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Clinical Case Study: Intensive Care Unit
Natalie Eyer
00831558
Submitted in partial fulfillment of the requirements in the course
Nurs451: Clinical Management Adult Health Nursing III
Old Dominion University
NORFOLK, VIRGINIA
Fall, 2013
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Introduction: Overview and Patient Presentation
The purpose of this discussion is to present a patient cared for in the intensive care unit
(ICU) by using knowledge from the humanities and sciences. This discussion will utilize nursing
research, scientific rationale, standards of practice, and nursing theory to discuss
pathophysiology, plan patient care, and evaluate care. The patient that will be discussed, CR, is a
31-year-old male who presented to the emergency department (ED) with complaints of
abdominal pain, chest pain, shortness of breath, productive cough, nausea, and vomiting.
Assessment revealed that the patient was tachycardic, with heart rate in the 120s, hypotensive,
with systolic in the 70s, and febrile. X-ray imaging revealed an extensive amount of fluid in the
lungs.
Medical Diagnosis
CR was diagnosed with Hodgkin’s Lymphoma in 2003 and successfully went into
remission with chemotherapy treatment. However, the cancer came back this year. The patient
had been undergoing chemotherapy treatments for the past few months. His last chemotherapy
treatment was 3 weeks prior to his arrival at the ED. The patient had received a fluid bolus prior
to chemotherapy treatment, which is suspected to be the cause of the patient’s presenting
symptoms. Other pertinent patient history includes: asthma, obesity, cardiomyopathy, and
autoimmune hemolytic anemia. The patient was intubated and admitted on 10/21/13 with a
medical diagnosis of severe pulmonary edema and suspected pneumonia.
The pathophysiology of this patient is multifactorial and includes several different body
systems. The fluids received for chemotherapy, history of cardiomyopathy, pulmonary edema,
and pneumonia are all interrelated to the present issue. Cardiomyopathy is a disease of the
muscle of the heart resulting in cardiac dysfunction. Damage to the muscle can be caused by
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many things, but in this case the cardiomyopathy was most likely chemotherapy induced.
Ventricular walls are dilated, with the left ventricle most often being more involved. The dilated
ventricles have to work harder than usual to eject blood to the body, and overtime the heart
grows weak and tried. The inadequate cardiac muscle does not work effectively as a pump, and
the result is decreased cardiac output, or systolic heart failure. Signs and symptoms include:
dyspnea, fatigue, palpitations, and pulmonary edema. CR’s history of heart failure is directly
related to the pulmonary edema experienced with the fluid bolus received for chemotherapy.
Because the left ventricle is more involved in heart failure, its failure leads to fluid backup in the
lungs. Being that the patient received a fluid bolus, fluid backup was exacerbated. Signs and
symptoms of pulmonary edema include: shortness of breath, productive cough, decreased
oxygen saturations, crackles upon auscultation, and use of accessory muscles to breath.
Excessive fluid in the lungs makes the patient more susceptible to pneumonias, because the
moist environment is more favorable to bacteria. Signs and symptoms of pneumonia includes:
shortness of breath, productive cough with thick mucus, elevated white blood cell count (WBC),
fever, and crackles upon auscultation (Ignatavicius & Workman, 2010).
Nursing Theory
The patient’s problems will be prioritized and addressed in accordance to The University
of British Columbia (UBC) “Model for Nursing” theory. The UBC Model for Nursing was
inspired by Dorothy Johnson’s Behavioral Systems model and was published by several faculty
members of the university in 1976. The theory recognizes that the nurse’s knowledge about the
patient’s health is a direct predictor of optimal patient outcome. A goal-directed system is
created by the nurse by combining knowledge of the individual patient and general knowledge of
illness and health. Because the nurse is aware of the patient’s history and current health status
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and has knowledge about health/illness, the nurse can prioritize and plan care by individualizing
patient goals to meet his or her own specific needs. The nurse should plan holistic care and not
overlook basic human needs (Johnson & Webber, 2010). To specifically relate the theory to
prioritization of CR’s care, the knowledge that the nurse acquires of CR’s history and current
health will be used to identify problems and plan an individualized plain of care. The knowledge
of CR’s health history and current health was obtained by reviewing the patient’s chart, assessing
the patient’s mother on patient history, and nursing assessment of the patient. This data along
with knowledge of health sciences will be used to identify nursing diagnosis and plan related
care. Nursing diagnoses will not only strive to achieve medical health, but to achieve overall
health.
