Analyze Nature of Treatment Unique to Addictions

TWO-PART ASSIGNMENT

 

Week 5: Treatment

Tadd’s wife, Sharon, gave Tadd an ultimatum: “Get help for your cocaine problem, or our marriage is over.” Tadd insisted that he just liked to party with his friends. “I can still hold down a job. In fact, I just got a promotion. So why do you care how I spend my money?” Analyze nature of treatment unique to addictions

Sharon began to research local addictions professionals. She found two organizations that sounded promising. Organization A featured counselors who had been former substance abusers themselves. “We know what you are going through,” their slogan read. Organization B featured counselors with advanced degrees in psychoanalytic theories. “We get at the heart of the defense mechanisms keeping you in the situation you are in now.” Analyze nature of treatment unique to addictions

How might an addictions professional advise Sharon? Should the fact that Tadd is demonstrating defense mechanisms impact her decision either way?

In the field of addictions, unlike in other counseling fields, it is not unusual for former substance abusers to provide counseling services to addicts. However, this common practice is controversial among addictions theorists and professionals. This week, you analyze the influence of a counselor’s personal experience on provision of addictions treatment. You also examine the impact of defense mechanisms on behavior and treatment processes.

Learning Objectives

Students will:

· Analyze nature of treatment unique to addictions

· Analyze impact of defense mechanisms on behavior

· Analyze impact of defense mechanisms on treatment processes

· Analyze manifestations of defense mechanisms in stages of change. Analyze Nature of Treatment Unique to Addictions

 

Learning Resources

Note:  To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Miller, G. (2015). Learning the language of addiction counseling (4th ed.). Hoboken, NJ: Wiley.

· Review Chapter 1, “Introduction” (p. 9) Focus on the difference between the medical and biopsychosocial models.

· Review Chapter 2, “Theories of Counseling Related to Addiction Treatment” (pp. 19-22) Focus on the goals and techniques of general counseling theories.

· Chapter 5, “The Treatment Process for Addictions” Focus on crisis intervention and therapies as part of the treatment process for addictions.

· Chapter 6, “Treatment-related Issues” (pp. 138-159) Focus on the difficult topics that arise in counseling settings.

· Chapter 8, “Self-Help Groups” Focus on the client’s best match for available outside support.

· Chapter 12, “Incorporating Spirituality Into Addiction Counseling” (p.408-411) Focus on counselor self-care and countertransference issues.

· Chapter 13, “Personal And Professional Development Of The Counselor” (pp. 429-427, 432-435, 436-439) Focus on the roles and vulnerabilities of the counselor and personal experience with addiction.

 

Gupta, R., Nower, L., Derevensky, J. L., Blaszczynski, A., Faregh, N., & Temcheff, C. (2013). Problem gambling in adolescents: An examination of the pathways model. Journal of Gambling Studies, 29(3), 575–88.

Problem Gambling in Adolescents: An Examination of the Pathways Model by Gupta, R.; Nower, L.; Derevensky, J.; Blaszczynski, A.; Faregh, N.; Temcheff, C., in Journal of Gambling Studies, Vol. 29/Issue 1. Copyright 2013 by Human Sciences Press – Journals. Reprinted by permission of Human Sciences Press – Journals via the Copyright Clearance Center. Analyze Nature of Treatment Unique to Addictions

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Focus on the three Pathways (pp. 577-578).

 

Muñoz, Y., Chebat, J., & Borges, A. (2013). Graphic gambling warnings: How they affect emotions, cognitive responses and attitude change. Journal of Gambling Studies, 29(3), 507–24.

Graphic Gambling Warnings: How they Affect Emotions, Cognitive Responses and Attitude Change by Muñoz, Y.; Chebat, J.; Borges, A., in Journal of Gambling Studies, Vol. 29/Issue 1. Copyright 2013 by Human Sciences Press – Journals. Reprinted by permission of Human Sciences Press – Journals via the Copyright Clearance Center.<

 

Focus on the Use of Graphic Images (p. 510)

 

 

Suissa, A. (2011). Vulnerability and gambling addiction: Psychosocial benchmarks and avenues for intervention. International Journal of Mental Health and Addiction, 9(1), 12–23.

