NURS 6650 Assignment: Treating Adults With Mood Disorders
Sample Answer for NURS 6650 Assignment: 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 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.
NURS 6650 Assignment Treating Adults With Mood Disorders - 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.
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A Sample Answer For the Assignment: NURS 6650 Assignment: Treating Adults With Mood Disorders
Title: NURS 6650 Assignment: Treating Adults With Mood Disorders
Subjective:
CC (chief complaint): ” I have these times when I don’t want to get out of bed. I have no energy, no motivation to do anything, I just can’t feel any interest in my creativity”. ” I have taken medications and discontinued them in the past; I don’t believe I require them.”
HPI: P.P, a twenty-seven-year-old Caucasian female patient, has visited the clinic for a mental health evaluation. She indicates that she has a history of bipolar, anxiety, and depression. She has stopped taking medication since they have done away with her creativity. She has been hospitalized on four occasions, the first of those coming during her teenage days when she was admitted for lacking sleep for up to five years. She also indicated that she has been hearing things. The patient also indicated that she had been admitted to a mental health facility due to recommendations from her mother. The patient also had an overdose of Benadryl, which she took with the intention of committing suicide. Recently, she was also taken in by the police to an emergency room since she was playing guitar and dancing in public while putting on her night dress. P.P also indicates that there are days when she feels completely exhausted, and therefore she struggles to get out of bed and lacks the desire to be creative. These happen after lacking sleep for several days. While there are talks of depression, she is not sure if she is depressed. She sometimes forgets to take her prescribed medications since she feels fatigued from work. The patient also shared that she has a lot of energy; hence she can do several things and can even go up to five days without sleep. She indicates that she is toxic whenever she is creative, something that lasts for seven days. In addition, her friends also say that she looks disorganized and talks too much.
Substance Current Use: the patient smoke a pack (nicotine).
Medical History: the patient has a history of anxiety disorder, bipolar disorder, and depressive disorders. The patient has had a total of four hospitalizations and a suicide attempt by using an excess of Benadryl.
- Current Medications: Zoloft, Seroquel, Risperidone and Klonopin. She uses medications for birth control and hypothyroidism.
- Allergies: no known allergies
- Reproductive Hx: No STIs reported, no children, the patient uses birth control pills, has many sexual partners, and has regular menses.
ROS:
- GENERAL: the patient has no distress; she is presentable and well nourished. She is jovial, though she gets irritated with repetitive questions.
- HEENT: No headaches, no dizziness, no eye or ear pain, no nasal discharge, no blurred vision or vision changes, no reports of swallowing difficulty
- SKIN: No bruising, no lesions, no skin rash
- CARDIOVASCULAR: no chest pain, breath shortness, or chest tightness
- RESPIRATORY: No dyspnea, no cough, no reports of breathlessness
- GASTROINTESTINAL: no constipation, stomach upset and diarrhea
- GENITOURINARY: no frequent or urgent urination, no pain reported.
- NEUROLOGICAL: no numbness, no headache, no ataxia
- MUSCULOSKELETAL: no reports of muscle or joint pain.
- HEMATOLOGIC: no bruising or bleeding
- LYMPHATICS: no pain or swelling reported
- ENDOCRINOLOGIC: reports of hypothyroidism
Objective:
Temp 98.2 Pulse 90 Respiration 18 B/P 138/88
Laboratory Data Available: Urine drug and alcohol screen negative. CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)
ROS
General: The patient has an appropriate attitude and mood, which are also congruent with each other.
HEENT: no deformities or traumas observed on the head, eyes, ears, and neck are all normal.
SKIN: The skin is warm and dry, with no ulcers, wounds, or rashes observed.
CARDIOVASCULAR: The heart rhythm is normal; no murmurs, no click sounds heard
RESPIRATORY: no shortness of breath, no wheezing, the breathing is non-labored
NEUROLOGICAL: The patient looks alert, oriented, and cooperative
Diagnostic results: Urine drug and alcohol screen negative. CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)
Assessment:
Mental Status Examination:
The patient is a twenty-seven-year-old Caucasian female. She looks polite and perceptive, well dressed and organized. However, her speech looks forced at times. Her speech tone is appropriate and consistent. The client has had fantasies of becoming famous when he gets a chance to publish her memoirs, apply make-up and sell artwork to movie stars. The client has reported episodes of creativity, a times when she is worried. The patient has lots of energy and sometimes only sleeps three hours per night, yearns for sex with strangers, and talks a lot during such a duration. The week of “creativity” is followed by a week of lack of motivation and energy, where she stays in bed. The patient has no current experiences with sensation, hearing, or vision problems, even though she could hear voices in the past. The long-term and short-term memory is intact. The patient is devoid of impulse control and judgments. Even though she has a history of suicide, she doesn’t have any suicidal thoughts currently. The patient experiences depressive episodes, which make her be away from her Aunt’s bookshop.
Diagnostic Impression:
- Bipolar disorder: the patient has been exhibiting manic behavior, including involvement in potentially harmful activities, possession of racing thoughts and ideas, talking more than usual, lack of sleep in some weeks, inflated self-esteem, and extravagance (Kessing et al., 2021). According to the DSM-V criteria, these symptoms befit bipolar disorder. Indeed, when a patient experiences frequent and several depressive episodes, bipolar I disorder is likely to follow.