Nursing Diagnoses
The priority nursing diagnoses for CR is impaired gas exchange related to chemotherapy
fluid bolus and cardiomyopathy, as evidenced by pulmonary edema, shortness of breath, and the
need for intubation. The pulmonary edema resulted in an inability to exchange gas, because the
alveoli were obstructed with fluid. Impaired gas exchange takes priority, because it is a direct
result of the admission diagnosis of pulmonary edema. This issue has left CR dependent on the
ventilator. CR’s respiratory status must be strictly evaluated and improved in order for him to be
weaned from ventilation; a process necessary for discharge. Other assessment data and physical
findings related to this diagnoses includes: shortness of breath, productive cough, fatigue, an
oxygen saturation of 78 at the ED, and course breath sounds.
The next priority diagnoses is decreased cardiac output related to chemotherapy induced
cardiomyopathy as evidenced by an ejection fraction of 18% and pulmonary edema. Although
respiratory is of priority to the nurse, cardiac status must also be closely monitored because of its
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relation to the pulmonary system. The cardiac and pulmonary systems work together in order to
maintain oxygenation of the body and its tissues. If one is compromised, the other will
compensate. If cardiac function of the heart can be optimized, the mechanism of impaired gas
exchange can be alleviated. The more effectively the heart acts as a pump, the less fluid backup
will back up into the lungs. Other assessment data supporting this diagnosis includes:
hypotension, tachycardia, fatigue, brain natriuretic peptide (BNP) of 2737, coarse breath sounds,
and fluid infiltrates of the lung on x-ray imaging.
The next diagnosis to be addressed is infection related to bacteria in the lungs as
evidenced by a positive respiratory culture of Streptococcus pneumonia, fever of 100.5, elevated
WBC of 24.5, and chest pain. This diagnosis is of importance, because the nurse understands that
the body will function more optimally without the presence of infection. This pneumonia goes
back to the priority of impaired gas exchange, because it further increases fluid amount and
viscosity of the lungs, further impairing the ability for the patient to exchange gas. In addition,
infection in a patient receiving chemotherapy is of huge concern. As a result of this treatment,
the immune system of the patient receiving chemotherapy is severely compromised. In the
immunocompromised patient, the body is unable to activate cell mediators and effectively fight
off infection (Ignatavicius & Workman, 2010). CR’s pneumonia needs to be aggressively
monitored by the nurse and treated in order for the patient to resume normal bodily function.
The preceding nursing diagnosis is ineffective renal tissue perfusion related to
hypotension as evidenced by decreased urine output during initial hospitilzation, dark urine at the
ED, and increased blood urea nitrogen (BUN) of 37. The low blood pressure experienced by the
patient, which was a result of the heart failure, does not secure adequate oxygenation and
perfusion to the kidneys. When the kidneys are not perfused, they are unable to work effectively
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and the patient goes into acute renal failure. The nurse realizes that kidney function is of extreme
importance, because the kidneys maintain homeostasis by filtering waste products of the body.
Without proper kidney function and perfusion, the body will begin to accumulate with various
toxins that are not optimal for patient healing. Additionally, the nurse realizes that injury to the
kidneys can very likely result in long term effects, such as chronic kidney disease (Ignatavicius
& Workman, 2010). Because of the short and long term effects of impaired renal perfusion, the
nurse would monitor kidney function of the patient closely. Additional assessment data that
supports this diagnosis includes a decreased red blood cell count (RBC) of 3.37 with other
findings of anemia; hemoglobin of 9.2 and hematocrit of 29.2).
It is essential that the competent and holistic nurse not only considers physical
assessment data of the patient but psychosocial data as well. The nurse recognizes the diagnosis
of altered family processes related to diagnosis of cancer and current hospitalization as
evidenced by maternal expression of anxiety. CR is a fairly young ICU patient; 31-years-old. At
this age he has already had cancer twice and gone through extensive chemotherapy treatments. In
addition, he suffers from other chronic diseases including obesity, hemolytic anemia, and
cardiomyopathy. Upon assessment of the patient’s family situation, it was revealed that the
mother is heavily involved in her son’s life and his care. The mother verbalized that she felt
guilty leaving her son at the hospital to eat, shower, or sleep. The nurse understands that chronic
disease and hospitalization has profound effects on the family of the individual. The competent
nurse will not only work to treat the patient, but to address problems and concerns of the
involved family. Relevant research aimed to study grief in parents to a child of cancer found that
97% of participants reported a high level of sacrifice burden, fewer than half the participants
reported being at peace with the situation and life in general, and 64% reported uncontainable
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sadness to the diagnoses of their loved one’s cancer. The nurse understands that the relevance of
these findings suggest that anticipatory grieving interventions should be provided to the family,
as sacrifice and sadness are prevalent themes experienced by these individuals (Al-Gamal &
Long, 2010).
