PRAC 6635 Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation
Walden University PRAC 6635 Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs 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 PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs
Whether one passes or fails an academic assignment such as the Walden University PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs 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 PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs
The introduction for the Walden University PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs 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 PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs
After the introduction, move into the main part of the PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs 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 PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs
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 PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs
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 PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs
CC “I feel stuck”
HPI: GN is a 50 year old African American female who is here for a Mental health follow up evaluation. Client is recently divorced after 12 yeas of marriage, has 3 children between the ages of 12 and 23 and is living alone as her husband has custody of the younger children.
Client reports feeling down and depressed almost daily and having trouble falling and staying asleep. She reports feeling very anxious and scared and fearful, and is worried about her job and life in general. Client reports she is easily agitated and vey confrontational and over reacts to certain situations that she later realizes are minor issues. “I feel stuck, I feel like I lost my fire in life, my marriage failed, my job sucks, everyone tries to take advantage of me”.
Past Psychiatric History:
- General Statement: GN is a 50 year old African American female with a previous history of depression
- Caregivers : Client lives alone and has no caregivers
PRAC 6635 Assignment 2 Comprehensive Psychiatric Evaluation and Patient Case Presentation - Hospitalizations: No history of previous hospitilizations except for child bearing
- Medication trials: Wellbutrin 150-300mg (for 3 years from 2005)
- Psychotherapy or Previous Psychiatric Diagnosis: Hx. of Depression
Substance Current Use and History: Denies use of illicit drugs or ETOH abuse.
Family Psychiatric/Substance Use History: Son and Maternal Aunt with bipolar disorder
Psychosocial History: Client lives alone although she has 3 children who live with their father, including a 23 year
old son who chose to live with his father. She has a college degree and is currently employed as a sales representative in a large retail company. Client reports she was sexually abused by her cousin when she was 9 years old but was yelled at and called a liar when she tried to tell her family. Client reports being constantly teased as a child as she was overweight and emotionally abused by her cousins, siblings and mother. She reports she still feels a sense of guilt as she had a strained relationship with her mother that was never resolved prior to her mother’s death.
Medical History:
Current Medications:
Mirtazpine 7.5 mg by mouth as needed at bedtime for insomnia.
Prozac 10 mg by mouth everyday for depression
Ferrous Sulpate 325 mg by mouth 3 times a day for anemia
Vitamin D 50000 iu by mouth weekly for vitamin D deficiency
- Allergies: No known drug or seasonal allergies
- Reproductive Hx: Menarche started at the age of 10, LMP 2 months ago, no abortions and miscarriages, currently not sexually active, 3 pregnancies and 3 living children.
ROS:
- GENERAL: Client is a 50 year old recently divorced AA female with a pevious hx. of depression.
- HEENT: The patient’s eyes appear normal. No abnormal discolorization of the sclera was observed. The ears are also normal. No sore throat or scratch. No sneezing and no cough.
- SKIN: no itchiness noted. The skin has no rashes, and no lesions were noted.
- CARDIOVASCULAR: No chest discomfort, no chest pressure or pain
- RESPIRATORY: no congestions nor respiratory issues were noted
- GASTROINTESTINAL: No nausea, vomiting,diarrhea,or abdominal pain. Client complains of poor appetite.
- GENITOURINARY: normal passing of urine with no pain, no hematuria
- NEUROLOGICAL: no numbness. No bowel movement changes or bladder control, no headache, dizziness or syncope.
- MUSCULOSKELETAL: Absence of joint pains, edema, and restricted movement in a range of motions
- HEMATOLOGIC: No bruises, bleeding, hx. of Iron deficiency anemia.
- LYMPHATICS: has no history of splenectomy and has no swollen lymph nodes
- ENDOCRINOLOGIC:No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.
Patient Health Questionnaire-9 (PHQ-9). Score is greater than 15
Diagnostic results: Major Depressive Disorder
Assessment
Mental Status Examination:
Client is well groomed, clean and overweight, appropriately dressed for the weather.She is calm, cooperative and pleasant with periods of tearfulness. Speech is clear, coherent and soft, client denies having any visual or auditory hallucinations, admits having suicidal ideations with no plans.
Cognition: A+O x 4, memory intact, intelligence average, memory remote, mood sad, affect anxious and tearful, insight and judgement intact, thought content unremarkable, motor activity intact.
Differential Diagnoses:
Major Depressive Disorder(MDD)
Bains, N. et al; (2021) reiterate the DSM-5 criteria for diagnosing MDD including a persistently low or depressed mood, anhedonia or decreased interest in pleasurable activities, feelings of guilt or worthlessness, lack of energy, poor concentration, appetite changes, psychomotor retardation or agitation, sleep disturbances, or suicidal thoughts and this client is experiencing all of these symptoms.
The DSM-5 specifier requires the presence of at least two of the five criterion symptoms for the majority of the depressive episode. The five symptoms of the anxious distress specifier are as follows: feeling keyed up or tense, feeling restless, difficulty concentrating because of worry, fear that something awful might happen, and feeling that one might lose control.( Zimmerman, M. et al; 2019).
