NRS 455 Case Study: Mrs. R.
Case Study: Mrs. R.
Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit this completed template to the assignment dropbox.
Case Study: Mrs. R.
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the lifespan.
Evaluate the Health History and Medical Information for Mrs. R., presented below.
Health History and Medical Information
Mrs. R. is a 68-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had a sudden onset of flu-like symptoms, including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Subjective Data
- Is very anxious and asks whether she is going to die.
- Denies pain but says she feels like she cannot get enough air.
- Says her heart feels like it is “running away.”
- Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
- Height 175 cm; Weight 95.5kg.
- Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
- Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
- Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
- Gastrointestinal: BS present: hepatomegaly 4cm below the costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
- IV furosemide (Lasix)
- Enalapril (Vasotec)
- Metoprolol (Lopressor)
- IV morphine sulfate (Morphine)
- Inhaled short-acting bronchodilator (ProAir HFA)
- Inhaled corticosteroid (Flovent HFA)
- Oxygen delivered at 2L/ NC
Critical Thinking Table
| Clinical Manifestations
Describe the clinical manifestations present in Mrs. R., focusing on the normal and abnormal findings and how this relates to his current condition. |
|
| Subjective | Mrs. R.’s symptoms are characterized by impending doom as she asks whether she is going to die and has palpitations. She denies being in pain and says she is exhausted and cannot eat or drink by herself.
Mrs. R has atypical symptoms of a myocardial infarction (MI) characterized by nausea, vomiting, diaphoresis, dizziness, and fatigue (Kolesova et al., 2023). It is crucial to note that females have a higher pain tolerance, which may lead to unrecognition or misdiagnoses of MI. |
| Objective | She has a height of 175 cm and weighs 95.5kg, with a T of 37.6C, an irregular HR of 118, RR of 34, and BP of 90/58. Distant S1, S2, and S3 are present with a faint apical beat at the sixth intercostal space, all peripheral pulses are 1+, and there is bilateral jugular vein distention. The initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation. Her respiratory exam reveals pulmonary crackles, decreased breath sounds in the right lower lobe, cough with frothy blood-tinged sputum, and a SpO2 of 82%. The gastrointestinal examination reveals the presence of bowel sounds and hepatomegaly. The findings are consistent with acute decompensated heart failure. |
| Cardiovascular Conditions Leading to Heart Failure
Describe cardiovascular conditions in which Mrs. R. is at risk. |
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| Describe four cardiovascular conditions in which Mrs. R. is at risk, and that may lead to heart failure. | Mrs. R. is at risk of developing pulmonary hypertension caused by hypoxemia with a resultant cor pulmonale and right-sided heart failure. Her obesity also increases the risk for coronary artery and ischemic heart diseases, which predispose her to heart failure. Obesity increases the risk of hypertension and hypertensive heart disease. |
| Discuss any comorbidities Mrs. R. displays. | Mrs. R. is obese, as her calculated body mass index (BMI) is 31.2. She also has atrial fibrillation, hypertension, and COPD. |
| How do these conditions increase her chance of heart failure? | Obesity increases the risk of coronary artery atherosclerosis, which reduces blood flow to the myocardial muscles. Rupture or erosion of an atherosclerotic plaque occludes flow to the muscles, resulting in ischemia and myocardial infarction (Henning, 2021). As a result, this reduces the ability of the heart to pump blood, resulting in heart failure. Additionally, pulmonary hypertension increases the resistance against which the heart pumps blood to the pulmonary arteries, resulting in right-sided heart failure (Bousseau et al., 2023). Hypertension causes the left ventricle to pump blood against high pressures in the aorta, resulting in ventricular hypertrophy and hypertensive heart disease (Nemtsova et al., 2023). |
