NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Walden University NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Whether one passes or fails an academic assignment such as the Walden University NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

The introduction for the Walden University NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

After the introduction, move into the main part of the NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Subjective:

CC (chief complaint): The mother states, “Sarah has some trouble paying attention. She hardly remembers things and often loses her items.”

The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 500-750-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:

Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child.
Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.
Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations during the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.

HPI: Sarah Higgins is a 9-year-old female client accompanied by her mother, who reports that she has trouble paying attention. She hardly remembers things and often loses her items. Sarah admits that she rarely remembers her school assignments, and the teacher has to write down a list of the assignments, but she loses the list all the time. The problem has persisted since Sarah started school in kindergarten. She fidgets on her chair, and she often gets in trouble for fidgeting or getting out of her chair in class. Besides, she rarely concentrates when reading books and only lasts a maximum of five minutes if she likes the books. However, she does not remember much after reading the book.

Sarah also misplaces her books and pencils in school and does not usually remember where she left her items. In addition, she sometimes has problems losing her temper and usually gets angry when teachers say they asked her to do something, and she does not hear them. Sarah also reports daydreaming at school and dreams about going home and playing with her dog. Furthermore, she admits to making many mistakes when doing her homework, which frustrates her because she tries to do it right. Sarah’s teachers report that sometimes she has trouble waiting her turn and is quite difficult when in groups.

Past Psychiatric History:

General Statement: The client first came for psychotherapy with features of inattentiveness and hyperactivity.
Caregivers (if applicable): Grandmother
Hospitalizations: No history of hospitalization
Medication trials: None
Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: No history of substance abuse.

Family Psychiatric/Substance Use History: No family history of psychiatric disorder or substance abuse.

Psychosocial History: Sarah has lived with her grandmother since she was separated from her mother. She sleeps 9hrs/night, but meals are difficult as she has difficulties sitting for meals. She gets proper nutrition per PCP. Sarah loves art and museums. She also likes video games, which she plays for prolonged periods.

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Medical History:

Current Medications: Vaccinations are up to date.
Allergies: No drug or food allergies.

Reproductive Hx: Not applicable.

ROS:

GENERAL: Negative for fever, chills, weight changes, or fatigue.
HEENT: Denies head injury, excessive tearing, visual changes, hearing loss, ear discharge, nasal congestion,rhinorrhea, or swallowing difficulties.
SKIN: Denies skin color changes, itching, or bruises.
CARDIOVASCULAR: Denies palpitations, SOB, or chest pain.
RESPIRATORY: Negative for chest pain, cough, wheezing, or sputum.
GASTROINTESTINAL: Denies nausea, vomiting, abdominal pain, diarrhea/constipation, or rectal bleeding.
GENITOURINARY: Negative for dysuria or abnormal urine color.
NEUROLOGICAL: Denies headache, dizziness, muscle weakness, or tingling sensations.
MUSCULOSKELETAL: Denies joint pain or muscle pain.
HEMATOLOGIC: Denies bruising or bleeding.
LYMPHATICS: Negative for enlarged lymph nodes.
ENDOCRINOLOGIC: Negative for excessive sweating, hot/cold intolerance, polyuria, excessive hunger, or thirst.

Objective:

Physical exam: if applicable

Vitals: T- 97.4; P- 62; R-14; BP- 95/60; Ht- 4’5; Wt.- 63lbs

Diagnostic results: No diagnostic tests were requested.

Assessment:

Mental Status Examination:

The patient is neat and appropriately dressed for the weather. She is alert but appears distracted. She maintains minimal eye contact and fidgets on her chair. Her speech varies from low tones to normal, and she often speaks using syllables. She demonstrates a coherent and logical thought process. No hallucinations, delusions, obsessions, or suicidal ideations were noted. She is oriented to person, place, and time. The patient’s recent memory is impaired, and she has a short attention span. She demonstrates good judgment.

Differential Diagnoses:

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is characterized by a persistent pattern of inattention and hyperactive-impulsive behavior that is more severe than expected of a child at that similar age and level of development. The diagnosis is made when the behavior causes problems at school or other places (Schroer et al., 2021). ADHD is a differential diagnosis based on the patient’s pertinent symptoms of inattentive behavior, including attention that causes impairment, short attention span, easy distractibility, losing things necessary for school tasks, and forgetfulness (Schroer et al., 2021). Besides, she has hyperactivity symptoms such as fidgeting, leaving her seat in the classroom, inability to be still for extended periods, and difficulty waiting in lines. She also has explosive and irritable behavior, evidenced by losing her temper at school.

Pediatric Generalized Anxiety Disorder (GAD)

GAD presents with persistent, excessive, and unrealistic worry and anxiety. Children with GAD worry more often and more deeply than other children in similar circumstances (Cho et al., 2019). In pediatric GAD, worry and anxiety are associated with one or more of the following symptoms: Restlessness or feeling keyed up or on edge, easy fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance (Cho et al., 2019). Pertinent positive symptoms consistent with Pediatric GAD include easy distractibility, concentration difficulties, and a temperamental mood. However, the client has no symptoms of excessive anxiety or worry, making GAD an unlikely diagnosis.

