer Disease)............................................................... 184
NGN Case Study 057: Massive Pulmonary Embolism (Hemodynamically Unstable PE)............................... 187
NGN Case Study 058: Ischemic Stroke in a Young Adult.................................................................................. 190
NGN Case Study 059: Acute Adrenal Crisis (Addisonian Crisis)..................................................................... 194
NGN Case Study 061: Pericardial Tamponade................................................................................................... 200
NGN Case Study 062: Myasthenic Crisis............................................................................................................ 204
NGN Case Study 063: Septic Shock.................................................................................................................... 207
NGN Case Study 064: Hemolytic Transfusion Reaction.................................................................................... 210
NGN Case Study 065: Septic Shock.................................................................................................................... 214
NGN Case Study 066: Acute Respiratory Failure............................................................................................... 217
NGN Case Study 067: Sickle Cell Crisis (Vaso-occlusive Crisis)..................................................................... 220
NGN Case Study 068: Acute Myocardial Infarction (ST-Elevation MI - STEMI)............................................... 224
NGN Case Study 069: Massive Pulmonary Embolism (PE)...............................................................................227
NGN Case Study 070: Acute Pancreatitis........................................................................................................... 231
NGN Case Study 071: Sepsis from Pneumonia..................................................................................................234
NGN Case Study 072: Acute Kidney Injury (AKI)............................................................................................... 238
NGN Case Study 073: Acute Myocardial Infarction (STEMI)............................................................................. 241
NGN Case Study 074: Acute Stroke (Ischemic Stroke)......................................................................................244
NGN Case Study 075: Septic Shock.................................................................................................................... 248
NGN Case Study 076: Acute Respiratory Distress Syndrome (ARDS)............................................................ 251
NGN Case Study 077: Acute Kidney Injury (AKI)............................................................................................... 255
NGN Case Study 078: Septic Shock.................................................................................................................... 258
NGN Case Study 079: Severe Asthma Exacerbation......................................................................................... 261
NGN Case Study 080: Acute Myocardial Infarction (STEMI)............................................................................. 265
NGN Case Study 081: Severe Asthma Exacerbation......................................................................................... 268
NGN Case Study 082: Acute Myocardial Infarction (STEMI)............................................................................. 272
NGN Case Study 083: Severe Asthma Exacerbation......................................................................................... 275
NGN Case Study 084: Septic Shock.................................................................................................................... 278
NGN Case Study 085: Acute Respiratory Failure............................................................................................... 282
NGN Case Study 086: Septic Shock.................................................................................................................... 285
NGN Case Study 087: Acute Stroke.....................................................................................................................289
NGN Case Study 088: Acute Respiratory Failure............................................................................................... 292
NGN Case Study 089: Acute Myocardial Infarction (STEMI)............................................................................. 296
NGN Case Study 090: Acute Stroke.....................................................................................................................299
NGN Case Study 091: Septic Shock.................................................................................................................... 302
NGN Case Study 092: Acute Myocardial Infarction (STEMI)............................................................................. 306
NGN Case Study 093: Septic Shock.................................................................................................................... 309
NGN Case Study 094: Acute Respiratory Failure............................................................................................... 313
NGN Case Study 095: Septic Shock.................................................................................................................... 316
NGN Case Study 096: Severe Asthma Exacerbation......................................................................................... 319
NGN Case Study 097: Acute Respiratory Failure............................................................................................... 323
, NGN Case Study 098: Septic Shock.................................................................................................................... 326
NGN Case Study 099: Acute Stroke.....................................................................................................................330
NGN Case Study 100: Acute Respiratory Failure............................................................................................... 333
NGN Case Study 100: Septic Shock.................................................................................................................... 337
NGN Case Study 101: Acute Myocardial Infarction (STEMI)............................................................................. 340
NGN Case Study 102: Acute Stroke.....................................................................................................................344
NGN Case Study 001: Acute Exacerbation of COPD
Stage 1: Patient Presentation (Recognize Cues)
Patient Information:
● Name: John Matthews
● Age: 68
● Medical History: COPD (diagnosed 8 years ago), hypertension, former smoker (40 pack-years,
quit 2 years ago)
Chief Complaint:
Patient presents to the emergency department with worsening shortness of breath, productive cough with
thick yellow-green sputum, and fatigue for the past 3 days.
