NRNP 6665 Assignment; Assessing, Diagnosing, and Treating Adults with Mood Disorders Essay

NRNP 6665 Assignment; Assessing, Diagnosing, and Treating Adults with Mood Disorders Essay

NRNP 6665 Assignment; Assessing, Diagnosing, and Treating Adults with Mood Disorders Essay

NRNP 6665 Assignment; Assessing, Diagnosing, and Treating Adults with Mood Disorders Sample Essay

Subjective:

CC (chief complaint): Petunia Park bemoans the fact that she has to stop taking her meds because they make her feel squashed and that she does not believe she needs them since they do not work.

HPI: A 26-year-old female patient named Petunia Park comes to the mental health facility today for a mental health assessment. She asserts that she has intermittently used medicines since she does not think she needs them. Petunia says she has sadness four to five times a year, which keeps her from working at her aunt’s bookshop. She adds that there are certain days when she doesn’t want to get out of bed because she is lacking in motivation. When she feels motivated, she somehow resists taking medicine because she feels confined. She may go 4-5 days without sleeping during these periods, has a lot of energy, accomplishes a lot, speaks a lot, and appears to be in disarray.

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Past Psychiatric History:

• General Statement: The patient’s mental health history is ordinary. She had been diagnosed with the bipolar illness when she was a child.
• Caregivers (if applicable): The patient presently resides with her lone mother, who has been raising her since her father passed away when she was 5 years old.
• Hospitalizations: Denies any hospitalization history.
• Medication trials: Although taking mood stabilizers, the patient has been disobedient because, in her words, they “squash who she is.”
• Psychotherapy or Previous Psychiatric Diagnosis: Denies any previous or ongoing counseling for her mental illness.

Substance Current Use: She consumes one pack of tobacco every day and quit drinking alcohol when she was 19 years old. She once tried marijuana but gave it up because of paranoia.

Medical History: History of Hypothyroidism.

 

• Current Medications: Polycystic ovaries are treated with hormone tablets, while hypothyroidism is treated with levothyroxine.
• Allergies: No known dietary or medication allergies.

• Reproductive Hx: Positive history of Polycystic Ovaries.

ROS:

• GENERAL: During crash episodes, there is a decrease in energy and an increase in hunger. Increased energy and a loss of appetite during periods of creativity. Denies having a fever, chills, or feeling weak.
• HEENT: denies hazy vision, earache, hearing loss, rhinorrhea, sneezing, or swallowing problems.
• SKIN: Refuses to accept discoloration, rashes, blisters, or ulcers.
• CARDIOVASCULAR: Refuses to acknowledge chest pain, dyspnea, palpitations, or edema.
• RESPIRATORY: Refuses to acknowledge SOB, cough, chest discomfort, or sputum production.
• GASTROINTESTINAL: Refuses to acknowledge nausea/vomiting, abdominal cramps, or abnormal bowel habits.
• GENITOURINARY: Abnormal PV discharge, dysuria, or urine urgency/frequency are all negative.
• NEUROLOGICAL: Disallows dizziness, headache, weariness, or loss of consciousness.
• MUSCULOSKELETAL: Prevents mobility restrictions.
• HEMATOLOGIC: Prevents bleeding and bruising.
• LYMPHATICS: Denies the presence of swollen lymph nodes.
• ENDOCRINOLOGICAL: Hypothyroidism. Polydipsia, polyphagia, and polyuria are all denied.

Objective:

Vital Signs: T- 98.9 P- 97 R 22 150/88 Ht 5’5 Wt. 135lbs

HEENT: Atraumatic and normocephalic head. Pupils are circular, equal, and light-reactive. On the tympanic membrane, there is no erythema or effusion. There was no discharge or edema in the ear canals. In anterior cervical lymphadenopathy, the neck is supple. There is no edema or exudates in the throat. Tonsils are not inflamed.

Chest/lungs: Auscultation of the chest and lungs reveals clean breathing sounds.

Heart: rate and rhythm are normal, with no murmurs or gallop.

Abdomen: The abdomen is firm, non-distended, and non-tender, with bowel sounds audible in all four quadrants.

Diagnostic results: There were no diagnostic tests ordered.

