HYPOGONADISM 1 Clinical evaluation and management of hypogonadism United States University FNP: 593 Acute illnesses across the lifespan Brittany Chavez 12/10/2021 TITLE OF PAPER Clinical evaluation and management of hypogonadism The purpose of this paper is to discuss Hypogonadism in regard to clinical evaluation, symptomatic presentation, management and evaluation of clinical guidelines. The paper will explore differing viewpoints and key concepts in relation to hypogonadism. The effects of cultural, spiritual and beliefs in treatment and evaluation, and the impact of research on this endocrine imbalance. Also reviewed will be research studies addressing the clinical symptoms and trials for new treatment options. Review of topic and rationale for selection of topic Hypogonadism is a common endocrine disorder originating from two causes. Primary hypogonadism is caused from a direct androgen imbalance originating from the testes. This clinical syndrome which the testes fail to produce physiologic levels of testosterone and a normal number of spermatozoa due to defects in the hypothalamic-pituitary-gonadal axis at one or more levels. (Ross & Bhasin, 2016). This topic was chosen due to the frequency of cases seen in the family practice setting. Hypogonadism is a common disorder associated with low bone density, poor muscle mass, anemia, and sexual dysfunction that affects men in a variety of ways. Among secondary osteoporosis risk factors, male hypogonadism is one of the most important, accounting for progressive bone loss in aging men, especially when late-onset hypogonadism is diagnosed (LOH). (Rochira, 2020) This disorder can affect all aspects of life and greatly impact the emotional state and feelings of self-worth. This paper will address primary hypogonadism in terms of diagnostic, and treatment based on guidelines. Evaluation of key concepts related to the topic The key concepts evaluated for the paper includes disease process in formation of androgen deficiency. Androgens are important for male reproductive and sexual functions, body TITLE OF PAPER 3 composition, erythropoiesis, muscle and bone health, and cognitive functions. Symptoms presentation commonly seen in the primary care setting. Diagnostic criteria in the evaluation to determine the extent of deficiency in relation to the symptoms presented and the treatment guidelines based on efficacy and positive outcomes. Primary Hypogonadism (PHG) is often underdiagnosed in the clinical setting due to the ambiguous symptoms presented often mimicking depression or often overlooked as normal aging process. These symptoms may present with decreased libido, weight gain, fatigue, low stamina, decrease in muscle mass, decreased energy, sleep disturbances, mood fluctuations and irritability. It is essential for the provider to consider hormonal deficiency into the differential diagnosis to effectively diagnose and rule o ...

1. HYPOGONADISM 1
Clinical evaluation and management of hypogonadism
United States University
FNP: 593 Acute illnesses across the lifespan
Brittany Chavez
12/10/2021
TITLE OF PAPER
Clinical evaluation and management of hypogonadism
The purpose of this paper is to discuss Hypogonadism in regard
to clinical evaluation,
symptomatic presentation, management and evaluation of
clinical guidelines. The paper will
explore differing viewpoints and key concepts in relation to
hypogonadism. The effects of
cultural, spiritual and beliefs in treatment and evaluation, and
the impact of research on this
endocrine imbalance. Also reviewed will be research studies
addressing the clinical symptoms

2. and trials for new treatment options.
Review of topic and rationale for selection of topic
Hypogonadism is a common endocrine disorder originating from
two causes. Primary
hypogonadism is caused from a direct androgen imbalance
originating from the testes. This
clinical syndrome which the testes fail to produce physiologic
levels of testosterone and a normal
number of spermatozoa due to defects in the hypothalamic-
pituitary-gonadal axis at one or more
levels. (Ross & Bhasin, 2016). This topic was chosen due to the
frequency of cases seen in the
family practice setting. Hypogonadism is a common disorder
associated with low bone density,
poor muscle mass, anemia, and sexual dysfunction that affects
men in a variety of ways. Among
secondary osteoporosis risk factors, male hypogonadism is one
of the most important, accounting
for progressive bone loss in aging men, especially when late-
onset hypogonadism is
diagnosed (LOH). (Rochira, 2020) This disorder can affect all
aspects of life and greatly impact
the emotional state and feelings of self-worth. This paper will