| What can be done by way of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions. | I would prescribe atorvastatin 20 mg PO qhs to help lower lipid levels and reduce the risk for coronary artery atherosclerosis. I would also administer oxygen and prescribe sildenafil 20 mg PO TDS for pulmonary hypertension and enalapril 5 mg for her hypertension. |
| Evaluation of Nursing Interventions at Admissions
Discuss the initial assessments and interventions provided to Mrs. R. |
|
| According to the nursing process, were the initial assessments and interventions at the time of admission beneficial for Mrs. R? | Some of the interventions offered were beneficial. For instance, the provision of furosemide for pulmonary and peripheral edema, oxygen for low oxygen saturation, inhaled short-acting bronchodilator for bronchoconstriction and inhaled corticosteroids to lower airway inflammation. Enalapril is also recommended in acute decompensated heart failure (ADHF) but may worsen the pre-existing hypotension, while metoprolol is contraindicated in ADHF. |
| Discuss changes to any of the initial assessments or interventions you would make to ensure patient independence and prevent readmission. | I would prescribe IV ceftriaxone 1 g OD and ciprofloxacin for the pneumonia. I would administer crystalloids and intravascular volume expanders to correct hypotension and withhold enalapril and furosemide until the blood pressures stabilize. I would also oral prednisolone as an alternative to the inhaled corticosteroid and add a short-acting antimuscarinic, such as ipratropium bromide (Agustí et al., 2023). |
| Medications and Prevention of Problems Caused by Multiple Drug Interactions
Explain each of the seven medications listed in the case study and increase the incidence of polypharmacy. |
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| Explain each of the seven medications listed in the case study. Include the classification, action, and rationale for each of these medications as they stem from the pathophysiology of this patient’s condition (e.g., consider morphine use outside of pain management). | IV furosemide (Lasix) is an example of a loop diuretic commonly used to relieve fluid overload in conditions such as pulmonary and peripheral edema. Enalapril (Vasotec) is an angiotensin-converting enzyme inhibitor that inhibits the conversion of angiotensin I to II, thus reducing vasoconstriction, hypertension, and myocardial remodeling in heart failure. Metoprolol (Lopressor) is an example of a beta-blocker commonly used as an anti-hypertensive and heart failure medication. IV morphine sulfate (Morphine) is an example of an opioid used in pain management. Inhaled short-acting bronchodilator (ProAir HFA) contains albuterol, a short-acting beta agonist. The medication is a reliever used during an acute exacerbation of COPD. Inhaled corticosteroid (Flovent HFA) is an example of an inhaled steroid used to reduce airway inflammation in COPD, thus minimizing the incidence of exacerbations. Oxygen delivered at 2L/ NC increases the amount of inhaled oxygen to improve saturation levels in patients with respiratory distress caused by COPD exacerbation. |
| Discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend. | I would administer the medications at different schedules to minimize interactions. I would also recommend medications with multiple pharmacodynamic properties to reduce the drugs needed for a condition (Schmelzer et al., 2023). I would also avoid prescribing medications that can counter the effects of the other to promote drug efficacy. I would also encourage the patient to avoid using over-the-counter medications and herbs to minimize drug-drug or herb interactions. |
| Health Promotion and Restoration Teaching Plan
Develop a multidisciplinary health promotion and restoration teaching plan for Mrs. R. |
