| Course | NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum |
|---|---|
| Week | 3 |
| Paper type | Treatment plan write-up |
| Length | About 1,110 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Psychiatric-Mental Health Nurse Practitioner (PMHNP) |
| Updated | October 2026 |
Free sample paper for NR 605 Week 3
Treatment Plan Write-Up: Mirtazapine, Panic-Focused Cognitive Behavioral Therapy, an Alcohol Conversation and a Safety Plan for T.N., Each With Its Comparison and Its Check
Student Name
College of Nursing, Chamberlain University
NR 605: Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum
Instructor Name
Month Day, Year
Treatment Plan Write-Up: Mirtazapine, Panic-Focused Cognitive Behavioral Therapy, an Alcohol Conversation and a Safety Plan for T.N., Each With Its Comparison and Its Check
Element 1: Mirtazapine
The element: mirtazapine 15 mg by mouth once daily, taken at about 08:00, at the start of T.N.'s daytime sleep, after the night shift. Increase to 30 mg at 2 weeks if mood has not begun to lift and drowsiness is tolerable. Maximum considered: 45 mg.
The comparison: escitalopram and bupropion were the obvious alternatives. Escitalopram was set aside because T.N. stopped sertraline in 2019 for sexual side effects and would likely stop another SSRI for the same reason. Bupropion was set aside because it can worsen insomnia and anxiety, and because it lowers the seizure threshold in a patient who drinks. Antidepressants differ only modestly in average effect (Cipriani et al., 2018); the choice therefore turns on side effects and this patient's history.
The check: daytime sleep at 2 weeks, by sleep diary; PHQ-9 at 2, 4 and 8 weeks, looking for a fall of at least 5 points by week 4 and a halving by week 8.
Monitoring that follows the choice: weight at every visit, because mirtazapine commonly causes weight gain; fasting glucose and lipids at baseline and at 12 weeks; daytime drowsiness at work start, since T.N. will take it at 08:00 and start the next shift at 22:00, 14 hours later.
Element 2: Cognitive Behavioral Therapy Aimed at Panic and Depression
The element: individual cognitive behavioral therapy with a licensed therapist, weekly for 12 sessions, by video at 15:00 on Tuesdays, which fits between T.N.'s sleep and shift. The first four sessions focus on panic: understanding the attack, breathing and graded return to the loading dock. Later sessions address depressive thinking and activity.
The comparison: supportive counseling alone was considered; it offers a place to talk, yet leaves untouched the avoidance that is keeping T.N. off the dock. Cognitive behavioral therapy has strong evidence for depression in adults (Cuijpers et al., 2013) and specific techniques for panic.
The check: panic attacks per week, from T.N.'s diary; shifts spent on the dock each week.
Element 3: Alcohol
The element: a brief intervention today, using the AUDIT-C result and T.N.'s own reason for drinking, to sleep, to agree a goal of no more than two drinks on any night and none within four hours of the mirtazapine dose. Mirtazapine and alcohol together increase drowsiness.
The comparison: referral to a specialist addiction service was considered; T.N.'s drinking is hazardous but does not appear to meet criteria for use disorder, and T.N. was willing to set a goal.
The check: drinks per week, recorded in the diary; AUDIT-C at 12 weeks.
Element 4: Safety Plan
The element: a written safety plan, completed with T.N. today, listing warning signs, things T.N. can do alone, people to contact, the crisis line and the agreement that the partner holds the firearm cabinet key. The safety planning intervention is a brief, structured approach shown to be feasible in clinical settings (Stanley & Brown, 2012).
The comparison: a no-harm contract was not used; such contracts have no evidence of benefit.
The check: Columbia screen at every visit; review of the plan at week 4.
Element 5: Education, Specific
T.N. was told: mirtazapine may make you drowsy and hungry; take it at 08:00 when you get home; do not drive within four hours of taking it; sleep should improve within days, mood within two to four weeks; if your mood worsens or you have thoughts of hurting yourself, call the clinic or the crisis line straight away, as on your safety plan.
Element 6: Blood Pressure
The element: a primary care appointment within four weeks for the untreated hypertension. Mirtazapine does not usually raise blood pressure, but cutting energy drinks will help.
The check: blood pressure at each psychiatric visit.
Review Schedule With Content
Week 2, video visit: sleep diary, drowsiness, PHQ-9, Columbia screen, decision on dose increase.
Week 4, in person: PHQ-9, GAD-7, panic count, weight, alcohol count, safety plan review.
Week 8, in person: PHQ-9 for response, weight, decision to continue, adjust or switch.
Week 12, in person: PHQ-9 for remission, fasting glucose and lipids, AUDIT-C, therapy progress.
Why Mirtazapine Is Taken at 08:00
For most patients mirtazapine is taken at bedtime. T.N.'s bedtime is 08:00, after the night shift. Taking it then aligns the sedation with daytime sleep and leaves 14 hours before the next shift begins. If T.N. moves to day shifts, the timing moves with the sleep period. This detail matters more than the dose for a shift worker, and getting it wrong would cause drowsiness at work.
Why Not Start Both a Medicine and an SSRI-Type Backup
Some clinicians start a sleep aid alongside an antidepressant. For T.N., mirtazapine is expected to cover sleep on its own; adding trazodone or a hypnotic at the start would add sedation, make it harder to tell which medicine was causing any side effect and add an interaction with alcohol. If sleep has not improved by week 2, a separate sleep strategy will be considered then.
