Tag: Clinical-Nursing

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay

Pharmacotherapy for acute gastroenteritis

Acute gastroenteritis

Due to the presenting symptoms of nausea vomiting and diarrhea, the patient may be suffering from acute gastroenteritis. Acute gastroenteritis is an intestinal inflammation commonly characterized by diarrhea, nausea, vomiting, fever and abdominal cramps. It is commonly caused by viruses or bacteria. More diagnostic procedures such as blood and stool tests are required to determine the definitive cause of the condition (U. Desselberger, 2003). Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay

Treatment of gastroenteritis is dependent on the cause. Risk factors of gastroenteritis include young children, elderly, and a weakened immune system. Based on the current medication taken by the patient, prednisolone, a corticosteroid is known of the effect of weakening the immune system which may in turn predispose the patient to other infections. Prednisolone may also have caused the presenting complaints since nausea, vomiting and diarrhea are its common side effects (Malangu, 2018) Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay.

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Appropriate drug therapy.

The appropriate drug therapy includes continuation of Synthroid 100mcg once daily to counter the hypothyroidism effect of hepatitis C. Tapering off prednisolone is also recommended to help elevate the body immune system as well as discontinue the possible associated side effects. The current nifedipine dosage should be investigated according to the underlying condition that could have led to the initiation and continuation of its dosage. Promethazine 25mg every 4 to 6 hours as desired is recommended to manage the nausea and vomiting. Oral rehydration by the use of Oral Rehydrating Salt is recommended to prevent dehydration due to excessive water loss through diarrhea and vomiting. Probiotics Saccharomyces boulardii is recommended for management of the acute diarrhea (Kenneth L. Koch, 2016). Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay.

 

 

References

Kenneth L. Koch, W. L. (2016).
Nausea and Vomiting: Diagnosis and Treatment.
Springer.

Malangu, N. (2018).
Pharmacokinetics and Adverse Effects of Drugs: Mechanisms and Risks Factors.
BoD – Books on Demand.

Desselberger, J. G. (2003).
Viral Gastroenteritis.
Gulf Professional Publishing. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay

 

By Day 7 of Week 4

Write
 a 1-page paper that addresses the following:

Explain your diagnosis for the patient, including your rationale for the diagnosis.

Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay

Asthma and Stepwise Management PowerPoint presentation

Asthma management.

By Day 7 of Week 3

Create
a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following: Asthma and Stepwise Management PowerPoint presentation

Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.

Explain the stepwise approach to asthma treatment and management for your patient. Asthma and Stepwise Management PowerPoint presentation

Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

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Introduction

According to the Centers for Disease  Control and Prevention, Asthma is a condition characterized by narrowed airways that produce excess mucus making breathing difficult.

Common symptoms of asthma include wheezing, coughing, chest pains, shortness of breath and trouble sleeping.

Asthma is classified into the following categories according to the signs and symptoms. Asthma and Stepwise Management PowerPoint presentation

Mild intermittent

Mild persistent

Moderate persistent

Severe persistent.

Mild intermittent symptoms occur to up to two days in a week and two nights in a month.

Mild persistent symptoms occur more than twice a week but do not exceed once a day.

Moderate persistent symptoms occur once daily and exceed more than one night a week.

Severe persistent symptoms occur throughout the day and frequently at night.

Asthma and Stepwise Management PowerPoint presentation

Management of asthma.

Long-term control involves use of medications that reduce the inflammation of the airways.

Long term control medications include inhaled corticosteroids, leukotriene modifiers, long acting beta agonists, combination inhalers and theophylline.

uQuick relief management involves use of medications that open up the airways.

uQuick relief medications include Short acting Beta agonists, ipratropium, and oral and intravenous corticosteroids.

Leukotriene modifiers relieve symptoms up to 24 hours. They are however linked to agitation, aggression, hallucinations and depression adverse effects.

LABA eg salmeterol and formoterol are often taken in combination to prevent the adverse effect of severe asthma attack.

Combination inhalers include a LABA and a corticosteroid such as fluticasone-salmeterol and mometasone-formeterol. Asthma and Stepwise Management PowerPoint presentation

SABA such as albuterol and levalbuterol are taken using devices such as portable hand inhalers and nebulizers to offer relief within minutes.

Ipratropium act immediately by causing bronchodilation.

Oral and intravenous corticosteroids such as methylprednisolone and prednisolone manage the inflammation of the airways during severe asthma and are used in short term to avoid side effects. Asthma and Stepwise Management PowerPoint presentation

Management of asthma.

stepwise approach of asthma is the increment or decrement of dose, number of medications and frequency of dosage to achieve symptomatic control.

stepwise approach occurs when dosage of the medication is increased until the patient can sleep well as night, stay active during the day and reduces emergency visits.

The goal of this approach is to establish the least amount of medication required to obtain good control.

Stepwise management is divided into intermittent asthma and persistent asthma.

The stepwise approach is aimed at assisting in the decision making process during prescription so as to attain individualized patient care.

The stepwise approach is imperative in addressing patient specific needs. Asthma and Stepwise Management PowerPoint presentation

Steps in asthma management.

Intermittent asthma-

ustep 1 SABA

uPersistent asthma-

uStep2  –  ICS

uStep 3 – low dose ICS + LABA or theophylline or LTRA

uStep 4 – medium dose ICS + LABA

uStep 5 – high dose ICS + LABA Asthma and Stepwise Management PowerPoint presentation

uStep 6 – High dose ICS + LABA + oral systemic Corticosteroid

Short acting beta-2 agonists such as salbutamol are used as needed for intermittent asthma. If symptoms recur more than two days in a week after treatment with SABA, the patient is treated for persistent asthma.