Pediatric Bipolar Affective Disorder

Bipolar is a mood disorder in which thoughts, feelings, behaviors, and perceptions are distorted in the context of mania and depression episodes. Classic symptoms of mania include an abnormal, often expansive, and elevated mood lasting for at least one week (Gautam et al., 2019). Other symptoms include racing thoughts, a decreased need for sleep, rapid and often pressured speech, distractibility, increased goal-directed activities or projects, hypersexuality, reckless behaviors, risk-taking, and delusions of grandeur (Gautam et al., 2019). Bipolar disorder is a differential diagnosis based on the patient’s symptom of distractibility. However, the patient’s symptoms do not meet the criteria for bipolar disorder.

Reflections:

If I were to conduct the session again, I would perform psychometric and educational testing, which is essential in diagnosing attention deficit disorder. I would also evaluate impulsivity and inattention using timed computer tests such as the Conners Continuous Performance Test and the Integrated Visual and Auditory (Keulers & Hurks, 2021). In addition, I would conduct a learning disability evaluation to assess for learning disorders, which usually occur with attention deficit disorder (Keulers & Hurks, 2021). Ethical considerations should center on promoting better outcomes for the patient by implementing interventions based on best practice, thus promoting beneficence. Autonomy should be upheld in this case by involving the patient’s caregiver in the treatment and seeking consent before conducting a test or initiating treatment (Keulers & Hurks, 2021). The caregiver should be formally educated about ADHD to understand the concept behind the diagnosis and how it is managed.

References

Cho, S., Przeworski, A., & Newman, M. G. (2019). Pediatric generalized anxiety disorder. In Pediatric anxiety disorders (pp. 251-275). Academic Press. https://doi.org/10.1016/B978-0-12-813004-9.00012-8

Gautam, S., Jain, A., Gautam, M., Gautam, A., & Jagawat, T. (2019). Clinical Practice Guidelines for Bipolar Affective Disorder (BPAD) in Children and Adolescents. Indian journal of psychiatry, 61(Suppl 2), 294–305. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_570_18

Keulers, E. H., & Hurks, P. P. (2021). Psychometric properties of a new ADHD screening questionnaire: Parent report on the (potential) underlying explanation of inattention in their school-aged children. Child Neuropsychology, 1-16. https://doi.org/10.1080/09297049.2021.1937975

Schroer, M., Haskell, B., & Vick, R. (2021). Treating Child and Adolescent Attention-Deficit/Hyperactivity Disorder and Behavioral Disorders in Primary Care. The Journal for Nurse Practitioners, 17(1), 70-75. https://doi.org/10.1016/j.nurpra.2020.08.007

Sample Answer 2 for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Subjective:

CC (chief complaint): “psychiatric evaluation of attention deficit hyperactivity disorder.”

HPI: The 9-year-old female patient was accompanied to the psychiatric department by her mother following the positive findings of the completed attention deficit hyperactivity disorder (ADHD) questionnaire. The patient’s teacher also got an opportunity to complete the ADHD questionnaire based on her behavior and habits at school. According to the patient’s mother, her daughter has displayed difficulties in paying attention and is always forgetful. The patient’s teacher also reports similar symptoms at school, as the patient frequently forgets her assignments. At school, the patient fidgets a lot, displaying difficulties in sitting still on a chair. Additional symptoms reported include daydreaming, temperamental, and engaging in injurious activities. The patient started experiencing the above symptoms when she joined the kindergarten. Her mother claims that no treatment approach has been used so far in the management of the patient’s symptoms.

Past Psychiatric History:

General Statement: The patient presents with attention deficit and memory problems which affect her academic performance and other daily activities.
Caregivers (if applicable): The 9-year-old girl is under the care of one of her mothers.
Hospitalizations: No history of hospitalization was reported.
Medication trials: No medication has been used to manage the patient’s current symptoms.
Psychotherapy or Previous Psychiatric Diagnosis: The patient has never been diagnosed with a mental disorder or taken part in therapy.

Substance Current Use and History: The patient lives and studies in a drug-free environment, with no exposure to cigarette or marijuana smoke.

Family Psychiatric/Substance Use History: No history of mental disorder or use of substances has been reported among any family member.

Psychosocial History: The patient is the only kid, who was being raised by her two moms. However, they recently got separated to resolve their marital issues, leaving the patient to stay with one, the current historian. The patient is in the 3^rd grade, with poor performance due to her mental condition. She gets adequate sleep every night, for about 9 hours. Her PCP reports that the patient displays difficulties in consuming an entire meal as a result of being unable to sit down but she manages to get proper nutrition. She has a dog and also likes visiting art galleries and playing video games.

Medical History: No history of any chronic medical condition was reported.

Current Medications: The patient is not on any medication.
Allergies: No known food, environmental, or drug allergies.

Reproductive Hx: Mother reports normal birth, with no birth defects. No family history of reproductive disorders.

ROS:

GENERAL: Generally healthy with no recent changes in body weight. Denies fever, chills, fatigue, headache, lethargy, or dizziness.
HEENT: Head: denies headache. Even distribution of hair. No signs of injury or trauma. Eyes: No redness, excessive tearing, itchiness, polyploidy, or pain. Ears: No tinnitus, hearing loss, inflammation, itchiness, or exudates. Nose & Throat: No congestion, sinus problems, bleeding nose, running nose, inflammation, or itchiness. No sore throat, swallowing difficulties, or bleeding gums.
SKIN: Warm but somehow dry. No lesions, bruises, lumps, redness, inflammation, or eczema.
CARDIOVASCULAR: No palpitations, murmurs, chest tightness, cyanosis, syncope, arrhythmias, or hypertension.
RESPIRATORY: No running nose, congestion, breathing difficulties, sneezing, wheezing, cough, sputum production, asthma, or chest discomfort.
GASTROINTESTINAL: No tenderness, hernia, abdominal distension, diarrhea, constipation, nausea, or vomiting.
GENITOURINARY: No urgency, frequency, or burning sensation when urination or incontinence. Has not yet experienced her first menses.
NEUROLOGICAL: No ataxia, headache, heat or cold intolerance, reduced appetite, paresthesia, or dizziness.
MUSCULOSKELETAL: No muscle or joint tenderness, stiffness, or inflammation. Confirm full range of movement in both lower and upper extremities.
HEMATOLOGIC: Denies easily bruising, bleeding gums, nose bleeding, anemia, or any other hematological disorder.
LYMPHATICS: No lymphadenopathy or splenectomy.
ENDOCRINOLOGIC: No hypothyroidism, hyperthyroidism, polyphagia, polyuria, or polydipsia.

Objective:

Physical exam: Vitals: Temp- 97.4 Pulse- 62 RR 14 95/60 Ht 4’5 Wt. 63lbs

Diagnostic results: To assess the patient for any underlying diseases complete blood count was ordered. Additional tests ordered for routine assessment include blood sugar tests, ELISA tests, basic metabolic panel, lipid profile, Hb test, and urine test for drugs. Imaging studies such as CT scans and X-rays of the head are also ordered to check for any anatomical deformities or signs of trauma, that may lead to the present symptoms. For further assessment of the patient’s signs of ADHD, the following screening tools were utilized, Conners Comprehensive Behavior Rating Scale (CBRS), National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scale, and ADHD parent-teacher questionnaire (Halperin & Marks, 2019).

Assessment:

Mental Status Examination: The patient appears healthy and well-groomed in age-appropriate clothing. Her orientation is compromised as she keeps forgetting where she is, and why she is there. She however fidgets a lot. She is also impulsive and unable to sit still for quite a short period. She is very forgetful and seems distracted most of the time. Her mood is slightly elevated. She is very irritable. She speaks with a normal tone rate but is sometimes loud. Her thought process is intact. Denies hallucinations or delirium. Her thought content is appropriate for her age. Denies suicidal or homicidal or psychotic symptoms.

Differential Diagnoses:

Attention Deficit Hyperactivity Disorder (ADHD): The diagnosis of ADHD as outlined in the DSM-V among children and adolescents requires a history of hyperactivity, behavioral problems, poor academic performance, distractibility, and inattention (Wolraich et al., 2019). The patient is also required to present with no less than 6 symptoms of hyperactivity or inattention or both leading to functional impairment just like for the patient in the provided case study. Consequently, the patient must start presenting with these symptoms before the age of 12 years, and the patient in the provided case study reported a set of symptoms immediately after joining kindergarten (Bélanger et al., 2018). From the mental status examination results, and provided patient history, in addition to the completed ADHD parent-teacher questionnaire, the patient qualifies for ADHD as the primary diagnosis.
Separation Anxiety Disorder (SAD): According to the DSM-V this disorder is assigned to patients who normally display anxiety or excessive fear when separated from an individual that they were strongly attached to like a family member (Becker et al., 2018). The patient was being raised by two mothers, who ended up separating leaving the patient to stay with one. Patients diagnosed with this disorder will also present with symptoms such as persistent worry about the unexpected event, nightmares about the separation, afraid of being left alone, and unusual distress (Sadaqa Basyouni, 2018). The patient in the provided case study is negative for most of these symptoms which disqualifies this diagnosis.
Unspecified Neurodevelopmental Disorder: According to the DSM-V, UNDD is usually diagnosed in patients who present with symptoms of a certain neurodevelopmental disorder but do not meet the criteria for any of them (Rivollier et al., 2019). It is one of the most common differential diagnoses for ADHD. The patient in the provided case study displayed ADHD symptoms, based on the complete ADHD questionnaire by both her mother and teacher. However, her mother was not sure whether the patient has this disorder, given that she was also separated from her other mother, which might contribute to her symptom and suggestion of another mental problem. This disorder will however be considered only if the patient fails to meet the diagnosis of ADHD.

Reflections: Based on the information provided, the PMHNP was very professional with the use of respectful language and maturing a healthy therapeutic relationship with the patient. The information gathered is quite adequate to support the diagnosis of ADHD. Since the patient’s mother was ready to seek medical attention based on the previously completed ADHD questionnaire, the PMHNP would have thus focused on discussing the available treatment options for the patient (Halperin & Marks, 2019). The patient’s mother has a legal obligation in making decisions concerning her child’s health. As such, the clinician must educate the patient’s mother on the advantages and disadvantages of each treatment option, and convince her of the most effective approach based on clinical judgment (Wolraich et al., 2019). Respecting the patient’s autonomy is crucial to promote positive treatment outcomes.

