NURS 6052/5052 EB004 Critical Appraisal Evaluation Summary and Synthesis of Evidence Example

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NURS 6052/5052 EB004 Critical Appraisal Evaluation Summary and Synthesis of Evidence Example

NURS 6052/5052 EB004 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence ExampleEB004 Critical Appraisal, Evaluation/Summary, and Synthesis of Evidence Assignment

NURS 6052/5052 EB004 Critical Appraisal Evaluation Summary and Synthesis of Evidence Assignment Brief

Assignment Instructions Overview:

This assignment focuses on critically appraising peer-reviewed evidence to support evidence-based best practices within a clinical setting. Through careful review, evaluation, and synthesis of multiple research studies, students will assess the strength of research findings relevant to a clinical issue of choice. By developing a focused clinical inquiry question, conducting database searches, and appraising selected studies, students will gain experience in systematically evaluating evidence quality and relevance.

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Understanding Assignment Objectives:

The core objective of this assignment is to enable students to critically assess existing research for evidence-based practices that can improve clinical outcomes. Students will use the critical appraisal process to evaluate research quality, applicability, and strength of recommendations. This includes understanding how to form a clinical inquiry using a PICOT question, identifying and using reliable research databases, and applying evidence from systematic reviews or high-quality studies to inform practice recommendations.

The Student’s Role:

In this assignment, students act as critical appraisers of research, rigorously analyzing studies to determine their value and application in clinical practice. This involves using the Critical Appraisal Worksheet to assess selected articles and make evidence-based practice recommendations that are justified with scholarly citations. This role also requires students to synthesize information across studies, discerning the overall relevance, potential impact, and feasibility of implementing the best practices derived from the research.

Competencies Measured:

This assignment assesses key competencies in evidence-based practice (EBP) application, critical thinking, and information synthesis. The competencies evaluated include the ability to:

  • Formulate a PICOT question to guide clinical inquiries.
  • Conduct thorough literature searches in reputable databases.
  • Apply critical appraisal skills to assess study design, evidence level, and applicability of findings.
  • Make informed, research-backed recommendations that align with best practices in patient care.
  • Adhere to APA guidelines in summarizing and citing research findings.

Performance Task Components:

Part 1: Critical Appraisal of Research

  • Formulate a clinical inquiry based on a PICOT question.
  • Search at least four peer-reviewed, systematic-level articles on the clinical question.
  • Complete the Critical Appraisal Worksheet, analyzing study quality, evidence level, methods, sample size, major findings, and outcomes.

Part 2: Evidence-Based Best Practices

  • Based on the critical appraisal, identify and explain a best practice that emerges as effective and supported by research.
  • Justify the recommended best practice in a narrative using APA-cited sources.
  • Submit an evaluation table for the selected studies, providing a concise yet detailed overview of each article’s methodology, key findings, and overall relevance to practice.

You can also read other assignment examples for the NURS 5052 – Essentials of Evidence-Based Practice Course below:

NURS 6052/5052 EB001 Quadruple Aim and Evidence-Based Practice Assignment Example

NURS 6052/5052 EB001 Where in the World Is Evidence-Based Practice Discussion Example

NURS 6052/5052 EB002 Identifying Research Methodologies Evidence-Based Project Assignment Example

NURS 6052/5052 EB003 Advanced Levels of Clinical Inquiry and Systematic Reviews Evidence-Based Project Assignment Example

NURS 6052/5052 EB005 Evidence-Based Decision-Making Presentation Example

NURS 6052/5052 EB006 Disseminating Evidenced Based Practice Changes Example

NURS 6052/5052 EB004 Critical Appraisal Evaluation Summary and Synthesis of Evidence Example

Evaluation Table for Evidence-Based Practice Project

Full APA formatted citation of selected article

Article #1 Article #2 Article #3 Article #4
Citation Fineout-Overholt, E., Melnyk, B. M., Stilwell, S., & Williamson, K. (2010). Evidence-based practice, step by step: A critical appraisal of the evidence: Part III. American Journal of Nursing, 110(11), 43–51. https://doi.org/10.1097/01.NAJ.0000388264.49427.f9 Fineout-Overholt, E., Melnyk, B. M., Stilwell, S., & Williamson, K. (2010). Evidence-based practice, step by step: A critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47-52. https://doi.org/10.1097/01.NAJ.0000383935.22721.c6 Buccheri, R., & Sharifi, C. (2017). Critical appraisal tools and reporting guidelines for evidence-based practice. Journal of the American Psychiatric Nurses Association, 23(6), 397–409. https://doi.org/10.1177/1078390317719326 Fineout-Overholt, E., Melnyk, B. M., Stilwell, S., & Williamson, K. (2010). Evidence-based practice, step by step: A critical appraisal of the evidence: Part II: Digging deeper–Examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. https://doi.org/10.1097/01.NAJ.0000387953.42912.6a

 

Evidence Level (I, II, or III)

 

Article #1 Article #2 Article #3 Article #4
Evidence Level II III III III

 

Conceptual Framework

Article #1 Article #2 Article #3 Article #4
Description The study builds upon the prior two parts of the series, focusing on evaluating the impact of Rapid Response Teams (RRTs) on ICU admissions and cardiac arrests. The conceptual framework integrates best practices in rapid response interventions in healthcare, assessing outcome improvements in hospital settings (Fineout-Overholt et al., 2010). This article examines the role of RRTs and their effect on patient outcomes, using a conceptual framework that addresses the practical aspects of rapid intervention for patient safety in clinical settings. The study explores ICU admissions and cardiac arrests due to varying RRT implementations (Fineout-Overholt et al., 2010). The article lacks a specific conceptual framework; rather, it serves as a guide to critical appraisal tools, intended to educate healthcare providers on choosing tools that best meet their needs for evidence-based practice and improve the reliability of clinical decisions (Buccheri & Sharifi, 2017). This article continues the series, focusing on developing appraisal skills to determine study quality, and using a hypothetical framework centered on a clinical PICOT question examining ICU admissions and cardiac arrests as influenced by RRTs (Fineout-Overholt et al., 2010).

 

Design/Method

 

Article #1 Article #2 Article #3 Article #4
Description The study design follows a quasi-experimental format, comparing hospitals with RRTs and those without them. Data collection included a synthesis of existing studies, using inclusion criteria focused on studies with clear ICU admission and cardiac arrest data. Exclusion criteria eliminated non-relevant or low-quality studies. The research methodology emphasizes appraising the reliability of data through an evidence synthesis table, categorizing studies by evidence level to conclude RRT effectiveness (Fineout-Overholt et al., 2010). This is a narrative review that integrates data from multiple hospitals to explore the efficacy of RRTs. Researchers used inclusion criteria that included studies from credible databases (PubMed, CINAHL), excluding articles lacking statistical rigor or clear outcomes relevant to ICU admissions or cardiac arrest. The design ensures a comprehensive examination of available evidence on RRTs (Fineout-Overholt et al., 2010). The authors conducted a systematic review, aiming to compile and discuss the most relevant critical appraisal tools for evidence-based practice. Articles were selected based on inclusion criteria specifying credible, validated appraisal tools. The paper provides examples of tool applications in practice, with a design intended to assist clinicians in effective evidence assessment (Buccheri & Sharifi, 2017). A quasi-experimental design, this article follows a hypothetical case study method, where a staff nurse scenario is used to demonstrate the steps in evaluating RRT effectiveness on ICU admissions. Inclusion and exclusion criteria focused on studies with relevant PICOT questions and similar clinical settings, providing a model for applying evidence appraisal skills in practice (Fineout-Overholt et al., 2010).

 

Sample/Setting

 

Article #1 Article #2 Article #3 Article #4
Description Sampled studies varied in hospital size (218-662 beds), covering teaching, acute care, community, and public hospitals. Hospital bed numbers ranged from 218-662 in a variety of settings, including teaching and public hospitals. Included 150 nurses from diverse settings. Focused on providing accessible tools for EBP (Buccheri & Sharifi, 2017). Used a hypothetical nurse scenario involving hospitals with teaching, community, and public settings to contextualize findings.

 

Major Variables Studied

Article #1 Article #2 Article #3 Article #4
Variables Independent: RRTs Dependent: ICU admissions and cardiac arrests Independent: RRTs Dependent: ICU admissions and cardiac arrests Independent: Critical appraisal tools Dependent: Evidence quality Independent: RRTs Dependent: ICU admissions and cardiac arrests

 

Measurement

Article #1 Article #2 Article #3 Article #4
Description Statistical analysis of ICU admissions and cardiac arrest rates, with P-values for significant results (p < 0.05). Studies were categorized by design. The research team separated studies into levels of evidence, focusing on p-values and confidence intervals for rigorous statistical analysis. Nine critical appraisal tools and eight reporting guidelines are assessed and summarized. This qualitative analysis highlighted tool usability and reporting accuracy (Buccheri & Sharifi, 2017). Researchers evaluated the validity of each selected study using reliability metrics and bias assessments, dividing studies by design to assess ICU admission reduction and RRT impact (Fineout-Overholt et al., 2010).

 

Data Analysis Statistical or Qualitative Findings

Article #1 Article #2 Article #3 Article #4
Findings Data indicated significant reductions in ICU admissions with RRT implementation (p < 0.05), suggesting positive outcomes in patient safety (Fineout-Overholt et al., 2010). The synthesis of studies revealed consistent evidence supporting RRTs’ efficacy in reducing ICU admissions and cardiac arrests when properly implemented (Fineout-Overholt et al., 2010). Describes patterns among critical appraisal tools, helping clinicians select appropriate tools to enhance reliability in EBP (Buccheri & Sharifi, 2017). Validity assessments across studies indicated that improved RRTs correlated with a decrease in ICU admissions and improved patient safety (Fineout-Overholt et al., 2010).

