NRNP-6665 Week 4: Assignment – ASSESSING, DIAGNOSING, AND TREATING ADULTS WITH MOOD DISORDERS
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
NRNP-6665 Week 4: Assignment WEEKLY RESOURCES
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.
Consider patient diagnostics missing from the video:
Provider Review outside of interview:
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)
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-TR
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:
Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, 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 INFORMATION
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To submit your completed NRNP-6665 Week 4: Assignment, save your Assignment as
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Rubric
NRNP_6665_Week4_Assignment_Rubric
NRNP_6665_Week4_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome
Create documentation in the
Focused SOAP Note Template
about the patient in the case study. In the Subjective section, provide: • Chief complaint• History of present illness (HPI)• Past psychiatric history• Medication trials and current medications• Psychotherapy or previous psychiatric diagnosis• Pertinent substance use, family psychiatric/substance use, social, and medical history• Allergies• ROS
15
to >
13.0
pts
Excellent
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
13
to >
11.0
pts
Good
The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
11
to >
10.0
pts
Fair
The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis but is somewhat vague or contains minor innacuracies.
10
to >
0
pts
Poor
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or the subjective documentation is missing.
15
pts
This criterion is linked to a Learning Outcome
In the Objective section, provide:• Review of Systems (ROS) documentation and relate if pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses
15
to >
13.0
pts
Excellent
The response thoroughly and accurately documents the patient’s ROS for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
13
to >
11.0
pts
Good
The response accurately documents the patient’s ROS for pertinent systems. Diagnostic tests and their results are accurately documented.
11
to >
10.0
pts
Fair
Documentation of the patient’s ROS is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor inaccuracies.
10
to >
0
pts
Poor
The response provides incomplete or inaccurate documentation of the patient’s ROS. Systems may have been unnecessarily reviewed. Or the objective documentation is missing.
15
pts
This criterion is linked to a Learning Outcome
In the Assessment section, provide:• Results of the mental status examination, presented in paragraph form• At least three differentials with supporting evidence. List them from top priority to least 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.
20
to >
17.0
pts
Excellent
The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
17
to >
15.0
pts
Good
The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.
15
to >
13.0
pts
Fair
The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vagueness or innacuracy.
13
to >
0
pts
Poor
The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or the assessment documentation is missing. NRNP-6665 Week 4: Assignment
20
pts
This criterion is linked to a Learning Outcome
In the Plan section, provide:• Your plan for psychotherapy• 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. • Incorporate one health promotion activity and one patient education strategy.
25
to >
22.0
pts
Excellent
The response provides an evidence-based, detailed, and appropriate plan for psychotherapy for the patient. The response provides an evidence-based, detailed, and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. A strong rationale for the plan is provided that demonstrates critical thinking and content understanding. … The response includes at least one evidence-based health promotion activity and one evidence-based patient education strategy.
22
to >
19.0
pts
Good
The response provides an evidence-based and appropriate plan for psychotherapy for the patient. The response provides an evidence-based and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. An adequate rationale for the plan is provided. … The response includes at least one health promotion activity and one patient education strategy.
19
to >
17.0
pts
Fair
The response provides a somewhat vague or inaccurate plan for psychotherapy for the patient. The response provides a somewhat vague or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is weak or general. … The response includes one health promotion activity and one patient education strategy, but it may contain some vagueness or innacuracy.
17
to >
0
pts
Poor
The response provides an incomplete or inaccurate plan for psychotherapy for the patient. The response provides an incomplete or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is inaccurate or missing. … The health promotion and patient education strategies are incomplete or missing.
25
pts
This criterion is linked to a Learning Outcome
• Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, 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.).
5
to >
4.0
pts
Excellent
Reflections are thorough, thoughtful, and demonstrate critical thinking.
4
to >
3.5
pts
Good
Reflections demonstrate critical thinking.
3.5
to >
3.0
pts
Fair
Reflections are somewhat general or do not demonstrate critical thinking.
