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NRNP 6650: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent

NRNP 6650: Psychiatric Mental Health Nurse Practitioner Role I: Child and AdolescentNRNP 6650: Psychiatric Mental Health Nurse Practitioner Role I: Child and AdolescentChild and AdolescentCase Study: I am Feeling Like I’m Going CrazyIDENTIFICATION: The patient is a 15–year–old male of Native American descent who resides at homewith his mother and 6–year–old brother.He is seen for the psychiatric evaluation on an inpatient crisis unit. Collateral information was obtainedfrom the patient’s mother.NRNP 6650: Psychiatric Mental Health Nurse Practitioner Role I: Child and AdolescentCHIEF COMPLAINT: “I am feeling like I’m going crazy”HISTORY OF CHIEF COMPLAINT: Patient reports that he intentionally cut his leg at school yesterdaybefore gym class. He realized that he would not be able to participate in class because he could notcontrol the bleeding of the cuts. He went to the nurse and she referred him to the ER for admission. TheER provider admitted him to the acute psychiatric unit as he was at risk of harming himself due tosuicidal ideation. He reports that he harmed himself by cutting as he was feeling abandoned by hisboyfriend. He states that he is not emotionally supportive. He reports that self–injurious behavior began10 months ago, and he uses a disposable razor to cut his upper arm or forearm. He reports problemswith sleep onset. He reports low self–esteem and low energy level. He endorsed a history of two priorsuicide attempts by taking a palm–full of acetaminophen; the most recent attempt was 2 months ago.He did not report his attempt denies serious adverse effects. His last suicidal ideation due to pressure ofgetting good grades and low self–esteem. He used to participate in the school band but stoppedattending rehearsals about 2 months ago because he was no longer interested.ORDER A PLAGIARISM-FREE PAPER HEREPatient’s mother expressed frustration and difficulty understanding why the patient treats herdisrespectfully when she gives the patient everything the patient wants, such as clothing and money togo out with friends. The patient’s mother acknowledged that she works a lot and is infrequently athome, but stated that when she tries to spend time with the patient and express interest in his life, thepatient shuts her out or states that he does not have time to spend with her because she needs to finishhis homework. Patient’s mother additionally expresses confusion about why the patient behaves sodifferently than she did at that age, reporting that he was expected to be respectful and comply with hermother’s requests.PAST PSYCHIATRIC HISTORY: No prior psychotherapy or trials of psychiatric medication.MEDICAL HISTORY: Multiple wounds noted on patient’s right upper arm, which appear to be healing. Noknown allergies. No acute or chronic medication conditions. Review of systems is negative. Patientappears to be average height and weight. He denies any recent changes in weight.HISTORY OF DRUG OR ALCOHOL ABUSE: No alcohol use. States that he tried marijuana once 3 monthsago. Denies use of any other illicit substances.NRNP 6650: Psychiatric Mental Health Nurse Practitioner Role I: Child and AdolescentFAMILY HISTORY: Patient’s parents were both born in the US. The patient was born in the United States.Patient reports that her parents got divorced when she was 5 years old. His father currently lives in LosAngeles and he has minimal contact with him. Family history of mental illness denied.Personal HistoryPerinatal: No known perinatal complications.Childhood/Adolescence: The patient attends the local private high school where he used to get goodgrades in her classes, mostly As and Bs; however, he states her grades have declined recently and she isin danger of failing several classes. He reports recent loss of close friends due to interpersonal conflict.He identifies as pansexual and is currently dating a male peer. They have been dating for the past 2months. He states that she would like to have sex with him, but he is not ready yet.TRAUMA/ABUSE HISTORY: Patient denies trauma or abuse history.Mental Status ExaminationAppearance: Good grooming and hygiene. Cooperative.Behavior and psychomotor activity: no increased or decreased psychomotor agitation. Sits quietly inchair.Consciousness: Alert.Orientation: To person, place, time.Memory: Not formally assessed but appears to be intact based on patient’s ability to relate details fromthe past.Concentration and attention: Not formally assessed, but no indication of abnormalities.Visuospatial ability: Not formally assessed.Abstract thought: Intact.Intellectual functioning: Appears to be above average.Speech and language: Quiet volume, regular rate and rhythm.Perceptions: No evidence of perceptual disturbance. Patient denies auditory and visual hallucinations.Thought processes: Coherent and goal directed.Thought content: Distressed about peer relationships.Suicidality or homicidality:Denies current suicidal or homicidal ideation; however, reports suicidal thoughts yesterday on the wayto the hospital.Mood: “Depressed”Affect: Constricted.Impulse control: Limited as evidenced by impulsive self–injurious behavior.Judgment/Insight/Reliability:NRNP 6650: Psychiatric Mental Health Nurse Practitioner Role I: Child and AdolescentGroup therapy may be beneficial for children and adolescents, because it often provides an environment that normalizes clients’ thoughts, feelings, and behaviors. However, as with any therapeutic approach, group therapy might not be appropriate for every client, every setting, or even every therapist. When selecting therapies, you must always consider the psychodynamics of the client and your own skill set.This week, as you assess and develop diagnoses for clients presenting for child and adolescent group psychotherapy, you examine the effectiveness of this therapeutic approach. You also consider legal and ethical implications of counseling children and adolescent clients with psychiatric disorders.Learning ObjectivesStudents will:· Assess clients presenting with disruptive behavior· Analyze group therapeutic approaches for treating clients presenting with disruptive behavior· Evaluate outcomes for clients presenting with disruptive behaviorTo prepare:NRNP 6650: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent· Review this week’s Learning Resources and reflect on the insights they provide.· Read the case study I am Feeling Like I’m Going Crazy below· For guidance on assessing the client, refer to pages 137-142 of the Wheeler text in this week’s Learning Resources.Post an explanation of the most likely DSM-5 diagnosis for the client in the case study. Be sure to link those behaviors to the criteria in the DSM-5. Then, explain group therapeutic approaches you might use with this client.  Explain expected outcomes for the client based on these therapeutic approaches. Finally consider legal and ethical implications of counseling children and adolescent clients with psychiatric disorders. Support your approach with evidence-based literature.Required Readings( Need 3 references)American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.McGillivray, J. A., & Evert, H. T. (2014). Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. Journal of Autism and Developmental Disorders, 44(8), 2041-2051. doi:10.1007/s10803-014-2087-9Restek-Petrović, B., Bogović, A., Mihanović, M., Grah, M., Mayer, N., & Ivezić, E. (2014). Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: A preliminary study. Nordic Journal of Psychiatry, 68(5), 333-340. doi:10.3109/08039488.2013.839738Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.Chapter 17, “Psychotherapy      with Children” (pp. 597–624)Chapter 20, “Termination and Outcome      Evaluation” (pp. 693–712)Document: I am Feeling Like I’m Going CrazyRequired MediaMicrotraining Associates (Producer). (2009). Leading groups with adolescents [Video file]. Alexandria, VA: (Producer). (2002). Adlerian parent consultation [Video file]. Mill Valley, CA: Author.The approximate length of this media pice is 117 minutes.Optional (Producer). (2012). Group counseling with adolescents: A multicultural approach [Video file]. Mill Valley, CA: Author. NRNP 6650: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent

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