NURS 6630 Week 7 Therapy for Patients With Schizophrenia

Sample Answer for NURS 6630 Week 7 Therapy for Patients With Schizophrenia Included After Question

NURS 6630 Week 7 Therapy for Patients With Schizophrenia

Week 7: Therapy for Patients With Schizophrenia 

According to the Schizophrenia and Related Disorders Alliance of America, approximately 3.5 million people in the United States are diagnosed with schizophrenia (n.d.), and it is one of the leading causes of disability. In practice, patients may present with delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior, as well as other negative symptoms that can be disabling for these individuals. Not only are these symptoms one of the most challenging symptom clusters you will encounter, many are associated with other disorders, such as depression, bipolar disorder, and disorders on the schizophrenia spectrum. As a psychiatric nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for patients. 

This week, as you examine antipsychotic therapies, you explore the assessment and treatment of patients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies. 

NURS 6630 Week 7 Therapy for Patients With Schizophrenia
NURS 6630 Week 7 Therapy for Patients With Schizophrenia

Reference:
Schizophrenia and Related Disorders Alliance of America. (n.d.). About  schizophrenia.https://sardaa.org/resources/about-schizophrenia/#:~:text=Quick%20Facts%20About%20Schizophrenia.%20Schizophrenia%20can%20be%20found,is%20one%20of%20the%20leading%20causes%20of%20disability 

Learning Objectives 

Students will: 

  • Assess client factors and history to develop personalized therapy plans for patients with insomnia 
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for insomnia 
  • Assess patient factors and history to develop personalized plans of antipsychotic therapy for patients 
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring antipsychotic therapy 
  • Synthesize knowledge of providing care to patients presenting for antipsychotic therapy 
  • Analyze ethical and legal implications related to prescribing antipsychotic therapy to patients across the lifespan 

 

Learning Resources 

 

Required Readings (click to expand/reduce) 

 

Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier. 

 

American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf 

 

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf 

 

Funk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M., Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J. (2018). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf 

 

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. https://doi.org/10.1093/schbul/13.2.261 

 

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/ 

 

McClellan, J. & Stock. S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9), 976–990. https://www.jaacap.org/article/S0890-8567(09)62600-9/pdf 

 

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649–659. https://doi.org/10.2165/00023210-200923080-00002 

 

 

Medication Resources (click to expand/reduce) 

 

 

IBM Corporation. (2020). IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537 

 

Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments. 

  • amisulpride 
  • aripiprazole 
  • asenapine 
  • brexpiprazole 
  • cariprazine 
  • chlorpromazine 
  • clozapine 
  • flupenthixol 
  • fluphenazine 
  • haloperidol 
  • iloperidone 
  • loxapine 
  • lumateperone 
  • lurasidone 
  • olanzapine 
  • paliperidone 
  • perphenazine 
  • pimavanserin 
  • quetiapine 
  • risperidone 
  • sulpiride 
  • thioridazine 
  • thiothixene 
  • trifluoperazine 
  • ziprasidone 

 

Required Media (click to expand/reduce) 

 

 

Case study: Pakistani woman with delusional thought processes 
Note: This case study will serve as the foundation for this week’s Assignment. 

 

 

Optional Resources (click to expand/reduce) 

 

 

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., Miller, A. L., & Miller, D. D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124–134. https://doi.org/10.3371/CSRP.5.3.2 

 

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728–738. https://doi.org/10.2146/ajhp130471 

 

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107–121. https://doi.org/10.1007/s11126-014-9326-2 

 

A Sample Answer For the Assignment: NURS 6630 Week 7 Therapy for Patients With Schizophrenia

Title: NURS 6630 Week 7 Therapy for Patients With Schizophrenia

Discussion: Treatment for a Patient With a Common Condition 

Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being. 

Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29 

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.   

Case: An elderly widow who just lost her spouse.  

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:  

  • Metformin 500mg BID  
  • Januvia 100mg daily  
  • Losartan 100mg daily  
  • HCTZ 25mg daily  
  • Sertraline 100mg daily  

Current weight: 88 kg 

Current height: 64 inches 

Temp: 98.6 degrees F 

BP: 132/86  

By Day 3 of Week 7 

Post a response to each of the following: 

  • List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.  
  • Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.  
  • Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.  
  • List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.  
  • List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.  
  • For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities? 
  • Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.  