Outcomes
It is necessary for the nurse to identify various outcomes for the patient in order to have
goals to work towards. The outcome of the first prioritized diagnosis of impaired gas exchange is
that the patient will effectively exchange gas. The nurse knows to set more specific and
measureable expected outcomes for the patient in relation to this diagnosis. An expected
outcome is that the patient will maintain oxygen saturations above 95 and PaO2 above 95
consistently before time of discharge. For the diagnosis of decreased cardiac output, the outcome
is that the patient will have adequate cardiac output to supply his tissues with oxygen. The
specific expected outcome is that the patient will maintain a blood pressure within normal limits
(systolic ranging from 90-120 and diastolic ranging from 60-80) consistently while on
vasopressor medication therapy.
Independent Interventions: Impaired Gas Exchange
The nurse will first implement many nursing interventions without the need for
collaborative intervention to improve the patient’s gas exchange. The first intervention will be
assessment. The patient will receive a focused respiratory assessment including: auscultation of
lung sounds bilaterally in all fields, presence of cough, amount/color/consistency of mucous with
suctioning, monitoring of all vital signs, monitoring of arterial blood gases (ABGs), monitoring
pulse oximetry, noting color of mucous membranes, monitoring chest x-ray imaging, and
rate/rhythm/depth of respirations. It is necessary for the nurse to get a baseline in order to have
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means of comparison to determine effectiveness of treatments. The nurse will utilize knowledge
of proper patient positioning to maintain optimal gas exchange by elevating the head of bed 30
degrees, which allows for “increased thoracic capacity and full descent of the diaphragm,
preventing the abdominal contents from crowding the lungs and preventing their full expansion”
(Gulanick & Myers, 2011, p.78). The nurse will turn the patient every 2 hours as tolerated in
order to provide ventilation/perfusion matching. For example, if the patient is on their right side,
the blood pulls to the downward side (right), while the oxygen pulls to the upward side (left).
When the patient is turned, the blood and oxygen content will be mixed, allowing for better
tissue oxygenation. In addition, the nurse will continually ensure that the patient is not slumped
in bed, which can possibly narrow the airway, further impeding gas exchange. The nurse will
perform the intervention of suctioning the airway as needed. The nurse will use nursing
judgment do this; when there is a drop in oxygen saturations, when the patient begins to cough,
or if the patient begins to appear restless. Suctioning will help to remove fluid and mucous from
the lungs, allowing the aveoli to be free for gas exchange (Gulanick & Myers, 2011).
With mechanical ventilation, the nurse should strive to be culturally competent and
recognize that the intervention of family teaching is needed when the mother is so heavily
involved in patient care, as was present with CR. A recent nursing research study found that
family members were generally very concerned about mechanical ventilation and sedation, that
not enough teaching was provided to them about this process, and that they could tell that their
loved one was frightened when they opened their eyes. The nurse should understand the
significance of these research findings and implement interventions to decrease family anxiety
and knowledge deficit related to mechanical ventilation/sedation. The nurse would do this by
providing education to the family in regards to the whole ventilation/sedation process and
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continually assessing the family for any further questions or concerns. The nurse should also
encourage the family to speak to the patient or hold their hand in order to decrease patient
confusion and anxiety (Dreyer & Nortvedt, 2008).
