Diabetes, knee arthritis, depression and hypertension share one integrated plan for NU568 Unit 9, organized around the composite patient's stated priority and a grid of treatment conflicts. Searches like "nu 568 unit 9 assignment example", "nu568 unit 9 sample" and "nu568 unit 9 example" land here.
Four Conditions, One Woman, One Plan: A Multimorbidity Case Built on the Ariadne Principles
[Student Name]
Purdue University Global
NU568: FNP I - Primary Care Across the Lifespan
Unit 9 Multimorbidity Case
[Instructor Name]
[Date]
The patient is a composite; values and agents in brackets are illustrative options for the prescriber.
The Patient
Ms. [V.], 59, manages the laundry at a large hotel, a job spent on her feet on concrete floors. She has type 2 diabetes, A1C [8.1] percent, on [metformin]; hypertension, [146/90] on [amlodipine]; knee osteoarthritis, worse on the right; and depression, PHQ-9 [14], untreated. She buys [naproxen] over the counter and takes it most days. Her eGFR is [64]. BMI [34]. She has stopped the evening walks she used to take and eats more in the evenings when her mood is low.
Guidelines written for single diseases, applied one after another to a patient with several, can produce a regimen that is burdensome and internally contradictory (Boyd et al., 2005). The Ariadne principles offer an alternative sequence for primary care: assess interactions between conditions and treatments, agree on priorities and goals with the patient, then individualize management (Muth et al., 2014).
Step 1: The Interaction Grid
Rows are treatments, current or candidate; columns are her four conditions. Each cell records help, harm or neutral.
1. [Naproxen]. Diabetes: neutral to harm, through kidney strain. Osteoarthritis: helps pain. Depression: neutral. Hypertension: harms, raising pressure and blunting antihypertensives.
2. Walking and strength exercise. Diabetes: helps. Osteoarthritis: helps function and pain over weeks. Depression: helps. Hypertension: helps. Blocked by knee pain.
3. A sedating, weight-gaining antidepressant such as [mirtazapine]. Depression: helps. Diabetes: harms through weight gain. Osteoarthritis: harms, since weight loads the knee. Hypertension: neutral.
4. [Bupropion]. Depression: helps. Diabetes: neutral to helps, weight-neutral or modest loss. Osteoarthritis: neutral. Hypertension: can raise pressure; needs monitoring.
5. [Duloxetine]. Depression: helps. Osteoarthritis: helps chronic knee pain. Diabetes: neutral. Hypertension: can raise pressure slightly.
6. A GLP-1 receptor agonist such as [semaglutide]. Diabetes: helps. Osteoarthritis: helps through weight loss. Depression: neutral. Hypertension: helps modestly.
7. [Topical diclofenac]. Osteoarthritis: helps knee pain. Diabetes, depression, hypertension: little systemic effect.
The cells that carry the case's tension are three. Naproxen helps her knee and harms her pressure and kidneys. Knee pain blocks the activity that would help every condition. Depression erodes the self-management that diabetes and hypertension depend on.
Step 2: Her Priority, in Her Words
Asked what matters most, she said: "I need to keep working on my feet until I retire at 65. If my knee goes, I lose my job, and then everything else falls apart."
Her priority turns the plan's first target into knee function, because knee function unlocks the activity that her glucose, pressure and mood all depend on. Her secondary goal, stated when asked about her mood, was "to want to do things again."
Step 3: One Integrated Plan
1. Knee first. Replace [naproxen] with [topical diclofenac], which the ACR and Arthritis Foundation guideline strongly recommends for knee osteoarthritis and which avoids most systemic effects (Kolasinski et al., 2020). Refer to physical therapy for a strengthening program; the same guideline strongly recommends exercise. Supportive work shoes with cushioned insoles.
2. Mood, chosen with the knee and weight in mind. [Duloxetine] treats depression and also has evidence for chronic knee pain, one drug serving two conditions; [bupropion] is weight-neutral and activating but can raise pressure. [Mirtazapine] is avoided because of weight gain. The choice is offered to her with the prescriber; blood pressure is rechecked two weeks after starting either.
3. Glucose, chosen with weight in mind. Add a GLP-1 receptor agonist, such as [semaglutide], which lowers A1C and weight, easing the knee and lowering pressure. Continue [metformin].
4. Pressure. Stopping naproxen alone may lower it by several points. Recheck in four weeks before changing [amlodipine].
5. Activity, staged. Once knee pain eases, the evening walks return, starting with ten minutes.
Why Naproxen Goes First
She asked to keep the naproxen, because it works. Keeping it with a stomach-protecting drug would address one of its harms and none of the others. In her grid, naproxen raises blood pressure and blunts her amlodipine, and it reduces blood flow to kidneys that are already slightly below normal and that diabetes and hypertension both threaten. It also interacts with the antidepressants on her list: combined with an SSRI or SNRI such as duloxetine, an NSAID raises the risk of gastrointestinal bleeding. Of all the changes, stopping it touches the most cells in the grid at once. The topical form keeps most of the benefit at the knee with little of the drug reaching the blood.
