NU676 Unit 6 Lithium and Kidney Conference Summary Example

Reviewed by Elspeth Marlowe, MSN, RN PMHNP Diagnosis and Management Across the Lifespan Clinical II Purdue University Global Free custom sample in 24 to 48h

This NU676 Unit 6 sample is a case conference summary for a composite 61-year-old retired textile mill supervisor who has stayed out of the hospital on lithium for eighteen years while her eGFR fell from 68 to 44 over four. It was written for Purdue Global NU 676, PMHNP Diagnosis and Management Across the Lifespan Clinical II, an MSN course. Nephrology's case for stopping draws on the Aiff and Close cohorts; psychiatry's case for continuing draws on her 2014 relapse into mania and the Suppes study of recurrence after stopping. Her own words set the direction, and the conference agrees a conditional path with a threshold for switching.

CourseNU676 PMHNP Diagnosis and Management Across the Lifespan Clinical II
UnitUnit 6
Paper typeCase conference summary
LengthAbout 630 words, 5 pages double-spaced
FormatAPA 7 student paper
SchoolPurdue University Global
ProgramMSN
UpdatedSeptember 2026

Free sample paper for NU676 Unit 6

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Eighteen Years of Lithium and a Falling eGFR: A Case Conference Summary Weighing Nephrology's Case for Stopping Against a Past Relapse Into Mania

[Student Name]

Purdue University Global

NU676: PMHNP Diagnosis and Management Across the Lifespan Clinical II

Unit 6 Case Conference Summary

[Instructor Name]

[Date]

The patient is composite; values, dates and doses are bracketed.

What this part is doingThe summary promises to present both positions before the decision, which is what a conference record must do.
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The Patient

Mrs. [W.], [61], bipolar I disorder since [28], with four hospitalizations for mania before lithium, the last in [2006]. On lithium since then, currently [600] mg daily, level [0.6] mmol/L. In [2014] she stopped lithium on her own and was hospitalized with mania within [three] months. Other conditions: hypertension on amlodipine, hypothyroidism on levothyroxine since [2012]. No NSAID use. Her eGFR has fallen from [68] to [44] mL/min/1.73 m² over four years, with urine protein normal. Nephrology was consulted after the most recent result.

The Case for Stopping Lithium

The nephrology consultant presented this position. Long-term lithium is associated with a decline in kidney function. In a Swedish cohort of adults treated for ten to thirty years, about a third showed evidence of chronic renal failure, though only [5] percent were in the severe categories (Aiff et al., 2015). A large UK primary care cohort found an increased risk of renal failure with lithium use, particularly in people aged [50] or older, although the absolute risk remained small (Close et al., 2014). Her decline is steady and she is now in stage 3b chronic kidney disease. Stopping lithium now may preserve the function she has; waiting may mean that decline continues toward a point where dialysis becomes a possibility.

The Case for Continuing Lithium

The psychiatry team presented this position. Lithium has kept her well for eighteen years after four hospitalizations. When she stopped it in [2014], mania followed within three months. The risk of early recurrence, especially of mania, rises after lithium is stopped and may exceed the risk expected from the untreated illness (Suppes et al., 1991). A reviewer of lithium's adverse effects notes that renal changes are one of several effects that require monitoring but that decisions should weigh them against the drug's substantial benefit (Gitlin, 2016). Another manic episode at [61] would carry its own risks, including to her physical health.

What She Wants

Mrs. [W.] attended the conference with her husband. She said: "I remember what 2014 was like. I don't want that again. But I don't want to end up on dialysis either." She asked whether there was a middle path.

Both positions were right about what they described; the question was which risk she and the team were more willing to accept, and she had already told them.

What this part is doingHer words are recorded between the two positions and the decision, because they settled the question the positions could not.
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The Decision

The conference agreed on a conditional middle path.

1. Continue lithium for now at the lowest effective level, target [0.5 to 0.6] mmol/L, given her history of rapid relapse off lithium and her preference.

2. Monitor kidney function every [three] months, with nephrology follow-up every [six] months.

3. Avoid additional kidney risks: no NSAIDs, careful hydration, review of any new medication with the pharmacist.

4. Define in advance the point at which lithium would be withdrawn: an eGFR below [30], or a further fall of more than [5] per year, would trigger a planned switch.

5. Prepare the alternative now, not in a crisis: discuss which mood stabilizer she would move to, and plan a slow cross-taper if the threshold is reached, rather than stopping lithium abruptly.

6. Her husband and she will learn her early warning signs of mania, reviewed at each visit.

Dissent

The nephrology consultant recorded a preference for a planned switch within [twelve] months but agreed to the monitoring plan with the thresholds above.

Follow-Up

Next kidney function test in [three] months; conference review in [six] months.