3. address primary hypogonadism in
terms of diagnostic, and treatment based on guidelines.
Evaluation of key concepts related to the topic
The key concepts evaluated for the paper includes disease
process in formation of
androgen deficiency. Androgens are important for male
reproductive and sexual functions, body
TITLE OF PAPER 3
composition, erythropoiesis, muscle and bone health, and
cognitive functions. Symptoms
presentation commonly seen in the primary care setting.
Diagnostic criteria in the evaluation to
determine the extent of deficiency in relation to the symptoms
presented and the treatment
guidelines based on efficacy and positive outcomes.
Primary Hypogonadism (PHG) is often underdiagnosed in the
clinical setting due to the
ambiguous symptoms presented often mimicking depression or
often overlooked as normal
aging process. These symptoms may present with decreased
libido, weight gain, fatigue, low

4. stamina, decrease in muscle mass, decreased energy, sleep
disturbances, mood fluctuations and
irritability.
It is essential for the provider to consider hormonal deficiency
into the differential
diagnosis to effectively diagnose and rule out PHG. Diagnosis
of PGH include total serum
testosterone taken in a time sensitive manner as the peak
testosterone in men is roughly 8am.
Diagnosis requires at minimum 2 low testosterone levels in
different occasions. Deficiency is
noted to be below 300 testosterone. FSH and LH are required to
be tested in addition to
testosterone as well as ruling out other factors such as
endocrine, thalamus, pituitary, and thyroid
as a cause for the decrease in testosterone. Age is a
consideration in the diagnosis of PHG as
there are multiple types of hypogonadism that should be
considered for a younger patient such as
congenital hypogonadism. In the patient case presented in
appendix B the patient was found to
have serum testosterone of 250. The treatment however was to
be delayed until further testing
was completed to follow diagnostic guidelines.

5. Treatment of PHG has been debated as there are pro’s and cons
of this therapy. Recent
studies have indicated that testosterone replacement therapy
(TRT) can greatly improve the
patients quality of life as well as can be cardioprotective.
Testosterone administration was found
TITLE OF PAPER 4
to increase skeletal muscle mass and performance while also
increasing myogenic gene
programming, myocellular translational efficiency and capacity,
resulting in higher protein
turnover and net protein accretion. (Gharahdaghi et al., 2019).
Some studies have found that TRT
could potentially be harmful in the older population, however
there is lack of supporting
evidence for this case.
Description of multiple viewpoints
Androgens are important for male reproductive and sexual
functions, body composition,
erythropoiesis, muscle and bone health, and cognitive functions.
(Professionals, 2021).

6. Guidelines for treatment of this disorder differ in the aspect of
age. Multiple studies were found
to state there despite lack of full study to the matter there is
thought to be a potential
cardiovascular risk associated with TRT in patients who are
older. On the other hand there is also
data and research studies finding that TRT can reduce LDLs
total cholesterol, increase skeletal
muscle mass and improve gene function. The risk associated
with not treating this condition
could lead to depression, impaired relations, increase in
cholesterol, increased weight gain, and
osteoporosis.
Assessment of the merit of evidence found on this topic
(soundness of research)
The research in the 2 studies reviewed were sound in their
method based on the method,
large sample size, randomization, time frame of research study
conducted, and the findings of the
results closely aligned with the current guidelines in terms of
diagnosis and treatment.
Evaluation of current EBM guidelines
Guidelines indicate that treatment with TRT should be started
and have been shown to

7. improve the overall health and outcome of patients. The one
consideration of withholding
treatment includes obesity as there is greater risk of adverse
outcomes. These patients should first
TITLE OF PAPER 5
be initiated on a lifestyle/weight reduction plan prior to starting
to decrease comorbidities that
may place them at greater risk. Although the effects of
testosterone treatment are usually minor,
they can have a positive impact on body composition, metabolic
control, psychological, and
sexual parameters. Observational studies reveal a link between
restored physiological
testosterone levels, muscle mass, and strength, as measured by
leg press strength and quadriceps
muscle volume. (Professionals, 2021)
Cultural, spiritual, and socioeconomic considerations
Considerations to spiritual and cultural beliefs should be
included in practice when
considering treatment with hormone therapy. Certain religious
beliefs forbid any form of animal

