Assessing and Treating Patients with Anxiety Disorders Essay

Assessing and Treating Patients with Anxiety Disorders Essay

One of the significant responsibilities of a healthcare provider is to assess a patient and contribute to the decision-making of the therapy or management of the patient’s condition. The healthcare provider also evaluates the effect the available options may have on the patient, thus making the most appropriate medication. Different mental health disorders present with different symptoms and may be influenced by a patient’s environmental or individual factors. The consideration of such factors influences the choice of medication. More so, the patient’s response to the medication selected, the effectiveness of the medication, and the manifestation of side effects are used to determine whether the patient should continue with the therapy over time. The focus of this essay is an analysis of the case of a patient with a generalized anxiety disorder, the most appropriate treatment decision for the patient at various points of interacting with the patient.

The client, a 46-year-old male welder, was referred by his primary care provider after feeling like he had a heart attack. He complains of shortness of breath, chest tightness, and an impending sense of doom. He is obese and has mild hypertension being managed with a low-sodium diet. Myocardial infarction is ruled out, and other physical exams are normal. He reports still having anxiety attacks, which come with a need to run or escape from wherever he is. He also reports occasional use of ETOH to manage work-related worries, consumes 3-5 beers daily, and denies using psychotropic medication. He is single and takes care of his aging parents. He adds that the management at his workplace is harsh, and he fears losing his job. His HAM-A test score is 26, showing severe anxiety. The patient has a broad affect. He denies having any hallucinations, delusions, and homicidal/suicidal ideations. His judgment and insight are grossly intact.

Decision Point One

The first decision is to begin Paxil 10 mg PO daily. Paxil, also known as Paroxetine (a selective serotonin reuptake inhibitor), is used for treating generalized anxiety disorder, panic attacks, depression, and Post Traumatic Stress Disorder. SSRIs reduce serotonin uptakes and increase the serotonin levels in the blood. d It has been approved by the FDA. The first-line medications for treating anxiety disorders include selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Bandelow, 2020). The desired effects for the patient include decreased psychic symptoms, including a sense of doom and fear. Paroxetine effectively addresses psychic symptoms such as fear and irritability. It also has a high tolerance and is associated with minimal side effects, thus the best option for this patient. Personal factors and side effects may affect Paxil adherence.

Buspirone, is a non-benzodiazepine antianxiety medication. It has been approved by FDA for treating Generalized Anxiety Disorder only. Munir, Takov & Coletti (2020) note that Buspirone is less sedating compared to benzodiazepine. However, the reason why Buspirone was not selected is that tolerance does not occur on therapeutic doses. Buspirone has a therapeutic lag; its efficacy is two to three weeks (Munir et al., 2020). Its use is limited since the desired effect takes time, especially in generalized anxiety disorder. However, the patient, in this case, has severe anxiety. Thus a medication that would produce the desired effect soon was required. In addition, the medication has side effects, including vomiting, chest pains, hypertension, nausea, and poor coordination. The patient, in this case, is already hypertensive, and thus, the medication is not the most appropriate. Also, with the current symptom manifestations, medication was required to produce the desired effect in a short time.

Imipramine 25 mg PO BID was the other available mediation option. It is a tricyclic antidepressant (TA) medication used to treat Generalized Anxiety Disorder. However, the medication was not selected since it is not FDA-approved. Imipramine has various side effects that can affect a patient’s daily activities, worsening their current condition and symptoms (Schliessbass et al., 2018). Note that some of the common side effects of the medication include nausea, dizziness, and sedation every 30 minutes after taking the medication. Since the client is working, such side effects would greatly affect his productivity by negatively affecting his daily activities. In addition, adherence to imipramine is likely to be low if the patient experiences the side effects.

Decision Point Two

According to the FDA guidelines, doses should be titrated depending on the patient’s response to the drug. [Paxil’s minimum licensed dose is 20mgbut it is introduced to the patient gradually to ensure the patient tolerates the drug. Paxil 20mg is the minimum licensed dose, and clinical studies have shown that 20mg of the drug achieves clinically significant results. Increasing the dose will lead to better control of symptoms and is thus the decision of interest.

The other option is increasing the dose to 40mg daily. According to Meralagno, Spera & Bui (2020), the licensed drug dosage is between 20-50mg, where patients exhibit maximal remission and above which the drug side effects and toxicity set in. Paxil has antipsychotic effects and has undesirable effects such as nausea and vomiting, drowsiness, weakness, insomnia, blurred vision, and sweating. Patients often associate the symptoms with taking the drug, thus interfering with drug adherence, a major problem with mentally ill patients. In addition, clinical studies show that there are no significant changes in clinical significance when the doses are raised above 20mg (Meralagno et al., 2020). However, dosages above 20mg are associated with increased side effects hence ruling out the decision.