Read a selection of your colleagues’ responses. 

By Day 6 of Week 7 

Respond to at least two of your colleagues on two different days in one of the following ways: 

  • If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained. 
  • If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days and 

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! 

Submission and Grading Information 

Grading Criteria 

 

To access your rubric: 

Week 7 Discussion Rubric 

 

Post by Day 3 of Week 7 and Respond by Day 6 of Week 7 

 

To Participate in this Discussion: 

Week 7 Discussion 

Rubric Detail 

  

Select Grid View or List View to change the rubric’s layout. 

 

Name: NURS_6630_Week7_Discussion_Rubric 

Grid View 

List View 

  Excellent 

 

Point range: 90–100 Good 

 

Point range: 80–89 Fair 

 

Point range: 70–79 Poor 

 

Point range: 0–69 

Main Posting: 

 

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.  

40 (40%) – 44 (44%) 

Thoroughly responds to the Discussion question(s). 

 

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. 

 

No less than 75% of post has exceptional depth and breadth. 

 

Supported by at least three current credible sources. 

35 (35%) – 39 (39%) 

Responds to most of the Discussion question(s). 

 

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 

 

50% of the post has exceptional depth and breadth. 

 

Supported by at least three credible references. 

31 (31%) – 34 (34%) 

Responds to some of the Discussion question(s). 

 

One to two criteria are not addressed or are superficially addressed. 

 

Is somewhat lacking reflection and critical analysis and synthesis. 

 

Somewhat represents knowledge gained from the course readings for the module. 

 

Post is cited with fewer than two credible references. 

0 (0%) – 30 (30%) 

Does not respond to the Discussion question(s). 

 

Lacks depth or superficially addresses criteria. 

 

Lacks reflection and critical analysis and synthesis. 

 

Does not represent knowledge gained from the course readings for the module. 

 

Contains only one or no credible references. 

Main Posting: 

 

Writing  

6 (6%) – 6 (6%) 

Written clearly and concisely. 

 

Contains no grammatical or spelling errors. 

 

Adheres to current APA manual writing rules and style. 

5 (5%) – 5 (5%) 

Written concisely. 

 

May contain one to two grammatical or spelling errors. 

 

Adheres to current APA manual writing rules and style. 

4 (4%) – 4 (4%) 

Written somewhat concisely. 

 

May contain more than two spelling or grammatical errors. 

 

Contains some APA formatting errors. 

0 (0%) – 3 (3%) 

Not written clearly or concisely. 

 

Contains more than two spelling or grammatical errors. 

 

Does not adhere to current APA manual writing rules and style. 

Main Posting: 

 

Timely and full participation  

9 (9%) – 10 (10%) 

Meets requirements for timely, full, and active participation. 

 

Posts main Discussion by due date. 

8 (8%) – 8 (8%) 

Posts main Discussion by due date. 

 

Meets requirements for full participation. 

7 (7%) – 7 (7%) 

Posts main Discussion by due date. 

0 (0%) – 6 (6%) 

Does not meet requirements for full participation. 

 

Does not post main Discussion by due date. 

First Response: 

 

Post to colleague’s main post that is reflective and justified with credible sources.  

9 (9%) – 9 (9%) 

Response exhibits critical thinking and application to practice settings. 

 

Responds to questions posed by faculty. 

 

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 

8 (8%) – 8 (8%) 

Response has some depth and may exhibit critical thinking or application to practice setting. 

7 (7%) – 7 (7%) 

Response is on topic, may have some depth. 

0 (0%) – 6 (6%) 

Response may not be on topic, lacks depth. 

First Response: 

Writing  

6 (6%) – 6 (6%) 

Communication is professional and respectful to colleagues. 

 

Response to faculty questions are fully answered, if posed. 

 

Provides clear, concise opinions and ideas that are supported by two or more credible sources. 

 

Response is effectively written in Standard, Edited English. 

5 (5%) – 5 (5%) 

Communication is mostly professional and respectful to colleagues. 

 

Response to faculty questions are mostly answered, if posed. 

 

Provides opinions and ideas that are supported by few credible sources. 

 

Response is written in Standard, Edited English. 

4 (4%) – 4 (4%) 

Response posed in the Discussion may lack effective professional communication. 

 

Response to faculty questions are somewhat answered, if posed. 

