Discussion: NRNP 6562 Common Health Conditions with Implications for Women

Discussion: NRNP 6562 Common Health Conditions with Implications for Women

Discussion: NRNP 6562 Common Health Conditions with Implications for Women

COMMON HEALTH CONDITIONS WITH IMPLICATIONS FOR WOMEN

Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, and diagnostic approaches, as well as to the development of treatment plans.

For this Case Study Discussion, you will propose a differential diagnosis with a minimum of 3 possible conditions or diseases. You will prioritize these diagnoses and explain which you would recommend.

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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:

By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Review the Learning Resources for this week as well as Weeks 5 and 6 and specifically review the clinical guideline resources specific to your assigned case study.

Use the Focused SOAP Note Template found in the Learning Resources to support Discussion. Based on the case study scenario provided, complete a SOAP note and critically analyze this and focus your attention on the diagnostic tests.

BY DAY 3

Based on your assigned case study, post a Focused SOAP NOTE with the following:

Differential diagnosis (dx) with a minimum of 3 possible conditions or diseases.

Define what you believe is the most important diagnosis. Be sure to include the first priority in conducting your assessment.

Explain which diagnostic tests and treatment options you would recommend for your patient and explain your reasoning.

Your differential diagnosis, what you believe the most important diagnosis is and why, additional diagnostic tests and treatments and rationales are what this assignment and grading is focused on. Your critical thinking for this assignment

Read a selection of your colleagues’ responses.

BY DAY 6

Respond to at least two of your colleagues’ posts on two different days and explain how you might think differently about the types of tests or treatment options your colleagues suggested and why. Use your learning resources and/or evidence from the literature to support your position.

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!

CHAUNCY

SOAP Note Case Study Week 8

Chauncy Hucke

RN-MSN, Walden University

NRNP 6552-5

Advanced Nurse Practice in Reproductive Health Care

Dr. DeLong

Episodic/Focused SOAP Note Case Study

Patient Information:

GA, 38 y/o Caucasian female, G2P2

S.

CC: Frequent menstrual bleeding occurring every 17-36 days, worsening since having a tubal ligation done 4-months ago.

HPI: GA is a 38 y/o Caucasian female here with complaints of menorrhagia, cycles that occur every 17-36 days and last 5-10 days. She reports the menorrhagia started after she had a tubal ligation 4-months ago, which was 9-months after having her last child, and after she stopped taking her OCP’s. She denies any pain or discomfort, she does report being increasingly tired and unable to stay awake, and reports having a 27lb. weight gain.

Current Medications:

No current medications

Allergies: NKDA, NKFA, no latex allergies, and no environmental allergies.

PMHx:

No medical history

The last tetanus is unknown; all childhood immunizations are up to date. She did not have the HPV vaccine. She declined the Influenza vaccine and COVID vaccines and boosters.

Hospitalizations:

Childbirth: 2020 and 2023

Soc & Substance Hx:

GA lives at home with her children and husband, she works full-time and has full medical health insurance coverage. She denies any tobacco use, alcohol use, or illicit substance use. She wears a seatbelt when she is in a vehicle and does not text and drive. She reports she has just recently started exercising with walking 1-2 miles each day, and is eating a low calorie, high protein diet to help lose weight that she has recently gained. She reports consuming copious amounts of caffeine daily, she drinks coffee, iced coffee and soda each day and does consume chocolate. She has a close relationship with her mother and feels she has an adequate support system with her mother and her husband. She reports she doesn’t have many hobbies as she focuses all of her free time on her husband and children.

Fam Hx:

Mother: Alive age 63, HTN, depression

Father: deceased age 43, MVC

Paternal grandmother: alive age 80, healthy

Paternal grandfather: alive age 80, HTN, CAD, DM 2

Maternal grandmother: alive age 82, HTN

Maternal grandfather: deceased age 55, MI

Sister: alive, age 40, depression and anxiety

Surgical Hx:

Tubal ligation, 10/23

Mental Hx: Denies any mental health history. Denies wanting to harm or hurt herself, has no suicidal or homicidal ideation currently, or has a history of having these thoughts.

Violence Hx: She denies being harmed or hurt by anyone currently or in her past relationships. She denies any sexual abuse or trauma in her childhood or past relationships.

