NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

Subjective:
CC (chief complaint): Allegations by the parents that the patient is having some difficulty in school. (Case video selection: Training Title 29)
HPI: Mr. Jay Feldman is a 19-year-old European American male patient who is in the psychiatric clinic for evaluation. This was following a call by his parents a week earlier with allegations that the patient was having some trouble in school. The patient is a freshman-year student at State College taking advanced placement courses similar to the ones he took in high school. He is specifically undertaking advanced calculus in theoretical physics although he was considering double majoring in philosophy and physics. He is intrigued by the mysteries of these courses which disappear once he understands them. He has a roommate in college whom he claims has been spying on him through a microwave he placed in their room. He also thinks another microwave oven was placed in the building he is currently being evaluated in. He suspects the practitioner assessing him is working with the spies. He thinks it is something to do with a bleeding degeneration of blood cells in the eyes that are impeding humanity from their rightful destiny.
Apart from these persecutory delusions, his appetite has been inconsistent and he has resultantly lost weight by 18 lbs since returning to school in the fall. He is currently home for spring. He has never had a previous report of this behavior but had mild paranoia during the last six months of high school for which he was on aripiprazole trial shortly. He discontinued the medication after graduating due to intolerable side effects of akathisia. He has a lot of friends but he has not been in contact with them since he came home. He has also not been showering. He has sleep disturbance managing to only sleep for 4-5hours.

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Past Psychiatric History:
General Statement: It has been reported that the patient has been on psychiatric treatment for mild paranoia during the final six months of high school. He was on short-term prescription aripiprazole but stopped it due to side effects of akathisia.
Caregiver (if applicable): His parents.
Hospitalizations: There are no reported past psychiatric admissions.
Medication trials: He was shortly initiated on an aripiprazole trial for which he experienced side effects.
Psychotherapy or Previous Psychiatric Diagnosis: Unknown
Substance Current Use and History: The patient reports no history of alcohol consumption or use of any other substance of abuse.
Family Psychiatric/Substance Use History: The patient’s family members all have a history of psychiatric disorders. His father has paranoid schizophrenia whereas his mother has an anxiety disorder. One of his brothers has a history of ADHD. The other brother, like their mother, has a history of anxiety.
Psychosocial History: The patient was raised by both his parents. He has two younger male siblings. He is in college after graduating from high school but is currently reported to be having trouble. He has several friends whom he has had good relations with but has currently not been in contact with them since coming home. He has no forensic history or any trouble with the legal authorities.
Medical History: The patient has had no past medical problems.
Current Medications: The patient was reportedly on aripiprazole shortly but stopped it due to adverse effects. There are no reported current prescription medications.
Allergies: There is no known allergy to any medications or food.
Reproductive Hx: He is single and has no children.
ROS: The case video selection, Training Title 29, has no review of systems. The information is hereby deduced from the case history report.
GENERAL: The is a reported recent weight loss of 18 lbs, but no fever, and no generalized body malaise.
HEENT: There is no visual disturbance, hearing loss, sore throat, or nasal blockage.
SKIN: There is no reported itchiness or skin eruptions.
CARDIOVASCULAR: He denies any left-sided chest pains, chest discomfort, awareness of heartbeat, easy fatigability, or paroxysmal nocturnal dyspnea.
RESPIRATORY: He has no dyspnea, no cough, and no chest pain.
GASTROINTESTINAL: He reports no abdominal pain, no change in bowel habits, no blood in stool, and no loss of appetite.
GENITOURINARY: The patient denies dysuria, hematuria, frequency, or foul-smelling urine.
NEUROLOGICAL: There are no reported headaches, no weakness, no bladder or bowel incontinence, and no seizures.
MUSCULOSKELETAL: He denies any muscle aches, joint pains, joint swelling, or joint stiffness.
HEMATOLOGIC: There is no anemia, no easy bruising, or uncontrolled bleeding.
LYMPHATICS: There is no reported lymphadenopathy or splenomegaly.
ENDOCRINOLOGIC: He denies any heat or cold intolerance, polydipsia, polyphagia, or polyuria.
Objective:
Physical exam:
Vital signs: BP 106/72mmHg, PR 69, RR 20, Temperature 98.3, Ht 5’2 Wt 117lbs
General: The patient is in fair general health, is not distressed, and is well groomed.
HEENT: The head is normocephalic, the pupils are equally and bilaterally reactive to light, eyes movements are normal, the nose is clear, there is minimal ear wax in the ear canals, the throat is not inflamed and the oral cavity is of good hygiene.
Neck: There are no swollen cervical lymph nodes, no thyromegaly, and no swollen or prominent neck veins.
Chest/Lungs: The chest rises symmetrically on breathing, normal breath sounds are heard upon auscultation, no wheezing or stridor.
Heart/Peripheral Vascular: There is normal precordial activity, s1 and s2 heard, and there are no heaves, no thrills, and no murmurs.
Abdomen: The abdomen is soft, with no scars or therapeutic marks, non-tender, and no masses or organomegaly.
Genital/Rectal: Examination not performed for privacy reasons.
Musculoskeletal: There is no myalgia, no joint swelling, tenderness, or stiffness, range of motion is normal for both active and passive movements.
Neurological: No cranial nerve abnormalities detected. The sensation is normal. The bulk, tone, power, and reflexes are normal.
Skin: The skin is intact with no lesions.