Inhaled corticosteroids (ICSs) are the preferred treatment for persistent asthma in step 2. Alternatives include theophylline, nedocromil, leukotriene receptor antagonist and cromolyn.

Long acting beta-2 agonists are used together with a low dose inhaled corticosteroid in step 3. Alternatives to LABA include Leukotriene receptor antagonists (e.g montelukast and zafirlukast) and theophylline.

A medium dose inhaled corticosteroid is used together with Long acting beta-2 agonist in step 4. A medium dose inhaled corticosteroid together with theophylline or LTRA.

A high dose inhaled corticosteroid is used together with long acting beta-2 agonist in step 5. alternative therapy includes a high dose inhaled corticosteroid together with theophylline or LTRA.

Step 6 include the use of oral systemic corticosteroid together with LABA and a high dose inhaled corticosteroid. Alternative therapy includes use of a high dose inhaled corticosteroid together with either LTRA or theophylline and oral systemic corticosteroid. Asthma and Stepwise Management PowerPoint presentation

uReference

uRosenthal, L. D., & Burchum, J. R. (2021). 
Lehne’s

pharmacotherapeutics
for advanced practice nurses and physician assistants 
(2nd ed.) St. Louis, MO: Elsevier.

u
https://www.cdc.gov/asthma/default.htm

u
http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

uKaplan, A., Mitchell, P. D., Cave, A. J., Gagnon, R., Foran, V., & Ellis, A. K. (2020). Effective Asthma Management: Is It Time to Let the AIR out of SABA?. 
Journal of clinical medicine
, 
9
(4), 921. Asthma and Stepwise Management PowerPoint presentation

NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

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When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.

Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post
 a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics. Be specific and provide examples.

By Day 6 of Week 1

Read
 a selection of your colleagues’ responses and 
respond
 to 
at least two
 of your colleagues on 
two different days
by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure. NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

Application of Data to Problem-Solving

As nurses I believe we all face problems that may arise at any moment. One issue we are constantly facing is patient violence. One study reported 80% of nurses had experienced verbal abuse from patients or families, with male nurses having higher rates than females (Cho et al., 2020). On my unit we receive quite a few alcohol withdraw patients. These individuals become incoherent and aggressive if not treated properly. Many times, these individuals have no recollection of the violence they exhibited. At our organization nurses can press charges legally through our police officers for acts of violence Application of Data to Problem-Solving. It is important that management supports their worker through these situations. If management helps control the verbal abuse, this may be linked to improved patient care (Cho et al., 2020).

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While I believe the electronic medical record is a great resource, much of the data measured cannot be found on this source. Incident reports would be a great way to track injuries that have been inflicted on staff or property. This would provide a detailed document of what occurred and who was present. All the data gathered can then be processed to provide information on this scenario (McGonigle & Masrian, 2017, p. 22). Another method that may be useful is an anonymous box. Application of Data to Problem-Solving Many individuals do not want to talk to management about situations that have occurred. This box provides a way for staff to still report incidences of violence that are occurring without being named. It also allows for more accurate reporting of the number of situations that may be occurring.

This is a great scenario to apply nursing informatics principles. It is important that you included how a timeline is necessary in this process. The nurse leader is crucial in this process. They are acting as the role models for these scenarios and any future problem solving Application of Data to Problem-Solving.

 

References

Cho, H., Pavek, K., & Steege, L. (2020). Workplace verbal abuse, nurse-reported quality of care and patient safety outcomes among early-career hospital nurses.
Journal of Nursing Management,
28(6), 1250-1258.
10.1111/jonm.13071

McGonigle, D., & Mastrian, K. G. (2017).
Nursing informatics and the foundation of knowledge
(4th ed.). Jones & Bartlett Learning. Application of Data to Problem-Solving

biological basis of psychotherapy essay

Post
 an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments. Support your rationale with evidence-based literature.

Foundations of psychotherapy

For the mental health nurse practitioner, the collection of the data is critical at the time of formulate the right diagnostic. Therefore, is important to gather as must information as possible from every part of patient life. According with American Nurses Association. (2014) the psychiatric nurse practitioner has the responsibility of collect comprehensive information from his client regarding psychiatric, substance physical, functional, psychosocial, emotional, cognitive, sexual, cultural, age related, environments, spiritual/transpersonal and economic assessment.  As provider is imperative to understand how each of this factor influence on our client daily life.   The purpose of this discussion is to explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments.

Cultural factor

Every culture has way of living and way they handed their problem. To understand our client, the psychotherapy needs to look on how culture affect positive and negative her/his client. The incorporation of cultural factors in psychotherapy will facilitate the adherence and acceptability Banerjee, P., & Sharma, V. (2020). For some culture, the alternative of threat mental health problem is a great choice, since do not involve the use of drug. In Addition, psychotherapy has been proving that help to threat mental health issue and it can be the first choice for some client Laureate Education (Producer). (2016).

If psychotherapy is acceptable culturally, it can be a factor where everybody wins, the client and the society. Another interesting factor is that no matter the kind of therapy you use can be effective and helpful, according with Dr. Richard Bentall Laureate Education (Producer). (2015e). The theory of Peplau`s relate the culture looking person, which is a developing organism that tries to reduce anxiety caused by needs; environment, which consists of existing forces outside of the person, and put in the context of culture; health, which is a word symbol that implies forward movement of personality and other human processes toward creative, constructive, productive, personal, and community living Petiprin, A. (2016).

