Assessing and Treating Patients With ADHD Essay Discussion

Assessing and Treating Patients With ADHD Essay Discussion

Assessing and Treating Patients With ADHD Essay Discussion

            In this discussion, the case of an 8-year-old Caucasian female by the name of Katie has been examined. The patient was brought to the clinic by her parents following her teacher’s suggestion that Katie may be having ADHD. The parents also report that their primary care physician also recommended a psychiatric review by a specialist. The Conner’s Teacher Rating Scale-Revised was completed by the patient’s teacher which revealed symptoms of inattentiveness, forgetfulness, being easily distracted, poor spelling, arithmetic and reading skills, lack of interest, and short attention span. The teacher also reported that the patient has a tendency of leaving school work incomplete, and failing to follow instructions. The patient’s parents however denied that their daughter has ADHD, with the father reiterating that she has no temper outbursts or defiant behavior. The patient however confirms that some of her subjects are boring, absentmindedness, and the feeling of being lost. The mental status examination was conducted where the results supported the diagnosis of attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation.

ORDER A PLAGIARISM-FREE PAPER HERE ON;Assessing and Treating Patients With ADHD Essay Discussion

The treatment plan for this patient will incorporate the selection of the safest and most effective drugs in addition to psychotherapeutic interventions depending on the outcome. Several patient-specific factors will guide the selection of these drugs. For instance, the patient’s diagnosis of ADHD and reported symptoms will promote the selection of the drug. Additionally, the patient’s young age, female gender, and the Caucasian race will be utilized in determining the dosage and frequency of the drugs selected. The purpose of this discussion is thus to illustrate the decisions made in the selection of the most effective pharmacological agent in the management of the 8-year-old patient with ADHD.

Decision Point One

Selected Decision and Rationale

            From the options provided, administering Start Ritalin (methylphenidate) 10mg chewable tablets every morning was selected as the first intervention. Methylphenidate is a psychostimulant medication FDA approved for the management of ADHD among adults, and the most commonly prescribed medication for the same disorder among children and adults (Faltinsen et al., 2018). Studies show that methylphenidate has displayed great safety and effectiveness in reducing symptoms of hyperactivity, impulsivity, and inattention in up to 80% of pediatric patients prescribed the medication (Hodgkins et al., 2012; Piovani et al., 2019). Considering the age of the child, chewable tablets at a starting dose of 10mg have been reported to be safe and effective (American Psychiatric Association, 2013; Yoshida et al., 2019). The drug is metabolized primarily by de-esterification in the liver and about 78-97% excreted in urine and 1 to 3% in the feces, hence the reduced risks of toxicity and adverse effects (Pozzi et al., 2020).

            Bupropion and Intuniv were not appropriate medications for this child. For instance, the risk of bupropion outweighs its benefits in children below the age of 13 years due to their increased risks of suicidal ideation (Padilha et al., 2018). Intuniv on the other hand is also associated with mental/mood changes and hallucinations that would otherwise compromise the patient’s condition (Piovani et al., 2019).

Expected Outcome

            With the use of methylphenidate, the patient’s ADHD symptoms are expected to reduce by not less than 50% over the following four weeks (American Psychiatric Association, 2013). Her interest in school work is expected to improve, with improved attention and concentration levels. She should be able to complete her homework from this time forward (Yoshida et al., 2019).

Ethical Considerations.

            The patient is a minor and extends the legal responsibility of making decisions concerning her health to her parents (Piovani et al., 2019). As such, the parents must be informed about the condition affecting their child, and all the available treatment options for this mental problem for them to consent to the most appropriate intervention (Yoshida et al., 2019).

Decision Point Two

Selected Decision and Rationale

            Administering long-acting ratline 20mg per oral every morning was selected as the second decision. This decision was based on the potential effectiveness of the medication in the management of her ADHD symptoms as reported (Padilha et al., 2018). However, since the drug was unable to manage the patient’s symptoms throughout the day, it was necessary to consider a long-acting formulation and increase the dose (American Psychiatric Association, 2013). Regarding the reported side effect of increased heartbeat, studies show that most of the common side effects of the drug such as cardiovascular events are normally self-limiting and diminish over time (Faltinsen et al., 2018; Yoshida et al., 2019). Additionally, with great tolerance and adherence to the medication, pediatric patients on Ritalin normally take between 4 to 8 weeks to completely manage the ADHD symptoms (Pozzi et al., 2020).

