| Course | D346 Advanced Psychiatric Mental Health Care of Adults and Older Adults Across Care Settings |
|---|---|
| Task | Task 1 |
| Paper type | Adult psychiatric treatment plan |
| Length | About 800 words, 3 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN Psychiatric Mental Health Nurse Practitioner |
| Updated | September 2026 |
Free sample paper for D346 Task 1
Adult Treatment Plan: Major Depression in a 71-Year-Old Man Receiving In-Center Hemodialysis Three Times a Week
Student Name
Leavitt School of Health, Western Governors University
D346: Advanced Psychiatric Mental Health Care of Adults and Older Adults, Task 1
Course Instructor
Month Day, Year
Adult Treatment Plan: Major Depression in a 71-Year-Old Man Receiving In-Center Hemodialysis Three Times a Week
Patient
This composite patient is a retired postal carrier, aged 71, with kidney failure from diabetic nephropathy, receiving in-center hemodialysis Monday, Wednesday and Friday for 14 months. Other conditions: type 2 diabetes on insulin, hypertension, peripheral neuropathy and mild hearing loss. Medications: insulin glargine and lispro, amlodipine, carvedilol, sevelamer, a vitamin D analog, and heparin during dialysis sessions. The dialysis social worker referred him after his Patient Health Questionnaire-9 score rose to 16. He reports eight weeks of low mood, loss of interest in his grandchildren and woodworking, poor sleep, low energy and feeling 'like a burden.' He has passive thoughts that 'it would be easier not to wake up' but no plan or intent, no prior attempts and no firearms at home. He has skipped two dialysis sessions in the past month. Montreal Cognitive Assessment 25 of 30. He lives with his wife, who drives him to dialysis.
Diagnosis and Formulation
Major depressive disorder, single episode, moderate, without psychotic features, meeting diagnostic criteria for at least two weeks of depressed mood and loss of interest with associated symptoms (American Psychiatric Association, 2022). Contributors: loss of role and independence since starting dialysis, fatigue and pain from neuropathy, disrupted sleep on dialysis days and the burden of a demanding treatment schedule. Uremia, hypothyroidism, anemia and medication effects were considered: his most recent thyroid tests and dialysis adequacy are within target, hemoglobin is 10.4 g/dL, stable on the dialysis unit's anemia protocol, and none of his medicines commonly cause depression. His cognitive score is mildly reduced, but he manages his insulin and medicines accurately, so reduced attention from depression is more likely than a major neurocognitive disorder; cognition will be rechecked when mood improves.
Capacity and Goals
He has capacity for treatment decisions: he understands his condition and options, appreciates how they apply to him, reasons about them and states a consistent choice. His goals are to feel like himself again and to enjoy time with his grandchildren. The missed sessions raise a question of whether he is starting to withdraw from dialysis; he says he missed them because he 'couldn't face it,' not because he wants to stop. A goals-of-care conversation with his nephrologist is scheduled separately so that any future decision about dialysis is made when he is not severely depressed.
Treatment Plan
Psychotherapy and medication are both reasonable. In a randomized trial of patients on maintenance hemodialysis with depression, both sertraline and chairside cognitive behavioral therapy improved symptoms over 12 weeks; sertraline produced modestly lower depression scores, while adverse events were more frequent with sertraline than with therapy (Mehrotra et al., 2019). Given his moderate symptoms and passive death wishes, both will be offered, and he chooses both.
Medication: sertraline 25 mg daily for one week, then 50 mg, with further increases no more often than every two to four weeks to a maximum of 150 mg. Sertraline is chosen because it is extensively metabolized by the liver, needs no adjustment for kidney failure, is not removed by dialysis and has few interactions with his medicines. Alternatives set aside: tricyclic antidepressants for anticholinergic and cardiac effects; mirtazapine, which could help sleep and appetite but accumulates in kidney failure and causes sedation and weight gain in a patient with diabetes. Among older adults, selective serotonin reuptake inhibitors can cause hyponatremia and increase fall risk (2023 American Geriatrics Society Beers Criteria Update Expert Panel, 2023), so sodium is checked on the dialysis unit's monthly laboratory draw, and a baseline electrocardiogram is obtained because of his heart medicines. Bleeding risk with heparin during dialysis is noted and the dialysis nurses are informed.
Psychotherapy: cognitive behavioral therapy delivered chairside during dialysis sessions, weekly for 12 weeks, by the dialysis unit's psychologist, focused on activity scheduling, problem solving and thoughts about being a burden. Behavioral activation includes returning to woodworking on non-dialysis mornings.
Sleep, pain and function: the neuropathic pain regimen will be reviewed with his nephrologist, since pain feeds low mood; sleep hygiene is adjusted for dialysis days.
Safety
Suicide risk is moderate given age, male sex, chronic illness, depression and passive death wishes, balanced by no plan, no prior attempts, no firearms and strong family ties. A written safety plan is completed with him and, with his permission, shared with his wife; the dialysis unit is told to contact the clinic if he misses a session. Crisis line information is on his phone.
