NURS-6630 Week 5: Assignment De-Prescribing
Prescribing and Deprescribing in Diverse Populations
Benzodiazepines and opioids are widely prescribed for managing anxiety and chronic pain, but their long-term use presents significant concerns, including dependence, withdrawal symptoms, cognitive impairment, and overdose risks. A structured method should be used for de-prescribing these medications because it helps minimize withdrawal symptoms without compromising symptom control (Montes-Castrejon et al., 2024). This paper examines patient-specific de-prescribing strategies, with a focus on individualized tapering protocols, patient education, and alternative treatments to enhance safety and efficacy.
Patient 1: Improving Pain and Anxiety Through Tapering in Opioid Therapy
The combination treatment of opioids with benzodiazepines produces heightened risks for sedation and respiratory depression, as well as cognitive decline and overdose risks. Clonazepam, a long-acting benzodiazepine, is commonly prescribed for panic disorders but has a high potential for dependence and withdrawal symptoms (Fung et al., 2024). The patient expressed concern about withdrawal side effects but agreed to stop taking clonazepam while continuing opioid treatment. A successful transition requires a systematic reduction plan, patient education, and safer pharmacologic and non-pharmacologic treatment options.
The simultaneous use of opioids and benzodiazepines causes intensified sedation effects along with deepened respiratory depression, which increases the likelihood of deadly overdoses. Research shows that long-term benzodiazepine use induces cognitive decline, increases dependence on the drug, and creates serious withdrawal symptoms when patients stop (Finlayson et al., 2022). Periodic reductions in dosage must be part of every risk-mitigation plan. A tapering schedule of clonazepam 0.25 mg every 1-2 weeks will be implemented to help the body adapt while avoiding dangerous withdrawal symptoms. Follow-up evaluations will assess the patient’s treatment response, address concerns, and adapt the tapering protocol to ensure safety and optimal outcomes.
For people with panic disorder, safer therapeutic options should be explored. Sertraline and other SSRIs work well to treat anxiety and panic episodes without the side effects of benzodiazepines (Archer et al., 2024). Buspirone offers further anxiolytic advantages without causing drowsiness or dependence. To help control symptoms over the long term, non-pharmacologic methods such as cognitive behavioral therapy (CBT) and relaxation techniques should be promoted.
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From a legal and ethical standpoint, healthcare providers must adhere to evidence-based guidelines and utilize prescription monitoring programs to prevent misuse and addiction. The patient should actively participate in shared decision-making, ensuring they have informed consent regarding any medication changes and alternative treatments. Edinoff et al. (2021) state that addressing social barriers, such as the stigma associated with mental health care and access to alternative therapies, is also crucial for a comprehensive, patient-centered approach.
Medication Order
Medication Name
: Sertraline
Dose
: 25 mg
Administration Route
: Oral
Dosage Timing
: One dose every morning
Total Supply
: 30 tablets
Number of Refills
: Three
Instructions
: If the medication is well tolerated, adjust the dose to 50 mg after two weeks. Schedule a follow-up in 2-4 weeks to evaluate progress.
Medication
: Clonazepam
Dose
: 0.75 mg
Route
: Oral
Dosage Schedule
: Twice daily while tapering
Total Dispensed
: 30 tablets
Refills Authorized
: None
Instructions
: Gradually decrease by 0.25 mg every 1-2 weeks. Monitor closely for withdrawal symptoms.
Patient 2: Benzodiazepine Tapering for Panic Disorder
The patient has been taking alprazolam for panic attacks, which are currently in remission. However, past efforts to stop the medication resulted in withdrawal symptoms, making the tapering process difficult. Withdrawal effects can range from mild issues like anxiety and insomnia to more serious complications such as seizures (Rosenthal & Burchum, 2021). Risk mitigation requires an organized tapering routine to transition gradually, minimizing potential threats. A prescription change toward the longer-acting benzodiazepine diazepam creates a smoother withdrawal process with enhanced symptom management. Patient education about withdrawal symptoms helps lower anxiety and enables better adherence to the scheduled tapering plan. The typical symptoms of withdrawal often manifest through restlessness, irritability, muscle tension, insomnia, and mild headaches NURS-6630 Week 5: Assignment De-Prescribing. Combining sustained guidance and continuing support leads to successful tapers that reduce patient discomfort.
Patients need emergency medical assistance if they develop hallucinations, seizures, or cardiovascular distress during benzodiazepine withdrawal (Archer et al., 2024). Follow-up care includes instructions for the patient to stay hydrated, learn relaxation techniques, and establish a normal sleep schedule to manage withdrawal symptoms. Regular check-ups enable clinicians to assess progress and adjust medication dosage schedules accordingly.
