NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

Your own experiences might tell you that expectations from family, friends, and work—as well as your own expectations regarding achievement, success, and happiness—can create stress. Stressors are a normal part of life, and stress traditionally has been viewed as an adaptive function with a set of physiological responses to a stressor. In a situation where stress is perceived, the organism is physiologically prepared to attack or flee from the threat. Those with effective fight or flight responses tended to survive long enough to reproduce, so we are descended from those who are genetically hardwired for self-protection. When you experience stress, your biology, emotions, social support, motivation, environment, attitude, immune function, and wellness all feel the ripple effect. NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

This stress response is an adaptive response the human body has to threats; however, stress can also be difficult to handle and—depending upon the nature and intensity of the stress—can result in anxiety disorders, obsessive-compulsive disorders, or trauma- and stressor-related disorders. This week, you will focus on these disorders and explore strategies to accurately assess and diagnose them.

Learning Objectives – NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

Students will:

  • Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
  • Formulate differential diagnoses using DSM-5 criteria for patients with anxiety disorders, PTSD, and OCD across the lifespan

Learning Resources

Required Readings (click to expand/reduce)

Sadock, B. J., Sadock, V. A., and Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

  • Chapter 9, Anxiety Disorders
  • Chapter 10, Obsessive-Compulsive and Related Disorders
  • Chapter 11, Trauma- and Stressor-Related Disorders
  • Chapter 31.11 Trauma-Stressor Related Disorders in Children
  • Chapter 31.13 Anxiety Disorders in Infancy, Childhood, and Adolescence
  • Chapter 31.14 Obsessive-Compulsive Disorder in Childhood and Adolescence

Document: Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation Exemplar

Required Media (click to expand/reduce)
Video Case Selections for Assignment (click to expand/reduce)

Select oneof the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Symptom Media. (Producer). (2017). Training title 15 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-15

Symptom Media. (Producer). (2016). Training title 21 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-21

Symptom Media. (Producer). (2016). Training title 37 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-37

Symptom Media. (Producer). (2016). Training title 40 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-40

Symptom Media. (Producer). (2017). Training title 55 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-55

Symptom Media. (Producer). (2017). Training title 85 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-85

Symptom Media. (Producer). (2018). Training title 95 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-95

Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

“Fear,” according to the DSM-5, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2013). All anxiety disorders contain some degree of fear or anxiety symptoms (often in combination with avoidant behaviors), although their causes and severity differ. Trauma-related disorders may also, but not necessarily, contain fear and anxiety symptoms, but their primary distinguishing criterion is exposure to a traumatic event. Trauma can occur at any point in life. It might not surprise you to discover that traumatic events are likely to have a greater effect on children than on adults. Early-life traumatic experiences, such as childhood sexual abuse, may influence the physiology of the developing brain. Later in life, there is a chronic hyperarousal of the stress response, making the individual vulnerable to further stress and stress-related disease. NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

Photo Credit: Hill Street Studios / Blend Images / Getty Images

For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5 criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5 criteria.

To Prepare:

  • Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.
  • Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
  • By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Identify at least three possible differential diagnoses for the patient.
By Day 7 of Week 4

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
  • Objective: What observations did you make during the psychiatric assessment?
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Submission and Grading Information – NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD
  • Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:

Week 4 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 4

To participate in this Assignment:

Week 4 Assignment

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BEGIN Transcript:

 

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DISCLAIMER

 

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THE INFORMATION CONTAINED HEREIN IS OF A GENERAL NATURE AND CANNOT SUBSTITUTE FOR THE ADVICE OF A MEDICAL PROFESSION THE CONTENT PROVIDED MAY NOT APPLY TO YOU OR YOUR SYMPTOMS. YOU SHOULD NOT REPLY ON THIS INFORMATION AS A SUBSTITUTE FOR, NOR DO THEY REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS YOUR HEALTH OR THE CONTENT, YOU SHOULD ALWAYS CONSULT WITH A PHYSICIAN OR OTHER HEALTH-CARE PROFESSIONAL. DO NOT DISREGARD, AVOID OR DELAY OBTAINING MEDICAL OR HEALTH RELATED ADVICE FROM YOUR HEALTH-CARE PROFESSIONAL. THE CONTENT SHOULD NOT BE USED IN PLACE OF A CALL OR VISIT TO A MEDICAL, HEALTH OR OTHER COMPETENT PROFESSIONAL, WHO SHOULD BE CONSULTED BEFORE ADOPTING ANY OF THE SUGGESTIONS IN THE CONTENT OR DRAWING INFERENCES FROM IT.

 

00:00:00

SYMPTOM MEDIA, LLC DISCLAIMS ALL RESPONSIBILITY FOR ANY LIABILITY LOSS OR RISK, PERSONAL OR OTHERWISE, OF THE USE AND APPLICATION OF ANY OF THE CONTENT CONTAINED HEREIN.