Diagnostic results:
A toxicological screen from urine and blood samples was negative for any substance of abuse.
Blood microscopy and cultures were negative for any micro-organism.
Cerebrospinal fluid obtained from the lumbar puncture was clear with no organism upon culture and staining.
A CT scan of the head showed normal findings.
Assessment:
Mental Status Examination: The patient is a 19-year-old European American male who looks his stated age. He is neat, well-kempt, and dressed appropriately. He is fully conscious, but rarely maintains eye contact with the examiner. He is restless and shows some features of motor agitation. He is repetitively fidgeting with his hands. He is otherwise cooperative. The patient is oriented to time, place, and person. He has clear and coherent speech of normal rate and volume. His mood is flat and his affect is congruent. His thought process is a bit illogical since he thinks spies are working to stop humans from reaching their rightful destiny. His thought content has paranoid ideations and persecutory delusions since he thinks he is being spied on by his roommate, his medical attendant, and others. There is no flight of ideas. He exhibits no suicidal thoughts or ideations and has no intentions of self-harm or harming other people. He experiences neither visual hallucinations. There is, however, a possibility of auditory hallucinations based on his shushing the evaluator during his assessment. His memory is intact, for immediate, recent, remote, and long-term memories. Her concentration is good. He lacks insight into his psychiatric condition. His judgment is poor because he thinks he is being watched and targeted by spies.
Differential Diagnoses:
1. Schizophrenia: The patient’s most likely diagnosis is Schizophrenia. This is because his presenting complaints and allegations are typical of Schizophrenia. The typical features present in this patient were auditory hallucinations, paranoid persecutory delusions, and thought disorder (Hany et al., 2022). The patient also presented with a negative schizophrenia symptom of flat affect found during mental status examination. Some of the identified risk factors that the patient exhibited include genetic predisposition, age, and social stressors such as his recently going to college which is a new environment (Robinson et al., 2021). His father has paranoid Schizophrenia thus there is a possibility of his diagnosis is hereditary. The onset of Schizophrenia is late teenage years. The patient being 19 years is thus more predisposed to this condition. The aripiprazole prescription medication which he discontinued is an antipsychotic. His non-compliance may have caused an emergence of his symptoms. He has not contacted his several friends ever since he came home. This may point to social withdrawal which is a negative symptom of Schizophrenia.

2. Medication-induced movement disorders: The patient is also likely to be experiencing extrapyramidal effects from the use of aripiprazole, an antipsychotic agent used to previously manage his paranoia. These disorders are attributed to dopamine receptor blockade (Ward et al., 2018). These disorders include acute dystonia, tardive dyskinesia, akathisia, and parkinsonism among others (Duma et al., 2018). The patient reports discontinuation of the drug due to its intolerable side effects of akathisia. Persistent fidgeting may be the residual feature of akathisia after cessation of treatment (Patel et al., 2022). The patient is also restless which is another manifestation of akathisia.

3. Major Depressive Disorder with Psychotic features: This is another likely differential diagnosis. Severe depression can sometimes present with psychotic features such as hallucinations and delusions seen in this patient (Dold et al., 2019). He also presents with typical features of depressive illness such as inconsistent appetite, weight loss, sleep disturbance with insomnia, and psychomotor agitation (Tolentino et al., 2018). Stress is likely the predisposing factor. His being recently admitted to college might have taken a toll on him.
Reflections: The healthcare professional in this particular case study did a commendable job in obtaining both objective and subjective data from the patient. He captured vital information despite the psychotic features of the patient that contributes immensely to working out an accurate diagnosis and treatment plan. The practitioner ensured privacy and confidentiality by assessing the patient in a room with no flow of other people. The practitioner was able to capture drug non-adherence and the side effects of the previously prescribed drug as the attributing factor. The challenging part will, however, arise when implementing the treatment plan for the patient. The patient, in her current state, may not be in the capacity to give informed consent. Assent from his health proxies may be necessary, especially in case of any medical trial. The healthcare provider will have to do this in the best interest of the patient and ensure that no harm befalls the patient.
Case Formulation and Treatment Plan:
The patient should be restarted on antipsychotics. An atypical antipsychotic agent such as olanzapine should be used instead and the typical antipsychotic discontinued to improve treatment adherence. This is to avoid drug-induced extrapyramidal side effects. The drug-induced movement disorders witnessed should further be managed by using anticholinergic drugs such as Benztropine or antihistamines such as Diphenhydramine. The patient should undergo psychoeducation regarding his condition since he lacks insight. He should also be enlightened on the need and importance of adhering to his treatment to avoid relapses. The patient should undergo supportive psychotherapy and follow-up should be done to monitor his response to the new treatment regimen.


References
Dold, M., Bartova, L., Kautzky, A., Porcelli, S., Montgomery, S., Zohar, J., Mendlewicz, J., Souery, D., Serretti, A., & Kasper, S. (2019). Psychotic Features in Patients With Major Depressive Disorder: A Report From the European Group for the Study of Resistant Depression. The Journal of clinical psychiatry, 80(1), 17m12090. https://doi.org/10.4088/JCP.17m12090
Hany, M., Rehman, B., Azhar, Y., & Chapman, J. (2022). Schizophrenia. In StatPearls. StatPearls Publishing.
Patel, J., & Marwaha, R. (2022). Akathisia. In StatPearls. StatPearls Publishing.
Robinson, N., & Bergen, S. (2021). Environmental Risk Factors for Schizophrenia and Bipolar Disorder and Their Relationship to Genetic Risk: Current Knowledge and Future Directions. Frontiers In Genetics, 12. https://doi.org/10.3389/fgene.2021.686666
Tolentino, J., & Schmidt, S. (2018). DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Frontiers In Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.00450
Ward, K., & Citrome, L. (2018). Antipsychotic-Related Movement Disorders: Drug-Induced Parkinsonism vs. Tardive Dyskinesia—Key Differences in Pathophysiology and Clinical Management. Neurology And Therapy, 7(2), 233-248. https://doi.org/10.1007/s40120-018-0105-0

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Week 7: Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders

At age 18, Rose rented her first apartment in the city. Although she had a short commute to work, Rose did not enjoy the chaos and noise of the city. Within months, Rose left her apartment in the city for a small, rural cabin in the country. It was then that Rose began to withdraw from family and friends. Generally, she avoided contact with others. Her co-workers noticed random, obscure drawings on scrap paper at her desk. Additionally, her co-workers noticed other strange behaviors. Frequently, Rose would whisper to herself, appear startled when people approached her desk, and stare at the ceiling at various times throughout the day.

For individuals with disorders such as schizophrenia and other psychotic disorders, the development of mental disorder seldom occurs with a singular, defining symptom. Rather, many who experience such disorders show a range of unique symptoms. This range of symptoms may impede an individual’s ability to function in daily life. As a result, clinicians address a patient’s ability or inability to function in life.

This week, you explore psychotic disorders, including schizophrenia. You also explore medication-induced movement disorders and formulate a diagnosis for a patient in a case study.
Learning Objectives

Students will:

Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
Formulate differential diagnoses using DSM-5-TR criteria for patients with schizophrenia, other psychotic disorders, and medication-induced movement disorders across the life span

Learning Resources

Required Readings (click to expand/reduce)

American Psychiatric Association. (2022). Medication-induced movement disorders and other adverse effects of medication. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.Medication_Induced_Movement_Disorders

American Psychiatric Association. (2022). Schizophrenia spectrum and other psychotic disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x02_Schizophrenia_Spectrum

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

Chapter 7, Schizophrenia Spectrum and Other Psychotic Disorders
Chapter 29.2, Medication Induced-Movement Disorders
Chapter 31.15, Early-Onset Schizophrenia

Document: Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation Exemplar

Document: NRNP 6635 Final Study Guide

Required Media (click to expand/reduce)

Classroom Productions. (Producer). (2016). Schizophrenia and other psychotic disorders [Video]. Walden University.

