| Course | NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum |
|---|---|
| Week | 4 |
| Paper type | Case analysis |
| 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 4
Case Analysis: A 19-Year-Old College Student With Generalized Anxiety, No Car, Night Work at a Diner and a Campus Counseling Waitlist, Where Management Is the Exercise
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
Case Analysis: A 19-Year-Old College Student With Generalized Anxiety, No Car, Night Work at a Diner and a Campus Counseling Waitlist, Where Management Is the Exercise
The Diagnosis, Briefly
The vignette describes a 19-year-old first-year student with eight months of constant worry about grades, money and a parent's health, restlessness, poor concentration, muscle tension in the neck and trouble falling asleep. GAD-7 is 15. No panic attacks, no depressive episode, no psychosis, no mania. Thyroid tests are normal. Coffee: two cups daily. Cannabis: smoked on two or three evenings a week, the student says "to calm down." This is generalized anxiety disorder, moderate to severe. Excluded briefly: hyperthyroidism (normal tests), a primary depressive disorder (PHQ-9 of 7, no anhedonia), substance-induced anxiety (the worry predates the cannabis use by several months, by the student's account).
The rest of this analysis is management, which is where the exercise lies.
The Constraints the Vignette Buried
No car; the student relies on the campus bus, which stops running at 21:00.
Works four nights a week at a diner, 17:00 to 23:00, to pay rent.
On the parent's insurance, with a $40 specialist copay that the student finds hard to afford.
The campus counseling center has a six-week waitlist for individual therapy, but runs a weekly cognitive behavioral group on Monday afternoons.
Uses cannabis to manage anxiety.
Age 19, which matters for antidepressant safety.
Medication: Escitalopram Instead of What
Choice: escitalopram 5 mg each morning for one week, then 10 mg.
Instead of sertraline: both are reasonable first-line options for generalized anxiety disorder, and a network meta-analysis found several SSRIs and SNRIs effective (Slee et al., 2019). Escitalopram was chosen for once-daily dosing with few interactions and a low starting dose suited to a student who reports being sensitive to medicines.
Instead of a benzodiazepine: quick relief, but dependence risk in a young person already using cannabis to manage anxiety, and no effect on the underlying disorder.
Instead of buspirone: it requires twice-daily dosing, which the student said would be hard to remember with a split schedule, and it has a weaker evidence base in the network meta-analysis.
Instead of hydroxyzine alone: useful for occasional sleep trouble but not as maintenance treatment.
Age: antidepressants carry a boxed warning for increased suicidal thinking in people under 25. An analysis of the regulator's trial data found raised risk of suicidality in young adults and not in older adults (Stone et al., 2009). This does not rule the medicine out, but it means closer contact in the first weeks.
Interval: phone or video check at week 1 and week 2; visit at week 4.
Therapy: The Group Instead of the Waitlist
Choice: the campus cognitive behavioral group, Mondays at 14:00, eight weeks, starting this week; free to students.
Instead of waiting six weeks for individual therapy: the group starts now, is free and happens during the day when the bus runs and before the diner shift.
Interval: attendance and GAD-7 at week 4.
Cannabis: A Conversation Instead of an Instruction
Choice: discuss how cannabis may worsen anxiety over time and interfere with sleep quality, agree a goal of no use on work nights and record use in a weekly log.
Instead of telling the student to stop: the student uses it as a coping tool and has no alternative yet; an instruction to stop is likely to end the conversation.
Interval: use per week at each contact.
Sleep and Caffeine
Choice: no coffee after 14:00; a fixed wind-down after the diner shift.
Instead of a sleep medicine: the sleep problem is likely to improve as anxiety falls.
How the Constraints Changed Each Choice
Without the bus constraint, in-person visits every two weeks would have been planned; video visits replace them. Without the night job, the campus group might have been one option among several; it became the first choice because it meets in the afternoon. Without the cost constraint, a branded medicine or a private therapist might have been considered; generic escitalopram and a free group were chosen instead. Without the student's age, the first month's contact could have been less frequent. Each constraint in the vignette changed at least one decision.
Why Not Wait for Therapy Alone
This was the one decision the student questioned most.
The student's GAD-7 of 15, the disruption to study and the use of cannabis to cope argue for starting medication now rather than waiting to see whether the group helps. A milder presentation, with a GAD-7 around 8 and no self-medication, might reasonably start with therapy alone. Both choices are defensible; this one rests on severity and on the student's own preference, stated at the visit, to "try something that works faster."
What the Student Was Told
That generalized anxiety is common and treatable, that escitalopram usually needs a few weeks before it helps and may cause mild nausea or jitteriness in the first week, that the group is the fastest way to start therapy and that any new thoughts of self-harm should be reported straight away. The student asked whether the medicine would be needed forever. I said that, if it works, it is usually continued for six to twelve months and then reviewed.
What Would Change the Plan
If GAD-7 has not fallen by at least 4 points by week 4 at 10 mg, increase to 15 or 20 mg. If side effects are intolerable, switch to sertraline. If any suicidal thinking appears, contact moves to weekly in person and the safety plan is reviewed. If cannabis use rises rather than falls, the conversation about it moves up the agenda before any medicine change.
Access and Cost
Follow-up visits by video, which avoids the bus problem and fits before shifts. Escitalopram generic costs under $10 a month with a pharmacy discount card. The clinic's sliding scale reduces the copay.