8. or human product be put in the body. For these patients it is
important to explore natural options
to improve the bodies ability to manufacture the testosterone on
its own and any type of hormone
replacement is contraindicated for these groups and they are
considered unclean.
Discussion regarding the Standardized Procedure for this
diagnosis
Standardized treatment for primary hypogonadism should
include lipid panels, cardiac
evaluation and EKG prior to initiating treatment due to the
variability and lack of evidence for
the true effect on cardiac function in the geriatric population.
The treatment measures would
remain the same due to the risk of osteoporosis and significant
mental health and changes in the
relationship that can occur along with the patients physical
symptoms.
Discussion on how the evidence did impact/would impact
practice
The outcomes of increase virility, improved mood, improved
stamina and decrease in
lipids outweight the risk of a possible cardiac challenge that has
yet to be proven. I would want

9. to conduct more specific testing on the affects of testosterone
replacement in the older
population. After reviewing in depth this topic and guidelines I
would be more aware of the risk
TITLE OF PAPER 6
factor of hypogonadism and be more willing to approach the
topic before simply assuming
depression based on the patients changes in mood and fatigue.
Conclusion
In conclusion, primary hypogonadism is a common occurrence
in primary care and often
underdiagnosed. This condition affects all age groups and can
cause significant health concerns
that affect the patients overall health both physical and mental.
Understanding the reasoning
behind the condition and having the insight to consider this in
the differential diagnosis is an
important factor to consider when addressing patient care.
Patients may present with ambiguous
symptoms that often mimic depression. Treatment should be
initiated baring significant risk
factors such as morbid obesity, cardiac failure or renal

10. impairment. The guidelines are
comprehensive and recommend the treatment with TRT to
improve quality of life and positive
outcomes.
TITLE OF PAPER 7
References
Gharahdaghi, N., Rudrappa, S., Brook, M. S., Idris, I.,
Crossland, H., Hamrock, C., Abdul Aziz,
M. H., Kadi, F., Tarum, J., Greenhaff, P. L., Constantin-
Teodosiu, D., Cegielski, J., Phillips,
B. E., Wilkinson, D. J., Szewczyk, N. J., Smith, K., & Atherton,
P. J. (2019). Testosterone
therapy induces molecular programming augmenting
physiological adaptations to
resistance exercise in older men. Journal of cachexia,
sarcopenia and muscle, 10(6), 1276–
1294. https://doi.org/10.1002/jcsm.12472
Professionals, S.- O. (2021). EAU guidelines: Male
hypogonadism. Uroweb. Retrieved
December 16, 2021, from https://uroweb.org/guideline/male-
hypogonadism/#5
Rochira, V. (2020). Late‐ onset hypogonadism: Bone Health.
Andrology, 8(6), 1539–1550.
https://doi.org/10.1111/andr.12827
Ross, A., & Bhasin, S. (2016). Hypogonadism: Its Prevalence
and Diagnosis. The Urologic

11. clinics of North America, 43(2), 163–176.
https://doi.org/10.1016/j.ucl.2016.01.002
https://doi.org/10.1002/jcsm.12472
https://doi.org/10.1016/j.ucl.2016.01.002
TITLE OF PAPER 8
Appendix A
Soap comprehensive
Subjective:
Patient: SG Age: 65 DOB: 04/23/1956 Gender: Male
Ethnicity: Caucasian
CC
“I don’t feel like I used to”
HPI
Mr. G was last seen in clinic 1 year ago for a wellness check.
Today he is here because he has not
been feeling himself. He reports increased fatigue, low libido,
weight gain and loss of muscle
mass. He feels this has been going on for a while now and he is
concerned because it was never
an issue before. His wife has noticed a difference in his energy

12. and stamina, he is no longer
interested in many activities he used to enjoy and he is more
easily fatigued. He is healthy
overall and works out 3x weekly but has been struggling with
this in the last couple months. He
reposts there has been no change in his diet or lifestyle.
PMI:
I10 Essential hypertension
E78.00 Pure cholesterol
PMP:
Surgery on left knee for meniscus repair 1987
MEDICATIONS:
-Lisinopril 10 mg tab PO once daily
-Vitamin D3 1000IU gel capsules: 2 capsules PO once daily
ALLERGIES: NKDA, no environmental or food allergies
TITLE OF PAPER 9
IMMUNIZATIONS:
-Quadravalent influenza 10/18/2021
-Moderna covid vaccine 3/25/2021, 04/28/2021, 12/08/2021
FAMILY HISTORY:
Parents: deceased -Father: age 87, HTN, AMI -Mother: 89
breast cancer
No siblings. 3 children: no health concerns