 

Few or no credible sources are cited. 

0 (0%) – 3 (3%) 

Responses posted in the Discussion lack effective communication. 

 

Response to faculty questions are missing. 

 

No credible sources are cited. 

First Response: 

Timely and full participation  

5 (5%) – 5 (5%) 

Meets requirements for timely, full, and active participation. 

 

Posts by due date. 

4 (4%) – 4 (4%) 

Meets requirements for full participation. 

 

Posts by due date. 

3 (3%) – 3 (3%) 

Posts by due date. 

0 (0%) – 2 (2%) 

Does not meet requirements for full participation. 

 

Does not post by due date. 

Second Response: 

Post to colleague’s main post that is reflective and justified with credible sources.  

9 (9%) – 9 (9%) 

Response exhibits critical thinking and application to practice settings. 

 

Responds to questions posed by faculty. 

 

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 

8 (8%) – 8 (8%) 

Response has some depth and may exhibit critical thinking or application to practice setting. 

7 (7%) – 7 (7%) 

Response is on topic, may have some depth. 

0 (0%) – 6 (6%) 

Response may not be on topic, lacks depth. 

Second Response: 

Writing  

6 (6%) – 6 (6%) 

Communication is professional and respectful to colleagues. 

 

Response to faculty questions are fully answered, if posed. 

 

Provides clear, concise opinions and ideas that are supported by two or more credible sources. 

 

Response is effectively written in Standard, Edited English. 

5 (5%) – 5 (5%) 

Communication is mostly professional and respectful to colleagues. 

 

Response to faculty questions are mostly answered, if posed. 

 

Provides opinions and ideas that are supported by few credible sources. 

 

Response is written in Standard, Edited English. 

4 (4%) – 4 (4%) 

Response posed in the Discussion may lack effective professional communication. 

 

Response to faculty questions are somewhat answered, if posed. 

 

Few or no credible sources are cited. 

0 (0%) – 3 (3%) 

Responses posted in the Discussion lack effective communication. 

 

Response to faculty questions are missing. 

 

No credible sources are cited. 

Second Response: 

Timely and full participation  

5 (5%) – 5 (5%) 

Meets requirements for timely, full, and active participation. 

 

Posts by due date. 

4 (4%) – 4 (4%) 

Meets requirements for full participation. 

 

Posts by due date. 

3 (3%) – 3 (3%) 

Posts by due date. 

0 (0%) – 2 (2%) 

Does not meet requirements for full participation. 

 

Does not post by due date. 

Total Points: 100 

Name: NURS_6630_Week7_Discussion_Rubric 

 

 

Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia 

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with psychosis and schizophrenia. 

To prepare for this Assignment: 

  • Review this week’s Learning Resources, including the Medication Resources indicated for this week. 
  • Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses. 

The Assignment: 5 pages 

Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. 

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. 

Introduction to the case (1 page) 

  • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. 

Decision #1 (1 page) 

  • Which decision did you select? 
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). 
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 

Decision #2 (1 page) 

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). 
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 

Decision #3 (1 page) 

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. 
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). 
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 

Conclusion (1 page) 

  • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. 

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature. 

 

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting. 

 

By Day 7 

Submit your Assignment.  

Submission and Grading Information 

To submit your completed Assignment for review and grading, do the following: 

  • Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name. 
  • Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment. 
  • Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area. 
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open. 
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. 
  • Click on the Submit button to complete your submission. 

Grading Criteria 

 

To access your rubric: 

Week 7 Assignment Rubric 

 

Check Your Assignment Draft for Authenticity 

 

To check your Assignment draft for authenticity: 

Submit your Week 7 Assignment draft and review the originality report. 

 

Submit Your Assignment by Day 7 of Week 7 

 

To participate in this Assignment: 

Week 7 Assignment 

 

 

What’s Coming Up in Week 8? 

 

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images 

Next week, you will continue to build on your assessment and treatment skills as you examine patients presenting with signs and symptoms consistent with sleep/wake disorders. 

Next Week 

 

To go to the next week: 

Week 8 

Rubric Detail 

  

Select Grid View or List View to change the rubric’s layout. 

 

Name: NURS_6630_Week7_Assignment_Rubric 

Grid View 

List View 

  Excellent 

 

Point range: 90–100 Good 

 

Point range: 80–89 Fair 

 

Point range: 70–79 Poor 

 

Point range: 0–69 

Introduction to the case (1 page) 

 

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.  