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| Discuss the steps needed to move the patient from acute care to subacute care before discharging home and beginning a rehabilitation process. | When preparing to discharge the patient from acute care, it is crucial to identify an interdisciplinary transitional care team that can handle the move. One must communicate with the patient, have a list of interventions and follow-up recommendations, and assess the patient’s and family’s needs (Oyesanya et al., 2021). It is crucial to develop a nursing report and individualized health plan, contact the receiving team, and set corroborative goals for treatment outcomes. One can schedule visits to monitor the patient’s progress and then discharge the patient. |
| Discuss alternative discharge options and qualifications to facilitate a smooth transition to the next level of care. | Alternative discharge options for patients include home care, rehabilitation centers, and long-term care facilities. When planning for a smooth transition, it is crucial to assess the patient’s and family’s needs and preferences and offer them the available options with their benefits and risks (Gledhill et al., 2023). Once a decision is made, a transition team is called upon to facilitate the discharge. The person receiving the patient should also receive a detailed care plan and instructions and follow-up done to ensure a smooth transition with continued care. |
| Explain how the rehabilitation resources, including medication management and modifications, will assist the patient’s transition to promote independence and prevent readmission. | Various rehabilitation resources can be utilized to improve Mrs. R.’s health. An example is pulmonary rehabilitation which combines patient education, lifestyle changes, and exercise to improve her overall health, reduce dyspnea and exacerbations, increase exercise capacity, promote psychological well-being, and lower hospitalizations (Arnold et al., 2020). Additionally, she may benefit from medication management owing to the multiple comorbid conditions she has. As a result, this would help reduce the risk of medication errors and improve adherence, thus lowering exacerbations and hospitalization. |
| Pathophysiological Changes
Discuss the pathophysiological changes that come with Mrs. R.’s long-term tobacco use. |
|
| Tobacco smoking impairs the normal mucosal immune function by damaging and altering the function of the airway epithelial barrier, secretory glands, ciliated, goblet, and basal cells. Alterations in mucociliary function result in the accumulation of mucus in the airway and occlusion, predisposing one to chronic bronchitis (Varghese et al., 2023). In addition, tobacco smoking impairs the phagocytic role of macrophages and neutrophils and suppresses the cough reflex, predisposing persons to certain pulmonary bacterial infections such as pneumonia. Alteration in neutrophilic function causes them to secrete neutrophil elastase, which degrades elastic tissue within the lung, resulting in emphysema. | |
| COPD Triggers and Options for Smoking Cessation
Discuss options for smoking cessation education. |
|
| What options for smoking cessation should be offered to Mrs. R? | Pharmacological therapy for tobacco smoking includes nicotine replacement therapy (NRT) which can be done as a patch, lozenge, gum, inhaler, and nasal spray. Additionally, bupropion and varenicline can also be used (Onwuzo et al., 2024). Psychotherapy is also crucial through various strategies such as support groups, cognitive behavioral therapy, and motivational interviewing and can be used with pharmacotherapy. |
| Explain the COPD triggers that can increase exacerbation frequency, resulting in readmission. | Various factors, such as respiratory infections, airway pollution, and tobacco smoking, can trigger an acute COPD exacerbation. These factors stimulate inflammatory processes in the airway, resulting in edema, increased bronchial tone, and excessive mucus secretion, especially in the small airways (Alobaidi et al., 2020). In addition, there is airway airflow resistance and ventilation/ perfusion mismatch, which increases the work of breathing and prolonged exhalation. As a result, there is a loss of pulmonary function, and exacerbations occur. |
References