Reproductive Hx: She reports having regular periods until she had her tubal ligation 4-months ago and stopping her OCP’s, now her cycle is irregular occurring every 17-36 days and last 5-10 days. She denies any dismenorrhagia, reports when her cycle is heavy, she will use a super tampon every 2-hours. She reports She reports her LMP was 12/12/23 and lasted 10 days. She denies any exposure to STIs, has been in a monogamous, heterosexual relationship for the last ten years with the same partner. She reports participating in oral and vaginal sexual intercourse and only with men. She reports she has had two previous planned pregnancies and had vaginal deliveries that were uncomplicated. She denies any abortions or miscarriages.

ROS:

GENERAL: No unexplained weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: Denies visual loss, blurred vision, double vision, or yellow sclerae. Denies any drainage from the eyes. Ears, Nose, Throat: Denies soreness to her pharynx, denies congestion, or runny nose. Denies hearing loss. Denies any pain in her ears bilaterally.

SKIN: No rash or itching. Denies any lumps to her breast bilaterally and no drainage from her nipples bilaterally.

CARDIOVASCULAR: Denies chest pain, chest pressure, or chest tightness. Denies any palpitations or edema.

RESPIRATORY: Denies any shortness of breath, cough, or sputum. Denies any wheezing.

GASTROINTESTINAL: Denies nausea and vomiting, denies any diarrhea. She has no abdominal pain or blood in her stools and denies any changes in appetite.

HEMATOLOGIC: Denies any anemia, bleeding, or bruising.

PSYCHIATRIC: Denies a history of depression or anxiety. Denies any suicidal or homicidal thoughts.

GENITOURINARY/Reproductive: Denies urgency, frequency, hematuria, or pain during urination. Denies any vaginal discharge or malodor. Denies any lumps or discharge to breasts and nipples bilaterally. Denies any pain during intercourse. Reports irregular menstrual bleeding.

O.

Physical exam: General appearance: Well nourished, no acute distress. She is alert and oriented and is cooperative with exams.

Vital signs: Temp. 97.8 oral, Pulse 90, Resp. 14, SPO2 100% Room Air, BP: 102/68.

Height: 170.18 cm

Weight: 102.27kg

BMI: 35.2

Chest: lungs clear to auscultation, non-labored respirations, symmetrical expansion. No wheezing, crackles, or rales auscultated.

Cardiac: Heart rate regular, S1, S2 auscultated, no murmur, gallop, or edema.

Abdomen: soft, non-tender to palpation to her suprapubic region and bilateral lower quadrants. Bowel sounds active in all four quadrants. No organomegaly or masses were palpated.

GYN: G2P2, vaginal deliveries with no complications, the most recent was 9-months ago.

VVBSU: Negative

Cervix: firm, smooth, parous, w/o CMT

Uterus: mild, mobile non-tender, approximately 10cm

Adnexa: without masses or tenderness

Skin: warm and dry, no rashes noted. Skin turgor is less than three seconds. No ecchymosis noted.

Neurologic: awake, alert, and oriented x3. Gait is steady, PERRLA.

Psychiatric: Cooperative, appropriate mood and affect.

Diagnostic results:

CBC: Hgb- 10.8, HCT- 32.1, Platelets- 210

TSH- 6.8

Free T4- 0.6

Hcg- Negative

Ferritin- 10

Prolactin- 16

PT, PTT, fibrinogen- negative

FSH- 21

Progesterone- 10

Pelvic US- uterus size is 82mm x5mm x4.8mm, endometrial stripe 2mm. No masses noted.

These labs will help the provider determine if the menorrhagia is due to an underlying bleeding disorder and should include a CBC, Ferritin, PTT, PT, VWF, FVIII, and Fibrinogen (James, 2020). The results of these tests, along with a pelvic or uterine US to rule out malignancy, endometriosis, or fibroids and will aid in the appropriate treatment plan for the patient (James, 2020).

A.

