NURS 6630 Week 9: Therapy for Patients With ADHD/ODD Essay

NURS 6630 Week 9: Therapy for Patients With ADHD/ODD Essay

NURS 6630 Week 9: Therapy for Patients With ADHD/ODD Essay

Assessing and Treating Patients with ADHD
Mental health issues often disruptively affect patients’ quality of life and those around them. Mental illnesses such as attention deficit hyperactivity disorder affect the patient’s functional and cognitive abilities. Clinical presentations are the basis for the diagnosis of most mental health illnesses. Due to their closely-similar symptoms, advanced practice nurses and psychiatrists assess patients’ presentations and utilize criteria in the DSM-5 to diagnose patients accurately. FDA-approved interventions are often the best interventions for mental health issues. However, evidence from studies play a huge role in informing these care choices, and some off-label medication can be chosen based on their efficacy and therapy goals. Ethical and legal considerations are essential in mental health to enhance outcomes and maintain human dignity, which is required for all patients. Follow-up helps determine the effectiveness of interventions and inform further patient management. This paper explores the case study of a patient with ADHD and subsequent management interventions.

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Case Study Analysis
Katie is an 8-year-old Caucasian female with suspected ADHD, a diagnosis the parents deny. Her teacher reports that she is easily distracted and only concentrates on things in which she is interested. Katie forgets things learned, has poor spelling, and is poor in reading and math. She has a short attention span and starts activities without completing them, thus having problems completing her schoolwork. Katie admits her mind wanders, and concentrating is hard because she feels lost. She admits to being caught unawares by the teacher. Katie denies any abuse or bullying at home or school and reports that her parents are good to her and that she loves them. Her mental status exam reveals a grossly intact concentration using Serial 2 and 5. Her judgment and insight appear age appropriate. The patient’s age and concern about her school life are important considerations during her management.
Decision Point #1 – Ritalin 10 mg
The goals of the first decision are to improve Katie’s concentration span and memory problem. Another goal is to increase the patient’s academic performance, given her current low performance. Ethics and legal considerations include acceptance of the medication by the parent because the client, Katie, is a minor. Extensive education of the patient and the parents is necessary to ensure adherence and quality outcomes. The first decision is to start her on Ritalin (methylphenidate) 10mg. Ritalin is a stimulant (stimulants are the first-line treatment for ADHD) that increases dopamine levels in the brain, improving attention (Gonçalves et al., 2020). The medication has fewer side effects and is FDA-approved for patients with ADHD and narcolepsy aged between 6 and 17 years. The medication has fewer side effects, is well tolerated, and is considered relatively safe (Ophir, 2022).
Wellbutrin (Bupropion) XL 10 mg orally OD was the next option. Bupropion is a substituted cathinone that is not FDA-approved for ADHD. It is used as an off-label medication. Hile (2020) notes that bupropion has superior effects to placebo in ADHD, and more studies are required to prove its effectiveness. It regulates the level of neurotransmitters dopamine, serotonin, and norepinephrine. Braich (2021) notes that bupropion has a higher rate of addiction and dependence and was thus avoided for this patient. Intuniv extended release 1mg at bedtime was the second option. The medication is a selective alpha2A receptor agonist, a non-stimulant, and an FDA-approved second-line treatment option for ADHD in children and adolescents-non-stimulants are second-line treatment options hence the decision not to give this medication. In addition, the medication has a high rate of somnolence (40%), severe side effects, and low efficacy (Childress et al., 2020). Follow-up after the first decision will evaluate the patient’s response to the medication and make decisions for subsequent management.
Decision Point #2 – Change to Ritalin LA 20mg Orally
After the initial decision to start Ritalin chewable 10 mg tablets OD, the patient is brought to the clinic after four weeks. Katie’s symptoms have improved in the morning, and so has her academic performance. In the afternoon, she is often daydreaming and staring into space. Katie ads that her heart felt funny, and her heart rate beats 130 beats per minute. The goal at this point is to ensure the changes in the patient are persistent, Katie concentrates throughout the day, the heart rate is moderated, and the heart palpitations cease. The selected intervention is to change to Ritalin LA 20mg orally daily in the morning. In this case, the ethical and legal considerations are beneficence and non-maleficence. It is vital to ensure that the selected intervention is effective for the function it is meant to achieve. Ritalin LA 20mg is a slow-release medication that gives patients sufficient drug levels for therapeutic effectiveness throughout the day (Radnedge, 2020). A low dose of Ritalin is associated with heart palpitations, leading to the choice of Ritalin LA 20mg.