3
to >
0
pts
Poor
Reflections are incomplete, inaccurate, or missing.
5
pts
This criterion is linked to a Learning Outcome
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
10
to >
8.0
pts
Excellent
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
8
to >
7.0
pts
Good
The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.
7
to >
6.0
pts
Fair
Three evidence-based resources are provided to support the assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.
6
to >
0
pts
Poor
Two or fewer resources are provided to support the assessment and diagnosis decisions. The resources may not be current or evidence based.
10
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting – The paper follows correct APA format for parenthetical/in-text citations and reference list.
5
to >
4.0
pts
Excellent
Uses correct APA format with no errors
4
to >
3.5
pts
Good
Contains a few (one or two) APA format errors
3.5
to >
3.0
pts
Fair
Contains several (three or four) APA format errors
3
to >
0
pts
Poor
Contains many (five or more) APA format errors
5
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and punctuation
5
to >
4.0
pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors
4
to >
3.5
pts
Good
Contains a few (one or two) grammar, spelling, and punctuation errors
3.5
to >
3.0
pts
Fair
Contains several (three or four) grammar, spelling, and punctuation errors
3
to >
0
pts
Poor
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5
pts
Total Points:
100 NRNP-6665 Week 4: Assignment
Assessing, Diagnosing, and Treating Adults with Mood Disorders: Petunia Park
Subjective:
CC
(chief complaint): The patient complains of noncompliance with prescriptions, getting frequent agitation, and having alternating mood swings of “being joyful and being depressed.”
HPI
: The patient is a 25-year-old female with a previous history of mental illness. The onset of her current symptoms was about seven days ago. She describes her symptoms as being “squashed” some of the time and believes that it is her hard work ethic that is making her mentally unstable. Symptoms are intermittent in duration but can last for up to seven consecutive days. Symptom characteristics include being severe, unrelenting, and recalcitrant. They are aggravated by being wakeful and somewhat relieved by sleep and medications. The timing of her symptoms is anytime day or night. She rates their severity at 6/10.
Substance Current Use:
She is a tobacco smoker and consumes a pack a day. She denies use of any other drugs or substances.
Medical History:
She suffers from polycystic ovarian syndrome or PCOS as well as hypothyroidism.
Current Medications
:
Levothyroxine 100 mcg by mouth every day (for hypothyroidism).
Allergies
: NKDA.
Reproductive Hx
: She describes herself as a heterosexual female currently in a relationship. She has n children and her LMP was 05/29/2024.
Review of Systems or ROS
:
GENERAL: Denies fever, chills, fatigue, weight loss, or malaise.
HEENT: Negative for headaches, light sensitivity, ear discharge, ear pain, rhinorrhea, sore throat or difficulty swallowing.
SKIN: Negative for itching, eczema, or rashes.
CARDIOVASCULAR: Denies chest pain, palpitations, or peripheral edema.
RESPIRATORY: Denies coughing, dyspnea, wheezing, or producing sputum.
GASTROINTESTINAL: Denies N/V/D as well as changes in bowel movements.
GENITOURINARY: Negative for dysuria, cloudy urine, or abnormal vaginal discharge.
NEUROLOGICAL: Denies dizziness, syncope, ataxia, paresis, paralysis, pins and needles, or loss of bowel and/ or bladder control. NRNP-6665 Week 4: Assignment
MUSCULOSKELETAL: Denies muscle pain, back pain, or joint pain.
HEMATOLOGIC: Negative for a history of blood and/or clotting disorders.
LYMPHATICS: Denies lymphadenopathy or having had a splenectomy before.
ENDOCRINOLOGIC: Negative for excessive thirst, excessive drinking of water, excessive eating, excessive sweating, heat/ cold intolerance, or a history of hormonal therapy/ treatment.
