| Course | NU673 PMHNP Diagnosis and Management Across the Lifespan I |
|---|---|
| Unit | Unit 3 |
| Paper type | Substance use screening write-up |
| Length | About 800 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU673 Unit 3
Green Powder in a Water Bottle: A Substance Use Screening Write-Up for Daily Kratom in a 26-Year-Old Delivery Driver Referred for Anxiety
[Student Name]
Purdue University Global
NU673: PMHNP Diagnosis and Management Across the Lifespan I
Unit 3 Substance Use Screening Write-Up
[Instructor Name]
[Date]
The patient is composite; amounts and scores are bracketed.
Reason for Referral
Mr. [L.] is a [26]-year-old package delivery driver referred by his primary care clinician for anxiety, restlessness, irritability and poor sleep for about [six] months. He works [ten]-hour shifts, [five] days a week. He asked for "something for anxiety" and mentioned a panic-like episode in his truck [two] weeks ago.
Screening
The Tobacco, Alcohol, Prescription medication and other Substance use tool was used at intake. In a validation study in adult primary care patients, the tool detected clinically relevant problem use of tobacco, alcohol and several drug classes, with sensitivity for problem use of illicit and prescription drugs ranging from [0.63] to [0.82] and specificity of [0.93] or higher (McNeely et al., 2016).
Part 1, past year frequency:
1. Tobacco: daily vape.
2. Alcohol, four or more drinks in a day: less than monthly.
3. Illegal drugs: "no," then, when asked about anything else he takes for energy or mood, "Does kratom count?"
4. Prescription medications for nonmedical reasons: never.
Because he answered yes to other substance use, Part 2 was completed for kratom. He uses it every day, has tried and failed to cut down, and has felt a strong urge to use.
Follow-Up Interview About Kratom
He began using kratom [18] months ago, when a coworker recommended it for energy on long routes. He now takes about [3] grams of powder [four] times a day, mixed in a water bottle, the first dose on waking. When he misses a dose he feels restless, sweaty and irritable, has a runny nose and aching legs, and sleeps poorly. He has never used opioids. He spends about [$60] a week on it.
Kratom is a plant product with dose-dependent effects: stimulant-like at lower doses and opioid-like at higher doses. In a large online survey of current users, most were middle-aged and used it to self-treat pain and emotional or mental conditions, and adverse effects were more common at higher and more frequent doses (Grundmann, 2017). A systematic review found that kratom may relieve anxiety and improve mood for some users, but that withdrawal can be uncomfortable and abstinence difficult to maintain for some (Swogger & Walsh, 2018).
How the Finding Changes the Differential
His anxiety, restlessness and poor sleep appear worst in the hours before his next dose, which is the pattern of withdrawal, not of a primary anxiety disorder. The differential now includes, in order of likelihood:
1. Kratom withdrawal between doses, producing anxiety, restlessness and insomnia.
2. A kratom use disorder, since he describes a failed attempt to cut back, strong urges, withdrawal between doses and a daily amount that has crept upward over the months.
3. A primary anxiety disorder that may have preceded or been masked by kratom, which cannot be assessed until his use is stable or stopped.
4. Nicotine-related symptoms from heavy vaping.
The panic-like episode occurred on a day when he had forgotten his bottle at home.
Timing of Treatment
Starting an SSRI now would risk treating withdrawal as anxiety and would make it hard to judge any benefit. The plan is to address the kratom first: a conversation about his goals, education about the withdrawal pattern, and a gradual taper over several weeks, with symptom tracking at each visit. If significant anxiety persists after he has been stable or abstinent for several weeks, a primary anxiety disorder will be reassessed. If withdrawal is severe or he cannot taper, referral to an addiction specialist will be discussed, since some clinicians treat kratom dependence with approaches used for opioid use disorder.
Driving
He drives a delivery truck for ten hours a day. Both the sedating effects of higher doses and the restlessness and poor sleep of withdrawal could affect his driving. He was advised not to take additional doses during his shift beyond his usual pattern, not to drive if he feels drowsy or unwell, and to discuss with his employer's occupational health service whether his use affects his fitness to drive under his workplace policies. No reporting obligation was identified in his state, and this was explained to him.
