NRNP 6665 PMHNP Across the Lifespan I: Assessing, Diagnosing, and Treating Adults With Mood Disorders -Comprehensive SOAP Note for Petunia Park Case Study

Sample Answer for NRNP 6665 PMHNP Across the Lifespan I: Assessing, Diagnosing, and Treating Adults With Mood Disorders -Comprehensive SOAP Note for Petunia Park Case Study 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 Walden faculty 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.

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

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

A Sample Answer For the Assignment: NRNP 6665 PMHNP Across the Lifespan I: Assessing, Diagnosing, and Treating Adults With Mood Disorders -Comprehensive SOAP Note for Petunia Park Case Study

Title: NRNP 6665 PMHNP Across the Lifespan I: Assessing, Diagnosing, and Treating Adults With Mood Disorders -Comprehensive SOAP Note for Petunia Park Case Study

Subjective:

CC (chief complaint): “I am here for a mental health assessment.”

HPI:

Petunia Park is a 27-year-old female client who presents for a mental health assessment. She mentions that she has a history of taking medications and failing to adhere to them because she thinks she does not need them. She feels that the meds squash her. Petunia also states that she has a history of falling into depression 4-5 times annually, which limits her from working at her aunt’s bookstore. When depressed, she sleeps a lot and has little to no motivation. She states that she lacks creativity when depressed leaving her feeling worthless. The depression comes after working hard for about five days on things she enjoys, like painting, writing, and music. Although people perceive that she has depression, Petunia thinks the sleepiness and lack of motivation are due to fatigue after several days of working hard.

Petunia reports that she is usually creative roughly a week before crushing. On her creative days, she declines to take her meds because they crush her and the lots of energy she has. She also sleeps for a few hours, does a lot of work, talks a lot, and seems scattered. Furthermore, the client reports engaging in sexual activity to explore her body and mind and get gratification. She is too busy to have meals when on the creative episodes but can eat everything when she crashes. She sleeps three hours a week when creative and 12-16 hours/per day when crushed. In addition, the client reports that when she has an inadequate sleep, she hears voices telling her that she is great and talented.

Substance Current Use: The last alcohol consumption was at 19 years. She admits to smoking 1PPD. She once used Marijuana, but it caused paranoia.

Medical History: Positive for Hypothyroidism

Current Medications: Levothyroxine for Hypothyroidism; and Hormonal pills for Polycystic Ovaries.
Allergies: None

Reproductive Hx: Has Polycystic Ovaries.

ROS:

GENERAL: Positive for increased appetite and low energy levels when depressed. Suppressed appetite and increased energy levels on creative episodes.
HEENT: Denies headache or eye, ear, nose, and throat symptoms.
SKIN: Denies skin symptoms.
CARDIOVASCULAR: Negative for cardiac symptoms.
RESPIRATORY: Negatives for difficulties in breathing.
GASTROINTESTINAL: Negative for abdominal distress.
GENITOURINARY: Negative for urinary symptoms.
NEUROLOGICAL: Denies paralysis, headaches, or loss of consciousness.
MUSCULOSKELETAL: Denies muscle, joint, or bone symptoms.
HEMATOLOGIC: Denies bleeding.
LYMPHATICS: Denies lymphatic symptoms.
ENDOCRINOLOGIC: Denies endocrine symptoms.

Objective:

Diagnostic results: No lab tests were ordered.

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Assessment:

Mental Status Examination: Female patient in her 20’s. She is neat and dressed appropriately for the function and weather. The client is alert and oriented and maintains adequate eye contact. Her speech is clear with normal rate and volume and logical. She demonstrates a coherent and logical thought process. Auditory hallucinations were reported, and delusions of grandeur were noted (states that she paints like Picasso and will sell paintings to movie stars). No evident suicidal ideations or thoughts. Her memory is intact, she demonstrates good judgment, and insight is present.