Vital Signs:
● Temperature: 100.6°F (38.1°C)
● Heart Rate: 112 bpm
● Respiratory Rate: 26/min
● Blood Pressure: 146/90 mmHg
● SpO₂: 87% on room air
Initial Assessment:
● Use of accessory muscles
● Audible wheezing and prolonged expiratory phase
● Sitting in tripod position
● Alert and oriented ×3
● Speaking in short phrases
NGN Case Study 001: Acute Exacerbation of COPD.............................................................................. 3
NGN Case Study 002: Acute Decompensated Heart Failure (ADHF).................................................... 6
NGN Case Study 003: Diabetic Ketoacidosis (DKA).............................................................................10
NGN Case Study 004: Ischemic Stroke (Acute Cerebrovascular Accident).......................................13
NGN Case Study 005: Sepsis (Progressing Toward Septic Shock).................................................... 17
NGN Case Study 006: Hypertensive Crisis (Emergency)..................................................................... 20
NGN Case Study 007: Acute Asthma Exacerbation..............................................................................24
NGN Case Study 008: Upper Gastrointestinal Bleeding (UGIB).......................................................... 27
NGN Case Study 009: Acute Pancreatitis.............................................................................................. 31
NGN Case Study 010: Sickle Cell Crisis (Vaso-Occlusive Crisis)....................................................... 34
NGN Case Study 011: Hepatic Encephalopathy....................................................................................38
NGN Case Study 012: Pulmonary Embolism.........................................................................................41
NGN Case Study 013: Acute Myocardial Infarction (ST-Elevation MI)................................................ 44
NGN Case Study 014: Acute Kidney Injury (Pre-Renal AKI due to Hypovolemia)............................. 48
NGN Case Study 015: Acute Bacterial Meningitis................................................................................ 51
NGN Case Study 016: Anaphylaxis........................................................................................................ 55
NGN Case Study 017: Severe Hypoglycemia........................................................................................ 58
NGN Case Study 018: Thyroid Storm.....................................................................................................61
NGN Case Study 019: Spinal Cord Injury (Cervical Trauma, C6 Level).............................................. 64
NGN Case Study 020: Heat Stroke......................................................................................................... 68
NGN Case Study 021: Hyperosmolar Hyperglycemic State (HHS)......................................................71
NGN Case Study 022: Tension Pneumothorax......................................................................................74
NGN Case Study 023: Status Epilepticus.............................................................................................. 77
NGN Case Study 024: Small Bowel Obstruction...................................................................................81
NGN Case Study 025: Acute Ischemic Stroke.......................................................................................84
NGN Case Study 026: Acute Respiratory Failure (Type I – Hypoxemic)............................................. 87
NGN Case Study 027: Upper GI Bleed (UGIB) – Suspected Peptic Ulcer........................................... 91
NGN Case Study 028: Acute Pancreatitis.............................................................................................. 94
NGN Case Study 029: Diabetic Ketoacidosis (DKA).............................................................................97
NGN Case Study 030: Bacterial Endocarditis..................................................................................... 100
NGN Case Study 031: Tumor Lysis Syndrome (TLS)..........................................................................104
NGN Case Study 032: Acute Asthma Exacerbation............................................................................107
NGN Case Study 033: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)......................... 110
NGN Case Study 034: Multiple Sclerosis (MS) Exacerbation.............................................................113
NGN Case Study 035: Myasthenic Crisis............................................................................................. 117
NGN Case Study 036: Guillain-Barré Syndrome................................................................................. 120
NGN Case Study 037: Amyotrophic Lateral Sclerosis (ALS).............................................................123
NGN Case Study 038: Neurogenic Shock............................................................................................126
NGN Case Study 039: Sepsis (Secondary to Urinary Tract Infection).............................................. 129
NGN Case Study 040: Anaphylactic Shock......................................................................................... 133
NGN Case Study 042: Acute Pulmonary Embolism (PE)................................................................... 139
NGN Case Study 043: Pediatric Diabetic Ketoacidosis (DKA)...........................................................142
NGN Case Study 044: Cerebral Aneurysm Rupture / Subarachnoid Hemorrhage.......................... 145
NGN Case Study 046: Classic (Non-Exertional) Heat Stroke.............................................................152
,NGN Case Study 047: Status Asthmaticus (Severe Asthma Exacerbation Unresponsive to Initial
Therapy).................................................................................................................................................. 155
NGN Case Study 048: Meningococcal Meningitis...............................................................................158
NGN Case Study 049: Acute Pancreatitis in Pregnancy (Third Trimester).......................................162
NGN Case Study 050: Traumatic Brain Injury (Moderate to Severe).................................................165
NGN Case Study 051: Toxic Shock Syndrome (TSS)..........................................................................168
NGN Case Study 052: Obstetric Hemorrhage – Postpartum Hemorrhage (Uterine Atony)............ 171
NGN Case Study 053: Necrotizing Fasciitis (Rapidly Spreading Soft Tissue Infection)................. 174
NGN Case Study 054: Tumor Lysis Syndrome (Oncologic Emergency).......................................... 178
NGN Case Study 055: Spinal Cord Compression (Secondary to Metastatic Cancer).....................................181
NGN Case Study 056: Acute Upper GI Bleed (Peptic Ulcer Disease)............................................................... 184
NGN Case Study 057: Massive Pulmonary Embolism (Hemodynamically Unstable PE)............................... 187
