| Course | NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum |
|---|---|
| Week | 6 |
| Paper type | Follow-up note |
| Length | About 860 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 6
Follow-Up Note: T.N. at Four Weeks on Mirtazapine With Three Therapy Sessions Done, the Same Measures Taken Again and Continue Made as a Decision
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
Follow-Up Note: T.N. at Four Weeks on Mirtazapine With Three Therapy Sessions Done, the Same Measures Taken Again and Continue Made as a Decision
Interval and Reason for Visit
Four weeks since the initial evaluation; two weeks since the dose was increased to 30 mg. Scheduled follow-up to review the targets named in the treatment plan.
Adherence, Asked
"How many doses did you miss in the last two weeks?" T.N. reported missing one dose, after a double shift when T.N. fell asleep before taking it. Pharmacy refill records match. Therapy: attended all three sessions offered.
Tolerability
Drowsiness: groggy for about an hour after waking at 15:00; gone by the 22:00 shift. No drowsiness at work.
Appetite and weight: appetite "back to normal, maybe more." Weight 81.1 kilograms, up 2.1 kilograms from baseline.
Sexual side effects: none, asked directly.
Dizziness, dry mouth, constipation: none.
The Same Measures, Taken Again
| Measure | Baseline | Week 2 | Week 4 |
|---|---|---|---|
| PHQ-9 | 17 | 15 | 11 |
| GAD-7 | 13 | 12 | 9 |
| Panic attacks per week (diary) | 2 | 2 | 1 |
| Daytime sleep, average hours (diary) | 4.5 | 6.0 | 6.5 |
| Drinks per week (diary) | 10 to 12 | 6 | 4 |
| Days on the dock floor in the past week | 0 | 0 | 2 |
PHQ-9 has fallen by 6 points, more than the 5-point change generally treated as clinically meaningful (Löwe et al., 2004), but not yet halved.
Safety
Columbia screen, repeated as at baseline (Posner et al., 2011): no wish to be dead in the past two weeks, no suicidal thoughts. Partner still holds the cabinet key, confirmed by T.N. today. Safety plan reviewed; T.N. added a coworker to the contacts.
Mental Status Examination
Appearance: clean-shaven, rested. Behavior: relaxed posture, good eye contact. Speech: normal rate and volume. Mood: "better, still not me." Affect: brighter, reactive, smiled when talking about the child's school play. Thought content: no suicidal ideation; less preoccupied with work errors. Insight and judgment: good.
Assessment
Major depressive disorder, recurrent, moderate, with anxious distress: partial response at 4 weeks, PHQ-9 down from 17 to 11.
Panic attacks: halved, with the first return to the dock.
Alcohol: reduced from about 11 to 4 drinks a week; goal of no drinks within four hours of the dose met.
Weight gain of 2.1 kilograms in four weeks, within expectation but to be watched.
Plan: Continue as a Decision
Continue mirtazapine 30 mg at 08:00. Reasons: PHQ-9 has fallen by more than 5 points in two weeks at this dose; sleep has improved; no sexual side effects, which mattered most to T.N.; drowsiness is confined to the hour after waking. Increasing to 45 mg now would risk more sedation and weight gain before the 30 mg dose has had a full four weeks; switching would discard a response that is still building.
Weight: T.N. agreed to cut energy drinks from three to one a shift and to walk the dock floor, which also counts toward therapy goals. If weight rises more than 5% from baseline by week 8, about 4 kilograms, a switch will be discussed.
Therapy: continue weekly; sessions 4 to 6 move to the graded dock list.
Alcohol: continue the diary.
Blood pressure: primary care appointment kept; 136/84 today.
Next Review Point
At the 8-week visit, in person: PHQ-9 checked against the halving target, GAD-7, panic count, weight, blood pressure and Columbia screen. If the PHQ-9 has not halved by week 8, the choices will be 45 mg or a second approach, weighed at that visit. Comparative data suggest antidepressants differ only modestly in average effect (Cipriani et al., 2018), so a switch would be judged on side effects as much as on response.
Therapist's Report
The therapist's note arrived the day before this visit and was read before T.N. came in, so the visit could build on it.
The therapist's account matches T.N.'s own: progress on panic is ahead of progress on mood.
With T.N.'s consent, the therapist reported that T.N. has completed the first three sessions, understands the panic cycle and has begun deliberately raising the heart rate at home without an attack. The graded dock list is drafted; T.N. completed its first step, five minutes at the open dock door, twice last week.
What Was Considered and Not Done
The dose, the therapy plan and the alcohol goal were each reviewed against the baseline and kept.
