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NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersNRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersAssignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersPsychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM. The symptoms of psychotic disorders may appear quite vivid in some patients; with others, symptoms may be barely observable. Additionally, symptoms may overlap among disorders. For example, specific symptoms, such as neurocognitive impairments, social problems, and illusions may exist in patients with schizophrenia but are also contributing symptoms for other psychotic disorders.For this Assignment, you will analyze a case study related to schizophrenia, another psychotic disorder, or a medication-induced movement disorder.NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersORDER A PLAGIARISM-FREE PAPER HEREAssignment Instructions: Use the Comprehensive Psychiatric Evaluation Template (Attached) to complete this Assignment. Review the Comprehensive Psychiatric Evaluation Exemplar (Attached)to see an example of a completed evaluation document. Select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. Video # 29(See the transcript). Consider what history would be necessary to collect from this patient. Consider what interview questions you would need to ask this patient.fIdentify at least three possible differential diagnoses for the patient. Complete and submit your Comprehensive Psychiatric Evaluation (attached), including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template: Subjective:What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersObjective: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 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis.Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case. 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.). Minimums 5 references  Week (enter week #): (Enter assignment title)NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders  Student NameCollege of Nursing-PMHNP, Walden UniversityNRNP 6635: Psychopathology and Diagnostic ReasoningFaculty NameAssignment Due Date Subjective:CC (chief complaint):HPI:Past Psychiatric History:General Statement:Caregivers (if applicable):Hospitalizations:Medication trials:Psychotherapy or Previous Psychiatric Diagnosis:Substance Current Use and History:Family Psychiatric/Substance Use History:Psychosocial History:Medical History:NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersCurrent Medications:Allergies:Reproductive Hx:ROS:GENERAL:HEENT:SKIN:CARDIOVASCULAR:RESPIRATORY:GASTROINTESTINAL:GENITOURINARY:NEUROLOGICAL:MUSCULOSKELETAL:HEMATOLOGIC:LYMPHATICS:ENDOCRINOLOGIC:Objective:Physical exam:if applicableDiagnostic results:Assessment:NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersMental Status Examination:Differential Diagnoses:Reflections:ReferencesINSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLYIf you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide.In the Subjective section, provide:Chief complaintHistory of present illness (HPI)Past psychiatric historyMedication trials and current medicationsPsychotherapy or previous psychiatric diagnosisPertinent substance use, family psychiatric/substance use, social, and medical historyAllergiesROSRead rating descriptions to see the grading standards!In the Objectivesection, provide:Physical exam documentation of systems pertinent to the chief complaint, HPI, and historyDiagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.Read rating descriptions to see the grading standards!NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersIn the Assessmentsection, provide:Results of the mental status examination, presented in paragraph form.At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.Read rating descriptions to see the grading standards!Reflecton this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.) NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersEXEMPLAR BEGINS HERECC (chief complaint):Abriefstatement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.OrP.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation.  Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS.  The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersPast Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. General Statement: Typically, this is a statement of the patients first treatment experience. For example:The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.Caregivers are listed if applicable.Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First,does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersSubstance Use History:This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information.Be sure to include a reader’s key to your genogram or write up in narrative form.Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology.  However, at a minimum, please include:Where patient was born, who raised the patientNumber of brothers/sisters (what order is the patient within siblings)Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?Educational LevelHobbies:Work History: currently working/profession, disabled, unemployed, retired?Legal history: past hx, any current issues?Trauma history: Any childhood or adult history of trauma?Violence Hx:Concern or issues about safety (personal, home, community, sexual (current & historical)Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersCurrent Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.Allergies:Include medication, food, and environmental allergies separately.Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.Reproductive Hx:Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:  oral, anal, vaginal, other, any sexual concernsROS: Cover all body systems that may help you include or rule out a differential diagnosis.  Please note: THIS IS DIFFERENT from a physical examination!You should list each system as follows: General:Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.Example of Complete ROS:GENERAL: No weight loss, fever, chills, weakness, or fatigue.HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.SKIN: No rash or itching.CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.RESPIRATORY: No shortness of breath, cough, or sputum.GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd colorNEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.HEMATOLOGIC: No anemia, bleeding, or bruising.LYMPHATICS: No enlarged nodes. No history of splenectomy.ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From headtotoe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersDiagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).AssessmentMental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.Differential Diagnoses:You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersAlso included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), 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.).References (move to begin on next page)You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.Training Title 29Name: Mr. Jay FeldmanGender: maleAge:19 years oldT- 98.3 P- 69 R 16 106/72 Ht 5’7 Wt 117lbsBackground: European-American male. He has two younger brothers, one with history ofADHD, the other with history of anxiety. His mother has anxiety; his father has paranoiaschizophrenia. He is home for spring break. He has no previous medical problems.Developmental milestones met as child. Appetite is inconsistent and it seems he has lost 18lbssince first going back to school in the fall. Jason has not acted this way before but did have ashort trial of aripiprazole in the last six months of high school for mild paranoia. He stopped themedication after graduation as he could not tolerate due to side effects of akathisia. Jason hasseveral friends but has not kept in touch with them since being back home. He has not beenshowering. Sleeping 4–5 hrs.NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement DisordersSymptom Media. (Producer). (2016). Training title 29 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-29  TRANSCRIPT OF VIDEO FILE:____________________________________________________________________________ 00:00:15OFF CAMERA Mr. Feldman? I understand you called us last week for an appointment. 00:00:20FELDMAN My parents. 00:00:25OFF CAMERA Excuse me? 00:00:25FELDMAN My parents called for the appointment. 00:00:25OFF CAMERA Oh. Do you know why your parents called for an appointment? 00:00:30FELDMAN No. 00:00:35OFF CAMERA When your parents called me they said you were having some difficulty in school. Where are you in school? 00:00:50FELDMAN State College. 00:00:50OFF CAMERA How long have you been at State College? 00:00:55FELDMAN My freshman year. 00:01:00OFF CAMERA And how is it going? 00:01:05FELDMAN Fine. 00:01:10OFF CAMERA What courses are you taking at State? 00:01:15FELDMAN In high school I took advanced placement courses. Theoretical physics, advanced calculus is what I’m taking now. Although I’m thinking about double majoring in philosophy and physics.NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders00:01:35OFF CAMERA That’s an interesting combination. 00:01:35FELDMAN Yes, the mysteries of life. The courses are mysteries, and just when you think you’ve understood it, it’s gone. 00:01:45OFF CAMERA Gone? 00:01:50FELDMAN The totality of life precludes us from repeating it. I mean what’s the point? 00:02:00OFF CAMERA Do you have a roommate at state? 00:02:05FELDMAN You could call him that. 00:02:10OFF CAMERA Can you tell me about him? 00:02:15FELDMAN Oh no. 00:02:15OFF CAMERA Why not? 00:02:20[sil.] 00:02:25FELDMAN He put a microwave in there, but I know what that means. But I won’t tell. Not a word.. 00:02:35OFF CAMERA A microwave oven? 00:02:40FELDMAN They had them in here too, in this building. But they’ll spare me, and they’ll spare you too, because you are with me, and what that’s about a bleeding degeneration of blood cells, bleeding the humanity from our rightful destiny… but this room spies on us.NRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders00:03:05OFF CAMERA I don’t understand what you mean. 00:03:10FELDMAN It’s in the eyes. You can hold of forever if you know how. 00:03:20OFF CAMERA Mr. Feldman, did you come here with anyone else today? 00:03:25[sil.] 00:03:30FELDMAN Sssshhhh. 00:03:35OFF CAMERA Mr. Feldman, I think I may need to contact your parents. 00:03:45SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com 00:03:45END TRANSCRIPTNRNP 6635 Week 7 Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

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