 

Religion Factor

The health care professional need to be aware of the spiritual believe of their client. Many patients believe on the guide of the pastor or any other religion leader. Knowing that when chose the type of psychotherapy and lean how to integrate can make a bid difference. The Role of modeling and role modeling theory see the human been as holism, which is the belief that people are more than the sum of their parts. Instead, mind, body, emotion, and spirit function as one unit, affecting and controlling the parts in dynamic interaction with one another. This means conscious and unconscious processes are equally important Petiprin, A. (2016).

According with study Some religious or spiritual (R/S) clients seek psychotherapy that integrates R/S values, while others may be reticent to disclose R/S-related aspects of struggles in a presumably secular setting Captari, L. E., Hook, J. N., Hoyt, W., Davis, D. E., McElroy-Heltzel, S. E., & Worthington, E. L., Jr. (2018). The psychotherapy professional need to be aware or influence in the recovery of the patient. In the case of client with suicide ideation and depression, the region can help then to stay alive depending how they see the dead. Some religion see suicide as unacceptable, but other believe that depending on the reason can bring then to heaven. The critique of religions by Sigmund Freud has continuously exerted a strong impact in the fields of psychiatry and psychotherapies; in addition, regarding psychodynamics and symptoms of psychic disorders, religious phenomena in the lives of patients may be just as affected as other cognitive and emotional aspects and behaviors. Consequently, religious experience and religious behavior of patients in psychiatry and psychotherapies have rarely been object of research and teaching apart from predominantly symptomatic and pathogenic perspectives Klaus Baumann, & Frank-Gerald B. Pajonk. (2014).

 

Socioeconomics Influence

Socioeconomic status is the social classification of an individual by such measures as income, education level, occupation, and community of residence. Socioeconomic status is often subdivided into high, middle, and low categories Berman, J. O. M. C. (2019). The socioeconomic factor is always in controversy, especially the limitation that some population must access to health care service. In the other hand, how the high society and important leader can be seen for other, if need to receive psychotherapy service.  In addition, change on life event that affect the socioeconomic statute can affect the client.  Study show that Life events are recognized to link low socio‐economic status (SES) with impaired mental health. Despite attention to patients’ historical environmental circumstances in psychotherapeutic practice, events that occur over the course of counselling and psychotherapy (‘intercurrent’ events) seem to have received little attention in research Blackshaw, E., Evans, C., & Cooper, M. (2018).

Conclusion

A great mental the nurse practitioner has the responsibilities to learn as much as possible above their client include, but not limited to their culture background, religion, socioeconomic status, family history, drug abuse and education level. Looking the client as all, can help the health care professional to identify the best psychotherapy for the client, and facilitate a soon recovery.

 

Reference

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

Standard 1 “Assessment” (pages 44 & 45)

 

Banerjee, P., & Sharma, V. (2020). An Insight into Psychotherapy: Indian Perspective. SIS Journal of Projective Psychology & Mental Health, 27(1), 54–56.

Blackshaw, E., Evans, C., & Cooper, M. (2018). When life gets in the way: Systematic review of life events, socioeconomic deprivation, and their impact on counselling and psychotherapy with children and adolescents. Counselling & Psychotherapy Research, 18(2), 143–153. https://doi-org.ezp.waldenulibrary.org/10.1002/capr.12156

Laureate Education (Producer). (2016). Introduction to psychotherapy with individuals [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2015e). Therapies are helpful: Dodo bird conjecture [Video file]. Baltimore, MD: Author.

Captari, L. E., Hook, J. N., Hoyt, W., Davis, D. E., McElroy-Heltzel, S. E., & Worthington, E. L., Jr. (2018). Integrating clients’ religion and spirituality within psychotherapy: A comprehensive meta-analysis. Journal of Clinical Psychology, 11, 1938. https://doi-org.ezp.waldenulibrary.org/10.1002/jclp.22681

Petiprin, A. (2016). Psychiatric and mental health nursing. Nursing Theory. Retrieve from: http: www/nursing-theory/theory-models/psychiatric-and -mental-health nursing.php

Berman, J. O. M. C. (2019). Socioeconomic status and addiction. Salem Press Encyclopedia of Health.

Klaus Baumann, & Frank-Gerald B. Pajonk. (2014). Religions and Psychotherapies—Special Issue. Religions, 5(3), 871–875. https://doi-org.ezp.waldenulibrary.org/10.3390/rel5030871

 

Respond
 to at least two of your colleagues by providing an additional scholarly resource that supports or challenges their position along with a brief explanation of the resource.

response

I enjoy reading your post. Psychotherapy is extremely beneficial in treating several mental health issues (Laureate Education Producer, 2016). Psychotherapy is regarded as the first line of treatment (Laureate Education Producer, 2016).  I agree with your post regarding how culture influences the client’s mental illness and therapy positively and negatively; thus, where psychotherapy is concerned. I think the overall goal should be that the treatment is culturally competent. This concept is fundamental, and I assume it encompasses what you were saying when you wrote how about the diversity of patients, problems, and beliefs.

Ensuring that all care, especially therapy, is culturally competent is an essential element to promote a positive patient experience. Also, promoting social justice which focuses on the achievement and full equal participation of all groups in a society that is mutually shaped to meet the needs of the community or culture.  While we transition from the role of the nurse to PMHNP, one must incorporate multiple different strategies but also focus on diversity and social justice, which can promote a concept know as multicultural competence. Multicultural competence is typically described as the extent to which counselors and psychotherapists possess appropriate awareness (self-awareness and of the other), knowledge, and skills in working with individuals from diverse cultural backgrounds(Moleiro, Freire, Pinto, & Roberto, 2018).  This strategy helps to respond to diversity and reduce mental health disparities.

 

References

Laureate Education (Producer). (2016). Introduction to psychotherapy with individuals [Video file]. Baltimore, MD: Author.

