NR 606 Week 7 Progress Note Series Example

Course	NR 606 Diagnosis & Management in Psychiatric-Mental Health II Practicum
Week	7
Paper type	Progress note series
Length	About 950 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 606 Week 7

Progress Note Series: Three Notes on D.L. Across Eight Weeks of Bupropion Augmentation, Each Reporting Against the Expectation the First Note Stated

Student Name

College of Nursing, Chamberlain University

NR 606: Diagnosis & Management in Psychiatric-Mental Health II Practicum

Instructor Name

Month Day, Year

What this page is doingThe series follows one patient at three moments, states an expectation in the first note, reports against it in the second, closes the loop in the third and keeps language consistent.

Progress Note Series: Three Notes on D.L. Across Eight Weeks of Bupropion Augmentation, Each Reporting Against the Expectation the First Note Stated

Note 1: Starting Bupropion (Week 0)

Interval: four weeks since the last review.

Status: sertraline 200 mg daily, adherent; airway pressure 6.5 hours a night. PHQ-9: 7. Interest item: 2. Activities chosen per week: 0 rides, 1 meal cooked. Delayed orgasm: worse at 200 mg. Blood pressure 132/84. Weight 94 kilograms.

Decision: start bupropion XL 150 mg, taken on waking.

Expectation, stated so the next note can report against it: by week 4, interest item 1 or below, or at least one ride or two meals cooked in a week; sexual side effect no worse; blood pressure below 140/90; no new insomnia on the airway data. By week 8, PHQ-9 below 5, which defines remission.

If at week 4 interest has not moved, increase to 300 mg. If blood pressure exceeds 140/90 or insomnia appears, reconsider.

What this page is doingStating the expectation as numbers in the first note gives every later note something to report against.

Note 2: Four Weeks on Bupropion (Week 4)

Interval: four weeks since bupropion started.

Reporting against the expectation:

Interest item: 1. Met.

Activities: two rides and three meals cooked last week. Met.

Sexual side effect: "a bit better," orgasm less delayed. Met.

Blood pressure: 136/86. Below 140/90. Met.

Sleep: airway use 6.3 hours, no new insomnia. Met.

PHQ-9: 5. On track for remission.

Adherence: both medicines daily, confirmed.

New: mild dry mouth; occasional jitteriness mid-morning, rated 2 of 10.

Decision: hold bupropion at 150 mg. The expectation was met without increasing to 300 mg, so the higher dose, with its greater risk of raising blood pressure and anxiety, is not needed. Review in four weeks.

Note 3: Eight Weeks on Bupropion (Week 8)

Interval: four weeks since the last note.

Closing the loop on the first note's expectation:

PHQ-9: 4. Below 5. Remission reached.

Interest item: 0. D.L. rode three times last week and cooked for friends on Saturday.

Blood pressure: 134/84.

Airway use: 6.6 hours.

Sexual side effect: "back to almost normal."

Jitteriness: gone.

Weight: 92 kilograms.

Assessment: recurrent major depression now in remission on the two-drug regimen; sleep apnea controlled on airway pressure.

Decision: continue both medicines unchanged. The next decision, about how long to continue, is due at the next visit, in two months.

Consistent Language Across the Series

Each note uses the same measures in the same order: PHQ-9 total, interest item, activity count, sexual side effect, blood pressure and airway use. "Met" or "not met" is reported for each expectation. The terms "remission," defined as PHQ-9 below 5, and "response," a 50% fall, are used the same way throughout. A reader can line up the three notes and see each number change.

Why the Series Works as a Chain

Note 1 set the test. Note 2 applied it and made a decision, holding the dose, that only makes sense because the expectation had been met. Note 3 answered the question note 1 asked, whether bupropion would bring remission, and moved the decision to the next stage. Without the stated expectation, note 2 would have had no basis for not increasing the dose, and note 3 could only have said "better."

Remission in STAR*D was associated with lower relapse rates than response without remission (Rush et al., 2006), which is why the target in note 1 was remission, not just improvement.

What this page is doingExplaining how each note depends on the one before shows the series was written as a chain rather than as three separate visits.

What D.L. Said at Each Visit

These lines were recorded in the notes at the time, not reconstructed, and each sits in the subjective section of its note, where a reader would look for the patient's own words in each visit.

Note 1: "I'll try anything that doesn't make me sleepy." Note 2: "I went for a ride on Sunday and didn't hate it." Note 3: "I feel like I'm back." Recording a line from the patient at each visit adds evidence the numbers cannot carry.

What the Series Does Not Repeat

None of the notes repeats the full history, the sleep apnea workup or the earlier dosing problem; each refers back to the plan by date. Copying the earlier sections forward would have buried the changes the series exists to show.

How the Measures Were Chosen

PHQ-9 was used because it was the measure at every earlier visit, so all numbers in D.L.'s record sit on one scale, and because change on it has been shown to track treatment response (Löwe et al., 2004). The interest item was singled out because it was the residual symptom the augmentation targeted. The activity count was added because a scale item can change without behavior changing, and D.L.'s own goal was to "do things again."

