| Course | NU 673 Psychiatric Mental Healthcare I |
|---|---|
| Unit | Unit 7 |
| Paper type | Interdisciplinary consultation request |
| Length | About 870 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 673 Unit 7
Consultation Request to Urology: Can a 79-Year-Old Woman's Oxybutynin Be Replaced With a Non-Anticholinergic Treatment?
Student Name
Department of Nursing, Herzing University
NU 673: Psychiatric Mental Healthcare I
Instructor Name
March 5, 2026
Consultation Request to Urology: Can a 79-Year-Old Woman's Oxybutynin Be Replaced With a Non-Anticholinergic Treatment?
The Question
To: the patient's urologist. From: the psychiatric mental health nurse practitioner treating Mrs. B. for depression and cognitive decline. Question: can her oxybutynin 5 mg twice daily be stopped and replaced with a treatment for overactive bladder that does not have anticholinergic effects, and if so, which would you recommend? We are asking because her cognitive decline appears to be substantially driven by her combined anticholinergic medications, and oxybutynin is one of three.
Why We Are Asking: The Short History
Mrs. B. is a composite 79-year-old woman who lives alone and was referred for six months of low mood and memory decline. On review of her full medication list, she was taking three strongly anticholinergic drugs: paroxetine, oxybutynin, and a nightly over-the-counter sleep product containing diphenhydramine which her daughter started buying for her about the time the decline started. Her Montreal Cognitive Assessment score was 20 of 30, with deficits mainly in attention and free recall and preserved recognition, a pattern more consistent with a reversible cause than with early Alzheimer disease. Oxybutynin is among the strongly anticholinergic drugs the latest Beers Criteria list as ones to avoid for older patients, a caution that weighs most for people whose thinking is already affected (American Geriatrics Society Beers Criteria Update Expert Panel, 2023), and the effects of anticholinergic drugs on cognition add together (Boustani et al., 2008).
What Has Already Been Done
The diphenhydramine product was stopped on February 24. Paroxetine is being cross-tapered to sertraline over four weeks, ending around March 23. Oxybutynin is the remaining strongly anticholinergic drug. Delirium screening was negative; thyroid function, B12, and calcium are normal; sodium was mildly low at 132 mmol/L and is being rechecked by primary care. We have not changed the oxybutynin, because we do not know the details of her bladder condition or what has been tried, and she relies on it: she told us that before starting it she was waking four or five times a night to urinate and had one fall on the way to the bathroom.
What Her Bladder Symptoms Are Now
To help you judge whether a change is realistic, here is what she and her daughter report. On oxybutynin, she wakes to urinate about twice a night, compared with four or five times before starting it. She has daytime urgency about once or twice a day, with occasional small leaks that she manages with a pad. Her coffee intake is four cups daily, mostly in the morning, and a glass of water with each medication dose. She has had no urinary tract infections in the past year that we know of. She is anxious about any change that might bring back the night waking, because of the fall she had before; any plan will need to address the night-time risk, perhaps with a bedside commode during the transition, which her daughter has said she can arrange. She also says she has never been offered bladder training or pelvic floor exercises, though she is willing to try them.
What Would Help Us
We would be grateful for your view on three specific points. First, whether behavioral treatment, such as bladder training and timed voiding, would be reasonable to start now, given that current guidance places behavioral therapies first for overactive bladder (Cameron et al., 2024). Second, whether a beta-3 agonist such as mirabegron or vibegron would be appropriate for her; her blood pressure is controlled on metoprolol and lisinopril, readings in our clinic have been 128/76 to 134/80, and we note that blood pressure monitoring is usually advised with mirabegron. Third, how you would sequence the change: whether to stop oxybutynin and start the replacement at the same time, or taper, and what to watch for in the first weeks.
How We Would Use Your Answer
If you recommend a non-anticholinergic replacement, we would ask you or her primary care clinician to make the change after the paroxetine cross-taper is complete in late March, so that we can see the effect of each change separately; we would then repeat her cognitive testing eight weeks later. If you recommend continuing oxybutynin, for example because her bladder symptoms are severe and other options have failed, we would accept that, note it as a continuing contributor, and focus on the other two changes. If a trospium formulation, which crosses into the brain less than oxybutynin, is your preferred compromise, we would find that helpful as well.
What We Are Not Asking
We are not asking you to evaluate her cognition or depression, which we are managing, or to change any other medication. We are also not asking for a new urological workup unless you think one is needed.
Timing and Contact
A reply within the next three weeks would allow us to plan the change for the end of March. Her daughter, who manages her pill organizer and has her consent to discuss her care, can help arrange an appointment. We can be reached through the clinic's secure messaging or by phone at the number below, and we are glad to discuss by phone if that is quicker for you.
