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NRNP 6635 WEEK 10 Assignment

NRNP 6635 WEEK 10 Assignment

Subjective:

CC (chief complaint): Mr. Harold Brown visits the clinic complaining of concentration difficulties.

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HPI: Mr. Brown is a 61-year-old male engineer at a large structural engineering firm. He reports that everything is good except for the accelerated deadlines and his concentration difficulties, which have put a lot of pressure on him and is unable to do the same job his coworkers can. He reports that his concentration difficulties have made him make mistakes that can cost the firm a lot of money. He reports that he does not seem to have similar problems when he is relaxed or when there are tight deadlines. He also says the coworkers seem to be coping well amidst these changes. He also says that in the past, while he was in school, he had to go to the library to cram for major exams. However, he would end up looking out the window and changing his seats while in the library. In addition, he also says he had concentration difficulties while at school that would make him not listen to lectures and end up thinking of alternative things unrelated to what was being taught. He also has difficulties sitting down to listen or work and has intruded on other peoples’ work, which has made him get in trouble. He also says he is disorganized and often forgets things despite having a calendar, which has caused delays when he is needed to pay bills. He has also been hyperactive since childhood, where he would constantly fidget and was inattentive or could walk out of class. He does take soda and coffee once in a while.

Past Psychiatric History:

  • General Statement: A 61-year-old man presenting with a chronic history of inattention.
  • Caregivers (if applicable): None
  • Hospitalizations: None
  • Medication trials: None
  • Psychotherapy or Previous Psychiatric Diagnosis:None

Substance Current Use and History:He drinks one scotch drink and smokes a cigar on weekends.

Family Psychiatric/Substance Use History: None

Psychosocial History: He has a younger brother.

Medical History:

  • Current Medications: Mr. Brown is hypertensive and currently on Cozaar 100 mg and Valsartan 80 mg daily.He also takes ASA 81 mg PO daily for angina, fenofibrate 160 mg for hypertriglyceridemia, and tamsulosin 0.4 mg PO at bedtime for benign prostrate hypertrophy
  • Allergies:He is allergic to Dilaudid.
  • Reproductive Hx:He has no children.

ROS:

  • GENERAL: The patient denies any abnormal discomfort or fatigue.
  • HEENT: He reports having decreased vision but no hearing loss or nasal discharge.
  • SKIN: The patient has some work-related bruises but denies any areas of hyperpigmentation or erythema.
  • CARDIOVASCULAR: The patient has had episodes of palpitations but no orthopnea or paroxysmal nocturnal dyspnea.
  • RESPIRATORY: The patient denies cough, dyspnea, or chest pain.
  • GASTROINTESTINAL: The patient denies abdominal pain or distension, abnormal bowel movements, and nausea.
  • GENITOURINARY: The patient has been experiencing some urinary retention but denies any dysuria, hematuria, or foul-smelling urine.
  • NEUROLOGICAL: The patient denies any headache, abnormal sensations, and vertigo.
  • MUSCULOSKELETAL: The patient has some back pain but denies joint swelling or stiffness and muscle pain or weakness.
  • HEMATOLOGIC: The patient denies any nose bleeds, abnormal infections, and abnormal bruising.
  • LYMPHATICS: The patient denies lymph node swellings.
  • ENDOCRINOLOGIC: The patient denies any abnormal weight gain or loss, increased thirst, or polyuria.

Objective:

Physical exam:Vitals: 98.8 P- 74 R 18 134/70 Ht 5’10 Wt 170lbs

Diagnostic results:No diagnostic test was done.

Assessment:

Mental Status Examination:

The patient was alert, well-groomed, and oriented in time, place, and person. He appeared slightly agitated and spoke at a normal rate and tone. He had an euthymic mood and appropriate affect. There was some looseness of association and thought block but no delusions and hallucinations. He has attention and concentration difficulties and memory gaps. He had good judgment and full insight.

Differential Diagnoses:

 

Attention Deficit Hyperactive Disorder (ADHD): ADHD is a condition characterized by inattention and hyperactivity inconsistent with the developmental stage whose symptoms affect the social and occupation of patients affected (Williams et al., 2023). ADHD symptoms seen in Mr. Harold include childhood hyperactivity, failure to give close attention or making careless mistakes at work, disorganization, increased forgetfulness, easy distractibility, inability to listen when talked to, and failure to follow instructions while at work (Cabral et al., 2020). He often fidgets and has difficulties remaining seated, thus making his symptoms consistent with the DSM-V diagnosis of the disorder.

 

Generalized Anxiety Disorder (GAD): GAD is an anxiety disorder characterized by excessive anxiety and worry about a situationthat occurs on most days for a period lasting more than six months. In this case, Mr. Brown seems to be in constant worry he cannot deliver on his job, which has made him feel restless at work and have concentration difficulties that have caused impairment in his occupation life (Eck et al., 2020). The symptoms are characteristic of the DSM-V criteria for the diagnosis. However, he denies experiencing some DSM-V GAD symptoms, such as easy fatiguability, irritability, and sleep disturbance.

