Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders

 

Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders. The Assignment: 5 pages

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. 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.

 

Insomnia

31-year-old Male

BACKGROUND

 

This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia.

 

 

 

 

CASE STUDY

 

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient’s medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.

 

 

MENTAL STATUS EXAM

 

The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.

 

 

Decision Point One

Select what you should do:

 

Zolpidem: 10 mg daily at bedtime

Trazodone: 50–100 mg daily at bedtime

Hydroxyzine: 50 mg daily at bedtime

 

 

Decision Point One

 

 

Zolpidem: 10 mg daily at bedtime

RESULTS OF DECISION POINT ONE

 

Patient returns to clinic in 2 weeks.

Patient states the medication “knocked him out” but felt he slept well.

His new girlfriend was concerned as he woke up in the middle of the night and cooked breakfast, yet the patient has no recollection of the occurrence.

Patient states that the medication helps him sleep especially well when taken with a beer right before bedtime. Patient denies auditory/visual hallucinations and is future oriented.

Decision Point Two

 

 

Decrease zolpidem to 5 mg daily at bedtime

RESULTS OF DECISION POINT TWO

 

Patient returns to clinic in 2 weeks.

Patient states his episodes of “nighttime activity” has greatly decreased.

His girlfriend told him that one time in the 2 weeks he got up and was getting ready to go for a drive.

Patient denies auditory/visual hallucinations and is future oriented.

Patient states that he likes the way the zolpidem helps him sleep and “is good with continuing to take it if most of the time I sleep through the night undisturbed.”

Decision Point Three

 

 

Maintain dose. Patient to return in 4 weeks for follow up appointment

Guidance to Student

Zolpidem is a medication that has a host of negative side effects. It should not be the first choice of therapy due to these side effects. Caution must be exercised if prescribing this medication to a patient. The patient should be instructed not to mix the medication with alcohol or any other medication unless first speaking with their provider.

 

In this case, the patient is experiencing complex sleep behavior. It is prudent as the patient’s healthcare provider to discontinue this medication and prescribe something different.

 

Trazodone is a selective serotonin reuptake inhibitor that is a much safer choice. In adults you will want to start with 50mg at bedtime and titrate up as needed.

 

Decision Point One

 

 

Zolpidem: 10 mg daily at bedtime

RESULTS OF DECISION POINT ONE

 

Patient returns to clinic in 2 weeks.

Patient states the medication “knocked him out” but felt he slept well.

His new girlfriend was concerned as he woke up in the middle of the night and cooked breakfast, yet the patient has no recollection of the occurrence.

Patient states that the medication helps him sleep especially well when taken with a beer right before bedtime. Patient denies auditory/visual hallucinations and is future oriented.

Decision Point Two

 

 

Discontinue zolpidem. Initiate therapy with eszopiclone 1 mg daily at bedtime

RESULTS OF DECISION POINT TWO

 

Patient returns to clinic in 2 weeks

Patient states the eszopiclone really helps with sleep

Patient states he takes it approximately 2 hours prior to sleep, and it makes him feel good until the point he passes out

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

 

 

Continue dose. Instruct patient medication is to be taken 30 minutes prior to bed. Follow up in 4 weeks

Guidance to Student

Eszopiclone is a medication that has a host of negative side effects. It should not be the first or even second choice of therapy due to these side effects. Caution must be exercised if prescribing this medication to a patient. The patient should be instructed not to mix the medication with alcohol or any other medication unless first speaking with their provider. In this case, the patient is experiencing euphoria to the point of becoming unconscious. It is prudent as the patient’s healthcare provider to discontinue this medication and prescribe something different. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia. Trazodone is a selective serotonin reuptake inhibitor that is a much more effective choice. In adults you will want to start with 50mg at bedtime and titrate up as needed.

 

Decision Point One

 

 

Zolpidem: 10 mg daily at bedtime

RESULTS OF DECISION POINT ONE

 

Patient returns to clinic in 2 weeks.