Diagnostic Impression:

Bipolar Disorder: Bipolar disorder presents with episodes of mania that alternate with depression. Petunia has manic episodes,

NRNP 6665 PMHNP Across the Lifespan I Assessing, Diagnosing, and Treating Adults With Mood Disorders -Comprehensive SOAP Note for Petunia Park Case Study

which she refers to as creative episodes, which alternate with depressive episodes, whereby she feels crushed. She presents with clinical manifestations consistent with the DSM-V diagnostic criteria for mania, including a decreased need for sleep, more talkative than usual, grandiosity, distractibility, increase in goal-directed activity, and engagement in activities with a high potential for adverse consequences like engaging in sexual activity for gratification (APA, 2013). The patient’s manic episodes alternate with depressed episodes, where she has low motivation, low energy levels, hypersomnia, and increased appetite (Vieta et al., 2018).

Major Depression: Major depression is a mood disorder that manifests with a depressed mood and significantly diminished interest/pleasure in almost all activities (APA, 2013). Petunia reports having depression episodes where she lacks the motivation to engage in activities she enjoys, like painting, writing, and music. In addition, she has clinical manifestations that meet the criteria for major depression, like hypersomnia, low energy levels, increased appetite, feelings of worthlessness, and decreased concentration (Christensen et al., 2020). This makes Major Depression a differential diagnosis. However, the patient also has manic episodes, making this a less likely primary diagnosis.

Schizophrenia: Schizophrenia presents with at least two of the following for not less than one month period: Delusions, Hallucinations, Disorganized speech, Grossly disorganized or catatonic behavior, and Negative symptoms (APA, 2013). Negative symptoms include diminished emotional expression, reduced motivation, poverty of speech, decreased emotional range, and diminished interests and drive (McCutcheon et al., 2020). Petunia presents with features consistent with schizophrenia, like auditory hallucinations (hears voices telling her that she is great and talented), delusions of grandeur, and negative symptoms such as lack of motivation and reduced interest and drive.

Reflections: When completing this assessment, I have learned that when diagnosing Bipolar disorder, the patient must meet the criteria for a manic episode, usually preceded by or followed by a major depressive episode. I have also learned that mood disturbance in Bipolar disorder is usually severe to cause significant impairment in social or occupational functioning. In a different situation, I would assess the patient for alcohol and substance abuse, which often presents as either mania or depression (Vieta et al., 2018). The mental health practitioner must consider the ethical duty to promote good and prevent patient harm by implementing treatment interventions supported by best practices. Furthermore, the practitioner should consider the patient’s level of income and insurance status when determining the treatment intervention. Health promotion should focus on practicing a healthy lifestyle in terms of diet and physical exercises to promote overall good health (Vieta et al., 2018).

Case Formulation and Treatment Plan:

The patient presents with clinical features consistent with Bipolar disorder- Mania. Treatment will comprise outpatient pharmacological therapy and psychotherapy.

Pharmacotherapy: Quetiapine (extended-release) Day 1: 300 mg orally once daily; Day 2: 600 mg orally once daily; Maintenance dose of 400 mg/day orally.

Quetiapine monotherapy is recommended for mild to moderate mania in patients not requiring hospitalization. It is indicated in the acute treatment of manic episodes related to Bipolar disorder (Vieta et al., 2018).

Psychotherapy: The patient will be started on Cognitive behavior therapy (CBT) to help her recognize and modify maladaptive beliefs, thoughts, and behaviors that contribute to and worsen the manic symptoms. Novick & Swartz (2019) explain that CBT for bipolar disorder is based on the hypothesis that feelings, thoughts, and behaviors are interrelated and that changes in mood and cognitive processes during affective episodes influence behavior, which contributes to a vicious cycle that leads to the burden of the disease.

Follow-up: The patient will be scheduled for a follow-up after four weeks to assess her response to treatment, assess for medication, and modify the drug therapy if needed.

