wk 3 assign
due 12/21
2 years ago
50
NRNPPRAC6635ComprehensivePsychiatricEvaluationTemplate-2.docx
assgnwk4.docx
Transcripttitle85.docx
- Videotranscript.docx
- NRNP_PRAC_6635_ComprehensivePsychiatricEvaluationExemplar_rev.4.2022.docx
- NRNP6635CaseHistoryReportsrev4.26.2022.pdf
NRNPPRAC6635ComprehensivePsychiatricEvaluationTemplate-2.docx
NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template
Week (enter week #): (Enter assignment title)
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date
Subjective:
CC (chief complaint):
HPI:
Past Psychiatric History:
· General Statement:
· Caregivers (if applicable):
· Hospitalizations:
· Medication trials:
· Psychotherapy or Previous Psychiatric Diagnosis:
Substance Current Use and History:
Family Psychiatric/Substance Use History:
Psychosocial History:
Medical History:
· Current Medications:
· Allergies:
· Reproductive Hx:
ROS:
· GENERAL:
· HEENT:
· SKIN:
· CARDIOVASCULAR:
· RESPIRATORY:
· GASTROINTESTINAL:
· GENITOURINARY:
· NEUROLOGICAL:
· MUSCULOSKELETAL:
· HEMATOLOGIC:
· LYMPHATICS:
· ENDOCRINOLOGIC:
Objective:
Physical exam: if applicable
Diagnostic results:
Assessment:
Mental Status Examination:
Differential Diagnoses:
Reflections:
References
© 2021 Walden University Page 1 of 3
assgnwk4.docx
ASSESSING AND DIAGNOSING PATIENTS WITH ANXIETY DISORDERS, PTSD, AND OCD
“Fear,” according to the
DSM-5-TR, “is the emotional response to real or perceived imminent threat, whereas
anxiety is anticipation of future threat” (APA, 2022). 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.
For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5-TR criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5-TR 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-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.).
· American Psychiatric Association. (2022). Anxiety disorders. In Diagnostic and statistical manual of mental disorders Links to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x05_Anxiety_Disorders
· American Psychiatric Association. (2022). Obsessive compulsive and related disorders In Diagnostic and statistical manual of mental disorders Links to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x06_Obsessive_Compulsive_and_Related_Disorders
· American Psychiatric Association. (2022). Trauma- and stressor-related disorders.. In Diagnostic and statistical manual of mental disorders Links to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x07_Trauma_and_Stressor_Related_Disorders
· Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
· Chapter 8, “Anxiety Disorders”
· Chapter 9, “Obsessive-Compulsive and Related Disorders”
· Chapter 10, “Trauma- and Stressor-Related Disorders”
· Chapter 2- only sections 2.13, “Anxiety Disorders of Infancy, Childhood, and Adolescence: Separation Anxiety Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder (Social Phobia)”; 2.14 “Selective Mutism” and 2.15 “Obsessive-Compulsive Disorder in Children and Adolescence”
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Transcripttitle85.docx
L Of course, who wouldn't be? We'll have to talk some other time.
00:00:55
OFF CAMERA Your husband must have his phone, he called that you were running late.
00:01:00
CAROL Yeah, he has his phone, but . . .
00:01:00
OFF CAMERA But what?
00:01:05
CAROL The children do not call their father when they want something.
00:01:10
OFF CAMERA They never call your husband?
00:01:10
CAROL No, they only call me.
00:01:10
OFF CAMERA Uh-huh, are you expecting your children to call?
00:01:15
CAROL My children are at home with the babysitter, my neighbor. She's a widow. I just, I don't feel comfortable, in case they need me. And I always call, they'll be worried if I don't.
00:01:35
OFF CAMERA How often do you call your children when you're away from home?
00:01:40
CAROL I don't know, a few times. Just normal checking.
00:01:45
OFF CAMERA Do you work?
00:01:45
CAROL I'm a mother, so yes, I work.
00:01:50
OFF CAMERA I'm sorry, I didn't mean to suggest parenting isn't work. It very much is work. Do you also have a job outside of the home?
00:02:00
CAROL I used to work from home. I quit my job after my last child, Colin, he's five now. But, this really isn't the time for this right now. Nor ever, really. I'm just here as a courtesy, no offense.
00:02:20
OFF CAMERA I understand you do not want to be here. But it would be helpful if we could talk for a few minutes. Perhaps your husband can call your children. Do you want me to go get him for you?
00:02:35
CAROL I'll be fine. We can talk for five more minutes.
00:02:40
OFF CAMERA Thank you. You seem to have strong feelings that you want to call your children. But you do not have strong feelings that you want to ask your husband to call them.
00:02:50
CAROL He refuse. We don't see eye-to-eye. But I'm not here for marriage counseling.
00:03:00
OFF CAMERA What is your understanding about why you're here?