 

00:00:10

[sil.]

 

00:00:15

UNKNOWN On your mental health checklist here, I see you checked shame and checked embarrassment.

 

00:00:20

UNKNOWN Yes.

 

00:00:25

UNKNOWN And checked feelings of loss of control. Is… is that all accurate?

 

00:00:30

UNKNOWN Very.

 

00:00:30

UNKNOWN Are those feelings weak feelings, strong feelings, somewhere in between?

 

00:00:35

UNKNOWN Strong.

 

00:00:40

UNKNOWN When… when did this feeling start?

 

00:00:40

UNKNOWN About the time I started pulling out my hair.

 

00:00:45

UNKNOWN Uh-huh. And how long ago was that?

 

00:00:50

UNKNOWN I have, maybe six years ago.

 

00:00:50

UNKNOWN Uh…

 

00:00:50

UNKNOWN Could’ve been seven, I’m not sure.

 

00:00:55

UNKNOWN Okay. Where… where on your body did you first pull out here?

 

00:00:55

UNKNOWN Hmm, my eyebrows.

 

00:00:55

UNKNOWN Uh-huh.

 

00:01:00

UNKNOWN Umm…Yeah, I just started playing with them while I was at work, proofreading reports I typed umm… with more just like rubbing them, you know, playing with them, not actually pulling the hairs out just like a nervous habit.

 

00:01:15

UNKNOWN Uh-huh.

 

00:01:15

UNKNOWN You know that that was all.

 

00:01:20

UNKNOWN And… and did that change what you were doing?

 

00:01:25

UNKNOWN Umm… Well, my coworkers noticed it before I didn’t…

 

00:01:30

UNKNOWN Uh-huh.

 

00:01:30

UNKNOWN You know, one day she said to me uh… goodness girl, that’s how we used to talk to each other.

 

00:01:35

UNKNOWN Oh, okay.

 

00:01:35

UNKNOWN She said, “Goodness girl, you’re plucking out your eyebrows.” And I… I said, “I was not.” Umm… “Maybe just some fell out while I was rubbing them. They can do that, you know, like fall out or never do…

 

00:01:50

UNKNOWN Right. Uh-huh.

 

00:01:50

UNKNOWN Well, at least, I think they can. Then when I checked in the mirror, my… my right eyebrow had fewer hairs on my left eyebrow. NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

 

00:02:00

UNKNOWN Was that the first time you ever had pulled out any hairs?

 

00:02:05

UNKNOWN I mean, apart from maybe when getting ready for a party, you know, the first time was by accident so…

 

00:02:10

UNKNOWN Uh… Uh-huh. And it was only your right eye… eyebrow?

 

00:02:15

UNKNOWN Uh… Well, at first, yeah, then uh… I… I put wax on my right eye… eyebrows so that when I reached up there it felt different.

 

00:02:25

UNKNOWN Oh, oh.

 

00:02:25

UNKNOWN Uh… Then umm… I started playing with my left eyebrow and pulling those hairs out umm… until all the hair was gone from both eyebrows umm… I mean, some women do that for fashion and then they… they draw them in.

 

00:02:45

UNKNOWN Right.

 

00:02:45

UNKNOWN Mostly older women, so that’s what I did, but then they both grew back and so I never touched him again.

 

00:02:55

UNKNOWN Uh-huh. They never pulled out eyebrow, hairs again?

 

00:02:55

UNKNOWN Never. Mm-mm. Then uh… I just started pulling out hair from my scalp.

 

00:03:05

UNKNOWN Mm-hmm.

 

00:03:05

UNKNOWN It just started the same, playing and twisting, and trolling like I was a little girl and then somewhere in that I started pulling the hairs out.

 

00:03:20

UNKNOWN How did you feel when you realize that’s what you were doing?

 

00:03:25

UNKNOWN Oh, shit. When I felt sorry… Pardon the language, but that’s what I felt like, here we go again.

 

00:03:35

UNKNOWN Did anyone else notice?

 

00:03:40

UNKNOWN Coworkers, I mean, you… you can’t get anything passed at bunch. I mean, I would deliberately play and twist and twirl with my hair in places that I knew I hadn’t pulled any hair out, you know, just in case I stopped subconsciously pulled more hair out uh… but they… they noticed the bald spots. I mean, they were little bald spots, but like I said, you… you can’t get anything passed at bunch. NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

 

00:04:05

UNKNOWN So you quit pulling hairs out of your eyebrows and then you started pulling hairs out of your scalp, did you pull hairs from anywhere else?

 

00:04:15

UNKNOWN Where else can I pull hairs from?

 

00:04:20

UNKNOWN Arms, legs, private parts.

 

00:04:20

UNKNOWN No. Hell, no. It was bad enough I was going to bald as it was.