Coordination and Monitoring
The plan is shared with the nephrologist, dialysis nurse manager and social worker, who see him three times a week and can monitor mood, attendance and side effects. Patient Health Questionnaire-9 every two weeks at dialysis; psychiatric follow-up at two, four and eight weeks, then monthly. A 50% reduction in score by 12 weeks, with attendance at every dialysis session, defines response; if response is inadequate, the dose is increased or a change of agent considered. Cognition is rechecked at 12 weeks.
References
2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Mehrotra, R., Cukor, D., Unruh, M., Rue, T., Heagerty, P., Cohen, S. D., Dember, L. M., Diaz-Linhart, Y., Dubovsky, A., Greene, T., Grote, N., Kutner, N., Trivedi, M. H., Quinn, D. K., ver Halen, N., Weisbord, S. D., Young, B. A., Kimmel, P. L., & Hedayati, S. S. (2019). Comparative efficacy of therapies for treatment of depression for patients undergoing maintenance hemodialysis: A randomized clinical trial. Annals of Internal Medicine, 170(6), 369-379. https://doi.org/10.7326/M18-2229
What the D346 Task 1 instructions ask
The first D346 task asks you to write a treatment plan for an adult or older adult with a psychiatric condition in a specific care setting. Most versions ask for the patient and context, diagnosis and formulation, capacity and goals, treatment with rationale, safety assessment and coordination and monitoring. Older adults and medically complex patients raise particular issues, such as drug interactions, renal dosing and capacity. Evaluators look for a plan that addresses those issues directly, a safety assessment with risk and protective factors, and coordination that uses the people and setting the patient already has rather than adding appointments he cannot attend. Most versions also ask how progress will be measured.
How this D346 Task 1 example is built
The plan starts with the patient's medical and social situation, since dialysis shapes every choice. The diagnosis is stated with criteria, and a formulation explains contributing factors. Capacity is assessed with the four standard abilities. Treatment compares therapy and medication using a trial in the same population and considers geriatric prescribing cautions. Safety is assessed with specific risk and protective factors. Coordination uses the dialysis team's thrice-weekly contact to monitor mood and adherence. Monitoring names measures and intervals. The plan reads as something a consulting PMHNP could hand to a dialysis unit and expect to be followed. The capacity section uses four standard abilities, each with evidence from the interview.
Where the D346 Task 1 rubric puts the marks
D346 Task 1 aspects are scored competent, approaching competence or not evident. A diagnosis aspect checks that the condition is identified with supporting criteria. A formulation aspect rewards explanation of contributing factors. A capacity and goals aspect looks for patient-centered goals and a capacity assessment. A treatment aspect wants evidence-based choices adapted to the patient's medical context. A safety aspect asks for a thorough risk assessment. Coordination and monitoring aspects look for specific roles and measures. Evaluators check that medication considerations reflect age and organ function and that evidence is current. Plans that turn the medical setting into an advantage, rather than a complication, tend to be credited. Evaluators also check that monitoring names a measure, such as a depression rating scale, and an interval.
D346 Task 1 help: what sends it back
Treatment plans for older adults come back most often when medical context is ignored. Address kidney function, drug interactions and fall risk in every medication decision. Second, capacity is assumed. Assess it briefly using the standard abilities. Third, safety assessments label risk without evidence. List risk and protective factors. Fourth, coordination is a sentence about the team. Name who monitors what and how often. Finally, include the patient's goals. A plan built around what he wants, such as staying well enough to see his grandchildren, reads as person-centered and is more likely to be followed. Confirm each medication decision with the nephrology team's input.
Get a D346 Task 1 example written to your instructions
Send the D346 Task 1 instructions and rubric aspects from your course of study, together with the case you were assigned or the population your task specifies. We build a composite example to those aspects, with comorbidity and capacity carried through the plan, and return it in 24-48h. The first custom sample is free.
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- D347 Task 1 Developmental Assessment
D346 Task 1 questions, answered
What makes an older adult case different to write?
Almost everything downstream of the diagnosis. Multiple conditions compete for attention, existing medicines create burden and interaction risk, sensory or cognitive change alters what the plan can ask, and capacity questions arrive earlier. A plan that would be adequate for a healthy thirty-year-old often reads as incomplete once those pressures are on the page.
Does the plan have to include therapy as well as medication?
Read your instructions, but in current versions the aspects usually reach beyond prescribing. Psychotherapy, behavioral intervention, family involvement and community support all belong in a whole plan, each with a reason and a source. Submissions that treat medication as the entire treatment tend to come back with that aspect marked not met.
How is safety handled in an example plan?
As documentation of a clinical process, never as instruction. The example records what was asked, what was found, which protective factors were present and what the plan puts in place, in the language a record would use. It is written to show an evaluator how the process is documented, not to guide anyone reading the page through an actual assessment.
What makes an older adult case different in D346?
Medical comorbidity, drug interactions, organ function, fall risk and capacity all shape treatment choices. The sample addresses each of these for a man receiving hemodialysis three times a week.
Where can I find a free D346 Task 1 sample paper?
The complete treatment plan is on this page with commentary. Send your D346 task and patient, and your first tailored plan is written for you at no cost.