NURS 6630 Week 2 Discussion Foundational Neuroscience

NURS 6630 Week 2 Discussion Foundational Neuroscience

Agonist-to-antagonist Spectrum of Psychopharmacologic Agents

A medicine or substance that binds to and activates a specific receptor to create a desired biological response is known as an agonist. Exogenous agonists are substances that imitate the activities of endogenous agonists. Endogenous agonists are those created within the body, whereas exogenous agonists are those synthesized outside of the body. Agonists are divided into three types based on their intrinsic efficacy: full agonists, partial agonists, and inverse agonists.

A complete agonist has a high intrinsic effectiveness, which means it activates all receptors to their maximum potential, resulting in the maximum expected response. A partial agonist has a lower intrinsic efficacy than a full agonist, which results in sub-maximal receptor activation and a reduced physiological response. Despite binding to the same receptor location as the agonist, an inverse agonist has a negative intrinsic effectiveness because it causes a physiological response that is antagonistic or opposite to the agonist (Berg & Clarke, 2018). An antagonist, unlike an agonist, has no intrinsic efficacy but has a high affinity for receptors and inhibits the effects of agonists. Depending on the drug’s intrinsic activity and affinity, the agonist-to-antagonist spectrum has consequences for the choice of psychopharmacological drugs.

Comparison Of G Couple Proteins And Ion Gated Channels

G protein-coupled receptors GPCRs and ion gated channels (IGCs) are receptors that are usually activated by stimuli to mediate cellular responses. GPRCs are more numerous than IGCs and function through second messenger networks. The activation of these receptors by ligands enables them to bind to G-proteins, which promote the exchange of GTP for GDP, resulting in a cascade of activities that induce a cellular response (Weis et al., 2018). IGCs are transmembrane proteins with a central pore that opens and closes to regulate ion flow across cell membranes (Phillips et al., 2020). Due to the coupling, GPCRs respond to signals more slowly and are activated by slower neurotransmitters like serotonin. Faster neurotransmitters, such as acetylcholine, activate IGCs, resulting in a faster response.

Role Of Epigenetics In Pharmacologic Action

Epigenetics is increasingly being adopted in the development of therapeutic pharmacological agents. In epigenetics, DNA methylation or histone modification regulate DNA transcription without inflicting any changes to the DNA sequence (Kringel et al., 2021). Through conformational changes in transcription factors, this results in enhanced or decreased transcription of the target genes or exposure of desired regions of the DNA. As a result, drugs targeting specific genes that contribute to the genesis of numerous diseases, including psychiatric illnesses, can be produced. However, the efficacy of these therapeutic epigenetic pharmacologic agents, as well as expected responses, may be dependent on the existence or modification of the target genes among individuals; so, diversity is to be expected.

Impact of the Above Information on Prescription of Medications to Patients

Given the foregoing, it is critical to understand an individual’s genetic background prior to treatment. This is due to the fact that some genes are heritable, which is most typically seen in the medical environment as a positive family history of a particular sickness. As a result, obtaining a complete medical and family history before to treatment is critical. In the case of multiple therapy failures, genetic testing should be considered. Epigenetics is influenced by genetic and environmental variables; thus, medical professionals must be aware of this. Similar conditions in twins, for example, may not respond to treatment in the same way, necessitating the need to tailor care.

NURS 6630 Week 2 Discussion Foundational Neuroscience References

Berg, K., & Clarke, W. (2018). Making Sense of Pharmacology: Inverse Agonism and Functional Selectivity. International Journal Of Neuropsychopharmacology, 21(10), 962-977. https://doi.org/10.1093/ijnp/pyy071

Kringel, D., Malkusch, S., & Lötsch, J. (2021). Drugs and Epigenetic Molecular Functions. A Pharmacological Data Scientometric Analysis. International Journal Of Molecular Sciences, 22(14), 7250. https://doi.org/10.3390/ijms22147250

Phillips, M., Nigam, A., & Johnson, J. (2020). The interplay between Gating and Block of Ligand-Gated Ion Channels. Brain Sciences, 10(12), 928. https://doi.org/10.3390/brainsci10120928

Weis, W. I., & Kobilka, B. K. (2018). The Molecular Basis of G Protein-Coupled Receptor Activation. Annual Review of Biochemistry, 87, 897–919. https://doi.org/10.1146/annurev-biochem-060614-033910

Also read:

NURS 6630 Week 9 A Young Girl With ADHD

NURS 6630 Week 2 Explain the Agonist-to-Antagonist Spectrum of Action of Psychopharmacologic Agents

NURS 6630 WEEK 1 ASSIGNMENT 2 – SHORT ANSWER ASSESSMENT

As a psychiatric and mental health nurse practitioner, before you can recommend potential pharmacotherapeutics to address a patient’s condition or disorder, you must understand the basic function and structure of the neuron and central nervous system. For this Assignment, you will review and apply your understanding of neuroanatomy by addressing a set of short answer prompts.

To Prepare:

Review the Learning Resources for this week in preparation to complete this Assignment.

Reflect on the basic function and structure of the neuron in relation to the central nervous system.

Reflect on the inter-connectedness between neurons and the central nervous system, including the pathway and distribution of electrical impulses.

Reflect on how neurons communicate with each other and review the concept of neuroplasticity.

TO COMPLETE:

Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous system, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples.