References

Becker, S. P., Schindler, D. N., Holdaway, A. S., Tamm, L., Epstein, J. N., & Luebbe, A. M. (2018). The Revised Child Anxiety and Depression Scales (RCADS): Psychometric Evaluation in Children Evaluated for ADHD. Journal of Psychopathology and Behavioral Assessment, 41(1), 93–106. https://doi.org/10.1007/s10862-018-9702-6

Bélanger, S. A., Andrews, D., Gray, C., & Korczak, D. (2018). ADHD in children and youth: Part 1—Etiology, diagnosis, and comorbidity. Paediatrics & Child Health, 23(7), 447–453. https://doi.org/10.1093/pch/pxy109

Halperin, J. M., & Marks, D. J. (2019). Practitioner Review: Assessment and treatment of preschool children with attention-deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 60(9), 930–943. https://doi.org/10.1111/jcpp.13014

Rivollier, F., Krebs, M.-O., & Kebir, O. (2019). Perinatal Exposure to Environmental Endocrine Disruptors in the Emergence of Neurodevelopmental Psychiatric Diseases: A Systematic Review. International Journal of Environmental Research and Public Health, 16(8), 1318. https://doi.org/10.3390/ijerph16081318

Sadaqa Basyouni, S. (2018). Separation Anxiety and its Relation to Parental Attachment Styles among Children. American Journal of Educational Research, 6(7), 967–976. https://doi.org/10.12691/education-6-7-12

Wolraich, M. L., Chan, E., Froehlich, T., Lynch, R. L., Bax, A., Redwine, S. T., Ihyembe, D., & Hagan, J. F. (2019). ADHD Diagnosis and Treatment Guidelines: A Historical Perspective. Pediatrics, 144(4), e20191682. https://doi.org/10.1542/peds.2019-1682

Sample Answer 3 for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Subjective:

Chief Complaint: “When teachers tell me assignments in school, I don’t very well remember what they said your assignments are. Sometimes, they have to write her down a list. Sometimes I lose the list. Actually, Every day.”

History of Presenting Illness: S.H an 11-year-old female Caucasian from Washington presents for a psychiatric evaluation due to difficulty in concentration. She is currently not on any medication. She is accompanied by her mum as she is a minor. They present filled forms on Attention deficit. The patient reports not remembering the assignments she is given at school. She also reports that when the assignments are written on a list she loses the list or forgets where she put the assignment. This problem started when she began school and is not improving or worsening. She also reports finding it difficult to sit still on her chair at school. She fidgets and gets out of the chair. She reports finding it difficult to sit still to read as she only sits still for an average of five minutes. She reports having difficulty remembering what she has read or what she was taught. She reports losing a lot of her personal belongings and making mistakes in classwork. These mistakes frustrate her as she tries to do her best. She reports remembering things that make her feel good. Her mum reports that she loves art but keeps jumping from one artwork to another and faces difficulties when she is in groups. She can however play video games for a long time. The mother reports that she liked engaging in risky behavior from her childhood. She gets adequate sleep of 9-10 hours. She does not feed well due to her inability to sit still for a significant duration of time. There is no reported history of head trauma. Developmental milestones were timely achieved and the vaccination schedule was up to the minute.

Past Psychiatric History: The patient has never been enrolled in treatment before, and no previous hospitalizations or psychiatric diagnoses reported.

Substance Current Use and History: There is no history of substance abuse reported. There is no history of maternal substance abuse during pregnancy.

Family History: There is no family history of mental illness reported.

Social History: The patient lives with both parents in Washington D.C. She has a younger brother. She goes to school. She loves art, playing with her dog, and playing video games.

Medical History: There is no history of head injury, convulsions, or any other illnesses.

Current Medications: S.H is not on any medication.
Allergies: There are no reported drug or food allergies.
Reproductive History: No menstrual history was reported.

ROS:

GENERAL: There is no fever, fatigue, or chills reported.

HEENT: no history of head trauma, no headache, no visual problems, no pain in the eye, no tearing, no blurring of vision, no excessive sensitivity to light, no reported ear discharge, no difficulty hearing, no reported history of sneezing or nasal stuffiness, no sore throat or voice changes.
Skin: no itchiness of the skin or rash eruptions on the skin, no skin pigmentation changes, no striae.
Cardiovascular: No chest pain, no awareness of heartbeat, no dyspnea on exertion, no paroxysmal nocturnal dyspnea, no body edema.
Respiratory: no cough, no chest pains, no breathing difficulties.
Gastrointestinal: no vomiting, no regurgitation of food after eating, no loose stools, no blood in stool, intact appetite.
Genitourinary: no increased frequency or urgency for urination, no per vaginal discharge, no anogenital warts.
Neurological: no headaches, no dizziness, no diplopia, no changes in the normal gait and posture, and no muscle weaknesses.
Musculoskeletal: no joint swellings, no joint pains, no stiffness of joints, and no obvious muscle wasting reported.
Hematologic: no bleeding tendencies such as bleeding gums or hemorrhage in the skin, no pallor, and no recurrent infections.
Lymphatics: no lymph node enlargement, no history of splenomegaly or splenectomy, and no one-sided leg swelling.
Endocrinologic: no awareness of heartbeat, no oversensitivity to heat or cold, no increased frequency of urination or thirst, normal appetite, no darkening of the skin.

Objective:

Physical exam: vital signs: Temperature- 97.4 F, Pulse rate- 58, Respiratory rate 14, Blood Pressure 98/62mmHg Height 4’5 Weight 65lbs.

Diagnostic results: Liver function tests, thyroid function tests, renal function tests, complete blood count and imaging studies are all normal.