Moleiro, C., Freire, J., Pinto, N., & Roberto, S. (2018). Integrating diversity into therapy processes: The role of individual and cultural diversity competences in promoting equality of care. 
Counselling & Psychotherapy Research
, 18(2), 190–198. https://doi-org.ezp.waldenulibrary.org/10.1002/capr.12157.

Nurs 6051 discussion The Application of Data to Problem-Solving

The development of an understanding of computer science principles as they apply to the technology used in nursing can facilitate optimal usage of the technology for knowledge development in the profession (McGonigle & Mastrian,2017). I work in a state psychiatric and mental health hospital in a forensic unit. I do not consider myself computer savvy but am able to navigate and complete all the tasks that require the use of computer and electronic devices to fulfill my job requirements. Nurs 6051 discussion The Application of Data to Problem-Solving. Introduction of Telehealth/telenursing was introduced at work after the surge of the COVID-19 pandemic. The doctors, psychiatrists, and other clinicians were not visiting the units as it was before the pandemic. iPad was introduced to the units and it was up to the nurses to connect with the other clinicians virtually. Clinical meetings were and are still conducted via zoom, emails were utilized more than usual to share ideas. Nurses felt a sense of connection with other providers around the clock. Nurses who must engage in shift work, recorded reports as social distancing was not adequate, we found it productive and found a sense of connectivity as we continued to provide care and navigate through the new norm Nurs 6051 discussion The Application of Data to Problem-Solving.

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The most challenging part is that the devices used namely the iPad is portable and user-friendly but there is no storage of data and the conversations cannot be recorded for future reference. The patients that we serve are highly assaultive and at times dysregulated, thus the chances of devices been broken are high. When a patient is being admitted to the unit or there is a psychiatric emergency, the attending doctor is informed via a phone call, and then he/she will call the unit for an update, Nurs 6051 discussion The Application of Data to Problem-Solving  “meeting is set up” so he/she could assess the patient. This can be very frustrating at times as issues are not attended to in a timely manner. Although communicating with others via audio-video conferencing in real and actual time to address immediate situations, sometimes does not occur, there are cliches that require to be fixed such as connectivity which could be poor at times. The iPad is numbered and configured with their own directory in which the files and folders are stored with their respective identifications. Nurs 6051 discussion The Application of Data to Problem-Solving Each unit manager is responsible for the iPad. To access the application, the user must log in to the system. The user enters his/her ID on the first screen, linking him/her with the person in charge of the observation/assessment.

The use of portable devices is all new to most of the employees and to the patients, it will take time to adjust and each day is a learning experience Nurs 6051 discussion The Application of Data to Problem-Solving. The long term goal is to steer into the future by realizing that the ability to communicate and interact with each other, collecting and using data will be easier as technology continues to evolve. Nurs 6051 discussion The Application of Data to Problem-Solving A nurse leader may use clinical reasoning and judgment in the formation of knowledge from this experience by meeting with staff nurses and brainstorming to find out what the challenges are and how well equipped the staff  are in terms of nursing informatics.

One way to obtain information about how workers allocate time for work activities is by using the work sampling technique, which is based on performing direct observations intermittently, instantaneously. and randomly during the workday Nursing should enjoy the advantages offered by mobile technologies and their applications, enabling researchers, professors, and students to successfully incorporate and use new technologies in health. This field still needs further studies, exchange of experiences, and innovative practices. Nurs 6051 discussion The Application of Data to Problem-Solving (Pereira et al.,2017). More needs to be done, hopefully, the future is leaning towards expanding the IT department.

 

References

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning Nurs 6051 discussion The Application of Data to Problem-Solving.

Pereira, I. M., Bonfim, D., Ciqueto Peres, H. H., Góes, R. F., & Rapone Gaidzinski, R. (2017). Mobile application for data collection in health research. Acta Paulista de Enfermagem, 30(5), 479–488. https://doi-org.ezp.waldenulibrary.org/10.1590/1982-0194201700069 Nurs 6051 discussion The Application of Data to Problem-Solving

Biological Basis of Psychotherapy Treatments

Introduction

Psychotherapy treatments are based on the functioning of the brain-mind and the ensuing behavior and maladaptive responses (Javanbakht & Alberini, 2019). Therefore, understanding how psychotherapy treatments can assist in improving  psychopathologies can improve approaches to mental health issues. This essay discusses the biological basis of psychotherapies and how culture, socioeconomics and religion influence an individual’s perspective regarding psychotherapy treatment.

Psychotherapy has biological basis because it targets the brain and how the brain functions. Tyron (2016) explains that psychotherapy targets the maladaptives in the brain and repairs the negative brain adaptivatives by substituting them with postive pathways. The brain maps experiences using nuerons and thus psychotherapy aims to disengage the defective mappings. For example, psychotherapy treatments line the cognitive behavioral therapy (CBT) alters the biological structure of the brain. For instance, the study by Tyron (2016) indicated that CBT lowered the levels of glucose mentabolism in people with obsessive-compulsive disorder (OCD) and thus improved the OCS symptoms.

Cultural beliefs impact the perspective of people regarding psychotherapy. For instance, some cultures stigmatize mental illness and may believe only in pharmacological treatments and this may hinder people from seeking psychotherapy treatment (Wegner & Rhoda, 2015). Similarly, religious beliefs can lead people to seek divine healing when having mental health problems and thus may not seek psychotherapy treatment (Goncalves et al, 2015). Lastly, the socioeconomic status may affect the ability of an individual to seek psychotherapy treatment. For example, psychotherapy treatment may be perceived as expensive and this may hinder people from a low socio-economic status from seeking  treatment (Sripada et al, 2015).