Coordination
No one involved in T.N.'s care should learn of a medicine change second-hand, and T.N. knows who has been told.
With T.N.'s permission, the therapist and the prescriber exchange their latest scores each month. Primary care receives a copy of the plan, including the mirtazapine and the blood pressure follow-up, so that any new prescription is checked for interactions. The pharmacy was asked to flag any future prescription that adds sedation.
What T.N. Agreed To
T.N. agreed to the medicine, the therapy and the alcohol goal, and asked that the partner be told about the plan. T.N. was most reassured that the medicine was unlikely to cause the sexual side effects that ended the last trial, and least keen on the alcohol goal, saying the beers were "the only thing that helps me sleep." We agreed to review the goal at week 2, once the medicine had begun to help sleep.
What Would Change the Plan
A rise in suicidal thinking at any visit means an immediate safety reassessment and possibly a higher level of care. No fall in PHQ-9 by week 4 at 30 mg means considering a dose increase or a switch. Weight gain over 5% by week 8 means discussing a switch.
References
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet, 391(10128), 1357-1366. https://doi.org/10.1016/S0140-6736(17)32802-7
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58(7), 376-385. https://doi.org/10.1177/070674371305800702
Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001
The Chamberlain NR 605 Week 3 instructions
The Week 3 write-up gives every element three things. First, the element itself, specific enough to act on: an agent with a starting dose and a titration point, or a named therapy at a stated frequency. Second, the comparison: why this element beat the one a reader would have reached for first. Third, the check: how many weeks and which measure will show whether it worked. Monitoring should follow from the agent chosen. Add a review schedule that says what happens at each visit. Most rubrics mark down a plan that is a list, therapy in a closing sentence, a dose with no monitoring and missing baseline tests. Tie each monitoring item to a known effect of the agent you chose.
How this NR 605 Week 3 example is built
The sample's first element is mirtazapine 15 mg at 08:00, increasing at two weeks, compared with escitalopram and bupropion and checked by sleep diary and PHQ-9. Monitoring follows the drug: weight, glucose and lipids, and drowsiness before the next shift. Therapy is weekly by video at a time that fits the shift, compared with supportive counseling and checked by panic counts and dock days. Alcohol, safety planning, specific education and blood pressure each get the same three parts. Sections explain the dosing time, why no second medicine is started, coordination, what the patient agreed to, a four-visit review schedule and what would change the plan.
Reading the NR 605 Week 3 grading rubric
The heaviest loss is the plan that is a list, and every element here carries its comparison and check. A pharmacology-only plan costs the next share, while therapy is argued against an alternative and given its own measures. A dose with no monitoring loses a row, and monitoring here follows mirtazapine's known effects. Missing baseline tests lose marks, and glucose and lipids are ordered. A review schedule with content earns credit, and explaining the 08:00 dosing for a night-shift worker shows the plan was built around this patient's day. Explaining why no second medicine is started shows restraint was reasoned. Coordinating with therapy and primary care means everyone uses the same plan.
NR 605 Week 3 help from the desk
Weak NR 605 Week 3 plans list a drug, a therapy and follow-up without defending any of them. Others mention therapy only at the end. Many give a dose without saying how side effects will be watched. Baseline tests are often left out. Review visits are scheduled with nothing said about what happens at them. For each element, write what it is, what it beat and how you will know it worked, and make monitoring follow the drug's known effects. Then say what each review will do. If your plan differs, list its elements, and a write-up in this three-part form can be prepared.
Get a NR 605 Week 3 example written to your instructions
Send the Week 3 instructions and the rubric your classroom publishes, plus the assigned case. What comes back inside 24 to 48 hours is a custom plan written against those instructions, finished rather than sketched, and there is no charge at all for a first one, whatever the case turns out to involve.
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- NR 605 Week 6: Follow Up Note
- NR 605 Week 7: Outcome Measure Plan
- NR 605 Week 8: Management Case Paper
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- NR 547 Week 3: Diagnostic Formulation
- NR 546 Week 3: Medication Selection Rationale
NR 605 Week 3 questions, answered
How specific does the medication element need to be?
Specific enough that another clinician could act on it. That normally means the agent, a starting dose, how and when it would be increased, and what would be monitored. Rubrics in many sections award separately for the choice and for its management, so a correct drug named with none of the surrounding detail collects only part of the available points.
Where does therapy belong in the write-up?
In the plan as its own element, carrying the same three parts as any other. A named modality, the specific target it is aimed at, and a frequency with a review point. Management is not only prescribing, and a write-up that reaches for a drug then adds therapy as a closing courtesy has made a real choice without arguing for it anywhere.
Can two different plans both be right?
Often, which is why the defense counts for more than the selection. Two well-supported options can be equally sound until this patient's history, tolerances, schedule and access separate them. A write-up naming those constraints and showing one option surviving them scores above one that arrives at the same agent by assertion and leaves the reader to trust it.
Where can I find a free NR 605 Week 3 sample paper?
The full treatment plan write-up with mirtazapine, panic-focused therapy, an alcohol goal and a safety plan is on this page.
Why is mirtazapine taken at 08:00 in the NR 605 Week 3 plan?
The patient sleeps after the night shift, so 08:00 is bedtime; it aligns the sedation with sleep and leaves 14 hours before the next shift.