What this part is doingThe dissent is recorded rather than smoothed over, which gives the next conference an accurate starting point.
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References

Aiff, H., Attman, P.-O., Aurell, M., Bendz, H., Ramsauer, B., Schön, S., & Svedlund, J. (2015). Effects of 10 to 30 years of lithium treatment on kidney function. Journal of Psychopharmacology, 29(5), 608-614. https://doi.org/10.1177/0269881115573808

Close, H., Reilly, J., Mason, J. M., Kripalani, M., Wilson, D., Main, J., & Hungin, A. P. S. (2014). Renal failure in lithium-treated bipolar disorder: A retrospective cohort study. PLoS ONE, 9(3), Article e90169. https://doi.org/10.1371/journal.pone.0090169

Gitlin, M. (2016). Lithium side effects and toxicity: Prevalence and management strategies. International Journal of Bipolar Disorders, 4(1), Article 27. https://doi.org/10.1186/s40345-016-0068-y

Suppes, T., Baldessarini, R. J., Faedda, G. L., & Tohen, M. (1991). Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Archives of General Psychiatry, 48(12), 1082-1088. https://doi.org/10.1001/archpsyc.1991.01810360046007

Reading the NU 676 Unit 6 instructions

For Unit 6 you summarize a case conference in which clinicians disagreed about management. Prompts usually ask for the patient's history, each position with its evidence, the patient's view, the decision reached and any dissent. Two to three pages is typical. Instructors look for fair presentation of both sides, using the evidence each side relied on, and a decision that follows from the discussion rather than one imposed by the author. Recording dissent accurately, rather than implying consensus, is part of good conference documentation. Defining in advance what would change the decision, such as a laboratory threshold, makes the summary useful to the next conference and to clinicians who were not present at this one.

How this NU676 Unit 6 example is built

The patient section gives her diagnosis, lithium dose and level, the 2014 relapse and her falling eGFR. The case for stopping follows, with the Swedish and UK cohort findings. The case for continuing follows, with the Suppes recurrence data and the Gitlin review. Her own words come next, including her request for a middle path, and a highlighted sentence explains how they settled the question. The decision is written as six conditions, from a lower lithium target to an eGFR threshold that would trigger a planned switch and preparing the alternative now. The nephrologist's dissent is recorded, and a follow-up date closes the summary.

Where the points sit in the NU676 Unit 6 rubric

Case conference summaries are usually graded on balance, use of evidence for each position, integration of the patient's view, clarity of the decision and documentation of dissent. Balance earns full points when each position is presented in its strongest form. Evidence credit goes to sources cited by the side that relied on them. Integration rewards summaries in which the patient's preference visibly shapes the outcome. Decision clarity is judged on conditions and thresholds that a clinician could apply at the next kidney result. Dissent points go to an honest record of who disagreed and on what terms, which protects the patient and gives the next conference an accurate starting point.

Common NU676 Unit 6 mistakes, and how to avoid them

Students often present the psychiatric position fully and the medical one briefly, or the reverse. Another common problem is recording a decision without the thresholds that would change it. Some summaries omit the patient, as if the decision belonged to the clinicians. Others smooth over disagreement, which misleads the next conference. Many forget to prepare the alternative in advance, leaving a switch to happen in a crisis. And a summary that cites only the risks of the current drug, without the risks of stopping it, makes the conference look one-sided and gives the patient an incomplete picture of her own choice. Record the date of each threshold so the next conference can check it against the latest kidney result without searching the chart.

Get an NU676 Unit 6 example written to your instructions

Conference formats range from a spoken ten-minute slot to a written brief circulated beforehand, so describe what your NU676 site does, add the Unit 6 prompt and rubric, and sketch the contested case without identifiers. A first summary costs nothing and returns within 24-48h: each position argued at full strength, the patient's view recorded, and one question to settle. 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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NU676 Unit 6 questions, answered

Should the summary take a side?

Present both positions fairly first, then say where you stand if the prompt asks, clearly labeled as your view. A summary that argues one side from the start leaves the team unable to trust its account of the other. Many instructors grade the fairness of the presentation separately from the recommendation, so keeping them apart protects both.

Why include the patient's preference in a clinical conference?

Because the decision is hers as much as the team's, and in a case like this her values may settle what the evidence leaves open. Recording her view in her own words, including any ambivalence, keeps the conference from deciding for her. It also shows faculty that shared decision-making was considered rather than assumed.

Where can I find a free NU676 Unit 6 sample paper?

The complete NU676 Unit 6 case conference summary is available here, with both positions and their evidence, her own words, the six-part decision and the recorded dissent, plus four references. A summary of your own conference case can be requested.

How much does lithium affect the kidneys in NU676 Unit 6?

In a Swedish cohort treated for 10 to 30 years, about a third showed chronic renal impairment, though only 5 percent were in severe categories. A UK cohort found higher renal failure risk with lithium, especially from age 50, with a small absolute risk.

What would trigger stopping lithium in NU676 Unit 6?

An eGFR below 30, or a further fall of more than 5 per year, would trigger a planned switch to another mood stabilizer with a slow cross-taper, prepared in advance rather than in a crisis.