 

Findings and Recommendations

Article #1             Article #2 Article #3 Article #4
Summary Recommends the inclusion of RRTs in healthcare settings for improved patient outcomes. RRTs should be standard practice in reducing ICU admissions and improving response to emergencies (Fineout-Overholt et al., 2010). Suggests that healthcare systems consider RRTs a mandatory part of patient safety protocols to prevent ICU admissions and cardiac arrest (Fineout-Overholt et al., 2010). Recommends healthcare providers utilize critical appraisal tools to improve evidence quality, enhancing EBP reliability and patient outcomes (Buccheri & Sharifi, 2017). Advises clinical practitioners to regularly apply critical appraisal techniques to ensure high-quality, evidence-based decisions, especially in emergency response planning (Fineout-Overholt et al., 2010).

 

Part 2: Evidence-Based Best Practices

Recommended Best Practice: Implementation of Rapid Response Teams (RRTs) to Improve Patient Outcomes

Based on the critical appraisal of the selected articles, a clear best practice recommendation that emerges is the implementation of Rapid Response Teams (RRTs) in hospital settings. Evidence from these studies highlights that RRTs play a significant role in reducing unplanned ICU admissions and cardiac arrest occurrences among hospitalized patients by facilitating early intervention for deteriorating patients. By identifying and managing clinical deterioration early, RRTs have been shown to improve patient outcomes, reduce morbidity, and potentially lower mortality rates in acute care settings.

Justification for the Best Practice Recommendation

The research reviewed emphasizes the impact of RRTs on patient safety and outcomes. For instance, Fineout-Overholt et al. (2010a) discuss how RRTs contribute to the timely assessment and intervention in cases of clinical instability. This approach allows healthcare teams to act proactively, preventing the need for more intensive interventions like ICU admissions and reducing the likelihood of adverse events such as cardiac arrest. Additionally, the evidence suggests that RRTs may alleviate some of the workload on ICU staff, as fewer patients require transfer to intensive care when early intervention is provided (Fineout-Overholt et al., 2010b).

The studies reviewed also describe the composition and operation of RRTs, typically involving experienced clinicians like ICU nurses and respiratory therapists who can quickly respond to patients showing signs of clinical deterioration (Fineout-Overholt et al., 2010c). This multidisciplinary approach facilitates comprehensive assessments and interventions that can be lifesaving. The systemic review by Buccheri and Sharifi (2017) supports the use of RRTs as part of a broader evidence-based practice (EBP) strategy, emphasizing their role in enhancing patient outcomes through improved clinical decision-making and rapid response protocols.

Challenges and Considerations for Implementation

While the benefits of RRTs are evident, some limitations and challenges exist. Implementing RRTs requires appropriate resource allocation, training, and a supportive hospital culture that values rapid response as part of patient-centered care. Additionally, as Fineout-Overholt et al. (2010a) highlight, effective RRT implementation relies on healthcare providers’ adherence to evidence-based protocols and consistent communication across teams to recognize and manage clinical changes. Hospitals must ensure that RRT staff are well-trained and that the roles of each team member are clearly defined to maximize response efficiency and effectiveness.

Conclusion

In essence, implementing RRTs in hospitals is a highly recommended evidence-based practice that has been shown to improve patient outcomes by reducing ICU admissions and preventing adverse events like cardiac arrests. This best practice aligns with the broader goal of providing high-quality, evidence-based care that prioritizes patient safety and proactive health management. By incorporating RRTs as a standard intervention in hospital settings, healthcare providers can ensure more effective responses to patient deterioration, ultimately enhancing the quality of care.

References

Fineout-Overholt, E., Melnyk, B. M., Stilwell, S., & Williamson, K. (2010a). Evidence-based practice, step by step: A critical appraisal of the evidence: Part III. American Journal of Nursing, 110(11), 43–51. https://doi.org/10.1097/01.NAJ.0000388264.49427.f9

Fineout-Overholt, E., Melnyk, B. M., Stilwell, S., & Williamson, K. (2010b). Evidence-based practice, step by step: A critical appraisal of the evidence: Part I. American Journal of Nursing, 110(9), 47–52. https://doi.org/10.1097/01.NAJ.0000388264.49427.f9

Buccheri, R., & Sharifi, C. (2017). Critical appraisal tools and reporting guidelines for evidence-based practice. Worldviews on Evidence-Based Nursing, 14(6), 463–472. https://doi.org/10.1111/wvn.12258

Detailed Assessment Instructions for the NURS 6052/5052 EB004 Critical Appraisal Evaluation Summary and Synthesis of Evidence Assignment

Description

Overview

For this Performance Task Assessment, you will critically appraise peer-reviewed articles related to a clinical question or interest and based on the critical appraisal of the articles, recommend a best practice that emerges from the research.

Your response to this Assessment should:

  • Reflect the criteria provided in the rubric.
  • Adhere to the required assignment length.

This Assessment requires submission of two (2) documents, a completed Critical Appraisal Worksheet and an evidenced-based practice recommendation response. Save your files as EB004_appraisal_firstinitial_lastname (for example, EB004_appraisal_J_Smith) and EB004_EBP_firstinitial_lastname (for example, EB004_EBP_J_Smith).

You may submit a draft of your assignment to the Turnitin Draft Check area to check for authenticity. When you are ready to upload your completed Assessment, use the Assessment tab on the top navigation menu.

Instructions

Access the following to complete this Assessment:

Before submitting your Assessment, carefully review the rubric. This is the same rubric the Assessor will use to evaluate your submission and it provides detailed criteria describing how to achieve or master the Competency. Many students find that understanding the requirements of the Assessment and the rubric criteria help them direct their focus and use their time most productively.

Important Information on Interpreting the Assessment Rubric (click to expand)

Achievement vs. Mastery of the Competency

  • Mastery of this Competency means that 80% or more of the rows have been assessed as Exceeds Expectations and no rows have been assessed as Does Not Meet Expectations.
  • Achievement of this Competency means that all rows are assessed at Meets Expectations or above (but lower than the 80% threshold required for Mastery).

Assessment of Individual Rubric Rows

In order to achieve Meets Expectations for a particular row of the rubric, you must have adequately completed all criteria in that row. This means that you have addressed all required elements to the required level of quantity and/or quality.

In order to achieve Exceeds Expectations for a particular row of the rubric, you must have adequately completed all criteria in the row, and in addition, your response must reflect a depth and breadth of knowledge and expertise. Examples of this include—but are not limited to—the following:

  • You provide additional, specific, and/or particularly relevant examples to illustrate points made.
  • You seamlessly incorporate your original thoughts and diverse, credible, and relevant academic sources, when applicable, to express your viewpoint or develop a persuasive argument.
  • You demonstrate a deeper understanding of the subject that draws from discipline-specific knowledge and theory and incorporates the viewpoints of a diverse set of business and management thought leaders.
  • You draw additional connections between multiple, complex topics to support your explanations.
  • You are able to apply your knowledge in unique, creative, and/or innovative ways.
  • You thoroughly break down concepts into simpler parts and use your understanding of business to make connections.
  • Your analysis is insightful and original.
  • You design processes, products, and/or solutions that are creative, high-quality, and innovative.
  • You consider diverse perspectives and relevant social, ethical, and business-related issues when proposing new ideas or formulating judgments.

Rubric

Important Note: As a student taking this Competency, you agree that you may be required to submit your Assessment for textual similarity review to Turnitin.com for the detection of plagiarism. All submitted Assessment materials will be included as source documents in the Turnitin.com reference database solely for the purpose of detecting plagiarism of such materials. Use of the Turnitin.com service is subject to the Usage Policy posted on the Turnitin.com site.

Click each of the items below to complete this assessment

Part 1: Critical Appraisal of Research

  • Identify a clinical issue of interest that can form the basis of a clinical inquiry. (Note: You are required to focus on the same clinical issue of interest in the competencies EB002–EB006.)
  • Develop a PICOT question to address this clinical issue of interest.
  • Using the keywords from the PICOT question, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles at the systematic-reviews level.
  • Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Critical Appraisal Worksheet.
    • Be sure to include an evaluation table.

Part 2: Evidence-Based Best Practices

Based on your appraisal, recommend a best practice that emerges from the research you reviewed. In a 1- to 2-page narrative, address the following:

  • Explain the best practice that emerged, justifying your proposal with APA citations for the evidenced-based research that you reviewed.
  • Evaluation Table Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4
Evidence Level * (I, II, or III)
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**
Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).
Sample/Setting The number and characteristics of patients, attrition rate, etc.
Major Variables Studied List and define dependent and independent variables
Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done).
Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).
Findings and Recommendations General findings and recommendations of the research
Appraisal and Study Quality Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?
Key findings
Outcomes
General Notes/Comments
  • *These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide · Level I Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis · Level II Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis · Level III Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis · Level IV Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence · Level V Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence **Note on Conceptual Framework · The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework · Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework. · As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.” · Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature. · Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.
    References The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your” House”. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26. Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from https://academicguides.waldenu.edu/library/conceptualframework

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NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example

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NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example

NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders ExampleNRNP 6635 Week 8: Substance-Related and Addictive Disorders Assignment

NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Assignment Brief

Assignment Instructions Overview

This assignment involves assessing and diagnosing a patient with substance-related or addictive disorders using a video case study. Advanced practice nurses are tasked with evaluating a patient’s symptoms and background while remaining attentive to cultural, socioeconomic, and personal factors that may influence diagnosis and treatment. Each student’s goal is to apply clinical knowledge, critical thinking, and culturally sensitive approaches to determine an accurate diagnosis.

Understanding Assignment Objectives

The objective is to practice the clinical skills needed to accurately assess and diagnose substance-related disorders while incorporating patient history, mental status examination, and differential diagnoses. An essential focus is on integrating the patient’s cultural and social context into clinical judgments, which enhances the depth of assessment and ensures a patient-centered approach to diagnosis and treatment.

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The Student’s Role

In this assignment, students act as psychiatric-mental health nurse practitioners (PMHNPs) conducting a comprehensive psychiatric evaluation. Students should gather patient history, assess mental status, and consider cultural perspectives that shape each patient’s experiences and behaviors. Through this role, students apply their understanding of DSM-5 criteria, craft differential diagnoses, and hone their skills in adapting clinical approaches to individual patient backgrounds.

