NRNP 6635 PRAC WEEK 5 Comprehensive Psychiatric Exam (CPE)

Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

Comprehensive psychiatric evaluations are a way to reflect on your practicum experiences and connect the experiences to the learning you gain from your weekly Learning Resources. Comprehensive notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.

For this Assignment, you will document information about a patient that you examined during the last 5 weeks, using the Comprehensive Psychiatric Evaluation Template provided.

You will then use this note to develop and record a case presentation for this patient.

 

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To Prepare

• Select a patient that you examined during the last 5 weeks. Review prior resources on the disorder this patient has. o It is recommended that you use the Kaltura Personal Capture tool to record and upload your assignment.

o    Review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura Personal Capture video. The Personal Capture Quickstart Guide will walk you through creating your video, uploading it to Blackboard and placing it into the assignment area.

• Conduct a Comprehensive Psychiatric Evaluation on this patient using the template provided in the Learning Resources. There is also a completed exemplar document in the Learning Resources so that you can see an example of the types of information a completed evaluation document should contain. All psychiatric evaluations must be signed, and each page must be initialed by your Preceptor.

When you submit your document, you should include the complete Comprehensive Psychiatric Evaluation as a Word document, as well as a PDF/images of each page that is initialed and signed by your Preceptor. You must submit your document using SafeAssign. Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Late Policies.

• Develop a video case presentation, based on your progress note of this patient, that includes chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis, including differentials that were ruled out.
• Include at least five (5) scholarly resources to support your assessment and diagnostic reasoning.
• Ensure that you have the appropriate lighting and equipment to record the presentation.

 

Also Read : NRNP 6635 Week 4 Assignment

 

Assignment

Record yourself presenting the complex case for your clinical patient.

Do not sit and read your written evaluation! The video portion of the assignment is a simulation to demonstrate your ability to succinctly and effectively present a complex case to a colleague for a case consultation. The written portion of this assignment is a simulation for you to demonstrate to the faculty your ability to document the complex case as you would in an electronic medical record. The written portion of the assignment will be used as a guide for faculty to review your video to determine if you are omitting pertinent information or including non-essential information during your case staffing consultation video.

In your presentation:

• Dress professionally and present yourself in a professional manner.
• Display your photo ID at the start of the video when you introduce yourself.
• Ensure that you do not include any information that violates the principles of HIPAA

(i.e., don’t use the patient’s name or any other identifying information).

• Present the full case. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis, including differentials that were ruled out.
• Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.

Be succinct in your presentation, and do not exceed 8 minutes. Address the following:

• Subjective: What details did the patient provide regarding their personal and medical history? What are their symptoms of concern? How long have they been experiencing them, and what is the severity? How are their symptoms impacting their functioning?
• Objective: What observations did you make during the interview and review of systems?
• Assessment: What were your differential diagnoses? Provide a minimum of three (3) possible diagnoses. List them from highest to lowest priority. What was your primary diagnosis, and why?
• Reflection notes: What would you do differently in a similar patient evaluation?

Reflect on one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health.  As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

By Day 7

Submit your Video and Comprehensive Psychiatric Evaluation. You must submit two (2) files for the evaluation, including a Word document and scanned PDF/images of each page that is initialed and signed by your Preceptor.

 

ORDER A NRNP 6635 PRAC WEEK 5 Comprehensive Psychiatric Exam (CPE) ORIGINAL PAPER TODAY !!

 

 Sample solution : 

Week 5: Comprehensive Psychiatric Exam (CPE)

NRNP 6635: Psychopathology and Diagnostic Reasoning

Patient information

Patient initials: AB   Age: 43          Gender: male       Race: Caucasian

CC (chief complaint): Follow-up

HPI: AB, a 43-year-old Caucasian male with a history of MDD, GAD, and Bipolar II, stepped in for a medication management check-up today, stating that he’s doing “good” but still experiencing anxiety. The patient acknowledges that his sleep and appetite are appropriate. Denies homicidal ideation and any medication side effect at the present.

Past Psychiatric History:

• General Statement: The patient has previously been diagnosed with anxiety, depression, and bipolar II disorder, all of which are adequately managed except for the anxiety, which periodically spirals out of control.
• Caregivers (if applicable): N/A
• Hospitalizations: The patient has been hospitalized three times with one being of suicide attempt.
• Medication trials: The patient is currently taking doses of LaMictal 150mg PO OD, Prozac, and Buspar 30mg 1tab PO bid for managing her GAD, MDD and Bipolar II. While he presently feel pretty well with the prescription, the medication are not as effective as he still experience some anxiety. He has never attempted using any other psychoactive drug out of prescription.
• Psychotherapy or Previous Psychiatric Diagnosis: GAD, MDD, and Bipolar II disorder.

