| Course | NU673 PMHNP Diagnosis and Management Across the Lifespan I |
|---|---|
| Unit | Unit 6 |
| Paper type | Baseline workup plan |
| Length | About 950 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU673 Unit 6
Before the First Treatment: A Baseline Workup Plan for Electroconvulsive Therapy in a 43-Year-Old With Psychotic Bipolar Depression Taking Lithium and Lamotrigine
[Student Name]
Purdue University Global
NU673: PMHNP Diagnosis and Management Across the Lifespan I
Unit 6 Baseline Workup Plan
[Instructor Name]
[Date]
The patient is composite; values, doses and dates are bracketed.
The Patient and the Indication
Mr. [C.] is a [43]-year-old landscaping crew lead with bipolar I disorder. He has been in a major depressive episode with psychotic features for [seven] weeks, believing that he has ruined his family and that his body is "rotting." Over the past [ten] days he has eaten very little and has lost [5] kg. He has not responded to an increase in lithium to a level of [0.8] mmol/L, and quetiapine was stopped after [four] weeks because of sedation without benefit. He also takes lamotrigine [200] mg daily, lisinopril [20] mg for hypertension, and ibuprofen most days for back pain.
Electroconvulsive therapy is being considered because of the severity of his depression, the psychotic features, poor oral intake and the failure of medication. Pooled randomized trials show that real electroconvulsive therapy is significantly more effective than simulated treatment and than pharmacotherapy for depression in the short term (UK ECT Review Group, 2003).
Purpose of the Workup
The pre-treatment evaluation aims to identify conditions that raise the risk of anesthesia or the seizure, to adjust medications that interact with the treatment, and to record a baseline against which benefits and side effects will be judged. A review of the medical evaluation of patients undergoing electroconvulsive therapy notes that there are no absolute contraindications, but that cardiovascular and neurological conditions carry the most risk and should be assessed and optimized (Tess & Smetana, 2009).
The Plan, Item by Item
1. History and physical examination, including dentition.
Purpose: identify cardiac, respiratory and neurological conditions, and loose or damaged teeth that could be injured during the seizure. Result that would change course: a loose tooth leads to dental review before the first treatment; signs of heart failure lead to cardiology review.
2. Electrocardiogram.
Purpose: he is over [40], has hypertension and the seizure produces a brief surge in heart rate and blood pressure. Result that would change course: evidence of ischemia, a significant arrhythmia or a prolonged QT interval leads to cardiology consultation before treatment.
3. Blood pressure control.
Purpose: his readings have been [148/92] despite lisinopril. Uncontrolled hypertension increases the risk of the blood pressure surge during treatment. Result that would change course: readings above [160/100] lead to adjustment of his antihypertensive treatment before the first session, and the anesthesia team will decide whether he takes lisinopril on treatment mornings.
4. Basic metabolic panel.
Purpose: check sodium and potassium, which affect seizure threshold and anesthesia, and creatinine, given his poor oral intake and his use of lithium, lisinopril and ibuprofen together. Result that would change course: a raised creatinine or abnormal potassium leads to correction and fluid replacement before treatment; ibuprofen will be stopped now in any case, since the combination with lisinopril and poor intake threatens his kidneys and his lithium level.
5. Lithium level and plan.
Purpose: lithium has been associated with prolonged confusion and delirium after electroconvulsive therapy. Result that would change course: the plan is to hold lithium for the course or reduce it to the lowest effective level after discussion with the treating team; a level above [0.6] mmol/L on the morning of treatment would lead to the dose being held.
6. Lamotrigine plan.
Purpose: anticonvulsants may raise the seizure threshold and make it harder to produce an adequate seizure. Result that would change course: if seizures are short or inadequate, the dose may be reduced or held on the evening before treatment, weighing the risk of mood destabilization.
7. Complete blood count.
Purpose: baseline, and to identify anemia after weight loss. Result that would change course: significant anemia would be investigated before anesthesia.
8. Cognitive baseline.
Purpose: electroconvulsive therapy can cause short-term memory and cognitive side effects, and a baseline allows them to be measured. A meta-analysis found that cognitive impairment after treatment was mainly limited to the first three days and that functioning returned to baseline, with some domains improving beyond baseline after [15] days (Semkovska & McLoughlin, 2010). Result that would change course: marked baseline impairment would lead to closer cognitive monitoring and consideration of right unilateral electrode placement.
9. Neurological assessment and imaging only if indicated.
Purpose: rule out a space-occupying lesion or raised intracranial pressure, which carry the highest neurological risk. Result that would change course: focal signs or new headache lead to brain imaging before treatment.
10. Anesthesia consultation, including aspiration risk and nutrition.
Purpose: he has eaten little, which affects fluid status and glucose, and he will need an overnight fast before each treatment. Result that would change course: dehydration or low glucose leads to intravenous fluids and a nutrition plan before treatment starts.
11. Capacity and consent.
Purpose: psychotic depression can impair decision-making. Result that would change course: if he lacks capacity to consent, the state's legal process for treatment without consent is followed, with his family involved.
Three of the eleven items concern the medicines he already takes, which is why the workup starts with his medication list rather than his blood tests.
After the Course
Relapse after a successful course is common. In a randomized trial of patients who remitted with electroconvulsive therapy, relapse over six months was similar with continuation treatment and with continuation medication, about a third in each group (Kellner et al., 2006). A plan for continuation treatment, whether maintenance sessions or medication including lithium, will be agreed before the course ends.