MedEasy. (2017). Psychotic disorders | USMLE & COMLEX [Video]. YouTube. https://www.youtube.com/watch?v=BdB6MgWAP1k

Video Case Selections for Assignment (click to expand/reduce)

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Symptom Media. (Producer). (2016). Training title 9 [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-9

Symptom Media. (Producer). (2016). Training title 24 [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-24

Symptom Media. (Producer). (2016). Training title 29 [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-29

Symptom Media. (Producer). (2018). Training title 134 [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-134

Document: Case History Reports

Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

Photo Credit: [Hero Images]/[Hero Images]/Getty Images

Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM. The symptoms of psychotic disorders may appear quite vivid in some patients; with others, symptoms may be barely observable. Additionally, symptoms may overlap among disorders. For example, specific symptoms, such as neurocognitive impairments, social problems, and illusions may exist in patients with schizophrenia but are also contributing symptoms for other psychotic disorders.

For this Assignment, you will analyze a case study related to schizophrenia, another psychotic disorder, or a medication-induced movement disorder.
To Prepare:

Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing psychotic disorders. Consider whether experiences of psychosis-related symptoms are always indicative of a diagnosis of schizophrenia. Think about alternative diagnoses for psychosis-related symptoms.
Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.

By Day 7 of Week 7

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
Objective: What observations did you make during the psychiatric assessment? 
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 7 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 7 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 7

To participate in this Assignment:

Week 7 Assignment

What’s Coming Up in Week 8?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Week 8, you will continue to practice your assessment and diagnosis skills, focusing next week on substance-related disorders.

Next Week

To go to the next week:

Week 8

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Rubric Detail

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Content
Name: NRNP_6635_Week7_Assignment_Rubric

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Excellent Good Fair Poor
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.

In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS
Points Range: 18 (18%) – 20 (20%)
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

Points Range: 16 (16%) – 17 (17%)
The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

Points Range: 14 (14%) – 15 (15%)
The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.

Points Range: 0 (0%) – 13 (13%)
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.
In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
Points Range: 18 (18%) – 20 (20%)
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

Points Range: 16 (16%) – 17 (17%)
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

Points Range: 14 (14%) – 15 (15%)
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

Points Range: 0 (0%) – 13 (13%)
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
In the Assessment section, provide:
• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Points Range: 23 (23%) – 25 (25%)
The response thoroughly and accurately documents the results of the mental status exam.

Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

Points Range: 20 (20%) – 22 (22%)
The response accurately documents the results of the mental status exam.

Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

Points Range: 18 (18%) – 19 (19%)
The response documents the results of the mental status exam with some vagueness or innacuracy.

Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.

Points Range: 0 (0%) – 17 (17%)
The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Points Range: 9 (9%) – 10 (10%)
Reflections are thorough, thoughtful, and demonstrate critical thinking.

Points Range: 8 (8%) – 8 (8%)
Reflections demonstrate critical thinking.

Points Range: 7 (7%) – 7 (7%)
Reflections are somewhat general or do not demonstrate critical thinking.

Points Range: 0 (0%) – 6 (6%)
Reflections are incomplete, inaccurate, or missing.
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
Points Range: 14 (14%) – 15 (15%)
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.

Points Range: 12 (12%) – 13 (13%)
The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

Points Range: 11 (11%) – 11 (11%)
Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

Points Range: 0 (0%) – 10 (10%)
Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
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%) – 5 (5%)
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

Points Range: 4 (4%) – 4 (4%)
Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Purpose, introduction, and conclusion of the assignment is vague or off topic.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time.

Points Range: 0 (0%) – 3 (3%)
No purpose statement, introduction, or conclusion were provided.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation
Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors

Points Range: 4 (4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors

Points Range: 3 (3%) – 3 (3%)
Contains several (three or four) grammar, spelling, and punctuation errors

Points Range: 0 (0%) – 2 (2%)
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Total Points: 100
Name: NRNP_6635_Week7_Assignment_Rubric