Journal 1 and 2

Running head: JOURNAL

Journal

Author's Name

Institutional Affiliation

JOURNAL

Instruction:

Reflect on your clinical experience by writing(four to five sentences)responses to each of the

following questions. Include references from the learning activities or from journal articles and

resources located in the Regis Library Database:

1. What were thehighlights of this week'sclinical? Describe a particular patient, patient

interaction, or disease process that stood out to you.Adjustment disorder

2. Reflect on a situation or a patient presentation that youwere unfamiliar withduring

clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe

how you handled this unfamiliar situation/case.Post-traumatic stress disorder

3. Describe a situation or encounter from this week that led you to anew understanding of

a specific mental health condition.Obsessive-compulsive disorder

4. Discuss any interactions with patients that you observed, either in a therapy or a

medication management session, that weremissing some of the conceptsyou have

been learning about regarding therapeutic relationships and communication.

5. How did youapply the content learnedin your online courses to your clinical setting this

week?

6. Which chief complaints did you see most often this week? Providedetails about how you

feltabout developing your own preliminary differential diagnoses lists for these patients

based on the complaints/symptoms they expressed.

7. Given the most frequent psychiatric disorders you encountered in your clinical rotation this

week, what is themost useful set of guidelines(i.e., depression guidelines, Beer’s

criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?

8. Thinking about the common mental health conditions you saw in your clinical this week

(see question #7), did you feel that you hadadequate knowledgeto discuss these

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diagnoses with your preceptor? If not, what preparation work do you have planned to help

you feel more confident for the upcoming clinical week?

9. List abrief plan of carefor one of the patients you saw this week. Include your

preceptor’s plan, too. Discuss, briefly, whether or not you agree with your preceptor’s plan

of care. If not, describe what you would have done differently and why.

10. What situation or patient presentation did you see in your clinical setting this week that

hasnot yet been coveredin your online psychiatric courses?Agoraphobia

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What were the highlights of this week's clinical? Describe a particular patient, patient

interaction, or disease process that stood out to you.

The key highlight of this week was the successful treatment of a 15-year old male patient. The

patient was brought to the hospital with several unfamiliar symptoms. For instance, according to

his parents, the child was constantly refusing to go to school and was obsessed who destoning

everything around. Also, the child was always fighting with friends and other people. After

evaluation of the patient's development history, life events, and emotions, we established the

conditions to be adjustment disorder with disturbance of conduct. The child was enrolled in

psychotherapy using cognitive-behavioral methods, and so far, he has improved remarkably.

Reflect on a situation or a patient presentation that you were unfamiliar with during

clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe

how you handled this unfamiliar situation/case

On the first day of the week, I came across a patient who exhibited somewhat unfamiliar

symptoms. The patient was a middle-aged male adult, and he exhibited recurrent and distressing

memories of a victim of attempted homicide. He also exhibited instructive thoughts and

distressing flashbacks, and he expressed distorted beliefs and excessive fear of being killed by

what he termed as his "assassins." According to one of his caregivers, the patient also had lost

interest in work, and he has occasional outbursts. Being an unfamiliar health problem to me, I

consulted our supervisor who immediately diagnosed the problem as Post-traumatic stress

disorder

Describe a situation or encounter from this week that led you to a new understanding of a

specific mental health condition.

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My encounter with the patient described above led me to a new understanding of Post-traumatic

stress disorder. Firstly, after reviewing the patient's medical history, I learned that he had been

treated for Post-traumatic stress disorder earlier after losing two of his family members. As

such, his recurrent post-traumatic stress disorder originated from his past traumatic experiences.

A traumatic experience is a significant risk factor for Post-traumatic stress disorder. According to

ADAMHS (2019), "while many people will have short term responses to life-threatening events,

some will develop longer-term symptoms that can lead to a diagnosis of Posttraumatic Stress

Disorder (PTSD)."

Discuss any interactions with patients that you observed, either in therapy or a medication

management session, that were missing some of the concepts you have been learning about

regarding therapeutic relationships and communication

During the week, I met a patient during the initial screening evaluation. One of the factors that

made it difficult to effectively engage with this particular patient was my ability to correctly

interpret the patient’s nonverbal behavior. The patient suffered Somatic symptom disorder. In

the words of Foley & Gentile (2010) "nonverbal behavior contributes significantly to all

interpersonal communication but unfortunately is often only a peripheral area of focus in the

psychotherapeutic setting."

How did you apply the content learned in your online courses to your clinical setting this

week?

All the content learned online was instrumental to my clinical settings this week. When faced

with an unfamiliar situation or condition, I refer to online materials for clarity and further

learning. In so doing, I was able to increase both the quality of my service. In addition,

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consulting the different materials helped me to develop all-rounded knowledge, which has, in

turn, enhanced my confidence in handling the more complex situations.