Conclusion

Psychotherapy treatment has a biological basis because it targets the maladaptive aspects in the brain. Finally, the cultural beliefs, religious beliefs, as well as the socioeconomic status impact the perspectives and ability of an individual to seek psychotherapy treatments.

References

Goncalves J, Luchetti G, Menezes P & Vallada H. (2015). Religious and spiritual interventions in mental health care: a systematic review and meta-analysis of randomized controlled clinical trials. Psychol Med, 45(14): 2937–2949.

Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological Models of Psychotherapy. Frontiers in behavioral neuroscience, 13, 144. https://doi.org/10.3389/fnbeh.2019.00144

Sripada R, Richards S, Sheila R, Walters H, Bohnert K, Gorman L, Kees M & Blow A. (2015). Socioeconomic Status and Mental Health Service Use Among National Guard Soldiers. Psychiatric Services, 1(66), 992-995;

Tyron W. (2016). Psychotherapy Integration via Theoretical Unification. International Journal of Integrative Psychotherapy, 7(1),1-26.

Wegner, L. & Rhoda, A. (2015). The influence of cultural beliefs on the utilization of rehabilitation services in a rural South African context: Therapists’ perspective. African Journal of Disability, 4(1), 128-136.

sample response

  When reading your post, I found it very interesting that cognitive behavioral therapy (CBT) has been shown to change glucose metabolism and cause neuronal changes in the brain, leading to an improvement in symptoms for clients with mental illness. I wondered if there was a link between mental illness and type 2 diabetes. I found that depression, especially when comorbid with anxiety, is considered a risk factor for type 2. In fact, there is a direct correlation between depression and type 2 diabetes, as depressed mood can oscillate with glycemic control.

Depression and obesity are among the top health concerns among our society today. Along with type 2 diabetes, each diagnosis perpetuates the other, especially when involving the factors of sedentary lifestyle, unhealthy diet choices, and inflammation. Clients with these comorbidities can benefit from both psychotherapy and pharmacotherapy, with the goal of regulating the function between the hypothalamus, pituitary, and adrenal glands (Deschênes et al., 2018).

Psychotherapy that focuses on the stabilization of mood and reduction of perceived stress will be most beneficial for these clients. The inclusion of diet and exercise specialists should also be considered, as behavior modification can achieve overall improvement in blood glucose readings and decrease undesired psychological and physical symptoms (Wroe et al., 2018). Barriers to adequate mental health and medical care and the desire to change are often the most difficult factors for clients to overcome.

Resources

Deschênes, S. S., Burns, R. J., & Schmitz, N. (2018). Comorbid depressive and anxiety symptoms and the risk of type 2 diabetes: Findings from the Lifelines Cohort Study. 
Journal of Affective Disorders
, 
238
, p.24–31. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2018.05.029

Wroe, A. L., Rennie, E. W., Sollesse, S., Chapman, J., & Hassy, A. (2018). Is cognitive behavioural therapy focusing on depression and anxiety effective for people with long- term physical health conditions? A controlled trial in the context of type 2 diabetes mellitus. 
Behavioural and Cognitive Psychotherapy
, 
46
(2), p.129–147. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1017/S1352465817000492

 

sample response 2

I found an article that dives into a great example how gene expression can be affected by psychotherapy, as you have mentioned in your post. It focuses on gene expression and explains that a presence of a gene does not mean it is active or turned on and that experiences by the individual during gene activation can affect if they develop a type of mental disorder. For example, PTSD can occur if the patient has the gene FKBP5 activated during a traumatic experience (Feinstein & Church, 2010). The article goes on to explain that genes cannot be removed, but psychotherapy can affect these gene variations. Expression inhibition of this gene can be achieved through psychotherapy, or further, exposure therapy to alter the strength of the synaptic connections (Feinstein & Church, 2010).

I believe this type of insight is crucial to treating patient with mental health disabilities. So often I feel as if medication is thought of as the intervention to alter biological processes. Knowing that less invasive measures are available to use alone and in conjunction with medication is the key to greater outcomes.

Psychotherapy can be affected by cultural barriers. It is pertinent providers are encouraging and engaging in action steps to ensure cultural differences do not hinder the availability of psychotherapy. An example is that black and migrant minorities have a higher rate of schizophrenia compared to white non-Hispanic individuals and have higher doses of medication, repeat hospital admissions, inferior access to psychotherapy, and more coercive care pathways (Degnan, Baker, Edge, Nottidge, & Noke, 2018). As providers, I believe it is our responsibility to break this statistic and ensure everyone is either getting the care they need or the care they desire. Thank you for sharing this week!

Kelsey Rindels

References

Degnan, A., Baker, S., Edge, D., Nottidge, W., Noke, M., Press, C. J., Husain, N., Rathod, S., & Drake, R. J. (2018). The nature and efficacy of culturally-adapted psychosocial interventions for schizophrenia: a systematic review and meta-analysis. 
Psychological Medicine
, 
48
(5), 714–727. https://doi-org.ezp.waldenulibrary.org/10.1017/S0033291717002264

Feinstein, D., & Church, D. (2010). Modulating gene expression through psychotherapy: The contribution of noninvasive somatic interventions. 
Review of General Psychology
, 
14
(4), 283–295. https://doi-org.ezp.waldenulibrary.org/10.1037/a0021252

 

sample response 3

Thank you for your post this week. Intercultural therapy is based on principles of cultural variations between the therapist and the client (Montgomery et al., 2019). For a provider to offer effective psychotherapy, cultural issues should be addressed quickly along with being mindful of culturally appropriate interactions. Competency can be defined as a person being prepared or qualified to perform a task. As a therapist, cultural competency can encourage a higher rate of effectiveness in treatment. Even with cultural competency, the delivery of quality services can be difficult due to the complexity of social and psychological diversity among all individuals and even though culture is one relevant factor, other aspects of a client life may be more influential when trying to effectively treat a mental health disorder. An example of another factor that would be influential is their socioeconomic status. Individuals with a low socioeconomic background are less likely to treat their mental health even though they are more likely to experience a mental health problem due to higher stressors such as finances, employment, and social relationships (Reiss et al., 2019). These individuals are more likely to spend their time and money on daily needs such as food, housing and utilities before they would ever consider spending money on their mental health.