13. SOCIAL HISTORY
Exposure to substance/tobacco/ Illicit or rec drugs: non-smoker,
denies alcohol or drug use.
Occupation: Construction worker
Nutrition: Follows dash diet and exercises 3 x weekly.
Sleep: Having difficulty sleeping, feels tired throughout the
day. He guesses he sleeps maybe 6
hours nightly.
Leisure activities/hobbies: Enjoys outdoor activities, hiking
kayaking, camping. In the winter
snow shoeing.
Stress: Has been having increased stress due to frustration in
lack of energy and libido.
Safety: No weapons in the homes, smoke detectors present and
functional, fire extinguisher in
home.
ROS:
Constitutional: Negative for appetite change, fever and
unexpected weight change.
HENT: Denies congestion, dental/mouth issues, hearing loss,
trouble swallowing, loss of smell
or rhinorrhea
Eyes: Denies any discharge or visual disturbances
Cardiovascular: Denies chest pain, shortness of breath,
palpations and leg swelling.

14. Pulmonary: Denies difficulty breathing, wheezing, cough,
hemoptysis, or chest tightness
Gastrointestinal: Negative for abdominal distention, abdominal
pain, or blood in stool
Genitourinary: Negative for decreased urine volume, difficulty
urinating and pelvic pain.
Musculoskeletal: Negative for gait problems, pain in muscle or
joints bilaterally.
Skin: denies skin changes or issues, no rash, color changes or
excessive dryness
TITLE OF PAPER 10
Neurological: Denies weakness, headaches, difficulty with
memory or dizziness
Allergic/Immunologic: no food or medication allergies and has
never been diagnosed with
seasonal allergies. Has not experienced frequent or long-term
sickness.
Psychiatric/Behavioral: Denies behavior issues, Admits to sleep
disturbance, increased stress and
depression
Objective
Vitals BP: 145/89 HR: 68 RR: 16 Temp: 98.6 Height: 5’9
Weight: 177lbs BMI: 26.14 kg/m2

15. General: Is well-dressed and tidy, and well developed. He
appears to be aware and active, and he
does not appear to be in mental or physical discomfort. Able to
maintain adequate eye contact
throughout the interview and exam.
HEENT: Extraocular Movements: Right eye- normal extraocular
motion, and no nystagmus. Left
eye- normal extraocular motion and no nystagmus. Normal
conjunctiva/sclera, PERRLA noted.
Head symmetrical without deformities. lesions or masses. Hair
evenly disbursed. Ear canals clear
with no erythema, or moisture. TM intact bilaterally.
Lungs/Thorax- Bilateral breath sounds, in all lung fields are
clear and equal. No difficulty
breathing noted. Chest wall symmetrical without barreling of
chest.
Cardiovascular- Heart sounds are WNL, strong pulses
throughout, no swelling in left or right
lower legs.
Neurological: Alert and oriented to person, place and time.
Speech is normal, without delay,
memory and thought process is intact. Cranial Nerves II, III, IV,
VI intact, visual fields normal in
all quadrants. No sensory deficits noted. No tremor or abnormal
muscle tone. Rapid alternating
movements normal, gait is steady and as expected.
Musculoskeletal – General: Normal range of motion Right
Shoulder: No tenderness or crepitus,
normal range of motion normal strength Left Shoulder: No
tenderness or crepitus, normal range
of motion normal strength Cervical back: Normal range of

16. motion, no tenderness, swelling,
edema, deformity, erythema or rigidity, normal range of motion.
Normal sensation
Gastrointestinal: Bowel tones brisk and equal all quadrants.
Abdomen is flat and soft to palpation
with no notable masses, or herniations. No distention or
guarding with palpation.
Lymphadenopathy: No cervical adenopathy
TITLE OF PAPER 11
Neuro: A/O x4, gait even and smooth, bilateral muscle strength
with no weakness noted.
Psychiatric: Appropriate mood and affect, behaviors, speech and
judgement as expected.
Skin: Free of lesions or masses, smooth, with dryness noted on
upper arms.
Assessment:
Differential DX:
- Z00.01 encounter for adult examination with abnormal
findings.
- E29.1 Hypogonadism
- G47.00 Insomnia Unspecified
- Z13.29 Screening for endocrine abnormalities