Objective:
Vitals:
T 98.2; P 90 ; R 18 ; B/P 138/88
Diagnostic Lab Results
: Urine drug tests, CMP, and full blood count were unremarkable. TSH was elevated at 6.3 on testing.
Psychometric test:
Young Mania Rating Scale or YMRS tool.
Assessment:
Mental Status Examination
: The patient is a 25-year-old female who is well-groomed for the occasion, time of the day, and the weather. She has normal appearance and gait with no obvious physical abnormalities. She is concious and aware of the place, time, space, person, and event. She is cooperative and maintains good eye contact throughout. Her speech is clear, coherent, and goal-oriented although pressured in rate. She displays no obvious mannerisms or tics. Her self-reported mood is “happy” and the observed affect is euphoric hence mood-congruent. She denies having suicidal or homicidal thoughts. She also denies getting hallucinations or delusions. Her immediate, short-term, and long-term memory is good. Her abstraction is also good as she can make sense of idioms. Her insight and judgment are somewhat impaired. Impression: Bipolar I disorder (APA, 2022; Boland et al., 2021; Stahl, 2021).
Diagnosis and Differential Diagnoses
Bipolar I Disorder: 296.42 (F31.12)
The euphoria and “happiness” described in the MSE means that this patient is in the manic phase of bipolar I disease. In her CC she stated that she usually has alternating depressive feelings and elation. She thus meets the diagnostic criteria for BD I as one requirement is that the patient must have had at least one manic episode (APA, 2022; Boland et al., 2021). According to the DSM-5-TR, the diagnostic criteria also include insomnia, excessive excitement, abnormally high self-esteem, talkativeness, distractibility, and excessive energy amongst others.
Major Depressive Disorder (MDD):
296.22 (F32.1)
One of the poles of BD I is depression. This patient can thus be mistakenly diagnosed with MDD when she is on the depression pole (APA, 2022). However, this cannot be true as she has also experienced mania making this BD instead.
Attention-Deficit/ Hyperactivity Disorder or ADHD: 314.01 (F90.2)
ADHD is a distant possibility but still plausible since it usually starts in childhood but goes up to adulthood. The irritability, distractibility, insomnia, social isolation (from peers), and inattentiveness amongst others may lead to a wrong diagnosis of ADHD. However, it may also be comorbid with the BD I. NRNP-6665 Week 4: Assignment
Case Formulation and Treatment Plan:
Cognitive behavioral treatment (CBT) brief therapy 45/ session x 8 weeks (Corey, 2023).
Lithium (Eskalith) 300 mg orally BID (Stahl, 2020).
Regular physical activity and a diet rich in fresh fruits and vegetables.
Reflection
I did everything according to the book for the patient (Carlat, 2023). I also observed all ethical principles including autonomy, fidelity, justice, beneficence, and nonmaleficence (Haswell, 2019). Social determinants of health applicable to the client included low educational achievement and poor access to quality mental health care. I tailored health education for her according to these and then gave her a return date for follow up after 4 weeks.
References
American Psychiatric Association [APA] (2022).
Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-5-TR), 5
th
ed
. Author.
Boland, R., Verdiun, M., & Ruiz, P. (Eds) (2021).
Kaplan and Sadock’s synopsis of psychiatry, 12
th
ed
. Wolters Kluwer.
Carlat, D.J. (2023).
The psychiatric interview, 5
th
ed
. Wolters Kluwer.
Corey, G. (2023).
Theory and practice of counselling and psychotherapy, 11
th
ed
. Cengage Learning.
Haswell, N. (2019). The four ethical principles and their application in aesthetic practice.
Journal of Aesthetic Nursing
, 8(4), 177-179.
https://doi.org/10.12968/joan.2019.8.4.177
Stahl, S. M. (2021).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications, 5
th
ed
. Cambridge University Press.
Stahl, S.M. (2020).
Stahl’s essential psychopharmacology: Prescriber’s guide, 7
th
ed
. Cambridge University Press. NRNP-6665 Week 4: Assignment
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