Generalized Anxiety Disorder
GAD presents with excessive and unrealistic worry or anxiety. Other symptoms include: Restlessness or feeling keyed up or on edge, concentration difficulties, easy fatigue, muscle tension, irritability, and sleep disturbance (Bandelow et al., 2017).
Toussaint, A. et al; (2020) explain depression and anxiety are overlapping constructs and worry levels are comparable in individuals with GAD and depression. The clinical features of GAD according to Sadock, B. et al;( 2015) are sustained and extensive anxiety and worry accompanied by motor tension or restlessness, some features which are exhibited by this client, but persistent depression is the prevalent symptom presented in this client.
Post Traumatic Stress Disorder
PTSD occurs after one experiences the traumatic event directly, witnesses a
traumatic event as it occurs to others, or learns that a traumatic event happened to a
loved one (Miao et al; 2018).
There is no doubt that the traumatic event of being sexually abused as a young child has played a significant role in how this client experiences events, and contributed to her low self esteem, anxiety and vulnerability but this experience does not appear to be a constant stressor for this client, and would therefore not be considered as the first diagnosis.
Reflections:
This client obviously has deep seated issues that are yet to be resolved, including her claim that she was sexually abused by a close relative as a 9 year old impressionable child. According to Gilbert, P. (2019), when a child’s basic needs for protection, security, guided stimulation, and affection are lacking or even abused, the developmental trajectory is very different. Threat system processing dominates the construction of the self-identity, interpersonal attentional sensitivity, vulnerability to mental health problems, and antisocial behaviour.
Pharmacological agents have proved their efficacy in mental and behavioral issues, but with this client, I am of the opinion that she needs extensive psychotherapy that will give her the opportunity to explore her feelings, lay rest to unresolved issues in her life and guide her in appropriate ways to channel her energy and resolve issues that bother her.
Client is also complaining of difficulty falling and staying asleep, I would rather have her on a routine sleep agent than a PRN medication for now, as insomnia could lead to further complications. Life style changes like inculcating a moderate exercise program into her daily routine and seeking nutritional expertise to guide her and make dietary changes would be helpful as obesity can lead to several health complications and poor self esteem.
References
Bains N, Abdijadid S. Major Depressive Disorder. [Updated 2021 Apr 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559078/
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
Gilbert, P. (2019). Psychotherapy for the 21st century: An integrative, evolutionary, contextual, biopsychosocial approach. Psychology and Psychotherapy: Theory, Research and Practice, 92(2), 164-189.
Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Post-traumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (Eleventh edition.). Philadelphia: Wolters Kluwer.
Toussaint, A., Hüsing, P., Gumz, A., Wingenfeld, K., Härter, M., Schramm, E., & Löwe, B. (2020). Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). Journal of affective disorders, 265, 395-401.
Zimmerman, M., Martin, J., McGonigal, P., Harris, L., Kerr, S., Balling, C., … & Dalrymple, K. l(2019). Validity of the DSM‐5 anxious distress specifier for major depressive disorder. Depression and anxiety, 36(1), 31-38.
Sample Answer 2 for PRAC 6645 WEEK 8 Assignment 1 : Clinical Hour and Patient Logs
CC (chief complaint): “I do not see any does not see any benefits with my medications.”
HPI:
RR is a 21-year-old Asian male who presents for a follow-up visit for ADHD and medication management. He reports that he does not see any benefits with his medications, and the current Adderall medication makes him more tense. He states that he does not want to go the stimulant way. RR reports having increased anxiety and depressive symptoms. The client reports that he is still experiencing insomnia and he is too tired to work or engage in physical exercises. Besides, he states that he does not currently have a therapist but will work on having one when he starts school. However, he mentioned that he watches a lot of sports and spends time with his family.
Past Psychiatric History:
- General Statement: The client first presented for psychiatric evaluation due to ADHD.
- Caregivers (if applicable): None
- Hospitalizations: None
- Medication trials: None
- Psychotherapy or Previous Psychiatric Diagnosis: Rejection Sensitive Dysphoria
Substance Current Use and History: He denies drug substance use, smoking, or taking alcohol.
Family Psychiatric/Substance Use History: No history of psychiatric or SUDs in the family.
Psychosocial History: RR lives with his parents and his younger sister. He is currently waiting to join university to study Theatre Arts. His hobbies include watching sports and acting, and he was a member of the Drama club in high school. He reports sleeping 3-4 hours daily with poor quality sleep due to insomnia.
Medical History:
- Current Medications: Adderall 5mg, guanfacine 1 mg, and Wellbutrin SR 100 mg daily.
- Allergies: None
- Reproductive Hx: No history of STIs.
ROS:
- GENERAL: Positive for increased fatigue. Denies fever, weight changes, or malaise.
- HEENT: Denies head injury, eye pain, excessive lacrimation, diplopia or blurred vision, ear pain/discharge, sneezing, nasal discharge, or pain when swallowing.