Alprazolam has a limited half-life; hence, switching to diazepam, a longer-acting benzodiazepine, is recommended. There are 10 milligrams of diazepam for every milligram of alprazolam. The patient will now take 1 mg of alprazolam BID twice daily, but diazepam (5 mg in the morning and 5 mg at night) will now be administered. To lessen withdrawal symptoms, the amount of diazepam will be tapered down by 1 mg every 1-2 weeks, depending on tolerance.
To ensure long-term anxiety management, an SSRI such as sertraline should be introduced once tapering is underway. Cognitive behavioral therapy (CBT) is also highly effective in preventing panic attacks and should be encouraged as part of the treatment plan (Brandt et al., 2024). If additional support is needed, hydroxyzine may be used as an as-needed (PRN) medication for acute anxiety episodes.
Medication Order
Medication
: Diazepam
Dose
: 5 mg
Administration Route
: Oral
Dosage Schedule
: Twice daily, in the morning and at bedtime
Total Dispensed
: 30 tablets
Refills Authorized
: None
Special Instructions
: Reduce by 1 mg every 1-2 weeks. Monitor for withdrawal symptoms. Follow up every two weeks.
Patient 3: Safe Discontinuation and Alternative Anxiety Management in Pregnancy
Lorazepam crosses the placenta and can accumulate in fetal tissues, increasing the risk of congenital disabilities, neonatal withdrawal, low birth weight, and respiratory issues (Meng et al., 2023). Exposure to lorazepam during the first trimester may increase the risk of cleft palate formation. However, later pregnancy use can result in neonatal withdrawal syndrome, which produces symptoms including excessive crying, feeding complications, and muscle tone abnormalities. Lorazepam passed to a nursing infant through breast milk leads to infant sedation and feeding difficulties. The potential pregnancy and breastfeeding risks of this medication exceed its therapeutic value, so discontinuing treatment remains the most secure course of action.
Safer alternatives should be considered. The preferred medication for treating anxiety during pregnancy is sertraline SSRIs because these drugs pose the least risk for congenital disabilities. Research indicates that SSRIs may lead to minor neonatal adaptation syndrome; however, jitteriness and short-lived feeding issues typically resolve within the first few days after birth (Garakani et al., 2020). The pregnancy safety data for buspirone remains unclear, but the medication stands as an alternative treatment. The non-addictive characteristic of Hydroxyzine makes it suitable for short-term prescribing. Healthcare providers should consider non-drug strategies such as cognitive behavioral therapy (CBT) and mindfulness techniques.
To avoid withdrawal symptoms, a structured tapering plan should be followed. Depending on tolerance, the dose should be reduced by 0.25 mg every 1-2 weeks. Common withdrawal symptoms include restlessness, anxiety, irritability, insomnia, dizziness, and nausea. More severe symptoms, such as hallucinations or seizures, require immediate medical attention (Meng et al., 2023). The patient should be encouraged to adopt relaxation techniques, maintain follow-up appointments, and utilize non-pharmacological coping strategies to facilitate a smoother transition.
Anxiety left untreated pushes up maternal cortisol levels, which in turn raises the chances for early birth weight problems and slowed brain development (Brandt et al., 2024). Children of anxious mothers develop heightened attention struggles alongside emotional instability problems. Uncontrolled anxiety affects both parent and baby by leading to lower self-care habits and worsening dietary patterns while raising postpartum depression risk. NURS-6630 Week 5: Assignment De-Prescribing Telling the patient about safer ways to manage anxiety will benefit both her health and that of her unborn child.
Medication Order
Medication
: Sertraline
Dose
: 25 mg
Administration Route
: Oral
Dosage Schedule
: Once per day
Total Dispensed
: 30 tablets
Number of Refills
: Two
Special Instructions
: Increase to 50 mg after two weeks if tolerated. Follow-up in four weeks.
Medication
: Lorazepam
Dose
: 0.5 mg
Route
: Oral
Dosage Schedule
: Two times per day
Total Dispensed
: 20 tablets
Refills
: None
Special Instructions
: Reduce by 0.25 mg every 1-2 weeks. Monitor for withdrawal symptoms. Follow up every two weeks.