Substance Current Use and History: Because of his mental instability, the patient reported drinking a considerable amount of alcohol every time. He also tried heroine, but the consequences were not as predicted. The use of alcohol has a substantial influence on anxiety disorders, making therapy more difficult. As a result, the patient’s statement of experiencing symptoms despite following the prescription might have been affected by his alcohol usage.

Family Psychiatric/Substance Use History: There is a family history of serious depressive illness and bipolar disorder. Her mother, who is now deceased, had a history of bipolar disorder, and his paternal mother (Joy), who died in a horrific car accident, had a history of MDD. The patient’s 73-year-old father is an alcoholic. While there appears to be no genetic link to drinking, studies have discovered that genetics account for around 50% of alcoholism. As a result, the patient’s history of MDD, bipolar illness, and drinking must have had a part in his disorders.

Psychosocial History: The patient was born in Athen, Gorgia. He married a lovely woman who died from borderline personality disorder. He had a daughter who was involved in a quarrel with her other daughter previous to her death and is still struggling with it. He was a full-time instructor at a nearby college, but he had to take some time off due to his ailment. He is presently running his firm in a neighboring town. For his family’s protection, he never uses the phone or drives when inebriated. He worked out on occasion. Taken nice meal, according to reports.

Medical History:

 

• Current Medications: Lamictal 150mg 1tab PO OD for management of bipolar II, PROzac 20mg 1cap OD for managing Mild episode of recurrent major depressive disorder, and BUSPAR 30mg 1tab PO BID for anxiety.
• Allergies: No known drug and food allergy

ROS:

• GENERAL: The patient denies headache, nausea, and vomoting
• HEENT: No visual or hearing issues reported.
• SKIN: Denies bruising,rash, redness or changes in skin colour.
• CARDIOVASCULAR: Denies chest pain, shortness of breathe and irregular heart rate.
• RESPIRATORY: Denies chronic cough, and night sweat
• GASTROINTESTINAL: Denies decrease in apetite, diarrhea, constipation, and frequent belching.
• GENITOURINARY: Denies dysuria, rash or ulcers and history of STIs
• NEUROLOGICAL: Denies headache, dizziness, an memory loss
• MUSCULOSKELETAL: Denies joint pain
• HEMATOLOGIC: Denies anemia
• ENDOCRINOLOGIC: Denies cold or hot intolerance, and increase thirst

Physical exam:

Vital signs: T. 98.0°F, HR:79, BP: 125/86, RR: 18, Wt. 93.9 kg (207 lb)

General: Well developed, and well nourished with no acute distress.

HEENT: normocephalic and atraumatic, EACs clear, hearing intact, no mucosal lessios or tonsillar hypertrophy noted.

CVS:RRR, no mumur, no respiratory distress and there is equal chest expansion bilaterally.

MSK: Gait and station are normal. All four extremities move spontaneously and with complete range of motion. Muscle strength and tone are completely normal. There are no tics or tremors. There was no evidence of atrophy or aberrant movement.

Abdomen: Bowel sounds normoactive. No masses or hernia noted.

Psychiatric: oriented x3.  Recent and remote memory intact. Normal mood and effect.

Diagnostic results:

An EKG was conducted on the patient to determine whether there was an issue with the heart or the brain. There was no problem found, indicating that the problem is physiological. The goal is to manage the patient’s chronic anxiety symptoms and help him live a happier life.

Assessment

Mental Status Examination:

The patient is appearance is age-appropriate. He is bearded, and casually dressed. He exhibits typical conversation in terms of rate, volume, and clarification, as well as being understandable and unrestrained. Language skills are outstanding. He appears to be happy. Body posture and behavior convey a harmonious state of mind. The outer look and overall demeanor reveal an optimistic temperament. He denies having self-destructive impulses. His mentality is in sync with the his influence. Affiliations are pristine and reasonable. There are no clear evidence of hallucinations, nightmares, or odd conduct. His reasoning is sound, and his thought quality is suitable. The mental functioning and content are flawless and age appropriate. Short and long-term memory hold true, as is the ability to collect and do numerical computations. This patient is well placed. Jargon and information elements validated mental working in the normal span. Comprehension of concerns appear competent. The judgment and impulsivity are apparent.