9 (9%) – 10 (10%) 

The response accurately, clearly, and fully summarizes in detail the case for the Assignment. 

 

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. 

8 (8%) – 8 (8%) 

The response accurately summarizes the case for the Assignment. 

 

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. 

7 (7%) – 7 (7%) 

The response inaccurately or vaguely summarizes the case for the Assignment. 

 

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. 

0 (0%) – 6 (6%) 

The response inaccurately and vaguely summarizes the case for the Assignment, or is missing. 

 

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. 

Decision #1 (1–2 pages) 

 

  • Which decision did you select?
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

18 (18%) – 20 (20%) 

The response accurately and clearly explains in detail the decision selected. 

 

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. 

 

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. 

 

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. 

 

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. 

 

Examples provided fully support the decisions and responses provided. 

16 (16%) – 17 (17%) 

The response accurately explains the decision selected. 

 

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. 

 

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. 

 

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. 

 

The response accurately explains how ethical considerations impact the treatment plan and communication with patients. 

 

Examples provided support the decisions and responses provided. 

14 (14%) – 15 (15%) 

The response inaccurately or vaguely explains the decision selected. 

 

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. 

 

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. 

 

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. 

 

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. 

 

Examples provided may support the decisions and responses provided. 

0 (0%) – 13 (13%) 

The response inaccurately and vaguely explains the decision selected. 

 

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. 

 

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. 

 

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. 

 

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. 

 

Examples provided do not support the decisions and responses provided, or is missing. 

Decision #2 (1–2 pages) 

 

  • Which decision did you select?
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

18 (18%) – 20 (20%) 

The response accurately and clearly explains in detail the decision selected. 

 

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. 

 

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. 

 

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. 

 

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. 

 

Examples provided fully support the decisions and responses provided. 

16 (16%) – 17 (17%) 

The response accurately explains the decision selected. 

 

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. 

 

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. 

 

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. 

 

The response accurately explains how ethical considerations impact the treatment plan and communication with patients. 

 

Examples provided support the decisions and responses provided. 

14 (14%) – 15 (15%) 

The response inaccurately or vaguely explains the decision selected. 

 

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. 

 

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. 

 

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. 

 

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. 

 

Examples provided may support the decisions and responses provided. 

0 (0%) – 13 (13%) 

The response inaccurately and vaguely explains in detail the decision selected. 

 

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. 

 

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. 

 

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. 

 

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. 

 

Examples provided do not support the decisions and responses provided, or is missing. 

Decision #3 (1–2 pages) 

 

  • Which decision did you select?
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

18 (18%) – 20 (20%) 

The response accurately and clearly explains in detail the decision selected. 

 

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. 

 

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. 

 

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. 

 

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. 

 

Examples provided fully support the decisions and responses provided. 

16 (16%) – 17 (17%) 

The response accurately explains the decision selected. 

 

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. 

 

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. 

 

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. 

 

The response accurately explains how ethical considerations impact the treatment plan and communication with patients. 

 

Examples provided support the decisions and responses provided. 

14 (14%) – 15 (15%) 

The response inaccurately or vaguely explains the decision selected. 

 

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. 

 

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. 

 

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. 

 

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. 

 

Examples provided may support the decisions and responses provided. 

0 (0%) – 13 (13%) 

The response inaccurately and vaguely explains in detail the decision selected. 

 

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. 

 

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. 

 

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. 

 

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. 

 

Examples provided do not support the decisions and responses provided, or is missing. 

Conclusion (1 page) 

 

  • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

14 (14%) – 15 (15%) 

The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient. 

 

The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. 

12 (12%) – 13 (13%) 

The response accurately summarizes the recommendations on the treatment options selected for this patient. 

 

The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. 

11 (11%) – 11 (11%) 

The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient. 

 

The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. 

0 (0%) – 10 (10%) 

The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing. 

 

The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing. 

Written Expression and Formatting – Paragraph Development and Organization: 

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.  

5 (5%) – 5 (5%) 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. 

 

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 

4 (4%) – 4 (4%) 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. 

 

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 

3.5 (3.5%) – 3.5 (3.5%) 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. 

 

Purpose, introduction, and conclusion of the assignment is vague or off topic. 