Patient 4: Reducing Fall Risk and Cognitive Decline in Elderly Patients Due to Benzodiazepines
The patient is a 71-year-old man experiencing progressive memory decline and repeated falls that suggest possible early dementia. His current medications include clonazepam, which affects older adult cognition through sedative effects along with heightened fall susceptibility. Medical experts recommend discontinuing treatment because of the dangerous side effects.
Benzodiazepines administered over prolonged periods confuse poor motor coordination and increase the risk of fractures as a result of falls (Fung et al., 2024). Studies have shown that these drugs create new dementia conditions while simultaneously making patients’ cognitive abilities worsen. Medical professionals need to advise both the patient and his daughter that stopping clonazepam could lead to improved cognitive function and reduced fall hazards.
A thorough assessment should determine the full extent of clonazepam’s health effects. The Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) both assess memory functions as part of their evaluation process. A medication review process identifies harmful drug interactions that impact balance functions and cognitive abilities (Rosenthal & Burchum, 2021). A professional evaluation of walking mechanics and postural stability should be conducted during assessment procedures. The daughter’s direct observations of both behavioral modifications and instances of falling will generate valuable analysis. Regular follow-up appointments allow practitioners to adjust the tapering plan as needed.
Gradual tapering is necessary to reduce withdrawal risks. The recommended tapering schedule involves reducing clonazepam by 0.125 mg every two weeks, rather than 0.25 mg, to provide a slower withdrawal process (Rosenthal & Burchum, 2021). The patient and his daughter should be educated on withdrawal symptoms. Mild symptoms include irritability, restlessness, insomnia, dizziness, and headaches. Moderate symptoms, such as nausea, muscle tension, and worsening anxiety, may require taper adjustments. Severe symptoms, including confusion, hallucinations, seizures, or agitation, require immediate medical care. The patient’s daughter should monitor symptoms and ensure adherence to the tapering plan. Sleep hygiene, light physical activity, and relaxation techniques should be encouraged.
Medical professionals should evaluate alternative treatments when patients develop worse anxiety following discontinuation. According to Montes-Castrejon et al. (2024). Sertraline, along with other SSRIs, delivers prolonged anxiety relief while keeping patients alert. Cognitive behavioral therapy (CBT), balance therapy, home safety modifications, and other non-drug interventions should be combined to support physical and cognitive health.
Medication Order
Medication
: Clonazepam
Dose
: 0.5 mg
Route
: Oral
Frequency
: Twice daily
Quantity
: 20 tablets
Refills
: None
Instructions
: Decrease the dose by 0.125 mg every two weeks. Monitor closely for withdrawal symptoms. Schedule follow-ups to assess progress and adjust tapering as needed.
Conclusion
Elderly patients need careful de-prescribing of benzodiazepines because a gradual withdrawal plan reduces negative effects on cognitive and physical well-being. The patient safety process requires a gradual decrease in medications, which helps avoid serious withdrawal symptoms. The combination of SSRIs with therapy, together with effective fall prevention methods, presents patients with safer long-term treatment options. NURS-6630 Week 5: Assignment De-Prescribing Patient education and regular check-ups are indispensable in creating a successful benzodiazepine tapering process that focuses on patient wellness.
References
Archer, C., Wiles, N., Kessler, D., Chew-Graham, C. A., & Turner, K. (2024). Prescribing benzodiazepines in young adults with anxiety: A qualitative study of GP perspectives.
British Journal of General Practice
, BJGP.2024.0211–BJGP.2024.0211.
https://doi.org/10.3399/bjgp.2024.0211
Brandt, J., Bressi, J., Lê, M.-L., Neal, D., Cadogan, C., Witt-Doerring, J., Witt-Doerring, M., & Wright, S. (2024). Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: An international scoping review.
EClinicalMedicine
,
70
, 102507–102507.
https://doi.org/10.1016/j.eclinm.2024.102507
Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Benzodiazepines: Uses, dangers, and clinical considerations.
Neurology International
,
13
(4), 594–607.
https://doi.org/10.3390/neurolint13040059
Finlayson, A. J. R., Macoubrie, J., Huff, C., Foster, D. E., & Martin, P. R. (2022). Experiences with benzodiazepine use, tapering, and discontinuation: An internet survey.
Therapeutic Advances in Psychopharmacology
,
12
, 204512532210823.
https://doi.org/10.1177/20451253221082386
Fung, C. H., Alessi, C., Martin, J. L., Josephson, K., Kierlin, L., Dzierzewski, J. M., Moore, A. A., Badr, M. S., Zeidler, M., Kelly, M., Smith, J. P., Cook, I. A., Der-Mcleod, E., Ghadimi, S., Naeem, S., Partch, L., Guzman, A., Grinberg, A., & Mitchell, M. (2024). Masked taper with behavioral intervention for discontinuing benzodiazepine receptor agonists: A randomized clinical trial.