 

Focus on “A Hidden Area of Vulnerability”: Internet Gambling. Read the entire article, as it is important and provides good information on gambling addiction (p. 18).

Optional Resources

Miller, G. (2010). Learning the language of addiction counseling. New York, NY: Wiley.

· Chapter 10, “Culturally Sensitive Addiction Counseling”

 

 

THIS IS DUE WEDNESDAY 03/31/21BY 10PM

Discussion: Unique Features of Addictions Treatment

A therapist specializing in childhood sexual abuse would not likely divulge his or her experience with a similar trauma. Instead, the therapist would most likely have a doctorate in psychology, counseling, or social work, and would take an objective role in therapy. However, this is not the case in addictions treatment. In fact, it was not until the mid-1970s that licensure of addictions counselors became common practice. Prior to that time, it was common for addictions counselors to enter the field with a history of substance abuse. Today, however, many view the treatment of addictions as a complex process requiring specialized skills and education.

The practice of recovering substance abusers serving as addictions professionals is one unique feature of the field of addictions. Addictions professionals should understand both sides of this argument and be familiar with other unique aspects of the addictions field.

To prepare for this Discussion:

Review the Learning Resources, particularly Learning the Language of Addiction Counseling, Chapter 13, “Personal and Professional Development of the Counselor” (pp. 436-438).

By Day 4

Post your response to the following question: Does personal history of addiction and treatment make counselors more effective? Provide an informed argument based on the week’s Learning Resources and any other factors you have identified. Finally, describe two other aspects of the addiction field that are uniquely different from the general field of mental health, and explain why they are different. Be specific and use the week’s Learning Resources in your response. Analyze Nature of Treatment Unique to Addictions

THIS IS DUE SATURDAY 4/3/21 BY 10PM

Assignment: Defense Mechanisms

“Hi. I’m John, and I’m an addict.”

 

While this might be a cliché attributed to a well-known addiction program, it is true that the first step in treating an addiction is admitting there is a problem. This might seem easy for most, but it is a major acknowledgment for an addict. Addictions serve a purpose in someone’s life, and working to change the addiction means letting go of that purpose. People often hold on to addictions by means of defense mechanisms.

Defense mechanisms are a long-standing part of psychology stemming back to the early work of Sigmund Freud. Although many aspects of Freud’s early theories are not a part of modern clinical practice, defense mechanisms are a part of the current vernacular, including addiction treatment. Therefore, understanding defense mechanisms is an important step in providing effective treatment.

By Day 7

Submit a 2- to 4-page paper that includes the following:

· A brief description of two defense mechanisms from the Learning Resources

· An explanation of how each defense mechanism you chose might impact behavior

· A description of how each defense mechanism might affect treatment processes, and an explanation of why

· A description of which stage of change in treatment processes each defense mechanism might manifest in behavior

· An explanation of why

· Provide one or two strategies for mitigating them. Analyze Nature of Treatment Unique to Addictions

DNP 955 DPI Project Proposal Chapter 2 Literature Review

Chapter 2 of the DPI Project Proposal is entitled “Literature Review” and expands upon work you completed in DNP-820 in the Develop a Literature Review assignment. Synthesis of the literature in the Literature Review (Chapter 2) defines the key aspects of the learner’s scholarly project, such as the problem statement, population and location, clinical questions, hypotheses or phenomena (if relevant to the project), methodology and design, purpose statement, data collection, and data analysis approaches. The literature selected must illustrate strong support for the learner’s practice change proposal. DNP 955 DPI Project Proposal Chapter 2 Literature Review

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General Requirements:

Use the following information to ensure successful completion of the assignment:

• Locate the “DPI Proposal Template” in the PI Workspace of the DC Network.
•  Locate the Develop a Literature Review assignment you completed in DNP-820. 

• Locate the “Research Article Chart” resource in the Topic Materials.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

Use the “DPI Proposal Template” and the Develop a Literature Review assignment from DNP-820 to develop a draft of a literature review (Chapter 2) for your DPI Project Proposal. The literature review (Chapter 2) is required to be a minimum of 30 pages. You have already completed some of this review in previous courses. No less than 85% of the articles must have been published in the past 5 years. Articles selected must further provide strong, relatable support for the proposal.