Answer the following (listing is acceptable for these questions):
What are the major components that make up the subcortical structures?
Which component plays a role in learning, memory, and addiction?
What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?
In 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples.
The synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.
In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

BY DAY 7

Submit your Assignment. 

SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area. 

To submit your completed assignment, save your Assignment as WK1Assgn2_LastName_Firstinitial
Then, click on Start Assignment near the top of the page.
Next, click on Upload File and select Submit Assignment for review.

LEARNING RESOURCES

Required Readings (MUST BE CITED)

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
Chapter 1, “Chemical Neurotransmission”  (pp. 1-28)
Required Media
Psychopharmacologic Approaches to Treatment of Psychopathology (3m)
Mental Health TV. (2022, Oct 7).  Psychopharmacology-Module one. [Video]. YouTube. https://www.youtube.com/watch?v=Ku8PZlXAYco
Mental Health TV. (2022, Oct 7).  Psychopharmacology-Module two. [Video]. YouTube. https://www.youtube.com/watch?v=jw9uc4qVqew
Mental Health TV. (2022, Oct 7).  Psychopharmacology-Module three. [Video]. YouTube. https://www.youtube.com/watch?v=xLGfB3E4rqE&t=538s

Optional Media

Pathopharmacology: Disorders of the Nervous System: Exploring the Human Brain
Dr. Norbert Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain. (15m)

Introduction to Advanced Pharmacology

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse. (6m)

Rubric – NURS_6630_Week1_Assignment_Rubric

NURS_6630_Week1_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeIn 4 or 5 sentences, describe the anatomy of the basic unit of the nervous system, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples.
13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly describes in detail the anatomy of the neuron. The response accurately and clearly describes in detail each part of the neuron, and it includes a detailed explanation of the general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse…. Examples fully support the response provided.
11 to >10.0 pts
Good Point range: 80–89
The response accurately describes the anatomy of the neuron. The response accurately describes each part of the neuron, and it includes a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse…. Examples support the response provided.
10 to >9.0 pts
Fair Point range: 70–79
The response provides an inaccurate or vague description of the anatomy of the neuron. The response inaccurately or vaguely describes each part of the neuron, and it includes an inaccurate or vague overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse…. Examples vaguely support the response provided.
9 to >0 pts
Poor Point range: 0–69
The response provides an inaccurate or incomplete description of the anatomy of the neuron, or is missing. The response inaccurately or incompletely describes each part of the neuron, and it includes an inaccurate or vague overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse, or is missing…. Examples do not support the response provided, or is missing.
13 pts
This criterion is linked to a Learning OutcomeAnswer the following (listing is acceptable for these questions):a. What are the major components that make up the subcortical structures?b. Which component plays a role in learning, memory, and addiction?c. What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?
13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly details the major components that make up the subcortical structures…. The response accurately and clearly details which component plays a role in learning, memory, and addiction…. The response accurately and clearly identifies the two neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control.
11 to >10.0 pts
Good Point range: 80–89
The response accurately identifies the major components that make up the subcortical structures…. The response accurately identifies which component plays a role in learning, memory, and addiction…. The response accurately identifies the two neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control.
10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately identifies the major components that make up the subcortical structures…. The response inaccurately identifies which component plays a role in learning, memory, and addiction…. The response inaccurately identifies two neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control.
9 to >0 pts
Poor Point range: 0–69
The response inaccurately and incompletely identifies the major components that make up the subcortical structures, or is missing…. The response inaccurately and incompletely identifies which component plays a role in learning, memory, and addiction, or is missing…. The response inaccurately and incompletely identifies two neurotransmitters in the nigra striatal region of the brain that play a major role in motor control, or is missing.
13 pts
This criterion is linked to a Learning OutcomeIn 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples.
13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly explains in detail how glia cells function in the central nervous system…. Examples fully support the response provided.
11 to >10.0 pts
Good Point range: 80–89
The response accurately explains how glia cells function in the central nervous system…. Examples support the response provided.
10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely explains how glia cells function in the central nervous system…. Examples inaccurately or vaguely support the response provided.
9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely explains how glia cells function in the central nervous system, or is missing…. Examples do not support the response provided, or is missing.
13 pts
This criterion is linked to a Learning OutcomeThe synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.
13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly explains in detail the part of the neurons that communicate with each other and the direction in which this communication occurs.
11 to >10.0 pts
Good Point range: 80–89
The response accurately explains the part of the neurons that communicate with each other and the direction in which this communication occurs.
10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely explains the part of the neurons that communicate with each other and the direction in which this communication occurs.
9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely explains the part of the neurons that communicate with each other and the direction in which this communication occurs, or is missing.
13 pts
This criterion is linked to a Learning OutcomeIn 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples.
13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly explains in detail the concept of neuroplasticity…. Examples provided fully support the response provided.
11 to >10.0 pts
Good Point range: 80–89
The response accurately explains the concept of neuroplasticity…. Examples provided support the response provided.
10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely explains the concept of neuroplasticity…. Examples inaccurately or vaguely support the response provided.
9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely explains the concept of neuroplasticity, or is missing…. Examples do not support the response provided, or is missing.
13 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 pts
Excellent Point range: 90–100
Uses correct grammar, spelling, and punctuation with no errors.
4 to >3.5 pts
Good Point range: 80–89
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3.5 to >2.0 pts
Fair Point range: 70–79
Contains several (3 or 4) grammar, spelling, and punctuation errors.
2 to >0 pts
Poor Point range: 0–69
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning OutcomeWritten 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 to >4.0 pts
Excellent Point range: 90–100
Uses correct APA format with no errors.
4 to >3.5 pts
Good Point range: 80–89
Contains a few (1 or 2) APA format errors.
3.5 to >2.0 pts
Fair Point range: 70–79
Contains several (3 or 4) APA format errors.
2 to >0 pts
Poor Point range: 0–69
Contains many (≥ 5) APA format errors.
5 pts
Total Points: 75

