| Course | NU674 PMHNP Diagnosis and Management Across the Lifespan Clinical I |
|---|---|
| Unit | Unit 9 |
| Paper type | Focused follow-up note |
| Length | About 670 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU674 Unit 9
Four Nights in Seven and One Dizzy Morning: A Focused Follow-Up Note Fourteen Days After Starting Prazosin for Trauma Nightmares in a 37-Year-Old Wildland Firefighter
[Student Name]
Purdue University Global
NU674: PMHNP Diagnosis and Management Across the Lifespan Clinical I
Unit 9 Focused Follow-Up Note
[Instructor Name]
[Date]
The patient is composite; doses, scores and dates are bracketed.
Subjective
Mr. [F.], [37], wildland firefighter, seen for a [20]-minute follow-up [14] days after starting prazosin for trauma-related nightmares. PTSD followed a burnover in [August] in which two crew members were injured. At intake he reported nightmares [six] nights a week and was sleeping about [four] hours. He is also in trauma-focused therapy, session [four] of [twelve].
Since the last visit: nightmares on [four] nights of the past seven, by his sleep log, and "not as vivid." Sleeping about [five and a half] hours. One episode of lightheadedness on [day 9] when getting up at night to use the bathroom; he sat on the edge of the bed and it passed within a minute; no fall. No palpitations, chest pain or fainting. Returned to light duty at the station on [day 10]. Takes prazosin [2] mg at bedtime, increased from [1] mg on [day 7] as planned. No other medications. No alcohol since starting.
Objective
Blood pressure [118/74] seated, [110/70] standing at one minute and [112/72] at three minutes; heart rate [72] seated, [80] standing. No orthostatic hypotension today by standard criteria. PCL-5 [44], down from [53] at intake; the checklist is a validated self-report measure of PTSD symptoms (Blevins et al., 2015). Nightmare frequency from sleep log: [4] per week, from [6]. Alert, engaged, affect brighter than at intake.
Interval Details Worth Recording
He reports that the nightmares that remain are shorter and that he can now get back to sleep after waking, which he could not do at intake. His wife, who joined by phone at his request, confirmed that he no longer shouts in his sleep most nights. He has not had a nightmare about the burnover itself for [five] nights, although he still dreams of smoke. He found the light-duty shifts easier than expected and says the crew has been "good about it." He is worried about fire season next year and whether he will be cleared to return to the line.
Assessment
Partial improvement in nightmare frequency and PTSD symptom severity at two weeks on a low dose, with one episode of likely orthostatic lightheadedness at night that has not recurred and no orthostatic change in the clinic today.
The evidence for prazosin is mixed, which is why progress is measured rather than assumed. In a trial of active-duty soldiers with combat-related PTSD and trauma nightmares, prazosin improved nightmares, sleep quality and global function compared with placebo, with no difference in blood pressure changes (Raskind et al., 2013). A larger later trial in military veterans with chronic PTSD found no benefit over placebo for distressing dreams, sleep quality or overall change (Raskind et al., 2018). His response so far is modest and could reflect the drug, therapy, return to work or time.
With one dizzy night, two weeks of modest gain and therapy only a third done, the most informative next step is to hold everything steady for two more weeks.
Plan
1. Prazosin: continue [2] mg at bedtime; do not increase today. Rationale: the one episode of lightheadedness occurred within two days of the dose increase, and he is benefiting; a further increase can be considered at the next visit if nightmares remain frequent and there is no further dizziness.
2. Safety: sit before standing at night; keep a light on the path to the bathroom; call if dizziness recurs or he faints. No driving of fire apparatus until the next review, per station policy, which he had already discussed with his captain.
3. Therapy: continue trauma-focused therapy; his therapist is aware of the medication.
4. Measurement: continue the sleep log and repeat the PCL-5 at the next visit.
5. Follow-up: [two] weeks.
References
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489-498. https://doi.org/10.1002/jts.22059
Raskind, M. A., Peskind, E. R., Chow, B., Harris, C., Davis-Karim, A., Holmes, H. A., Hart, K. L., McFall, M., Mellman, T. A., Reist, C., Romesser, J., Rosenheck, R., Shih, M.-C., Stein, M. B., Swift, R., Gleason, T., Lu, Y., & Huang, G. D. (2018). Trial of prazosin for post-traumatic stress disorder in military veterans. New England Journal of Medicine, 378(6), 507-517. https://doi.org/10.1056/NEJMoa1507598
Raskind, M. A., Peterson, K., Williams, T., Hoff, D. J., Hart, K., Holmes, H., Homas, D., Hill, J., Daniels, C., Calohan, J., Millard, S. P., Rohde, K., O'Connell, J., Pritzl, D., Feiszli, K., Petrie, E. C., Gross, C., Mayer, C. L., Freed, M. C., . . . Peskind, E. R. (2013). A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. American Journal of Psychiatry, 170(9), 1003-1010. https://doi.org/10.1176/appi.ajp.2013.12081133
Reading the NU 674 Unit 9 instructions
For Unit 9 you write a focused follow-up note for a patient on a new treatment. Prompts usually want the interval history since the last visit, target symptoms measured against baseline, side effects asked about and examined, an assessment of response, and a plan with reasons. Keep it to a page or two. Faculty favor notes that record change rather than repeat the evaluation, that use the same measures as the baseline, and that explain every decision, including a decision not to change anything. Relevant examination findings, such as orthostatic vital signs for a drug that lowers blood pressure, should be recorded with their numbers, not summarized as normal.