            Maintaining the dose of retaining at this point was not necessary as the patient would continue experiencing limited management of ADHD symptoms hence compromising her confidence in the treatment plan (Hodgkins et al., 2012). Using Adderall in place of Ritalin was also not necessary as this drug is associated with increased suicidal ideation, hence discouraged among children (Piovani et al., 2019).

Expected Outcome

            With the long-acting formulation, the patient is expected to exhibit even further improvement in ADHD symptoms over the following 4 weeks (American Psychiatric Association, 2013). Her concentration and interest in school work are expected to improve significantly with further improved school performance (Faltinsen et al., 2018). The symptoms of elevated heart rate are expected to diminish over this period.

Ethical Consideration

            The PMHNP has an ethical and legal obligation of using their clinical skills and reasoning in promoting the health of the patient by satisfying their healthcare needs and preventing harm (Padilha et al., 2018). Ethical principles such as justice, nonmaleficence, beneficence, and autonomy must be upheld (Piovani et al., 2019).

Decision Point Three

Selected Decision and Rationale

            Finally, it was decided the patient maintain the present dose of the drug and report for reevaluation after 4 weeks. The decision was based on the reported outcome of the previous intervention as the patient displayed great tolerance and further effectiveness of the medication in the management of her ADHD symptoms (American Psychiatric Association, 2013). Studies show that at low and effective doses, Ritalin can take up to 12 weeks for complete management of the patient’s symptoms (Pozzi et al., 2020). However, close monitoring of the patient outcome every month is necessary to promote positive outcomes (Padilha et al., 2018). Consequently, the patient already displayed resolved side effects of increased heart rate, which confirms the safety of the drug for the patient (Hodgkins et al., 2012). Long-term use of the medication will promote further tolerance to the medication hence improving the safety profile (Piovani et al., 2019).

            There was no need to increase the dose at this point as it is usually advisable to administer lower effective doses of stimulants among pediatric patients (Faltinsen et al., 2018). Consequently, a pulse of 92 is appropriate for the patient’s age, hence is no need to conduct an EKG at the moment. EKG is mainly ordered among pediatric patients who record a heart rate above 110 bpm (Hodgkins et al., 2012).

Expected Outcome

            With already displayed improved symptoms and resolved side effects, the patient is expected to display even further improvement in ADHD symptoms onwards, with no side effects (American Psychiatric Association, 2013). Her performance at school should improve significantly with appropriate language, arithmetic, and spelling skills (Pozzi et al., 2020).

Ethical Consideration

            Since the patient was satisfied with the treatment outcome of the initial intervention, the PMHNP needed to explain to the parent why she needed to continue taking the medication for another four weeks (Faltinsen et al., 2018). With clinical reasoning and observation of ethical principles such as beneficence and nonmaleficence, the PMHNP must ensure that the patient attains optimal care outcomes (Padilha et al., 2018).

Conclusion

            Due to limited clinical trials and a lack of substantial evidence, only a few drugs have been recommended for the management of ADHD among the pediatric population. Even for the few available options, clinicians are still required to take keen measures when deciding on which drug and dosage to administer. For instance, for the 8-year-old patient in the assigned case study, such factors include her ADHD diagnosis, presenting symptoms, age, gender, and race. Based on these factors, the first decision was to administer Ritalin 10mg every morning (Faltinsen et al., 2018). The drug is the most common psychostimulant recommended as the first line for the management of ADHD among pediatric patients (Hodgkins et al., 2012). Due to adverse effects and risks of suicidal ideation, drugs such as bupropion and Intuniv are discouraged for use in children (Padilha et al., 2018). After 4 weeks, the patient reported improved symptoms in the morning, but with limited effectiveness of the drug during the day in addition to side effects of elevated heart rate (Pozzi et al., 2020). It was necessary to increase the dose to 20mg and change the formulation to long-acting as the second decision to promote the effectiveness of the drug throughout the day. The side effect is self-limiting and expected to diminish with time (Piovani et al., 2019). Continuing the same dose or replacing Ritalin with Adderall was not appropriate at this time.

