NRNP 6635 Week 7: Personality and Paraphilic Disorders

Week 7: Personality and Paraphilic Disorders

Assignment: Clinical Hour and Patient Logs

Record your clinical hours and patient encounters in Meditrek by Day 7.

At your practicum site, you have been strengthening your communication, assessment, diagnostic reasoning, and treatment planning skills. This week, you highlight these skills as you participate in a Grand Rounds Discussion, just as you did in Week 4.

The Grand Rounds put presenters in the facilitator role, allowing each of you a turn to demonstrate your clinical leadership skills as you bridge to advanced practice nursing in this, your final practicum course. You also continue to track your clinical time and patients in Meditrek.

Students will:

• Describe clinical hours and patient encounters
• Assess and diagnose patients in mental health settings
• Develop plans of care for patients in mental health settings
• Develop a case study presentation based on a clinical patient
• Analyze cases involving advanced practice care of patients in mental health settings
• Advocate health promotion and patient education strategies across the lifespan

 

ORDER AN ORIGINAL NRNP 6635 Week 7: Personality and Paraphilic Disorders CUSTOM WRITTEN PAPER FROM US TODAY  !

 

This week you participate in the second of three clinical discussions called grand rounds. In one of these 3 weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience.

You should have received an assignment from your Instructor letting you know which week of the course you are assigned to present.

To prepare:

• Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
• Select a child/adolescent patient from your clinical experience that presents with a significant concern. Create a focused SOAP note for this patient using the template in the Resources. All SOAP notes must be signed, and each page must be initialed by your Preceptor. When you submit your SOAP note, you should include the complete SOAP note as a Word document and PDF/images of each page that is initialed and signed by your Preceptor. You must submit your SOAP note 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.
• Then, based on your SOAP note of this patient, develop a video case study presentation. Set aside time to practice what you will say beforehand and ensure that you have the appropriate lighting and equipment to record the presentation.
• Your presentation should include objectives for your audience, at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources to support your diagnostic reasoning and treatment plan.
• Video assignment for this week’s presenters:
• Record yourself presenting the complex case study for your clinical patient.

 

Read Also : NRNP 6635 PRAC Psychpathology Diagnostic Reasoning

 

In your presentation:

• Dress professionally with a lab coat 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).
• State 3-4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.
• Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.
• 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.
• Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.
• Be succinct in your presentation, and do not exceed 8 minutes.

 

Specifically address the following for the patient, using your SOAP note as a guide:

 

• 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?
• Objective: What observations did you make during the psychiatric assessment?
• Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum of 3 possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and is supported by the patient’s symptoms.
• Plan: What was your plan for psychotherapy (include one health promotion activity and patient education)? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.

Reflection notes: What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow-up, discuss what your next intervention would be.

A note on grading:

• Presenters: Review the Grand Rounds Presenter Rubric to ensure you meet the scoring criteria.
• Participants: Review the Grand Rounds Participant Rubric to ensure you meet the scoring criteria.

 

Also Read Week 4 Assignment

NRNP 6635 Week 4 Assignment

Week 7: Personality and Paraphilic Disorders Sample

NRNP 6635: Psychopathology and Diagnostic Reasoning

 Personality and Paraphilic Disorders

By the end of this presentation, the learner will be able to:

1. State at least five features of Borderline Personality disorder.
2. List two differential diagnoses of Borderline Personality disorder.
3. Discuss two psychotherapy strategies for Borderline Personality disorder.

CC (chief complaint): “All my relationships fail; I feel empty all the time.”

HPI: A.F is a 28-year-old White female client who presented with a chief complaint of her relationships failing and feeling empty all the time. The client stated that since she was a teenager, she has had difficulties maintaining friendships and her romantic relationships are always unstable. This has left her with chronic feelings of emptiness since she mostly finds herself alone and lonely. She mentioned that most people do not want to be friends with her, probably because she is not attractive enough. As a result, she uses make-up and puts on revealing clothes to make people attracted to her. Besides, the client admitted that she strives as much to avoid being abandoned, and this includes frequently entering into sexual liaisons with men she has recently met. She also admits that she engages in actions without thinking to please her friends, which led her to start using marijuana. The client states that her current romantic relationship is on the rocks, and her boyfriend describes her as toxic.

Past Psychiatric History:

• General Statement: History of GAD at 22 years.
• Caregivers (if applicable): None
• Hospitalizations: None
• Medication trials: Prozac for GAD.
• Psychotherapy or Previous Psychiatric Diagnosis: CBT

Substance Current Use and History: Positive for Marijuana and Alcohol use.

Family Psychiatric/Substance Use History: The father has a history of PTSD secondary to combat activities. Paternal grandmother had Alzheimer’s disease. The elder brother had an Alcohol use disorder.

Psychosocial History: A.F has a Diploma in Hospitality and works as a hotelier in a restaurant. She currently lives with her boyfriend, who she moved in with two months ago. Hobbies include traveling and swimming. She has a history of arrest due to drink driving 7 months ago.

Medical History: No history of chronic illnesses.

