Assessing and Treating Clients with Bipolar Disorder Essay

Bipolar disorder is a psychiatric disorder that is typified by symptoms of depression and manic or hypomanic episodes. Bipolar type 1 is characterized by depressive and manic episodes. Symptoms of manic episodes include increased energy levels, aggression, talking excessively, risky behaviors, extreme happiness and euphoria, racing mind, lack of sleep, and lack of focus and concentration when carrying out tasks. The depressive episodes in bipolar disorder are typified by symptoms such as sadness, fatigue, social withdrawal, sleep disturbances, forgetfulness, suicidal ideation, poor concentration, and lack of interest in activities that were once appealing (Baldessarini et al., 2020).  A PMHNP needs to have a good understanding of mental health disorders like bipolar disorder to facilitate proper treatment and management of the disorder. The case study presents a Korean female client aged 28 years old who presented for assessment after 21-days of hospital admission for acute mania. The client’s self-reported mood was “fantastic” and she also reported that she was experiencing insomnia. Her medical records showed that she was in good health, while her lab findings were within the normal range. The client tested positive for the CYP2D6*10 allele. She reported that she had discontinued her lithium treatment. The MSE revealed that the client’s speech was rapid, while her mood revealed broad effect and euthymic mood. The MSE further revealed insight impairment, but her judgment was intact. Her YMRS score was 22, indicating bipolar type 1 disorder. The assignment focuses on the review of the case study in order to come up with the appropriate treatment decisions. Ethical considerations applied when making the decisions will also be analyzed.

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Decision Point One

The treatment choices for decision point one, were “Lithium 300 mg orally BID; Risperdal 1 mg orally BID and Seroquel XR 100 mg orally at HS.” The selected decision is lithium 300 mg. Lithium was chosen because the client was already taking the medication but discontinued it and also because the medication is an effective mood stabilizer. Lithium is also an FDA approved first-line treatment for bipolar type 1 disorder and mania symptoms such as for this client (Jelen & Young, 2020). The medication’s mechanism of action is by changing how sodium is transported across muscle and nerve cell membranes and also alters how catecholamines and serotonin are metabolized and therefore stabilizes mood and common symptoms of bipolar disorder (Alda, 2015).

Risperdal was not selected due to its numerous metabolic side effects and also because the efficacy of lithium has not been tested (Yunusa & El Helou, 2020). Moreover, Seroquel was also not selected since the efficacy of lithium the first-line treatment choice for the client has not been tested due to the client’s discontinuation with the medication.

The decision aimed to ensure that the client would gradually achieve symptom remission.  This is due to lithium’s effectiveness and efficacy in treating and improving manic symptoms in individuals with bipolar (Jelen & Young, 2020). The decision also expected that she would not report any side effects.

Nonetheless, after four weeks the client did not manifest any improvement. The client had also discontinued lithium medication. Therefore, the lack of symptom improvement for the client is attributable to poor adherence to treatment.

Ethical principles relevant to the decision include informed consent. Informed consent should be obtained from patients before starting any treatment (Maldonado-Castellanos, 2020). This should involve educating patients about all the available treatment choices, including their side effects to allow patients to make informed choices.

Decision Point Two

The treatment options for decision point two are increase lithium to 450 mg, assess the reasons for the client not adhering to treatment and educate her about lithium medication, and to change from lithium to Depakote ER 500 mg. the decision that was chosen was to evaluate the reasons why the client was not adhering and educate her about the pharmacology and side effects associated with lithium. The reason for selecting this decision is because non-adherence to treatment is high among bipolar medications like lithium due to side effects associated with these medications (Volkmann et al., 2020). Therefore, it would be important to assess the reasons for her nonadherence. The option of having the lithium dose increased to 450 mg was not considered because the client reported nonadherence to lithium and thus the effectiveness of lithium, which is the client’s first-line treatment choice has not been evaluated. Likewise, Depakote was not considered because it is appropriate to first evaluate the efficacy of the first-line treatment (lithium) before changing her medication (Jelen & Young, 2020).

The treatment goal included identifying why the client was nonadherent in order to have the reasons addressed. Additionally, educating the client about the pharmacology and side effects of lithium can improve the client’s adherence to treatment (Volkmann et al., 2020).

