| Course | NU678 PMHNP Diagnosis and Management Across the Lifespan Clinical III |
|---|---|
| Unit | Unit 8 |
| Paper type | Recorded case presentation |
| Length | About 1,090 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU678 Unit 8
"His Wife Noticed the Chewing First": A Recorded Case Presentation Recommending a VMAT2 Inhibitor, Not an Antipsychotic Switch, for Tardive Dyskinesia in a 61-Year-Old Stable for Eight Years
[Student Name]
Purdue University Global
NU678: PMHNP Diagnosis and Management Across the Lifespan Clinical III
Unit 8 Recorded Case Presentation
[Instructor Name]
[Date]
The patient is composite; scores, doses, dates and slide timings are bracketed.
Slide 1, [0:00]: The Recommendation
Slide text: Start a VMAT2 inhibitor for moderate tardive dyskinesia; keep the antipsychotic that has kept him well.
Speaker notes: Good afternoon. This presentation is about one decision for one patient, and I will tell you the decision now so you can test my reasoning as I go. I recommend that Mr. [B.] start a VMAT2 inhibitor for his tardive dyskinesia and that we do not change the antipsychotic that has kept him out of hospital for eight years.
Slide 2, [0:30]: The Patient in One Line
Slide text: 61, retired bus mechanic, schizoaffective disorder, bipolar type; stable eight years; new mouth movements.
Speaker notes: Mr. [B.] is sixty-one. He retired from maintaining city buses two years ago. He has schizoaffective disorder, bipolar type, diagnosed at [twenty-six], with [five] hospitalizations before his current treatment. For eight years he has been well on paliperidone palmitate by monthly injection. Three months ago his wife noticed that he was chewing when he was not eating. He had not noticed.
Slide 3, [1:30]: What We See
Slide text: Chewing, lip pursing, tongue darting; worse when talking; AIMS items 1-7 total [12].
Speaker notes: On examination he has repetitive chewing movements, pursing of the lips and intermittent darting of the tongue, most visible while he is concentrating on something else. His fingers show mild, irregular movements. Using the Abnormal Involuntary Movement Scale, the total for the seven body-area items was [twelve], with moderate severity in the lips and jaw. He is not distressed by the movements, but his wife is, and he stopped attending his church's coffee hour after someone asked if he was all right.
Slide 4, [2:45]: His Treatment History
Slide text: Haloperidol [eleven] years, then paliperidone eight years; no anticholinergics now.
Speaker notes: This history matters for two reasons. He took haloperidol, a first-generation antipsychotic, for eleven years before switching, and his total exposure to dopamine-blocking drugs is now about nineteen years. A meta-analysis of studies in the era of second-generation antipsychotics found a mean prevalence of tardive dyskinesia of about 25 percent among people taking antipsychotics, lower on current second-generation than first-generation drugs, and higher with older age and longer illness (Carbon et al., 2017). He has several of those risk factors. Second, he has been well on his current drug for eight years, after five hospitalizations before it.
Slide 5, [4:00]: What Else It Could Be
Slide text: Four options, each with the finding that keeps it alive or rules it out.
Speaker notes: I considered four possibilities. First, tardive dyskinesia: long exposure, typical orofacial pattern, onset while on treatment. This is the working diagnosis. Second, oral dyskinesia from poorly fitting dentures: he has his own teeth, so this is unlikely. Third, drug-induced parkinsonism, which can coexist: he has no tremor at rest, no slowing and no rigidity, so it is not present now. Fourth, a new neurological disorder such as Huntington's disease: no family history, no cognitive change and no gait problem, but I would refer him to neurology if the movements spread or progressed quickly.
Slide 6, [5:15]: The Options
Slide text: Watch; switch the antipsychotic; add a VMAT2 inhibitor.
Speaker notes: There are three broad options. The first is to watch and wait. The movements are moderate and are already affecting his social life, so waiting has a cost. The second is to switch to a different antipsychotic with lower movement risk. That is a reasonable option for some patients, but for him it means risking a relapse after eight stable years, and a switch will not reliably reverse movements already present. The third is to add a VMAT2 inhibitor, a class of drug that reduces the release of dopamine and has been studied specifically in tardive dyskinesia.
For this man, the risk of losing eight years of stability outweighs the uncertain benefit of switching a drug that is working.
Slide 7, [6:30]: The Evidence
Slide text: Randomized trial: valbenazine reduced AIMS scores vs placebo in six weeks; guideline supports VMAT2 inhibitors.
Speaker notes: In a six-week, placebo-controlled phase 3 trial of adults with moderate or severe tardive dyskinesia, most of whom had schizophrenia or schizoaffective disorder, valbenazine at 80 milligrams a day reduced the AIMS dyskinesia score significantly more than placebo, as rated by blinded central video raters, and was generally well tolerated (Hauser et al., 2017). Patients could stay on their antipsychotics during the trial, which matches his situation. The American Psychiatric Association's schizophrenia guideline recommends a reversible VMAT2 inhibitor for patients with moderate to severe or disabling tardive dyskinesia associated with antipsychotic treatment (Keepers et al., 2020).
Slide 8, [7:45]: The Plan
Slide text: Start at [40] mg, increase to [80] mg at week [one]; AIMS every visit; check interactions and ECG.
Speaker notes: The plan is to start valbenazine at [forty] milligrams daily, increasing to [eighty] milligrams after one week if tolerated. Before starting, I will review his other medicines for strong interactions and check a baseline ECG, because the drug can affect heart rhythm in some patients. I will repeat the AIMS at each visit, recorded the same way each time, and ask his wife what she notices. Sleepiness is the side effect to watch for. His paliperidone stays exactly as it is.