Patient states the medication “knocked him out” but felt he slept well.

His new girlfriend was concerned as he woke up in the middle of the night and cooked breakfast, yet the patient has no recollection of the occurrence.

Patient states that the medication helps him sleep especially well when taken with a beer right before bedtime. Patient denies auditory/visual hallucinations and is future oriented.

Decision Point Two

 

 

Discontinue zolpidem. Initiate therapy with trazodone 50–100 mg daily at bedtime

RESULTS OF DECISION POINT TWO

 

Patient returns to clinic in 2 weeks

Patient states trazodone is effective at 50 mg dose but sometimes wakes up following day with next-day drowsiness

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

 

 

Continue dose. Explain to patient he may split the 50 mg tablet in half. The decreased dose should minimize next day drowsiness. Follow up in 4 weeks

Guidance to Student

Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. It would not be prudent to prescribe sonata as it carries with it the risk of complex sleep behaviors.

 

Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia.

 

The patient is presenting with excessive somnolence. It would be prudent to reduce the dose of trazodone by 50% and reassess in 4 weeks.

 

Trazodone: 50–100 mg daily at bedtime

RESULTS OF DECISION POINT ONE

 

Patient returns to clinic in 2 weeks

Patient states medication works well but gives him an unpleasant side effect of a prolonged erection of the penis, approximately 15 minutes after waking

Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Two

 

 

Explain that priapism is a side effect of trazodone that should diminish over time. Continue dose

RESULTS OF DECISION POINT TWO

 

Patient returns to clinic in 2 weeks

Patient states priapism has diminished over time

Patient denies auditory/visual hallucinations and is future oriented

Patient states trazodone is effective at 50 mg dose but sometimes wakes up following day with next-day drowsiness

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

 

 

Discontinue trazodone. Initiate therapy with sonata 10 mg nightly at bedtime. Follow up in 4 weeks

Guidance to Student

Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. It would not be prudent to prescribe sonata as it carries with it the risk of complex sleep behaviors. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia.

 

The patient is presenting with excessive somnolence. It would be prudent to reduce the dose of trazodone by 50% and reassess in 4 weeks.

 

Decision Point One

 

 

Trazodone: 50–100 mg daily at bedtime

RESULTS OF DECISION POINT ONE

 

Patient returns to clinic in 2 weeks

Patient states medication works well but gives him an unpleasant side effect of a prolonged erection of the penis, approximately 15 minutes after waking

Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Two

 

 

Discontinue trazodone. Initiate therapy with suvorexant 10 mg daily at bedtime

RESULTS OF DECISION POINT TWO

 

Patient returns to clinic in 2 weeks

Patient states suvorexant works well for sleep but leaves him with an awful next-day feeling, and “it’s very difficult to get out of bed.”

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

 

 

Discontinue suvorexant. Initiate therapy with hydroxyzine 50 mg nightly at bedtime. Follow up in 4 weeks

Guidance to Student

Next day drowsiness is a common side effect of suvorexant. This would be a major concern as it can affect the patient’s ability to perform daily activities such as driving or going to work. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia. The patient is presenting with excessive somnolence from the suvorexant. It would be prudent to discontinue therapy and initiate trazodone for insomnia, reassessing in 4 weeks.

 

Decision Point One

 

 

Trazodone: 50–100 mg daily at bedtime

RESULTS OF DECISION POINT ONE

 

Patient returns to clinic in 2 weeks

Patient states medication works well but gives him an unpleasant side effect of a prolonged erection of the penis, approximately 15 minutes after waking

Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Two

 

 

Decrease trazodone to 25 mg daily at bedtime

RESULTS OF DECISION POINT TWO

 

Patient returns to clinic in 2 weeks

Patient states trazodone is very effective for sleep

Patient states sometimes the 25 mg dosage isn’t quite enough to help him sleep through the night

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

 

 

Discontinue trazodone. Initiate therapy with hydroxyzine 50 mg nightly at bedtime. Follow up in 4 weeks

Guidance to Student

Since the patient is already showing a partial response from trazodone, it may not be prudent to switch therapy. A thorough sleep hygiene analysis should always be performed prior to initiation of pharmacotherapy as well as at reassessments. If you find the patient isn’t practicing proper sleep hygiene, you may continue the dose and encourage sleep hygiene. If the patient is practicing good sleep hygiene, you may consider discontinuing trazodone and initiating hydroxyzine. Although there are some negative side effects associated with hydroxyzine such as Xerostomia and Xerophthalmia, it is still a safer medication to prescribe than ramelteon.