The client reported that she was experiencing nausea and diarrhea after taking lithium and these side effects were causing her not to adhere to the treatment. Evidence shows that nausea and diarrhea are common side effects in individuals taking lithium (Volkmann et al., 2020).

The ethical principle applied when making this decision is the principle of beneficence. Beneficence takes into account and acts according to the patient’s best interests (Ethics Subcommittee of the Council on Ethics et al., 2020). Therefore, it was important to establish what was causing the non-compliance to treatment to address the issue.

Decision Point Three

The treatment choices in decision point three include changing to Depakote, changing to Trileptal, or changing lithium to sustained-release preparation. The appropriate decision is to have the treatment changed to sustained-release preparation. The rationale for this decision is because sustained-release preparations tend to have few side effects and at the same time they are effective mood stabilizers (Girardi et al., 2016). Evidence has demonstrated the efficacy of lithium in improving mania symptoms (Jelen & Young, 2020). Depakote was not chosen since the efficacy of lithium medication has not been assessed for this patient; therefore, the best option is to administer the patient with sustained-release lithium to improve her adherence and examine the efficacy of lithium to improve the patient’s mania symptoms. Trileptal was not chosen since it is a second-line treatment when treating bipolar and hence there is no clinical reason to start a second-line treatment, before testing the efficacy of the first-line treatment.

The treatment goal with this choice is to ensure that the client adheres to treatment and starts responding to the treatment. This will lead to symptom improvement and eventually, the client will attain complete symptom remission. Secondly, it is expected that the client will stop experiencing side effects.

Informed consent is pertinent in the decision, as the PMHNP needs to educate the client about lithium sustained-release preparation to ensure that she consents to the treatment at the point of knowledge (Maldonado-Castellanos, 2020). The autonomy of the patient was also respected since her judgment is not impaired and therefore her decision-making ability is intact.

Conclusion

Lithium 300 mg was the first treatment choice for this client. This is because the drug is an FDA approved mood stabilizer and a first-line treatment choice when treating people with bipolar type 1 disorder. However, after four weeks the client did not manifest any improvement and she reported that she discontinued the treatment. As a result, the second treatment decision involved investigating the reason why she was not adhering and educate her about the lithium medication, pharmacology, and the associated side effects. The outcome of this decision was that the client reported that nonadherence was due to the medication’s side effects. As a result, the third decision involved changing to lithium to sustained-release preparation. This is because lithium to sustained-release preparation is associated with a few side effects and hence this will improve her adherence and facilitate symptom improvement. The ethical considerations when making the treatment decisions for this client included patient autonomy, informed consent, and beneficence. It is important to obtain informed consent from patients before starting any treatment and the decision-making ability of the clients should be respected. For example, the patient’s judgment is intact and hence her decision-making ability should be respected. For the principle of beneficence, the PMHNP should prioritize the client’s best interests.

References

Alda M. (2015). Lithium in the treatment of bipolar disorder: pharmacology and pharmacogenetics. Molecular psychiatry, 20(6), 661–670. https://doi.org/10.1038/mp.2015.4

Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: a major unsolved challenge. International journal of bipolar disorders, 8(1), 1. https://doi.org/10.1186/s40345-019-0160-1

Ethics Subcommittee of the Council on Ethics, Bylaws, and Judicial Affairs (2020). Ethical practice during the COVID-19 pandemic. Journal of the American Dental Association (1939), 151(5), 377–378. https://doi.org/10.1016/j.adaj.2020.03.038

Girardi, P., Brugnoli, R., Manfredi, G., & Sani, G. (2016). Lithium in bipolar disorder: optimizing therapy using prolonged-release formulations. Drugs in R&D, 16(4), 293-302.

Jelen, L. A., & Young, A. H. (2020). The Treatment of Bipolar Depression: Current Status and Future Perspectives. Current Behavioral Neuroscience Reports, 7(1), 1-14.