 

Use the following guidelines to create your draft Literature Review (Chapter 2):

1. Using the PICOT question format, identify at least three empirical or scholarly articles (25 articles total) related to the theme in the PICOT question.
2. Use the “Research Article Chart” resource located in the Topic Materials as a guide to: (a) analyze and synthesize the literature into your paper, (b) state the article title, (c) identify the author, (d) state the research question(s), (e) identify the research sample, (f) explain the research methodology, (g) identify the limitations in the study, (h) provide the research findings of the study, and (i) identify the opportunities for practice implementation. For scholarly, nonempirical articles, state the article title and author, and provide a brief contextual summary of the article. DNP 955 DPI Project Proposal Chapter 2 Literature Review
3. Identify at least three subthemes that relate to each theme (six subthemes total).
4. Identify at least three empirical or scholarly articles related to each subtheme (18 articles total). At least one article must demonstrate a quantitative methodology.
5. Write statements that synthesize the three studies for each subtheme based on the information you stated above. You will write six synthesis statements.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours and are indicated in the assignment by a Portfolio Practice Hours statement that reminds you, the learner, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

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You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-955

I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor. DNP 955 DPI Project Proposal Chapter 2 Literature Review

NRNP 6665 Assignment 2: Focused SOAP Note And Patient Case Presentation

 Psychiatric notes are a way to reflect on your practicum experiences and connect them to the didactic learning you gain from your NRNP courses. Focused SOAP notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.

For this Assignment, you will document information about a patient that you examined during the last three weeks, using the Focused SOAP Note Template provided. You will then use this note to develop and record a case presentation for this patient.

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To Prepare
Review this week’s Learning Resources and consider the insights they provide. Also, review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
Select a patient of any age (either a child or an adult) that you examined during the last 3 weeks.
Create a Focused SOAP Note on this patient using the template provided in the Learning Resources. There is also a completed Focused SOAP Note Exemplar provided to serve as a guide to assignment expectations. NRNP 6665 Assignment 2: Focused SOAP Note And Patient Case Presentation

Please Note:
All SOAP notes must be signed, and each page must be initialed by your Preceptor. Note: Electronic signatures are not accepted.
When you submit your note, you should include the complete focused SOAP note as a Word document and PDF/images of each page that is initialed and signed by your Preceptor.
You must submit your SOAP note using SafeAssign. Note: If both files are not received by the due date, faculty will deduct points per the Walden Grading Policy.
Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice your presentation before you record it.
Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.
Ensure that you have the appropriate lighting and equipment to record the presentation.

The Assignment
Record yourself presenting the complex case study for your clinical patient. In your presentation:

• Dress professionally in a lab coat and present yourself in a professional manner.
• Display your photo ID at the start of the video when you introduce yourself.
• Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
• Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.
• Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value. NRNP 6665 Assignment 2: Focused SOAP Note And Patient Case Presentation

Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide:

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 their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and is supported by the patient’s symptoms.

Plan:What was your plan for psychotherapy? What was 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, be sure to include at least one health promotion activity and one patient education strategy.

Reflection notes:What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow-up, discuss what your next intervention would be.

PRAC 6665 Assignment 2 WEEK 3 Sample Solution

PRAC 6665 Assignment 2 WEEK 3: Comprehensive Psychiatric Evaluation and Patient Case Presentation

Subjective:

CC (chief complaint): “I have been experiencing suicidal thoughts for the last three weeks.”

HPI: A.A. is a 35-year-old male that came to the clinic today with complaints of suicidal thoughts for the last three weeks. The client reported a series of events leading to the symptoms. They included having a depressed mood almost all day and feeling hopeless. He also reported feelings of lack of energy, changes in appetite, and being socially isolated. He was worried that his interest in pleasure had declined significantly. A.A. also reported experiencing insomnia for the last two months and finding it hard to concentrate on things. He denied any suicidal plan or attempt. The symptoms could not be attributed to substance abuse, medication, or medical condition. The symptoms had affected his ability to engage in his social and occupational roles.