Which chief complaints did you see most often this week? Provide details about how you

felt about developing your own preliminary differential diagnoses lists for these patients

based on the complaints/symptoms they expressed.

The most common complaints observed this week were stress, insomnia, and depression. One of

the trends I observed this week higher depression prevalence among middle-aged adults.

Majority of the patients who were diagnosed with depression were mostly individuals aged

between 28years-40 years. A similar trend is reported by Anxiety and Depression of America

(2019):" While major depressive disorder can develop at any age, the median age at onset is 32.5

years old." Developing preliminary differential diagnoses lists for the patients with these

symptoms and complaints was both challenging and informative. The more diagnose lists I

made, the deeper and better I understood each mental disorder. It was an interesting experience

that enhanced my confidence significantly.

Given the most frequent psychiatric disorders you encountered in your clinical rotation

this week, what is the most useful set of guidelines (i.e., depression guidelines, Beer's

criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?

I found Beer's criteria the most useful set of guidelines. Other than being easier to understand,

Beer's criteria help healthcare providers to effectively differentiate between potentially

appropriate and inappropriate medications for patients with depression. According to in the

words of Lund et al. (2011), these criteria provider healthcare providers with a rating of severity

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for adverse outcomes as well as a description of the concerns associated with different

medications.

Thinking about the common mental health conditions you saw in your clinical this week

(see question #7), did you feel that you had adequate knowledge to discuss these diagnoses

with your preceptor? If not, what preparation work do you have planned to help you feel

more confident about the upcoming clinical week?

Yes. I believe the knowledge and experience I have gained is adequate to discuss the diagnoses

of the various mental health conditions with our preceptor. However, I still need several

additional preparations in order to improve my confidence and overall preparedness. For

example, I will need to consult our online content and other reading materials further.

List a brief plan of care for one of the patients you saw this week. Include your preceptor's

plan, too. Discuss, briefly, whether or not you agree with your preceptor's plan of care. If

not, describe what you would have done differently and why.

Care plan for depression

Assessment Data Expected Outcomes Nursing

Interventions

Rationale

Feelings of

helplessness and

hopelessness.

Insomnia, appetite or

weight changes, loss

of interest, insomnia,

Improve sleeping patterns

Overcome feelings of loss

of helplessness,

hopelessness and

restlessness.

Eradicate feelings of self-

Cognitive

restructuring

Activity

scheduling

Prescribe

The patient’s

understanding

of his

depression

systems will

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self-loathing and

chest pains.

loathing.

Return to the previous

level of work functioning.

medications.

Cognitive

restructuring,

cognitive

behavior

therapy

(CBT),

be improved. .

 Psychotherap

y will help to

help identify

the patient’s

cognitive

distortions.

What situation or patient presentation did you see in your clinical setting this week that has

not yet been covered in your online psychiatric courses?

During the week I came across a patient with Agoraphobia, which is not yet covered in our

online course.

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References

ADMHS (2019). Facts about Post-Traumatic Stress Disorder (PTSD). Retrieved from

http://adamhscc.org/en-us/facts-ptsd.aspx

Anxiety and Depression of America (2019). Depression Symptoms and Warning Signs. Retrieved from

https://www.helpguide.org/articles/depression/depression-symptoms-and-warning-signs.htm

Foley, G. N., & Gentile, J. P. (2010). Nonverbal communication in psychotherapy. Psychiatry

(Edgmont), 7(6), 38.

Lund, B. C., Steinman, M. A., Chrischilles, E. A., & Kaboli, P. J. (2011). Beers criteria as a proxy for

inappropriate prescribing of other medications among older adults. Annals of Pharmacotherapy,

45(11), 1363-1370

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Journal 13

Reflect on your clinical experience by writing(four to five sentences)responses to each of the

following questions. Include references from the learning activities or from journal articles and

resources located in the Regis Library Database:

1. What were thehighlights of this week'sclinical? Describe a particular patient, patient

interaction, or disease process that stood out to you.schizophrenia

2. Reflect on a situation or a patient presentation that youwere unfamiliar withduring

clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe

how you handled this unfamiliar situation/case.schizotypal personality disorder

3. Describe a situation or encounter from this week that led you to anew understanding of

a specific mental health condition.

4. Discuss any interactions with patients that you observed, either in a therapy or a

medication management session, that weremissing some of the conceptsyou have

been learning about regarding therapeutic relationships and communication.

5. How did youapply the content learnedin your online courses to your clinical setting this

week?

6. Which chief complaints did you see most often this week? Providedetails about how you

feltabout developing your own preliminary differential diagnoses lists for these patients

based on the complaints/symptoms they expressed.