17. - E34.9 Screening for hormonal imbalance
Final diagnosis: Z00.01 encounter for adult examination with
abnormal findings.
Plan:
Diagnostic:
- Laboratory blood draw for TSH, testosterone, lipid panel,
CBC, and CMP
Treatment: None at this time
Education:
- Discussed nutrition/ diet and exercise
- Setting routine for sleeping, avoiding read, or watching TV or
using phone in bed.
- Keep log over next week twice daily of blood pressure
readings to bring to next visit.
Follow up: Follow up in 1 week for lab results and further
testing if needed.
Goals:
TITLE OF PAPER 12
- Increase sleep from 6 to 8 hours nightly

18. - Address increased fatigue at next visit.
Appendix B
TITLE OF PAPER 13
Follow up SOAP
Subjective:
Patient: SG Age: 65 DOB: 04/23/1956 Gender: Male
Ethnicity: Caucasian
CC
“Here to follow up on laboratory results”
HPI
Mr. G was last seen in clinic 1 week ago with complaints of
fatigue, decreased stamina,
decreased libido, and insomnia. He is here today with his wife
to review his resent labs to help
determine if her has an endocrine or hormonal imbalance
causing his symptoms. He reports that
he continues to struggle with sleep and decreased libido. He was
not able to work out this week
as he was not “feeling up to it”. He denies illness, fever, or
malaise at this time.

19. PMI:
I10 Essential hypertension
E78.00 Pure cholesterol
PMP:
Surgery on left knee for meniscus repair 1987
MEDICATIONS:
-Lisinopril 10 mg tab PO once daily
-Vitamin D3 1000IU gel capsules: 2 capsules PO once dail y
ALLERGIES: NKDA, no environmental or food allergies
IMMUNIZATIONS:
-Quadravalent influenza 10/18/2021
-Moderna covid vaccine 3/25/2021, 04/28/2021, 12/08/2021
FAMILY HISTORY:
Parents: deceased -Father: age 87, HTN, AMI -Mother: 89
breast cancer
No siblings. 3 children: no health concerns
TITLE OF PAPER 14
SOCIAL HISTORY
Exposure to substance/tobacco/ Illicit or rec drugs: non-smoker,
denies alcohol or drug use.
Occupation: Construction worker
Nutrition: Follows dash diet and exercises 3 x weekly.
Sleep: Having difficulty sleeping, feels tired throughout the

20. day. He guesses he sleeps maybe 6
hours nightly.
Leisure activities/hobbies: Enjoys outdoor activities, hiking
kayaking, camping. In the winter
snow shoeing.
Stress: Has been having increased stress due to frustration in
lack of energy and libido.
Safety: No weapons in the homes, smoke detectors present and
functional, fire extinguisher in
home.
ROS:
Constitutional: Negative for appetite change, fever and
unexpected weight change.
HEENT: Denies congestion, dental/mouth issues, hearing loss,
trouble swallowing, loss of smell
or rhinorrhea
Eyes: Denies any discharge or visual disturbances
Cardiovascular: Denies chest pain, shortness of breath,
palpations and leg swelling.
Pulmonary: Denies difficulty breathing, wheezing, cough,
hemoptysis, or chest tightness
Gastrointestinal: Negative for abdominal distention, abdominal
pain, or blood in stool
Genitourinary: Negative for decreased urine volume, difficulty
urinating and pelvic pain.

21. Musculoskeletal: Negative for gait problems, pain in muscle or
joints bilaterally.
Skin: denies skin changes or issues, no rash, color changes or
excessive dryness
Neurological: Denies weakness, headaches, difficulty with
memory or dizziness
Allergic/Immunologic: no food or medication allergies and has
never been diagnosed with
seasonal allergies. Has not experienced frequent or long-term
sickness.
Psychiatric/Behavioral: Denies behavior issues, Admits to sleep
disturbance, increased stress and
depression
TITLE OF PAPER 15
Objective
Vitals BP: 145/89 HR: 68 RR: 16 Temp: 98.6 Height: 5’9
Weight: 177lbs BMI: 26.14 kg/m2
General: Is well-dressed and tidy, and well developed. He
appears to be aware and active, and he
does not appear to be in mental or physical discomfort. Able to
maintain adequate eye contact
throughout the interview and exam.
HEENT: Extraocular Movements: Right eye- normal extraocular
motion, and no nystagmus. Left