            The final decision was to continue the same dose of the drug and reevaluate the patient after 4 weeks, given the great tolerance, and effectiveness displayed with the previous intervention (Yoshida et al., 2019). Obtaining the patient’s EKG was not necessary as her heart rate was normal. Increasing the dose was also not necessary as low effective doses are considered safer. The PMHNP encountered several ethical considerations in each decision process based on ethical principles such as respect for autonomy, justice, nonmaleficence, and beneficence (American Psychiatric Association, 2013).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Faltinsen, E. G., Gluud, C., Simonsen, E., Zwi, M., & Storebø, O. J. (2018). Unbalanced risk-benefit analysis of ADHD drugs. The Lancet Psychiatry, 5(11), 870. https://doi.org/10.1016/s2215-0366(18)30334-1

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000

Padilha, S. C. O. S., Virtuoso, S., Tonin, F. S., Borba, H. H. L., & Pontarolo, R. (2018). Efficacy and safety of drugs for attention deficit hyperactivity disorder in children and adolescents: a network meta-analysis. European Child & Adolescent Psychiatry, 27(10), 1335–1345. https://doi.org/10.1007/s00787-018-1125-0

Piovani, D., Clavenna, A., & Bonati, M. (2019). Prescription prevalence of psychotropic drugs in children and adolescents: an analysis of international data. European Journal of Clinical Pharmacology, 75(10), 1333–1346. https://doi.org/10.1007/s00228-019-02711-3

Pozzi, M., Bertella, S., Gatti, E., Peeters, G. G. A. M., Carnovale, C., Zambrano, S., & Nobile, M. (2020). Emerging drugs for the treatment of attention-deficit hyperactivity disorder (ADHD). Expert Opinion on Emerging Drugs, 25(4), 1–13. https://doi.org/10.1080/14728214.2020.1820481

Yoshida, M., Obara, T., Kikuchi, S., Satoh, M., Morikawa, Y., Ooba, N., Yamaguchi, H., & Mano, N. (2019). Drug Prescriptions for Children With ADHD in Japan: A Study Based on Health Insurance Claims Data Between 2005 and 2015. Journal of Attention Disorders, 24(2), 175–191. https://doi.org/10.1177/1087054719843179

BUY A CUSTOM- PAPER HERE ON;Assessing and Treating Patients With ADHD Essay Discussion

‌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 lifespan. 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.Learning Resources

Required Readings (click to expand/reduce)

Prince, J. B., Wilens, T. E., Spencer, T. J., & Biederman, J. (2016). Stimulants and other medications for ADHD. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 99–112). Elsevier.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000

Martin, L. (2020). A 5-question quiz on ADHD. Psychiatric Times.
https://www.psychiatrictimes.com/view/5-question-quiz-adhd

Medication Resources (click to expand/reduce)

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

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
• armodafinil
• amphetamine (d)
• amphetamine (d,l)
• atomoxetine
• bupropion
• chlorpromazine
• clonidine • guanfacine
• haloperidol
• lisdexamfetamine
• methylphenidate (d)
• methylphenidate (d,l)
• modafinil
• reboxetine

Required Media (click to expand/reduce)

Case Study: A Young Caucasian Girl with ADHD
Note: This case study will serve as the foundation for this week’s Assignment.

CASE STUDY
Attention Deficit Hyperactivity Disorder
A Young Girl With ADHD

BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.
The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.
Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE
Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”
Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

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

RESOURCES
§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Decision Point One
Select what the PMHNP should do:

B bebegin Wellbutrin (bupropion) XL 150 mg orally dailyBegin Wellbutrin (bupropion) XL 150 mg orally daily

Begin Intuniv extended release 1 mg orally at BEDTIME

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

RUBRIC:

Excellent

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

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

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. 9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. 8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. 7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. 0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

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

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided. 16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided. 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

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

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

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

Examples provided may support the decisions and responses provided. 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.

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

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

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

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

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

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided. 16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided. 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

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

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

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

Examples provided may support the decisions and responses provided. 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.

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

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

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

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

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

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided. 16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided. 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

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

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

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

Examples provided may support the decisions and responses provided. 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.

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

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

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

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

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

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. 14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.

The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. 12 (12%) – 13 (13%)
The response accurately summarizes the recommendations on the treatment options selected for this patient.

The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. 11 (11%) – 11 (11%)
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient.

The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. 0 (0%) – 10 (10%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.

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

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic. 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

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