Paroxetine is antipsychotic that deals with irrational fear and other symptoms. The drug’s effectiveness is evaluated based on its ability to manage these symptoms. The patient presents with improved symptoms and a change of the HAM-A test from 18 to 10, meaning the anxiety has improved from moderate to mild. Dose titration is recommended when patients have achieved partial remission. Failure to adjust the dose may lead to tolerance and resistance. The patient has not achieved remission, and there is also a high risk for symptoms relapse. The goal is to ensure the patient does not exhibit any anxiety symptoms, and maintaining the dose may thus end up harming the patient more, violating the beneficence ethical principle.

For this decision, it is important to consider decisions that relay less harm and maximum benefits to the patients. The interest is to promote remission and decrease patient symptoms while ensuring drug side effects do not interfere with the patient’s life or medication adherence.

Decision Point Three

Different patients respond to different medications, doses, and therapies differently. Thus, the healthcare provider is responsible for observing therapy response and medication effectiveness to determine if any changes should be made. However, when a patient responds positively to treatment therapy and is not adversely affected by the side effects, the care provider considers continuing with the dose and medication without making any changes or titrating the dose.

The patient returned to the clinic after four weeks, reporting a further reduction in his symptoms. The symptoms had reduced by 61%, and the HAM-A score had decreased to 10, which showed mild anxiety. Symptoms reduction of more than 50% shows that the patient is responding well to the medication and dosage. Thus, the most appropriate decision at this point is to maintain the current medication and dosage. The US FDA mandates that healthcare providers continue with Paxil administration if the patient presents a desirable symptom reduction.

The other option, increasing the dosage to 30mg PO daily, was not selected since it can lead to drug toxicity and even increase the risk of side effects. Since the current dose is effective, it should be maintained. Increasing the dose may not have significant therapeutic outcomes, considering the current dosage is effective (Meralagno et al., 2020).

The third option, adding an augmentation agent such as Buspirone, was not selected since Paroxetine and Buspirone have the same effects. More so, augmentation was avoided to prevent polypharmacy. Thus, using the two may increase the risk of precipitate serotonin syndrome. In addition, Buspirone is a benzodiazepine that doesn’t help with symptoms relapse, unlike SSRIs like Paxil (Clevenger et al., 2020). Therefore, Paxil and the current dose remain to be the best option. The ethical consideration at this point is non-maleficence and beneficence. The selected decision aims to minimize side effects, prevent harm to the patient, and achieve total remission of anxiety.

Conclusion

Generalized anxiety disorder is one of the anxiety disorders where patients experience a sense of impending doom and fear. Different patients present different symptoms, including perceived cardiac arrests and chest pains. The recommendations and treatment options selected for this care were Paxil 10mg PO daily, followed by an increase in the dose to 20mg PO daily, and maintaining the drug and dose. The low dose was chosen initially so that the care provider would assess the patient’s response, tolerance, and side effects. Other medications, such as imipramine, were ruled out since they are not FDA-approved, are less tolerated, and would have taken time to give positive results. The medication was effective, and the patient progressively reported a reduced presentation of symptoms. The first dosage increase was made since the patient had good tolerance to the medication, yet he still presented the symptoms. Maintaining the dosage and the medication without augmentation was selected to avoid polypharmacy and prevent the patient from precipitate serotonin syndrome and symptoms relapse.


References

Bandelow, B. (2020). Current and novel psychopharmacological drugs for anxiety disorders. Anxiety Disorders, 347-365. https://doi.org/10.1007/978-981-32-9705-0_19

Clevenger, S. S., Malhotra, D., Dang, J., Vanle, B., & IsHak, W. W. (2018). The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder. Therapeutic Advances in Pychopharmacology8(1), 49-58. https://doi.org/10.1177/2045125317737264

Melaragno, A., Spera, V., & Bui, E. (2020). Psychopharmacology of Anxiety Disorders. Clinical Handbook of Anxiety Disorders, 251-267. https://doi.org/10.1007/978-3-030-30687-8_13

Munir, S., Takov, V., & Coletti, V. A. (2022). Generalized anxiety disorder (nursing). In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568696/

Schliessbach, J., Siegenthaler, A., Bütikofer, L., Limacher, A., Juni, P., Vuilleumier, P. H., Stamer, U., Arendt, L. & Curatolo, M. (2018). Effect of single-dose imipramine on chronic low-back and experimental pain. A randomized controlled trial. PLoS One13(5), e0195776. https://doi.org/10.1371/journal.pone.0195776

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Week 6: Therapy for Patients with Anxiety Disorders and PTSD Treatment