 

References

Montgomery, A., Ventriglio, A., & Bhugra, D. (2019). Standards in intercultural psychotherapy. 
Intercultural Psychotherapy. 
https://doi.org/10.1007/978-3-030-24082-0_3

Reiss, F., Meyrose, A., Otto, C., Klasen, F., & Ravens-Sieverer, U. (2019, March 13). Socioeconomic status, stressful life situations and mental health problems in children and adolescents: Results of the German BELLA cohort-study. 
PLOS ONE. 
https://doi.org.10.1371/journals.pone.0213700

 

Discussion: Does Psychotherapy Have a Biological Basis?

Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology? For this Discussion, consider whether psychotherapy also has a biological basis.

Learning Objectives

Students will:

Evaluate biological basis of psychotherapy treatments

Analyze influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatments

To prepare:

Review this week’s Learning Resources.

Reflect on foundational concepts of psychotherapy.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking 
Submit!

By Day 3

Post
 an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments. Support your rationale with evidence-based literature.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond
 to at least two of your colleagues by providing an additional scholarly resource that supports or challenges their position along with a brief explanation of the resource.

 

The answer to this week’s discussion about psychotherapy having a biological basis can be initially unclear, especially due to the conflicting evaluation between the benefits of psychopharmacology and psychotherapy. Research suggests that negative changes to the body’s and brain’s stress-response system can correct themselves when children and adults receive psychotherapy (Holttum, 2014). We already know that this can happen with medication, but how exactly does the brain correct itself after psychotherapeutic intervention?

After some extensive research, it is more evident that psychotherapy does, in fact, have a significant impact on biological and chemical brain activity. There is an increasing consensus that psychotherapy entails a specific type of learning in the context of an emotional or therapeutic relationship that may lead to epigenetic modifications across different therapeutic treatment modalities (Jiménez et al., 2018). In order to delve deeper into the understanding of exactly how any form of talk therapy can alter gene expression, the nurse practitioner must first understand the role of epigenetics in neuroscience.

Epigenetics refer to phenotypic changes that do not alter the DNA sequence, but rather modify its structure chemically in order to dictate whether a particular gene is expressed or ignored (Stahl, 2013). This is relevant to psychotherapy because the phenomena of epigenetics is directly responsive to one’s own environment (Kumsta, 2019). An environment that cultivates active listening, goal oriented dialogue, and research based therapeutic approaches will be an environment that positively enhances epigenetic modifications. Psychotherapy targets the regulation of genes and thereby produces bottom-up change into phenotypic expressions of various traits, ultimately altering the biological basis of one’s actions and emotions without the use of medication (Kumsta, 2019). This information allows the nurse practitioner to better understand the impact that various therapeutic modalities have on each client that he or she may encounter in practice.

One’s own culture, religion, and socioeconomic status can strongly influence the environment and how effectively the psychotherapy works. A homosexual from a strict conservative religious family may struggle with acceptance. A family in poverty may not have the funds to afford consistent therapy or medications. The chosen psychotherapeutic approach has to take into account ones biologic background and expectations for treatment.

Recovery-focused practice is about focusing more on people’s strengths, and supporting them to achieve goals they have set for themselves, rather than the provider’s goals (Holttum, 2014).  As a result, psychotherapy is successful in bringing about persistent changes in attitudes, habits, and conscious and unconscious behavior and it does so by producing alterations in gene expression that produce structural changes in the brain (Jiménez et al., 2018). The nurse psychotherapist creates a healing presence of acceptance, patience, lovingness, nonjudgemental attitude, understanding, good listening skills, honesty, and empathy (Wheeler, 2014). As future nurse practitioners ourselves, this discussion has provided us a better understanding of the effectiveness of the various treatments available in practice, as opposed to a consistent reliance on medication.

References

Holttum, S. (2014). When bad things happen our brains change but psychotherapy and support can help the recovery of our brains and our lives. Mental Health and Social Inclusion, 18(2), 52–58. doi:10.1108/MHSI-02-2014-0006

Jiménez, J. P., Botto, A., Herrera, L., Leighton, C., Rossi, J. L., Quevedo, Y., Silva, J. R., Martínez, F., Assar, R., Salazar, L. A., Ortiz, M., Ríos, U., Barros, P., Jaramillo, K., & Luyten, P. (2018). Psychotherapy and Genetic Neuroscience: An Emerging Dialog. 
Frontiers in genetics
, 
9
, 257. 
https://doi.org/10.3389/fgene.2018.00257

Kumsta, R. (2019). The role of epigenetics for understanding mental health difficulties and its implications for psychotherapy research. 
Psychology & Psychotherapy: Theory, Research & Practice
 92(2), 190–207. 
https://doi-org.ezp.waldenulibrary.org/10.1111/papt.12227

Stahl, S. M. (2013).
 Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications 
(4th ed.). Cambridge University Press.

Wheeler, K. (Eds.). (2014). 
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
 (2nd ed.). Springer Publishing Company.