NURS 6630 Week 2 Discussion Foundational Neuroscience

As a psychiatric and mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat patients, you must not only understand the pathophysiology of psychiatric disorders but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

For this Discussion, review the Learning Resources and reflect on the concepts of foundational neuroscience as they might apply to your role as the psychiatric mental health nurse practitioner in prescribing medications for patients

BY DAY 3 OF WEEK 2

Post a response to each of the following:

1. Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact the efficacy of psychopharmacologic treatments.
2. Compare and contrast the actions of g couple proteins and ion gated channels.
3. Explain how the role of epigenetics may contribute to pharmacologic action.
4. Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 2

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.

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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply! 

LEARNING RESOURCES

Required Readings

• Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
  • Chapter 2, “Transporters, Receptors, and Enzymes as Targets of Psychopharmacological Drug Action” (pp. 29-50)
  • Chapter 3, “Ion Channels as Targets of Psychopharmacological Drug Action) (pp. 51-76)

Required Media

• The University of British Columbia. (n. d.). Neuroanatomy videosLinks to an external site.. http://neuroanatomy.ca/videos.html

Note: Please review all of the media under the neuroanatomy series.

• Mental Health TV. (2022, Oct 7).  Psychopharmacology-Module fourLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=46Ioy6SSta4&t=89s
• Mental Health TV. (2022, Oct 7).  Psychopharmacology-Module five [Video]. YouTube. https://www.youtube.com/watch?v=1ynTQB59KW0&t=16s

Optional Resources

• Pathopharmacology: Disorders of the Nervous System: Exploring the Human Brain

• Introduction to Advanced Pharmacology

Dr. Norbert Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain. (15m)

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse. (6m)

NURS 6630 Week 3: Concepts in Assessing Medication Adherence and Strategies To Mitigate Non-Adherence

Self Assessment QUIZ

Question 1       0 pts

Introducing adherence in facilitating treatment goals is something that would be necessary in a patient who has previously displayed nonadherence patterns.

Group of answer choices

True

False

Question 2       0 pts

G-protein coupled receptors are targets for several psychiatric medications. Given what we know about these receptors, what is the ultimate result we will see when one of them is activated in a way that would potentiate an action?

Group of answer choices

A. Intracellular activation of second messengers

B. Protein phosphorylation

C. Modification of gene expression

Question 3       0 pts

Which neurotransmitter is considered the major excitatory neurotransmitter?

Group of answer choices

A. Glycine

B. GABA

C. Glutamate

D. Serotonin

Question 4       0 pts

G-protein coupled receptors are examples of what type of effector pathway?

Group of answer choices

A. Slow effector pathways

B. Rapid effector pathways

C. NMDA glutamate receptor pathways

D. Modulated effector pathways

Question 5        0 pts

Of the components of patient-focused interventions to enhance adherence, which component includes the following strategies: adaptive thinking, use of cues, and support?

Group of answer choices

Motivation

Skills

Logistics

Education

Question 6        0 pts

Motivation is a component of patient-focused interventions to enhance adherence. Based on the transtheoretical model, readiness to change can fluctuate across five stages. Which stage is represented by the patient who is aware that a problem exists and, while seriously thinking about overcoming it, has not yet committed to a plan of action?

Group of answer choices

Preparation

Action

Contemplation

Maintenance

Question 7        0 pts

The human brain is subcategorized into four major structures. These structures include the cerebral cortex, brainstem, subcortical structures, and the cerebellum. Of these major categories, which one houses the area of the brain that has been found in some neuropathological studies of patients with schizophrenia to be of smaller size?

Group of answer choices

Cerebral cortex

Brainstem

Subcortical structures

Cerebellum

Question 8       0 pts

Neurotransmitters are defined by four essential characteristics. These are:

Group of answer choices

A. Neurotransmitters are synthesized within presynaptic neurons.

B. Depolarization of a neuron results in the release of a neurotransmitter, which exerts a multitude of actions on the postsynaptic neuron.

C. Their action on postsynaptic neurons can be replicated by administering a drug that mimics the activity of the endogenous neurotransmitter.

D. Their action in the synaptic cleft is terminated by a specific action.

E. A, C, and D only

Question 9       0 pts

Serotonin (5HT) is a neurotransmitter associated with mood, sleep, and psychosis. There are several serotonin receptors all over the human body. A unique aspect of the second generation antipsychotics is their ability to block 5HT2a receptors. What is the effect of this inhibition?

Group of answer choices

A. Stabilizes dopamine concentrations in the CNS

B. Induces anxiety

C. Causes hallucinations

D. Reduces platelet function

Question 10       0 pts

Treatment adherence is affected by several different factors. Clinical factors include mood, anxiety, psychosis, and substance misuse. There are also patient factors such as knowledge, attitude, and beliefs; economic and racial/ethnic disparities, and clinical encounters. A patient who presents hopeless, with decreased energy, and poor concentration is affected by which factor?