Hypothyroidism E03.9

Hypothyroidism occurs when the thyroid gland can’t or isn’t making enough thyroid hormone to keep the body running efficiently and normally (Wilson, Stem, & Bruehlman, 2021). Some symptoms include heat or cold intolerances, fatigue, weight gain, dry skin, and constipation and diagnosis is made based not only on how the patient presents, a detailed history and exam blood testing that would show a decreased TSH and free T4 levels (Wilson, Stem, & Bruehlman, 2021). This patient has a TSH level of 6.8 which is greater than the cutoff level of 4 and she has a free T4 level of 0.6, which is below the normal 0.8 level. These levels along with her clinical presentation of lethargy, weight gain, and menorrhagia, I would diagnose her with hypothyroidism.

Differential Diagnosis:

Iron deficiency anemia D50.9

Iron plays an important role in the body to help maintain bodily functions, the production of hemoglobin, and maintaining healthy cells, skin, hair, and nails (Lee, 2020). Patients can present with symptoms such as pale skin, unexplained fatigue or feeling of lack of energy, shortness of breath, tachycardia, brittle nails or hair loss, pagophagia, and headaches (Lee, 2020). A CBC is collected and completed to test for iron deficiency anemia and would result in the patients having low hemoglobin and hematocrit, low MCV, low ferritin, low FE, high transferrin or total iron-binding capacity, and low iron saturation (Lee, 2020). Treatment is the replacement of iron by increasing the consumption of iron rich foods such as beef, pork, lamb, organ meats such as liver, chicken, turkey, duck, fish, leafy greens like broccoli, kale, turnip greens and collard greens, legumes, and iron-enriched pastas, grains, rice, and cereals (Lee, 2020), and or taking oral iron supplements. Based on the patient’s CBC results of a Hgb of 10.8, Hct 32.1, and Ferritin 10, plus her history of menorrhagia and going through super tampons every two hours, and increased fatigue I would diagnose this patient with Iron deficiency anemia secondary to menorrhagia that has been caused by her stopping OCP’s and hypothyroidism.

Hashimoto’s E06.3

Hashimoto’s is an autoimmune disorder that is caused by the immune system attacking healthy tissues leading to the death of the thyroid’s hormone-producing cells which in turn causes hypothyroidism (Ihnatowicz, Drywien, Wator, & Wojsiat, 2020). Hashimoto’s will present with very similar symptoms as hypothyroidism, symptoms such as cold intolerance, constipation, irregular or excessive menstrual bleeding, depression, fatigue, weight gain, and brittle nails and hair loss (Ihnatowicz, Drywien, Wator, & Wojsiat, 2020). Environmental factors could play a role in developing Hashimoto’s as well. Increased stress, smoking and alcohol consumption can all play a role in a patient developing Hashimoto’s. Hashimoto’s also affects women more than men, and usually middle-aged women are more affected. Based on the patient’s history of increased fatigue, weight gain, and her irregular and heavy menstrual cycle, this patient has a high probability of developing Hashimoto’s disease. Further testing would be needed to make a definite diagnosis.

Menorrhagia N92.0

Menorrhagia is defined as menstrual bleeding that lasts more than seven days and can have heavy bleeding with or without clots (MacGregor, Munro, & Lumsden, 2023). First line treatment option is typically medical management instead of procedural management. Some first line treatment options include oral contraceptive pills, tranexamic acid, NSAIDS, and IUD’s. Procedural treatment is a hysterectomy, hyperthermic ablation, and uterine artery embolization (MacGregor, Munro, & Lumsden, 2023). This patient has given enough of a detailed history of increased uterine bleeding that last longer than seven days, is irregular, and is considered heavy bleeding since she goes through super tampons every two hours, that she can be diagnosed with menorrhagia.

P:

Labs:

TPOAb CPT 86376 to test for antibodies that are a sign of Hashimoto’s disease (Ihnatowicz, Drywien, Wator, & Wojsiat, 2020).

Iron 83550, this test will help support the diagnosis of iron deficiency anemia. Iron levels less than 10umol/L is considered to be iron-deficiency anemia (Lee, 2020).

Prescribe: Ortho Tri-Cylcen-Lo 1-tab PO daily, # 1 pack, 3 refills.

This oral contraceptive pill is a combination pill that has over a 98% efficacy rate to reduce unwanted pregnancies but can also aid in menstrual cycle bleeding and improving lifestyles for those who suffer from menorrhagia. Combination pills contain both estrogen and progestin and mimic the natural hormones that occur in our body the closet (Walter & Koenig, 2023).