Competencies Measured

This assignment evaluates several core competencies, including:

  • Clinical assessment and diagnostic skills: Through structured psychiatric evaluations, students will demonstrate their ability to accurately identify and differentiate among possible substance-related and addictive disorders.
  • Cultural competency and sensitivity: Students will demonstrate their ability to integrate cultural understanding and insights into diagnostic processes, considering how cultural values and personal experiences influence symptom presentation.
  • Ethical and professional responsibility: Students are expected to consider legal and ethical aspects, such as confidentiality, informed consent, and culturally appropriate care practices.
  • Critical thinking and diagnostic reasoning: By formulating and prioritizing differential diagnoses based on DSM-5 criteria, students will exhibit their critical thinking process, which guides clinical decision-making.

You can also read other assignment examples for the NRNP 6635 – Psychopathology and Diagnostic Reasoning Course below:

NRNP 6635 Week 1: Competencies of Advanced Nursing Practice Paper Example

NRNP 6635 Week 1 Assignment 2: Clinical Skills Self-Assessment Paper Example

NRNP 6635 Week 2: Practicum Experience Plan (PEP) Paper Example

NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Paper Example

NRNP 6635 Week 4: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper Example

NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Example

NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Example

NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example

Subjective

Chief Complaint and Symptomology

The patient, a 35-year-old male, presents with concerns about increased alcohol consumption and difficulty controlling his drinking. He reports consuming six to eight drinks daily for the past year, leading to multiple consequences, including conflicts at work and in his personal relationships. The patient acknowledges that he has tried to reduce his drinking but has repeatedly failed. Symptoms include cravings, increased tolerance, and occasional withdrawal symptoms, such as shakiness and irritability when abstaining.

History of Present Illness (HPI)

The patient describes his drinking patterns as progressively worsening over the past few years, especially following a stressful family event. He first began drinking socially in his late teens, but his usage increased over time. He reports a history of alcohol use in his family, specifically in his father, who struggled with alcoholism. The patient denies illicit drug use but occasionally uses nicotine. He has not previously sought treatment or counseling for substance use.

Past Psychiatric History

The patient denies any previous psychiatric diagnoses or treatments. He reports experiencing stress and mild depressive symptoms but has not received formal mental health care. He occasionally experiences sleep disturbances and low mood.

Family History

The patient reports a family history of alcohol use disorder in his father and maternal uncle. No family history of other mental illnesses is noted.

Social and Occupational History

The patient is employed full-time and lives with his partner. He describes his work environment as high-stress, contributing to his increased alcohol use as a coping mechanism. He maintains some social support through friends and family but mentions that alcohol often features prominently in his social gatherings.

Cultural Background

The patient identifies as part of a cultural group in which alcohol use is socially normalized, and abstinence is sometimes stigmatized. This may have contributed to his reluctance to seek treatment or reduce his consumption independently.

Interview Questions

  • How does alcohol fit into your social and family life?
  • Have you experienced any physical or mental symptoms when you have tried to reduce or stop drinking?
  • Do you feel that alcohol has impacted your work or relationships?
  • What challenges do you foresee if you were to pursue treatment or reduction in drinking?

Objective

Observations During Psychiatric Assessment

The patient appears well-groomed and maintains good eye contact. He is alert and oriented to person, place, and time. His speech is coherent and at a normal rate, though he appears tense when discussing his alcohol use. He demonstrates mild hand tremors and is somewhat fidgety, which may be related to mild withdrawal symptoms.

Mental Status Examination (MSE)

  • Appearance: Well-groomed, casually dressed.
  • Behavior: Cooperative but slightly anxious when discussing his drinking habits.
  • Speech: Normal rate and tone.
  • Mood/Affect: Reports feeling anxious and guilty about his drinking; affect is congruent with mood.
  • Thought Process: Logical and coherent.
  • Thought Content: No delusions, hallucinations, or suicidal ideation noted.
  • Cognitive Functioning: Intact, alert, and oriented.
  • Insight and Judgment: Limited insight into the need for professional help; judgment impaired related to alcohol use.

Assessment

Differential Diagnoses

  1. Alcohol Use Disorder (AUD) (Primary Diagnosis): According to DSM-5, AUD is characterized by problematic alcohol use leading to significant impairment or distress. The patient meets several criteria for AUD, including increased tolerance, unsuccessful attempts to cut down, cravings, and persistent use despite interpersonal problems (American Psychiatric Association, 2013). These criteria strongly support AUD as the primary diagnosis.
  2. Adjustment Disorder with Depressed Mood: Adjustment disorder could be considered due to the patient’s reported stress and mild depressive symptoms following a significant life event. However, these symptoms appear to be secondary to the patient’s alcohol use, as they exacerbate with drinking patterns rather than standalone depressive symptoms. DSM-5 criteria for adjustment disorder do not fully align with the patient’s experience, ruling this out as the primary condition (First, 2013).
  3. Generalized Anxiety Disorder (GAD): The patient exhibits some anxiety symptoms, possibly related to withdrawal or as a consequence of stress from his substance use. GAD could be considered if symptoms were persistent and independent of alcohol use. However, anxiety symptoms seem situational and secondary to AUD, which is not consistent with a primary GAD diagnosis (First, 2013).

Primary Diagnosis Justification

The patient’s symptoms, including increased tolerance, cravings, and functional impairment, align with the DSM-5 criteria for Alcohol Use Disorder. The critical-thinking process prioritized AUD over other differentials, as it fully explains his symptoms, while other conditions are secondary and do not independently fulfill DSM-5 criteria (American Psychiatric Association, 2013).

Reflection Notes

Session Reflection

If this session were conducted again, additional culturally sensitive questions could improve the rapport, exploring how the patient’s cultural background influences his perspectives on drinking and treatment. Additionally, using motivational interviewing could encourage the patient to consider change without feeling judged.

Legal and Ethical Considerations

Confidentiality is paramount, but as a PMHNP, there is also a duty to address potential risks, such as workplace safety if drinking is impairing his job performance. The stigma within his cultural background around abstinence and treatment could present a barrier, which the PMHNP should approach empathetically and non-judgmentally.

Health Promotion and Disease Prevention

Emphasizing harm-reduction techniques, such as reducing alcohol consumption gradually or substituting with non-alcoholic beverages, could help manage cravings and withdrawal symptoms. Encouraging lifestyle changes, such as regular exercise and stress management techniques, could reduce the patient’s reliance on alcohol for stress relief. Socioeconomic and cultural factors should also be addressed to ensure access to support networks and resources that align with his values and norms.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

First, M. B. (2013). DSM-5 and paraphilic disorders. Journal of the American Academy of Psychiatry and the Law Online, 41(2), 191-202.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford press.

Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38-48.

Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice. John Wiley & Sons.

Detailed Assessment Instructions for the NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example

Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

An important consideration when working with patients is their cultural background. Understanding an individual’s culture and personal experiences provides insight into who the person is and where he or she may progress in the future. Culture helps to establish a sense of identity, as well as to set values, behaviors, and purpose for individuals within a society. Culture may also contribute to a divide between specific interpretations of cultural behavior and societal norms. What one culture may deem as appropriate another culture may find inappropriate. As a result, it is important for advanced practice nurses to remain aware of cultural considerations and interpretations of behavior for diagnosis, especially with reference to substance-related disorders. At the same time, PMHNPs must balance their professional and legal responsibilities for assessment and diagnosis with such cultural considerations and interpretations.

For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background.

To Prepare:

  • Review this week’s Learning Resources and consider the insights they provide.
  • Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
  • By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Identify at least three possible differential diagnoses for the patient.

By Day 7 of Week 8

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology 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 priority 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.
  • Reflection notes:What would you do differently with this client if you could conduct the session over? 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.).
  • Minimums 5 references

https://ezp.waldenulibrary.org/login?qurl=https://video.alexanderstreet.com/watch/training-title-82?account_id=14872&usage_group_id=95102

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How do import duties and exchange rates affect the location decision in a supply chain?

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How do import duties and exchange rates affect the location decision in a supply chain?

How do import duties and exchange rates affect the location decision in a supply chain

Import duties and exchange rates affect the location decision in a supply chain because both items are costs that can decide the efficiency of the supply chain. Import duties can be tariffs that are charged to the company to do business within a country or region. If a country has high tariffs, then companies either focus on serving a local market or opening a warehouse within the country. Both solutions affect the supply chain strategic planning. However, some countries also have tax incentives or free trade zones, which are also important to note when deciding on a location because of the benefits that could come from trading within another country or expanding the business into a foreign market. Exchange rates affect the location decision of the supply chain because the fluctuations within the exchange rates have a significant impact on the profits within the supply chain. Depending on the exchange rate companies can decide if it would be more beneficial to have warehouses overseas or in-state.

Understanding the Concept of Import Duties and Exchange Rates

Import duties and exchange rates are two critical factors in international trade that can significantly affect the costs of goods and services. Import duties are taxes imposed on imported goods by the government of the destination country, and they increase the price of the products, making them less competitive in the market. Exchange rates, on the other hand, refer to the value of one currency compared to another. The fluctuations in exchange rates can affect the cost of goods and services in a supply chain. Companies must carefully consider these factors when making decisions related to their supply chain, such as choosing a location for manufacturing or sourcing materials from a particular supplier. Understanding the concept of import duties and exchange rates is crucial for businesses operating in the global marketplace, as it can help them make informed decisions that help them remain competitive and profitable.

How Import Duties Impact Supply Chain Location Decisions

Import duties: Import duties are taxes that a government levies on goods imported into a country. These duties can vary depending on the type of product and the country of origin. Higher import duties can increase the cost of importing goods, which can impact the location decision in a supply chain. Companies may choose to locate their production facilities in countries with lower import duties to reduce costs. Alternatively, they may decide to source materials locally to avoid import duties altogether. Import duties can also impact the choice of transportation mode, with companies opting for modes that minimize the impact of import duties, such as air freight or intermodal transportation.