How the NU 674 Unit 9 example is put together
The subjective section gives the reason for the visit, the intake baseline and the interval: nightmares from his sleep log, hours of sleep, one lightheaded night after the dose increase and return to light duty. A section adds details from his wife by phone. The objective section records seated and standing blood pressure and heart rate at one and three minutes and the PCL-5 with its validation source. The assessment weighs partial improvement against the mixed trial evidence, and a highlighted sentence gives the reason to hold steady. Five numbered plan items each carry a reason, including safety at night and station driving policy. Each measure repeats the intake method.
NU674 Unit 9 rubric: what earns full points
Instructors typically mark a follow-up note on interval history, comparison with baseline, side effect assessment, clinical reasoning and plan clarity. Interval history earns full points when it records what changed since the last visit. Comparison rewards the same measures used at baseline, reported side by side. Side effect assessment is judged on whether the expected effects of the specific drug were asked about and examined, here orthostatic change. Clinical reasoning scores when the assessment weighs the evidence for the drug and other possible reasons for improvement. Plan clarity looks for a reason attached to each item, including the decision to keep the dose unchanged at this visit. Clear, concise wording and correct citations complete the marks.
Common NU674 Unit 9 mistakes, and how to avoid them
Students often copy the evaluation into the follow-up note instead of recording what changed. Another common error is reporting orthostatic symptoms without measuring standing blood pressure. Some notes increase the dose automatically on schedule, even after a side effect. Others record an unchanged plan without saying why, which reads as inattention. Many attribute all improvement to the drug when therapy, work and time may also contribute. And forgetting occupational safety, for someone who drives a fire engine or works on a fire line, leaves out a risk the patient and employer both need addressed in writing. Keep the note to one page if you can.
Get an NU674 Unit 9 example written to your instructions
Follow-up note formats run from SOAP to DAP to a site's own template, so name the one NU674 expects for Unit 9 and share the rubric with an anonymized summary of the visit. The composite note that comes back, free the first time and within 24-48h, measures interval change against a named baseline and gives the plan its reasons. 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 NU674 papers and MSN samples
- NU674 Unit 1: Outpatient Clinic Learning Objectives
- NU674 Unit 2: Observational Mental Status Exam
- NU674 Unit 3: HPI With a Seasonal Pattern
- NU674 Unit 4: SAFE-T Suicide Risk Assessment
- NU674 Unit 5: Reflective Narrative on a Rushed Intake
- NU674 Unit 6: Two Intake Styles Compared Post
- NU674 Unit 7: Evaluation, Persistent Depression
- NU674 Unit 8: Biopsychosocial Formulation, Trucker
- NU674 Unit 10: Revised Psychiatric Evaluation
- NU673 Unit 9: GAD-7 Follow-Up Score Interpretation
- NU672 Unit 9: Comparative Process Recording, Grief
- NU671 Unit 9: Alliance With a Court-Mandated Client
- NU670 Unit 9: Study Critique, Santarelli 2003
NU674 Unit 9 questions, answered
What belongs in a focused follow-up note that is not in the evaluation?
Change. The note assumes the evaluation exists and records what is different since then: target symptoms, side effects explored, adherence, safety, a brief examination, and whether the plan moves. Repeating the history wastes the reader's time. A short line citing the evaluation and its date is enough to anchor every comparison the note makes.
What is the PCL-5?
The PTSD Checklist for DSM-5, developed at the National Center for PTSD by Weathers and colleagues, is a 20-item self-report measure scored from 0 to 80. It tracks symptom change well across visits. It is not a diagnosis on its own, and the note reports the score beside the clinical picture rather than letting a number stand in for the assessment.
Why record a decision not to change anything?
Because an unchanged plan is still a clinical judgment, and a reader needs its reasons as much as the reasons for a dose change. Without them, continuing the same dose can look like a missed opportunity or an oversight. One sentence naming the improvement seen, the side effect weighed and the condition that would prompt a change is usually enough.
Where can I find a free NU674 Unit 9 sample paper?
This page holds the full NU674 Unit 9 focused follow-up note, with the interval history, measured change from baseline, orthostatic vital signs, an assessment weighing the evidence and a reasoned five-item plan, plus three references. Share your own patient's baseline and interval and a note can be drafted from them.
What does the evidence say about prazosin in NU674 Unit 9?
It is mixed. A trial in active-duty soldiers found prazosin improved nightmares, sleep quality and function, but a larger trial in veterans with chronic PTSD found no benefit over placebo. That is why the note measures his response rather than assuming it.