References
Kellner, C. H., Knapp, R. G., Petrides, G., Rummans, T. A., Husain, M. M., Rasmussen, K., Mueller, M., Bernstein, H. J., O'Connor, K., Smith, G., Biggs, M., Bailine, S. H., Malur, C., Yim, E., McClintock, S., Sampson, S., & Fink, M. (2006). Continuation electroconvulsive therapy vs pharmacotherapy for relapse prevention in major depression: A multisite study from the Consortium for Research in Electroconvulsive Therapy (CORE). Archives of General Psychiatry, 63(12), 1337-1344. https://doi.org/10.1001/archpsyc.63.12.1337
Semkovska, M., & McLoughlin, D. M. (2010). Objective cognitive performance associated with electroconvulsive therapy for depression: A systematic review and meta-analysis. Biological Psychiatry, 68(6), 568-577. https://doi.org/10.1016/j.biopsych.2010.06.009
Tess, A. V., & Smetana, G. W. (2009). Medical evaluation of patients undergoing electroconvulsive therapy. New England Journal of Medicine, 360(14), 1437-1444. https://doi.org/10.1056/NEJMra0707755
UK ECT Review Group. (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: A systematic review and meta-analysis. The Lancet, 361(9360), 799-808. https://doi.org/10.1016/S0140-6736(03)12705-5
The Purdue Global NU673 Unit 6 instructions
The Unit 6 assignment asks you to plan the baseline evaluation before starting a treatment that carries specific risks. Prompts usually ask for the indication, the purpose of the workup, each test or assessment with its reason, and the result that would alter the plan. Three to five pages is typical, with sources for the treatment's evidence and for its medical evaluation. Graders reward plans in which every item is justified for this patient and linked to a decision, and in which current medications are reviewed for interactions. Including capacity and consent, and a plan for after the course, shows the plan was built for the whole treatment rather than the first session.
Inside the NU673 Unit 6 example
The patient's illness, weight loss and failed medications are described first, with the UK ECT Review Group meta-analysis supporting the indication. A short purpose section cites the Tess and Smetana review. Eleven numbered items follow, each in three parts: the item, its purpose and the result that would change course. The medication items stop ibuprofen now, set a plan for holding or reducing lithium, and explain how lamotrigine may affect seizure length. The cognitive item cites the Semkovska meta-analysis. A highlighted sentence explains why three items concern his existing medicines. The final section uses the CORE trial to show why continuation treatment must be planned before the course ends. Every item is dated for review.
Reading the NU673 Unit 6 grading rubric
Workup plans are usually graded on the justification of the indication, completeness, the link between each item and a decision, medication review and planning beyond the first treatment. The indication earns full points when it is tied to severity, psychosis or failed treatments. Completeness is judged against the recognized pre-treatment evaluation. The link row rewards items that state the result that would change course, rather than listing tests. Medication review points go to plans that address interactions with the treatment itself, such as lithium and anticonvulsants. The forward planning row looks for relapse prevention and consent arrangements, including a legal pathway if capacity is lacking. Accurate citations support each item.
Common NU673 Unit 6 mistakes, and how to avoid them
Plans most often fall short by listing routine tests without saying why each is there. Another is overlooking medications that interact with the treatment, which in this case were three of his four drugs. Students often forget dental assessment, cognitive baseline and nutrition in a patient who is not eating. Some plans treat capacity as assumed, which is risky in psychotic depression. Others end at the first session with no plan for continuation. And omitting a result that would change course for each item turns the plan into a checklist that another clinician cannot use to make decisions when an abnormal value comes back.
Get an NU673 Unit 6 example written to your instructions
Name the option your NU673 Unit 6 prompt proposes, then send the case with its medication list and the rubric, since a baseline plan depends on the treatment under consideration. Every measure arrives with its purpose, its timing and the result that would change course in the free first plan, returned 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 3: Kratom Screening Write-Up
- NU673 Unit 4: YMRS Rating Scale Rationale
- NU673 Unit 5: Wilson Disease Seminar Reflection
- 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
- NU672 Unit 6: Helping Skills Feedback Post
- NU671 Unit 6: Activation vs Cognitive Therapy
- NU670 Unit 6: Dopamine Pathways and Haloperidol
- NU657 Unit 6: ICU Handoff Comparison Post
NU673 Unit 6 questions, answered
How should the plan handle tests another clinician already ordered?
Use recent results where they are reliable and say so, with the date. Repeating a normal creatinine drawn two weeks ago adds cost without information, while a thyroid test from two years ago may be too old. State the recency rule the plan applies, which shows judgment rather than a reflex to reorder everything.
Where can I find a free NU673 Unit 6 sample paper?
This page gives the full NU673 Unit 6 baseline workup plan for electroconvulsive therapy, with the indication, eleven items with purposes and deciding results, and relapse prevention, plus four references. A workup plan for a different treatment can be requested.
Why is lithium held before ECT in NU673 Unit 6?
Lithium has been associated with prolonged confusion and delirium after electroconvulsive therapy. The plan holds it for the course or reduces it after discussion with the team, and holds a dose if the morning level is above 0.6 mmol/L.
What cognitive effects of ECT does NU673 Unit 6 describe?
A meta-analysis found that cognitive impairment after treatment was mainly limited to the first three days, with functioning returning to baseline and some domains improving beyond it after about 15 days. The plan records a baseline to measure this.
Why stop ibuprofen in the NU673 Unit 6 plan?
He takes it with lisinopril and lithium while eating very little. Together these threaten his kidneys and can raise his lithium level, so ibuprofen is stopped now, whatever the other results show.