0 (0%) – 3 (3%) 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. 

 

No purpose statement, introduction, or conclusion were provided. 

Written Expression and Formatting – English writing standards: 

Correct grammar, mechanics, and proper punctuation  

5 (5%) – 5 (5%) 

Uses correct grammar, spelling, and punctuation with no errors. 

4 (4%) – 4 (4%) 

Contains a few (1 or 2) grammar, spelling, and punctuation errors. 

3.5 (3.5%) – 3.5 (3.5%) 

Contains several (3 or 4) grammar, spelling, and punctuation errors. 

0 (0%) – 3 (3%) 

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. 

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.  

5 (5%) – 5 (5%) 

Uses correct APA format with no errors. 

4 (4%) – 4 (4%) 

Contains a few (1 or 2) APA format errors. 

3.5 (3.5%) – 3.5 (3.5%) 

Contains several (3 or 4) APA format errors. 

0 (0%) – 3 (3%) 

Contains many (≥ 5) APA format errors. 

Total Points: 100 

Name: NURS_6630_Week7_Assignment_Rubric 

 

 

 

Case: An Elderly Widow Who Just Lost Her Spouse 

 

Name 

Institution 

Course 

Date 

 

Case: An Elderly Widow Who Just Lost Her Spouse 

The case study portrays a 75-year-old female patient presenting with a chief complaint of insomnia. She has a history of DM, HTN, and MDD. The patient’s husband passed away ten months ago. Since the husband’s demise, she states her depression has worsened and her sleep habits. She had no history of depression before her husband’s death. 

Three Questions I Might Ask the Patient  

  1. How has insomnia and depression affected your daily activities or interactions with people? The question will determine if the depressive symptoms have caused social and occupational dysfunction. 
  1. When did you begin experiencing insomnia? To determine if insomnia started after starting Sertraline since it is an adverse effect of the drug.  
  1. What is your current living status? The question will identify the persons currently living with the patient and her social support system. Living alone may be a cause of the depressive symptoms. 

People in the Patient’s Life I Would Need to Speak To 

Patient’s Primary Caregiver 

  1. Which activities of daily living have the patient had difficulties in carrying out in the past days?  The question will determine the impact of depression on the patient’s daily functioning. 
  1. Does the patient engage in activities that put her life at risk? To identify the presence of self-mutilating behaviors. 
  1. How have been your interactions with the patient in the past weeks? To determine whether the patient’s depression and insomnia have resulted in impaired interpersonal or social functioning.   

Physical Exams and Diagnostic Tests Appropriate For the Patient 

  1. Depression screening using the Patient Health Questionnaire (PHQ)-9. The PHQ-9 self-questionnaire will help rate the severity of the patient’s depression (Avasthi & Grover, (2018) 
  1. Hemoglobin A1c- To identify the mean glycemic level and establish whether the patient has achieved adequate glycemic control. 
  1. Cardiovascular Exam: To assess any abnormalities in the cardiovascular system, this can be caused by hypertension and diabetes mellitus.  
  1. Thyroid-stimulating Hormone Test to rule out Hypothyroidism, which presents with depression (Avasthi & Grover, (2018) 
  1. Mental Status Examination (MSE). An MSE will assess the patient’s affect, speech, memory, judgment, and cognition, which can be grossly affected by depression. 

Differential Diagnoses 

Major Depressive Disorder 

Major depressive disorder (MDD) is a mood condition marked by a depressed mood or diminished pleasure or interest in most pleasurable activities.  The DSM V diagnostic criteria require that a person presents with four other symptoms in addition to a depressed mood or diminished interest (APA, 2013). The symptoms are changes in appetite, weight changes, fatigue or low energy levels, sleeping difficulties, psychomotor agitation or retardation, reduced ability to concentrate and think or indecisiveness, feelings of worthlessness, and recurrent thoughts of death, suicidal ideations, or attempt (APA, 2013). MDD is a presumptive diagnosis based on the patient’s symptoms of worsening depression and insomnia. Besides, she has a history of MDD, which suggest a relapse of the disorder. 