The Evidence Behind the Expectation

The expectation of remission within eight weeks was set from the augmentation trial in STAR*D, where many patients who remitted with bupropion added did so within the first several weeks (Trivedi et al., 2006). Setting the expectation from evidence, rather than hope, made it fair to judge.

What Would Have Happened if Note 2 Had Not Met the Expectation

Had interest not moved by week 4, note 2 would have increased bupropion to 300 mg, with blood pressure checked weekly for two weeks. Had blood pressure risen above 140/90, the plan would have reduced the dose and reconsidered the choice. Each branch was written into note 1, so note 2 would only have needed to follow it.

Coordination

Primary care and the sleep clinic received a copy of note 3.

References

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

Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Stewart, J. W., Warden, D., Niederehe, G., Thase, M. E., Lavori, P. W., Lebowitz, B. D., McGrath, P. J., Rosenbaum, J. F., Sackeim, H. A., Kupfer, D. J., Luther, J., & Fava, M. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D report. American Journal of Psychiatry, 163(11), 1905-1917. https://doi.org/10.1176/ajp.2006.163.11.1905

Trivedi, M. H., Fava, M., Wisniewski, S. R., Thase, M. E., Quitkin, F., Warden, D., Ritz, L., Nierenberg, A. A., Lebowitz, B. D., Biggs, M. M., Luther, J. F., Shores-Wilson, K., & Rush, A. J. (2006). Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine, 354(12), 1243-1252. https://doi.org/10.1056/NEJMoa052964

What the NR 606 Week 7 assignment asks for

Read alone, the Week 7 notes look ordinary; read together, they carry a line of reasoning. The first note sets a decision and states what would count as evidence it worked. The second reports against that expectation rather than a fresh impression and either holds or revises with the reason. The third answers the first. Use consistent language and the same measures throughout. Avoid copying text forward. Most rubrics mark down three first visits with no thread, identical paragraphs carried forward and a first note with no stated target. Define your terms, such as remission and response, once and use them the same way throughout.

Inside the NR 606 Week 7 example

The sample's first note starts bupropion and sets expectations: interest item at 1 or below and an activity count by week 4, blood pressure under 140/90, no new insomnia and remission by week 8, with branches if they are not met. The second note reports each expectation as met and holds the dose rather than increasing it. The third reports remission and moves the next decision to maintenance. Sections explain consistent language, why the series works as a chain, how measures were chosen, the evidence behind the expectation, what the alternate branches would have been, the patient's words and what was not copied forward. Margin notes mark the expectation, the report against it and the closed loop.

Where the points sit in the NR 606 Week 7 rubric

The costliest loss is three first visits, each complete and none referring to the one before; each note here reports against note 1. Copy-forward buries changes, and this series states what it deliberately did not repeat. A missing expectation leaves later notes nothing to report against, so note 1 sets numbers. Inconsistent terms lose marks, while remission and response are defined once and used throughout. Closing the loop in note 3 earns the chain criterion, and the written branches show what would have happened otherwise. Recording a line from the patient at each visit adds evidence the numbers cannot carry. Writing the alternate branches into note 1 shows the series was planned.

NR 606 Week 7 help from the desk

Weak NR 606 Week 7 series read like three separate first visits. Others copy the same paragraphs into each note. Many never state in the first note what would count as success. Language changes from note to note, so numbers cannot be lined up. The third note rarely answers the first. Set measurable expectations in note 1, report each as met or not met in note 2 with a decision and close the loop in note 3. Keep the same measures in the same order. If your series differs, share the first note's decision, and a linked series can be drafted. Write the alternate branches into the first note.

Get a NR 606 Week 7 example written to your instructions

Send the Week 7 instructions and your section's note template, and a custom example is written to your headings and returned inside 24 to 48 hours. The first one is free. Include the case if one was assigned, since the thread between the notes has to be built on a specific treatment history.

More NR 606 papers and PMHNP samples

NR 606 Week 7 questions, answered

How much can the notes repeat each other?

Stable history can carry forward and no marker expects it retyped from scratch. What cannot repeat is the assessment, since identical reasoning across three visits says either that nothing was reconsidered or that the paragraph was pasted. The safe approach is a brief carried history with the assessment and plan rewritten each time against what the interval actually produced.

Do the notes have to show improvement?

No, and a series where nothing moves can be the stronger submission. What is graded is whether each note responds to the last, so notes documenting a change that failed, with the failure named and answered, demonstrate more than a smooth recovery. Manufactured improvement across three visits tends to read as convenient and it usually leaves the reasoning with nothing to do.

Which template should I follow?

Whichever one your classroom supplies, and it will typically be a structured format with fixed headings. Sections differ in what they require inside each heading, so the published version governs. A sample built to your template is more useful than a generically formatted one, because the difficulty in this assignment is fitting a running argument into boxes designed for single encounters.

Where can I find a free NR 606 Week 7 sample paper?

The full three-note progress series on bupropion augmentation, each reporting against the first note's expectation, is on this page.

Why is the dose held at four weeks in the NR 606 Week 7 series?

Every expectation set in the first note had already been met at 150 mg, so the higher dose and its added risks were not needed.