Slide 9, [8:45]: One Question for You
Slide text: How long do we continue treatment if the movements improve?
Speaker notes: That brings me back to where I began: add a VMAT2 inhibitor, keep the antipsychotic. My question for the group is one I could not answer from the evidence I found. If his movements improve substantially over the next six months, how long should we continue the VMAT2 inhibitor, and would you ever try stopping it? I would value your experience. Thank you.
Timing Check
The notes total about [1,000] spoken words. At roughly [130] words per minute, that is under eight minutes of speech, and the slide timings allow the rest for pauses, a slower pace on the evidence slide and the question at the end. Each slide carries one idea and fewer than twenty words, so the audience listens rather than reads.
References
Carbon, M., Hsieh, C.-H., Kane, J. M., & Correll, C. U. (2017). Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: A meta-analysis. The Journal of Clinical Psychiatry, 78(3), e264-e278. https://doi.org/10.4088/JCP.16r10832
Hauser, R. A., Factor, S. A., Marder, S. R., Knesevich, M. A., Ramirez, P. M., Jimenez, R., Burke, J., Liang, G. S., & O'Brien, C. F. (2017). KINECT 3: A phase 3 randomized, double-blind, placebo-controlled trial of valbenazine for tardive dyskinesia. American Journal of Psychiatry, 174(5), 476-484. https://doi.org/10.1176/appi.ajp.2017.16091037
Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., Servis, M., Walaszek, A., Buckley, P., Lenzenweger, M. F., Young, A. S., Degenhardt, A., & Hong, S.-H. (2020). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry, 177(9), 868-872. https://doi.org/10.1176/appi.ajp.2020.177901
NU678 Unit 8 instructions, in plain terms
For Unit 8 you record a short presentation of a patient case, usually about ten minutes, with slides and speaker notes. The assignment tends to call for a case summary, relevant history and findings, a differential, a recommendation with its evidence, a plan, and a question or discussion point for the audience. Eight to ten slides is a sensible number. Instructors reward presentations ordered for a listener, with the conclusion previewed early, slides that carry one idea each, notes that are timed and written as speech, and evidence placed where the audience needs it. The recording itself, in your own voice, is yours to produce; the sample shows the slides and notes behind it, timed so that a practice run shows where the pace needs work.
How this NU678 Unit 8 example is built
Slide one gives the recommendation, not a topic, and slide two previews it at thirty seconds. Slide three reports the examination and AIMS total, slide four the treatment history, placing the Carbon meta-analysis of tardive dyskinesia prevalence exactly where his risk factors appear. Slide five lays out four possible causes with the finding that keeps or rules out each. Slide six weighs watching, switching and adding a VMAT2 inhibitor and carries the highlighted sentence about eight years of stability. Slide seven gives one trial and one guideline. Slide eight sets out the dose, ECG, interaction review and AIMS monitoring. Slide nine returns to the recommendation and asks one question. A timing check closes the set.
Reading the NU678 Unit 8 grading rubric
Recorded presentations are typically assessed on organization, clinical content, use of evidence, delivery and timing, and visual design. Organization rewards a clear line from the opening recommendation to its restatement. Clinical content covers accurate findings, a reasonable differential and a safe plan. Evidence points go to current trials or guidelines cited at the point they matter. Delivery and timing are judged on pace, clarity and staying within the limit, which timed notes make easier. Visual design is credited when slides carry few words and one idea each, with the explanation spoken rather than read. A final question or discussion point that targets a real uncertainty often earns engagement credit, and a slide of references at the end is normally expected as well.
NU678 Unit 8 help from the desk
A frequent problem is too many words on each slide, so the presenter reads aloud what the audience can already see. Another is saving the recommendation for the end, which leaves listeners unsure where the case is heading. Some presentations run long because notes were never timed. Others list many studies on one slide, which no listener can absorb. Many students skip the differential or treat it as a formality. The plan sometimes omits monitoring, such as a baseline ECG or a repeat rating scale. And a closing question that anyone could answer, such as any questions, wastes a chance to show where the real uncertainty lies. Ask about the one point your evidence could not settle.
Get an NU678 Unit 8 example written to your instructions
Share the time limit your NU678 Unit 8 presentation must meet, the format, slides with narration or camera only, and the rubric. Slides and timed speaker notes for a composite patient arrive within 24-48h, free on a first request; recording and presenting them, in your own voice and on your own case, is yours to do. 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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NU678 Unit 8 questions, answered
How many slides suit a ten-minute case presentation?
Roughly one per minute is a common guide, so eight to ten. More slides push the pace and invite reading text aloud; fewer can leave the audience staring at one image too long. Put the explanation in your speaker notes and keep each slide to one idea with few words.
Where should the recommendation appear?
Preview it early and state it fully near the end. Listeners follow a case more easily when they know its destination, and graders judging order look for evidence arranged to support a conclusion already named. Restate the recommendation where it lands, with its basis, so that anyone who drifted still hears the decision.
Can a sample include a recorded video?
No. The recording is your own presentation, in your voice, of a case you present. A sample provides the slides and timed speaker notes for a composite patient, showing structure and pacing. Your recording, and anything your instructor evaluates about your delivery, is yours to produce. The notes are timed so a run-through shows where your own delivery might run long.
Where can I find a free NU678 Unit 8 sample paper?
This page presents the full NU678 Unit 8 case presentation, nine slides with timed speaker notes from the recommendation through history, differential, options, evidence and plan, ending with a question, plus three references. Slides and notes for your own case can be requested.
Why keep the antipsychotic in NU678 Unit 8?
He has been well on it for eight years after five hospitalizations. Switching risks a relapse and will not reliably reverse movements already present, while a VMAT2 inhibitor can be added without changing the antipsychotic, as patients did in the trial cited.