One of the options was to continue the same dose of Ritalin and reevaluate in 4 weeks. The patient achieved partial remission, and side effects developed and continuing the same dose can be termed professional negligence. The patient has side effects (that occur in a low dose therapy), tachycardia, and symptom recurrence in the afternoon, as the parents and teacher assessed and reported. Maintaining the dose may lead to persistent palpitations and tachycardia, worsening the symptoms or leading to recurrence. The other option was to stop Ritalin and start Adderall XR 15 mg orally daily. It is a non-stimulant that is FDA-approved for ADHD. The medication is an effective intervention in managing ADHD (although non-stimulants are avoided due to side effects and low efficacy in ADHD), as Cortese (2020). In addition, Ritalin has achieved partial remission, and there is no need for a therapy change. The mild side effects and symptoms recurrence in the afternoon do not warrant therapy change.
After initiating Ritalin 20mg LA, Katie returned to the clinic and reported that her attention has improved since she sustained it throughout her school day. Her pulse was 92, and she reports that her heart does not “feel funny” now. The goals of this decision are to sustain the symptom remission achieved so far and avoid side effects. The current dose fully achieves these goals, and it is safe to say that the patient has achieved complete remission. Thus, the decision is to maintain the current Ritalin LA dose and reevaluate in four weeks. Reevaluation after four weeks will allow the care providers to assess the effectiveness of interventions and any arising side effects. Follow-ups also allow providers to implement more care interventions, such as education, to prevent disease recurrence. The selected decision is thus the best in achieving the desired outcome.
One of the options is to increase Ritalin LA to 30mg orally daily. According to Gonçalveset al. (2021), patients can respond differently to the Ritalin LA, and the side effects are dose-dependent; increasing the doses increases the risk for side effects. Thus, it is unsafe to increase the dose of Ritalin for this patient. The other option is to obtain EKG based on the current heart rate. An EKG can be obtained as part of the therapy because Ritalin affects the heart rate (Farhat et al., 2022). However, the current heart rate is 92, which is appropriate for Katie’s age, thus ruling out the option. The ethics guiding the actions are beneficence and maleficence because the desire is to ensure the patients achieve the best outcomes while avoiding side effects.
Summary
Katie is an 8-year-old Caucasian female who presents with ADHD. The patient is started on Ritalinn10mg orally daily in the morning. The clinic visit after weeks reveals that she has achieved partial remission and has developed side effects such as a “funny heart feeling” and tachycardia. Other options are avoided due to their side effects profiles and effectiveness based on class and mechanism of action. The patient is a minor, and the patient’s consent to implement the care interventions is necessary. The second decision was to change the dose to Ritalin LA 20mg for the prolonged effects of the drug. The goals were to ensure symptom remission and elimination of the side effects.
The other options were avoided due to their efficacy and because the current therapy had already achieved the desired outcomes. Beneficence and non-maleficence were significant to this decision. The patient achieved total remission and raised no complaints on the third visit. The third decision was to continue Ritalin LA 20mg. The goals of the decision are to ensure sustained symptom remission and side effects avoidance. At this point, no reason warrants a therapy change or withdrawal of medication. Reevaluation after four weeks will give the care provider a clear picture of the effectiveness of the therapy and help make further care decisions for Katie.
References
Braich, J. S. (2021). Pharmacotherapeutic Options for Management of Attention Deficit Hyperactivity Disorder. Highlights on Medicine and Medical Science. Vol. 9, 80-90.
Childress, A., Hoo-Cardiel, A., & Lang, P. (2020). Evaluation of the current data on guanfacine extended release for the treatment of ADHD in children and adolescents. Expert Opinion on Pharmacotherapy, 21(4), 417–426. https://doi.org/10.1080/14656566.2019.1706480
Cortese, S. (2020). Pharmacologic treatment of attention deficit–hyperactivity disorder. New England Journal of Medicine, 383(11), 1050–1056. https://doi.org/10.1056/NEJMra1917069
Farhat, L. C., Flores, J. M., Behling, E., Avila-Quintero, V. J., Lombroso, A., Cortese, S., Polanczyk, G. V., & Bloch, M. H. (2022). The effects of stimulant dose and dosing strategy on treatment outcomes in attention-deficit/hyperactivity disorder in children and adolescents: a meta-analysis. Molecular Psychiatry, 27(3), 1562-1572. https://doi.org/10.1038/s41380-021-01391-9
Gonçalves, C. Q., Do Nascimento, D. C., Anunciação, R. S., & de Almeida, A. C. G. (2021). The effectiveness of methylphenidate (Ritalin) in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children: a systematic review/The efficacy of methylphenidate (Ritalin) in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children: a systematic review. Brazilian Journal of Development, 7(12), 110880-110897. https://doi.org/10.34117/bjdv7n12-053
Hile, A. L. (2020). Bupropion for the treatment of ADHD. Lynchburg Journal of Medical Science, 2(1), 15.
Ophir, Y. (2022). Reconsidering the Safety Profile of Stimulant Medications for ADHD. Ethical Human Psychology and Psychiatry, 24(1), 41–50. https://doi.org/10.1891/EHPP-2021-0007
Pheils, J., & Ehret, M. J. (2021). Update on methylphenidate and dexmethylphenidate formulations for children with attention-deficit/hyperactivity disorder. American Journal of Health-System Pharmacy, 78(10), 840-849. https://doi.org/10.1093/ajhp/zxab069
Radnedge, K. (2020). ADHD in Australia: An overview of diagnosis and treatment. AJP: The Australian Journal of Pharmacy, 101(1194), 77–81. https://doi.org/10.3316/informit.091804668015603