Maldonado-Castellanos I. (2020). Ethical issues when planning mental health services after the COVID-19 outbreak. Asian journal of psychiatry, 54, 102285. https://doi.org/10.1016/j.ajp.2020.102285

Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium Treatment Over the Lifespan in Bipolar Disorders. Frontiers in psychiatry, 11, 377. https://doi.org/10.3389/fpsyt.2020.00377

Yunusa, I., & El Helou, M. L. (2020). The Use of Risperidone in Behavioral and Psychological Symptoms of Dementia: A Review of Pharmacology, Clinical Evidence, Regulatory Approvals, and Off-Label Use. Frontiers in pharmacology, 11, 596. https://doi.org

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Bipolar disorder is a unique disorder that causes shifts in mood and energy, which
results in depression and mania for clients. Proper diagnosis of this disorder is often a
challenge for two reasons: 1) clients often present as depressive or manic, but may
have both; and 2) many symptoms of bipolar disorder are similar to other disorders.
Misdiagnosis is common, making it essential for you to have a deep understanding of
the disorder’s pathophysiology. For this Assignment, as you examine the client case
study in this week’s Learning Resources, consider how you might assess and treat
clients presenting with bipolar disorder.

Learning Objectives

Students will:

· Assess client factors and history to develop personalized plans of bipolar therapy for
clients
· Analyze factors that influence pharmacokinetic and pharmacodynamic processes in
clients requiring bipolar therapy
· Evaluate efficacy of treatment plans
· Analyze ethical and legal implications related to prescribing bipolar therapy to clients
across the lifespan

To prepare for this Assignment:

· Review this week’s Learning Resources. Consider how to assess and treat clients
requiring bipolar therapy.

The Assignment

Examine Case Study: An Asian American Woman With Bipolar Disorder (https://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_04/index.html )

You will be asked to make three decisions concerning the medication to prescribe to
this client. Be sure to consider factors that might impact the client’s pharmacokinetic
and pharmacodynamic processes.

I want you to answer the questions given to you (decision points one, two, and
three) before you click on the option. The answers will be based on your decisions
made and patient outcomes during the decision tree. I am looking for an essay that is
long enough to cover the topic BUT short enough to keep my interest.  The course
page suggests writing 1 page per decision – my opinion is that it will be very difficult
to justify your treatment decisions and provide scientific evidence in 1 page

(especially for decision #1). I do not need you to tell me about the patient or the
treatment options available to you – I am very familiar with the cases. Your introductory
page should be an overview of the disease state you are treating along with a purpose
statement for the assignment.  Remember this is a Pharmacology class that
incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell
me why you selected an option (why is it the best option- using clinically relevant and
patient specific data) AND why you did not choose the other options (with clinically
relevant and patient specific data).
Introduction to the case (1 page)
· Briefly explain and summarize the disease state you are treating this Assignment. Be
sure to include the specific patient factors that may impact your decision making when
prescribing medication for this patient.
Decision #1
· Which decision did you select?
§ Why did you select this decision? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary literature. Again, provide
STRONG scientific evidence.  Clinical studies or treatment guidelines are a good place
to start!
· Why did you not select the other two options provided in the exercise? Be specific and
support your response with clinically relevant and patient-specific resources, including
the primary literature.
· What were you hoping to achieve by making this decision? Support your response with
evidence and references to the Learning Resources (including the primary literature).
· Explain how ethical considerations may impact your treatment plan and communication
with patients. Be specific and provide examples.
Decision #2 (1 page)
§ Why did you select this decision? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary literature. Again, provide
STRONG scientific evidence.  Clinical studies or treatment guidelines are a good place
to start!
· Why did you not select the other two options provided in the exercise? Be specific and
support your response with clinically relevant and patient-specific resources, including
the primary literature.
· What were you hoping to achieve by making this decision? Support your response with
evidence and references to the Learning Resources (including the primary literature).
· Explain how ethical considerations may impact your treatment plan and communication
with patients. Be specific and provide examples.
Decision #3 (1 page)
· Why did you select this decision? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary literature.
§ Why did you not select the other two options provided in the exercise? Be specific and
support your response with clinically relevant and patient-specific resources, including

the primary literature. Again, provide STRONG scientific evidence.  Clinical studies or
treatment guidelines are a good place to start!
· What were you hoping to achieve by making this decision? Support your response with
evidence and references to the Learning Resources (including the primary literature).
· Explain how ethical considerations may impact your treatment plan and communication
with patients. Be specific and provide examples.
Conclusion (1 page)
· Summarize your recommendations on the treatment options you selected for this
patient. Be sure to justify your recommendations and support your response with
clinically relevant and patient-specific resources, including the primary literature.