7. Given the most frequent psychiatric disorders you encountered in your clinical rotation this

week, what is themost useful set of guidelines(i.e., depression guidelines, Beer’s

criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?

8. Thinking about the common mental health conditions you saw in your clinical this week

(see question #7), did you feel that you hadadequate knowledgeto discuss these

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diagnoses with your preceptor? If not, what preparation work do you have planned to help

you feel more confident for the upcoming clinical week?

9. List abrief plan of carefor one of the patients you saw this week. Include your

preceptor’s plan, too. Discuss, briefly, whether or not you agree with your preceptor’s plan

of care. If not, describe what you would have done differently and why.

10. What situation or patient presentation did you see in your clinical setting this week that

hasnot yet been coveredin your online psychiatric courses?Drug abuse/adverse

reaction

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Required

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).Synopsis of psychiatry(11th ed.). London,

UK: Lippincott Williams and Wilkins.

oChapter 7, “Schizophrenia Spectrum and Other Psychotic Disorders”

Yearwood, E. L., Pearson, G. S., & Newland J. A. (2012).Child and adolescent behavioral

health. Sussex, UK: Wiley-Blackwell.

oChapter 11, “Perceptual Alterations Disorders” (pp. 204-216)

Johnson, K., & Vanderhoef, D. (2016).Psychiatric-mental health nurse practitioner review &

resource manual(4th ed.). Silver Spring, MD: American Nurses Credentialing Center.

oChapter 11, “Schizophrenia Spectrum and Other Psychotic Disorders”

American Psychiatric Association. (2013).Diagnostic and statistical manual of mental

disorders(5th ed.)(DSM-5). Washington DC: APA Press.

o“Schizophrenia Spectrum and Other Psychotic Disorders”

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What were the highlights of this week's clinical? Describe a particular patient, patient

interaction, or disease process that stood out to you.

The key highlight of this week's clinical was an effective treatment of a patient

with .schizophrenia. The 19-year old male was brought to the facility exhibiting several

schizophrenia symptoms such as hallucinations, delusions, disorganized speech, and neglect of

personal hygiene, withdrawal from family and friends, and insomnia. After a successful

diagnosis, we put the patient under both medications and psychotherapy, and his condition

significantly improved within 24-hours. The anti-depressants prescribed for the patient

significantly relieved his symptoms. His improved speech and thought organization made it

easier to engage the patient during the CBT sessions.

Reflect on a situation or a patient presentation that you were unfamiliar with during

clinical this week (i.e., the disorder and symptoms the patient was exhibiting). Describe

how you handled this unfamiliar situation/case

One of the unfamiliar conditions I countered in this week is a schizotypal personality disorder.

This was middle-aged women who were brought to the facility exhibit unknown symptoms,

including unusual beliefs about God and life, discomfort in social circumstances, extreme social

anxiety, abnormal emotional responses, and paranoia. Being a medically unfamiliar condition, I

had to consult our preceptor, who diagnosed it as a schizotypal personality disorder. In addition,

I also consulted a variety of reading materials in order to understand the disorder better.

Describe a situation or encounter from this week that led you to a new understanding of a

specific mental health condition.

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My encounter with the patient schizotypal personality disorder led to a new and better

understanding of the disease. Firstly, this encounter led to the realization that schizotypal

personality disorder is both a personality disorder and schizophrenia spectrum disorder. Further,

I learned that the major risk factors of schizotypal personality disorder are both hereditary as

well as environmental. Individuals with relatives who have suffered schizotypal personality

disorder and schizophrenia are at higher risk of suffering the disorder during their lifetime

(Yearwood et al. 2012). In addition, environmental factors such as abuse, trauma, stress, and

neglect play a role in the development of schizotypal personality disorder. Moreover, our

preceptor revealed that successful treatment of schizotypal personality disorder requires lifelong

treatment.

Discuss any interactions with patients that you observed, either in a therapy or a

medication management session that were missing some of the concepts you have been

learning about regarding therapeutic relationships and communication.

During the week, I came across a patient with Asperger's syndrome. The patient was a 10-year

old female with unfamiliar symptoms. The patient was missing obvious social cues, including

body language and facial expressions. For instance, the patient could not realize that when a

person crosses their arms and scowls, it actually means he or she is angry. The child also

exhibited a few emotions. For example, she could not smile or laugh even when told a joke. It

was difficult to effectively attend to this patient because both therapy and medication

management information needed to treat him were missing from the concepts learned in class.

How did you apply the content learned in your online courses to your clinical setting this

week?