Group of answer choices

Substance misuse

Knowledge deficits

Attitude ad belief system

Mood

Question 11      0 pts

A patient arrives in the ED via EMS having a grand mal seizure. The ED physician instructs the RN to give 10 milligrams of Diazepam IV X1 dose STAT. The patient’s seizure breaks within 2 minutes of the Diazepam being administered. The mechanism by which this medication causes rapid resolution of seizure activity is via which receptor type (effector pathway/receptor subtype)?

Group of answer choices

A. Slow effector pathways/G-protein coupled receptor

B. Slow effector pathway/ion channel

C. Rapid effector pathways/G-protein coupled receptor

D. Rapid effector pathway/ion channel

Question 12      0 pts

Neurotransmission is unidirectional insofar as chemical and electrical conduction is concerned within the individual neuron. Of the following descriptions, which best characterizes the order of neurotransmitter/receptor interaction that results in an electrical signal impulse and the release of another neurotransmitter for interaction in the synaptic cleft (signal conduction through a neuron)?

Group of answer choices

Cell body, dendrites, Axon, Axon terminals

Dendrites, Axon, Cell body, Axon, Axon terminals

Dendrites, Cell body, Axon, Axon terminals

Axon terminals, Axon, Cell body, Dendrites

Question 15      0 pts

If a patient admits to taking his medication every other day (instead of daily, as prescribed), a potential concern would be:

Group of answer choices

A. Sufficient understanding or acceptance of the illness

B. Abuse of the medication

C. Expense

D. Is the desired effect recognized at a lower daily dose?

Question 16     0 pts

Receptors trigger one of two effector pathways resulting in changes in neuronal activity. These changes will, ultimately, effect gene expression. Which effector pathway is characterized by ion flux through transmitter-activated channels resulting in an altered membrane potential and neuronal activity?

Group of answer choices

A. Slow effector pathways

B. Modulated effector pathways

C. Rapid effector pathways

D. NMDA glutamate receptor pathways

Question 17      0 pts

Upon blocking a Serotonin reuptake pump, what happens in the synaptic cleft and on the post synaptic cell membrane?

Group of answer choices

A. The result will be an increase in available Serotonin in the synaptic cleft causing the post synaptic cell to increase the number of Serotonin receptors.

B. The result will be an increase in the available Serotonin in the synaptic cleft causing the post synaptic neuron to reduce the number of Serotonin receptors.

C. The result will be an increase in Serotonin in the synaptic cleft resulting in an increase in reuptake pumps on the presynaptic neuron.

D. The result will be an increase in Serotonin in the synaptic cleft resulting in a decrease in reuptake pumps on the pre-synaptic neuron.

Question 18     0 pts

When dopamine (subtype 2) receptors are blocked in this pathway (system), it is evident by EPS.

Group of answer choices

A. Mesocortical

B. Tuberoinfundibular

C. Nigrostriatal

D. Mesolimbic

Question 19     0 pts

Which of the following consists of all the known major neurotransmitters that are relevant in psychiatry?

Group of answer choices

glutamate, GABA, dopamine, serotonin, norepinephrine, histamine, steroids, nitric oxide

glutamate, GABA, dopamine, norepinephrine, serotonin, acetylcholine, histamine, endogenous opioids, steroids, cannabinoids, nitric oxide

glutamate, GABA, dopamine, serotonin, acetylcholine, endogenous opioids, nitric oxide, cannabinoids, steroids

glutamate, GABA, dopamine, serotonin, norepinephrine, endogenous opioids, steroids, histamine, nitric oxide

Question 20    0 pts

Glia cells play a supportive role to the neuron. A few of the functions of the glial cells include providing nutrition, maintaining homeostasis, stabilizing synapses, and myelinating axons. The glial cells are categorized as microglia and macroglia. Of these two cell types, which one plays an active and critical role in glutamatergic neurotransmission by providing a co-agonist required for glutamate receptor function?

Group of answer choices

microglial

macroglial

NURS 6630 Week 4: Therapy for Patients With Major Depressive Disorder (MDD)

ASSESSING AND TREATING VULNERABLE POPULATIONS FOR DEPRESSIVE DISORDERS

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 vulnerable patient populations requiring antidepressant therapy.

THE ASSIGNMENT: 5 PAGES

For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your patient guide, include discussion on the following:

• Depressive disorder causes and symptoms
• How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable
• Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice
• Medication considerations of medication examples prescribed (see last bullet item)
• What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
• Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health
• Where to follow up in your local community for further information
• Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy. 

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 INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area. 

1. To submit your completed assignment, save your Assignment as WK4Assgn_LastName_Firstinitial
2. Then, click on Start Assignment near the top of the page.
3. Next, click on Upload File and select Submit Assignment for review.