22. eye- normal extraocular motion and no nystagmus. Normal
conjunctiva/sclera, PERRLA noted.
Head symmetrical without deformities. lesions or masses. Hair
evenly disbursed. Ear canals clear
with no erythema, or moisture. TM intact bilaterally.
Lungs/Thorax- Bilateral breath sounds, in all lung fields are
clear and equal. No difficulty
breathing noted. Chest wall symmetrical without barreling of
chest.
Cardiovascular- Heart sounds are WNL, strong pulses
throughout, no swelling in left or right
lower legs.
Neurological: Alert and oriented to person, place and time.
Speech is normal, without delay,
memory and thought process is intact. Cranial Nerves II, III, IV,
VI intact, visual fields normal in
all quadrants. No sensory deficits noted. No tremor or abnormal
muscle tone. Rapid alternating
movements normal, gait is steady and as expected.
Musculoskeletal – General: Normal range of motion Right
Shoulder: No tenderness or crepitus,
normal range of motion normal strength Left Shoulder: No
tenderness or crepitus, normal range
of motion normal strength Cervical back: Normal range of
motion, no tenderness, swelling,
edema, deformity, erythema or rigidity, normal range of motion.
Normal sensation
Gastrointestinal: Bowel tones brisk and equal all quadrants.
Abdomen is flat and soft to palpation
with no notable masses, or herniations. No distention or
guarding with palpation.

23. Lymphadenopathy: No cervical adenopathy
Neuro: A/O x4, gait even and smooth, bilateral muscle strength
with no weakness noted.
Psychiatric: Appropriate mood and affect, behaviors, speech and
judgement as expected.
Skin: Free of lesions or masses, smooth, with dryness noted on
upper arms.
TITLE OF PAPER 16
Assessment:
Differential DX:
- Primary Hypogonadism
- Central Hypogonadism
- Depression
Final DX: Primary Hypogonadism
Plan:
Laboratory results from last week:
TSH – 2.4
Total serum Testosterone: 250

24. Diagnostic:
- FSH, LH hormonal testing, Total testosterone in 1 week at
8am
Treatment:
- None prescribed until further testing. Once completed if
indication remains
Hypogonadism. We will begin Hormone replacement therapy as
below.
- Testosterone Ciponate 200mg/ml injectable solution: inject
1ml= 200mg IM Q 2 weeks.
Education:
- Hormonal replacement may not be covered by insurance, it is
important to speak with
your insurance provider if you wish to begin this treatment.
Follow up: Follow up in 2 weeks once further testing has been
completed to begin treatment.
Assignment Prompt
Select a client from clinical experience with an acute health
problem or complaint requiring at least two visits. Submit a
complete history and physical H & P from the initial visit with
this client and a focused SOAP note for the follow -up visit.
Based on this client’s condition, conduct a literature search for
two research articles that discuss various approaches to the
treatment of this condition. Peer reviewed articles must address
the standardized procedure or guidelines for this diagnosis.

25. Incorporate the research findings into the decision-making for
this client’s treatment. In the paper, compare and contrast or
address how treatment or the plan may have been different
based on the research findings. The discussion on relating
research to practice should be 3-4 pages and the total paper
should be no longer than 8 pages including references. The
research articles must be an original research contributions (no
review articles or meta-analysis) and must have been published
within the last five years. Cover the criteria listed below. The
paper should be APA formatted and no longer than 8 pages.
· Reviews topic and explains rationale for its selection in the
context of client care. (2 pts)
· Evaluates key concepts related to the topic. 2 pts)
· Describes multiple viewpoints if this is a controversial issue
or one for which there are no clear guidelines. (2 pts)
· Assesses the merit of evidence found on this topic i.e.
soundness of research (5pts)
· Evaluates current EBM guidelines, if available. Or,
recommends what these guidelines should be based on available
research. Discuss the Standardized Procedure for this diagnosis.
(5 pts)
· Discusses how the evidence did impact/would impact practice.
What should be done differently based on the knowledge
gained? (3 pts)
· Consider cultural, spiritual, and socioeconomic issues as
applicable. (2pts).
· Utilizes APA guidelines, cite references (2 pts)
· Writing style at the graduate level (2pts)
Expectations
· Length: no longer than 8 pages, including references
· Format: APA Formatted
· Research: citations required
See USU NUR Research Paper Rubric for additional details and
point weighting.