Levothyroxine 25mcg 1-tab PO daily, #30, 2 refills.

Levothyroxine is the medication that is used to replace the thyroid hormone that is not being produced sufficiently in the body (Wilson, Stem, & Bruehlman, 2021). Taking Levothyroxine will help reduce symptoms of hypothyroidism and will bring your TSH back to normal levels.

Education/Disposition:

You were diagnosed today with hypothyroidism which could be contributing to your irregular menstrual cycle. We will start you today on Levothyroxine 25mcg, take this at the same time each day at least 30 minutes before you have anything to eat so it absorbs better. We will recheck your TSH level in 8-weeks to see how well your body is responding and to see if we need to adjust the dosage. If bringing your TSH up to normal levels does not improve your menorrhagia, we will start you on the birth control medication. I only want to start one new medication at a time in case of a reaction, we will know which one you are reacting to.

You were also diagnosed with iron-deficiency anemia, to improve and correct this I want you to start by eating iron rich foods to help increase your iron levels. Beef, chicken, turkey, organ meats such as liver, leafy greens like broccoli, kale, turnip greens and collard greens, legumes, and iron-enriched pastas, grains, rice, and cereals (Lee, 2020). Consuming foods that are also rich in Vitamin C will help the body absorb the Iron foods better. Some examples are citrus fruits like oranges and grapefruits, green leafy vegetables such as broccoli, kale, and cauliflower, white potatoes, red peppers, and strawberries (Foyer, Kyndt, & Hancock, 2020) just to name a few. Increasing fruits and vegetables into your diet will also aid in weight loss, you will need to increase your water intake and decrease the intake of sugary drinks such as soda, and cream and sugar in your coffee and iced coffee.

Disposition is to home, follow up in the office in 8-weeks. We will recheck the following labs and adjust and start medications if needed: TSH, TPO, Ferritin, Free T4, and CBC. If you begin to bleed through a super tampon more than one per hour, call and make an appointment to be seen sooner or go to the ER for evaluation.

Reflection and further questions:

This case is one that I have seen multiple times in the office during my clinical rotation, both in Women’s Health and in my Family Practice rotation. These types of cases have individualized treatment plans to help the patient the best, depending on how low their iron levels were, how heavy their cycles were, and what kind of lifestyle they live such as smoking, alcohol consumption, sexual history, and number of children they’ve had, which can make them difficult to diagnose and treat. Compliance is also a factor when prescribing medications and education needs to be done on the importance of taking the Levothyroxine at the same time each day and before they eat anything. Increasing both iron and vitamin C so that the Iron is absorbed better. I have been taught in all three of my clinical rotations so far to not start more than one new medication at a time, so if this patient doesn’t have improvement of her cycle with the Levothyroxine and increasing her TSH, I would instruct her to start the birth control at the next visit. If her iron levels are not improving, I would start her on an Iron and Vitamin C supplement at the next visit, but decreasing the menorrhagia would also improve the iron levels. In order for all of this to work together like it should, she needs to be compliant in taking her medications and adjusting her diet.

Also, while compiling my history for this patient, I want to ask questions about her cycle such as what age she started, has it been normal prior to her tubal ligation, and has she had any STI exposures. I also want to know if she is breast feeding or bottle feeding so when I go to prescribe medications, I am not prescribing medications that are not safe for her baby if she is breastfeeding. Since she is also less than a year postpartum, I want to check a PHQ-9 and assess for any depression that she may be having, especially with an unexpected weight gain that she is experiencing.

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References

Foyer, C.H., Kyndt, T., & Hancock, R.D. (2020). Vitamin C in plants: Novel concepts, new perspectives, and outstanding issues. Anitoxidants & Redox Signaling, 32(7). https://doi.org/10.1089/ars.2019.7819Links to an external site.

Ihnatowicz, P., Drywien, M., Wator, P., & Wojsiat, J. (2020). The importance of nutritional factors and dietary management of Hashimoto’s thyroiditis. Annals of Agricultural and Environmental Medicine, 27(2): 184-193. doi: 10.26444/aaem/112331

James, A.H. (2020). Heavy menstrual bleeding: workup and management. Hematology The American Society of Hematology Education Program, 1: 236-242. doi: 10.1182/asheducation-2016.1.236Links to an external site.