JAMA Internal Medicine
,
184
(12), 1448–1456.
https://doi.org/10.1001/jamainternmed.2024.5020
Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options.
Frontiers in Psychiatry
,
11
(595584). https://doi.org/10.3389/fpsyt.2020.595584
Meng, L.-C., Lin, C.-W., Chuang, H.-M., Chen, L.-K., & Hsiao, F.-Y. (2023). Benzodiazepine use during pregnancy and risk of miscarriage.
JAMA Psychiatry
, e234912.
https://doi.org/10.1001/jamapsychiatry.2023.4912
Montes-Castrejon, A., Moncayo-Samperio, L. G., & Flores-Ramos, M. (2024). Benzodiazepine consumption, functionality, cognition, and somnolence in older adults at a tertiary care psychiatric hospital in Mexico City.
Cureus
. https://doi.org/10.7759/cureus.53252
Rosenthal, L. D., & Burchum, J. R. (2021).
Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants
(2nd ed.). Elsevier NURS-6630 Week 5: Assignment De-Prescribing.
NURS-6630 Week 5: Assignment De-Prescribing
De-Prescribing
What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication?
In this Assignment, you will use the following patient examples to write a 5- to 6-page paper on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources in this course.
Note:
APA style format guidelines will apply.
Patient Examples:
Patient 1:
A 36-year-old male presents to your office being prescribed by his primary care physician (PCP) for the past 3 years an opioid analgesic medication for a work accident. He has chronic pain and is attending a pain clinic. It is determined the best course of treatment for pain is to remain on opioid medication. The patient is also being prescribed clonazepam 1mg BID for “relaxation” and panic attacks.
Patient 2:
A 42-year-old female on alprazolam 1mg BID for panic attacks. Panic attacks have been in remission and the patient wants to taper off the medication. But, every time she has attempted to do so in the past, she experienced withdrawal effects. She is wondering how to safely taper off the benzodiazepine medication without having withdrawal effects.
Patient 3:
A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder. She recently found out she is pregnant (9 weeks gestation). She was referred to you by her OB-GYN to discuss this medication for her current situation. The patient is wondering if she can stay on the lorazepam through her pregnancy and postpartum, as it is an effective medication for anxiety symptoms. She plans to exclusively breastfeed for the first 6 months postpartum. She has not had any other trials of medication to treat anxiety as lorazepam has been effective.
Patient 4:
A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia. He is forgetful and seems to be tripping on things or walking into walls, although he has lived in the same home for the past 35 years. The patient does not agree with his daughter but does admit he has had a “few stumbles and falls” lately. Medication reconciliation shows the following medications: metoprolol ER 50mg q day, omeprazole 20mg q day, clonazepam 1mg TID, levothyroxine 75mcg q am. His daughter is wondering if he should be started on a “dementia medication.”
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 for this Assignment:
Review the assigned Learning Resources for this week.
Review the definitions presented in your text and resources for de-prescribing and tapering.
Consider the importance of de-prescribing.
NURS-6630 Week 5:
Assignment
De-Prescribing
Based on the example(s) provided, consider how you might de-prescribe a patient.
The Assignment
Answer the following questions using the patient examples described above.
Patient 1
What are the concerns of the patient remaining on the opioid medication and clonazepam?
How might you educate the patient about these risks and concerns?
The patient agrees that he should not continue both medications in combination. He would like to “get off” the clonazepam but worries about “bad withdrawals” that he’s heard about from stopping clonazepam “cold turkey” and is concerned about re-occurring panic attacks. How might you respond to the following:
How would you instruct the patient to taper off clonazepam?
What other medication would you recommend for the patient for the treatment of his panic attacks? Keep in mind, he will continue the opioid medication for pain relief.
How would you start the new recommended psychotropic medication for the patient?
Discuss one legal, ethical, or social consideration with the treatment plan.
Patient 2
The patient reports withdrawal symptoms when previously tapering off the alprazolam. What symptoms are common withdrawal symptoms from this medication?
Provide the patient education of withdrawal symptoms that range from common and less serious to withdrawal symptoms that are a cause for concern and that should prompt patient should seek medical attention.
Given the patient’s history of having withdrawal effects from attempting to taper off alprazolam, what longer-acting benzodiazepine would you choose to convert the patient to?
What is the dose you would prescribe and how would you taper off the medication?