Assessment:

Mental Status Examination: Petunia Park is a woman that fits her given age and is 26 years old. Although she found some of the questions annoying, she is properly attired, beautifully groomed, and answered the examiner. She shows no indications of unusual motor activity. Her intonation and volume are appropriate, and her speech is clear and coherent. She exhibits a well-organized, logical, and goal-oriented way of thinking without any instances of tangentiality, circumstantiality, loose association, or idea flight. She claims, however, that her pals complain that she talks too much. She formerly had hallucinations as a teenager, but she doesn’t now have any perceptual impairments. She claims that a few months earlier, she overheard voices complimenting her on how brilliant and creative she was. She displays a good attitude by answering the psychiatrist’s inquiries correctly. She has a history of unsuccessful suicide attempts, including one in 2017 involving a Benadryl overdose, although she claims to have never attempted suicide afterward. Her current and distant memories are both intact. Her focus and wisdom are amazing.

Diagnostic Impression:

1. Bipolar II Disorder: The patient is most likely dealing with this primary diagnosis. A patient with bipolar II appears with one severe depressive episode, which is followed by another episode of hypomania, lasting one week, and the mood fluctuates between the two presentations, according to the DSM-5 (Vieta et al., 2018). Moreover, patients would exhibit aggressive tendencies, distraction propensity, heightened goal focus, exhilaration, and hurried thinking. Despite having a history of sadness, Petunia Park displayed most of the case study’s indicators.
2. Major Depressive Disorder (MDD): The ICD 10 designation for this condition is F33.0 and it is characterized by episodes of low mood coupled with feelings of worthlessness, hopelessness, or guilt. Suicidal thoughts are another symptom of the disease, and some people actively try it (Tolentino & Schmidt, 2018). The DSM-5 manual states that the condition also manifests as a lack of interest in once-enjoyable activities. These episodes ought to go on for at least a week. In this scenario, the patient alternates between episodes of high energy and overactivity, and poor mood presentations. Nevertheless, given that the client does not now have any suicidal thoughts, has not lost interest in her social activities, and that the episodes only last one week, this image is ruled out.
3. Schizophrenia: Hallucinations, disorganized speech, catatonic behavior, and delusions are common in patients with this condition. Also, patients would experience a change in how they view the world and how things are done. Other than the patient exhibiting auditory hallucinations, the symptoms are insufficiently frequent to justify the diagnosis (Carpenter, 2021).

Case Formulation and Treatment Plan:

• To treat the client’s bipolar disorder and regulate her mood, lithium would need to be prescribed. Also crucial for aiding in cognitive recognition that results in behavior modification are cognitive-behavioral therapy (Gunjal et al., 2019). To generate a supportive atmosphere that coincides with the patient’s mood, milieu and social treatments might also be included in the management of the patient.
• During the first two weeks, advise the patient to take 25 mg of lamotrigine at bedtime; then, increase the dose to 50 mg and then 100 mg. Lamotrigine, recently approved by the FDA for the treatment of bipolar patients, is a possibility for women at risk for PCOS5 (Vieta et al., 2018). The medicine also lessens the likelihood of relapsing during manic or depressive episodes. Headaches and lightheadedness are among the mild side effects.
• The client is urged to stop using nicotine as continued use might result in another disorder the health education and promotion are included in the management (Bonnin et al., 2019). Instruct the client about the necessity and significance of medication adherence as well.

• Follow-up: After four weeks, the patient will be checked on again.

Reflections: Making a diagnosis of bipolar disorder with the patient information provided is highly beneficial. The doctor did a great job of obtaining information that clearly illustrates the patient’s symptoms, including manic and depressive episodes, according to Bonnn et al. (2019). Further information is still necessary to determine the severity of the condition. I would thus give the patient Health Questionnaire (PHQ-9) to better assess their MDD symptoms (Talen & Edberg, 2020). To ensure that the therapies chosen will promote the best results and are not associated with undesirable effects, the treatment plan should be guided by the ethical principles of beneficence and nonmaleficence. The patient should be involved in the therapy’s design to promote autonomy.