- SKIN: Negative for itching, rashes, or lesions.
- CARDIOVASCULAR: Denies dyspnea, edema, chest pain, or racing heart.
- RESPIRATORY: Denies cough, chest pain, wheezing, or difficulties in breathing.
- GASTROINTESTINAL: Denies abdominal distress, vomiting, or bowel changes.
- GENITOURINARY: Denies pelvic pain, dysuria, or blood in the urine.
- NEUROLOGICAL: Denies muscle weakness, paralysis, dizziness, or numbness.
- MUSCULOSKELETAL: Negative for limitations in movement.
- HEMATOLOGIC: Negative for bleeding or hx of anemia.
- LYMPHATICS: Denies lymph node swelling.
- ENDOCRINOLOGIC: No excessive perspiration, heat/cold intolerance, or polyuria.
Diagnostic results: No results available.
Assessment
Mental Status Examination:
Male client in his early 20’s. He is calm, alert, neat, and appropriately dressed. He maintains adequate eye contact and exhibits a positive attitude toward the clinician. The client has clear speech with normal rate and volume, and his thought process is goal-directed and logical. He denies auditory/visual hallucinations, homicidal ideations, or suicide ideations. No delusions, obsessions, or phobias were noted. His memory is intact, and he demonstrates good judgment.
Differential Diagnoses:
Attention Deficit Hyperactive Disorder (ADHD): ADHD manifests with impulsivity, hyperactivity, and inattention. Patients with the inattentive type are easily distracted, forgetful, disorganized, and do not follow instructions (Cabral et al., 2020). The patient had been previously diagnosed with ADHD and is on a follow-up visit. ADHD continues to be the primary diagnosis.
Generalized Anxiety Disorder (GAD): GAD presents with persistent and excessive anxiety or worries about everything. Other symptoms include restlessness, easy fatigue, concentration difficulties, muscle tension, irritability, and sleep disturbance (DeMartini et al., 2019). GAD is a likely diagnosis based on the client’s positive symptoms of fatigue, insomnia, and increased anxiety levels.
Major Depressive Disorder (MDD): MDD is a severe mood disorder that presents with persistent feelings of sadness and hopelessness and loss of interest in activities one previously enjoyed. Other clinical features include significant weight changes, sleep disturbances, fatigue, feelings of worthlessness, reduced capacity to think/concentrate or indecisiveness, and recurrent thoughts of death or suicidal ideations (Christensen et al., 2020). MDD is a differential based on the patient’s symptoms of fatigue, insomnia, and worsening depressive symptoms.
Reflections:
I agree with the preceptor’s diagnostic impression of ADHD since the patient did not exhibit other significant symptoms to warrant the diagnosis of MDD or GAD as the primary diagnosis. Patients with ADHD often have co-existing depression and anxiety symptoms similar to this patient. The preceptor stopped the patient’s Adderall, Guanfacine, and Wellbutrin treatment and discharged the patient for inability to manage medication. The PMHNP should implement treatment interventions associated with the best outcomes for ADHD patients. In this regard, I would have referred the patient for psychotherapy to help manage the ADHD, anxiety, and depression symptoms (Tourjman et al., 2022). Health promotion for this patient should focus on promoting healthier lifestyle practices with regard to diet and exercise. The patient should be recommended to exercise at least 30 minutes daily since it alleviates the severity of ADHD symptoms and improves cognitive functioning (Drechsler et al., 2020). Besides, he should be advised to eat foods that lower inflammation in the body as it helps the brain function better. This includes consuming more fruits, vegetables, and omega-3 fatty acid-rich foods like salmon or tuna and reducing the intake of white flour, processed foods, and sugar.
References
Cabral, M., 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
Christensen, M. C., Wong, C., & Baune, B. T. (2020). Symptoms of Major Depressive Disorder and Their Impact on Psychosocial Functioning in the Different Phases of the Disease: Do the Perspectives of Patients and Healthcare Providers Differ?. Frontiers in psychiatry, 11, 280. https://doi.org/10.3389/fpsyt.2020.00280
DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized Anxiety Disorder. Annals of internal medicine, 170(7), ITC49–ITC64. https://doi.org/10.7326/AITC201904020
Drechsler, R., Brem, S., Brandeis, D., Grünblatt, E., Berger, G., & Walitza, S. (2020). ADHD: Current Concepts and Treatments in Children and Adolescents. Neuropediatrics, 51(5), 315–335. https://doi.org/10.1055/s-0040-1701658
Tourjman, V., Louis-Nascan, G., Ahmed, G., DuBow, A., Côté, H., Daly, N., Daoud, G., Espinet, S., Flood, J., Gagnier-Marandola, E., Gignac, M., Graziosi, G., Mansuri, Z., & Sadek, J. (2022). Psychosocial Interventions for Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis by the CADDRA Guidelines Work GROUP. Brain sciences, 12(8), 1023. https://doi.org/10.3390/brainsci12081023