Insomnia  

Insomnia is characterized by a continuous difficulty in initiating sleep, maintaining sleep, consolidation, or quality of sleep. Persons with insomnia present with difficulty falling asleep, frequent awakenings, or early morning awakening (APA, 2013). Persons with insomnia report dissatisfaction with quantity or quality of sleep. Insomnia is associated with daytime effects, such as fatigue, tiredness, lack of energy, irritability, reduced work performance, and difficulty concentrating (APA, 2013). Insomnia is a differential diagnosis based on the patient’s symptoms of difficulties in sleeping. Insomnia could be due to MDD, in which patients present with sleeping difficulties of insomnia or hypersomnia. Insomnia can also be attributed to the side effects of Sertraline.  

Persistent Complex Bereavement Disorder (PCBD) 

PCBD is a condition marked by unshakeable grief that does not follow the typical pattern of improvement over time. Persons continue to exhibit persistent and intense emotions or moods and unusual (APA, 2013). They also experience adverse symptoms that impair significant areas of functioning or cause extreme distress. Symptoms of PCBD include Indefinitely yearning for the deceased; A preoccupation with the events of the deceased’s death; Intense sorrow and distress that does not improve over time; Depression; Difficulty trusting others; Detachment and isolation (APA, 2013). In addition, one may experience difficulties pursuing interests or activities, persistent feelings of loneliness or emptiness, and impairment in occupational, social, and other areas of life (APA, 2013). PBCD is a differential diagnosis based on the patient’s report of depression and insomnia that has worsened since his husband’s death.  

Pharmacologic Agents Appropriate For The Patient’s Antidepressant Therapy 

  1. Fluoxetine (Prozac) 10 mg PO once daily. 

Prozac is an antidepressant belonging to the class of Selective serotonin reuptake inhibitors (SSRIs). SSRIs are indicated as first-line agents in uncomplicated depression owing to their few anticholinergic effects. Prozac is a preferred treatment choice in geriatric patients due to its fewer side effects (Avasthi & Grover, (2018). The dose will be gradually increased by 10-20 mg after four weeks based on the patient’s tolerance to the drug.  Contraindications for Prozac include hypersensitivity to the drug and concomitant administration of Pimozide or Thioridazine (Avasthi & Grover, (2018). According to Simon et al. (2015), African Americans have a worse response to SSRIs than Whites. If the patient were an African American, she would have a low response rate.  

  1. Duloxetine (Cymbalta) 30 mg PO once daily. 

Duloxetine is an antidepressant under the class of serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs are indicated as second-line agents in patients who have not responded to SSRIs (Muscatello et al., 2019). The patient will be started on a low dose of 30mg/day due to her advanced age. The dose will be increased after two weeks to a target dose of 60 mg/day. Contraindications for Duloxetine include concomitant administration of the drug with Monoamine oxidase inhibitors (MAOIs) prescribed to treat a psychiatric disorder (Muscatello et al., 2019). I would choose Prozac over Duloxetine since the former exerts no effect on cardiac conduction, heart rate, or blood pressure (Avasthi & Grover, (2018). It would thus be appropriate for this patient with HTN. 

Check Points 

After four weeks, I would evaluate the patient for improvement of depressive symptoms and insomnia. I would also assess for side effects. If there is a partial improvement of symptoms and no associated side effects with Prozac treatment, I will increase the dose to 20 mg per day. In week 8, I would assess for severity of depressive symptoms and compare them with the patient’s depression in the previous visit. If there is a partial improvement, I would increase the dose to 40 mg/day and monitor any side effects.  

 

References 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. 

Avasthi, A., & Grover, S. (2018). Clinical Practice Guidelines for Management of Depression in the Elderly. Indian journal of psychiatry, 60(Suppl 3), S341–S362. https://doi.org/10.4103/0019-5545.224474 

Muscatello, M., Zoccali, R. A., Pandolfo, G., Mangano, P., Lorusso, S., Cedro, C., Battaglia, F., Spina, E., & Bruno, A. (2019). Duloxetine in Psychiatric Disorders: Expansions Beyond Major Depression and Generalized Anxiety Disorder. Frontiers in psychiatry, 10, 772. https://doi.org/10.3389/fpsyt.2019.00772 

Simon, G. E., Coleman, K. J., Waitzfelder, B. E., Beck, A., Rossom, R. C., Stewart, C., & Penfold, R. B. (2015). Should measures of antidepressant treatment quality be adjusted for race and ethnicity?. JAMA psychiatry, 72(10), 1055.https://doi.org/10.1001/jamapsychiatry.2015.1437