References

Bonnín, C. D. M., Reinares, M., Martínez-Arán, A., Jiménez, E., Sánchez-Moreno, J., Solé, B., … & Vieta, E. (2019). Improving functioning, quality of life, and well-being in patients with bipolar disorder. International Journal of Neuropsychopharmacology, 22(8), 467-477. https://doi.org/10.1093/ijnp/pyz018

Carpenter, W. T. (2021, February 1). Primary psychosis: more to know, much more to do. World Psychiatry, Vol. 20, pp. 1–2. https://doi.org/10.1002/wps.20807

Gunjal, A., Tajane, M., & Londhe, R. (2019). Formulation and evaluation of lamotrigine 25 mg immediate-release tablet. Journal of Drug Delivery and Therapeutics, 9(4-s), 295-297. https://doi.org/10.22270/jddt.v9i4-s.3321

Talen, M. R., & Edberg, D. L. (2020). What is the most effective screening tool for bipolar disorder in primary care? Evidence-Based Practice, 23(3), 16-17. https://doi.org/10.1097/EBP.0000000000000543

Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Frontiers in Psychiatry, 9(OCT), 450. https://doi.org/10.3389/fpsyt.2018.00450

Vieta, E., Berk, M., Schulze, T. G., Carvalho, A. F., Suppes, T., Calabrese, J. R., … & Miskowiak, K. W. (2018). Grande. Bipolar disorders. Nat Rev Dis Primers, 4, 18008. https://doi.org/10.1038/nrdp.2018.8

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It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.

In this Assignment you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder.

RESOURCES

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE

• Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders.
• Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
• Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.
• Consider patient diagnostics missing from the video:Provider Review outside of interview:

  Temp 98.2  Pulse  90 Respiration 18  B/P  138/88

  Laboratory Data Available: Urine drug and alcohol screen negative.  CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)

THE ASSIGNMENT

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

• Subjective: What details did the patient provide regarding their chief complaint and symptomatology 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 to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 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.
• Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
• Reflection notes: Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

BY DAY 7 OF WEEK 4

Submit your Focused SOAP Note.

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

1. To submit your completed assignment, save your Assignment as WK1Assgn+last name+first initial.
2. Then, click on Start Assignment near the top of the page.
3. Next, click on Upload File and select Submit Assignment for review.

 

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Rubric

NRNP_6665_Week4_Assignment_Rubric

NRNP_6665_Week4_Assignment_Rubric

Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeCreate documentation in the Focused SOAP Note Template about the patient in the case study. In the Subjective section, provide: • Chief complaint• History of present illness (HPI)• Past psychiatric history• Medication trials and current medications• Psychotherapy or previous psychiatric diagnosis• Pertinent substance use, family psychiatric/substance use, social, and medical history• Allergies• ROS	15 to >13.0 ptsExcellent The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. 13 to >11.0 ptsGood The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. 11 to >10.0 ptsFair The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis but is somewhat vague or contains minor innacuracies. 10 to >0 ptsPoor The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or the subjective documentation is missing.	15 pts
This criterion is linked to a Learning OutcomeIn the Objective section, provide:• Review of Systems (ROS) documentation and relate if pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses	15 to >13.0 ptsExcellent The response thoroughly and accurately documents the patient’s ROS for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. 13 to >11.0 ptsGood The response accurately documents the patient’s ROS for pertinent systems. Diagnostic tests and their results are accurately documented. 11 to >10.0 ptsFair Documentation of the patient’s ROS is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor inaccuracies. 10 to >0 ptsPoor The response provides incomplete or inaccurate documentation of the patient’s ROS. Systems may have been unnecessarily reviewed. Or the objective documentation is missing.	15 pts
This criterion is linked to a Learning OutcomeIn the Assessment section, provide:• Results of the mental status examination, presented in paragraph form• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 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.	20 to >17.0 ptsExcellent The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected. 17 to >15.0 ptsGood The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected. 15 to >13.0 ptsFair The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vagueness or innacuracy. 13 to >0 ptsPoor The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or the assessment documentation is missing.	20 pts
This criterion is linked to a Learning OutcomeIn the Plan section, provide:• Your plan for psychotherapy• Your plan for treatment and management, including alternative therapies. Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. • Incorporate one health promotion activity and one patient education strategy.	25 to >22.0 ptsExcellent The response provides an evidence-based, detailed, and appropriate plan for psychotherapy for the patient. The response provides an evidence-based, detailed, and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. A strong rationale for the plan is provided that demonstrates critical thinking and content understanding. … The response includes at least one evidence-based health promotion activity and one evidence-based patient education strategy. 22 to >19.0 ptsGood The response provides an evidence-based and appropriate plan for psychotherapy for the patient. The response provides an evidence-based and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. An adequate rationale for the plan is provided. … The response includes at least one health promotion activity and one patient education strategy. 19 to >17.0 ptsFair The response provides a somewhat vague or inaccurate plan for psychotherapy for the patient. The response provides a somewhat vague or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is weak or general. … The response includes one health promotion activity and one patient education strategy, but it may contain some vagueness or innacuracy. 17 to >0 ptsPoor The response provides an incomplete or inaccurate plan for psychotherapy for the patient. The response provides an incomplete or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is inaccurate or missing. … The health promotion and patient education strategies are incomplete or missing.	25 pts
This criterion is linked to a Learning Outcome• Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).	5 to >4.0 ptsExcellent Reflections are thorough, thoughtful, and demonstrate critical thinking. 4 to >3.5 ptsGood Reflections demonstrate critical thinking. 3.5 to >3.0 ptsFair Reflections are somewhat general or do not demonstrate critical thinking. 3 to >0 ptsPoor Reflections are incomplete, inaccurate, or missing.	5 pts
This criterion is linked to a Learning OutcomeProvide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).	10 to >8.0 ptsExcellent The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making. 8 to >7.0 ptsGood The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study. 7 to >6.0 ptsFair Three evidence-based resources are provided to support the assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification. 6 to >0 ptsPoor Two or fewer resources are provided to support the assessment and diagnosis decisions. The resources may not be current or evidence based.	10 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for parenthetical/in-text citations and reference list.	5 to >4.0 ptsExcellent Uses correct APA format with no errors 4 to >3.5 ptsGood Contains a few (one or two) APA format errors 3.5 to >3.0 ptsFair Contains several (three or four) APA format errors 3 to >0 ptsPoor Contains many (five or more) APA format errors	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and punctuation	5 to >4.0 ptsExcellent Uses correct grammar, spelling, and punctuation with no errors 4 to >3.5 ptsGood Contains a few (one or two) grammar, spelling, and punctuation errors 3.5 to >3.0 ptsFair Contains several (three or four) grammar, spelling, and punctuation errors 3 to >0 ptsPoor Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding	5 pts
Total Points: 100