LEARNING RESOURCES

Required Readings

• Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
  • Chapter 6, “Mood Disorders and the Neurotransmitter Networks Norepinephrine and y-Aminobutyric Acid (GABA)” (pp. 244-282)
  • Chapter 7, “Treatments for Mood Disorders: So-Called “Antidepressants” and “Mood Stabilizers” (pp. 283-338)
• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
• Howland, R. H. (2008a). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. https://doi.org/10.3928/02793695-20080901-06
• Howland, R. H. (2008b). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21–24. https://doi.org/10.3928/02793695-20081001-05
• Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019).  Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-textbook of child and adolescent mental health. https://iacapap.org/_Resources/Persistent/45bdffb25befc353c9f61988e82105029504ab85/A.7-Psychopharmacology-2019.1.pdf
• Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
• Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scale—Revised. Western Psychological Services.
• Rao, U. (2013). Biomarkers in pediatric depression. Depression & AnxietyLinks to an external site., 30(9), 787–791. https://doi.org/10.1002/da.22171
• Yasuda, S. U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf

Medication Resources

• U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

Review the following medications:

amitriptyline bupropion citalopram clomipramine desipramine desvenlafaxine doxepin duloxetine escitalopram fluoxetine fluvoxamine	imipramine ketamine mirtazapine nortriptyline paroxetine selegiline sertraline trazodone venlafaxine vilazodone vortioxetine

Required Media

• Doc Snipes. (2022, April 13). Major depressive disorders in the DSM 5 TRLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=q5Npw03I0t8

Note: The approximate length of this media piece is 59 minutes.

• Psych Hub. (2020, October 5). Social determinants of healthLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=17jeXGbKlTQ

Note: The approximate length of this media piece is 4 minutes.

Optional Resources

• El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. https://doi.org/10.1007/s00787-014-0558-3
• Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. https://doi.org/10.1111/jpc.12655
• Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. https://doi.org/10.2989/17280583.2014.938497

Rubric – NURS_6630_Week4_Assignment_Rubric

NURS_6630_Week4_Assignment_Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning Outcome Develop a patient medication guide for treatment of depressive disorders in a vulnerable population you selected. • Depressive disorder causes and symptoms • How depression is diagnosed for the vulnerable population of your choice	20 to >17.0 ptsExcellent Point range: 90–100 Discussion includes Depressive disorder causes and symptoms; Discussion includes how depression is diagnosed for the chosen vulnerable population. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.17 to >15.0 ptsGood Point range: 80–89Discussion is vague regarding Depressive disorder causes and symptoms; Discussion is vague on how depression is diagnosed for the chosen vulnerable population.15 to >13.0 ptsFair Point range: 70–79Discussion is vague regarding Depressive disorder and missing causes and/or symptoms; Discussion is vague on how depression is diagnosed for the chosen vulnerable population.13 to >0 ptsPoor Point range: 0–69Discussion is inaccurate regarding Depressive disorder and missing causes and/or symptoms; Discussion is missing and/or inaccurate on how depression is diagnosed for the chosen vulnerable population.	20 pts
This criterion is linked to a Learning Outcome• Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice • Medication considerations of medication examples prescribed • What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring of medications prescribed	20 to >17.0 ptsExcellent Point range: 90–100Medication treatment options are discussed including risk vs benefits; side effects; FDA approvals for the chosen vulnerable population; Medication considerations of medication examples prescribed; contains discussion of items important to monitor in terms of labs, comorbid medical issues with why important for monitoring.17 to >15.0 ptsGood Point range: 80–89Medication treatment options are briefly discussed and vague regarding risk vs benefits; side effects; FDA approvals for the chosen vulnerable population is vague; vague discussion medication considerations of medication examples prescribed; contains discussion of items important to monitor in terms of labs, comorbid medical issues with why important for monitoring.15 to >13.0 ptsFair Point range: 70–79Medication treatment options are vague and missing risk vs benefits; side effects; missing discussion of FDA approvals for the chosen vulnerable population; no medication considerations of medication examples prescribed; missing elements of discussing items important to monitor in terms of labs, comorbid medical issues with why important for monitoring.13 to >0 ptsPoor Point range: 0–69Medication treatment options are inaccurate, vague and/or missing including risk vs benefits; side effects; missing or inaccurate discussion on FDA approvals for the chosen vulnerable population; no medication considerations of medication examples prescribed discussed; contains inaccurate, minimal, or no discussion of items important to monitor in terms of labs, comorbid medical issues with why important for monitoring.	20 pts
This criterion is linked to a Learning Outcome• Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health • Where to follow up in your local community for further information	20 to >17.0 ptsExcellent Point range: 90–100Special Considerations are discussed and specific, not general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion includes directions for where to follow up in local community for further information.17 to >15.0 ptsGood Point range: 80–89Special Considerations are discussed not specific, but general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion includes directions for where to follow up in local community for further information.15 to >13.0 ptsFair Point range: 70–79Special Considerations are discussed not specific, but general and missing 1-2 of EACH category and does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion directions for where to follow up in local community for further information are vague.13 to >0 ptsPoor Point range: 0–69Special Considerations are discussed not specific, is inaccurate and/or general and missing 3+ or more or does not discuss any of EACH category, inaccurate discussion and/or does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. Discussion does not include directions for where to follow up in local community for further information.	20 pts
This criterion is linked to a Learning Outcome• The medication guide discusses why the chosen population is considered vulnerable. The medications guide language is appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is interesting and appealing including use of graphics/tables.	15 to >13.0 ptsExcellent Point range: 90–100The medication guide discusses why the chosen population is considered vulnerable. The medications guide language is appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is interesting and appealing including use of graphics/tables.13 to >11.0 ptsGood Point range: 80–89The medication guide is vague in discussion why the chosen population is considered vulnerable. The medications guide language is not consistently appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is interesting and appealing including use of graphics/tables.11 to >9.0 ptsFair Point range: 70–79The medication guide does not discuss why the chosen population is considered vulnerable. The medications guide language is not consistently appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide has limited appeal with use of graphics/tables.9 to >0 ptsPoor Point range: 0–69The medication guide does not discuss why the chosen population is considered vulnerable. The medications guide language is not appropriate for the intended audience (patient, caregiver, parent, etc). The medication guide is not interesting and appealing in and/or missing use of graphics/tables.	15 pts
This criterion is linked to a Learning OutcomeProvides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.	15 to >13.0 ptsExcellent Point range: 90–100Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.13 to >11.0 ptsGood Point range: 80–89Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 1-2 elements of the following; date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.11 to >9.0 ptsFair Point range: 70–79Provides two examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 3 of the following: date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.9 to >0 ptsPoor Point range: 0–69Provides one example of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 4+ or is inaccurately written for date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.	15 pts
This criterion is linked to a Learning OutcomeWritten 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 to >4.0 ptsExcellent Point range: 90–100Paragraphs 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 to >3.5 ptsGood Point range: 80–89Paragraphs 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 to >3.0 ptsFair Point range: 70–79Paragraphs 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.3 to >0 ptsPoor Point range: 0–69Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. … No purpose statement, introduction, or conclusion were provided.	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources. Paper is limited to 5 pages not including title and reference page.	5 to >4.0 ptsExcellent Point range: 90–100Uses correct grammar, spelling, and punctuation with no errors; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources; Paper is limited to 5 pages not including title and reference page.4 to >3.5 ptsGood Point range: 80–89Contains a few (one or two) grammar, spelling, and punctuation errors; includes the following: title page and reference page. Only contains 2 scholarly supporting resources outside of course provided resources; Paper is 6 pages not including title and reference page.3.5 to >3.0 ptsFair Point range: 70–79Contains several (three or four) grammar, spelling, and punctuation errors; missing one of the following; title page or reference page; only contains 1 scholaraly supporting resources outside of course provided; Paper is 7 pages not including title and reference page resources.3 to >0 ptsPoor Point range: 0–69Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding; missing the following; title page and reference page; contains no scholaraly supporting resources outside of course provided resources; Paper is 8+ pages not including title and reference page.	5 pts
Total Points: 100

