Nursing Homework

Name: Mr. Ralph Newsome

Gender: male

Age:19 years old

T- 97.0 P- 70 R 18 116/68 Ht 5’9 Wt 175lbs

Background: Lives in Columbus, OH with his dog Chance, only child. Parents live locally.

Works part time in Construction. Not currently partnered. No previous psychiatric history.

Symptoms began in the last 2 months when he discovered he is being activated with the Navy

Reserves. His MOS is CM3 Construction Mechanic; no medical illnesses, no legal hx. Allergies:

NKDA; sleeps 8hrs; appetite good

Video notes

The patient reported experiencing increased sadness, fear, and emotional distress related to returning to his military tour. He described an internal struggle regarding his sexual orientation and expressed difficulty accepting and openly discussing being homosexual, particularly within the military environment.

The patient reported hearing derogatory and homophobic language used among other service members, including terms such as “gay” and “faggot.” These experiences have contributed to his fear that disclosing his sexual orientation could cause others in the military to perceive or treat him differently.

The patient stated, “I’m scared that if I tell people I’m gay, they will treat me differently.” He also expressed difficulty openly discussing his sexuality and stated, “I don’t feel comfortable telling anyone else.” According to the patient, we are currently the only individuals to whom he has disclosed his sexual orientation.

The patient also expressed emotional conflict regarding his return to military duties, stating, “I have to go back on tour, and I’m upset about it.” His presentation suggests significant emotional distress surrounding both his return to military service and concerns about openly expressing his sexual orientation within that environment.

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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.).