Patient 3
Review the potential risks, benefits, and side effects of continuing lorazepam throughout the pregnancy and postpartum for both the patient and fetus.
Review other alternative medications to treat generalized anxiety disorder. Include risks, benefits, and potential side effects to both the patient and the developing fetus. Keep in mind, the patient is looking to breast feed for 6 months postpartum.
The patient agrees that it would be safest for her pregnancy and fetus to discontinue the lorazepam. How would you recommend she discontinue lorazepam? Provide education on potential side effects from tapering off the medication, including common side effects to more serious side effects and when to seek medical attention.
The patient would like to forgo medications at this time, given she is early in her pregnancy and is concerned about “damage” to the fetus if she were to continue medications. Provide education to the patient about the risks of untreated anxiety symptoms during pregnancy for both the patient and the fetus NURS-6630 Week 5: Assignment De-Prescribing.
Patient 4
Review potential side effects for elderly on benzodiazepines providing education to both the patient and the patient’s daughter. What are the risks of continuing the benzodiazepine for this patient?
How would you evaluate the patient for these side effects?
The patient and daughter agree he will need to taper off the clonazepam given the risks of continuing this medication. How would you recommend tapering off this medication?
Review with the patient and daughter potential side effects of tapering off the medication. Review with them common side effects to more serious side effects and when to seek medical attention.
Reminder:
The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The
Walden Writing Center Sample Paper
Links to an external site.
provides an example of those required elements.
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Rubric
NURS_6630_Week5_Assignment_Rubric
NURS_6630_Week5_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome
Patient 1: Describes concerns for patient remaining on the medication and how these risks and concerns will be addressed to the patients. Describes how to assist Patient 1 in tapering medication, as well as what other medication might be prescribed with considerations of legal, ethical, or social considerations to the plan.
20
to >
18.0
pts
Excellent
The response comprehensively describes medication risks and concerns. The response comprehensively and clearly explains how the patient will be educated. The response comprehensively and clearly explains considerations for medication tapering. The response comprehensively and clearly reflects on legal, ethical, or social considerations of the plan NURS-6630 Week 5: Assignment De-Prescribing.
18
to >
15.0
pts
Good
The response clearly describes medication risks and concerns. The response clearly explains how the patient will be educated. The response clearly explains considerations for medication tapering. The response clearly reflects on the legal, ethical, or social considerations of the plan.
15
to >
10.0
pts
Fair
The response inaccurately or vaguely describes medication risks and concerns. The response inaccurately or vaguely explains how the patient will be educated. The response inaccurately or vaguely explains considerations for medication tapering. The response inaccurately or vaguely reflects on legal, ethical, or social considerations of the plan.
10
to >
0
pts
Poor
The response vaguely or inaccurately describes medication risks and concerns, or it is missing. The response includes inaccurate and vague examples that does not explain how the patient will be educated, or it is missing. The response vaguely or inaccurately explains considerations for medication tapering, or it is missing. The response includes inaccurate and vague examples that does not reflect on legal, ethical, or social considerations of the plan, or it is missing.
20
pts
This criterion is linked to a Learning Outcome
Patient 2: Describes common withdrawal symptoms and patient education information. Describes which benzodiazepine might be prescribed to convert the patient, as well as the specific dosing and tapering information.
20
to >
18.0
pts
Excellent
The response comprehensively and clearly explains withdrawal symptoms. The response comprehensively and clearly provides patient education information. The response comprehensively and clearly identifies a benzodiazepine for the patient. The response comprehensively and clearly details dosing and tapering information.
18
to >
15.0
pts
Good
The response clearly explains withdrawal symptoms. The response clearly provides patient education information. The response clearly identifies a benzodiazepine for the patient. The response clearly details dosing and tapering information.
15
to >
10.0
pts
Fair
The response inaccurately or vaguely explains withdrawal symptoms. The response inaccurately or vaguely provides patient education information. The response inaccurately or vaguely identifies a benzodiazepine for the patient. The response inaccurately or vaguely details dosing and tapering information.
10
to >
0
pts
Poor
The response vaguely or inaccurately explains withdrawal symptoms, or it is missing. The response includes inaccurate and vague examples that does not provide patient education information, or it is missing. The response vaguely or inaccurately identifies a benzodiazepine for the patient, or it is missing. The response includes inaccurate and vague examples that does not detail dosing and tapering information, or it is missing.