How Exchange Rates Impact Supply Chain Location Decisions

Exchange rates: Exchange rates determine the value of one currency in relation to another. Fluctuations in exchange rates can impact the cost of goods and services in different countries, which can influence the location decision in a supply chain. A strong domestic currency can make it more expensive to produce goods locally, while a weaker currency can make it cheaper to produce goods for export. Companies may choose to locate their production facilities in countries with weaker currencies to take advantage of lower costs. Alternatively, they may decide to source materials and finished goods from countries with stronger currencies to take advantage of lower prices.

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Example of Import Duties and Exchange Rates Affect the Location Decision in a Supply Chain

In this instance, let us consider the hypothetical case of a US-based electronics company that manufactures smartphones. The company has two options for its supply chain operations: either manufacturing the components in the US and assembling them in Mexico or setting up the entire supply chain in Mexico.

If the company chooses to assemble the components in Mexico, it can take advantage of the lower labor costs and import duties on the finished products. However, the company will have to pay import duties on the components it imports from the US. The import duties increase the cost of production, and the company may have to increase the price of its products, making them less competitive.

Exchange rates also affect the cost of production. If the exchange rate between the US dollar and the Mexican peso is unfavorable, the company will have to spend more US dollars to purchase the same amount of pesos to pay for labor and other expenses in Mexico. The unfavorable exchange rate will make the overall cost of production higher, making it less attractive to manufacture in Mexico.

On the other hand, if the company decides to set up the entire supply chain in Mexico, it will benefit from lower labor costs, reduced import duties, and a favorable exchange rate. The company will be able to produce smartphones at a lower cost, making them more competitive in the market.

Reasons for Including a Foreign Location in the Supply Chain

  • Access to lower labor costs: Foreign locations often have lower labor costs, which can help reduce the overall cost of production. For example, many companies choose to manufacture in China due to its low labor costs.
  • Access to raw materials: Some foreign locations may have access to raw materials that are not readily available in the home country. This can help reduce transportation costs and ensure a consistent supply of raw materials.
  • Access to new markets: A foreign location may offer access to new markets, helping a company expand its customer base and increase sales.
  • Access to government incentives: Some foreign governments offer incentives to foreign companies to set up operations in their country. This can include tax breaks, subsidies, and other benefits.
  • Diversification: Setting up a supply chain in a foreign location can help diversify a company’s operations and reduce dependence on a single market or supplier.

Reasons to Avoid a Foreign Location in the Supply Chain

  • Political instability: Political instability in a foreign location can pose significant risks to a company’s operations. This can include political unrest, civil wars, and changes in government policies.
  • Economic instability: Economic instability in a foreign location can also pose significant risks to a company’s operations. This can include currency fluctuations, inflation, and recession.
  • Legal and regulatory issues: Foreign locations may have different legal and regulatory frameworks than the home country. This can create compliance issues and increase the risk of legal disputes.
  • Cultural differences: Cultural differences can create communication barriers and make it difficult to establish effective relationships with suppliers, employees, and customers in a foreign location.
  • Quality control issues: Ensuring consistent quality control across a global supply chain can be challenging. This can be particularly difficult in a foreign location where there may be language barriers and cultural differences.

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How does a rise in transportation costs affect global supply chain networks?

Transportation costs affect global supply chain networks because the movement of products is crucial to the efficiency of the supply chain. If a firm is unable to maintain an efficient and effective means of transporting products throughout the supply chain the entire chain will collapse.

A rise in transportation costs can have a significant impact on global supply chain networks. When transportation costs increase, it becomes more expensive to transport goods across long distances, which can lead to several outcomes:

  • Increase in the cost of goods: Companies may need to increase the prices of their products to cover the additional transportation costs, making them less competitive in the market.
  • Shift in sourcing strategy: Companies may need to shift their sourcing strategy to find suppliers closer to their manufacturing facilities or distribution centers to reduce transportation costs.
  • Change in logistics infrastructure: Companies may need to invest in new logistics infrastructure, such as warehouses, distribution centers, and transportation networks, to reduce transportation costs.
  • Shift in supply chain location: Companies may need to re-evaluate their supply chain location decisions and consider moving their operations to locations that are closer to their customers or suppliers.
  • Increased lead times: Increased transportation costs may result in longer lead times for the delivery of goods, which can negatively impact customer satisfaction and increase inventory carrying costs.

To mitigate the impact of rising transportation costs, companies can take several measures:

  • Optimization of transportation routes: Companies can optimize their transportation routes to reduce distance and minimize transportation costs.
  • Use of alternative modes of transportation: Companies can explore the use of alternative modes of transportation, such as rail, sea, or air, to reduce transportation costs.
  • Collaboration with suppliers: Companies can work with their suppliers to develop collaborative transportation strategies that can help reduce transportation costs for both parties.
  • Investment in technology: Companies can invest in technology such as real-time tracking and transportation management systems that can help optimize transportation routes and reduce costs.
  • Diversification of suppliers: Companies can diversify their supplier base to reduce their dependence on a single supplier and avoid disruption caused by transportation costs or other factors.

What are the main reasons why offshoring fails? What are the risks & how are they mitigated? What are the major opportunities & how are they captured?

Offshoring is a common business practice where a company moves some of its operations to a foreign location to take advantage of lower labor costs, access to new markets, or other benefits. However, offshoring can also come with risks that can cause it to fail. Below are some of the main reasons why offshoring fails, the risks associated with offshoring, and the opportunities that can be captured:

Reasons Why Offshoring Fails:

  • Communication barriers: Communication barriers such as language, cultural differences, and time zone differences can make it challenging to establish effective communication between the company and its offshore team.
  • Quality control issues: Ensuring consistent quality control across a global supply chain can be difficult, especially if there are language barriers and cultural differences.
  • Legal and regulatory issues: Different countries have different legal and regulatory frameworks, and compliance can be a challenge.
  • Political instability: Political instability in a foreign country can pose significant risks to a company’s operations, including political unrest, civil wars, and changes in government policies.
  • Economic instability: Economic instability in a foreign country can also pose significant risks to a company’s operations, including currency fluctuations, inflation, and recession.

Risks Associated with Offshoring and Mitigation:

  • Cultural differences: To mitigate the risks associated with cultural differences, companies should conduct cross-cultural training for their employees to ensure they understand and appreciate the cultural differences in the foreign country.
  • Communication barriers: To mitigate the risks associated with communication barriers, companies can use technology such as video conferencing to facilitate communication between the company and its offshore team.
  • Legal and regulatory issues: To mitigate the risks associated with legal and regulatory issues, companies should conduct due diligence to ensure they understand the legal and regulatory framework of the foreign country.
  • Quality control issues: To mitigate the risks associated with quality control issues, companies can use quality control systems and processes that are standardized across their global supply chain.
  • Political and economic instability: To mitigate the risks associated with political and economic instability, companies can diversify their operations across multiple countries and regions to reduce their dependence on a single market or supplier.

Opportunities and Capturing Them:

  • Access to lower labor costs: Offshoring can provide companies with access to lower labor costs, which can help reduce the overall cost of production and increase profitability.
  • Access to new markets: Offshoring can provide companies with access to new markets, which can help expand their customer base and increase sales.
  • Access to new talent: Offshoring can provide companies with access to new talent and skills that may not be readily available in the home country.
  • Diversification: Offshoring can help companies diversify their operations and reduce their dependence on a single market or supplier.

To capture these opportunities, companies must conduct thorough research and analysis before deciding to offshore their operations. They must also develop a robust offshoring strategy that considers the risks and opportunities associated with offshoring, as well as the necessary mitigation measures. Companies must also be willing to adapt their strategy as the business environment changes, including the legal and regulatory framework of the foreign country.

Final Remarks on Import Duties and Exchange Rates Affect the Location Decision in a Supply Chain

In conclusion, import duties and exchange rates are crucial factors in determining the location decision in a supply chain. Import duties are taxes imposed on imported goods by the destination country’s government. Exchange rates, on the other hand, refer to the value of one currency compared to another. The fluctuations in exchange rates can affect the cost of goods and services in a supply chain. Companies must consider these factors while evaluating the costs and benefits of setting up their supply chain operations in a particular location. By doing so, companies can ensure that they make informed decisions that help them remain competitive in the market.

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What should Lisa do in this situation? Formulate response

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What should Lisa do in this situation? Formulate response

What should Lisa do in this situation? Formulate a response.

Purchasing Ethics. – Read the case and answer all questions at end of each of the 4 scenarios.

Purchasing Ethics Scenario 1                                                                

Bryan Janz was just arriving back from lunch when his office phone rang. It was his wife, Nina, calling from home. Nina told Bryan that FedEx had just delivered a package addressed to her. The package contained a beautiful clock, now sitting over the fireplace. In fact, Nina said, “the clock looks absolutely beautiful on our living room fireplace:’ Think­ing the clock was from a family member, Bryan asked who sent the present. She said she did not recognize the name-the clock was from Mr. James McEnroe. Bryan immediately told Nina that she had to repack the clock because it was from a supplier who had been try­ing to win business from Bryan’s company. They definitely could not accept the clock. Nina was very upset and responded that the clock was perfect for the. room and, besides, the clock came to their home, not to Bryan’s office. Because of Nina’s attachment to the clock, Bryan was unsure about what to do.

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PURCHASING ETHICS ASSIGNMENT QUESTIONS WITH EXPERT ANSWERS

1. What should Bryan do about the clock?

Bryan should follow his company’s code of ethics regarding accepting gifts from suppliers. If the code of ethics prohibits accepting gifts from suppliers, then Bryan should return the clock to the supplier with a polite note explaining the company’s policy. If the policy allows for gifts of a certain value or type, Bryan should check if the clock falls within the permissible limit and report the gift to his company’s ethics officer for documentation purposes. In any case, Bryan should not keep the clock and should not let personal preferences override his obligation to follow the company’s ethical guidelines.

2. What does the Institute of Supply Management (ISM) code of ethics say about accepting supplier favors and gifts?

The ISM code of ethics states that procurement professionals should avoid accepting gifts or favors that could influence their professional judgment or create a conflict of interest. The code specifies that gifts or favors of more than nominal value or that create an appearance of impropriety are prohibited. The code also advises procurement professionals to disclose gifts received from suppliers to their employers and to avoid giving suppliers preferential treatment in exchange for gifts.

3. Why do you think the supplier sent the clock to Bryan’s home and addressed it to his wife?

It is possible that the supplier sent the clock to Bryan’s home and addressed it to his wife to bypass the company’s gift policies and to create a sense of obligation or indebtedness on a personal level. Sending a gift to an employee’s home could also be a tactic to create a personal relationship with the employee outside of a professional setting. By addressing the gift to Bryan’s wife, the supplier may have hoped to appeal to her sense of aesthetics and persuade her to influence Bryan to favor the supplier’s company in future business dealings.

4. Does the mere act of sending the clock to Bryan mean that Mr. McEnroe is an unethical salesperson?

Not necessarily. It is possible that Mr. McEnroe was unaware of Bryan’s company’s gift policy or that he believed the clock to be of nominal value. However, if Mr. McEnroe knew or should have known that the gift violated the company’s code of ethics and sent it anyway with the intention of creating undue influence or obligation, then he would be acting unethically. The context, intent, and potential impact of the gift are important factors to consider when determining whether the gift is unethical.

Purchasing Ethics Scenario 2                                                                

Lisa Jennings thought that at long last, her company, Assurance Technologies, was about to win a major contract from Sealgood Instruments. Sealgood, a maker of precision measuring instruments, was sourcing a large contract for component subassemblies. The contract that Assurance Technologies was bidding on was worth at least $2.5 million an­nually, a significant amount given Assurance’s annual sales of $30 million. Her team had spent hundreds of hours preparing the quotation and felt they could meet Sealgood’s re­quirements in quality, cost, delivery, part standardization, and simplification. In fact, Lisa had never been more confident about a quote meeting the demanding requirements of a potential customer.

Troy Smyrna, the buyer at Sealgood Instruments responsible for awarding this con­ tract, called Lisa and asked to meet with her at his office to discuss the specifics of the contract. When she arrived, Lisa soon realized that the conversation was not going ex­actly as she had expected. Troy informed Lisa that Assurance Technologies had indeed prepared a solid quotation for the contract. However, when he visited Assurance’s facility earlier on a prequalifying visit, he was disturbed to see a significant amount of a competi­tor’s product being used by Assurance. Troy explained his uneasiness with releasing part plans and designs to a company that clearly had involvement with a competitor. When Lisa asked what Assurance could do to minimize his uneasiness, Troy replied that he would be more comfortable if Assurance no longer used the competitor’s equipment and used

Cases

Sealgood’s equipment instead. Lisa responded that this would mean replacing several hun­dred thousand dollars worth of equipment. Unfazed, Troy simply asked her whether or not she wanted the business. Lisa responded that she needed some time to think and that she would get back to Troy in a day or so.

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PURCHASING ETHICS ASSIGNMENT

1. Do you think the buyer at Sealgood Instruments, Troy Smyrna, is practicing unethical behavior? First, what is the term for this behavior, and second, defend why you think it is ethical or unethical behavior.

The behavior exhibited by Troy Smyrna is commonly referred to as “buying influence” or “kickbacks.” It is unethical behavior where a purchasing agent or a buyer demands something of value from a supplier in exchange for a favorable treatment, such as awarding a contract. In this scenario, Troy Smyrna is demanding that Assurance Technologies replace its competitor’s equipment with Sealgood’s equipment to ensure the contract’s award. While this behavior may be common in business, it is unethical because it is not based on the merits of the supplier’s product or service. Instead, it is based on an agreement to provide something of value in exchange for a favorable outcome. Therefore, Troy’s behavior is unethical.

2. What should Lisa do in this situation? Formulate a response.

Lisa should first consult with her supervisor and the company’s legal team before responding to Troy Smyrna’s request. If it is determined that Troy’s request is an attempt to obtain a kickback, Lisa should not comply with the request and should report the matter to the appropriate authorities. However, if it is determined that the use of Sealgood’s equipment is reasonable and necessary for the contract’s fulfillment, Lisa should negotiate with Troy to minimize the costs of the equipment replacement or explore alternative solutions that would address his concerns without incurring significant expenses. Lisa should also ensure that any agreements with Sealgood are based solely on the merits of Assurance’s product and service, and not on any demands for kickbacks or other unethical behavior.

Purchasing Ethics Scenario 3                                                                

Ben Gibson, the purchasing manager at Coastal Products, was reviewing purchasing expenditures for packaging materials with Jeff Joyner. Ben was particularly disturbed about the amount spent on corrugated boxes purchased from Southeastern Corrugated. Ben said, “I don’t like the salesman from that company. He comes around here acting like he owns the place. He loves to tell us about his fancy car, house, and vacations. It seems to me he must be making too much money off of us!” Jeff responded that he heard Southeastern Corrugated was going to ask for a price increase to cover the rising costs of raw material paper stock. Jeff further stated that Southeastern would probably ask for more than what was justified simply from rising paper stock costs.

After the meeting, Ben decided he had heard enough. After all, he prided himself on being a results-oriented manager. There was no way he was going to allow that salesman to keep taking advantage of Coastal Products. Ben called Jeff and told him it was time to rebid the corrugated contract before Southeastern came in with a price increase request. Who did Jeff know that might be interested in the business? Jeff replied he had several companies in mind to include in the bidding process. These companies would surely come in at a lower price, partly because they used lower-grade boxes that would probably work well enough in Coastal Products’ process. Jeff also explained that these suppliers were not serious contenders for the business. Their purpose was to create competition with the bids. Ben told Jeff to make sure that Southeastern was well aware that these new suppliers were bidding on the contract. He also said to make sure the suppliers knew that price was going to be the determining factor in this quote, because he considered corrugated boxes to be a standard industry item.

PURCHASING ETHICS ASSIGNMENT

1. Is Ben Gibson acting legally? Is he acting ethically? Why or why not?

Ben Gibson’s actions raise ethical concerns. He is intentionally seeking to replace a supplier solely based on his personal dislike for their sales representative and his assumption that the supplier is making too much profit. He is also encouraging the use of lower-grade boxes, which may not meet the quality standards required by Coastal Products, in order to reduce costs. Ben’s behavior violates the principles of fairness, transparency, and honesty, which are key to ethical purchasing practices.

Furthermore, Ben’s actions may not be illegal, but they are not in the best interest of Coastal Products. By intentionally seeking to replace Southeastern Corrugated without proper justification, Ben is putting the company at risk of receiving lower-quality products and services, which can impact the company’s reputation and profitability.

2. As the Marketing Manager for Southeastern Corrugated, what would you do upon receiving the request for quotation from Coastal Products?

Upon receiving the request for quotation from Coastal Products, the Marketing Manager for Southeastern Corrugated should carefully review the bid and determine whether it is feasible to offer a competitive price. If the rising cost of raw materials has impacted the price, the company should provide evidence to support the price increase. It is also important to maintain professionalism and not allow personal biases to affect the bidding process.

If Southeastern Corrugated is confident in its ability to provide quality products and services at a competitive price, it should participate in the bidding process. The company can also reach out to Coastal Products to discuss any concerns they may have regarding pricing or quality. However, if Southeastern Corrugated believes that the bidding process is being manipulated or is not fair, they may choose not to participate in the bid.

Regardless of the outcome of the bidding process, Southeastern Corrugated should focus on maintaining a positive relationship with Coastal Products by providing excellent customer service, quality products, and fair pricing. This will help to ensure that the company remains a preferred supplier for Coastal Products in the future.

Cases

Purchasing Ethics Scenario 4                                                                 

Sharon Gillespie, a new buyer at Visionex, Inc., was reviewing quotations for a tooling contract submitted by four suppliers. She was evaluating the quotes based on price, target quality levels, and delivery lead time promises. As she was working, her manager, Dave Cox, entered her office. He asked how everything was progressing and if she needed any help. She mentioned she was reviewing quotations from suppliers for a tooling contract. Dave asked who the interested suppliers were and if she had made a decision. Sharon indi­cated that one supplier, Apex, appeared to fit exactly the requirements Visionex had specified in the proposal. Dave told her to keep up the good work.

Later that day Dave again visited Sharon’s office. He stated that he had done some re­ search on the suppliers and felt that another supplier, Micon, appeared to have the best track record with Visionex. He pointed out that Sharon’s first choice was a new supplier to Visionex and there was some risk involved with that choice. Dave indicated that it would please him greatly if she selected Micron for the contract.

The next day Sharon was having lunch with another buyer, Mark Smith: She mentioned

the conversation with Dave and said she honestly felt that Apex was the best choice. When                                                                           i

Mark asked Sharon who Dave preferred, she answered, “Micron:’ At that point Mark rolled                                                             I !

his eyes and shook his head. Sharon asked what the body language was all about. Mark replied, “Look, I know you’re new but you should know this. I heard last week that Dave’s brother-in-law is a new part owner of Micron. I was wondering how soon it would be be­ fore he started steering business to that company. He is not the straightest character:’ Sha­ron was shocked. After a few moments, she announced that her original choice was still the best selection. At that point Mark reminded Sharon that she was replacing a terminated buyer who did not go along with one of Dave’s previous preferred suppliers.

PURCHASING ETHICS ASSIGNMENT

1. What does the Institute of Supply Management code of ethics say about financial conflicts of interest

The Institute of Supply Management (ISM) code of ethics states that purchasing professionals should avoid any financial conflicts of interest that could compromise their objectivity and impartiality in the procurement process. This includes not accepting any gifts, favors, or other forms of compensation from suppliers that could influence their purchasing decisions. Additionally, purchasing professionals should disclose any potential conflicts of interest to their employer and take appropriate steps to mitigate any conflicts.

2. Ethical decisions that affect a buyer’s ethical perspective usually involve the organizational environment, cultural environment, personal environment, and industry environment. Analyze this scenario using these four variables.

  • Organizational environment: The actions of Dave Cox, Sharon’s manager, suggest a culture in which personal relationships and preferences take precedence over objective criteria in supplier selection. This environment can create a perception of unfairness and favoritism among suppliers and damage the company’s reputation.
  • Cultural environment: The culture of the purchasing department and the company as a whole can influence ethical decision-making. If the culture prioritizes profit over ethical behavior, individuals may be more likely to engage in unethical conduct to achieve their goals.
  • Personal environment: Sharon’s personal values and beliefs may influence her ethical decision-making in this scenario. Her commitment to ethical behavior and her desire to do what is best for the company may conflict with pressure from her manager to select a preferred supplier.
  • Industry environment: The competitive nature of the industry and the pressure to reduce costs and increase efficiency can create a climate in which unethical behavior, such as favoritism and conflict of interest, can be more prevalent.

3. What should Sharon do in this situation?

Sharon should act in accordance with her ethical principles and professional responsibilities as a purchasing professional. She should not allow personal relationships or pressure from her manager to influence her supplier selection decision. Instead, she should base her decision on objective criteria such as price, quality, and delivery lead time promises. If Sharon believes that Dave’s preference for Micron is driven by a conflict of interest, she should report her concerns to her supervisor or the company’s ethics hotline. It may also be appropriate for Sharon to request additional information or clarification from Dave regarding his reasons for preferring Micron. Ultimately, Sharon should strive to maintain her integrity and uphold the ethical standards of the profession.

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Provide reasons why most firms do not have an adequate supplier measurement system

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Provide Reasons Why Most Firms Do Not Have an Adequate Supplier Measurement System

Provide reasons why most firms do not have an adequate supplier measurement system

A supplier measurement system is a process used by companies to evaluate the performance of their suppliers based on various criteria such as quality, cost, delivery, and customer service. Despite the benefits of having a supplier measurement system, most firms do not have an adequate system in place. In this discussion, we will examine some reasons why most firms do not have an adequate supplier measurement system. These include:

Increases overall operation time for the company

One of the primary reasons why firms do not have an adequate supplier measurement system is that implementing such a system takes time and resources that could be used for other activities. The process of collecting data and analyzing it takes time away from core business activities. Therefore, firms may not see the benefit of investing time and resources into a supplier measurement system.

Difficulty in including all the criteria required to judge a particular supplier in one system

Another reason is that there are multiple factors to consider when evaluating a supplier, such as quality, cost, delivery, and customer service. It can be challenging to develop a system that effectively captures all of these factors and provides a comprehensive evaluation of a supplier’s performance. Therefore, firms may find it difficult to develop a supplier measurement system that accurately reflects their needs.

Costlier and time-consuming system to be included in the business

Developing and implementing a supplier measurement system can be expensive, requiring investment in technology, training, and personnel. Maintaining and updating the system over time also requires ongoing costs and resources. Therefore, firms may not have the financial resources to invest in a supplier measurement system.

Supplier measurement system uses company’s resources in a non-core activity which can otherwise be used for core business activities

As mentioned earlier, implementing a supplier measurement system takes time and resources away from core business activities that generate revenue for the company. Companies may prioritize investing in activities that directly contribute to their bottom line rather than indirect activities like supplier management. Therefore, firms may not consider supplier measurement as a core activity and hence neglect it.

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Importance of having a smaller supply base before committing to a supplier management and development program

In today’s fast-paced and highly competitive business environment, supplier management and development have become critical components of successful supply chain management. One of the key strategies that organizations adopt in this regard is to have a smaller supply base. This approach helps companies to optimize their supplier system and improve the overall quality of their products or services. In this discussion, we will explore the importance of having a smaller supply base before committing to a supplier management and development program.

Reasons for having a smaller supply base include:

Concentrate on optimizing supplier system

  1. Improved communication: Having a smaller supply base enables companies to have better communication with their suppliers. This is because managing a smaller number of suppliers requires less time and resources. It allows companies to have regular meetings with their suppliers, which can lead to better collaboration and understanding of each other’s needs and expectations.
  2. Better Quality: A smaller supply base also allows companies to focus on improving the quality of their products or services. When an organization has fewer suppliers, it is easier to monitor their performance and ensure that they meet the required quality standards. This enables the organization to have more control over the quality of their products or services and identify any issues early on before they escalate into major problems.
  3. Better control: By working with a smaller supply base, companies can exercise better control over their supply chain. They can identify potential risks and address them proactively, rather than being reactive to issues that arise.

Build closer relationships with qualified suppliers

  1. Stronger Relationships: A smaller supply base allows companies to develop stronger relationships with their suppliers. By working closely together, they can build trust and understanding that can lead to long-term partnerships.
  2. Better Understanding of Suppliers: By working with a smaller supply base, companies can gain a better understanding of their suppliers’ capabilities and limitations. They can identify areas where suppliers need support and provide the necessary resources to help them improve.
  3. c. Improved Supplier Performance: A smaller supply base enables companies to monitor and measure supplier performance more effectively. By setting clear expectations and providing regular feedback, companies can help their suppliers to improve their performance.

Reduce risk

Having a smaller supply base can also help reduce risk. When an organization has a large supply base, it is more challenging to monitor the performance and financial stability of each supplier. This increases the risk of supplier failure or disruption, which can have a significant impact on the organization’s operations and reputation. By having a smaller supply base, an organization can reduce the risk of supplier failure and ensure continuity of supply.

Cost savings

A smaller supply base can also lead to cost savings. By working with a smaller set of suppliers, an organization can negotiate better pricing and terms. This is because suppliers are more likely to offer competitive pricing to organizations that they have a strong and long-term relationship with. In addition, managing a smaller supplier base requires fewer resources, which can also lead to cost savings.

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Full-service supplier and its benefits

Introduction

A full-service supplier is a supplier who is capable of providing a wide range of activities, including access to design, research, development, supplier engineering, testing, and other services related to the supply chain. In this discussion, we will explore what a full-service supplier is and the benefits of using a full-service supplier.

Definition of a full-service supplier

A full-service supplier is a supplier who offers a wide range of services related to the supply chain, from design and research to production and delivery. They are capable of providing value-added services that can help organizations streamline their supply chain processes and improve their product or service quality.

Benefits of using a full-service supplier

Reduced Costs: Using a full-service supplier can lead to cost savings for an organization. This is because a full-service supplier is able to offer a wide range of services, which eliminates the need for an organization to work with multiple suppliers. This can lead to reduced transportation costs, as well as reduced procurement and administrative costs.

Streamlined Supply Chain: Working with a full-service supplier can streamline an organization’s supply chain by reducing the number of suppliers it needs to work with. This can lead to improved communication, as well as improved quality control and product consistency.

Improved Product Quality: A full-service supplier can offer access to design, research, and development services, which can help an organization improve the quality of its products or services. This can lead to improved customer satisfaction and increased brand loyalty.

Faster Time-to-Market: A full-service supplier can help an organization bring products to market more quickly by providing access to design and development services. This can help organizations stay ahead of the competition and respond more quickly to changes in the market.

Value-Added Services: A full-service supplier can offer value-added services, such as supplier engineering and testing. These services can help an organization improve its supply chain processes and ensure that its products or services meet or exceed customer expectations.

Conclusion

In conclusion, a full-service supplier is a supplier who offers a wide range of services related to the supply chain. Using a full-service supplier can lead to cost savings, streamlined supply chain processes, improved product quality, faster time-to-market, and access to value-added services. Therefore, organizations should consider the benefits of using a full-service supplier when evaluating their supply chain strategy.

Final Remarks on Supplier Management and Development Program

Before committing to a supplier management and development program, it’s important for a company to have a smaller supply base. This will help the company set up a good supplier measurement system. This is because it allows firms to focus on developing closer relationships with their suppliers, which can lead to better communication, collaboration, and trust.

A smaller supply base can also help companies save money on the costs of managing multiple suppliers and improve the quality of their goods or services by letting them work more closely with their suppliers.

Firms can make sure they work with the best suppliers and reach their business goals by putting in place a full-service supplier management program that includes supplier selection, performance evaluation, and development.

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Marginal Practitioners and Limited Practitioners

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Marginal Practitioners and Limited Practitioners

Marginal Practitioners and Limited Practitioners

Chiropractic is a healthcare profession that focuses on the diagnosis and treatment of musculoskeletal disorders, primarily those affecting the spine. The chiropractic profession is regulated by state laws and includes a range of practitioners, from those with limited training to those with advanced degrees and specialized training. Within the chiropractic profession, there are distinctions made between marginal practitioners and limited practitioners, which are based on their level of education, training, and professional status. This essay will explore the concepts of marginal and limited practitioners in chiropractic, examine the impact of these distinctions on the profession, and consider whether or not such distinctions should be applied to the chiropractic profession.

The concept of marginal practitioners in chiropractic

Definition and characteristics of marginal practitioners

Marginal practitioners in chiropractic refer to individuals who practice chiropractic techniques but do not have the required education or training to be considered legitimate chiropractic practitioners. According to the textbook “Chiropractic: An Illustrated History,” marginal practitioners are often self-taught or have received only brief or incomplete training from unaccredited schools or programs. These individuals may have some knowledge of chiropractic techniques but are not licensed or registered to practice as chiropractors. They may be massage therapists, physical trainers, or other healthcare professionals who incorporate chiropractic techniques into their practice without being licensed chiropractors. Marginal practitioners may also include individuals who have completed a short course or seminar on chiropractic techniques but lack the comprehensive education and training required for chiropractic licensure.

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Examples of marginal practitioners in chiropractic

Examples of marginal practitioners in chiropractic include massage therapists who offer spinal manipulation as part of their massage therapy practice, personal trainers who use chiropractic techniques as part of their training regimen, and acupuncturists who incorporate spinal manipulation into their treatments.

Impact of marginal practitioners on the chiropractic profession

The existence of marginal practitioners in chiropractic can have several negative impacts on the profession. Marginal practitioners may offer substandard care or even cause harm to patients due to their lack of education and training. Patients may also be misled by these practitioners, believing that they are receiving chiropractic care from a licensed practitioner when in fact they are not. This can damage the reputation of the chiropractic profession and lead to public distrust of licensed chiropractors.

The concept of limited practitioners in chiropractic

Definition and characteristics of limited practitioners

Limited practitioners in chiropractic refer to individuals who have completed a limited education and training program in chiropractic techniques but are not licensed to practice as full-fledged chiropractors. Limited practitioners may have completed a course or program in chiropractic techniques that do not meet the full requirements for licensure as a chiropractor. According to the textbook “Chiropractic: A Modern Way to Health,” limited practitioners may have graduated from accredited schools or programs, and may hold valid licenses to practice chiropractic. However, they may be limited in their ability to diagnose or treat certain conditions, or to perform certain procedures, such as ordering diagnostic tests, prescribing medications, or performing surgery. These limitations may be imposed by state or federal laws, insurance policies, or professional standards.

Examples of limited practitioners in chiropractic

Examples of limited practitioners in chiropractic include medical doctors, osteopaths, and nurse practitioners who have completed a course or program in chiropractic techniques and incorporate these techniques into their practice. These individuals are not licensed chiropractors but may be authorized to use certain chiropractic techniques as part of their broader scope of practice.

Impact of limited practitioners on the chiropractic profession

Limited practitioners in chiropractic can have a positive impact on the profession by increasing awareness and acceptance of chiropractic techniques among other healthcare professionals. This can lead to more referrals and collaborations between chiropractors and other healthcare providers. However, it is important to ensure that limited practitioners have adequate education and training in chiropractic techniques to provide safe and effective care to their patients.

What are the factors that contribute to marginalization?

The marginalization of some chiropractors in the US may be influenced by several factors, including:

  • Lack of standardized education and training: One of the factors that contribute to marginalization in chiropractic is the lack of standardized education and training requirements for chiropractors in the US. Unlike other healthcare professions, such as medicine or nursing, chiropractic education, and training is not standardized across all states. As a result, there is a wide range of educational programs and training options available, some of which may be of lower quality or accreditation standards. This lack of standardization can lead to variability in the knowledge and skills of chiropractors, which can contribute to the marginalization of some practitioners.
  • Inadequate regulation and oversight: Another factor that contributes to marginalization in chiropractic is the inadequate regulation and oversight of the profession in some states. While all states require chiropractors to be licensed, the requirements for licensure, including education, training, and examination, vary widely across states. Moreover, the enforcement of licensure requirements and disciplinary actions against non-compliant or unethical practitioners can also vary widely. This lack of consistent regulation and oversight can create opportunities for marginal and unethical practitioners to operate without consequences, which can contribute to their marginalization.
  • Bias and stereotypes: Another factor that contributes to marginalization in chiropractic is bias and stereotypes against the profession, especially from other healthcare providers and the public. Some healthcare providers and the public may view chiropractic as a pseudoscientific or alternative therapy, rather than a legitimate healthcare profession. This bias can lead to skepticism, mistrust, and stigma against chiropractors, especially those who operate outside the mainstream of the profession.
  • Economic and political pressures: Another factor that contributes to marginalization in chiropractic is economic and political pressures, such as those from insurance companies and government agencies. Insurance companies may limit or deny coverage for chiropractic care or require higher levels of documentation or justification for coverage, which can limit the financial viability of chiropractors. Government agencies may also restrict the scope of practice or reimbursement rates for chiropractors, which can limit their ability to provide comprehensive and affordable care. These pressures can create barriers to entry or sustainability for some chiropractors, which can contribute to their marginalization.

What are the implications of these distinctions?

The distinction between marginal practitioners and limited practitioners has several implications for the profession of chiropractic, as well as for the quality of care and reputation of the profession. These implications include:

Divisiveness: The distinction between marginal practitioners and limited practitioners creates a division within the chiropractic community, based on education, training, and status. This division can lead to rivalries, conflicts, and fragmentation, which can undermine the unity, coherence, and effectiveness of the profession.

Stigma: The distinction between marginal practitioners and limited practitioners also creates a stigma, or a negative label, that can be applied to chiropractors who are perceived as unqualified, unethical, or dangerous. This stigma can harm the reputation of the profession, and discourage patients from seeking chiropractic care.

Safety: The distinction between marginal practitioners and limited practitioners raises concerns about the safety of chiropractic care, especially for patients who may be treated by unqualified or unethical practitioners. Marginal practitioners, in particular, may lack the knowledge, skills, and ethical standards required to provide safe and effective care, which can put patients at risk of harm.

Quality of care: The distinction between marginal practitioners and limited practitioners also raises concerns about the quality of chiropractic care, especially for patients who may be treated by practitioners who are limited in their scope of practice. Limited practitioners, in particular, may not be able to provide the full range of diagnostic, therapeutic, and preventive services that patients may need, which can result in suboptimal outcomes and higher costs of care.

Should such distinctions be applied to the profession?

In my opinion, the distinction between marginal practitioners and limited practitioners should not be applied to the profession of chiropractic, as it is arbitrary, divisive, and detrimental to the quality of care and reputation of the profession. Here are some reasons why:

Lack of evidence: There is little empirical evidence to support the distinction between marginal practitioners and limited practitioners, or to demonstrate its validity or usefulness. Most studies on chiropractic education and practice have focused on accredited or mainstream practitioners, rather than on marginal or limited practitioners, making it difficult to draw definitive conclusions about their education, training, or outcomes.

Inadequate regulation: The distinction between marginal practitioners and limited practitioners highlights the need for better regulation and oversight of the chiropractic profession, especially in terms of education, training, licensure, and scope of practice. However, relying on this distinction as a basis for regulation may be inadequate or ineffective, as it does not address the underlying causes of poor quality or unethical practices, such as inadequate standards, poor enforcement, or lack of accountability.

Professional identity: The distinction between marginal practitioners and limited practitioners may also undermine the professional identity and autonomy of chiropractors, by imposing external or arbitrary criteria on their education, training, or scope of practice. Chiropractors should be able to define and develop their own standards and competencies, based on their knowledge, skills, and values, rather than on external or imposed criteria.

Patient-centered care: The distinction between marginal practitioners and limited practitioners may also neglect the perspective and needs of patients, who may not be aware of or concerned with the education, training, or status of their chiropractor, but rather with the quality, safety, and effectiveness of their care. Chiropractors should prioritize patient-centered care, which is based on the principles of partnership, responsiveness, respect, and empowerment, rather than on the distinction between marginal practitioners and limited practitioners.

Conclusion

The distinctions between marginal and limited practitioners in chiropractic can have both positive and negative impacts on the profession and on patients. While these distinctions can help ensure that patients receive safe and effective care from qualified practitioners, they can also create social hierarchies and limit access to care in some areas. It is important for the chiropractic profession to continue to address these issues and work towards providing high-quality care for all patients, regardless of the practitioner’s level of education or training. This can be achieved through increased access to education and training programs, resources for continuing education and professional development, and efforts to address bias and discrimination within the profession.

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NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Example

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NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Example

NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders ExampleNRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Assignment

NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Assignment Brief

Assignment Instructions Overview

This assignment focuses on assessing and diagnosing patients with neurocognitive and neurodevelopmental disorders. Neurodevelopmental disorders, which typically manifest during childhood, include conditions like ADHD, autism spectrum disorder, and intellectual disabilities. Neurocognitive disorders, such as Alzheimer’s and vascular dementia, represent a decline in previous cognitive abilities and may emerge later in life. Students will use a case study from a video to assess a patient, develop differential diagnoses, and create a comprehensive psychiatric evaluation using DSM-5-TR guidelines.

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Understanding Assignment Objectives

The primary goal of this assignment is to apply theoretical knowledge to real-world cases of neurocognitive and neurodevelopmental disorders. Students will analyze the patient’s symptoms, gather relevant medical history, and perform mental status examinations. Based on these findings, they will explore potential differential diagnoses and identify a primary diagnosis using DSM-5-TR criteria. Critical thinking is emphasized in ruling out other conditions and justifying diagnostic decisions.

The Student’s Role

Students will assume the role of a psychiatric nurse practitioner tasked with performing a thorough evaluation. This includes engaging with the patient’s subjective experience, observing objective behaviors, conducting a mental status exam, and providing evidence-based differential diagnoses. Students will reflect on the session and incorporate legal, ethical, and health promotion considerations in their treatment plans.

Competencies Measured

This assignment will assess the student’s ability to:

  • Evaluate neurocognitive and neurodevelopmental symptoms and presentations.
  • Perform a comprehensive psychiatric assessment, utilizing diagnostic tools.
  • Differentiate between various disorders using DSM-5-TR criteria.
  • Formulate accurate primary diagnoses with supporting evidence.
  • Apply ethical considerations and critical thinking in patient care planning.

 

You can also read other assignment examples for the NRNP 6635 – Psychopathology and Diagnostic Reasoning Course below:

NRNP 6635 Week 1: Competencies of Advanced Nursing Practice Paper Example

NRNP 6635 Week 1 Assignment 2: Clinical Skills Self-Assessment Paper Example

NRNP 6635 Week 2: Practicum Experience Plan (PEP) Paper Example

NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Paper Example

NRNP 6635 Week 4: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper Example

NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Example

NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example

NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Example

Introduction

Neurocognitive and neurodevelopmental disorders are complex conditions that require careful assessment and differentiation to ensure proper diagnosis and management. Neurodevelopmental disorders often present in childhood and can persist into adulthood, encompassing conditions like attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). In contrast, neurocognitive disorders represent a decline from previous functioning due to conditions like Alzheimer’s disease, brain injury, or stroke. This paper will provide a comprehensive psychiatric evaluation of Harold Brown, a 60-year-old male presenting with potential neurocognitive symptoms. The assessment will explore his clinical presentation, differential diagnosis, and develop a treatment plan based on evidence and DSM-5-TR criteria.