 

Decision Point One

 

 

Hydroxyzine: 50 mg daily at bedtime

RESULTS OF DECISION POINT ONE

 

Patient returns to clinic in 2 weeks

Patient states medication helps with sleep but leaves a similar next-day feeling to what the patient experienced with diphenhydramine

Patient also states his mouth and eyes are extremely dry in the morning

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Two

 

 

Discontinue hydroxyzine. Initiate therapy with temazepam 15 mg daily at bedtime

RESULTS OF DECISION POINT TWO

 

Patient returns to clinic in 2 weeks

Patient states temazepam really helps with sleep and makes him feel great when he washes it down with a beer

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

 

 

Discontinue temazepam. Initiate therapy with trazodone 50–100 mg nightly at bedtime. Follow up in 4 weeks

Guidance to Student

The mixture of alcohol and benzodiazepines is one that can result in respiratory depression and death. It would be prudent to discontinue any benzodiazepines your patient is on if you are aware, or even have a suspicion, that the patient consumes alcohol. The mixture of hypnotics and alcohol can also cause respiratory depression and death. Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. Alcohol counseling should also be discussed with the patient to rule out any issues.

Decision Point One

 

 

Hydroxyzine: 50 mg daily at bedtime

RESULTS OF DECISION POINT ONE

 

Patient returns to clinic in 2 weeks

Patient states medication helps with sleep but leaves a similar next-day feeling to what the patient experienced with diphenhydramine

Patient also states his mouth and eyes are extremely dry in the morning

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Two

 

 

Decrease dose of hydroxyzine to 25 mg daily at bedtime

RESULTS OF DECISION POINT TWO

 

Patient returns to clinic in 2 weeks

Patient states the decrease in dose has helped with the dry eyes, however he is still not sleeping great

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

 

 

Continue dose. Counsel patient that once his body adjusts to medication more, it should help with insomnia. Follow up in 4 weeks

Guidance to Student

Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia. Trazodone is a selective serotonin reuptake inhibitor that is a much more effective choice. In adults you will want to start with 50mg at bedtime and titrate up as needed. The addition of diphenhydramine would augment the anticholinergic properties of the hydroxyzine that the patient is currently experiencing.

 

Decision Point One

 

 

Hydroxyzine: 50 mg daily at bedtime

RESULTS OF DECISION POINT ONE

 

Patient returns to clinic in 2 weeks

Patient states medication helps with sleep but leaves a similar next-day feeling to what the patient experienced with diphenhydramine

Patient also states his mouth and eyes are extremely dry in the morning

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Two

 

 

Decrease dose of hydroxyzine to 25 mg daily at bedtime

RESULTS OF DECISION POINT TWO

 

Patient returns to clinic in 2 weeks

Patient states the decrease in dose has helped with the dry eyes, however he is still not sleeping great

Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

 

 

Continue dose. Instruct patient to augment with diphenhydramine 25 mg nightly at bedtime, as needed. Follow up in 4 weeks

Guidance to Student

Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia. Trazodone is a selective serotonin reuptake inhibitor that is a much more effective choice. In adults you will want to start with 50mg at bedtime and titrate up as needed. The addition of diphenhydramine would augment the anticholinergic properties of the hydroxyzine that the patient is currently experiencing.

 

 

 

 

 

​Rubric Detail

 

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

 

​Name: NURS_6630_Week8_Assignment2_Rubric

 

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_Week8_Assignment2_Rubric

 

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