​Assignment: Assessing and Treating Patients With ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.

​

​The Assignment: 5 pages

Examine Case Study: A Young Caucasian Girl with ADHD. 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.

 

Attention Deficit Hyperactivity Disorder

A Young Girl With ADHD

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.

The parents give you a copy of a form titled â€œConner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

 

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

 

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

Decision Point One

Select what you should do:

 

Begin Wellbutrin (bupropion) XL 150 mg orally daily

Begin Intuniv extended release 1 mg orally at BEDTIME

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNINGDecision Point One

 

 

Begin Wellbutrin (bupropion) XL 150 mg orally daily

RESULTS OF DECISION POINT ONE

 

Client returns to clinic in four weeks

Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks

Decision Point Two

 

 

Educate the parents that Bupropion sometimes causes suicidal ideation in children and that this is normal, and re-start the drug at the previous dose

RESULTS OF DECISION POINT TWO

 

Client returns to clinic in four weeks

Katie’s parents again report that after about a week of treatment with the Bupropion, Katie began telling her parents that she wanted to hurt herself and began having dreams about being dead. This scared her parents and they stopped giving her the medication

At this point, they are quite upset with the results of their daughter’s treatment and are convinced that medication is not the answer

Decision Point Three

 

 

Refer the parents to a pediatric psychologist who can use behavioral therapy to treat Katie’s ADHD

Guidance to Student

Bupropion is used off-label for ADHD and is used more commonly in adults. It’s mechanism of action results in increasing the neurotransmitters norepinephrine/noradrenaline and dopamine. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex, (which largely lacks dopamine transporters) bupropion can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Bupropion as well as other antidepressants have been linked to suicidal ideation in children and adolescents- despite the fact that it was being used initially to treat ADHD, it is still an antidepressant.

 

At this point, the parents are probably quite frustrated as no parent wants to hear their child talking about hurting themselves or having dreams about being dead. If the parents are adamant about no more medications, referral to a pediatric psychologist or similar therapist skilled in the use of behavioral therapies to treat ADHD in children. However, it should be noted that behavioral therapies work best when combined with medication, however, if the parents are insistent, then behavioral therapy may be the only alternative left in the treatment of Katie.

 

In terms of the pathophysiology of ADHD, whereas it may be true that increasing age may demonstrate some improvement in symptoms (some people will actually experience complete resolution of symptoms by adulthood), it is not helping Katie in the here and now. Katie still needs help with her symptoms which are causing academic issues.

 

You should attempt to repair the rupture in the therapeutic alliance (the parents now believe that medications are not the answer) by explaining rationale for the use of Bupropion (many people like to start with Bupropion because it has a low-risk for addiction). The family should be encouraged to allow you to initiate Adderall as it has a very good track record in terms of its efficacy in treating ADHD.

Decision Point One

 

 

Begin Wellbutrin (bupropion) XL 150 mg orally daily

RESULTS OF DECISION POINT ONE

 

Client returns to clinic in four weeks

Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks

Decision Point Two

 

 

Discontinue Wellbutrin and begin Strattera (atomoxetine) 10 mg orally daily

RESULTS OF DECISION POINT TWO

 

Client returns to clinic in four weeks

Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are getting a bit better

They are very concerned, however, about Katie’s decreased appetite. They say that Katie was never a “big eater” but have become concerned that her appetite has worsened

Decision Point Three

 

 

Discontinue Strattera and begin Intuniv extended release, 1 mg orally daily

Guidance to Student

Wellbutrin is used off-label for ADHD but is used more commonly in adults. Its mechanism of action results in increasing the neurotransmitters norepinephrine/noradrenaline and dopamine. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex (which largely lacks dopamine transporters), Wellbutrin can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Wellbutrin, as well as other antidepressants, has been linked to suicidal ideation in children and adolescents. Despite the fact that it is being used to treat ADHD, it is still an antidepressant.

 

After discontinuing the Wellbutrin and beginning Strattera (atomoxetine), a decrease in symptoms was noted by Katie’s teacher. This indicates that the drug is working. However, the parents are concerned about Katie’s decreased appetite. This side effect may improve with the passage of time, but you will need to monitor it. Keep in mind that if you decides to increase the dose at this point, the side effects may worsen. Additionally, Strattera can take up to 8 to 12 weeks to demonstrate the full therapeutic actions of the drug; therefore, it may be prudent at this point to maintain the current dose.