NRNP 6665 PMHNP Across the Lifespan I: Assessing, Diagnosing, and Treating Adults With Mood Disorders -Comprehensive SOAP Note for Petunia Park Case Study References

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

Christensen, M. C., Wong, C. M. J., & Baune, B. T. (2020). Symptoms of major depressive disorder and their impact on psychosocial functioning in the different phases of the disease: do the perspectives of patients and healthcare providers differ?. Frontiers in Psychiatry, 11, 280. https://doi.org/10.3389/fpsyt.2020.00280

McCutcheon, R. A., Reis Marques, T., & Howes, O. D. (2020). Schizophrenia-An Overview. JAMA psychiatry, 77(2), 201–210. https://doi.org/10.1001/jamapsychiatry.2019.3360

Novick, D. M., & Swartz, H. A. (2019). Evidence-based psychotherapies for bipolar disorder. FOCUS, A Journal of the American Psychiatric Association, 17(3), 238-248. https://doi.org/10.1176/appi.focus.20190004

Vieta, E., Berk, M., Schulze, T. G., Carvalho, A. F., Suppes, T., Calabrese, J. R., Gao, K., Miskowiak, K. W., & Grande, I. (2018). Bipolar disorders. Nature reviews. Disease primers, 4, 18008. https://doi.org/10.1038/nrdp.2018.8

Vieta, E., Salagre, E., Grande, I., Carvalho, A. F., Fernandes, B. S., Berk, M., … & Suppes, T. (2018). Early intervention in bipolar disorder. American Journal of Psychiatry, 175(5), 411-426.https://doi.org/10.1176/appi.ajp.2017.17090972

As we begin this session, I would like to take this opportunity to clarify my expectations for this course:

Please note that GCU Online weeks run from Thursday (Day 1) through Wednesday (Day 7).

Course Room Etiquette:

It is my expectation that all learners will respect the thoughts and ideas presented in the discussions.
All postings should be presented in a respectful, professional manner. Remember – different points of view add richness and depth to the course!

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Late Policy and Grading Policy

Discussion questions:

I do not mark off for late DQ’s.
I would rather you take the time to read the materials and respond to the DQ’s in a scholarly way, demonstrating your understanding of the materials.
I will not accept any DQ submissions after day 7, 11:59 PM (AZ Time) of the week.
Individual written assignments – due by 11:59 PM AZ Time Zone on the due dates indicated for each class deliverable.

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Participation in each week’s Discussion Board forum accounts for a large percentage of your final grade in this course.
Please review the Course Syllabus for a comprehensive overview of course deliverables and the value associated with each.
It is my expectation that each of you will substantially contribute to the course discussion forums and respond to the posts of at least three other learners.
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Please use peer-related journals found through the GCU library and/or class materials to formulate your answers. Do not try to “Google” DQ’s as I am looking for class materials and examples from the weekly materials.
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Whether this happens deliberately or inadvertently, whenever plagiarism has occurred, you have committed a Code of Conduct violation.
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Every act of plagiarism, no matter the severity, must be reported to the GCU administration (this includes your DQ’s, posts to your peers, and your papers).

Plagiarism includes:

Representing the ideas, expressions, or materials of another without due credit.
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Depending upon the amount, severity, and frequency of the plagiarism that is committed, students may receive in-class penalties that range from coaching (for a minor omission), -20% grade penalties for resubmission, or zero credit for a specific assignment. University-level penalties may also occur, including suspension or even expulsion from the University.
If you are at all uncertain about what constitutes plagiarism, you should review the resources available in the Student Success Center. Also, please review the University’s policies about plagiarism which are covered in more detail in the GCU Catalog and the Student Handbook.
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LopesWrite

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The final grade of Incomplete is granted at the discretion of the instructor; however, students must meet certain specific criteria before this grade accommodation is even possible to consider.
The grade of Incomplete is reserved for times when students experience a serious extenuating circumstance or a crisis during the last week of class which prevents the completion of course requirements before the close of the grading period. Students also must pass the course at the time the request is made.
Please contact me personally if you are having difficulties in meeting course requirements or class deadlines during our time together. In addition, if you are experiencing personal challenges or difficulties, it is best to contact the Academic Counselor so that you can discuss the options that might be available to you, as well as each option’s academic and financial repercussions.

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If you have any questions about a grade you have earned on an individual assignment or activity, please get in touch with mepersonally for further clarification.
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