 

response

I appreciate your reference to the article by Kumsta (2019). I enjoyed reading it and always learn so much from others’ references. I think epigenetics is fascinating! I read an article by Kaliman (2019), in which the author discussed epigenetics and describes a study of meditation’s genetic effects. It was found that long term meditating participants had decreased expression of histone deacetylase genes which precluded increased cortisol recovery after acute psychosocial stress, as well as the downregulation of a key proinflammation gene. This data is regarded as significant because an accepted psychopharmacological method of treatment for depression as well as for inflammatory disorders focusses on the inhibition of histone deacetylase genes (Kaliman, 2019).

Another study reviewed by the author discusses DNA methylation which is a primary concept in epigenetics along with a key mechanism termed “epigenetic aging rate”. The rate of epigenetic aging is measured by noting the difference in the amount of  DNA methylation and the chronological age of a subject. Evidence has shown that the cumulative effects of stress and trauma increase epigenetic aging rate, which is associated with numerous age-related chronic diseases and increased mortality risk. Conversely, a decreased epigenetic aging rate is associated with improved cognitive and physical fitness and longevity in later life. Because the rate of epigenetic aging was found to be dependent on the number of years subjects meditated, it is concluded that daily meditation significantly decreases the rate of epigenetic aging (Kaliman, 2019).

Thank you for your thoughtful discussion. I hope you find this information as interesting as I do, and that you are also having a great week!

References

Kaliman, P. (2019). Epigenetics and meditation. 
Current Opinion in Psychology
, 
28
, 76–80. https://doi.org/10.1016/j.copsyc.2018.11.010

Kumsta, R. (2019). The role of epigenetics for understanding mental health difficulties and its implications for psychotherapy research. 
Psychology and Psychotherapy: Theory, Research and Practice
, 
92
(2), 190–207. https://doi.org/10.1111/papt.12227

petunia park case study – NRNP 6665 Week 4 Assignment

Focused Soap psychiatric evaluation Examplar
( Please this is just an example/template to follow. Do not copy)

INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

If you are struggling with the format or remembering what to include, follow the
Focused SOAP Note Evaluation Template
AND
the Rubric
as your guide. petunia park case study – NRNP 6665 Week 4 Assignment It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required.  After reviewing full details of the rubric, you can use it as a guide.

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

Read rating descriptions to see the grading standards! 

In the
Objective
section, provide:

Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses. petunia park case study – NRNP 6665 Week 4 Assignment

Read rating descriptions to see the grading standards!

 

WAL_NRNP6665_04_A_EN-CC (6)

Depression

Premenstrual dysphoric disorder

Seasonal affective disorder (MDD with Seasonal Variation)

agomelatine

amitriptyline

amoxapine

aripiprazole

(adjunct)

brexpiprazole (adjunct)bupropion

citalopram

clomipramine

cyamemazine

desipramine

desvenlafaxine

dothiepindoxepin

duloxetine

escitalopram

fluoxetine

fluvoxamine

iloperidone

imipramine

isocarboxazid

ketamine

lithium (adjunct)

l-methylfolate (adjunct) 

lofepramine

maprotiline

mianserin

milnacipran

mirtazapine

moclobemide

nefazodone

nortriptyline

paroxetine

phenelzine

protriptyline quetiapine (adjunct)

reboxetine

selegiline

sertindole

sertraline

sulpiride

tianeptine

tranylcypromine

trazodone

trimipramine

venlafaxine

vilazodone

vortioxetine 

citalopram

desvenlafaxine

duloxetin

eescitalopram

fluoxetin

eparoxetine

pepexev

sarafe,

sertraline

venlafaxinepetunia park case study – NRNP 6665 Week 4 Assignment

Bupropion HCL extended-release

Bipolar depression

Bipolar disorder (mixed Mania/Depression

Bipolar maintenance

Mania

lithium (used with lurasidone)

lurasidone

olanzapine-fluoxetine combination (symbyax)

quetiapine

valproate (divalproex) (used with lurasidone)

aripiprazole

asenapine

carbamazepine

olanzapine

ziprasidone

aripiprazole

lamotrigine

lithium

olanzapine

aripiprazole

asenapine

carbamazepine

lithium

olanzapine

quetiapine

risperidonevalproate (divalproex)

ziprasidone

 

 

 

 

 

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. petunia park case study – NRNP 6665 Week 4 Assignment 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
.

Read rating descriptions to see the grading standards!

Reflect on this case. Include: 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
!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.) petunia park case study – NRNP 6665 Week 4 Assignment.

(The FOCUSED SOAP psychiatric evaluation is typically the
follow-up visit
patient note. You will practice writing this type of note in this course. You will be focusing more on the symptoms from your differential diagnosis from the comprehensive psychiatric evaluation narrowing to your diagnostic impression. You will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for illnesses which could be impacting your patient. petunia park case study – NRNP 6665 Week 4 Assignment. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

EXEMPLAR BEGINS HERE

Subjective:

CC
(chief complaint): A
brief
statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI
: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example: petunia park case study – NRNP 6665 Week 4 Assignment

N.M. is a 34-year-old Asian male presents for medication management follow up for anxiety. He was initiated sertraline last appt which he finds was effective for two weeks then symptoms began to return.

Or

P.H., a 16-year-old Hispanic female, presents for follow up to discuss previous psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications as we deferred until further testing and screening was conducted.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. First what is bringing the patient to your follow up evaluation? Document symptom onset, duration, frequency, severity, and impact. What has worsened or improved since last appointment? What stressors are they facing? Your description here will guide your differential diagnoses into your diagnostic impression. You are seeking symptoms that may align with many
DSM-5
diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Substance Use History:
This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures. petunia park case study – NRNP 6665 Week 4 Assignment.

