| Course | NU675 PMHNP Diagnosis and Management Across the Lifespan II |
|---|---|
| Unit | Unit 10 |
| Paper type | Year-long case review |
| Length | About 1,100 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU675 Unit 10
Twelve Months, Three Turning Points: A Year-Long Case Review of Stimulant Treatment for Adult ADHD in a 37-Year-Old Sign-Language Interpreter
[Student Name]
Purdue University Global
NU675: PMHNP Diagnosis and Management Across the Lifespan II
Unit 10 Year-Long Case Review
[Instructor Name]
[Date]
The patient is composite; doses, readings and dates are bracketed.
Baseline
Ms. [S.] is a [37]-year-old freelance sign-language interpreter referred for difficulty sustaining attention during long assignments, missed deadlines on invoices and paperwork, and lifelong disorganization. Her mother confirmed childhood inattention, and report cards described her as "bright but distracted." Her Adult ADHD Self-Report Scale screen was positive; the six-item screener was developed with the World Health Organization and showed good concordance with clinical diagnosis in its validation (Kessler et al., 2005). A full evaluation diagnosed ADHD, predominantly inattentive presentation, with no current mood, anxiety or substance use disorder. Baseline blood pressure [118/76], heart rate [72]. No personal or family history of heart disease; ECG normal.
Stimulants are the most effective medications for adult ADHD; in a network meta-analysis, amphetamines and methylphenidate were both better than placebo for clinician-rated core symptoms in adults, with amphetamines showing the largest effect (Cortese et al., 2018). She began mixed amphetamine salts extended release [10] mg each morning, increased to [20] mg at week [three].
Months 1 and 2: Response
Her self-rated symptoms fell by about [40] percent. She completed invoices on time for the first time in years and said she could hold focus through a two-hour legal interpretation. Appetite fell slightly; weight dropped [1.5] kg. Sleep was unchanged.
Month 3: The Blood Pressure Climb
At the month three visit her blood pressure was [138/88], confirmed at [136/90] a week later with home readings averaging [134/86]; heart rate [86]. Stimulants modestly raise blood pressure and heart rate in adults, and monitoring is recommended throughout treatment (Faraone et al., 2021).
Decision: rather than stop a medication that was working, the dose was held at [20] mg, and she was asked to reduce caffeine, which she had increased to four cups a day on work days, and to keep a home log. Rationale: the rise was modest, she had no cardiovascular risk factors, and caffeine was a likely contributor.
Result: at month four, with caffeine reduced to one cup, home readings averaged [124/80].
Month 5: The Shortage
During a national shortage of amphetamine salts, her pharmacy could not fill her prescription for [three] weeks, and neighboring pharmacies had none. She went eight days without medication, missed an assignment deadline and felt "back to square one."
Decision: switch to methylphenidate extended release [36] mg, which was available. Rationale: methylphenidate is also effective in adults, although with a somewhat smaller average effect in the network meta-analysis (Cortese et al., 2018), and availability mattered more than a small difference in average efficacy.
Result: after titration to [54] mg over [four] weeks, her symptom ratings returned to near their month two level. Blood pressure remained at [122/78].
Month 9: Extra Doses on Long Days
At the month nine visit she disclosed that on long conference days, which run [ten] hours, she had been taking an extra [18] mg tablet in the early afternoon, about twice a month, running out a few days early. She had not told the clinic because she feared being seen as misusing the medication.
Decision: rather than treat this as misuse, the review asked what problem the extra dose solved. Her medication wore off at about [15:00], and conference days ran until [18:00]. The plan added a prescribed short-acting methylphenidate [10] mg at [14:00] on long days only, with a set number of tablets each month. Rationale: the need was real and predictable, and a prescribed plan is safer than an informal one. The consensus statement notes that stimulant misuse and diversion are concerns, especially with immediate-release forms, which is why the supply is limited and reviewed at each visit (Faraone et al., 2021).
Each of the three turning points could have ended treatment, and each was instead met by asking what the event meant for her before deciding what to change.
Her View of the Year
At the twelve-month review Ms. [S.] was asked what had mattered most. She named three things. The first was being believed about her symptoms at the start, after years of being told she was simply disorganized. The second was that the blood pressure rise was handled by looking at her caffeine rather than by stopping the medicine, which she had feared. The third was that her disclosure about extra doses led to a plan rather than a lecture. She said that if the clinic had reacted to the extra doses with suspicion, she would probably have stopped telling the truth about her use. She also described what had not changed: she still finds invoicing tedious and uses a weekly reminder her partner set up, and she wondered whether coaching might help with the habits medication alone does not build.
Measures Across the Year
Her self-rated symptom scores fell from [42] at baseline to [25] at month two, rose to [38] during the eight days without medication at month five, and settled between [24] and [27] from month seven onward. Her blood pressure peaked at month three and returned to near baseline after caffeine was reduced. Her weight fell [1.5] kg in the first two months and then stayed stable. Missed invoice deadlines, which she tracked herself, fell from about [four] a month before treatment to none in the last six months, apart from the month of the shortage.