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The content learned online was very important in my clinical setting this week because it

provided me with a deeper understanding of how to approach various problems and situations in

the hospital. In addition to consulting our preceptor whenever faced with an unfamiliar situation

or condition, I relied on the online content to come up with more informed decisions. In so

doing, this content helped me to avoid costly mistakes and errors that may not only put the

patient's health at risk but also put the hospital at the risk of lawsuits and broken reputation.

Which chief complaints did you see most often this week? Provide details about how you

felt about developing your own preliminary differential diagnoses lists for these patients

based on the complaints/symptoms they expressed.

From the medical records, the most common complaints seen this week anxiety, depression, and

stress. Many patients from different ages, gender, and racial backgrounds complained about

these three mental health conditions. The process of developing preliminary differential

diagnoses for each of these patients was both complicated as well as informative. Developing

preliminary differential diagnoses for different patients from different backgrounds and with

varied symptoms and severity enabled me to enhance my skills and competence.

Given the most frequent psychiatric disorders you encountered in your clinical rotation

this week, what is the most useful set of guidelines (i.e., depression guidelines, Beer's

criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?

Compared to the other criteria, Beer's criteria were the most useful set of guidelines that relied on

for additional information this clinical week. For instance, I used the Beer's criteria to

differentiate between potentially appropriate and inappropriate medications for depression

patients. In addition, Beer's criteria was a valuable resource for me this week since because it

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improved my understanding of the safety of prescribing medications, particularly for older

patients with depression. According to Lund et al. (2011), Beer's criteria provide health care

professionals with a rating of severity for adverse outcomes as well as a descriptive summary of

the various concerns associated with these medications.

Thinking about the common mental health conditions you saw in your clinical this week

(see question #7), did you feel that you had adequate knowledge to discuss these diagnoses

with your preceptor? If not, what preparation work do you have planned to help you feel

more confident for the upcoming clinical week?

Given the complexities of the depression and stress, especially when attending patients from

different backgrounds, I do not believe I possess all the knowledge to discuss the diagnoses with

my preceptor. Part of the preparations that I will take to increase my confidence is reading more

extensive and from a variety of sources. More knowledge and competence will help improve my

confidence. Additional research will improve my understanding of symptoms and phases of

depression and stress and the necessary treatment approaches. Further, I will world closely with

my experienced colleagues in order to learn from and enhance my experience and confidence.

Assessment DataList a brief plan of care for one of the patients you saw this week. Include

your preceptor’s plan, too. Discuss, briefly, whether or not you agree with your preceptor’s

plan of care. If not, describe what you would have done differently and why.

Assessment Data Expected Outcomes Nursing

Interventions

Rationale

Agitation, anxiety,

sleeping difficulties,

Help the patient

overcome feelings of

Medications

(Selective

Improve the

patient’s

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restlessness, mood

swings, increased

fatigue feelings of

guilt and

worthlessness.

agitation, anxiety, and

loss of interest in

activities.

Effectively manage the

patient’s ideation of

feelings of guilt and

worthlessness.

Overcome insomnia and

improve sleeping

patterns.

Help the patient return to

his previous level of work

functioning.

serotonin

reuptake

inhibitors

(SSRIs).

Collaboratively

engage the

patient on a

one-to-one

basis.

Activity

scheduling

Take the

patient through

Cognitive

restructuring,

cognitive

behavior

therapy (CBT)

sessions.

Interpersonal

therapy (IPT)

and Behavior

Therapy.

understanding

and ability to

manage of his

depression.

To help

stabilize the

his negative

thought

pattern and

mood swings

 CBT, IPT

and cognitive

restructuring

will help

identify the

patient’s

cognitive

distortions.

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I fully agree with my preceptor’s plan of care especially because it combines both medications

and psychotherapy, hence it is more effective. According to Cuijpers et al. (2014), “combined

treatment is superior for major depression, panic disorder, and obsessive-compulsive disorder

(OCD). Combined treatment appears to be more effective than treatment with antidepressant

medication alone in major depression, panic disorder, and OCD. These effects remain strong and

significant up to two years after treatment.”

What situation or patient presentation did you see in your clinical setting this week that has

not yet been covered in your online psychiatric courses?

Over the week, I came across several patients whose mental problems are closely associated with

their drug and substance abuse. For this reason, I would like we cover this topic our clinical

setting this week.

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References

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds III, C. F.

(2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders:

a meta-analysis.HFocus,H12(3), 347-358.

Yearwood, E. L., Pearson, G. S., & Newland J. A. (2012). Child and adolescent behavioral

health. Sussex, UK: Wiley-Blackwell. Chapter 11, “Perceptual Alterations Disorders” (pp. 204-

216)

Johnson, K., & Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner review &

resource manual (4th ed.). Silver Spring, MD: American Nurses Credentialing Center. Chapter

11, “Schizophrenia Spectrum and Other Psychotic Disorders”

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