NRNP 6665 Assessing, Diagnosing, and Treating Adults With Mood Disorders

Sample Answer for NRNP 6665 Assessing, Diagnosing, and Treating Adults With Mood Disorders Included After Question

It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.

In this Assignment you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder.

To Prepare

Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders.
Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Waldenfaculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
NRNP 6665 Assessing, Diagnosing, and Treating Adults With Mood Disorders

The Assignment

Develop a Focused SOAP Note, 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 symptomatology 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 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 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.
Plan: What is your plan for psychotherapy? What is 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. Also incorporate one health promotion activity and one patient education strategy.
Reflection notes: What would you do differently with this client if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. 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 that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

By Day 7 of Week 4

Submit your Focused SOAP Note.

Submission and Grading Information

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Click on the Submit button to complete your submission.

A Sample Answer For the Assignment: NRNP 6665 Assessing, Diagnosing, and Treating Adults With Mood Disorders

Title: NRNP 6665 Assessing, Diagnosing, and Treating Adults With Mood Disorders

Subjective:

CC (chief complaint): “I have a history of taking medications and then stopping

them”

HPI: A 29-year-old female, P.P., seeks a mental health assessment at the facility, detailing a history of medication usage and cessation. She has discontinued her medication as she feels it is unnecessary. Petunia reports experiencing periodic episodes of depression, happening around four to five times per year, which are impacting her job performance at her aunt’s bookshop. She describes instances of low motivation where she chooses to remain in bed. When exposed to stimulation, she avoids taking medication because she feels restricted. Throughout these periods, she exhibits symptoms of decreased sleep, heightened energy, increased productivity, excessive talking, and disorganized behavior.

Past Psychiatric History:

General Statement: The diagnosis of bipolar disorder was made during the patient’s childhood.
Caregivers (if applicable): Mother.
Hospitalizations: There is no history of hospitalization.
Medication trials: The patient is not following the prescribed treatment of mood stabilizers because she feels these medications inhibit her authentic self.
Psychotherapy or Previous Psychiatric Diagnosis: She denies ever having received treatment for her mental illness.

Substance Current Use: She uses one pack of cigarettes a day and stopped drinking when she was nineteen. She tried smoking marijuana for experimentation, but she gave it up because she started to become paranoid.

Medical History: PCOS and hypothyroidism

Current Medications: She prescribes hormone tablets for PCOS and uses levothyroxine for hypothyroidism.
Allergies: No food or drug allergies have ever been reported.

Reproductive Hx: Heterosexual individual with a history of PCOS.

ROS:

GENERAL: Disavows experiencing weakness, fever, or dizziness.
HEENT: Head: No indications of a headache or head injury are present. There are no enlarged or swollen lymph nodes in the neck. There isn’t any yellow sclera or double vision. There is no ear itchiness or hearing loss. Nose: There are no nasal mucosal inflammations, runny or stuffy noses, or epistaxis. Mouth/Throat: No sore throats, toothaches, bleeding gums, ulcers, or swallowing issues.
SKIN: rejects rashes, blisters, ulcers, or other skin imperfections.
CARDIOVASCULAR: denies having edema, tachycardia, dyspnea, or chest discomfort.
RESPIRATORY: Refutes experiencing dyspnea, coughing, soreness in the chest, and sputum production.
GASTROINTESTINAL: denies feeling queasy or throwing up, as well as any alteration in bowel habits.
GENITOURINARY: denies experiencing dysuria, an irregular PV discharge, or frequent or urgent urination. Mentions a PCOS history.
NEUROLOGICAL: rejects experiencing symptoms including headaches, dizziness, loss of consciousness, or easily becoming tired.
MUSCULOSKELETAL: Disagrees that there are any limitations on movement.
HEMATOLOGIC: She disputes that she bruises or bleeds readily.
LYMPHATICS: denies swollen nodes in the body.
ENDOCRINOLOGIC: indicates a history of hypothyroidism. Denies experiencing polyphagia, polyuria, or polydipsia.

Objective:

Vital Signs: temperature of 9.9, pulse rate of 97, respiratory rate of 22, blood pressure of 150/88, height of 5’5″, weight of 135 lbs, and BMI of 22.46.

HEENT: The individual’s head is within normal parameters and has not experienced any trauma. The pupils display a circular shape and consistent size and react to light. There are no indications of redness or fluid buildup on the tympanic membrane. There were no signs of discharge or edema in the ear canals. There are no exudates or signs of edema in the neck. No signs of inflammation are present in the tonsils.

Chest/lungs: The results of the auscultation of the chest and lungs show normal breathing sounds.

Heart: shows no murmurs or gallop and has a regular rate and rhythm.

Abdomen: Sound bowel movements in every quadrant, which are firm, non-tender, and non-extended.

Diagnostic results: There was no order for diagnostic testing.