Assessment:

Mental Status Examination: S.H is 11 years old female Caucasian minor of medium build and looks her age. She is well kempt and neat. She is initially pleasant in manner but becomes easily distractible. She is fairly calm at the start of the assessment but becomes fidgety and restless within a short time. She has difficulty maintaining eye contact and maintaining social engagement. She displays agitation as she is unable to sit still, and keeps fidgeting, picking her cloth. Her speech rate, rhythm, and volume are fairly normal. Objectively, her mood is appropriate with an anxious affect. She exudes anxiety. Her thought process is coherent, and logical, with a goal-directed stream of thought but she loses interest fast. She is easily distracted. She has no perception anomalies. In cognition, she is alert and oriented. She has difficulties with short-term memory, poor attention, and concentration. Her judgment is intact but only has a grade two insight as she has a slight awareness of being sick and needing help.

Primary Diagnosis: DSM-V 314.01 (F90.2) Combined presentation of Attention Deficit and Hyperactivity Disorder: S.H meets the criteria of both Inattention and hyperactivity according to the DSM-V criteria. She makes classwork mistakes as a result of not paying attention to the details, she daydreams constantly even in situations where there are no distractions, reluctant in school work but she can sit long hours for video games, and she keeps losing her personal belongings like books and her bracelet, is easily distractible and immensely forgetful. She shows hyperactivity by being fidgety, getting off her chair when she is not supposed to, she can’t concentrating on one artwork at a time and having difficulties waiting for her turn. These symptoms must occur before age 12 (American Psychiatric Association, 2013). For this patient, these symptoms started when she began school. According to Cabral et al., (2020) ADHD interferes with the social and academic development of patients. As discussed, S.H is unable to do her class work in the right manner as per the rubrics. The symptomatology of ADHD in this patient is also displayed both at home and school.

Differential Diagnoses: 299.00 (F84.0) Autism Spectrum Disorder, 300.02 (F41.1) Generalized Anxiety disorder, and 312.34 (F63.81) Intermittent Explosive Disorder.

299.00 (F84.0) autism spectrum disorder: Children with ASD tend to display inattention and social difficulties just like those with ADHD (American Psychiatric Association, 2013). Both ASD and ADHD may be manifested in poor academic and social performance. Inattention in ASD is due to an inherent lack of interest in something while in ADHD is due to distraction from external stimuli (Rommelse et al., 2018). This rules out ASD as S.H have an interest in things like art and class work but is just distracted.

300.02 (F41.1) Generalized Anxiety disorder: Anxiety state disorder is a plausible differential as it is also marked by inattention and hyperactivity. There is restlessness and difficulty in concentration characterized by daydreaming (Ströhle et al., 2018). These symptoms are both present in S.H who keeps on daydreaming and is unable to concentrate on a single task for long. However, anxiety states are generally marked with worry and ruminations which are absent in this patient.

312.34 (F63.81) Intermittent Explosive Disorder: Both ADHD and Intermittent Explosive Disorder manifest through heightened impulsivity and hyperactivity (Radwan & Coccaro, 2020). Although these disorders may coexist in a single patient, they are demarcated by the fact that IED patients exhibit severe aggression and temper outbursts. This rules out IED as S.H does not exhibit aggression.

Reflections:

A detailed history and quality in-hospital and out-of-hospital evaluation are critical in the diagnosis of ADHD. The patient must be monitored in more than one environment (Wolraich et al., 2019). It is plausible that the care provider gives questionnaires to be filled out at home and school. This patient presents with the classical features of ADHD consisting of inattention and hyperactivity. According to Grimm et al., (2020) the heritability of ADHD stands at 77-88%. This is a high value. If I were to redo this case, I would look for any family history of ADHD in first-degree relatives. The diagnosis of a child to be having a mental disorder of any kind is a distressing experience for parents, especially first-time parents. Such situations require adequate counseling to help them know that they can be helped to shape the child’s future into a desirable one.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th edition). Reference Reviews, 28(3). https://doi.org/10.1108/rr-10-2013-0256

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(S1), S104–S113. https://doi.org/10.21037/tp.2019.09.08

Grimm, O., Kranz, T. M., & Reif, A. (2020). Genetics of ADHD: What Should the Clinician Know? Current Psychiatry Reports, 22(4). https://doi.org/10.1007/s11920-020-1141-x

Radwan, K., & Coccaro, E. F. (2020). Comorbidity of disruptive behavior disorders and intermittent explosive disorder. Child and Adolescent Psychiatry and Mental Health, 14(1). https://doi.org/10.1186/s13034-020-00330-w

Rommelse, N., Visser, J., & Hartman, C. (2018). Differentiating between ADHD and ASD in childhood: some directions for practitioners. European Child & Adolescent Psychiatry, 27(6), 679–681. https://doi.org/10.1007/s00787-018-1165-5

Ströhle, A., Gensichen, J., & Domschke, K. (2018). The Diagnosis and Treatment of Anxiety Disorders. Deutsches Aerzteblatt Online, 115(37). https://doi.org/10.3238/arztebl.2018.0611

Sample Answer 4 for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Subjective:

Name: Harold Griffin

Gender: Male

Age: 58 years old

Informant: Self

CC (chief complaint): “I am having difficulties with concentration.”

HPI: Griffin is a 58-year-old male patient who presents to the psychiatric clinic with difficulties concentrating. The client informed his supervisor that he was having concentration difficulties, and the supervisor set up a psychiatric appointment. Griffin reports that he is having trouble concentrating on his work at an architectural engineering firm with the accelerated deadlines and pressure at work. The concentration difficulties interfere with the quality of his work since he makes silly mistakes that may cost the firm a lot of money. However, the patient did not have these problems when there was no pressure and tight deadlines at work. He states that he had concentration problems when studying in the library. He would often get distracted, look out the window, take a walk, and be disrupted by whispers. The patient states that he currently gets distorted during work lectures and finds it difficult to sit and listen. He also tends to be distracted doing his work, and his attention shifts to other people’s work.