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NURS 6630 Week 9: Therapy for Patients With ADHD/ODD
WEEK 9: AT A GLANCE
THERAPY FOR PATIENTS WITH ADHD/ODD

INTRODUCTION
Diego, a 9-year-old third grader, had always been an energetic child with a short attention span. For years, his mother attributed his behaviors to him being “all boy” and assumed it would improve as he grew older. Instead, daily tasks like chores and homework became increasingly overwhelming for Diego, resulting in disruptive behaviors at home and school. After being evaluated by his healthcare provider, Diego was diagnosed with and treated for attention deficit hyperactivity disorder (ADHD).
ADHD is a prevalent disorder for patients across the lifespan, as more than 6 million children (CDC, n.d.) have been diagnosed with the disorder. Further, consider that about 60% of children with ADHD in the United States become adults with ADHD (ADAA, n.d.). Like Diego, individuals of all ages find that symptoms of ADHD can make life challenging. However, when properly diagnosed and treated, patients often respond well to therapies and have positive health outcomes.
This week, as you study ADHD therapies, you examine the assessment and treatment of patients with ADHD. You also explore ethical and legal implications of these therapies.
References:
Centers for Disease Control and Prevention. (n.d.). Data and statistics about ADHD. https://www.cdc.gov/ncbddd/adhd/data.html
Anxiety and Depression Association of America. (n.d.). Adult ADHD (Attention Deficit Hyperactive Disorder). https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd
________________________________________
LEARNING OBJECTIVES
Students will:
 Assess patient factors and history to develop personalized therapy plans for patients with ADHD
 Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for ADHD
 Synthesize knowledge of providing care to patients presenting for ADHD
 Analyze ethical and legal implications related to prescribing therapy for patients with ADHD
 Identify concepts related to psychopharmacologic treatments and therapy for patients across the lifespan

Week 9: Assignment
ASSESSING AND TREATING PATIENTS WITH ADHD
Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. Different people may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for patients across the life span. For this Assignment, you consider how you might assess and treat patients presenting with ADHD.

TO PREPARE FOR THIS ASSIGNMENT:
• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with ADHD.
THE ASSIGNMENT: 5 PAGES
Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
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
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 WK9Assgn_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.

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Rubric
NURS_6630_Week9_Assignment_Rubric
NURS_6630_Week9_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeIntroduction 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 pts
Excellent Point range: 90–100
The response accurately, clearly, and fully summarizes in detail the case for the Assignment…. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. 8 to >7.0 pts
Good 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 pts
Fair Point range: 70–79
The response inaccurately or vaguely summarizes the case for the Assignment…. The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. 6 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing…. The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
10 pts
This criterion is linked to a Learning OutcomeDecision #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 pts
Excellent Point range: 90–100
The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 17 to >15.0 pts
Good Point range: 80–89
The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 15 to >13.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 13 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely explains the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing.
20 pts
This criterion is linked to a Learning OutcomeDecision #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 pts
Excellent Point range: 90–100
The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 17 to >15.0 pts
Good Point range: 80–89
The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 15 to >13.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 13 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely explains in detail the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing.
20 pts
This criterion is linked to a Learning OutcomeDecision #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 pts
Excellent Point range: 90–100
The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 17 to >15.0 pts
Good Point range: 80–89
The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 15 to >13.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 13 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely explains in detail the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing.
20 pts
This criterion is linked to a Learning OutcomeConclusion (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 pts
Excellent Point range: 90–100
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient…. The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. 13 to >11.0 pts
Good Point range: 80–89
The response accurately summarizes the recommendations on the treatment options selected for this patient…. The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. 11 to >10.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient…. The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. 10 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing…. The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.
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 pts
Excellent Point range: 90–100
Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.5 pts
Good Point range: 80–89
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time….Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 3.5 to >3.0 pts
Fair Point range: 70–79
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment is vague or off topic. 3 to >0 pts
Poor Point range: 0–69
Paragraphs 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 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 >3.0 pts
Fair Point range: 70–79
Contains several (3 or 4) grammar, spelling, and punctuation errors. 3 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 >3.0 pts
Fair Point range: 70–79
Contains several (3 or 4) APA format errors. 3 to >0 pts
Poor Point range: 0–69
Contains many (≥ 5) APA format errors.
5 pts
Total Points: 100

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Medicine
Well researched paper. Excellent work
Customer 452441, November 11th, 2022
Medicine
Good work. Will be placing another order tomorrow
Customer 452441, November 11th, 2022
DESIGN AND IMPLEMENTATION OF NURSE ADVOCATE HEALTHCARE PROGRAM
The absolute best ! Thanks for great communication, quality papers, and amazing time delivery!
Customer 452467, November 14th, 2022
Medicine
This was done very well. Thank you!
Customer 452441, November 11th, 2022
Medicine
Great work, Thank you, will come back with more work
Customer 452441, November 11th, 2022
Medicine
Very fond of the paper written. The topic chosen is defiantly trending at this time
Customer 452495, July 27th, 2023
11,595
Customer reviews in total
96%
Current satisfaction rate
3 pages
Average paper length
37%
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