Lee, N.H. (2020). Iron deficiency anemia. Clinical Pediatric Hematology-Oncology, 27: 101-112. https://doi.org/10.15264/cpho.2020.27.2.101Links to an external site.

MacGregor, B., Munro, M.G., & Lumsden, M.A. (2023). Therapeutic options for the management of abnormal uterine bleeding. International Journal of Gynecology and Obstetrics, 162(S2): 43-57.

https://doi.org/10.1002/ijgo.14947Links to an external site.

Walter, J., & Koenig, L.A. (2023). Types of birth control Pills: Monophasic vs. bipashic vs. triphasic. ADYN. Types of Birth Control Pills: Monophasic vs. Biphasic vs. Triphasic | adynLinks to an external site.

Wilson, S.A., Stem, L.A., & Bruehlman, R.D. (2021). Hypothyroidism: Diagnosis and treatment. American Family Physician, 103(10): 605-613. Hypothyroidism: Diagnosis and Treatment | AAFP

NRNP_6552_Week8_Case_Study_Discussion_Rubric

NRNP_6552_Week8_Case_Study_Discussion_Rubric

Criteria Ratings Pts
This criterion is linked to a Learning OutcomeMain Posting:

Response to the case study discussion questions includes appropriate diagnoses with explanations of appropriate diagnostic tests and treatment options as directed, is based on evidence-based research where appropriate, and is incorporates syntheses representative of knowledge gained from the course readings for the module and current credible sources.
44 to >39.16 pts
Excellent Point range: 90–100

Thoroughly responds to the discussion question(s)… Post includes appropriate diagnoses including explanations of appropriate diagnostic tests and treatment options… Incorporates syntheses representative of knowledge gained from the course readings for the module and current credible sources, with no less than 75% of post the post having exceptional depth and breadth… Supported by at least 3 current credible sources.

39.16 to >34.76 pts
Good Point range: 80–89

Responds to most of the discussion question(s).. Post includes appropriate diagnoses with explanations of appropriate diagnostic tests and treatment options… Somewhat incorporates syntheses representative of knowledge gained from the course readings for the module and current credible sources with no less than 50% of the post having exceptional depth and breadth… Supported by at least 3 credible references.

34.76 to >30.36 pts

Fair Point range: 70–79

Responds to some of the discussion question(s)… Post contains incomplete or vague diagnoses or explanations of appropriate diagnostic tests and treatment options… Is somewhat lacking in synthesis of knowledge gained from the course readings for the module and current credible sources… Post is cited with fewer than 2 credible references.

30.36 to >0 pts

Poor Point range: 0–69

Does not respond to the discussion question(s)… Post contains incomplete diagnoses or explanations of appropriate diagnostic tests and treatment options, or diagnoses and/or explanations are missing… Lacks synthesis gained from the course readings for the module and current credible sources… Contains only 1 or no credible references.
44 pts
This criterion is linked to a Learning OutcomeMain Posting:

Writing

6 to >5.34 pts
Excellent Point range: 90–100

Written clearly and concisely… Contains no grammatical or spelling errors… Further adheres to current APA manual writing rules and style.

5.34 to >4.74 pts
Good Point range: 80–89

Written concisely… May contain one to two grammatical or spelling errors… Adheres to current APA manual writing rules and style.

4.74 to >4.14 pts
Fair Point range: 70–79

Written somewhat concisely… May contain more than two spelling or grammatical errors… Contains some APA formatting errors.

4.14 to >0 pts
Poor Point range: 0–69

Not written clearly or concisely… Contains more than two spelling or grammatical errors… Does not adhere to current APA manual writing rules and style.

6 pts

This criterion is linked to a Learning OutcomeMain Posting:

Timely and full participation
10 to >8.9 pts

Excellent Point range: 90–100

Meets requirements for timely, full, and active participation… Posts main discussion by due date.

8.9 to >7.9 pts
Good Point range: 80–89

Posts main discussion by due date… Meets requirements for full participation.

7.9 to >6.9 pts
Fair Point range: 70–79

Posts main discussion by due date.