Dependent Interventions: Impaired Gas Exchange
The nurse will implement the intervention of medication administration to improve gas
exchange. Guaifuenesin 600mg will be administered orally by the nurse every 12 hours to help
decrease mucous viscosity. This will allow the secretions to be more easily cleared with
suctioning, freeing aveoli for gas exchange. The nurse recognizes that there are few side effects
associated with this medication, but that related assessment should include auscultation of breath
sounds and assessment of color/consistency of secretions. The nurse will administer antibiotics
as ordered to treat the pneumonia. Ciprofloxacin 400mg will be administered intravenously
every 8 hours, and meropenum 1000mg will be administered intravenously every 8 hours. The
nurse must evaluate the effectiveness of antibiotic administration by monitoring chest x-rays for
decrease in fluid, monitoring WBC counts along with cultures, monitoring amount of respiratory
secretions, and monitoring ABGs. In addition, side effects of antibiotics such as superinfection,
diarrhea, and renal/hepatic toxicity will be considered and monitored. The last medication that
the nurse will administer to improve gas exchange is furosemide 40mg twice daily in order to
help eliminate the fluid from the lungs. With this medication, the nurse knows to monitor
electrolyte status, specifically for a decrease in potassium, sodium, and magnesium levels, and
monitor input and output, with an ideal output ranging from 75-300mL/hr (Hodgson & Kizior,
2012).
Collaborative Interventions: Impaired Gas Exchange
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The nurse will collaborate with whole healthcare team, specifically respiratory therapy,
extensively to help improve oxygenation of the patient. This collaboration is essential, as it is
Sentara policy to do so for mechanically ventilated patients. Policy states that “Critical care
nurses shall collaborate with the physician, anesthesia care provider, nurse practitioner, physician
assistant and respiratory therapist in the initiation of endotracheal intubation and the initiation of
positive pressure ventilation” (Sentara, 2008). The nurse will work with respiratory therapy to
explain how the patient has been responding to ventilator settings so that respiratory can alter or
wean settings as needed. The patient will receive various medications from respiratory therapy,
including albuterol and ipratropium. It is necessary for the nurse to not only rely on the
respiratory therapists’ assessment of these mediations, but to also independently monitor their
effectiveness. The nurse will monitor for a decrease in coarse breath sounds or crackles with
auscultation. In addition, the nurse will monitor for side effects such as tachycardia, hypotension,
and dry mucous membranes and intervene as necessary (Hodgson & Kizior, 2012).
Independent Interventions: Decreased Cardiac Output
The first independent nursing intervention to be utilized by the nurse to address decreased
cardiac output it thorough cardiac assessment. The nurse recognizes assessment as an essential
nursing intervention according to the American Association of Critical Care Nurses (AACN)
Standards of Practice I, which states “The nurse caring for the acutely and critically ill patient
collects relevant data pertinent to the patient’s health or situation” (AACN, 2013). Assessment of
the cardiac system will include: monitoring all vital signs, specifically heart rate and blood
pressure, assessment of skin color and temperature, assessing peripheral pulse and capillary
refill, monitoring input and output along with daily weights, auscultating heart sounds,
monitoring cardiac imaging such as electrocardiogram and echocardiogram, monitoring of
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potassium and magnesium levels, and monitoring BNP. The nurse will implement holistic
interventions such as providing a quiet and relaxed environment. This reduction in external
stimuli will reduce the oxygen demands of the patient, resulting in more optimal cardiac
functioning. To further reduce oxygen demands and workload of the heart, the nurse will cluster
care such as bathing, oral care, suctioning, and positing to prevent overexertion of the cardiac
system (Gulanick & Myers, 2011). Patient teaching should also be implemented as an
independent intervention before time of patient discharge. A recent research study showed that
patient teaching interventions for chemotherapy patients aimed at reducing fatigue and
optimizing cardiac performance are successful. Some of the successful patient teaching
interventions included: stress management strategies, methods of energy conservation, and
methods of relaxation including distraction. Results suggest that the nurses should strive to
educate patients of these interventions in order to optimize cardiac function (Yesilbalkan,
Karadakovan, & Göker, 2009). Because CR was sedated during time of patient care, this patient
teaching would be implemented before time of discharge when the patient would be fully
conscious and aware.
Dependent Interventions: Decreased Cardiac Output
The nurse will administer vasopressors to CR in order to improve cardiac output.
Norepinepherine will be administered continuously at a rate of 2-20 mcg/min according to
cardiac assessment and nursing judgment. Vasopressin will be administered at 0.04units/min.
Norepinepherine is used in order to stimulate beta1 and alpha adrenergic receptors, thus causing
constriction of the vessels and increasing the blood pressure. The medication also can increase
contractility, thus increasing cardiac output to maintain blood pressure and keep the blood
pumping effectively. Vasopressin is used to increase reabsorption of fluid in the renal tubules,
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therefore increasing blood pressure to maintain perfusion. The nurse knows to monitor for side
effects of vasopressive therapy such as: decreased peripheral perfusion/tissue death,
hypertension, tachycardia, palpitations, and decreased urine output (Hodgson & Kizior, 2012).