Substance Current Use: The client does not have a history of drug and substance abuse.

Medical History: No history of chronic illnesses or admission.

• Current Medications: None
• Allergies: Allergic to latex

• Reproductive Hx: Married, has two children. He does not have a history of sexually transmitted infections or infertility. He does not have a history of increased urinary urgency and frequency.

ROS:

GENERAL:  There is no evident weight loss, fever, chills, weakness, or fatigue.

HEENT:  Eyes:  The patient denies visual loss, blurred vision, double vision, or yellow sclera. Ears, Nose, Throat:  The patient denies hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN:  The client denies rash or itching.

CARDIOVASCULAR:  The client denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY:  The client denies shortness of breath, cough, or sputum.

GASTROINTESTINAL: The patient denies anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: The patient denies burning on urination and has a history of sexually transmitted infections

NEUROLOGICAL:  The patient denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:  The client denies muscle or joint pain, joint rigidity, tenders, and difficulty in movement. He also denies fractures.

HEMATOLOGIC:  The patient denies anemia, bleeding, or bruising.

LYMPHATICS:  The patient denies enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  The patient denies any history of depression or anxiety.

ENDOCRINOLOGIC:  The patient denies sweating, cold, or heat intolerance reports. No polyuria or polydipsia.

ALLERGIES:  The patient is allergic to latex.

Objective:

Diagnostic results: Some diagnostic investigations were ordered to determine the cause of the client’s problem accurately. Laboratory investigations, including complete blood count and thyroid function tests, were performed. Complete blood work aimed at determining any other conditions contributing to the worsening of the client’s symptoms. Thyroid function tests were performed to rule out thyroid disorders such as hyperthyroidism, which may produce symptoms similar to depression. Radiological investigations, including an MRI scan, were ordered to rule out pathologies such as brain tumors, which may contribute to the client’s symptoms (Alshawwa et al., 2019). The results were unremarkable, leading to a potential diagnosis of a mental health problem. NRNP 6665 Assignment 2: Focused SOAP Note And Patient Case Presentation

Assessment:

Mental Status Examination: The client appeared dressed appropriately for the occasion. His orientation to self, others, time, and events were intact. His speech had a normal rate, speed, and volume. He maintained normal eye contact during the assessment. The self-reported mood of the client was depressed. He denied illusions, delusions, and hallucinations. He reported suicidal thoughts without plans or intent. The thought process was future-oriented.

Diagnostic Impression:

Major Depression: Major depression is the primary diagnosis for the client. He presents with symptoms that align with depression, as stated in DSM-5. According to DSM-5, patients suffering from depression present with complaints that include depressed mood for most days, almost every day, diminished interest and pleasure, social isolation, and feelings of guilt. They also experience suicidal thoughts, attempts, or plans alongside having trouble making decisions. Patients also report increased irritability, sleeping patterns, and appetite changes (Kraus et al., 2019; Pradier et al., 2021). A.A. has most of the above symptoms, making depression the primary diagnosis.

Insomnia: The secondary differential diagnosis that should be considered for the client is insomnia. According to DSM-5, patients with insomnia report a decline in the quality and quantity of sleep. Poor sleep quality alters their normal routines and their ability to undertake their social, academic, and occupational roles (Albrecht et al., 2019). Unlike A.A., patients with insomnia do not experience depressed moods, lack of interest and pleasure, and suicidal thoughts.

Bipolar Disorder: The third secondary diagnosis that may be considered for the client is bipolar disorder. Patients with bipolar disorder experience cycles of mania and hypomania. The symptoms of elevated mood alternate with those of depressed mood (Perrotta, 2019). A.A. did not report such cycling in mood experiences, ruling out bipolar disorder as a possibility in his case.

Reflections:I believe that I did my best in examining this client. I utilized professional knowledge and skills in obtaining accurate data that led to the diagnosis. I also utilized evidence-based data to make informed decisions about the potential mental health problem of the client. I also incorporated collaboration in patients’ assessment and development of diagnosis and the plan of care. I would use the Patient Health Questionnaire-9 (PHQ-9) to determine the severity of depressive symptoms should I have the opportunity to assess the patient again. The assessment data will guide the determination of the appropriate dosing for the client’s medications.