Depression as One of the Four, Not Behind Them
It would be easy to treat her depression as a background problem, something to address once the medical conditions are in order. The grid argues the reverse. Her depression is why the walks stopped and why evening eating began, and it will decide whether she takes four new instructions home and follows them. Treating it early is not a detour from diabetes care; it is part of it. A PHQ-9 of 14 is moderate depression, and she was offered talking therapy through her employer's assistance program alongside the medicine, with the choice left to her.
What Would Reorder the Plan
A PHQ-9 that rises, or any thought of self-harm, would move mood to the top at once. A sharp rise in blood pressure on bupropion or duloxetine would move pressure ahead of mood. And if physical therapy and topical treatment do not restore her ability to work a shift, an orthopedic referral would be brought forward, because her stated priority is the measure the plan answers to.
What the Plan Chooses Not to Address Yet
Treatment burden must stay within what she can carry. Deferred, with dates:
1. Statin decision: at visit two, [date], once the new medicines are settled.
2. Diabetic eye examination referral: at visit two.
3. Sleep assessment for possible sleep apnea, given her weight and fatigue: at visit three, [date].
4. Dietary counseling beyond the evening-eating pattern: referral at visit three.
Staged Follow-Up
Visit one, today: stop naproxen, start topical diclofenac, physical therapy referral, antidepressant chosen, GLP-1 receptor agonist discussed and started if she agrees. Visit two, in [four] weeks: pressure, PHQ-9, knee function, tolerance of new medicines; statin and eye referral. Visit three, in [three] months: A1C, weight, walking minutes, sleep and diet.
At each visit, the first question is her own: "Can you still work your shift?" Her answer is recorded in the note beside the A1C and blood pressure, because it is the outcome she chose, and the plan is judged by it as much as by the numbers.
References
Boyd, C. M., Darer, J., Boult, C., Fried, L. P., Boult, L., & Wu, A. W. (2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: Implications for pay for performance. JAMA, 294(6), 716-724. https://doi.org/10.1001/jama.294.6.716
Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., ... Reston, J. (2020). 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 72(2), 149-162. https://doi.org/10.1002/acr.24131
Muth, C., van den Akker, M., Blom, J. W., Mallen, C. D., Rochon, J., Schellevis, F. G., Becker, A., Beyer, M., Gensichen, J., Kirchner, H., Perera, R., Prados-Torres, A., Scherer, M., Thiem, U., van den Bussche, H., & Glasziou, P. P. (2014). The Ariadne principles: How to handle multimorbidity in primary care consultations. BMC Medicine, 12, 223. https://doi.org/10.1186/s12916-014-0223-1
How this NU568 Unit 9 example is structured
The case follows the Ariadne sequence: assess interactions, agree on priorities and goals with the patient, then individualize management. The interaction assessment is the grid, explained cell by cell for the cells that matter. The priority section quotes her words and translates them into clinical goals, knee function first because it unlocks activity, glucose and pressure. Management is then written as one plan with each change justified by its effect across conditions: naproxen replaced with [topical diclofenac], bupropion or another weight-neutral antidepressant weighed against her pressure, a glucose-lowering agent chosen with weight in mind, all bracketed as options for the prescriber. A deferral list records what the plan is choosing not to address yet, with a date, so that treatment burden stays within what she can carry. Follow-up is staged across three visits instead of one.
Get an NU568 Unit 9 example written to your instructions
Multimorbidity cases vary in their mix, so send your NU568 Unit 9 case in full, including the medication list and anything recorded about the patient's goals, together with the rubric. The model case maps interactions in a grid, orders the plan by the patient's priority and brackets every value. It comes back in 24-48h, free on a first request. 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.
NU568 Unit 9 questions, answered
Is a framework like Ariadne required?
Only if your prompt names one, but a framework helps the paper show a method rather than a series of judgments. Ariadne suits primary care consultations, while the American Geriatrics Society's 2012 guiding principles suit older adults. Name the framework, cite it with its year, and let its steps organize the paper so the grader can follow the reasoning.
How many conditions should the plan address at once?
All of them in the assessment, fewer in the first round of changes. Treatment burden is a real harm, and graders often credit a plan that sequences changes across visits with dates. Stating what is deferred, and why, shows judgment; silently dropping a condition looks like an oversight, even when the choice was deliberate.
Where do the patient's goals belong in the paper?
Early, directly after the interaction assessment, and quoted in the patient's words where the case provides them. Everything after should refer back to those goals. A plan that records goals in a closing paragraph, after every decision has already been made, suggests the priorities were an afterthought rather than the organizing principle.