 

Mild neurocognitive disorder: The disorder may result from complications of hypertension and hypertriglyceridemia, resulting in a minor hemorrhagic or ischemic stroke. This may result in a mild cognitive decline in attention, concentration, and memory, as seen in Mr. Brown (Chen et al., 2021). DSM-V also describes that the symptoms should not interfere with the capacity for independence in everyday activities as Mr. Brown can still manage to perform his activities, including taking his medication. However, he requires more time to perform activities or compensatory strategies like having a calendar.

 

Reflections:

In my next session, I would wish to inquire about Mr. Brown’s symptoms, including their onset, severity, and the impact they have had on his personal and social life(Acoba, 2024). I would also like to inquire about his relationship with his brother, friends, and coworkers to enable me to understand his social life, which forms a crucial element in his recovery.

I would encourage him to be compliant with his current medications and avoid using alcohol and smoking cigars to promote his physical and psychological health. I would also encourage him to exercise and take nutritious diets to help him in weight loss, thus reducing any risk of cardiovascular and cerebrovascular complications due to hypertension and hypertriglyceridemia, such as stroke and ischemic heart disease (Ng et al., 2020). I would also encourage him to take some breaks while at work to help him reduce work stress, thus promoting his psychological health.

References

Acoba, E. F. (2024). Social support and mental health: The mediating role of perceived stress. Frontiers in Psychology, 15. https://doi.org/10.3389/fpsyg.2024.1330720

Cabral, M. D. I., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational Pediatrics, 9(Suppl 1), S104–S113. https://doi.org/10.21037/tp.2019.09.08

Chen, X., Liang, N., Li, L., Yang, H., Wang, P., & Shi, N. (2021). Diagnosis and Treatment for Mild Cognitive Impairment: A Systematic Review of Clinical Practice Guidelines and Consensus Statements. Frontiers in Neurology, 12. https://doi.org/10.3389/fneur.2021.719849

Eck, K., & Quick, V. (2020). Psychometric Properties of the Generalized Anxiety Disorder-7 and Generalized Anxiety Disorder-Mini in United States University Students. Frontiers in Psychology, 11, 550533. https://doi.org/10.3389/fpsyg.2020.550533

Ng, R., Sutradhar, R., Yao, Z., Wodchis, W. P., & Rosella, L. C. (2020). Smoking, drinking, diet and physical activity—Modifiable lifestyle risk factors and their associations with age to first chronic disease. International Journal of Epidemiology, 49(1), 113-130. https://doi.org/10.1093/ije/dyz078

Williams, O. C., Prasad, S., McCrary, A., Jordan, E., Sachdeva, V., Deva, S., Kumar, H., Mehta, J., Neupane, P., & Gupta, A. (2023). Adult attention deficit hyperactivity disorder: A comprehensive review. Annals of Medicine and Surgery, 85(5), 1802-1810. https://doi.org/10.1097/MS9.0000000000000631

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Assignment

Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from the very specific to a general or global impairment, and often co-occur (APA, 2022). They include specific learning and language disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and intellectual disabilities. Neurocognitive disorders, on the other hand, represent a decline in one or more areas of prior mental function that is significant enough to impact independent functioning. They may occur at any time in life and be caused by factors such brain injury; diseases such as Alzheimer’s, Parkinson’s, or Huntington’s; infection; or stroke, among others.

For this Assignment, you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder.

Resources

 

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

WEEKLY RESOURCES

 

Learning Resources

Required Readings

Required Media

Video Case Selections for Assignment

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

To Prepare:

  • Review this week’s Learning Resources and consider the insights they provide. Consider how neurocognitive impairments may have similar presentations to other psychological disorders.
  • Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
  • 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 10

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.).

submission information

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Rubric

NRNP_6635_Week10_Assignment_Rubric

NRNP_6635_Week10_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeCreate documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. 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
20 to >17.0 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.

 17 to >15.0 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.

 15 to >13.0 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.

 13 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, subjective documentation is missing.
20 pts
This criterion is linked to a Learning OutcomeIn 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.
20 to >17.0 ptsExcellent

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

 17 to >15.0 ptsGood

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

 15 to >13.0 ptsFair

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

 13 to >0 ptsPoor

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
20 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-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.
25 to >22.0 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.

 22 to >19.0 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.

 19 to >17.0 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 vaguess or innacuracy.

 17 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, assessment documentation is missing.
25 pts
This criterion is linked to a Learning OutcomeReflect 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 taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
10 to >8.0 ptsExcellent

Reflections are thorough, thoughtful, and demonstrate critical thinking.

 8 to >7.0 ptsGood

Reflections demonstrate critical thinking.

 7 to >6.0 ptsFair

Reflections are somewhat general or do not demonstrate critical thinking.

 6 to >0 ptsPoor

Reflections are incomplete, inaccurate, or missing.
10 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).
15 to >13.0 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.

 13 to >11.0 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.

 11 to >10.0 ptsFair

Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

 10 to >0 ptsPoor

Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
15 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 ptsExcellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

 4 to >3.5 ptsGood

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. … Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

 3.5 to >3.0 ptsFair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. … Purpose, introduction, and conclusion of the assignment is vague or off topic.

 3 to >0 ptsPoor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. … No purpose statement, introduction, or conclusion were provided.
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 >3.0 ptsGood

Contains a few (one or two) grammar, spelling, and punctuation errors

 3 to >2.0 ptsFair

Contains several (three or four) grammar, spelling, and punctuation errors

 2 to >0 ptsPoor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts
Total Points: 100

 

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