20
pts
This criterion is linked to a Learning Outcome
Patient 3: Describes potential risks, benefits and side effects of lorazepam, as well as alternative medications that might be prescribed for the patient. Describes how the patient might discontinue lorazepam, with necessary patient education regarding discontinuing medication and patient/fetus needs.
20
to >
18.0
pts
Excellent
The response comprehensively and clearly describes risks, benefits and side effects of lorazepam. The response comprehensively and clearly identifies potential alternative medications. The response comprehensively and clearly describes how the patient might discontinue the medication. The response comprehensively and clearly provides necessary education for discontinuing the medication for patient and fetus.
18
to >
15.0
pts
Good
The response clearly describes risks, benefits and side effects of lorazepam. The response clearly identifies potential alternative medications. The response clearly describes how the patient might discontinue the medication. The response clearly provides necessary education for discontinuing the medication for patient and fetus.
15
to >
10.0
pts
Fair
The response inaccurately or vaguely describes risks, benefits and side effects of lorazepam. The response inaccurately or vaguely identifies potential alternative medications. The response inaccurately or vaguely describes how the patient might discontinue the medication. The response inaccurately or vaguely provides necessary education for discontinuing the medication for patient and fetus.
10
to >
0
pts
Poor
The response vaguely or inaccurately describes risks, benefits and side effects of lorazepam, or it is missing. The response includes inaccurate and vague examples that does not identify potential alternative medications, or some or all are missing. The response vaguely or inaccurately describes how the patient might discontinue the medication, or it is missing. The response includes inaccurate and vague examples that does not provide necessary education for discontinuing the medication for patient and fetus, or some or all are missing.
20
pts
This criterion is linked to a Learning Outcome
Patient 4: Describes potential risks and side effects of continuing benzodiazepine. Describes how to taper the medication and education regarding the tapering. NURS-6630 Week 5: Assignment De-Prescribing
20
to >
18.0
pts
Excellent
The response comprehensively and clearly describes potential side effects and risks. The response comprehensively and clearly describes how to taper the medication. The response comprehensively and clearly provides necessary patient education for tapering.
18
to >
15.0
pts
Good
The response clearly describes potential side effects and risks. The response clearly describes how to taper the medication. The response clearly provides necessary patient education for tapering.
15
to >
10.0
pts
Fair
The response inaccurately or vaguely describes potential side effects and risks. The response inaccurately or vaguely describes how to taper the medication. The response inaccurately or vaguely provides necessary patient education for tapering.
10
to >
0
pts
Poor
The response vaguely or inaccurately describes potential side effects and risks, or it is missing. The response vaguely or inaccurately describes how to taper the medication, or it is missing. The response includes inaccurate and vague examples that does not provide necessary patient education for tapering, or some or all are missing.
20
pts
This criterion is linked to a Learning Outcome
Paper demonstrates critical thinking and synthesis of literature with five (5) evidence-based, peer reviewed scholarly references
5
to >
4.0
pts
Excellent
Paper demonstrates critical thinking and synthesis of literature with five (5) evidence-based, peer reviewed scholarly references outside of course resources.
4
to >
3.0
pts
Good
Paper demonstrates some critical thinking and/or vague synthesis of literature with four (4) evidence-based, peer reviewed scholarly references outside of course resources.
3
to >
1.0
pts
Fair
Paper demonstrates vague critical thinking and/or little synthesis of literature with three (3) evidence-based, peer reviewed scholarly references.
1
to >
0
pts
Poor
Paper demonstrates no critical thinking and/or synthesis of literature with two (2) or less evidence-based, peer reviewed scholarly references.
5
pts
This criterion is linked to a Learning Outcome
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 is provided, which delineates all required criteria.
5
to >
4.0
pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.
4
to >
3.0
pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the Assignment is stated yet is brief and not descriptive.
3
to >
1.0
pts
Fair
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.
1
to >
0
pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion was provided.
5
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation
5
to >
4.0
pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.
4
to >
3.0
pts
Good
Contains one or two grammar, spelling, and punctuation errors.
3
to >
1.0
pts
Fair
Contains several (three or four) grammar, spelling, and punctuation errors.
1
to >
0
pts
Poor
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5
pts
This criterion is linked to a Learning Outcome
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
to >
4.0
pts
Excellent
Uses correct APA format with no errors.
4
to >
3.0
pts
Good
Contains one or two APA format errors.
3
to >
1.0
pts
Fair
Contains three or four APA format errors.
1
to >
0
pts
Poor
Contains many (five or more) APA format errors.
NURS-6630 Week 5: Assignment De-Prescribing
5
pts
Total Points:
100
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