Plan
1. Taper plan agreed: reduce to [three] doses a day for [one] week, then [two], with symptom tracking.
2. Follow-up in [one] week, and weekly during the taper.
3. Sleep advice and a brief anxiety management skill for withdrawal symptoms.
4. Reassess anxiety after [four] weeks of stable use or abstinence.
5. Discuss vaping reduction at the next visit.
References
Grundmann, O. (2017). Patterns of kratom use and health impact in the US: Results from an online survey. Drug and Alcohol Dependence, 176, 63-70. https://doi.org/10.1016/j.drugalcdep.2017.03.007
McNeely, J., Wu, L.-T., Subramaniam, G., Sharma, G., Cathers, L. A., Svikis, D., Sleiter, L., Russell, L., Nordeck, C., Sharma, A., O'Grady, K. E., Bouk, L. B., Cushing, C., King, J., Wahle, A., & Schwartz, R. P. (2016). Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) tool for substance use screening in primary care patients. Annals of Internal Medicine, 165(10), 690-699. https://doi.org/10.7326/M16-0317
Swogger, M. T., & Walsh, Z. (2018). Kratom use and mental health: A systematic review. Drug and Alcohol Dependence, 183, 134-140. https://doi.org/10.1016/j.drugalcdep.2017.10.012
The Purdue Global NU673 Unit 3 instructions
For Unit 3 you document substance use screening for a patient referred for a psychiatric complaint. Prompts usually ask you to name and justify the screening tool, record the results, follow up positive answers with focused questions, and explain how the findings change the differential diagnosis, the timing of treatment and any safety concerns. Write-ups of three to four pages are common, with sources for the tool and for the substance involved. Graders reward write-ups that show how one screening answer led to the next question and that treat substance use as information about the psychiatric picture rather than a separate issue. Safety concerns specific to the patient's work, such as driving, should be addressed directly.
How this NU673 Unit 3 example is built
The referral is described first, then the TAPS tool with its validation figures. Part 1 answers are listed, including the moment the patient asked whether kratom counted. Part 2 findings follow. The follow-up interview records the amount, pattern, withdrawal symptoms and cost, with the Grundmann survey and Swogger review for context. The differential section reorders four possibilities around the timing of his symptoms, with a highlighted sentence on the withdrawal pattern and the observation that the panic episode came on a day he forgot his bottle. Sections on the timing of treatment and on driving follow, and a five-step plan closes the write-up. The references follow APA style.
Where the points sit in the NU673 Unit 3 rubric
Screening write-ups are generally graded on the choice and use of the tool, the quality of follow-up questions, the effect on the differential, safety planning and documentation. The tool row earns full points when a validated screen is used and its limits are stated. Follow-up is judged on whether positive answers lead to specific questions about amount, pattern and consequences. The differential row rewards a reordered list that reflects the new information. Safety points go to concrete advice about risks tied to the patient's work and life. Documentation covers clear structure, accurate citations and a plan that states when the psychiatric diagnosis will be reassessed. Tone matters too, since patients disclose more when the write-up reflects a nonjudgmental interview.
Common NU673 Unit 3 mistakes, and how to avoid them
Students often ask only about alcohol and illegal drugs, missing legal products such as kratom, cannabis products or supplements. Another common error is treating a positive screen as a separate problem instead of a possible cause of the psychiatric symptoms. Some write-ups start an SSRI while the patient is in daily withdrawal, which makes any effect impossible to judge. Others ignore safety at work, especially for patients who drive. Many forget to ask about cost and failed attempts to cut down, which show how much control the substance has. And advising abrupt stopping without a taper plan can make withdrawal worse and lead the patient to disengage.
Get an NU673 Unit 3 example written to your instructions
Has your NU673 Unit 3 prompt fixed the screening tool, or left the choice to the writer? Send the case, that detail and the rubric. The instrument reported accurately, its score read as a screen and a positive result followed into the differential and the timing of treatment: expect all three in a free first write-up within 24-48h. 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.
More NU673 papers and MSN samples
- NU673 Unit 1: Medical Causes Before Anxiety Post
- NU673 Unit 2: Differential for Late-Life Apathy
- NU673 Unit 4: Rating Scale Rationale
- NU673 Unit 5: Seminar Reflection
- NU673 Unit 6: Baseline Workup Plan
- NU673 Unit 7: Initial Treatment Plan
- NU673 Unit 8: Informed Consent Note
- NU673 Unit 9: Follow-up Score Interpretation
- NU673 Unit 10: Measurement-based Care Case
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NU673 Unit 3 questions, answered
Which substance screening tool fits which situation?
Single-question screens and the TAPS tool work as broad first steps in adults. The AUDIT and AUDIT-C address alcohol, the DAST-10 covers other drugs, the CUDIT-R focuses on cannabis, and CRAFFT 2.1 is built for adolescents. Match the instrument to the substance and the patient's age, and give a one-sentence reason for the choice.
Does a positive screen mean the psychiatric diagnosis is wrong?
Not necessarily. Substance use and primary psychiatric disorders often coexist. A positive screen means substance-induced symptoms must be considered and the timing of diagnosis may change, since symptoms that persist through a sustained period of reduced use point toward an independent disorder. The write-up should say what observation would distinguish the two.
Should the write-up include a urine drug test?
It can, offered with consent and with its purpose stated. A urine test confirms recent exposure but says nothing about amount, pattern or impairment, and cannabis metabolites can remain detectable for weeks in daily users. Present it as a complement to the interview and screening instrument, never as a replacement for asking.
Where can I find a free NU673 Unit 3 sample paper?
You can read the NU673 Unit 3 screening write-up in full here, including the TAPS results, the kratom history, the reordered differential, the timing of treatment, driving advice and a taper plan, plus three references. A write-up for your own patient can be drafted.
Why is the anxiety diagnosis delayed in NU673 Unit 3?
His anxiety, restlessness and poor sleep are worst in the hours before his next kratom dose, which suggests withdrawal. Starting an SSRI now would risk treating withdrawal as anxiety, so the plan tapers kratom first and reassesses anxiety after several stable weeks.