NURS 6630 Week 5 Assignment  Assessing And Treating Patients with Bipolar Disorder

Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. 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 bipolar disorder.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

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 requiring bipolar therapy.

THE ASSIGNMENT: 5 PAGES

For this assignment, you will write a 5–6-page paper on the topic of bipolar and bipolar and related disorders. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.

In your paper, you will choose one of the following diagnoses: Bipolar I, Bipolar II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, Bipolar and Related Disorder Due to Another Medical Condition. Your paper will include discussion for your chosen diagnosis of bipolar and related disorder on the following:

• Prevalence and Neurobiology of your chosen disorder
• Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria
• Discuss special populations and considerations (children, adolescents, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder; demonstrating critical thinking beyond basics of HIPPA and informed consent with discussion of at least one for EACH category:  legal considerations, ethical considerations, cultural considerations, social determinants of health
• Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder
• Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings.  What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
• Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy. 

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 CenterLinks to an external site. 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 INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area. 

1. To submit your completed assignment, save your Assignment as WK5Assgn_LastName_Firstinitial
2. Then, click on Start Assignment near the top of the page.
3. Next, click on Upload File and select Submit Assignment for review.

LEARNING RESOURCES

Required Readings

• Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
  • Chapter 7, “Treatments for Mood Disorders: So-Called “Antidepressants” and “Mood Stabilizers” (pp. 338-358)
• American Psychiatric Association. (2010b). Practice guideline for the treatment of patients with bipolar disorder. (2nd ed.).  https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar.pdf
• Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: Comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835–841. https://doi.org/10.1007/s00228-015-1855-6
• Hirschfeld, R. M. A. (n.d.). Guideline watch: Practice guideline for the treatment of patients with bipolar disorder, (2nd ed.).  https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar-watch.pdf
• Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331–333. https://doi.org/10.1007/s40263-013-0060-3

Medication Resources

• U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

Review the following medications:

amitriptyline bupropion citalopram clomipramine desipramine desvenlafaxine doxepin duloxetine escitalopram fluoxetine fluvoxamine	imipramine ketamine mirtazapine nortriptyline paroxetine selegiline sertraline trazodone venlafaxine vilazodone vortioxetine

Required Media

• Doc Snipes. (2022, February 14). Bipolar disorder assessment and diagnosis. [Video]. YouTube. https://www.youtube.com/watch?v=onKHtQWkNaU
  Note: The approximate length of this media piece is 1 hour and 5 minutes

Optional Resources

Mostafavi, A., Solhi, M., Mohammadi, M., Hamedi, M., Keshavarzi, M., & Akhondzadeh, S. (2014). Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: A randomized double-blind placebo-controlled trial. Acta Medica Iranica, 52(10), 734–739. http://acta.tums.ac.ir/index.php/acta