The client also mentions that he is disorganized and often forgets where he places his items. He also forgets to pay his bills. He had a history of hyperactivity in school, but his focus has improved. Besides, he states that caffeine increases his concentration levels.

Past Psychiatric History:

General Statement: No
Caregivers (if applicable): None
Hospitalizations: None
Medication trials: None
Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History Takes one scotch drink with a cigar on weekends. Denies history of drug use.

Family Psychiatric/Substance Use History: No family history of psychiatric disorder or substance abuse.

Psychosocial History: Griffin has a Bachelor’s degree in engineering. He is homosexual and dates casually. He is not married and has no children. The patient has one younger sister. He sleeps 4-6 hours and reports having a good appetite. He denies having a history of legal issues.

Medical History: Positive history of HTN, Angina, Hypertriglyceridemia, and BPH.

Current Medications: Losartan 100mg daily; ASA 81mg PO daily, Metoprolol 25mg BD; Fenofibrate 160mg OD; Tamsulosin 0.4mg PO
Allergies: Morphine

Reproductive Hx: Not applicable.

ROS:

GENERAL: Negative for weight gain/loss, fever, chills, or fatigue.
HEENT: No eye pain, blurred/double vision, ear discharge/pain, rhinorrhea, or sore throat.
SKIN: No discoloration, itching, or lesions.
CARDIOVASCULAR: No chest pain, palpitations, or SOB.
RESPIRATORY: No cough, wheezing, or breathing difficulties.
GASTROINTESTINAL: No nausea/vomiting, abdominal pain, or tarry stools.
GENITOURINARY: No urinary symptoms.
NEUROLOGICAL: No headache, paralysis, or tingling sensations.
MUSCULOSKELETAL: No muscle pain, joint pain/stiffness.
HEMATOLOGIC: No bruising or bleeding.
LYMPHATICS: No lymph node swelling.
ENDOCRINOLOGIC: No excessive sweating, hot/cold intolerance, excessive hunger, urine production, or thirst.

Objective:

Physical exam:

Vitals: T- 98.8; P- 86; R-18; BP- 134/88; Ht- 5’11; Wt- 180lbs

Diagnostic results: No diagnostic tests ordered.

Assessment:

Mental Status Examination:

Appearance- Well-groomed and appropriately dressed.

Movement and behavior- Normal gait and posture; Positive facial expressions.

Mood- Nervous

Affect- Appropriate

Speech- Normal rate and volume.

Thought process- Coherent, logical, and goal-directed.

Thought content- No hallucinations, delusions, obsessions, or suicidal thoughts.

Cognition- Oriented to person, place, and time.

Memory- Short and long-term memory is intact.

Judgment- Good.

Insight- Present.

MOCA- 27/30, difficulty with attention and delayed recall; ASRS-5: 20/24.

Differential Diagnoses:

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD presents with difficulties paying attention, controlling impulsive behaviors, and being excessively active. Adults with ADHD have difficulties paying close attention to details and making careless errors. They have trouble paying attention to tasks and when spoken to directly. Besides, they often do not follow instructions and fail to finish duties at work (Prakash et al., 2021). They have difficulties organizing tasks and activities and often lose things needed for tasks and activities. In addition, adults with ADHD are easily distracted and are forgetful in daily activities. Furthermore, adults often complain of impairment in occupation and social life due to hyperactivity, impulsiveness, and trouble paying attention (Geffen & Forster, 2018). ADHD is a differential diagnosis for this patient based on his history of concentration difficulties, trouble paying attention to tasks at work, making silly job mistakes, disorganization, easy distractions, and losing items.

Generalized Anxiety Disorder (GAD)

GAD presents with a persistent, unjustifiable, and unrealistic worry and anxiety. The worry/anxiety is accompanied by one or more of the following symptoms: Restlessness, irritability, easy fatigue, concentration difficulties, easy distraction, muscle tension, and sleeping difficulties (Ströhle et al., 2018). GAD is a differential diagnosis based on the patient’s history of worrying about his work, easy distraction, and concentration difficulties. However, the patients did not present with worry as the main concern and did not have excessive worry/anxiety, which justifies GAD as a primary diagnosis.

Borderline Personality Disorder (BPD)

BPD presents with affective lability, impulsivity, and angry outbursts. Symptoms in BPD patients are more goal-directed and continuous (Kulacaoglu & Kose, 2018). BPD is a differential based on the patient’s history of impulsive behavior. However, it is a less likely primary diagnosis since the patient does not exhibit labile mood swings.

Reflections:

From this assignment, I learned that adults also present with ADHD. ADHD is diagnosed in adults if they have a history of symptoms of inattention present for at least six months. I also learned that adults with ADHD often present with chaotic lifestyles, psychiatric comorbidities, and disorganization and may use drugs and alcohol to cope.

If I were to conduct the assessment again, I would utilize psychological testing tools such as the Conner’s Adult ADHD Rating Scale and Copeland Symptom Checklist for Adult ADHD to assess ADHD-related cognitive, social, and emotional symptoms (Prakash et al., 2021). Ethical factors that should be considered for this patient include autonomy by obtaining consent and involving the patient in making treatment decisions. Beneficence and nonmaleficence should be considered by implementing treatment interventions with the best outcomes and least side effects. Health promotion should involve educating the patient on healthy lifestyle practices, such as healthy dietary habits, regular physical exercises, and adequate sleep (UK, 2018).