The development of common side effects are not an indication to discontinue one drug and begin a different medication unless they are severe enough to warrant intervention (i.e., they are severe or incapacity for the individual); therefore, it would not be appropriate to discontinue Strattera and begin Intuniv.

 

Decision Point One

 

 

Begin Intuniv extended release 1 mg orally at BEDTIME

RESULTS OF DECISION POINT ONE

 

Client returns to clinic in four weeks

Katie’s teacher reports no change in her classroom behaviors

Katie’s parents are reporting that Katie has become “impossible” to wake in the morning and that for the first few hours of the day, she seems “sluggish”

Decision Point Two

 

 

Discontinue Intuniv and begin Dexedrine (dextroamphetamine) 5 mg orally daily

RESULTS OF DECISION POINT TWO

 

Client returns to clinic in four weeks

Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are better, but that she can be a bit “hyper” at times. Katie’s parents report that Katie is sometimes too “wound up” to go to bed and bedtime has become a “difficult” time in the house

Katie’s parents are also concerned about her appetite, which has decreased since beginning the Dexedrine. They say that Katie was never a “big eater” but have become concerned that her appetite has worsened

Decision Point Three

 

 

Increase Dexedrine to 10 mg extended release

Guidance to Student

Dexedrine can cause agitation and overstimulation, which may explain Katie’s being “hyper” behaviors in the classroom. You should assess the time of day that parents administer the medication as long-acting stimulants should be given in the morning as opposed to afternoon as afternoon administration could impact sleep. Normal side effects of Dexedrine use include decreased appetite. If Katie is experiencing these side effects with just 5 mg daily, it would be expected that side effects may worsen at 10 mg daily.

 

Concerta may be an appropriate choice, as other stimulant classes should be tried before moving to second-line treatments (such as Strattera). If Katie demonstrates similar side effects to Concerta, then a second-line agent may be considered.

Decision Point One

 

 

Begin Intuniv extended release 1 mg orally at BEDTIME

RESULTS OF DECISION POINT ONE

 

Client returns to clinic in four weeks

Katie’s teacher reports no change in her classroom behaviors

Katie’s parents are reporting that Katie has become “impossible” to wake in the morning and that for the first few hours of the day, she seems “sluggish”

Decision Point Two

 

 

Discontinue Intuniv and begin Focalin (dexmethylphenidate) XR 10 mg orally daily

RESULTS OF DECISION POINT TWO

 

Client returns to clinic in four weeks

Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better, and that her academic performance has improved considerably

Katie’s parents are very concerned, however, about Katie’s decreased appetite. They say that Katie was never a “big eater” but have become concerned that her appetite has worsened

Decision Point Three

 

 

Discontinue Focalin XR and begin Strattera (atomoxetine) 10 mg orally daily

Guidance to Student

Focalin XR [Methylphenidate (d)] is a first line agent with strong evidence of efficacy in ADHD. Side effects such as decreased appetite are not unusual with stimulant medications. The side effect may not have been as pronounced with a starting dose of 5 mg daily, but since she was started on 10 mg daily, the most prudent course of action from the available choices would be to maintain the current dose of Focalin XR until the next visit in 4 weeks. At that time, appetite should be assessed. No action will be required if it stabilizes or improves. However, worsening of appetite may herald the need to decrease to 5 mg orally daily.

 

Increasing the dose to 20 mg orally daily would not be appropriate as it may increase the side effects- and since there is evidence of good efficacy at the 10 mg, there is no clinical indication to increase the dose (recall that with stimulants, you always want to use the smallest effective dose).

 

Common side effects are not an indication to discontinue the drug and begin a different medication, therefore, it would not be appropriate to discontinue Focalin XR and begin Strattera at this time.