Rubric – NURS_6630_Week5_Assignment_Rubric

NURS_6630_Week5_Assignment_Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeWrite a 5–6-page paper on the topic of bipolar and bipolar related disorders: • Prevalence • Neurobiology	20 to >17.0 ptsExcellent Point range: 90–100Discussion includes Prevalence and Neurobiology of chosen bipolar and related disorder.17 to >15.0 ptsGood Point range: 80–89Discussion is vague regarding Prevalence and Neurobiology of chosen bipolar and related disorder.15 to >13.0 ptsFair Point range: 70–79Discussion is missing one section for Prevalence and Neurobiology of chosen bipolar and related disorder.13 to >0 ptsPoor Point range: 0–69Discussion is inaccurate or missing more than one section for Prevalence and Neurobiology of chosen bipolar and related disorder.	20 pts
This criterion is linked to a Learning Outcome• Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria.	20 to >17.0 ptsExcellent Point range: 90–100Discussion includes the differences between chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria.17 to >15.0 ptsGood Point range: 80–89Discussion includes the differences between chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM version older than DSM 5 TR criteria.15 to >13.0 ptsFair Point range: 70–79Discussion is vague in differences between chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria and/or missing discussion presentation of symptoms according to DSM 5 TR criteria or older version of DSM.13 to >0 ptsPoor Point range: 0–69Discussion is inaccurate or does not include the differences between chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria or older version of DSM.	20 pts
This criterion is linked to a Learning Outcome• Discuss special populations and considerations (children, adolescent, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder-be specific, not general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health.	20 to >17.0 ptsExcellent Point range: 90–100Special Populations and Considerations are discussed and specific, not general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health.17 to >15.0 ptsGood Point range: 80–89Special Populations and Considerations are discussed not specific, but general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health.15 to >13.0 ptsFair Point range: 70–79Special Populations Considerations are discussed not specific, but general and missing 1-2 of EACH category and does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health.13 to >0 ptsPoor Point range: 0–69Special Populations Considerations are vaguley or not discussed, not specific, is inaccurate and/or general and missing 3+ or more of or none of EACH category, inaccurate discussion and/or does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health.	20 pts
This criterion is linked to a Learning Outcome• Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder • Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings. What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring.	15 to >13.0 ptsExcellent Point range: 90–100Discussion includes FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is discussion regarding side effects, FDA approvals and warnings. Paper includes what is important to monitor in terms of labs, comorbid medical issues with why important formonitoring.13 to >11.0 ptsGood Point range: 80–89Discussion includes vague FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is vague discussion regarding side effects, FDA approvals and warnings. Paper includes vague discussion what is important to monitor in terms of labs, comorbid medical issues with why important for monitoring.11 to >9.0 ptsFair Point range: 70–79Discussion includes pharmacological treatment options but not aligned with FDA approved and/or clinical practice guidelines in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is missing elements for discussion regarding side effects, FDA approvals and warnings. Paper includes what is important to monitor in terms of labs, comorbid medical issues but does not discuss why important for monitoring.9 to >0 ptsPoor Point range: 0–69Discussion inaccurate and/or missing pharmacological treatment options but not aligned with FDA approved and/or clinical practice guidelines in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is inaccurate or no elements for discussion regarding side effects, FDA approvals and warnings. Paper does not include what is important to monitor in terms of labs, comorbid medical issues but does not discuss why important for monitoring.	15 pts
This criterion is linked to a Learning OutcomeProvides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.	15 to >13.0 ptsExcellent Point range: 90–100Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.13 to >11.0 ptsGood Point range: 80–89Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 1-2 elements of the following; date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.11 to >9.0 ptsFair Point range: 70–79Provides two examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 3 of the following: date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.9 to >0 ptsPoor Point range: 0–69Provides one example of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 4+ or is inaccurately written for date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.	15 pts
This criterion is linked to a Learning OutcomeWritten 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 to >4.0 ptsExcellent Point range: 90–100Paragraphs 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 to >3.5 ptsGood Point range: 80–89Paragraphs 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 to >3.0 ptsFair Point range: 70–79Paragraphs 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.3 to >0 ptsPoor Point range: 0–69Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources; Paper is 5-6 pages not counting title page and reference page.	5 to >4.0 ptsExcellent Point range: 90–100Uses correct grammar, spelling, and punctuation with no errors; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources. Paper is 5-6 pages not counting title page and reference page.4 to >3.5 ptsGood Point range: 80–89Contains a few (one or two) grammar, spelling, and punctuation errors; includes the following: title page and reference page. Only contains 2 scholarly supporting resources outside of course provided resources. Paper is 4 pages not counting title page and reference page.3.5 to >3.0 ptsFair Point range: 70–79Contains several (three or four) grammar, spelling, and punctuation errors; missing one of the following; title page or reference page; only contains 1 scholaraly supporting resources outside of course provided. Paper is 3 pages or exceeds to page 7 not counting title page and reference page.3 to >0 ptsPoor Point range: 0–69Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding; missing the following; title page and reference page; contains no scholaraly supporting resources outside of course provided resources. Paper is 2 pages or exceeds 8 pages not counting title page and reference page.	5 pts
Total Points: 100

NURS 6630 Week 6: Therapy for Patients With Anxiety Disorders and PTSD Treatment

ASSESSING AND TREATING PATIENTS WITH ANXIETY DISORDERS

Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt patients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, patients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. 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 anxiety disorders.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

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 requiring anxiolytic therapy.

THE ASSIGNMENT: 5 PAGES

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. 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 formattingLinks to an external site..