An increase to 45 mg was considered and not made, for the reasons above. Adding a medicine for the residual anxiety was not considered, since GAD-7 is falling and therapy is under way.
Patient's View
T.N. said the improvement in sleep had made the biggest difference and asked how long the medicine would be needed. I said that once recovered, most people stay on treatment for six months or more, since stopping early raises relapse risk, and that we would discuss it at the 12-week visit.
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
Löwe, B., Unützer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004). Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Medical Care, 42(12), 1194-1201. https://doi.org/10.1097/00005650-200412000-00006
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704
The Chamberlain NR 605 Week 6 instructions
The Week 6 note opens with the interval and the reason for the visit, then goes straight to what the first plan promised to watch. Ask about adherence specifically rather than assuming it. Record tolerability, including the effects the chosen agent is known for. Measure the target the same way it was measured before, so two numbers can sit side by side. Make continue a real decision with reasons. State the next review point. Most rubrics mark down a note written as though the first plan never existed, improvement asserted without measurement, adherence unasked and side effects in a single word. Include the therapist's view if the patient agrees, and record what you considered and did not do.
How the NR 605 Week 6 example is put together
The sample states four weeks since evaluation and two since the dose increase. Adherence is asked as a count of missed doses and checked against refills. Tolerability covers drowsiness, appetite, a 2.1-kilogram weight gain and sexual side effects asked directly. A table repeats PHQ-9, GAD-7, panic attacks, sleep hours, drinks and dock days against baseline and week 2. The Columbia screen is repeated. Assessment notes a partial response. Continuing at 30 mg is explained against increasing and switching, with a weight threshold. Sections cover the therapist's report, what was considered and not done, the next review and the patient's question about duration. Margin notes mark the table and the decision against the rubric.
Reading the NR 605 Week 6 grading rubric
The largest loss is a note written as if the first plan never existed, and this note returns to each target named at evaluation. Improvement asserted without measurement costs the next share, while six measures sit beside their baselines. Adherence unasked loses a row, and missed doses are counted and checked against refills. Side effects in a single word lose marks, and each known effect is recorded. Making continue a decision with reasons and a threshold earns the judgment criterion. A next review with named measures completes the note. Including the therapist's report shows the two parts of treatment are being read together. Recording what was considered and not done makes the decision visible.
NR 605 Week 6 help from the desk
Weak NR 605 Week 6 notes repeat the full history as if the patient were new. Others say the patient is doing better without a number. Many never ask how many doses were missed. Side effects are often summarized as none or tolerating well. Continue is written as a default rather than a decision. Return to the targets from the first plan, measure them the same way, ask about adherence directly, record known side effects and explain why you are continuing, increasing or switching. Bring your baseline and current scores side by side, and a follow-up in this shape can be prepared around them.
Get a NR 605 Week 6 example written to your instructions
Send the Week 6 instructions and, if your section supplies one, the earlier plan this note is meant to follow. A custom example returns within 24 to 48 hours, free for a first request, written to your own wording rather than to a generic version of the week. It arrives as a complete note with each line traceable to a reason.
More NR 605 papers and PMHNP samples
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- NR 605 Week 3: Treatment Plan Write-Up
- NR 605 Week 4: Anxiety Case Analysis
- NR 605 Week 5: Psychotherapy Rationale
- NR 605 Week 7: Outcome Measure Plan
- NR 605 Week 8: Management Case Paper
- NR 548 Week 6: Psychiatric Evaluation Note
- NR 547 Week 6: Lifespan Variation Write-Up
- NR 546 Week 6: Adverse Effect Brief
NR 605 Week 6 questions, answered
What if the patient is only slightly better?
That is the usual finding at a first review and it is not a failure. Many elements are judged over a longer window than this note covers, so continuing as written and saying why, with the next review named, is frequently the right call. The rubric wants the reasoning attached to the decision, whichever way the decision goes.
Do I need to change something to score well?
No. A change made to look decisive costs points when nothing in the note supports it. The graded object is the argument, and the case for holding a plan steady through its expected window is as strong as the case for altering it. Plans that have plainly not worked are the material of the later courses in this sequence.
How much of the original case should be repeated?
Only what a reader needs in order to follow the decision. A line or two placing the patient and the plan under review is normally enough. A full history restated inside a follow-up note is the clearest single sign that the writer treated the week as a second initial evaluation instead of a review.
Where can I find a free NR 605 Week 6 sample paper?
The full follow-up note at four weeks on mirtazapine, with measures beside their baselines, is published on this page.
Why is the dose not increased in the NR 605 Week 6 note?
The PHQ-9 had already fallen by 6 points in two weeks at 30 mg, and a higher dose would add sedation and weight gain before the current dose had a full trial.