Current Medications
: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies
: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx
: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:  oral, anal, vaginal, other, any sexual concerns

ROS
: Cover all body systems that may help you include or rule out a differential diagnosis.  Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows:
General:

Head
:
EENT
: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS
:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum. petunia park case study – NRNP 6665 Week 4 Assignment.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. petunia park case study – NRNP 6665 Week 4 Assignment

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Objective:

Diagnostic results
: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines) petunia park case study – NRNP 6665 Week 4 Assignment.

Assessment:

Mental Status Examination:
For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good petunia park case study – NRNP 6665 Week 4 Assignment.

Diagnostic Impression
: You must begin to narrow your differential diagnosis to your diagnostic impression.  You must explain how and why (your rationale) you ruled out any of your differential diagnoses. You must explain how and why (your rationale) you concluded to your diagnostic impression.  You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection.
Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (
demonstrating critical thinking beyond confidentiality and consent for treatment!
), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Case Formulation and Treatment Plan

Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions including psychotherapy and/or psychopharmacology, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner.
  *
See an example below. You will modify to your practice so there may be information excluded/included. If you are completing this for a practicum, what does your preceptor document?

Risks and benefits of medications are discussed including non- treatment. Potential side effects of medications discussed (be detailed in what side effects discussed). Informed client not to stop medication abruptly without discussing with providers. Instructed to call and report any adverse reactions. Discussed risk of medication with pregnancy/fetus, encouraged birth control, discussed if does become pregnant to inform provider as soon as possible. Discussed how some medications might decreased birth control pill, would need back up method (exclude for males) petunia park case study – NRNP 6665 Week 4 Assignment.

 

Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Encouraged abstinence. petunia park case study – NRNP 6665 Week 4 Assignment . Discussed how drugs/alcohol affect mental health, physical health, sleep architecture.

 

Initiation of (list out any medication and why prescribed, any therapy services or referrals to specialist):

 

Client was encouraged to continue with case management and/or therapy services (if not provided by you)

 

Client has emergency numbers:  Emergency Services 911, the  Client’s Crisis Line
1-800-_______
. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal petunia park case study – NRNP 6665 Week 4 Assignment. (only if you or preceptor provided them)

 

Reviewed hospital records/therapist records for collaborative information; Reviewed PMP report (only if actually completed)

 

Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (this relates to informed consent; you will need to assess their understanding and agreement)

 

Follow up with PCP as needed and/or for:

 

Labs ordered and/or reviewed (write out what diagnostic test ordered, rationale for ordering, and if discussed fasting/non fasting or other patient education) petunia park case study – NRNP 6665 Week 4 Assignment

 

Return to clinic:

Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care.

 

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses petunia park case study – NRNP 6665 Week 4 Assignment. Be sure to use correct APA 7th edition formatting.

 

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. petunia park case study – NRNP 6665 Week 4 Assignment

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. petunia park case study – NRNP 6665 Week 4 Assignment

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.).

 

Novice

Competent

Proficient

New Column4

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

14 (14%) – 15 (15%)

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. petunia park case study – NRNP 6665 Week 4 Assignment

12 (12%) – 13 (13%)

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 (11%) – 11 (11%)

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 inaccuracies. petunia park case study – NRNP 6665 Week 4 Assignment

0 (0%) – 10 (10%)

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.

In the Objective section, provide:

• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses

14 (14%) – 15 (15%)

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

12 (12%) – 13 (13%)

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. petunia park case study – NRNP 6665 Week 4 Assignment

11 (11%) – 11 (11%)

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

0 (0%) – 10 (10%)

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed. Or the objective documentation is missing.

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.

18 (18%) – 20 (20%)

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.

16 (16%) – 17 (17%)

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.

14 (14%) – 15 (15%)

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.

0 (0%) – 13 (13%)

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.

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.

23 (23%) – 25 (25%)

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.

20 (20%) – 22 (22%)

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.

18 (18%) – 19 (19%)

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.

0 (0%) – 17 (17%)

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.

• 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!), 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 (5%) – 5 (5%)

Reflections are thorough, thoughtful, and demonstrate critical thinking.

4 (4%) – 4 (4%)

Reflections demonstrate critical thinking.

3.5 (3.5%) – 3.5 (3.5%)

Reflections are somewhat general or do not demonstrate critical thinking.

0 (0%) – 3 (3%)

Reflections are incomplete, inaccurate, or missing. petunia park case study – NRNP 6665 Week 4 Assignment

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).

9 (9%) – 10 (10%)

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 (8%) – 8 (8%)

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 (7%) – 7 (7%)

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.

0 (0%) – 6 (6%)

Two or fewer resources are provided to support the assessment and diagnosis decisions. The resources may not be current or evidence based.

Written Expression and Formatting – The paper follows correct APA format for parenthetical/in-text citations and reference list.

5 (5%) – 5 (5%)

Uses correct APA format with no errors

4 (4%) – 4 (4%)

Contains a few (one or two) APA format errors

3.5 (3.5%) – 3.5 (3.5%)

Contains several (three or four) APA format errors

0 (0%) – 3 (3%)

Contains many (five or more) APA format errors

Written Expression and Formatting – English Writing Standards:

Correct grammar, mechanics, and punctuation

5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors

4 (4%) – 4 (4%)

Contains a few (one or two) grammar, spelling, and punctuation errors

3.5 (3.5%) – 3.5 (3.5%)

Contains several (three or four) grammar, spelling, and punctuation errors

0 (0%) – 3 (3%)

Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

Total Points: 100 petunia park case study – NRNP 6665 Week 4 Assignment

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NRNP_6665_Week4_Assignment_Rubric

Rubric petunia park case study – NRNP 6665 Week 4 Assignment