Esketamine chosen, then adjusted for blood pressure, driving and a safety-sensitive job: MN665's Unit 10 report tracks one composite operator's depression care decision by decision. Searches like "mn 665 unit 10 assignment example", "mn665 unit 10 sample" and "mn665 unit 10 example" land here.
Four Decisions in Ten Weeks: A Longitudinal Case Report on Esketamine for Treatment-Resistant Depression
[Student Name]
Purdue University Global
MN665: PMHNP Diagnosis and Management Across the Lifespan II
Unit 10 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Doses and dates are bracketed; nothing here is a prescribing instruction.
Baseline
A composite 44-year-old water treatment operator has major depressive disorder, recurrent, with the current episode lasting 14 months. Two adequate antidepressant trials in this episode have failed: sertraline for 10 weeks at a full dose, then a switch to venlafaxine, which he continues now at a full dose after 12 weeks. His Montgomery-Åsberg Depression Rating Scale (MADRS) score is 34 (Montgomery & Åsberg, 1979). He has passive thoughts of death, "I wouldn't mind not waking up," without intent or plan, and no history of attempts. He runs chlorination and filtration at a municipal plant on rotating 12-hour shifts, drives 30 minutes to work, and is responsible for chemical dosing that affects a town's drinking water. He lives with his wife and two teenage sons. His blood pressure at baseline is 132/84, and he has no history of substance use or psychosis.
Decision 1: The First Fork
Facts. Two failed trials in this episode meet the usual definition of treatment-resistant depression. He wants something that works "this year, not next year."
Options. Three were weighed. Quetiapine augmentation, added to his venlafaxine: widely used, taken at home, but sedating and associated with weight gain. Lithium augmentation: supported by a meta-analysis showing benefit when added to antidepressants (Nelson et al., 2014), and associated with lower suicide risk, but it requires blood levels and kidney and thyroid monitoring, and toxicity is a concern in a man working 12-hour shifts in heat. Esketamine nasal spray, given under observation at a certified clinic twice weekly for four weeks and then less often, alongside his venlafaxine.
Choice. Esketamine.
Reasoning. In ESCAPE-TRD, which compared esketamine with quetiapine augmentation in 676 patients with treatment-resistant depression, remission at week 8 occurred in 27.1 percent on esketamine and 17.6 percent on quetiapine, and more patients on esketamine remained remitted through week 32 (Reif et al., 2023). That trial compared the two options he was actually choosing between, which makes it more useful to him than trials of either against placebo. Quetiapine's sedation also weighed against it for a man responsible for chemical dosing. Lithium was kept as the next option.
What it changed. Nothing earlier; this is the first decision. Risk was reassessed: passive thoughts of death, no plan, a safety plan written with him and his wife.
Decision 2: A Blood Pressure Reading
Facts. At his fourth session in week 2, his blood pressure 40 minutes after the dose was 168/100, up from 136/86 before the dose. He had no headache, chest pain or neurologic symptoms, and his pressure fell to 142/88 by the end of the two-hour observation period.
Options. Stop esketamine, continue it unchanged, or continue with added precautions.
Choice. Continue with precautions.
Reasoning. Esketamine commonly causes a temporary rise in blood pressure that peaks around 40 minutes after dosing and settles within a few hours, and the prescribing information calls for pressure to be checked before and after each dose (Janssen Pharmaceuticals, 2023). His reading was a peak that settled as expected, and his baseline pressure was normal. Stopping a treatment that was starting to help, because of an expected and transient effect, would have cost him more than it protected.
What it changed. The original weighing of risks in Decision 1 assumed a low cardiovascular burden. That assumption was tested and adjusted rather than reversed. Three additions followed: blood pressure checked before each dose, with the dose delayed if it is above 140/90; a primary care referral to check for underlying hypertension; and a lower threshold for pausing treatment if a post-dose reading exceeds 180/110 or he has symptoms. Risk was reassessed: MADRS 27, passive thoughts less frequent.
Decision 3: Driving and Shifts
Facts. The prescribing information states that patients should not drive or operate machinery until the day after a session, following a restful sleep (Janssen Pharmaceuticals, 2023). His rotating shifts meant that some sessions fell on days before a 6 a.m. start, and he had been planning to drive himself home.
Options. Continue with his wife driving him and accept that some sessions would precede work shifts, reschedule sessions around his shifts, or take short-term leave.
Choice. Reschedule sessions to his days off, with his wife driving him home.
Reasoning. Scheduling sessions on his days off meant that the driving restriction never overlapped a shift, and his wife could plan around a fixed pattern. Leave would have removed the structure that work gave him.