Agustí, A., Celli, B. R., Criner, G. J., Halpin, D., Anzueto, A., Barnes, P., Bourbeau, J., Han, M. K., Martinez, F. J., Mortimer, K., Papi, A., Pavord, I., Roche, N., Salvi, S., Sin, D. D., Singh, D., Stockley, R., López Varela, M. V., Wedzicha, J. A., . . . Vogelmeier, C. F. (2023). Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. American Journal of Respiratory and Critical Care Medicine, 207(7), 819. https://doi.org/10.1164/rccm.202301-0106PP
Alobaidi, N. Y., Stockley, J. A., Stockley, R. A., & Sapey, E. (2020). An overview of exacerbations of chronic obstructive pulmonary disease: Can tests of small airways’ function guide diagnosis and management? Annals of Thoracic Medicine, 15(2), 54. https://doi.org/10.4103/atm.ATM_323_19
Arnold, M. T., Dolezal, B. A., & Cooper, C. B. (2020). Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease: Highly Effective but Often Overlooked. Tuberculosis and Respiratory Diseases, 83(4), 257. https://doi.org/10.4046/trd.2020.0064
Bousseau, S., Fais, R. S., Gu, S., Frump, A., & Lahm, T. (2023). Pathophysiology and new advances in pulmonary hypertension. BMJ Medicine, 2(1), e000137. https://doi.org/10.1136/bmjmed-2022-000137
Gledhill, K., Bucknall, T. K., Lannin, N. A., & Hanna, L. (2023). The role of collaborative decision-making in discharge planning: Perspectives from patients, family members and health professionals. Journal of Clinical Nursing, 32(19-20), 7519-7529. https://doi.org/10.1111/jocn.16820
Henning, R. J. (2021). Obesity and obesity-induced inflammatory disease contribute to atherosclerosis: A review of the pathophysiology and treatment of obesity. American Journal of Cardiovascular Disease, 11(4), 504. https://pmc.ncbi.nlm.nih.gov/articles/PMC8449192/
Kolesova, M. V., & Minor, S. (2023). Silent Myocardial Infarction: A Case Report. Cureus, 15(8), e43906. https://doi.org/10.7759/cureus.43906
Nemtsova, V., Vischer, A. S., & Burkard, T. (2023). Hypertensive Heart Disease: A Narrative Review Series—Part 1: Pathophysiology and Microstructural Changes. Journal of Clinical Medicine, 12(7), 2606. https://doi.org/10.3390/jcm12072606
Onwuzo, C. N., Olukorode, J., Sange, W., Orimoloye, D. A., Udojike, C., Omoragbon, L., Hassan, A. E., Falade, D. M., Omiko, R., Odunaike, O. S., Adams-Momoh, P. A., Addeh, E., Onwuzo, S., & Joseph-Erameh, U. (2024). A Review of Smoking Cessation Interventions: Efficacy, Strategies for Implementation, and Future Directions. Cureus, 16(1), e52102. https://doi.org/10.7759/cureus.52102
Oyesanya, T. O., Loflin, C., Byom, L., Harris, G., Daly, K., Rink, L., & Bettger, J. P. (2021). Transitions of care interventions to improve quality of life among patients hospitalized with acute conditions: A systematic literature review. Health and Quality of Life Outcomes, 19, 36. https://doi.org/10.1186/s12955-021-01672-5
Schmelzer, K. P., Liebetrau, D., Kämmerer, W., Meisinger, C., & Hyhlik-Dürr, A. (2023). Strategies for Avoiding Typical Drug–Drug Interactions and Drug-Related Problems in Patients with Vascular Diseases. Medicina, 59(4), 780. https://doi.org/10.3390/medicina59040780
Varghese, J., & Gharde, P. M. (2023). A Comprehensive Review on the Impacts of Smoking on the Health of an Individual. Cureus, 15(10), e46532. https://doi.org/10.7759/cureus.46532
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Assessment Description
Use the “Case Study: Mrs. R.” template to complete the assignment.
Case Study: Mrs. R. has indirect care experience requirements. The “NRS-455 – Case Studies: Indirect Care Experience Hours” form, found in the Topic 1 Resources, will be used to document the indirect care experience hours completed in the case study. As progress is made on the case study, update this form indicating the date(s) each section is completed. This form will be submitted in Topic 3.
You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
American Association of Colleges of Nursing Core Competencies for Professional Nursing Education
This assignment aligns to AACN Core Competencies 2.5, 2.7, and 8.2.
AttachmentsNRS-455-RS-T1-CaseStudyMrsR.docx
Case Study: Mrs. R. – Rubric
Rubric Criteria
Total 130 points
| Criterion | 1. Unsatisfactory | 2. Insufficient | 3. Approaching | 4. Acceptable | 5. Target |
|---|---|---|---|---|---|
| Clinical Manifestations of Mrs. R.