Decision Point One

 

 

Begin Intuniv extended release 1 mg orally at BEDTIME

RESULTS OF DECISION POINT ONE

 

Client returns to clinic in four weeks

Katie’s teacher reports no change in her classroom behaviors

Katie’s parents are reporting that Katie has become “impossible” to wake in the morning and that for the first few hours of the day, she seems “sluggish”

Decision Point Two

 

 

Increase Intuniv to 2 mg orally at BEDTIME

RESULTS OF DECISION POINT TWO

 

Client returns to clinic in four weeks

katie’s parents report that Katie is even more sedate and has been refusing to get out of bed in the morning. Her teacher reports that she has gone from being a “daydreamer” in class to being on the “verge of falling asleep.”

Katie’s parents state that there were two instances where Katie fell asleep on the school bus on her way to school in the morning prompting the school nurse to call Katie’s parents

Decision Point Three

 

 

Maintain current dose of Intuniv

Guidance to Student

Intuniv is a nonstimulant medication used in the treatment of ADHD. It is generally used to treat the oppositional behaviors associated with ADHD. Although less sedating that clonidine, Intuniv can be quite sedating. Whereas you can definitely improve symptoms by decreasing the dose, it is clear that after 4 weeks of therapy Katie is experiencing sedation with no real improvement in attention. However, decreasing the drug to 1 mg at bedtime and evaluating the effect may be considered. Clearly, the current dose of Intuniv cannot be maintained as it is having a negative impact on Katie’s academic performance and quality of life.

 

Although Strattera a second-line agent, the most appropriate course of action would be to discontinue Intuniv at this point and begin Strattera 10 mg orally daily, as this drug primarily targets attention span and concentration and is not associated with the same levels of sedation as Intuniv.

Decision Point One

 

 

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

RESULTS OF DECISION POINT ONE

 

Client returns to clinic in four weeks

Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again

Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute

Decision Point Two

 

 

Continue same dose of Ritalin and re-evaluate in 4 weeks

RESULTS OF DECISION POINT TWO

 

Client returns to clinic in four weeks

Katie’s academic performance is still improved, but her attention continues to worsen throughout the school day

Katie is still reporting that her heart feels “funny.” Today’s pulse rate is 122 beats per minute, regular rhythm

Decision Point Three

 

 

Change to Ritalin LA 20 mg orally daily in the morning

Guidance to Student

Ritalin LA would be a good choice in this case as the side effect of tachycardia could be related to the immediate release Ritalin. There is no indication for a STAT EKG unless Katie’s pulse were irregular or there were other signs of cardiac abnormality noted. Discontinuation of immediate release Ritalin in favor of immediate release Adderall would be of questionable benefit, and may be associated with the same side effect. Additionally, immediate release preparations will not last throughout the school day to maintain Katie’s attention.

Decision Point One

 

 

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

RESULTS OF DECISION POINT ONE

 

Client returns to clinic in four weeks

Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again

Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute

Decision Point Two

 

 

Change to Ritalin LA 20 mg orally daily in the MORNING

RESULTS OF DECISION POINT TWO

 

Client returns to clinic in four weeks

Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day

Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit

Decision Point Three

 

 

Increase Ritalin LA to 30 mg orally daily

Guidance to Student

At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.

Decision Point One

 

 

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

RESULTS OF DECISION POINT ONE

 

Client returns to clinic in four weeks

Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again

Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute

Decision Point Two

 

 

Discontinue Ritalin and begin Adderall XR 15 mg orally daily

RESULTS OF DECISION POINT TWO

 

Client returns to clinic in four weeks

Katie’s academic performance is still improved, and the XR preparation has helped sustain her attention throughout the school day, however, you also learn that Katie is having tachycardia with this medication, too

Decision Point Three

 

 

Discontinue Adderall XR and begin Strattera 10 mg orally daily

Guidance to Student

Adderall XR should be initiated at 10 mg orally daily and increased by 5–10 mg/day at weekly intervals; maximum dose generally 30 mg/day. Tachycardia is one of the side effects of Adderall, and may be worse because it was started at a higher dose. You should decrease the dose to 10 mg orally daily and re-evaluate at the next office visit.

 

Continuing the same dose will most likely not significantly improve the side effect of tachycardia, so maintaining the current dose of medication would not be prudent as Katie may refuse to take the medication if it causes unpleasant side effects.

 

There is no indication to move to a second line agent at this point due to a side effect which may be caused by a high starting dose of medication.

 

​Rubric Detail

 

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

 

​Name: NURS_6630_Week9_Assignment_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_Week9_Assignment_Rubric

 

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