NURS-6521 Week 9 Assignment

NURS-6521 Week 9 Assignment

Week 9 Assignment: Case Studies/Scenarios

Case Studies

Scenario 1

In the first case, there are multiple discrepancies in medications that need to be addressed for appropriate medication therapy to be accomplished. The medication for Lupron 3.75 mg incorrectly identifies the mode of administration by administering it subcutaneously, since Lupron Depot is administered intramuscularly as a single injection monthly. In that case, the correct medication order is thus Lupron Depot 3.75 mg IM monthly for six months, dispense one vial with five refills. The medication is for treating endometriosis using a gonadotropin-releasing hormone (GnRH) agonist, which is done using continuous stimulation of the receptors (Kim et al., 2021). Such mechanisms lead to down-regulation of gonadotropin secretion and subsequent suppression of estrogen secretion, providing symptomatic relief from endometriosis.

Also, the medication for the finasteride treatment incorrectly identifies 1 mg daily for benign prostatic hyperplasia (BPH), but it is supposed to be 5 mg daily for BPH. The correct medication order is therefore: Finasteride 5 mg PO daily, dispense thirty tablets with three refills, and it is important to acknowledge that finasteride is an inhibitor of 5-alpha-reductase (Pompili et al., 2021). The medication reduces the conversion rate from testosterone to dihydrotestosterone, hence regenerating prostate volume with improvement in urinary obstructs.

The erythromycin medication order is also inaccurate because it identifies “otic,” which is for ophthalmic medication only. The correct medication order should thus read “Erythromycin 0.5% ophthalmic ointment; apply ½-inch ribbon to the affected eye (s) every four hours for five days; dispense one 3.5-gram tube with no refills. According to Mahfouz et al. (2023), erythromycin is a macrolide antibiotic that is an inhibitor that binds specifically to the 50S ribosomal subunit in bacterial treatment.

There is also an inaccuracy in the medication order for Augmentin, since there is an ingredient amount reversal written as 125 mg amoxicillin and 875 mg clavulanate. The correct administration should be 875 mg amoxicillin with 125 mg clavulanate acid administered every twelve hours for ten days, dispense 20 tablets, no refills (Gregory et al., 2021).

There is also an inaccuracy in the spelling of the last medication order rivoraxaban 20 mg PO daily. The correct medication order is thus: Rivaroxaban 20 mg tablet daily with evening meal; dispense thirty tablets with no refills. The medication is an oral direct anticoagulant, an inhibitor with action on factor Xa; it prevents the formation of thrombosis (Genis‐Najera et al., 2022).

Scenario Two

JL is a 65-year-old female presenting with fatigue, sore throat, and mild fever, who has tested positive for COVID-19, where her stable oxygen saturation and standard chest X-ray indicate mild disease. Given her age and concurrent therapy with Atorvastatin, antiviral treatment is needed to reduce the risk of disease progression. The recommended regimen is Nirmatrelvir 300 mg, which involves two 150 mg tablets with the ritonavir 100 mg medication where just one tablet is taken orally every twelve hours for five days, known commercially as Paxlovid (Hammond et al., 2022). Atorvastatin on the other hand should be stopped for three days during and after the course due to significant CYP3A4 inhibition by ritonavir and the potential increase of statin serum levels and myopathy risk. In addition, acetaminophen 500 mg every six hours may be used as an alternative for fever or sore throat, adequate fluid intake, and rest (Krohmer et al., 2023).

Additionally, JL should be educated about potential side effects such as altered taste, diarrhea, and possible drug interactions and instructed to complete the entire five-day antiviral regimen even if symptoms improve and to seek medical attention once respiratory symptoms worsen or oxygen saturation falls below 94 percent. Also, the effectiveness of the therapy must be monitored by assessing the symptoms and ensuring that follow-up happens within three days. On the same note, Nirmatrelvir inhibits the SARS-CoV-2 main protease (Mpro), preventing viral replication. In contrast, ritonavir is a pharmacokinetic enhancer that inhibits CYP3A-mediated metabolism, thus maintaining therapeutic drug levels (Hammond et al., 2022). Such a combination, illustrated by Hammond et al. (202), has significantly reduced hospitalization and mortality rates in high-risk, nonhospitalized adults with mild-to-moderate COVID-19 infection.

Scenario 3

JS, aged 23 years, is presenting with weakness, poor concentration, and excessive menstrual bleeding. After carrying out a series of tests on the patient, JS was found to have high levels of TSH measured at 20 µIU/mL with low levels of MCV, MCHC, and ferritin, hence confirming the diagnosis for the case of primary hypothyroidism together with iron deficiency anemia (Davis & Phillippi, 2022). The treatment procedure follows a strategy for simultaneously handling these two situations in relation to medications on an ongoing basis.

In addition, the appropriate treatment for the condition is using Levothyroxine 75 mcg orally daily before eating anything, 30-60 minutes before breakfast, with vitamin C 500mg for improved bioavailability. Levothyroxine is proposed since it is a pure formulation acting on the hormone T4, which is metabolized in the body with a new hormone named T3, thus restoring body metabolism (Eghtedari & Correa, 2023). Ferrous sulfate 325 mg (65mg elemental iron) would also be effective in enhancing iron deficiency, even if the patient must be advised to separate levothyroxine and iron by at least four hours to avoid absorption interference.