 

00:04:25

UNKNOWN I… I notice you have a scarf on today.

 

00:04:30

UNKNOWN Yeah, I’ve got a scarf on over a wig. I mean, there’s not much hair going on underneath it. No one seeing me with a bald head. No.

 

00:04:40

UNKNOWN That… that uh… embarrasses you and makes you feel ashamed?

 

00:04:45

UNKNOWN Yes, sir, it does.

 

00:04:45

UNKNOWN Uh-huh.

 

00:04:45

UNKNOWN Do you have any other habits or rituals that concern you?

 

00:04:50

UNKNOWN What do you mean “rituals”?

 

00:04:55

UNKNOWN Umm… Some people have habits or rituals is like, they have to touch a refrigerator a certain number of times before they open or they have to wash their hands at a certain number of times before they feel like their hands are clean, ritual something you do is a habit that maybe other people don’t usually do. NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

 

00:05:15

UNKNOWN Yeah. I mean, when I have to unplug my… my mixer or… or hair dryer, I mean, not that I’m drying much hair nowadays, but I have to unplug it then plug it back in, unplug it, plug it back in…

 

00:05:30

UNKNOWN Uh-huh.

 

00:05:30

UNKNOWN Just same with the light switch. You know, I have to switch it on, switch off, switch it on, switch it off.

 

00:05:35

UNKNOWN Uh-huh. How many times?

 

00:05:40

UNKNOWN Eleven.

 

00:05:40

UNKNOWN Eleven times plugging and unplugging and also turning on and off switches. Uh-huh.

 

00:05:45

UNKNOWN Yes.

 

00:05:45

UNKNOWN They must cut in your time.

 

00:05:45

UNKNOWN Sure, it does.

 

00:05:50

UNKNOWN Mm-hmm. How long has that been going on?

 

00:05:55

UNKNOWN Since I was a little girl. You know, my mom would always get mad at me for taking so long, you know. I mean, I don’t know what she thought I was doing in the bathroom and bedroom for so long all the time. I can pitch her yelling at me to come downstairs to dinner or get into the car.

 

00:06:15

UNKNOWN Uh-huh. Any other rituals?

 

00:06:15

UNKNOWN I think that’s enough for one person.

 

00:06:20

UNKNOWN Yeah. What… what about thoughts that get stuck in your head, they play over and over you think about it and even though you want to quit thinking about it. NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

 

00:06:35

UNKNOWN Like cats?

 

00:06:35

UNKNOWN Uh-huh. What… what about cats?

 

00:06:40

UNKNOWN Cats carry diseases, you know.

 

00:06:40

UNKNOWN Uh-huh.

 

00:06:45

UNKNOWN I mean, cats being around babies can make babies sick, same with mother is carrying baby sick. Cats… cats are like pigeons carrying diseases. I think about this all the time when I’m… when I’m on the bus, when I’m walking on the grass, when I’m… when I’m sitting on the couch in my friend’s house like, I’m always worried that I might touch something, there’s some dirty cat has like licked or… or spit on on something. You know, I can’t stop thinking about it. Like, I’m worried that I might then carry that disease to some poor woman somewhere that’s pregnant with a baby or… or that my new neighbor will bring a cat or my old neighbor will get a cat like, I hate cats.

 

00:07:30

[sil.]

 

00:07:35

END Transcript

NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Excellent Good Fair Poor
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.

In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS

18 (18%) – 20 (20%)
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
16 (16%) – 17 (17%)
The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
14 (14%) – 15 (15%)
The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD
(0%) – 13 (13%)
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.
In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
18 (18%) – 20 (20%)
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
16 (16%) – 17 (17%)
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.
14 (14%) – 15 (15%)
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.
(0%) – 13 (13%)
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
In the Assessment section, provide:
• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
23 (23%) – 25 (25%)

The response thoroughly and accurately documents the results of the mental status exam.

Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

20 (20%) – 22 (22%)

The response accurately documents the results of the mental status exam.

Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

18 (18%) – 19 (19%)

The response documents the results of the mental status exam with some vagueness or innacuracy.

Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.

(0%) – 17 (17%)
The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
(9%) – 10 (10%)
Reflections are thorough, thoughtful, and demonstrate critical thinking.
(8%) – 8 (8%)
Reflections demonstrate critical thinking. NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD
(7%) – 7 (7%)
Reflections are somewhat general or do not demonstrate critical thinking.
(0%) – 6 (6%)
Reflections are incomplete, inaccurate, or missing.
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
14 (14%) – 15 (15%)
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
12 (12%) – 13 (13%)
The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.
11 (11%) – 11 (11%)
Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.
(0%) – 10 (10%)
Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
(5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

(4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

(0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation
(5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
(4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors
(3%) – 3 (3%)
Contains several (three or four) grammar, spelling, and punctuation errors
(0%) – 2 (2%)
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Total Points: 100

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