BY DAY 7

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Case Study: Generalized Anxiety Disorder – Middle-Aged White Male With Anxiety

BACKGROUND INFORMATION

The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.

He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.

In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.

Client has never been on any type of psychotropic medication.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.

You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.

Diagnosis: Generalized anxiety disorder

RESOURCES

§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Decision Point One

Select what you should do:

Begin Paxil 10 mg po daily

Begin Imipramine 25 mg po BID

Begin Buspirone 10 mg po BID

Decision Point One

Begin Buspirone 10 mg orally BID

RESULTS OF DECISION POINT ONE

·    Client returns to clinic in four weeks

·    Client reports slight decrease in symptoms

·    Client states that he still feels very anxious

·    HAM-A score decreased from 26 to 23

Decision Point Two

Select what you should do next:

Increase buspirone to 10 mg orally TID

Increase buspirone to 20 mg orally TID

Discontinue buspirone and begin Lexapro 10 mg orally daily

Decision Point Two

Discontinue buspirone and begin Lexapro 10 mg orally daily

RESULTS OF DECISION POINT TWO

·    Client returns to clinic in four weeks

·    Client reports that he feels “great”

·    Client states that his anxiety is getting “better”

·    HAM-A score has decreased from 23 to 13

·    Client does report that he sometimes feels sleepy for a few hours after taking the medication, but “perks up” by early to midafternoon

Decision Point Three

Select what you should do next:

Increase Lexapro to 15 mg orally daily in AM

Continue same dose of Lexapro but change administration time to bedtime

Re-start BuSpar at 10 mg orally TID

Decision Point Three

Continue same dose of Lexapro but change administration time to bedtime

Guidance to Student
At this point, the client reports that he is feeling “great” with a decrease in symptoms from an initial HAM-A score of 26 down to 13. This represents a 50% decrease in symptoms in just 4 weeks. Recall that an adequate trail can be as long as 12 weeks, we may not need to increase the drug any more at this point as we do not know how much more the current dose will improve the client’s symptoms. You could increase the dose but this could increase the risk of side effects- especially the sleepiness that the client is complaining about in the morning after taking the medication. It is plausible that an increase in the dose would increase morning sedation.

The most prudent course of action would be to continue the same dose of medication, but change the administration time to bedtime. This way, the client will not be troubled by the sedating effects of the medication, and sleep may be enhanced which could also improve overall anxiety.

At this point, nothing in the client presentation suggests the need to augment his Lexapro with any other agents. Therefore, buspirone augmentation would not be an appropriate response.

Rubric – NURS_6630_Week6_Assignment_Rubric

NURS_6630_Week6_Assignment_Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning Outcome 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.	10 to >8.0 ptsExcellent Point range: 90–100The 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 to >7.0 ptsGood Point range: 80–89 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 to >6.0 ptsFair Point range: 70–79The 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.6 to >0 ptsPoor Point range: 0–69The 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.	10 pts
This criterion is linked to a Learning Outcome 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.	20 to >17.0 ptsExcellent Point range: 90–100The 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.17 to >15.0 ptsGood Point range: 80–89The 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.15 to >13.0 ptsFair Point range: 70–79The 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.13 to >0 ptsPoor Point range: 0–69The 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.	20 pts
This criterion is linked to a Learning Outcome 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.	20 to >17.0 ptsExcellent Point range: 90–100The 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.17 to >15.0 ptsGood Point range: 80–89The 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.15 to >13.0 ptsFair Point range: 70–79The 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.13 to >0 ptsPoor Point range: 0–69The 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.	20 pts
This criterion is linked to a Learning Outcome 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.	20 to >17.0 ptsExcellent Point range: 90–100The 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.17 to >15.0 ptsGood Point range: 80–89The 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.15 to >13.0 ptsFair Point range: 70–79The 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.13 to >0 ptsPoor Point range: 0–69The 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.	20 pts
This criterion is linked to a Learning Outcome 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.	15 to >13.0 ptsExcellent Point range: 90–100The 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.13 to >11.0 ptsGood Point range: 80–89The 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 to >10.0 ptsFair Point range: 70–79The 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.10 to >0 ptsPoor Point range: 0–69The 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.	15 pts
This criterion is linked to a Learning Outcome 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 to >4.0 ptsExcellent Point range: 90–100Paragraphs 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 to >3.5 ptsGood Point range: 80–89Paragraphs 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 to >3.0 ptsFair Point range: 70–79Paragraphs 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.3 to >0 ptsPoor Point range: 0–69Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 to >4.0 ptsExcellent Point range: 90–100Uses correct grammar, spelling, and punctuation with no errors.4 to >3.5 ptsGood Point range: 80–89Contains a few (1 or 2) grammar, spelling, and punctuation errors.3.5 to >3.0 ptsFair Point range: 70–79Contains several (3 or 4) grammar, spelling, and punctuation errors.3 to >0 ptsPoor Point range: 0–69Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.	5 pts
This criterion is linked to a Learning OutcomeWritten 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 to >4.0 ptsExcellent Point range: 90–100Uses correct APA format with no errors.4 to >3.5 ptsGood Point range: 80–89Contains a few (1 or 2) APA format errors.3.5 to >3.0 ptsFair Point range: 70–79Contains several (3 or 4) APA format errors.3 to >0 ptsPoor Point range: 0–69Contains many (≥ 5) APA format errors.	5 pts
Total Points: 100