|
0 points
Subjective and objective clinical manifestations are not present. |
4.88 points
Subjective and objective clinical manifestations are incomplete or incorrect. |
5.14 points
Subjective and objective clinical manifestations are present but lack detail. |
5.79 points
Subjective and objective clinical manifestations are detailed. |
6.5 points
Subjective and objective clinical manifestations are thorough. |
| Cardiovascular Conditions and Comorbidities
|
0 points
Description of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is not present. |
4.88 points
Description of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is incomplete or incorrect. |
5.14 points
Description of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is present but lacks detail. |
5.79 points
Description of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is detailed. |
6.5 points
Description of four cardiovascular conditions in which the patient is at risk, as well as a discussion of comorbidities displayed by the patient, is thorough. |
| Medical and Nursing Interventions
|
0 points
Explanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is not present. |
14.63 points
Explanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is incomplete or incorrect. |
15.41 points
Explanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is present but lacks detail. |
17.36 points
Explanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is detailed. |
19.5 points
Explanation of what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the conditions is thorough. |
| Evaluation of Nursing Interventions at Admissions
|
0 points
Evaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is not present. |
14.63 points
Evaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is incomplete or incorrect. |
15.41 points
Evaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is present but lacks detail. |
17.36 points
Evaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is detailed. |
19.5 points
Evaluation of whether the initial assessments and interventions at the time of admission were beneficial to the patient according to the nursing process is thorough. |
| Changes to Initial Assessments
|
0 points
Explanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is not present. |
14.63 points
Explanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is incomplete or incorrect. |
15.41 points
Explanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is present but lacks detail. |
17.36 points
Explanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is detailed. |
19.5 points
Explanation of any changes to the initial assessments or interventions to ensure patient independence and prevent readmission is thorough. |
| Medications and Nursing Interventions
|
0 points
Explanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is not present. |
4.88 points
Explanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is incomplete or incorrect. |
5.14 points
Explanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is present but lacks detail. |
5.79 points
Explanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is detailed. |
6.5 points
Explanation of the seven medications listed in the scenario, including the classification, action, and rationale for each, and a discussion of four nursing interventions to prevent problems caused by multiple drug interactions, is thorough. |
| Health Promotion and Restoration Teaching Plan
|
0 points
Multidisciplinary health promotion and restoration teaching plan is not present. |
4.88 points
Multidisciplinary health promotion and restoration teaching plan is incomplete or incorrect. |
5.14 points
Multidisciplinary health promotion and restoration teaching plan for the patient, including a description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications, is provided but lacks detail. |
5.79 points
Multidisciplinary health promotion and restoration teaching plan is provided for the patient and includes a detailed description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications. |
6.5 points
Multidisciplinary health promotion and restoration teaching plan is provided for the patient and includes a thorough description of the steps needed to move the patient from acute care through the rehabilitation process, necessary modifications, and maintenance of medications. |
| Alternative Discharge Qualifications and Rehabilitation Resources
|
0 points
Discussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is not present. |
14.63 points
Discussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is incomplete or incorrect. |
15.41 points
Discussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is present but lacks detail. |
17.36 points
Discussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is detailed. |
19.5 points
Discussion of alternative discharge options and qualifications to facilitate a smooth transition to the next level of care, including an explanation of how the rehabilitation resources promote independence and prevent readmission, is thorough. |
| Options for Smoking Cessation
|
0 points
Discussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is not present. |
4.88 points
Discussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is incomplete or incorrect. |
5.14 points
Discussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is present but lacks detail. |
5.79 points
Discussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is detailed. |
6.5 points
Discussion of the pathophysiological changes that come with long-term tobacco use and options for smoking cessation is thorough. |
| COPD Triggers
|
0 points
Explanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is not present. |
4.88 points
Explanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is incomplete or incorrect. |
5.14 points
Explanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is present but lacks detail. |
5.79 points
Explanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is detailed. |
6.5 points
Explanation of COPD triggers that can increase exacerbation frequency, resulting in readmission is thorough. |
| Mechanics of Writing
Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc. |
0 points
Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout. |
5.85 points
Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent. |
6.16 points
Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted. |
6.94 points
Few mechanical errors are present. Suitable language choice and sentence structure are used. |
7.8 points
No mechanical errors are present. Appropriate language choice and sentence structure are used throughout. |
| Format/Documentation
Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline. |
0 points
Appropriate format is not used. No documentation of sources is provided. |
3.9 points
Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident. |
4.11 points
Appropriate format and documentation are used, although there are some obvious errors. |
4.63 points
Appropriate format and documentation are used with only minor errors. |
5.2 points
No errors in formatting or documentation are present. |
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