However, there is an appropriate need for withholding the kelp vitamin completely since it contains high levels of iodine, making it potentially dangerous for body functions for all individuals with hypothyroidism (Eghtedari & Correa, 2023). Also, chromium, turmeric, and other tea formulations would warrant consideration for potential interactions, even though they would also be safe for unidirectional usage with high caution (Garber et al., 2021). Overall, the outcome of the treatment would depend on enhanced iron deficiency and hypothyroidism, hematologic stability, and metabolic equilibrium.

Scenario 4

In a 60-kg patient, the appropriate dosage would be 300 mg IV daily; since the pharmacy gives the dosage in 2 mL vials with 80 mg medication, 7.5 mL would have to be obtained for each treatment session. Moreover, since the infusion rate is 10 mg/min, it would take 30 minutes to administer the medication wholly. When trough levels were down to 3 mcg/mL, it is clear it is too high since it would need to be under two mcg/mL for once-daily dosing in order to avoid renal nephrotoxicity and ototoxicity where either the dose would need to be reduced for 4 mg/kg (IV 240 mg daily) or the dosing interval would need to be extended to 36 hours(Chaves & Tadi, 2023). Hence, the reordered medication would be: Gentamicin 240 mg IV q24h; infused IV over 30 min, and there is a need to monitor renal function and trough levels before the fourth treatment cycle is administered.

As an aminoglycoside antibiotic, gentamicin binds to the 30S ribosomal subunit irreversibly in bacterial cells, thus preventing protein synthesis and causing cell death in a concentration-dependent way with bactericidal rates. In that regard, when gentamicin is administered intravenously, gentamicin bioavailability is so low due to its high polarity, projecting its inability to pass equally well throughout the gastrointestinal tract, thus requiring parenteral therapy for systemic infections only (Gamaan et al., 2023). The two significant toxicities associated with the aminoglycosides belong to their nephrotoxicity in the renal tubular cell concentration, which affects receptor function in the vestibular system, aside from their toxic function within inner ear cells (Chaves & Tadi, 2023). As such, monitoring creatinine levels and any audiological toxicities, in addition to blood urea nitrogen levels, is required to avoid its toxic effects and to maintain gentamicin efficacy in its usage.

 

References

Chaves, B. J., & Tadi, P. (2023, April 10). Gentamicin. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557550/

Davis, M. G., & Phillippi, J. C. (2022). Hypothyroidism: Diagnosis and Evidence‐Based Treatment. Journal of Midwifery & Women’s Health, 67(3), 394–397. https://doi.org/10.1111/jmwh.13358

Eghtedari, B., & Correa, R. (2023, August 28). Levothyroxine. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539808/

Gamaan, M., Zaky, H., & Ahmed, H. (2023). Gentamicin-induced nephrotoxicity: A mechanistic approach. Azhar International Journal of Pharmaceutical and Medical Sciences, 0(0). https://doi.org/10.21608/aijpms.2023.161755.1167

Genis‐Najera, L., Sañudo‐Maury, M. E., & Moquete, T. (2022). A Single‐blind, Randomized, Single‐dose, Two‐sequence, Two‐period, Crossover Study to Assess the Bioequivalence between Two Oral Tablet Formulations of Rivaroxaban 20 mg in Healthy Mexican Volunteers. Clinical Pharmacology in Drug Development, 11(7), 826–831. https://doi.org/10.1002/cpdd.1092

Gregory, J., Huynh, B., Tayler, B., Korgaonkar-Cherala, C., Garrison, G., Ata, A., & Sorum, P. (2021). High-Dose vs Standard-Dose Amoxicillin Plus Clavulanate for Adults With Acute Sinusitis: A Randomized Clinical Trial. JAMA Network Open, 4(3), e212713. https://doi.org/10.1001/jamanetworkopen.2021.2713

Hammond, J., Leister-Tebbe, H., Gardner, A., Abreu, P., Bao, W., Wisemandle, W., Baniecki, M., Hendrick, V. M., Damle, B., Simón-Campos, A., Pypstra, R., & Rusnak, J. M. (2022). Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. New England Journal of Medicine, 386(15). https://doi.org/10.1056/nejmoa2118542

Kim, G.-Y., Kim, J.-H., Lee, T., Bae, B.-C., Baik, H., Kim, T., Kim, J., Kang, D. W., Kim, J. H., Kim, D., Cho, H.-Y., & Kim, D.-D. (2021). In vitro and in vivo evaluations of a 3-month sustained-release microsphere depot formulation of leuprolide acetate. Journal of Pharmaceutical Investigation, 52(1), 129–138. https://doi.org/10.1007/s40005-021-00551-x

Krohmer, E., Rohr, B. S., Stoll, F., Gümüs, K. S., Bergamino, M., Mikus, G., Sauter, M., Jürgen Burhenne, Weiss, J., Meid, A. D., Czock, D., Blank, A., & Haefeli, W. E. (2023). Influence of a Short Course of Ritonavir Used as a Booster in Antiviral Therapies Against SARS-CoV-2 on the Exposure of Atorvastatin and Rosuvastatin. Cardiovascular Drugs and Therapy. https://doi.org/10.1007/s10557-023-07538-w