Assessment:

Mental Status Examination: The patient seems well-groomed and appropriately dressed for the occasion and time of day. The individual is aware and well-oriented in terms of their surroundings, location, and time. The individual consistently maintains eye contact and exhibits suitable facial emotions. The speaker’s delivery is articulate, presented at a standard pace and loudness, and centered on a particular objective. She exhibits logical and consistent thinking in her cognitive process. She shows no signs of hallucinations, delusions, compulsions, obsessive or suicidal thoughts. Her memory, including immediate, recent past, and long-term memory, is fully preserved. The patient lacks insight and has poor judgment, demonstrating a limited ability to recognize the consequences of her actions.

Diagnostic Impression:

Bipolar II Disorder: A patient diagnosed with bipolar II disorder has a single episode of intense depression followed by a week-long period of hypomania, with fluctuations in mood between the two states, as outlined in the DSM-5 (Talen & Edberg, 2020). Patients may exhibit aggressive behavior, a tendency for distraction, heightened focus on goals, euphoria, as well as rapid thinking.
Major Depressive Disorder (MDD): The DSM-5 manual states that this condition may also manifest as anhedonia (McIntyre et al., 2020). Each episode should last a minimum of one week. The patient alternates between episodes of high energy and depressed symptoms. The client does not have suicidal ideation, remains engaged in social activities, and has episodes lasting just one week, making this diagnosis inappropriate.
Schizophrenia: Patients with this illness often experience hallucinations, delusions, catatonic behavior, and illegible speech. Patients may also notice a shift in their perceptions of the world around them and how things work. With the exception of the patient’s auditory hallucinations, the symptoms are not frequent enough to support the diagnosis (Carpenter, 2021).

Case Formulation and Treatment Plan:

Petunia presents with manic and depressed episodes characteristic of bipolar illness; medication and psychotherapy will be used in her treatment (Jelen & Young, 2020) with the goal of reducing the severity of her manic episodes.

The prescription drug is Lamotrigine, to be taken at a dose of 25 mg before bedtime for two weeks. The dose will be raised to 50 mg for two weeks, then further increased to 100 mg weekly. Lamotrigine has been approved by the FDA for the treatment of bipolar illness, providing a different choice for women with a heightened risk of polycystic ovarian syndrome (PCOS) (Jelen & Young, 2020). The medicine also reduces the likelihood of relapse in manic and depressed periods.
Advise undergoing psychotherapy, particularly cognitive behavior therapy (CBT). CBT educates clients on Bipolar disease and provides cognitive-behavioral strategies to assist them in handling their condition and associated psychosocial stresses and problems (Jelen & Young, 2020).
It is advised that the patient exercise in order to increase blood flow to the brain and lessen depressed episodes. The patient’s general health may be improved by adhering to a regular sleep pattern and eating a balanced diet (Jelen & Young, 2020). Quitting smoking is another technique for promoting health.
To improve treatment results, it’s critical to let the patient know how crucial it is to follow the prescribed course of action and take their prescription on time.
Follow-up: Four weeks later, the patient will have a follow-up exam.

Reflections: The patient data that is now available is enough for bipolar disorder diagnosis. The PMHNP efficiently acquired information on the patient’s signs and symptoms, including alternating periods of depression and mania (Bonnín et al., 2019). To determine the severity of the ailment, further data is necessary. I would further perform the Patient Health Questionnaire (PHQ-9) to identify the individual’s signs and symptoms of depressive disorder. In addition, a Mood Illness Questionnaire (MDQ) may be applied to verify the diagnosis of Bipolar illness. The recommended remedies should encourage favorable results and avoid any undesirable consequences. The ethical precepts of beneficence and nonmaleficence need to direct the treatment plan (Jelen & Young, 2020). Patient engagement in treatment planning is vital to enhance autonomy.

References ‌

Bonnín, C. D. M., Reinares, M., Martínez-Arán, A., Jiménez, E., Sánchez-Moreno, J., Solé, B., … & Vieta, E. (2019). Improving functioning, quality of life, and well-being in patients with bipolar disorder. International Journal of Neuropsychopharmacology, 22(8), 467-477. https://doi.org/10.1093/ijnp/pyz018

Jelen, L. A., & Young, A. H. (2020). The Treatment of Bipolar Depression: Current Status and Future Perspectives. Current Behavioral Neuroscience Reports. https://doi.org/10.1007/s40473-020-00200-x

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841–1856. https://doi.org/10.1016/s0140-6736(20)31544-0

Talen, M. R., & Edberg, D. L. (2020). What is the most effective screening tool for bipolar disorder in primary care? Evidence-Based Practice, 23(3), 16-17. https://doi.org/10.1097/EBP.0000000000000543

Carpenter, W. T. (2021, February 1). Primary psychosis: more to know, much more to do. World Psychiatry, Vol. 20, pp. 1–2. https://doi.org/10.1002/wps.20807

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Important information for writing discussion questions and participation

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Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

Your response needs to be a minimum of 150 words (not including your list of references)
There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
Include in-text citations in your response
Do not include quotes—instead summarize and paraphrase the information
Follow APA-7th edition
Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

A minimum of 6 responses per week, on at least 3 days of the week.
Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
Each response needs to be at least 75 words in length (does not include your list of references)
Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
Follow APA 7th edition
Points will be deducted if the above is not followed
Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
Here are some helpful links
Student paper example
Citing Sources
The Writing Center is a great resource