What it changed. It revisited the scheduling assumption in Decision 1, which had treated twice-weekly sessions as a clinic matter. Twice-weekly sessions now depended on his shift roster, so the clinic and he agreed on a calendar for the next month. Risk was reassessed: no thoughts of death this week.
Decision 4: What His Employer Needed to Know
Facts. His supervisor asked why his shift pattern had changed and whether he was safe to handle chemicals. His employer's occupational health service asked for a statement of fitness for duty.
Options. Share full clinical details, refuse to share anything, or share a limited statement with his written consent.
Choice. A limited statement, with his consent.
Reasoning. Occupational health needed to know whether he was fit for his safety-sensitive duties and whether any restrictions applied, not his diagnosis. The statement said that he was receiving treatment, that he was fit for his usual duties, that he should not drive or work within the day after certain appointments, which were now scheduled on his days off, and that the clinic would tell occupational health if that changed.
What it changed. It confirmed that Decision 3's scheduling solved the safety question at work. It also added a task: telling occupational health if the esketamine schedule moved to weekly or if his fitness changed.
Week 8 and the Next Decision Point
At week 8 his MADRS was 14, down from 34, a 59 percent reduction. That meets the usual definition of response, a reduction of at least 50 percent, but not remission, which ESCAPE-TRD defined as a MADRS of 10 or less. The report states the result plainly: real progress, short of the goal. He has had no thoughts of death for four weeks. Blood pressure checks have remained within the plan's limits.
The next decision point is week 12. If his MADRS reaches 10 or less, the plan continues esketamine at a reduced frequency. If it has not, the options are to continue for longer, since some patients remit later, or to add lithium, the option held in reserve since Decision 1.
References
Janssen Pharmaceuticals. (2023). Spravato (esketamine) nasal spray: Prescribing information. Janssen Pharmaceuticals.
Montgomery, S. A., & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134(4), 382-389. https://doi.org/10.1192/bjp.134.4.382
Nelson, J. C., Baumann, P., Delucchi, K., Joffe, R., & Katona, C. (2014). A systematic review and meta-analysis of lithium augmentation of tricyclic and second generation antidepressants in major depression. Journal of Affective Disorders, 168, 269-275. https://doi.org/10.1016/j.jad.2014.05.053
Reif, A., Bitter, I., Buyze, J., Cebulla, K., Frey, R., Fu, D.-J., Ito, T., Kambarov, Y., Llorca, P.-M., Oliveira-Maia, A. J., Messer, T., Mulhern-Haughey, S., Rive, B., von Holt, C., Young, A. H., & Godinov, Y. (2023). Esketamine nasal spray versus quetiapine for treatment-resistant depression. New England Journal of Medicine, 389(14), 1298-1309. https://doi.org/10.1056/NEJMoa2304145
How this MN665 Unit 10 example is structured
Each decision is written as a block with the same five parts, so the report can be read down the page as one reasoning thread. The fifth part carries the report's distinctive work: it says what the new decision changed about earlier ones. The blood pressure reading did not reverse the esketamine choice, but it added pre- and post-dose checks, a primary care referral and a lower threshold for pausing treatment, each traced back to the original weighing of risks. The transport decision revisited scheduling, moving sessions to his days off so the driving restriction never overlapped a shift. Risk is reassessed at every block rather than once at intake. The closing page separates response from remission, stating that a MADRS of 14 is progress short of the goal, and names the next decision point.
Get an MN665 Unit 10 example written to your instructions
Longitudinal reports typically draw on the full term's case, so the MN665 Unit 10 prompt and whatever earlier units supplied about the same patient both help, along with the rubric. The report, free as your first custom sample, arrives within 24-48h arranged by decision, each block showing what it changed in the ones before. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN665 Unit 10 questions, answered
How is a longitudinal case report different from a single case study?
It follows one patient through several decisions over time and shows how each changed the next. A single case study captures one point. Organize the report so the reader can trace the reasoning across decisions, and state explicitly when new information confirmed, adjusted or reversed an earlier choice. That connective reasoning is the thing being graded.
Can the report include a newer treatment such as esketamine?
Yes, if the evidence and the patient's circumstances support it. Cite approval dates and trial results accurately, describe the monitoring the label requires, and weigh practical demands such as supervised administration and transport. Graders tend to reward a new option chosen for reasons specific to the patient, and they notice when novelty is doing the arguing.
How should the report handle a patient's employer?
Carefully, and only with explicit consent. Share the minimum needed, such as scheduling or fitness-for-duty information, and keep diagnosis and medication private unless the patient agrees otherwise. Where a job is safety-sensitive, explain how the plan protects both the patient and the public without disclosing more than necessary, and record what was shared and when.