References

Geffen, J., & Forster, K. (2018). Treatment of adult ADHD: a clinical perspective. Therapeutic advances in psychopharmacology, 8(1), 25–32. https://doi.org/10.1177/2045125317734977

Kulacaoglu, F., & Kose, S. (2018). Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe. Brain sciences, 8(11), 201. https://doi.org/10.3390/brainsci8110201

Prakash, J., Chatterjee, K., Guha, S., Srivastava, K., & Chauhan, V. S. (2021). Adult attention-deficit hyperactivity disorder: From clinical reality toward conceptual clarity. Industrial psychiatry journal, 30(1), 23–28. https://doi.org/10.4103/ipj.ipj_7_21

Ströhle, A., Gensichen, J., & Domschke, K. (2018). The Diagnosis and Treatment of Anxiety Disorders. Deutsches Arzteblatt international, 155(37), 611–620. https://doi.org/10.3238/arztebl.2018.0611

UK, N. G. C. (2018). Evidence reviews for Information and support for people with ADHD: Attention deficit hyperactivity disorder: diagnosis and management.

Sample Answer 5 for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Subjective:

CC (chief complaint): “Completed questionnaires on attention deficit hyperactivity disorder.”

HPI: S.H. is a 9 year old female patient who was brought to the psychiatric department with chief complaint of attentions deficit hyperactivity disorder (ADHD). Her mother and teacher were asked to complete questionnaires on ADHD, following the patients presenting signs and symptoms of the disorder. Her mother reports that the patient has problems with paying attention, and being very forgetful. Things have to be written down for her to remember. Her teacher also claims that the patient even forgets her assignments every day, which have to be listed on her mothers cell phone. The patient is also unable to sit still in a chair at school as she fidgets a lot. She reports that these symptoms started immediately when the patient first reported to kindergarten. She also displays signs of daydreaming about both good and bad things, loosing her temper, and getting injured. She thinks of her mother sometimes when she daydreams, who separated from them a while back. The patient has no history of treatment, with all the developmental milelstones being met on time, and vaccinations up to date. Her PCP reports that she gets adequate amount of sleep every night for about 9 hours per night, but does not get proper nutrition as she finds it hard to sit down for meals.

Past Psychiatric History:

General Statement: The patient started experiencing problems with her memory and attention when she joined kindergarten.
Caregivers (if applicable): She currently lives with one of her mothers, after they separated.
Hospitalizations: Denies any previous history of hospitalization.
Medication trials: The patient denies taking any medication for the management of her mental health disorder.
Psychotherapy or Previous Psychiatric Diagnosis: The patient has never been diagnosed with any psychiatric disorder, with no history of psychotherapy.

Substance Current Use and History: Denies use of caffeine, or nicotine. No history of drug use such as tobacco or marijuana at home, which could expose the patient to passive smoking.

Family Psychiatric/Substance Use History: No history of mental health disorders within the family that is known to the historian.

Psychosocial History: The patient was raised by her two moms as the only kid. She was however separated from one of the moms as a result of marital issues. She is currently in grade 3, but experiencing academic difficulties as a result of her mental condition. She likes playing video games and visiting art gallaries. She has a dog, which she enjoys playing with. Reports no history of trauma or violence at home.

Medical History: Denies past history of any serious health complication.

Current Medications: Denies use of any drugs at the moment.
Allergies: No known food, environmental or drug allergies.

Reproductive Hx: No family history of reproductive disorders. The patient has not yet gotten her first menses.

ROS:

GENERAL: No chills, fever, weakness, weight loss, fatigue, changes in appetite or loss of energy.
HEENT: Head: No signs of head injuries with equal distribution of hair. Eyes: No blurred vision, use of corrective leneces, changes in visual aquity, yellowing of sclear or double vision. Ears: No tinnitus, discharge, itchiness, pain, hearing loss or inflammation. Nose: No congestions, running nose, inflammation, itchiness or bleeding nose. Throat: No sore throat, dswallowing difficulties, or swollen tonsils.
SKIN: Smooth and warm, with no rashes, hives, or itchiness.
CARDIOVASCULAR: No chest tightness, palpitations, pressure, discomfort, edema or chest discomfort.
RESPIRATORY: No breathing difficulties, shortness of breath, wheezing, sneezing, sputum or cough.
GASTROINTESTINAL: No signs of abdominal distention, diarrhoea, constipation, hernia, abdominal tenderness or changes in bowel movement.
GENITOURINARY: No signs of urgency, or hesitancy. Denies burning sensation when passing urine.
NEUROLOGICAL: No changes in bladder or bowel control. No dizziness, tingling in the extremeties, numbness, paralysis, ataxia, or headache.
MUSCULOSKELETAL: Full ranges of movement in both upper and lower extremeties. No joint stiffness or muscle pain.
HEMATOLOGIC: No signs of bruising, bleading or anaemia.
LYMPHATICS: No signs of enlarged lymph nodes, or a history of splenomegaly.
ENDOCRINOLOGIC: No heat or cold intolerance, polyuria, excessive sweating or polydipsia.