 

• Current Medications: None
• Allergies: No known food or drug allergies.

• Reproductive Hx: Para 0+0; History of recurrent Chlamydia infection 2 years ago.

ROS:

• GENERAL: Denies fatigue, fever, or chills.
• HEENT: Denies headache, visual changes, eye pain, ear pain, hearing loss, nasal discharge, sneezing, or sore throat.
• SKIN: Negative for skin rashes or lesions.
• CARDIOVASCULAR: Denies edema, palpitations, chest pain, or dyspnea.
• RESPIRATORY: Denies cough, sputum, chest pressure, or dyspnea.
• GASTROINTESTINAL: Denies nausea/vomiting, indigestion, abdominal tenderness, diarrhea, or constipation.
• GENITOURINARY: Denies pelvic pain, abnormal vaginal discharge, dysuria, or urinary urgency/frequency.
• NEUROLOGICAL: Denies headache, dizziness, tingling sensations, or muscle weakness.
• MUSCULOSKELETAL: Denies joint pain/stiffness or limitations in movement.
• HEMATOLOGIC: Negative for bruising or history of anemia.
• LYMPHATICS: Negative for lymph node enlargement.
• ENDOCRINOLOGIC: Denies excessive sweating, excessive thirst/hunger, or cold/heat intolerance.

Physical exam: if applicable

BP: 116/72; HR: 84; RR: 18; Temp: 98.24

Diagnostic results: No diagnostic tests were ordered at this point.

Assessment

Mental Status Examination:

The patient was well-groomed, neat, but with heavy make-up. She was alert and maintained adequate eye contact throughout the interview. The self-reported mood was ‘anxious. Affect was constricted. The speech was clear with normal rate and volume.  Coherent thought process. No hallucinations, delusions, phobias, or obsessions were noted. Memory was intact, and she demonstrated good judgment. Insight was present.

Differential Diagnoses:

Borderline Personality Disorder (BPD)

BPD is a personality disorder that manifests with hypersensitivity to rejection and results in instability of self-image, interpersonal relationships, affect, and behavior (Kulacaoglu & Kose, 2018). The DSM V diagnostic criteria for BPD include frenzied efforts to avoid real or imagined abandonment. Individuals have a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation (APA, 2013). They also have identity disturbance characterized by obvious and persistently unstable self-image or sense of self. Besides, individuals have impulsivity in at least two areas that are potentially self-damaging (APA, 2013). There is affective instability caused due to a marked reactivity of mood and chronic feelings of emptiness. In addition, an individual has inappropriate, intense anger or difficulty controlling anger and transient paranoid ideation.

BPD was the primary diagnosis based on the patient’s history of unstable interpersonal relationships, chronic feelings of emptiness, self-image problems, avoiding too much to be abandoned, and impulsive actions such as drunk driving and substance abuse.

Histrionic Personality Disorder

Histrionic personality disorder is characterized by a pattern of inflated emotionality and attention-seeking behaviors (Ekselius, 2018). The DSM V criteria include: Uncomfortable when not the center of attention; Seductive or provocative behavior; Shifting and shallow emotions; Using appearance to draw attention; Impressionistic and vague speech; Dramatic or exaggerated emotions; Easily influenced by others; Consider relationships more intimate than they are (APA, 2013). Histrionic personality disorder is a differential diagnosis based on the patient’s history of getting into sexual liaisons with strangers. In addition, she uses physical appearance such as exaggerated make-up and revealing clothing to draw attention to herself.

Substance use disorder

Substance use disorder is a differential diagnosis based on the patient’s history of taking alcohol and using marijuana. However, it is an unlikely diagnosis since the patient does not take in large amounts, has a strong craving to use the substances, or interferes with her economic and social functioning.

Plan

Psychotherapy: Mentalizing-based therapy (MBT) to help the patient manage emotion dysregulation by feeling understood, prompting them to be more curious and making fewer assumptions about other people’s intentions (Kulacaoglu & Kose, 2018).

Dialectical behavior therapy (DBT): To enable the client to practice mindfulness practices with concrete interpersonal and emotion regulation skills (Kulacaoglu & Kose, 2018).

Patient education: The patient was educated about BPD and provided learning materials about the diagnosis. She was also advised to seek psychiatric help immediately when she experiences suicidal ideations.

Follow-up: The patient was scheduled for a follow-up visit after 8 weeks to assess her progress with psychotherapy.

Reflections:

In a different patient situation, I would utilize screening tools such as the McClean screening instrument for borderline personality disorder and the Personality diagnostic questionnaire (Ekselius, 2018). The tools would help rate the severity of the diagnosis. My next intervention in the patient follow-up would be to assess the patient’s response to psychotherapy, including her perceived benefits of therapy.

Questions

1. What nursing diagnoses would you give a patient with BPD?
2. When managing a patient with BPD using an interprofessional team, what would be the roles of the different members of the team?
3. What are the likely complications of BDP?

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Ekselius, L. (2018). Personality disorder: a disease in disguise. Upsala journal of medical sciences, 123(4), 194–204. https://doi.org/10.1080/03009734.2018.1526235

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