NGN Case Study 058: Ischemic Stroke in a Young Adult.................................................................................. 190
NGN Case Study 059: Acute Adrenal Crisis (Addisonian Crisis)..................................................................... 194
NGN Case Study 061: Pericardial Tamponade................................................................................................... 200
NGN Case Study 062: Myasthenic Crisis............................................................................................................ 204
NGN Case Study 063: Septic Shock.................................................................................................................... 207
NGN Case Study 064: Hemolytic Transfusion Reaction.................................................................................... 210
NGN Case Study 065: Septic Shock.................................................................................................................... 214
NGN Case Study 066: Acute Respiratory Failure............................................................................................... 217
NGN Case Study 067: Sickle Cell Crisis (Vaso-occlusive Crisis)..................................................................... 220
NGN Case Study 068: Acute Myocardial Infarction (ST-Elevation MI - STEMI)............................................... 224
NGN Case Study 069: Massive Pulmonary Embolism (PE)...............................................................................227
NGN Case Study 070: Acute Pancreatitis........................................................................................................... 231
NGN Case Study 071: Sepsis from Pneumonia..................................................................................................234
NGN Case Study 072: Acute Kidney Injury (AKI)............................................................................................... 238
NGN Case Study 073: Acute Myocardial Infarction (STEMI)............................................................................. 241
NGN Case Study 074: Acute Stroke (Ischemic Stroke)......................................................................................244
NGN Case Study 075: Septic Shock.................................................................................................................... 248
NGN Case Study 076: Acute Respiratory Distress Syndrome (ARDS)............................................................ 251
NGN Case Study 077: Acute Kidney Injury (AKI)............................................................................................... 255
NGN Case Study 078: Septic Shock.................................................................................................................... 258
NGN Case Study 079: Severe Asthma Exacerbation......................................................................................... 261
NGN Case Study 080: Acute Myocardial Infarction (STEMI)............................................................................. 265
NGN Case Study 081: Severe Asthma Exacerbation......................................................................................... 268
NGN Case Study 082: Acute Myocardial Infarction (STEMI)............................................................................. 272
NGN Case Study 083: Severe Asthma Exacerbation......................................................................................... 275
NGN Case Study 084: Septic Shock.................................................................................................................... 278
NGN Case Study 085: Acute Respiratory Failure............................................................................................... 282
NGN Case Study 086: Septic Shock.................................................................................................................... 285
NGN Case Study 087: Acute Stroke.....................................................................................................................289
NGN Case Study 088: Acute Respiratory Failure............................................................................................... 292
NGN Case Study 089: Acute Myocardial Infarction (STEMI)............................................................................. 296
NGN Case Study 090: Acute Stroke.....................................................................................................................299
NGN Case Study 091: Septic Shock.................................................................................................................... 302
NGN Case Study 092: Acute Myocardial Infarction (STEMI)............................................................................. 306
NGN Case Study 093: Septic Shock.................................................................................................................... 309
NGN Case Study 094: Acute Respiratory Failure............................................................................................... 313
NGN Case Study 095: Septic Shock.................................................................................................................... 316
NGN Case Study 096: Severe Asthma Exacerbation......................................................................................... 319
NGN Case Study 097: Acute Respiratory Failure............................................................................................... 323
, NGN Case Study 098: Septic Shock.................................................................................................................... 326
NGN Case Study 099: Acute Stroke.....................................................................................................................330
NGN Case Study 100: Acute Respiratory Failure............................................................................................... 333
NGN Case Study 100: Septic Shock.................................................................................................................... 337
NGN Case Study 101: Acute Myocardial Infarction (STEMI)............................................................................. 340
NGN Case Study 102: Acute Stroke.....................................................................................................................344
NGN Case Study 001: Acute Exacerbation of COPD
Stage 1: Patient Presentation (Recognize Cues)
Patient Information:
● Name: John Matthews
● Age: 68
● Medical History: COPD (diagnosed 8 years ago), hypertension, former smoker (40 pack-years,
quit 2 years ago)
Chief Complaint:
Patient presents to the emergency department with worsening shortness of breath, productive cough with
thick yellow-green sputum, and fatigue for the past 3 days.
Vital Signs:
● Temperature: 100.6°F (38.1°C)
● Heart Rate: 112 bpm
● Respiratory Rate: 26/min
● Blood Pressure: 146/90 mmHg
● SpO₂: 87% on room air
Initial Assessment:
● Use of accessory muscles
● Audible wheezing and prolonged expiratory phase
● Sitting in tripod position
● Alert and oriented ×3
● Speaking in short phrases