What the Year Shows
1. Blood pressure: a modest rise, largely explained by caffeine, managed without stopping treatment.
2. Supply: a shortage forced a switch that worked, and showed the value of having a second option ready.
3. Dosing: extra doses signaled an unmet need, not misuse, and a structured plan replaced an informal one.
Plan for Year Two
1. Continue methylphenidate [54] mg each morning and [10] mg on long days, [six] tablets a month.
2. Blood pressure at each visit and home readings monthly.
3. Symptom ratings every [three] months, and a review of whether coaching for organization skills would add benefit.
4. A standing plan for another shortage: a prescription for an alternative on file, agreed in advance.
5. Annual review of whether the diagnosis and dose still fit her work and life.
The second year will also test something the first could not: whether the gains hold during her busiest season, the spring conference circuit, when long days cluster and her sleep is shortest.
References
Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H.-C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727-738. https://doi.org/10.1016/S2215-0366(18)30269-4
Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., . . . Wang, Y. (2021). The World Federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789-818. https://doi.org/10.1016/j.neubiorev.2021.01.022
Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245-256. https://doi.org/10.1017/S0033291704002892
Reading the NU 675 Unit 10 instructions
The final NU675 assignment asks you to review a year of treatment for one patient and to explain the reasoning behind every major decision. Prompts usually want the baseline assessment, the events of the year in order, the evidence and reasoning behind each decision, outcomes on the same measures over time, the patient's perspective, and a plan for the coming year. Five to seven pages is common. Instructors reward reviews that treat outside events, such as supply shortages, as part of the clinical story, and that respond to difficult disclosures, such as extra doses, by asking what problem they solved. Consistent measures across the year let the reader see the effect of each turning point.
How this NU675 Unit 10 example is built
The review opens with the baseline: her difficulties, childhood history confirmed by her mother, the ASRS screen, a normal ECG and the choice of amphetamine salts with the Cortese network meta-analysis. Months one and two record her response. Each turning point then follows the same pattern of event, decision, rationale and result, with the World Federation consensus statement on blood pressure and on misuse. A highlighted sentence explains the common approach to all three events. Her own view of the year and a paragraph of measures across the year follow, then a three-line summary of what the year shows and a five-point plan for year two. Dates anchor each event.
NU675 Unit 10 rubric: what earns full points
Year-long reviews are usually graded on the baseline, the reasoning at each turn, the sources chosen, tracking of outcomes and the plan ahead. The baseline earns full points when diagnosis is supported by history, collateral and a screening tool. Decision reasoning rewards a clear rationale for each change or non-change. Evidence points go to sources matched to each decision, including efficacy, cardiovascular effects and misuse. Outcome tracking is judged on the same measures reported across the whole year. The plan earns credit when it anticipates foreseeable problems, such as another shortage, and schedules a yearly review of whether the diagnosis and dose still fit her life and work.
Common NU675 Unit 10 mistakes, and how to avoid them
The most common weakness is a chronological diary with no reasoning at each decision. Another is stopping a stimulant at the first rise in blood pressure without looking for a simpler cause. Students often treat a shortage as an administrative problem rather than an unplanned trial. Some reviews respond to extra doses with suspicion alone, which can end honest disclosure. Others report only the latest scores. And a plan for year two that simply continues the current regimen, without asking whether the need, the dose and the diagnosis still fit, misses the purpose of a yearly review, which is to decide rather than renew. Date every entry.
Get an NU675 Unit 10 example written to your instructions
Include each visit, measure and event from your NU675 Unit 10 case, even the ones that seem minor, plus the rubric. Following your instructions, the review returns within 24-48h at no cost as a first custom sample, reading the year block by block and closing on whether treatment should continue, with its conditions dated. 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.
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NU675 Unit 10 questions, answered
How many review points should a year-long case include?
Enough to show the pattern of the year, commonly one every two to three months, plus any unscheduled visit where something important happened. Use the same measures at each review so they can be compared. Where the case fixes the visits, work with all of them; where the spacing is yours to choose, give the reason for it.
Should a year-long review reconsider whether treatment is still needed?
Yes. For many long-term treatments, guidance recommends revisiting the need at least yearly rather than renewing automatically. Weigh current benefit against accumulated risks and burdens, state the conditions under which treatment continues, and schedule the next reconsideration. A review that simply carries treatment forward misses one of its main purposes.
How should the review handle a supply shortage or other outside event?
Treat it as part of the clinical story. A forced switch is effectively an unplanned trial, so record what changed, measure the effect against baseline and note the patient's experience. Date the event where possible and avoid speculating about causes outside the case. Outside events frequently explain turning points that would otherwise look arbitrary.
Where can I find a free NU675 Unit 10 sample paper?
The complete NU675 Unit 10 year-long case review is available here, with the baseline, three turning points and their decisions, her view of the year, measures across twelve months and the plan for year two, plus three references. A year of your own patient's visits can be turned into a review like this one.
How were the extra doses handled in NU675 Unit 10?
The review asked what problem they solved. Her medication wore off around 3 p.m. on ten-hour conference days, so a prescribed short-acting dose for long days only, with a set number of tablets each month, replaced her informal extra doses.