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LEARNING RESOURCES

Required Readings

• Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
  • Chapter 8, “Mood Disorders”
• Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
  • Chapter 11, “Mood Disorders”
• Document: Focused SOAP Note TemplateDownload Focused SOAP Note Template
• Document: Focused SOAP Note ExemplarDownload Focused SOAP Note Exemplar

Required Media

Medication Review

• CrashCourse. (2014, September 8). Depressive and bipolar disorders: Crash course psychology #30Links to an external site. [Video]. YouTube. https://youtu.be/ZwMlHkWKDwM https://www.youtube.com/watch?v=ZwMlHkWKDwM&t=1sLinks to an external site.
• Walden University. (2021). Case study: Petunia Park. Walden University Blackboard. https://waldenu.instructure.com

 

Medication Review

Depression		Premenstrual dysphoric disorder	Seasonal affective disorder (MDD with Seasonal Variation)
agomelatine amitriptyline amoxapine aripiprazole (adjunct) brexpiprazole (adjunct)bupropion citalopram clomipramine cyamemazine desipramine desvenlafaxine dothiepindoxepin duloxetine escitalopram fluoxetine fluvoxamine iloperidone imipramine isocarboxazid ketamine lithium (adjunct) l-methylfolate (adjunct)	lofepramine maprotiline mianserin milnacipran mirtazapine moclobemide nefazodone nortriptyline paroxetine phenelzine protriptyline quetiapine (adjunct) reboxetine selegiline sertindole sertraline sulpiride tianeptine tranylcypromine trazodone trimipramine venlafaxine vilazodone vortioxetine	citalopram desvenlafaxine duloxetin eescitalopram fluoxetin eparoxetine pepexev sarafe, sertraline venlafaxine	Bupropion HCL extended-release

 

Bipolar depression	Bipolar disorder (mixed Mania/Depression		Bipolar maintenance	Mania
lithium (used with lurasidone) lurasidone olanzapine-fluoxetine combination (symbyax) quetiapine valproate (divalproex) (used with lurasidone)	aripiprazole asenapine carbamazepine	olanzapine ziprasidone	aripiprazole lamotrigine lithium olanzapine	aripiprazole asenapine carbamazepine lithium olanzapine quetiapine risperidone valproate (divalproex) ziprasidone