Risk
Columbia screen: no suicidal thinking. A safety plan was still written, using a brief structured format (Stanley & Brown, 2012), given the boxed warning, with the student's roommate as a contact and the campus crisis line.
Review Schedule
Week 1: call to check side effects and mood. Week 2: video visit. Week 4: GAD-7, side effects, cannabis log, group attendance. Week 8: GAD-7 for response, a fall of at least 50%. Week 12: decide on continuing for 6 to 12 months if improved.
References
Slee, A., Nazareth, I., Bondaronek, P., Liu, Y., Cheng, Z., & Freemantle, N. (2019). Pharmacological treatments for generalised anxiety disorder: A systematic review and network meta-analysis. The Lancet, 393(10173), 768-777. https://doi.org/10.1016/S0140-6736(18)31793-8
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
Stone, M., Laughren, T., Jones, M. L., Levenson, M., Holland, P. C., Hughes, A., Hammad, T. A., Temple, R., & Rochester, G. (2009). Risk of suicidality in clinical trials of antidepressants in adults: Analysis of proprietary data submitted to US Food and Drug Administration. BMJ, 339, b2880. https://doi.org/10.1136/bmj.b2880
The Chamberlain NR 605 Week 4 instructions
The Week 4 vignette hands you a diagnosis that settles quickly, and the analysis that scores treats that as the starting line. Place the diagnosis in a page or less and say briefly what was excluded. Spend everything after that on management, answering instead of what for each element. Use the constraints the case buried in its details: night work, no transport, a waitlist, cost, substance use, age. Attach an interval to every element. Match headings to the questions asked. Most rubrics mark down two thirds of a paper spent proving an obvious diagnosis, management that never says what it replaced and constraints left unused. Keep the diagnosis to a paragraph.
How the NR 605 Week 4 example is put together
The sample confirms generalized anxiety disorder in one paragraph and excludes three alternatives. Six constraints are listed, from no car to age 19. Escitalopram is chosen instead of sertraline, a benzodiazepine, buspirone and hydroxyzine, each with a reason, and the boxed warning for under 25 sets closer contact. The campus group replaces the six-week waitlist. A cannabis conversation replaces an instruction to stop. Sleep and caffeine advice follows. Sections show how each constraint changed a choice, explain why medication starts now, record what the student was told, cover access, cost and safety and set a review schedule with what would change the plan.
Where the points sit in the NR 605 Week 4 rubric
The costliest habit is proving an obvious diagnosis and running out of room for management; this analysis spends one paragraph on diagnosis. Management that never answers instead of what costs the next share, while each element here names what it replaced. Unused constraints are the giveaway that a case was skimmed, and a section shows each constraint changing a decision. A plan with no intervals loses a row, and each element has one. Addressing the boxed warning for a 19-year-old earns the safety criterion. Showing how each constraint changed a decision is the clearest proof the case was read closely. Explaining why medication starts now, rather than after the group, shows severity was weighed. Recording what the student was told shows the plan was shared.
NR 605 Week 4 help: mistakes that cost points
Weak NR 605 Week 4 analyses spend most of their length on diagnostic criteria. Others list a treatment without saying what it was chosen over. Many ignore details such as transport, work hours or cost that the vignette included on purpose. Intervals are often missing. Age-specific safety warnings are frequently overlooked. Place the diagnosis briefly, then for each element say what you chose and instead of what, using the case's constraints, and attach an interval. If your vignette differs, share its details, and a management-focused sample can be built from them. Say how each detail of the case changed your plan. Address any age-specific warning.
Get a NR 605 Week 4 example written to your instructions
Send the vignette itself and the question list your section issues with it. A custom analysis written against that exact case returns in 24 to 48 hours, free the first time, with every decision carrying the reason it was made. Whatever the case involves, the example is written against it and not against a template.
More NR 605 papers and PMHNP samples
- NR 605 Week 1: Defended First Choice Post
- NR 605 Week 2: Initial Evaluation Note
- NR 605 Week 3: Treatment Plan Write-Up
- NR 605 Week 5: Psychotherapy Rationale
- NR 605 Week 6: Follow Up Note
- NR 605 Week 7: Outcome Measure Plan
- NR 605 Week 8: Management Case Paper
- NR 548 Week 4: Suicide Risk Assessment Note
- NR 547 Week 4: Rule Out Analysis
- NR 546 Week 4: Titration and Monitoring Plan
NR 605 Week 4 questions, answered
The vignette seems too easy. Is that deliberate?
Usually yes. The case is built to settle so that the paper spends its length on management rather than on detection. Treating an obvious presentation as a puzzle is the commonest way to write a long paper that collects few points, because the rubric weights the decisions and their reasons far above the label at the top.
How much of the vignette should I quote?
Very little. Facts from the case earn their place by doing work inside an argument, so they belong within the reasoning rather than in a summary paragraph at the front. A short restatement orients a reader, and anything longer eats the room the management section needs while adding nothing a marker is able to award.
What if two of the questions overlap?
Answer both under their own headings and let the second carry a cross-reference instead of a repeat. Markers in many sections work down the question list in order, and material given once under the wrong heading reads as missing entirely. A little repetition costs far less than an answer a marker cannot locate.
Where can I find a free NR 605 Week 4 sample paper?
The full case analysis of generalized anxiety in a 19-year-old student, focused on management and constraints, is published on this page.
Why does the NR 605 Week 4 plan use the campus group?
It starts this week, is free and meets in the afternoon when the bus runs and before the diner shift, while individual therapy has a six-week waitlist.