Mahfouz, A. A., Said, H. S., Elfeky, S. M., & Shaaban, M. I. (2023). Inhibition of Erythromycin and Erythromycin-Induced Resistance among Staphylococcus aureus Clinical Isolates. Antibiotics, 12(3), 503. https://doi.org/10.3390/antibiotics12030503

Pompili, M., Magistri, C., Maddalena, S., Mellini, C., Persechino, S., & Baldessarini, R. J. (2021). Risk of Depression Associated With Finasteride Treatment. Journal of Clinical Psychopharmacology, 41(3), 304–309. https://doi.org/10.1097/jcp.0000000000001379

 

NURS-6521 Week 9 Assignment

Case studies are a useful way for you to apply your knowledge of pharmacokinetic and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.

For your week 9 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

Directions:
 
For each of the scenarios below, answer the questions using your required learning resources, Medscape, and clinical practice guidelines (ie AHA, ACC, ADA). When recommending medications, write out a 
complete prescription
 for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills etc. Also state if you would continue, discontinue or taper the patient’s current medications (if applicable). Use 
at least 3 sources
 for 
each scenario
 and cite sources using APA format.

Week 9 Cases

SCENARIO 1

What are the errors in the following prescriptions (5 total)? Rewrite each prescription correctly. What is each medication classification? What is the mechanism of action (MOA)?

Lupron 3.75 mg Inject SC monthly for endometriosis up to 6 months #1 5RF

finasteride 1 mg PO daily for BPH #30 3RF (
Note: women should not handle crushed/broken tablets- teratogenic to male fetus
)

erythromycin 0.5% otic ointment Apply a ½ inch ribbon to the affected eye(s
) every 4 hours x 5 days #1 tube (3.5g) 0RF

Augmentin (875 mg 
clavulanate/125 mg amoxicillin) PO every 12 hours x 10 days #20 0RF

rivoraxaban 20 mg PO daily with evening meal #30 0RF

 

SCENARIO 2

JL is a 65-year-old female seen in the clinic today. She presents with fatigue, brain fog, sore throat and temperature of 99.1. She reports that symptoms began three days ago with a sore throat and have progressively worsened. She also mentions loss of appetite. Oxygen sat 97%, respiratory rate 17, bp 122/73. Her rapid COVID-19 antigen test is positive. Chest x-ray is clear, no signs of pneumonia. Current medication includes atorvastatin 40 mg po daily. What treatment plan would you implement for JL (include complete medication order)? What patient education and monitoring would you provide?

 

SCENARIO 3

JS is a 23-year-old woman that presents with fatigue, poor concentration and heavy menstrual periods. Her labs today show TSH 20, MCV 76, MCHC 27, ferritin 11, TIBC 421, Hgb 11.8. Current medications include sumatriptan prn for migraine with aura and drospirenone 4mg one tablet po daily prescribed by her pharmacist, as well as kelp, chromium picolinate, turmeric and green tea supplements daily. What treatment plan would you implement for JS? What medication changes would you make? Include complete medication order(s). How would you monitor the effectiveness of this plan, and what patient education would you provide?

 

SCENARIO 4

A patient is prescribed 
gentamicin 5 mg/kg IV once daily
 for a 
60 kg
 patient. The pharmacy stocks gentamicin in 
80 mg/2 mL vials
.

How much gentamicin (mg) should be administered per dose?

How many milliliters of gentamicin solution should be drawn up for each dose?

If the infusion rate is 10 mg/min, how long will it take to administer one dose?

A trough level is drawn 30 minutes before the next dose, and the result is 3 mcg/mL. Is the current dosing regimen appropriate based on the trough level? Would you increase, decrease, or leave the dose the same?
 Please include a complete medication order. What are risks associated with aminoglycoside therapy?

Why is gentamicin typically administered intravenously rather than orally? How does this relate to bioavailability?

 

Assignment: Case Studies

Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.

For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

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:

Review the case study posted in “Announcements” by your Instructor for this Assignment

Review the information provided and answer questions posed in the case study

When recommending a medication, write out a complete prescription for the medication

Whenever possible, use clinical practice guidelines in developing your answers when possible

Include at least three references to support your answer and cite them in APA format.

By Day 7 of Week 9

Submit the Assignment.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
WK9Assgn_LastName_Firstinitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

Rubric

NURS_6521_Week9_Assignment_Rubric

NURS_6521_Week9_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Scenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. NURS-6521 Week 9 Assignment 

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15
 
to >
11.0
 pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11
 
to >
7.0
 pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7
 
to >
3.0
 pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3
 
to >
0
 pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3
 pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0
 pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3
 pts

This criterion is linked to a Learning Outcome
Scenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4
 pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3
 pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2
 pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0
 pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4
 pts

This criterion is linked to a Learning Outcome
Scenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

NURS-6521 Week 9 Assignment

3
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

2
 pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

1
 pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

0
 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

3
 pts

Total Points: 
100