Objective:

Physical exam: Vitals: Temp- 97.4 Pulse- 62 RR 14 95/60 Ht 4’5 Wt 63lbs

Diagnostic results: Routine blood works such as complete blood count, haematocrit count and white blood cell count to rule out other possible causes of the patients symptoms. Screening for thyroid disorders by measuring the levels of T3, T4 and TSH to rule out differential diagnosis. Brain imaging studies such as MRI and CT scan for assessment of anatomical deformities (Emser et al., 2018). Electroencephalogram (EEG) or brain-wave test to evaluate the possible cause of the patient symptoms. Other diagnostic tools utilised include ADHD questionnaires for the patient and the teacher and DSM-V diagnostic creteria.

Assessment:

Mental Status Examination: The 9 year old patient appears well groomed in age appropriate clothes. She however fails to maintain eye contact, and fidgets in her chair throughout the interview. She is however well oriented in person, place and time. She is unable to concentrate and focus on the same topic for longer. She is polite and answers questions eaily. However, she seems distracted and forgets some questions in the course of the interview. She displays signs of short term memory loss, with relatively intact long term memory. She confirms signs of anger management problems. Denies signs of hallucination, or suicidal ideation.

Differential Diagnoses:

Attention Deficit Hyperactivity Disorder (ADHD): Also known as attention deficit disorder, ADHD is a behavioral disorders which is normally first diagnosed during childhood. According to DSM-V, ADHD is characterized by impulsivity, inattention and in some cases hyperactivity. The DSM-V diagnostic creteria however, requires a patient to display with the following 6 or more symptoms for children below the age of 16 years, to qualify for the diagnosis of ADHD: inattention with signs of being easily distracted, forgetful, trouble organizing tasks, avoidance behavior to perform some tasks, failing to finish school work, and loss of fucus and; Hyperactivity and impulsive behavior characterized by talkativeness, fidgeting, restlessness, interrupting conversations, and absentmindedness among others (Llanes, Blacher, Stavropoulos, & Eisenhower, 2020). The patient in the provided case study displayed with most of these symptoms qualifying for the diagnosis of ADHD as the primary diagnosis.
Social Anxiety Disorder (SAD): Studies show that most children diagnosed with ADHD might also be suffering from social phobia, which is characterized by poor social skills as a result of increased stress and lonliness, that compromises the patients overall mental and physical health (D’Agati, Curatolo, & Mazzone, 2019). According to DSM-V, patients diagnosed with this diaorder must display with persistent, intense fear or anxiety, regarding a certain social situation as a result of the belief that they may be negatively judged or embarrassed or humiliated. The patient in the provided case study started displaying symptoms of ADHD immediately after joining kindergarten. He also displayed signs of impulsive behavior, fidgety and loose of temper, when at school, which are indicators of social phobia. Her ADHD might have developed as a result of social phobia, making this SAD, a differential diagnosis.
Neurodevelopmental syndromes: These are very rare conditions, but commonly misdiagnosed among patients suffering from ADHD. Neurodevelopmental syndromes include fetal alcohol syndrome, fragile X syndrome, and Klinefelter syndrome (Scandurra et al., 2019). Despite the patient’s developmental milestones being met on time, there are still possibilities of developing these disorders. The patients primary diagnosis might be ADHD, but it is necessary to perform genetic testing to distinguish between fragile Klinefelter syndrome or X syndrome syndrome from ADHD, since little information was provided regarding the patients family history.

Reflections: The patient in the provided case study is most likely suffering from ADHD as speculated by the PMHNP. The assessment and evaluation procedure utilised is appropriate to gather all the necessary information to make a definitive diagnosis for the patient, which is essential in formulating the most appropriate treatment plan. For instance, filling out the ADHD questionnaires helps in assessing the patients symptoms both at home and at school (Guo et al., 2021). However, little information was provided regarding the patient family history of psychiatric disorder, which would have helped with the diagnosis. The PMHNP also observed appropriate legal and ethical considerations such as involving the patients mother and seeking her approval in helping the patient. The patient being a monor gives her the legal right to make decisions concerning the health of her child.

References

Emser, T. S., Johnston, B. A., Steele, J. D., Kooij, S., Thorell, L., & Christiansen, H. (2018). Assessing ADHD symptoms in children and adults: evaluating the role of objective measures. Behavioral and Brain Functions, 14(1), 1-14. doi: 10.1093/pch/pxy111

Guo, N., Fuermaier, A., Koerts, J., Mueller, B. W., Diers, K., Mroß, A., … & Tucha, O. (2021). Neuropsychological functioning of individuals at clinical evaluation of adult ADHD. Journal of Neural Transmission, 128(7), 877-891. https://doi.org/10.1007/s00702-020-02281-0

Scandurra, V., Emberti Gialloreti, L., Barbanera, F., Scordo, M. R., Pierini, A., & Canitano, R. (2019). Neurodevelopmental disorders and adaptive functions: a study of children with autism spectrum disorders (ASD) and/or attention deficit and hyperactivity disorder (ADHD). Frontiers in psychiatry, 10, 673. https://doi.org/10.3389/fpsyt.2019.00673

D’Agati, E., Curatolo, P., & Mazzone, L. (2019). Comorbidity between ADHD and anxiety disorders across the lifespan. International journal of psychiatry in clinical practice, 23(4), 238-244. https://doi.org/10.1080/13651501.2019.1628277

Llanes, E., Blacher, J., Stavropoulos, K., & Eisenhower, A. (2020). Parent and teacher reports of comorbid anxiety and ADHD symptoms in children with ASD. Journal of autism and developmental disorders, 50(5), 1520-1531. https://doi.org/10.1007/s10803-018-3701-z