Collaborative Interventions: Decreased Cardiac Output
The nurse works collaboratively with the heath care team in order to maintain the
patient’s cardiac output. The nurse will collaborate with the physician and respiratory therapy in
regards to oxygen therapy for the patient. The nurse must be able to communicate with these
health care team members about how the patient has been responding to current oxygen therapy,
and must recommend or adhere to suggestions by the physician or respiratory therapist in regards
to oxygen administration. The nurse will also collaborate with the cardiologist to interpret
cardiac findings and provide cardiac care as needed. Lastly, the nurse must collaborate with the
patient’s oncologist to manage the cardiac toxic effects of the chemotherapy treatment.
Evaluation of Interventions
The nurse will determine effectiveness of interventions by evaluating progress towards
previously discussed outcomes. The expected outcome proposed for CR’s impaired gas exchange
was that he would maintain oxygen saturations and PaO2 above 95 consistently before time of
discharge. Failure to meet this expectation at any given time would prompt evaluation and
intervention by the nurse. ABG values on the first day cared for CR revealed a PaO2 of 78 while
on 60% oxygen. This does not meet the expected outcome, and the nurse recognizes that this
does not show that the patient is adequately exchanging gas. If a healthy person is able to
maintain a PaO2 of 100 on room air, which is comprised of about 21% oxygen, a person
receiving 60% oxygen should theoretically have a PaO2 of 300. The nurse also is aware that the
patient’s condition of hemolytic anemia and chemotherapy treatments can be contributing factors
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to this concerning value (Urden, Stacy, & Lough, 2010). As a result of the concerning value, the
nurse would begin to evaluate previously described nursing interventions and make changes as
needed. The nurse can help to increase PaO2 by implementing independent interventions such as
changing patient position or suctioning (Gulanick & Myers, 2011). The nurse would collaborate
with the physician and respiratory therapist in order to determine new possible interventions as
well. In this case, it was decided by the physician that there should be a change in ventilator
settings to improve gas exchange. The amount of oxygen remained at 60% while positive endexpiratory pressure (PEEP) was increased from 10 to 12. The patient showed a positive response
to this change, as his next PaO2 was 96. The nurse would continue to monitor the patient’s
respiratory status on this new ventilator setting and report concerning findings as necessary.
The nurse evaluates the effectiveness of interventions aimed at optimizing cardiac output
to maintain blood pressure within normal limits throughout hospitalization. This can be done by
evaluating the effectiveness of the vasopressive therapy (Gulanick & Myers, 2011). CR was on
10mcg of norepinephrine on the first day of care. Towards the end of this day, CR’s blood
pressure was decreasing, ranging from 80-90/49-60. The nurse evaluates this data and
understands that this blood pressure is below normal limits. The nurse knows that vasopressive
therapy is used to cause vessel constriction and increase contractility of the heart; therefore, an
increase in the amount of this medication would increase blood pressure (Hodgson & Kizior,
2012). To correct the low blood pressure, the norepinephrine was increased to 12mcg. This
change would be continually evaluated for effectiveness by cardiac assessment, specifically
focusing on blood pressure. This change proved to be effective, because CR’s blood pressure
went up to the 100s/80s, which is an ideal blood pressure to ensure perfusion.
Conclusion
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In conclusion, in order to properly plan, implement, and evaluate patient care, the whole
patient must be considered. By analyzing CR’s medical history, pathophysiology of presenting
medical diagnosis, and by careful assessment, it is possible to assign pertinent nursing diagnoses
that can be prioritized by utilizing nursing theory. Outcomes and interventions are aimed at
addressing priority issues and are based on scientific rationale and nursing research.
Interventions are continually evaluated by the nurse with the goal to obtain expected outcomes.
Personal learning gained from this discussion includes the importance of viewing the patient as a
holistic being, the meticulous art of prioritization, and the importance and necessity of basic
independent nursing interventions.
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References
Al-Gamal, E., & Long, T. (2010). Anticipatory grieving among parents living with a child with
cancer. Journal Of Advanced Nursing, 66(9), 1980-1990. doi: 10.1111/j.13652648.2010.05381.x
Dreyer, A., & Nortvedt, P. (2008). Sedation of ventilated patients in intensive care units:
Relatives’ experiences. Journal Of Advanced Nursing, 61(5), 549-556. doi:
10.1111/j.1365-2648.2007.04555.x
Gulanick, M., & Myers, L. J. (2011). Nursing care plans. (7th ed.). St Louis, MO: Elsevier
Mosby.