- Generalized Anxiety Disorder: There are indications of engaging in impulsive behavior to cope with particularly uncomfortable feelings. Such behavior can easily be misinterpreted as racing thoughts. However, it does not have manic behavior connected to bipolar disorder, hence ruling it out. However, it points to the patient’s reported fatigue, lack of concentration, and restlessness.
- Borderline Personality Disorder: Impulsivity and emotional instability are both common among patients with borderline personality disorder and bipolar disorder (Videler et al.,2019). However, the patient’s symptoms do not meet the full criteria for the diagnosis of this condition according to DSM-V guidelines.
Reflections:
The examination performed on the patient was compressive, and it was appropriate in revealing and addressing the patient medication and medical History. Performing a review of current and past medications is key in coming up with the right treatment and management plan, as a practitioner would know how particular medications made the patient feels. As part of the plan, the patient and the family members should be well educated regarding the medications and their effective use and allow the patient to make appropriate medication choices, led by the presented information. The patient should also get the right direction and education on the disadvantages of using psychotropic medications, their side effects, and potential adverse impacts. Ethical principles should also take center stage when prescribing psychotropic medications to patients (Hunt Grubbe et al.,2020). For instance, non-maleficence should lead the professionals to assess the patient’s safety depending on the patient’s current actions and the possibility of the existence of suicidal ideation or plans. Autonomy should make the practitioner let the patient have a say on the medications to use and the treatment plan and also get the necessary education plan. This client also needs to receive some sex education as she has a sexual relationship with several partners.
Case Formulation and Treatment Plan:
From the guidelines of the DSM-5 criteria, the patient’s symptoms best fit Bipolar Personality disorder. Indeed, the patient has shown a lack of self-control, poor judgment, a diminished need to sleep, bloated self-esteem, and promiscuous character. The patient also has delusional thinking, irrational thought process, racing emotions and opinions, and is also too friendly. The patient also has experiences of hopelessness, lack of desire, diminished interest in activities that she is otherwise used to enjoying, difficulty getting up in the morning, tiredness, and exhaustion.
The patient needs appropriate management to help her cope with the symptoms. The patient can start using Lamictal (25 mg) BID, which will be used until the expected impact is realized. Cognitive behavioral therapy is also indicated for this patient to help her with her racing thoughts. Lamictal is the medication of choice since the previous medication has resulted in weight gain. According to Wang & Osser, 2020 Lamictal has been proven by FDA for treating bipolar disease. The patient has complained of weight gain due to previous medications. Therefore, such a view can negatively impact compliance with the current plan. Therefore, the patient has to be educated that the issue will be addressed, but it may take a few weeks. The patient also needs to be informed of the possible side effects, such as nausea, rash, and dizziness ( Rosenberg et al., 2021).
References
Hunt-Grubbe, H. (2020). Ethical Issues Arising from the Prescription of Antipsychotic Medication in Clinical Forensic Settings. In Ethical Issues in Clinical Forensic Psychiatry (pp. 99-114). Springer, Cham. https://doi.org/10.1007/978-3-030-37301-6_6
Kessing, L. V., González-Pinto, A., Fagiolini, A., Bechdolf, A., Reif, A., Yildiz, A., … & Vieta, E. (2021). DSM-5 and ICD-11 criteria for bipolar disorder: Implications for the prevalence of bipolar disorder and validity of the diagnosis–A narrative review from the ECNP bipolar disorders network. European Neuropsychopharmacology, 47, 54-61. https://doi.org/10.1016/j.euroneuro.2021.01.097
Rosenberg, R., Schweitzer, P. K., Steier, J., & Pepin, J. L. (2021). Residual excessive daytime sleepiness in patients treated for obstructive sleep apnea: guidance for assessment, diagnosis, and management. Postgraduate Medicine, 133(7), 772-783. https://doi.org/10.1080/00325481.2021.1948305
Videler, A. C., Hutsebaut, J., Schulkens, J. E., Sobczak, S., & Van Alphen, S. P. (2019). A life span perspective on borderline personality disorder. Current Psychiatry Reports, 21(7), 1-8. https://doi.org/10.1007/s11920-019-1040-1
Wang, D., & Osser, D. N. (2020). The psychopharmacology algorithm project at the Harvard South Shore Program: an update on bipolar depression. Bipolar Disorders, 22(5), 472-489. https://doi.org/10.1111/bdi.12860
NURS 6650 Assignment: Treating Adults With Mood Disorders Grading Criteria
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NURS 6650 Assignment: Treating Adults With Mood Disorders Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
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Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three or more of the following elements
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| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in the all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three of the following elements
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| 10 Points | 9 Points | 6 Points | 0 Points | |||
| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
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Demonstrated 3 of the following:
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Demonstrated 2 of the following:
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Demonstrated 1 or less of the following:
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| 8 Points | 7 Points | 6 Points | 5 Points | 4 Points | 0 Points | |
| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
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| 0 Points Deducted | 5 Points Lost | |||||
| Participation
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Demonstrated the following:
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| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |