Assignment: Diagnosing and Treating Patients With Neurocognitive Disorders NRNP 6665

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Assignment: Diagnosing and Treating Patients With Neurocognitive Disorders NRNP 6665

Assignment: Diagnosing and Treating Patients With Neurocognitive Disorders NRNP 6665

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Introduction: This is a comprehensive psychiatric evaluation of a 9 year old female child who presents to the clinic with her mother along with copies of questionnaires on attention deficit and hyperactivity disorder completed by her teacher and parent due to problems paying attention in school.

Purpose statement: The purpose of this assignment is to complete a comprehensive psychiatric evaluation of a 9 year old child with attention issues in school, to assess and diagnose her with any neurocognitive/neurodevelopmental disorders that may be present.

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Subjective:

CC (chief complaint): Sarah has trouble paying attention in school as well as with remembering and losing things every day.

HPI: Sarah is a 9 year old African American child who is currently separated from her mother and has been having trouble paying attention and remembering things since Kindergarten. Teachers were giving Sarah a list of her assignments, but Sarah kept losing the list every day because she couldn’t remember where she put it. Therefore, teachers have been leaving the assignment list in her mom’s cell phone. Sarah has also been having problem sitting still in her chair in school, which often gets her in trouble. Sarah finds it hard to sit still even while she is reading a book or a paper that she really likes, the maximum she can last in her chair is about five minutes. Sarah has difficulty remembering what she or the teacher has read. Sarah loses or misplaces her things every day: she lost her Geography book (mother thinks she left it on her school bus), a bracelet she loved that was gifted to her by her grandmother (mother thinks she may have taken it off to wash her hands and left it in the bathroom at a restautant). Sarah feels sad when she loses her stuff. Sarah gets angry at times when teachers say they asked her to do something and she didn’t listen. Sarah day dreams in school about going home and playing with her dog Conley and sometimes missing her mom because Sarah and her mom are separated at the moment. (Provider should have asked about the living situation). Sarah gets frustrated because despite her trying to do it right, she ends up making a lot of mistakes in her classwork and homework. Sarah loves art and museums, but runs from painting to painting three or four times. Sarah has trouble waiting her turn especially in groups. Sarah loves video games and can stay on them for long time. When she was younger, parents were afraid to take her to zoo because she would stick her hand inside of the bars where animals could bite her. There were times when Sarah jumped into the pool before she even learned how to swim. However, that hasn’t happened since she was little.

Assignment: Diagnosing and Treating Patients With Neurocognitive Disorders NRNP 6665

Past Psychiatric History:

  • General Statement: Sarah is a 9 years old female child who is currently separated from her mother and has a history of trouble with paying attention in school as well as remembering and losing things since kindergarten.
  • Caregivers (if applicable): Separated from mom. Provider should have asked about the living condition/arrangement
  • Hospitalizations: None
  • Medication trials: none
  • Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History:

Provider should have asked.

Family Psychiatric/Substance Use History:

Provider should have asked

Psychosocial History:

Sarah is a 9 years old child who is currently separated from her mother (provider should have asked about number of siblings, lives at home with, marital status of parents, friends, what grade Sarah is in, if she is part of any special program in school). Sarah likes art, museums, and playing video games. She sleeps 9 hours at night. Despite having hard time sitting for meals, her nutrition is adequate per PCP. Sarah met her developmental milestones on time and her vaccinations are up to date.

Medical History:

 

  • Current Medications: None
  • Allergies: provider should have asked
  • Reproductive Hx: Female with all developmental milestones met on time. Provider should have asked about periods/menstrual cycle.

ROS:

  • GENERAL: Alert and oriented, appears stated aged, well groomed.
  • HEENT: Provider should examine
  • SKIN: Provider should examine
  • CARDIOVASCULAR: Provider should examine
  • RESPIRATORY: Provider should examine
  • GASTROINTESTINAL: Provider should examine
  • GENITOURINARY: Provider should examine
  • NEUROLOGICAL: Provider should examine
  • MUSCULOSKELETAL: Provider should examine
  • HEMATOLOGIC: Provider should examine
  • LYMPHATICS: Provider should examine
  • ENDOCRINOLOGIC: Provider should examine

Objective:

Physical exam:

T – 97.4

P – 62

R – 14

B/P – 95/60

Ht – 4’5”

Wt – 63 lbs

Diagnostic results: Questionnaire of attention deficit hyperactivity disorder filled out by teachers and mother.

Besides the questionnaire on ADHD, provider should request screen for learning disabilities such as inability to read or do mathematics.

Assessment:

Mental Status Examination:

Appearance:  Sarah appears well groomed and stated aged

Eye contact: hesitant

Speech: clear and coherent with normal rate, rhythm, and volume

Behavior: anxious, distracted

Psychomotor: restless.

Mood: anxious, guarded

Affect: restricted

Thought Process:  linear, goal directed

Thought Content: Provider should have asked for suicidal, homicidal, or self-harm ideation. Provider should have explored further for delusion thinking.

Perception:  No reaction to external or internal stimuli.

Attention/ Concentration: distractable

Cognition:  Alert and oriented.

Memory:  Impaired short-term memory as evidenced by inability to recall questions asked during the interview. Long-term memory grossly intact as evidenced by their recall of narrative.

Insight: fair

Judgment: fair

Fund of Knowledge:  consistent with age and education, as demonstrated by use of grammar, vocabulary, and sentence structure

Intelligence: consistent with age and education, as demonstrated by use of grammar, vocabulary, and sentence structure.

Differential Diagnoses:

 

Attention Deficit Hyperactivity Disorder: As evidenced by inattention: Sarah is reported to make a lot of mistakes in her classwork and homework, she can’t stay focused or attentive in class, she gets frustrated because teachers think she doesn’t do what asked/didn’t listen, looses important things such as Geography book and gifted bracelet,distractible during interview, forgets assignments daily and requires a list from teachers. As evidenced by impulsivity: fidgets, can’t sit still in chair in school, eating is an issue because she can’t sit still, can’t wait turn as reported in questionnaire from teachers, runs from painting to painting three of four times, acts without thinking sucha as jumped in pool before learning to swim.

Learning Disability: As evidenced by missing assignments, despite trying hard Sarah can’t do her assignments right and makes a lot mistakes in classwork as well as homework. Can’t focus on reading or doesn’t remember what she or the teacher read. However, she can stay focused on videogames.

Anxiety Disorder: As evidenced by distractibility, reported frustration (irritability), missing mom in school, difficulty paying attention, fidgety/restless.

Mania: As evidenced by excessive distractibility, extreme fidgeting, and frustration (irritability) which is more common than euphoria in children.

 

Reflections:

This case is quite simple and I was able to quickly come to a conclusion that sarah probably has ADHD. According to Radmanović and Burgić (2020), ADHD is a very common neurodevelopmental disorder seen in children. However, learning disability can cause much similar symptoms such as inattention, as a provider I would get neuropsych testing done to rule out if Sarah has any learning disability before finalizing the ADHD diagnosis. In a study by Reale et al. (2017), learning disability was highly associated in children with ADHD. Since Sarah is separated from her mother, this may cause extreme anxiety in a 9 years old child and can manifest symptoms such as inattention, frustration, and easily distracted. Sarah mentions daydreaming about missing mom. Much of sarah’s ADHD symptoms may be sprouting from anxiety related to separation from her mother. As stated by Sayal, Prasad, Daley, Ford, and Coghill (2018), Child psychiatrist and psychologists have been arguing that attachement and trauma should be considered when diagnosing children with ADHD. Mania is another condition that may be the cause of Sarah’s intattention, inability to wait for turn, excessive distractibility, extreme fidgeting and frustrations (irritability) which is more common than euphoria in children. Bhandari (2018), reports that Bipolar disorder is more frequently being diagnosed in children with ADHD.

References

Bhandari, S. (2018). Bipolar Disorder or ADHD? Diagnosing teens with both the conditions. Mental Health Matters5(1), 15-16.

Radmanović, M. B., & Burgić, S. S. (2020). Comorbidity in Children and Adolescents with ADHD. In ADHD. IntechOpen.

Reale, L., Bartoli, B., Cartabia, M., Zanetti, M., Costantino, M. A., Canevini, M. P., … & Bonati, M. (2017). Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. European child & adolescent psychiatry26(12), 1443-1457.

Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry5(2), 175-186.

Assignment: Diagnosing, and Treating Patients With Neurocognitive Disorders

Photo Credit: Getty Images/iStockphoto
Neurocognitive disorders (NCDs) such as delirium, dementia, and amnestic disorders are more prevalent
in older adults. As the population ages and as life expectancy in the United States continues to increase,
the incidence of these disorders will continue to increase. Cognitive functioning in such areas as
memory, language, orientation, judgment, and problem solving are affected in clients with NCDs. Caring
for someone with a neurocognitive disorder is not only challenging for the clinician; it is stressful for the
family as well. The PMHNP needs to consider not only the patient but also the “family as patient.”
Collaboration with primary care providers and specialty providers is essential. Anticipatory guidance also
becomes extremely important.
There is no Assignment due this week. You should review this week’s Learning Resources and consider
the insights they provide about assessing, diagnosing, and treating neurocognitive disorders. Use this
quiet week to work on your practicum assignment if you are taking both courses concurrently.

What’s Coming Up in Week 8?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Week 8, you will analyze the signs, symptoms, and pathophysiology of neurodevelopmental disorders.
These disorders occur when brain development does not follow expected trajectories. While some of
these disorders can be resolved with appropriate intervention, others are chronic.
Next Week

To go to the next week:
Week 8

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Assignment: Diagnosing and Treating Patients With Neurocognitive Disorders NRNP 6665

 

Learning Resources

Required Readings (click to expand/reduce)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.).
Wolters Kluwer.
 Chapter 21, “Neurocognitive Disorders”
Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.
 Chapter 8, “Delirium and Neurocognitive Disorders”

Required Media (click to expand/reduce)

PhysioPathoPharmaco. (2018, December 19). Alzheimer’s disease – plaques, tangles, pathogenesis, risk
factors, disease progression [Video]. YouTube. https://www.youtube.com/watch?v=2du03tXjopQ

Speed Pharmacology. (2019, July 6). Pharmacology – drugs for Alzheimer’s disease (Made easy) [Video].
YouTube. https://www.youtube.com/watch?v=euzRPrvrwj0

Medication Review
Review the FDA-approved use of the following medicines related to treating neurocognitive disorders.
Alzheimer’s
disease Delirium Parkinson’s disease
dementia/psychosis

caprylidene
donepezil
galantamine
memantine
rivastigmine

There are no FDA-approved medications
for the treatment of delirium.

nuplazid
rivastigmine
pimavanserin

Name: NRNP_6635_Week10_Assignment_Rubric

Excellent Good Fair Poor
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.

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

Points Range: 18 (18%) – 20 (20%)
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.
Points Range: 16 (16%) – 17 (17%)
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.
Points Range: 14 (14%) – 15 (15%)
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.
Points Range: 0 (0%) – 13 (13%)
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, 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.
Points Range: 18 (18%) – 20 (20%)
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
Points Range: 16 (16%) – 17 (17%)
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.
Points Range: 14 (14%) – 15 (15%)
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.
Points Range: 0 (0%) – 13 (13%)
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, 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.
Points Range: 23 (23%) – 25 (25%)

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.

Points Range: 20 (20%) – 22 (22%)

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.

Points Range: 18 (18%) – 19 (19%)

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 vaguess or innacuracy.

Points Range: 0 (0%) – 17 (17%)
The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is 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 taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Points Range: 9 (9%) – 10 (10%)
Reflections are thorough, thoughtful, and demonstrate critical thinking.
Points Range: 8 (8%) – 8 (8%)
Reflections demonstrate critical thinking.
Points Range: 7 (7%) – 7 (7%)
Reflections are somewhat general or do not demonstrate critical thinking.
Points Range: 0 (0%) – 6 (6%)
Reflections are incomplete, inaccurate, or missing.
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).
Points Range: 14 (14%) – 15 (15%)
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.
Points Range: 12 (12%) – 13 (13%)
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.
Points Range: 11 (11%) – 11 (11%)
Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.
Points Range: 0 (0%) – 10 (10%)
Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
Points Range: 5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

Points Range: 4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

Points Range: 3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

Points Range: 0 (0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation
Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
Points Range: 4 (4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors
Points Range: 3 (3%) – 3 (3%)
Contains several (three or four) grammar, spelling, and punctuation errors
Points Range: 0 (0%) – 2 (2%)
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Total Points: 100
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