00:03:00
CAROL Ask my husband, Greg.
00:03:05
OFF CAMERA What current concerns do you have when you leave your children?
00:03:10
CAROL There's a laundry list on that one. Start with serial rapists and end with Newtown, and you've only scratched the surface.
00:03:20
OFF CAMERA How often do you worry about those types on incidents?
00:03:20
CAROL I'm mother of three. I have to keep in mind the world as it is. Part of my job description. Every day, people die from gun deaths. 18,000 people are raped. Over 50,000 children go missing every year.
00:03:40
OFF CAMERA Those are unsettling statistics.
00:03:45
CAROL Dr. Phil did a profile on a serial rapist, that was horrifying. I called my friends to watch it. I TiVo'ed it for them.
00:03:50
OFF CAMERA Do you follow a lot of news programs?
00:03:55
CAROL Yeah.
00:03:55
OFF CAMERA What do you tend to watch?
00:03:55
CAROL Most of the shows. I have CNN on background for when I'm doing laundry or cooking, or prepping lessons.
00:04:05
OFF CAMERA Lessons, what lessons do you prepare?
00:04:10
CAROL For the children.
00:04:10
OFF CAMERA Oh, do you school your children at home?
00:04:15
CAROL Yes, I homeschool my children. I don't appreciate your connotations. The stereotype that homeschooling is for religious nuts is outdated. The reality is our school systems are broken. Our public schools can't even afford protection for our children.
00:04:35
OFF CAMERA Was that one of the reasons you decided to homeschool your children was because of school violence?
00:04:45
CAROL You mean... ?
00:04:45
OFF CAMERA Pardon?
00:04:45
CAROL Ridge View?
00:04:50
OFF CAMERA Yes, Ridge View, uh-huh.
00:04:50
CAROL 12 students murdered, three teachers gunned down trying to protect students. They couldn't protect themselves. Campus police didn't have time to stop it. That kid's mother and father lay dead in their house for over a week before that school massacre. Today Show profiled the ex-girlfriend. She said there was plenty of warning signs. Did the administrators listen? No. No one was capable of seeing what was coming. Yet, their signs were obvious. That child murderer drew horrifying pictures in his art classes, and you know what the teachers said?
00:05:25
OFF CAMERA No.
00:05:25
CAROL The teachers defended him. Said his evil artwork was a school assignment. Yes, to answer your question. Yes, I think school violence is a reason for homeschooling children.
00:05:45
OFF CAMERA Do these violent events seem to stay with you, hang with you?
00:05:55
CAROL I see those children's faces. They could have been my children. Greg is heartless. Instead of helping me protect our children, he sent me to a shrink.
00:06:15
OFF CAMERA Do you think that there are times where you over-worry?
00:06:25
CAROL I won't lose my children.
00:06:25
OFF CAMERA Do you fear that similar violent events may happen here at these schools?
00:06:35
CAROL Ridge View is only 100 miles from here, 100. That may as well be one mile.
00:06:45
OFF CAMERA How long have you been homeschooling your children?
00:06:50
CAROL Two months.
00:06:50
OFF CAMERA So you began homeschooling them, so that was about a month after the Ridge View incident shootings?
00:07:00
CAROL Yeah. When I pulled the children from school, Greg and I had a big fight, but it's for the best. The children are learning more now than they ever learned at school. They still socialize, they still have friends. Now, my girlfriends are considering doing the same with their children. They see how well mine are doing. My girlfriends are every bit as frightened as I was. This isn't some sort of frantic phobia on my part. I'm an educated woman about these matters. Greg, doesn't understand what it's like to lose family.
00:07:50
OFF CAMERA Do you have stronger feelings about losing people than your husband does?
00:07:55
CAROL Yes, I do.
00:08:00
OFF CAMERA Have you lost people who were close to you?
00:08:05
CAROL My parents, car accident, drunk driver, I was 19.
00:08:10
OFF CAMERA Oh, I'm sorry to hear that.
00:08:15
CAROL It happens, like that. They're gone. I won't lose a child. I won't lose more people I love.
00:08:25
OFF CAMERA Have these fears been increasing more recently for you? Preoccupying you, more of your time?
00:08:35
CAROL Yes. I think about what happened to me, to my parents, what could happen to my children.
00:08:50
OFF CAMERA What is it like to realize you cannot protect them all of the time?
00:09:00
CAROL That's what Greg says.
00:09:05
OFF CAMERA Do you disagree with him?
00:09:10
CAROL You protect them from what you can. You stop what you can. I couldn't prevent that driver from sideswiping my parents, pinning them to the freeway median. I can prevent another Adam Lanza from pointing a gun at my babies. I won't send them back to school. I won't turn off the television, and I won't stop informing myself. I will do what I can as a mother to protect my children. I'm sorry, I have to end this now, and call my children. I'll call them now.
00:09:45
END TRANSCRIPT
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