Differential Diagnoses:

Based on the patient’s clinical presentation, past medical history, laboratory tests, and mental state evaluation, the differential diagnoses for his case include generalized anxiety disorder, bipolar II, and major depressive disorder.

Generalised anxiety disorder

This is a mental condition marked by excessive and exaggerated tension and stress, difficulty focusing, impatience, a distorted picture of the situation, difficulty sleeping, muscular pains, and fatigue (Goodwin et al.,2021). It can cause an individual to withdraw from social interactions, and it is likely that the patient has been isolating himself from the public, as seen by his departure from the neighboring college where he was lecturing. This illness is connected to trauma and stressful circumstances, and it may have stemmed from his wife’s death. It worsens when addictive chemicals such as alcohol, nicotine, and caffeine are used. Because the patient has been using alcohol on a regular basis, it is probable that his worry over medicine will remain.

Bipolar II disorder

This is a mental disease defined by a typical fluctuation in mood, energy, activity levels, and capacity to carry out day-to-day tasks. The mood might be tremendously high, exhilarated to terribly low, apathetic of dismal phase (Ostacher et al.,2021). It is also characterized by changes in appetite, sleep patterns, and difficulty focusing. The patient is probably having a hypomanic episode. This is demonstrated by his account of feeling happy. It had also been diagnosed on the patient’s last appointment. Based on a mental state examination, the patient’s mood and performance were both outstanding. He also reported that he had no sleep or hunger issues.

Mild episode of recurrent major depressive disorder (HCC)

This is a kind of depressive disorder characterized by repeated bouts of depression with no history of separate bouts of mood elevation or mania. This condition is usually caused by the use of antidepressants (Behnke et al.,2021). The patient’s loss of his wife in a horrific accident following her phone call may have caused him lifelong pain. However, given his claim of feeling OK, the drug is most likely supporting him in dealing with the facts.

Primary diagnosis: Generalised anxiety disorder.

Reflection

This case study has shown various variables that may have predisposed the patient to a variety of mental health issues. Some of the patient’s symptoms were connected to alcoholism and genetics. The evaluation findings are agreeable, and the present prescription appears to have worked based on her reports and mental status examination, but some of his prescriptions, such as buspar, should be adjusted for better results. This study raised legal and ethical concerns, such as autonomy and confidentiality. Patients who report using illicit drugs may be imprisoned, hence it is critical to preserve patient confidentiality (Peckham et al.,2021). Furthermore, it is critical to examine the potential risk and effects of consuming such illicit drugs. Furthermore, it is critical to clarify the condition and significance of each drug with them in a language they understand.

Case Formulation and Treatment Plan

The patient ought to attend an outpatient session. He must be advised on dangers of taking alcohol while on his current prescription. Moreover, he should join certain medical group such as alcohol anonymous group twice in a week for counselling. He should continue his current current prescription of Lamictal 150mg and Prozac 20mg, but dosage of Buspar need to be adusted from 30mg BID.  Furthermore, he must be encourage to exercise at thrice a week for 30+ minutes and be thoroughy counseled on sleep hygiene and technique. He should come for follow-up in 2 months.

 

References

Goodwin, G. M. (2021). Revisiting treatment options for depressed patients with generalised anxiety disorder. Advances in Therapy, 38(2), 61-68.

Ostacher, M. J. (2021). Slowly working toward more treatments for depression in bipolar II disorder. American Journal of Psychiatry, 178(12), 1075-1076.

Behnke, A., Gumpp, A. M., Krumbholz, A., Bach, A. M., Schelling, G., Kolassa, I. T., & Rojas, R. (2021). Hair-based biomarkers in women with major depressive disorder: glucocorticoids, endocannabinoids, N-acylethanolamines, and testosterone. Comprehensive Psychoneuroendocrinology, 7, 100068.

Peckham, A. M., Ball, J., Colvard, M. D., Dadiomov, D., Hill, L. G., Nichols, S. D., … & Tran, T. H. (2021). Leveraging pharmacists to maintain and extend buprenorphine supply for opioid use disorder amid COVID-19 pandemic. American Journal of Health-System Pharmacy, 78(7), 613-618.