Hodgson, B. B., & Kizior, J. R. (2012). Nursing drug handbook. St. Louis, MO: Elsevier
Saunders.
Ignatavicius, D. D., & Workman, L. M. (2010). Medical-surgical nursing. (6th ed.). St. Louis,
MO: Saunders Elsevier.
Johnson, M. B., & Webber, B. P. (2010). An introduction to theory and reasoning in nursing.
(3rd ed.). Philadelphia, PA: Wolters Kluwer.
Sentara. (2008). Mechanical ventilation. Retrieved from
https://secure3.compliance360.com/DMZ/Policy/PolicyCatalog.aspx?PD=O8WBP3JVW
9YCIJhFJydbn%2b2Rec4w1e5f5ycctGV5d65h0A1EP4gQHTqBDqGiAYlPqCwDNY5L
uOw7Bl0sq5PZH9zIs%2btSy%2b13A3ed1tXEktXueIG2EyWWnixJCugrg8Xze0kOJ0O
nHQiNe3qvqHqby7phvrVZ5BI1#Section420
The American Association of Critical Care Nurses. (2013). AACN Scope and Standards of For
Acute and Critical Care Nursing Practice. Retrieved from
http://www.aacn.org/WD/Practice/Content/standards.content
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Urden, D. L., Stacy, M.K., & Lough, E. M. (2010). Critical care nursing. (6th ed.). St. Louis,
MO: Mosby Elsevier.
Yesilbalkan, Ö., Karadakovan, A., & Göker, E. (2009). The effectiveness of nursing education as
an intervention to decrease fatigue in Turkish patients receiving chemotherapy. Oncology
Nursing Forum, 36(4), E215-E222. Retrieved from
http://ehis.ebscohost.com.proxy.lib.odu.edu/ehost/detail?sid=e747e170-7393-43fa-aa03a2983376acbb%40sessionmgr4003&vid=7&hid=116&bdata=JnNpdGU9ZWhvc3QtbGl2
ZQ%3d%3d#db=a9h&AN=42986412
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Honor Code:
"I pledge to support the Honor System of Old Dominion University. I will refrain from
any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as
a member of the academic community, it is my responsibility to turn in all suspected violators of
the Honor Code. I will report to a hearing if summoned."
Natalie Eyer
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NURS 451 Client Case Study
Grading Criteria
Grading Criteria
Points
Introduction
Pt. Overview
Scope of paper
2
1
Medical Diagnosis
Dx for ICU adm.
Patho
Related S/S
2
4
4
Nursing Diagnosis
5 NANDA (1+ psych/soc)
Priority with theorist support
5
10
Outcomes for top 2 NDX
Appropriate for NDX
Attainable within timeframe
#1 #2
2.5 2.5
2.5 2.5
Interventions for top 2 NDX
Interventions with rationale
SOP /Clinical Path
Patient/family teaching
Critical Thinking
Cultural Considerations
#1
6
2
2
2
Evaluation
Progress toward outcomes
Additional/alternative plan
#1 #2
5 5
1 1
Conclusion
Review of learning
#2
6
2
2
2
3
3
Faculty Comments
Points
Awarded
CASE STUDY
Grading Criteria
Sources
5+ sources
3+ primary nursing research
Study results reviewed/applied
Study poorly reviewed/applied
Research omitted
19
Points
1
3 3 3
1 1 1
0 0 0
APA Format (Cover page,
headings, margins, type size)
Format conforms to APA Format
Format includes 1-3 APA errors
Format includes 4-6 APA errors
Format includes >6 errors
3
2
1
0
APA- References/Reference Page
Conform to APA Format
Include 1-3 APA errors
Include 4-6 APA errors
Include >6 APA errors
Do not conform to APA format
4
3
2
1
0
Writing Style (Grammar, spelling,
punctuation, language)
Logical, organized, without errors
3
Logical, organized minor errors
(<5)
2
Lacks logic/organization OR major
spelling/grammar/errors (>5)
1
Lacks logic / organization AND
major spelling / grammar / errors
(>5)
0
Comments:
Faculty Comments
Points
Awarded