Case Formulation and Treatment Plan: A.A. has been diagnosed with major depression. He has been initiated on PO Zoloft 25 mg daily for the next month. He has also been enrolled in group psychotherapy sessions. He has been scheduled for a follow-up visit after four weeks to determine his response to treatment. NRNP 6665 Assignment 2: Focused SOAP Note And Patient Case Presentation

References

Albrecht, J. S., Wickwire, E. M., Vadlamani, A., Scharf, S. M., & Tom, S. E. (2019). Trends in Insomnia Diagnosis and Treatment Among Medicare Beneficiaries, 2006–2013. The American Journal of Geriatric Psychiatry, 27(3), 301–309. https://doi.org/10.1016/j.jagp.2018.10.017

Alshawwa, I. A., Elkahlout, M., El-Mashharawi, H. Q., & Abu-Naser, S. S. (2019). An Expert System for Depression Diagnosis.

aKraus, C., Kadriu, B., Lanzenberger, R., Zarate Jr., C. A., & Kasper, S. (2019). Prognosis and improved outcomes in major depression: A review. Translational Psychiatry, 9(1), 1–17. https://doi.org/10.1038/s41398-019-0460-3

Perrotta, G. (2019). Bipolar disorder: Definition, differential diagnosis, clinical contexts, and therapeutic approaches. J Neuroscience and Neurological Surgery, 5.

Pradier, M. F., Hughes, M. C., McCoy, T. H., Barroilhet, S. A., Doshi-Velez, F., & Perlis, R. H. (2021). Predicting change in diagnosis from major depression to bipolar disorder after antidepressant initiation. Neuropsychopharmacology, 46(2), 455–461. https://doi.org/10.1038/s41386-020-00838-x

NRNP 6665 Week 4 Assignment: Assessing, Diagnosing, and Treating Adults with Mood Disorders

Patients presenting with mood disorders may find that their moods impact their ability to function or that their moods are not consistent with their circumstances. Bipolar and related disorders are one category of mood disorders. They affect nearly 3% of the U.S. population each year (Depression and Bipolar Support Alliance, n.d.). Although being relatively rare in terms of lifetime prevalence, bipolar disorder is burdensome to the individual and health care system because of its early onset, severity, and chronic nature. The average age of onset is around 25 and it affects men and women equally.

The importance of evidence-based intervention for treatment in persons with mood disorders cannot be underestimated. Unstable moods can result in repeat chronic hospitalizations and profound life disruption. Mood disorders are a leading cause of disability worldwide and can contribute to suicide (World Health Organization, 2020). Practitioners should understand that developing a good rapport and relationship with the patient can make a significant difference in the course, symptom management, and stability of the patient.

This week, you will assess, diagnose, and develop appropriate treatment plans for adults presenting with mood disorders.

Reference: Depression and Bipolar Support Alliance. (n.d.). Bipolar disorder statistics.

World Health Organization. (2020). Depression.

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Learning Objectives

Students will:

• Assess adults presenting with mood disorders
• Develop differential diagnoses for adult patients with mood disorders
• Develop appropriate treatment plans for adult patients with mood disorders
• Advocate health promotion and patient education strategies for adult patients with mood disorders. NRNP 6665 Week 4 Assignment: Assessing, Diagnosing, and Treating Adults with Mood Disorders

Learning Resources

Required Readings (click to expand/reduce)

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 Template

Document: Focused SOAP Note Exemplar

Required Media (click to expand/reduce)

CrashCourse. (2014, September 8). Depressive and bipolar disorders: Crash course psychology #30[Video]. YouTube.?

 

Week 4: Mood Disorders in Adults

I am finally doing everything right. I stayed up all night studying for my final exams and even managed to clean out my closet and order a whole new bedroom from the internet. I know I will ace all my exams. Nothing can go wrong like they did a few months ago. I was so low and was sleeping all the time. I did not think I would ever be happy again, but now I know I can do anything.