References
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
Boustani, M., Campbell, N., Munger, S., Maidment, I., & Fox, C. (2008). Impact of anticholinergics on the aging brain: A review and practical application. Aging Health, 4(3), 311-320. https://doi.org/10.2217/1745509X.4.3.311
Cameron, A. P., Chung, D. E., Dielubanza, E. J., Enemchukwu, E., Ginsberg, D. A., Helfand, B. T., Linder, B. J., Reynolds, W. S., Rovner, E. S., Souter, L., Suskind, A. M., Takacs, E., Welk, B., & Smith, A. L. (2024). The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder. Journal of Urology, 212(1), 11-20. https://doi.org/10.1097/JU.0000000000003985
Reading the NU 673 Unit 7 instructions
Unit 7 asks you to write a consultation request to another discipline. Expect to state the question, give a short relevant history, describe what has been done, provide information the consultant needs, ask specific questions, explain how the answer will be used, say what you are not asking and give timing and contact details. Many versions ask which discipline to address. Check whether your section allows a consultation from your placement. A good consultation note respects the consultant's time by putting the question first and leaving out irrelevant detail. Specific questions get specific answers. Saying what you are not asking prevents scope creep and shows awareness of each discipline's role. A one-page note is usually enough.
How this NU 673 Unit 7 example is built
The note opens with the question in a sentence, addressed to the urologist. The history is brief and focused on why the question matters, the anticholinergic burden and cognitive decline. The section on what has been done shows the consultant the request is part of a planned sequence. Bladder symptoms are described in the patient's terms, which helps the urologist judge whether a change is realistic. Three numbered questions follow. The section on using the answer explains who will make the change. The section on what is not being asked keeps the request focused. Timing and contact details close the note, including the daughter who manages the pill organizer. Each point cites guidance where relevant.
NU 673 Unit 7 rubric: what full points look like
Herzing's rubric for a consultation note generally covers clarity of the question, relevance of the history, information provided for the consultant, specificity of questions, professional communication and scope. Question clarity decides much of the grade, and graders look for the request in the opening sentence. History points reward relevant detail without excess. Information criteria look for data the consultant needs to answer. Specificity earns credit for numbered, answerable questions. Communication points go to a respectful, concise tone. Scope criteria reward stating what is not being asked. The 2023 Beers Criteria and the AUA overactive bladder guideline belong in the APA 7 list.
NU 673 Unit 7 help: mistakes that cost points
Consultation notes in Unit 7 often fall short by burying the question at the end of a long history. Another frequent problem is vague requests, such as please evaluate. Students often include the full psychiatric history when the consultant needs only what bears on the question. Information the consultant needs, such as current symptoms, is missing. The note does not say how the answer will be used. Timing is left out. Scope is unclear, so the consultant may wonder whether to address cognition too. Finally, put the question first, because graders read the note as a busy specialist would and judge it by whether the request is clear within the first lines.
Get a NU 673 Unit 7 example written to your instructions
Send the Unit 7 instructions and the rubric from your NU 673 classroom, and name the discipline the note is addressed to. The custom example leads with one question, filters the history to it, records what has been excluded, names the uncertainty as a choice between alternatives and states what each answer would change. First custom sample free, returned in 24 to 48 hours.
More NU 673 papers and PMHNP samples
- NU 673 Unit 1: Presenting problem profile
- NU 673 Unit 2: Community resource pathway
- NU 673 Unit 3: Psychoeducation session outline
- NU 673 Unit 4: Consent and confidentiality brief
- NU 673 Unit 5: Medication and cognition review
- NU 673 Unit 6: Follow-up interval rationale
- NU 673 Unit 8: Serial encounter record
- NU 672 Unit 7: Treatment review and revision brief
- NU 674 Unit 7: Treatment frame stability plan
- NU 670 Unit 7: Lifestyle and psychoeducation package
- NU 671 Unit 7: Collateral information summary
NU 673 Unit 7 questions, answered
Which discipline should the note address?
Whichever discipline your instructions point at. Where the choice is yours, pick one whose answer cannot be reached inside psychiatry: primary care, pharmacy, neurology, occupational therapy or a school-based team. The sharper the boundary between what you can settle and what you cannot, the easier it is to write a question worth sending, and the reasoning carries the grade.
How long should the note run?
Short enough that the question survives the reading. One page is usually plenty, and consultants generally prefer less. Where the instructions require a fuller case description, keep the question and the consequences at the front and let the history follow, so a reader who stops after the first section still knows exactly what is being asked and why.
Can I use a consultation from my placement?
No. Write a composite and say so. Notes you exchanged in a real service belong to that record and to the people in it, and consent for a course file was not part of that exchange. A constructed case also lets you build the specific uncertainty the deliverable needs, which the encounters you happen to see rarely supply on time.
Where can I find a free NU 673 Unit 7 sample paper?
The full NU 673 Unit 7 urology consultation note is on this page free of charge, the question, focused history and three specific asks. A consultation note to another discipline can be written on request.
How do I write a consultation request to another specialty?
State the question first, give only the history that bears on it, describe what has been done, ask numbered questions, say how the answer will be used and what you are not asking, and give timing. This sample does that for a urology referral.