Decision Tree Assignment – Same drill as your previous decision tree assignment. Please be sure to incorporate the feedback I provided into this week’s decision tree.
Treating patients with Anxiety Disorders
I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. The course page suggests writing 1 page per decision – my opinion is that it will be very difficult to justify your treatment decisions and provide scientific evidence in 1 page (especially for decision #1). I do not need you to tell me about the patient or the treatment options available to you – I am very familiar with the cases. Your introductory page should be an overview of the disease state you are treating along with a purpose statement for the assignment. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data).
Introduction to the case (1 page)
• Briefly explain and summarize the disease state you are treating this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1
• 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. Again, provide STRONG scientific evidence. Clinical studies or treatment guidelines are a good place to start!
• 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. Again, provide STRONG scientific evidence. Clinical studies or treatment guidelines are a good place to start!
• 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. Again, provide STRONG scientific evidence. Clinical studies or treatment guidelines are a good place to start!
• 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.

After writing up your rationale at each decision point, I would ask yourself the following questions:
• Have I provided clinical data from a meta-analysis, case report or clinical trial to support the drug I picked being safe, efficacious and the best choice for this patient?
• Have I provided clinical data, etc. to support a clear rationale as to why the other treatment options are NOT optimal?
• Is the focus of my discussion on mechanism of action and receptors/neurotransmitters that the drug acts on? If the answer is YES, you should consider doing additional research to address the above two questions

Also include how ethical considerations might impact your treatment plan and communication with clients.

The rubric, as I interpret it, suggests 5 references cited with every assignment for full credit on this portion (20 points). References used for your introductory paragraph, ethical considerations or conclusion do not count towards the 5 references required. As a general rule of thumb, I would encourage you to reference AT LEAST two sources (not including the textbook) for each decision point – this will result in 6 references total for your clinical decision making.

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.
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.

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Excellent

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

Point range: 0–69
Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Points Range:9 (9.00%) – 10 (10.00%)
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. Points Range:8 (8.00%) – 8 (8.00%)
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. Points Range:7 (7.00%) – 7 (7.00%)
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. Points Range:0 (0.00%) – 6 (6.00%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
Decision #1 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Points Range:18 (18.00%) – 20 (20.00%)
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. Points Range:16 (16.00%) – 17 (17.00%)
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. Points Range:14 (14.00%) – 15 (15.00%)
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. Points Range:0 (0.00%) – 13 (13.00%)
The response inaccurately and vaguely explains the decision selected.

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

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

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

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

Examples provided do not support the decisions and responses provided, or is missing.
Decision #2 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Points Range:18 (18.00%) – 20 (20.00%)
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. Points Range:16 (16.00%) – 17 (17.00%)
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. Points Range:14 (14.00%) – 15 (15.00%)
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. Points Range:0 (0.00%) – 13 (13.00%)
The response inaccurately and vaguely explains in detail the decision selected.

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

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

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

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

Examples provided do not support the decisions and responses provided, or is missing.
Decision #3 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Points Range:18 (18.00%) – 20 (20.00%)
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. Points Range:16 (16.00%) – 17 (17.00%)
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. Points Range:14 (14.00%) – 15 (15.00%)
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. Points Range:0 (0.00%) – 13 (13.00%)
The response inaccurately and vaguely explains in detail the decision selected.

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

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

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

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

Examples provided do not support the decisions and responses provided, or is missing.
Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. Points Range:14 (14.00%) – 15 (15.00%)
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. Points Range:12 (12.00%) – 13 (13.00%)
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. Points Range:11 (11.00%) – 11 (11.00%)
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. Points Range:0 (0.00%) – 10 (10.00%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.

The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. Points Range:5 (5.00%) – 5 (5.00%)
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. Points Range:4 (4.00%) – 4 (4.00%)
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. Points Range:3.5 (3.50%) – 3.5 (3.50%)
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. Points Range:0 (0.00%) – 3 (3.00%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation Points Range:5 (5.00%) – 5 (5.00%)
Uses correct grammar, spelling, and punctuation with no errors. Points Range:4 (4.00%) – 4 (4.00%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. Points Range:3.5 (3.50%) – 3.5 (3.50%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. Points Range:0 (0.00%) – 3 (3.00%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. Points Range:5 (5.00%) – 5 (5.00%)
Uses correct APA format with no errors. Points Range:4 (4.00%) – 4 (4.00%)
Contains a few (1 or 2) APA format errors. Points Range:3.5 (3.50%) – 3.5 (3.50%)
Contains several (3 or 4) APA format errors. Points Range:0 (0.00%) – 3 (3.00%)
Contains many (≥ 5) APA format errors.

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