—Jessica, age 22

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Assignment: Assessing, Diagnosing, and Treating Adults with Mood Disorders

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.

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. NRNP 6665 Week 4 Assignment: Assessing, Diagnosing, and Treating Adults with Mood Disorders

· 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.).

 

NRNP/PRAC 6665 & 6675 Focused SOAP Psychiatric Evaluation Exemplar

INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

If you are struggling with the format or remembering what to include, follow the Focused SOAP Note Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. After reviewing full details of the rubric, you can use it as a guide.

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

Read rating descriptions to see the grading standards!

In the Objective section, provide:

· Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

· Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

Read rating descriptions to see the grading standards!

In 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-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 .

· Read rating descriptions to see the grading standards!

Reflect on this case. Include: 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 taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

(The FOCUSED SOAP psychiatric evaluation is typically the follow-up visit patient note. You will practice writing this type of note in this course. You will be focusing more on the symptoms from your differential diagnosis from the comprehensive psychiatric evaluation narrowing to your diagnostic impression. You will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for illnesses that could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

 

EXEMPLAR BEGINS HERE: Click here  to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NRNP 6665 Week 4 Assignment: Assessing, Diagnosing, and Treating Adults with Mood Disorders

Subjective:

CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with the patient’s initials, age, race, gender, the purpose of evaluation, current medication, and referral reason. For example:

N.M. is a 34-year-old Asian male who presents for medication management follow-up for anxiety. He was initiated sertraline the last appt, which he found was effective for two weeks, then symptoms began to return.

Or

P.H., a 16-year-old Hispanic female, presents for follow-up to discuss previous psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications as we deferred until further testing and screening was conducted.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. First what is bringing the patient to your follow up evaluation? Document symptom onset, duration, frequency, severity, and impact. What has worsened or improved since last appointment? What stressors are they facing? Your description here will guide your differential diagnoses into your diagnostic impression. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe. NRNP 6665 Week 4 Assignment: Assessing, Diagnosing, and Treating Adults with Mood Disorders

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Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Objective:

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

Assessment:

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

Diagnostic Impression: You must begin to narrow your differential diagnosis to your diagnostic impression. You must explain how and why (your rationale) you ruled out any of your differential diagnoses. You must explain how and why (your rationale) you concluded to your diagnostic impression. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations ( demonstrating critical thinking beyond confidentiality and consent for treatment!), social determinates of health, 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.).

Case Formulation and Treatment Plan

Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions including psychotherapy and/or psychopharmacology, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. *See an example below. You will modify to your practice so there may be information excluded/included. If you are completing this for a practicum, what does your preceptor document?

Risks and benefits of medications are discussed including non- treatment. Potential side effects of medications discussed (be detailed in what side effects discussed). Informed client not to stop medication abruptly without discussing with providers. Instructed to call and report any adverse reactions. Discussed risk of medication with pregnancy/fetus, encouraged birth control, discussed if does become pregnant to inform provider as soon as possible. Discussed how some medications might decreased birth control pill, would need back up method (exclude for males).

 

Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Encouraged abstinence. Discussed how drugs/alcohol affect mental health, physical health, sleep architecture. NRNP 6665 Week 4 Assignment: Assessing, Diagnosing, and Treating Adults with Mood Disorders

 

Initiation of (list out any medication and why prescribed, any therapy services or referrals to specialist):

 

Client was encouraged to continue with case management and/or therapy services (if not provided by you)

 

Client has emergency numbers: Emergency Services 911, the Client’s Crisis Line 1-800-_______. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them)

 

Reviewed hospital records/therapist records for collaborative information; Reviewed PMP report (only if actually completed)

Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (this relates to informed consent; you will need to assess their understanding and agreement)

Follow up with PCP as needed and/or for:

Labs ordered and/or reviewed (write out what diagnostic test ordered, rationale for ordering, and if discussed fasting/non fasting or other patient education)

Return to clinic:

Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care.

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting. NRNP 6665 Week 4 Assignment: Assessing, Diagnosing, and Treating Adults with Mood Disorders