6.9 to >0 pts
Poor Point range: 0–69

Does not meet requirements for full participation… Does not post main discussion by due date.
10 pts
This criterion is linked to a Learning OutcomeFirst Response:

Post to colleague’s main post that is reflective and justified with credible sources.
9 to >8.01 pts
Excellent Point range: 90–100

Response exhibits critical thinking and application to practice settings… Responds to questions posed by faculty… The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8.01 to >7.11 pts
Good Point range: 80–89

Response has some depth and may exhibit critical thinking or application to practice setting.

7.11 to >6.21 pts
Fair Point range: 70–79

Response is on topic, may have some depth.

6.21 to >0 pts
Poor Point range: 0–69

Response may not be on topic, lacks depth.
9 pts
This criterion is linked to a Learning OutcomeFirst Response:

Writing
6 to >5.34 pts
Excellent Point range: 90–100

Communication is professional and respectful to colleagues… Response to faculty questions are fully answered, if posed… Provides clear, concise opinions and ideas that are supported by two or more credible sources… Response is effectively written in Standard, Edited English.

5.34 to >4.74 pts
Good Point range: 80–89

Communication is mostly professional and respectful to colleagues… Response to faculty questions are mostly answered, if posed… Provides opinions and ideas that are supported by few credible sources… Response is written in Standard, Edited English.

4.74 to >4.14 pts
Fair Point range: 70–79

Response posed in the discussion may lack effective professional communication… Response to faculty questions are somewhat answered, if posed… Few or no credible sources are cited.

4.14 to >0 pts
Poor Point range: 0–69

Responses posted in the discussion lack effective communication… Response to faculty questions are missing… No credible sources are cited.
6 pts
This criterion is linked to a Learning OutcomeFirst Response:

Timely and full participation

5 to >4.45 pts

Excellent Point range: 90–100

Meets requirements for timely, full, and active participation… Posts by due date.

4.45 to >3.95 pts

Good Point range: 80–89

Meets requirements for full participation… Posts by due date.

3.95 to >3.45 pts

Fair Point range: 70–79

Posts by due date.

3.45 to >0 pts

Poor Point range: 0–69

Does not meet requirements for full participation… Does not post by due date.

5 pts
This criterion is linked to a Learning OutcomeSecond Response:

Post to colleague’s main post that is reflective and justified with credible sources.

9 to >8.01 pts
Excellent Point range: 90–100

Response exhibits critical thinking and application to practice settings… Responds to questions posed by faculty… The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8.01 to >7.11 pts
Good Point range: 80–89

Response has some depth and may exhibit critical thinking or application to practice setting.

7.11 to >6.21 pts
Fair Point range: 70–79

Response is on topic, may have some depth.

6.21 to >0 pts
Poor Point range: 0–69

Response may not be on topic, lacks depth.

9 pts

This criterion is linked to a Learning OutcomeSecond Response:

Writing

6 to >5.34 pts
Excellent Point range: 90–100

Communication is professional and respectful to colleagues… Response to faculty questions are fully answered, if posed… Provides clear, concise opinions and ideas that are supported by two or more credible sources… Response is effectively written in Standard, Edited English.

5.34 to >4.74 pts
Good Point range: 80–89

Communication is mostly professional and respectful to colleagues… Response to faculty questions are mostly answered, if posed… Provides opinions and ideas that are supported by few credible sources… Response is written in Standard, Edited English.

4.74 to >4.14 pts
Fair Point range: 70–79

Response posed in the discussion may lack effective professional communication… Response to faculty questions are somewhat answered, if posed… Few or no credible sources are cited.

4.14 to >0 pts
Poor Point range: 0–69

Responses posted in the discussion lack effective communication… Response to faculty questions are missing… No credible sources are cited.

6 pts
This criterion is linked to a Learning OutcomeSecond Response:

Timely and full participation

5 to >4.45 pts
Excellent Point range: 90–100

Meets requirements for timely, full, and active participation… Posts by due date.

4.45 to >3.95 pts
GoodPoint range: 80–89

Meets requirements for full participation… Posts by due date.

3.95 to >3.45 pts
Fair Point range: 70–79

Posts by due date.

3.45 to >0 pts

Poor Point range: 0–69

Does not meet requirements for full participation… Does not post by due date.
5 pts

Total Points: 100