After writing up your rationale at each decision point, I would ask yourself the following questions:
· Have I provided clinical data from a meta-analysis, case report or clinical trial to support the
drug I picked being safe, efficacious and the best choice for this patient?
· Have I provided clinical data, etc. to support a clear rationale as to why the other treatment
options are NOT optimal?
· Is the focus of my discussion on mechanism of action and receptors/neurotransmitters that
the drug acts on? If the answer is YES, you should consider doing additional research to
address the above two questions

 

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Also include how ethical considerations might impact your treatment plan and
communication with clients.

The rubric, as I interpret it, suggests 5 references cited with every assignment for full
credit on this portion (20 points).  References used for your introductory paragraph,
ethical considerations or conclusion do not count towards the 5 references
required.  As a general rule of thumb, I would encourage you to reference AT
LEAST two sources (not including the textbook) for each decision point – this will result
in 6 references total for your clinical decision making.

 

 

Rubric

  Excellent

Point range: 90–100

Good

Point range: 80–89

Fair

Point range: 70–79

Poor

Point range: 0–69

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

9 (9%) – 10 (10%)

The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.

8 (8%) – 8 (8%)

The response accurately summarizes the case for the Assignment.

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.

7 (7%) – 7 (7%)

The response inaccurately or vaguely summarizes the case for the Assignment.

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

0 (0%) – 6 (6%)

The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

Decision #1 (1–2 pages)

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

18 (18%) – 20 (20%)

The response accurately and clearly explains in detail the decision selected.

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

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

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

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

Examples provided fully support the decisions and responses provided.

16 (16%) – 17 (17%)

The response accurately explains the decision selected.

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

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

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

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

Examples provided support the decisions and responses provided.

14 (14%) – 15 (15%)

The response inaccurately or vaguely explains the decision selected.

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

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

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

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

Examples provided may support the decisions and responses provided.

0 (0%) – 13 (13%)

The response inaccurately and vaguely explains the decision selected.

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

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

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

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

Examples provided do not support the decisions and responses provided, or is missing.

Decision #2 (1–2 pages)

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

18 (18%) – 20 (20%)

The response accurately and clearly explains in detail the decision selected.

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

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

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

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

Examples provided fully support the decisions and responses provided.

16 (16%) – 17 (17%)

The response accurately explains the decision selected.

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

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

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

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

Examples provided support the decisions and responses provided.

14 (14%) – 15 (15%)

The response inaccurately or vaguely explains the decision selected.

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

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

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

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

Examples provided may support the decisions and responses provided.

0 (0%) – 13 (13%)

The response inaccurately and vaguely explains in detail the decision selected.

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

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

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

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

Examples provided do not support the decisions and responses provided, or is missing.

Decision #3 (1–2 pages)

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

18 (18%) – 20 (20%)

The response accurately and clearly explains in detail the decision selected.

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

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

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

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

Examples provided fully support the decisions and responses provided.

16 (16%) – 17 (17%)

The response accurately explains the decision selected.

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

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

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

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

Examples provided support the decisions and responses provided.

14 (14%) – 15 (15%)

The response inaccurately or vaguely explains the decision selected.

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

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

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

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

Examples provided may support the decisions and responses provided.

0 (0%) – 13 (13%)

The response inaccurately and vaguely explains in detail the decision selected.

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

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

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

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

Examples provided do not support the decisions and responses provided, or is missing.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

14 (14%) – 15 (15%)

The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.

The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.

12 (12%) – 13 (13%)

The response accurately summarizes the recommendations on the treatment options selected for this patient.

The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided.

11 (11%) – 11 (11%)

The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient.

The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided.

0 (0%) – 10 (10%)

The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.

The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)

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

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 (4%) – 4 (4%)

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

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)

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

Purpose, introduction, and conclusion of the assignment is vague or off topic.

0 (0%) – 3 (3%)

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

No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

4 (4%) – 4 (4%)

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

3.5 (3.5%) – 3.5 (3.5%)

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

0 (0%) – 3 (3%)

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

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

3.5 (3.5%) – 3.5 (3.5%)

Contains several (3 or 4) APA format errors.

0 (0%) – 3 (3%)

Contains many (≥ 5) APA format errors.

 

Total Points: 100

 

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