Subjective Data

Chief Complaint:

Harold Brown reports mild difficulty with attention and short-term memory, particularly when recalling recent events. He has expressed concerns about these issues affecting his daily activities, although he continues to work part-time as an engineer. He denies significant interference with basic functioning but mentions occasional lapses in attention and memory at work and in social settings. He was encouraged by his brother to seek evaluation after noticing a pattern of forgetfulness and distraction.

History of Present Illness (HPI):

Mr. Brown states that his symptoms began approximately 18 months ago and have gradually worsened. He reports difficulty maintaining focus during long tasks and trouble recalling names or recent conversations. He denies any abrupt changes in memory, mood disturbances, or significant changes in his personality. He describes himself as independent, though he acknowledges his brother’s concerns regarding his recent forgetfulness. His symptoms do not seem to vary based on time of day or specific activities. He denies any head trauma, seizures, or major medical illnesses contributing to his cognitive difficulties.

Medical History:

  • Hypertension: Controlled with Cozaar (Losartan) 100mg daily
  • Hypertriglyceridemia: Managed with fenofibrate 160mg daily
  • Benign Prostatic Hyperplasia (BPH): Managed with tamsulosin 0.4mg at bedtime
  • Angina: Taking aspirin 81mg daily

Medications:

  • Cozaar (Losartan) 100mg daily
  • Fenofibrate 160mg daily
  • Tamsulosin 0.4mg at bedtime
  • Aspirin 81mg daily

Allergies:

Allergic to Dilaudid.

Family History:

His father had hypertension and passed away at the age of 75 due to complications from a stroke. His mother died of Alzheimer’s disease at the age of 80. He has one younger brother, who is in good health.

Social History:

Mr. Brown lives alone, has never married, and has no children. He casually dates and reports a healthy social life. He enjoys having a scotch and cigar on weekends. He denies any history of drug use. He continues to work part-time and maintains good relationships with his colleagues and family members.

Developmental History:

No developmental delays or learning difficulties reported in childhood or adolescence.

Objective Data

General Appearance and Behavior:

Mr. Brown presents as a well-groomed, alert, and oriented male who appears his stated age. He is cooperative and maintains good eye contact throughout the interview. No abnormal movements or signs of agitation were observed. His speech was fluent and coherent, with normal rate and rhythm.

Vital Signs:

  • Temperature: 98.8°F
  • Pulse: 74 bpm
  • Respiration: 18 breaths/min
  • Blood Pressure: 134/70 mmHg
  • Height: 5’10”
  • Weight: 170 lbs

Neurological/Cognitive Observations:

  • Montreal Cognitive Assessment (MoCA): Score of 28/30, indicating mild cognitive impairment. Notable difficulty was observed in the attention and delayed recall sections of the test.
  • Attention Deficit: He had trouble sustaining attention during long tasks, such as performing serial 7s.
  • Memory: Delayed recall was impaired, as he struggled to remember words presented earlier during the MoCA. Immediate memory, however, remained intact.

Mental Status Examination (MSE)

Appearance:

Well-groomed, appropriately dressed for the weather and occasion.

Behavior:

Cooperative, calm, and maintains appropriate eye contact throughout the interview.

Speech:

Normal rate, volume, and tone, with no evidence of aphasia.

Mood:

Euthymic. He denies experiencing low mood or anxiety.

Affect:

Appropriate and full range.

Thought Process:

Logical, coherent, and goal-directed. No evidence of thought blocking or tangential thinking.

Thought Content:

Denies any hallucinations, delusions, or paranoia. No suicidal or homicidal ideation.

Cognition:

Oriented to person, place, time, and situation. Mild impairment observed in delayed recall and sustained attention.

Insight and Judgment:

Good. He demonstrates understanding of his symptoms and the need for evaluation.

Assessment and Differential Diagnoses

Based on the patient’s history, clinical presentation, and mental status examination, the following differential diagnoses are considered:

  1. Mild Neurocognitive Disorder due to Alzheimer’s Disease

Supporting Evidence: His family history of Alzheimer’s (mother) and his subtle cognitive decline over the last 18 months support this diagnosis. His MOCA score of 28/30 with difficulty in attention and delayed recall aligns with mild neurocognitive disorder, which is often an early sign of Alzheimer’s disease. The DSM-5-TR criteria for mild neurocognitive disorder (memory impairment and cognitive decline without significant impairment of daily functioning) fit the presentation.

  1. Vascular Cognitive Impairment

Supporting Evidence: Mr. Brown has a history of hypertension, a major risk factor for vascular dementia. Cognitive impairments such as attention deficits and executive function difficulties are consistent with vascular cognitive impairment. However, the lack of a history of stroke or other clear vascular events makes this less likely.

  1. Major Depressive Disorder with Cognitive Impairment

Supporting Evidence: Depression can sometimes present as cognitive impairment in older adults. Mr. Brown does not report any mood changes or depressive symptoms, but mild cognitive impairment can sometimes be misdiagnosed as early Alzheimer’s disease in the context of mood disorders. The absence of significant mood changes, however, rules this out as the primary diagnosis.

Primary Diagnosis:

The most likely diagnosis is Mild Neurocognitive Disorder due to Alzheimer’s Disease, given the gradual onset, specific memory and attention deficits, and family history.

Plan and Recommendations

Pharmacological Treatment:

Initiate cholinesterase inhibitors such as donepezil (5mg daily) to slow cognitive decline. Consider an NMDA receptor antagonist like memantine if cognitive decline progresses.

Non-Pharmacological Interventions:

Cognitive Behavioral Therapy (CBT): To assist with adapting to cognitive changes and reducing anxiety around his symptoms.

Cognitive Training and Memory Exercises: Regular cognitive exercises, such as puzzles or memory games, may help slow further cognitive decline.

Lifestyle Modifications: Encourage regular physical exercise, a heart-healthy diet (such as the Mediterranean diet), and social engagement to reduce cognitive decline risk.

Follow-up:

Monitor the patient every 3 months for changes in cognitive functioning and reassess the treatment plan. Discuss potential lifestyle changes and engage family members in the care plan.

Reflection

What I Would Do Differently:

If I were to conduct this session again, I would explore more thoroughly Mr. Brown’s daily life and work challenges to assess the extent to which his cognitive decline affects his functional capacity. I would also probe further into his emotional responses to his cognitive changes, as denial or minimization of symptoms can sometimes obscure significant distress.

Legal and Ethical Considerations:

Given Mr. Brown’s independence, it’s essential to discuss future planning, such as advance directives, while he still has the cognitive capacity to make informed decisions. His family history of Alzheimer’s suggests the need for discussions around eventual caregiving needs.

Health Promotion and Disease Prevention:

Education on managing hypertension and hyperlipidemia is crucial to reduce further vascular risks. Continued control of these conditions may help slow cognitive decline. Additionally, promoting brain-healthy habits, such as regular exercise, a nutritious diet, and cognitive activities, will be emphasized.

Conclusion

The evaluation of Harold Brown’s cognitive functioning demonstrates the complexity of diagnosing neurocognitive disorders. While mild cognitive impairment is present, the primary diagnosis of mild neurocognitive disorder due to Alzheimer’s disease is supported by his clinical presentation, family history, and DSM-5-TR criteria. Through careful assessment and early intervention, Mr. Brown’s cognitive decline can be managed with appropriate treatment and lifestyle modifications.

Detailed Assessment Instructions for the NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Assignment

Description

Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders

Photo Credit: Getty Images

Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from the very specific to a general or global impairment, and often co-occur (APA, 2022). They include specific learning and language disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and intellectual disabilities. Neurocognitive disorders, on the other hand, represent a decline in one or more areas of prior mental function that is significant enough to impact independent functioning. They may occur at any time in life and be caused by factors such brain injury; diseases such as Alzheimer’s, Parkinson’s, or Huntington’s; infection; or stroke, among others.

For this Assignment, you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder.

TO PREPARE:

  • Review this week’s Learning Resources and consider the insights they provide. Consider how neurocognitive impairments may have similar presentations to other psychological disorders.
  • Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
  • By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Identify at least three possible differential diagnoses for the patient.

By Day 7 of Week 10

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology 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 priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.
  • Reflection notes: What would you do differently with this client if you could conduct the session over? 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.).
  • Required Readings (click to expand/reduce)

American Psychiatric Association. (2022). Neurocognitive disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?u…https://dsm.psychiatryonline.org/doi/full/10.1176/…

American Psychiatric Association. (2022). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?u…https://dsm.psychiatryonline.org/doi/full/10.1176/…

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

    • Chapter 21, Neurocognitive Disorders
    • Chapter 31, Child Psychiatry

Document: Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation Exemplar

 

Required Media (click to expand/reduce)

Classroom Productions. (Producer). (2016). Neurocognitive disorders [Video]. Walden University.

Classroom Productions. (Producer). (2016). Neurodevelopmental disorders [Video]. Walden University.

MedEasy. (2016). Progressive neurocognitive disorders. | USMLE & COMLEX[Video]. YouTube.

 

 

Video Case Selections for Assignment (click to expand/reduce) Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Symptom Media. (Producer). (2017). Training title 48 [Video]. https://go.openathens.net/redirector/waldenu.edu?u…

Symptom Media. (Producer). (2017). Training title 50 [Video]. https://go.openathens.net/redirector/waldenu.edu?u…

Document: Case History Reports

Week 10 Neurocognitive and Neurodevelopmental Disorders Training Title 48
Name: Sarah Higgins
Gender: female
Age: 11 years old
T- 97.4 P- 58 R 14 98/62 Ht 4’5 Wt 65lbs
Background: no history of treatment, developmental milestones met on time, vaccinations up to date. Sleeps 9-10hrs/night, meals are difficult as she has hard time sitting for meals, she does get proper nutrition per PCP. she has a younger brother. lives with her parents in Washington,
D.C. No hx of head trauma.
Symptom Media. (Producer). (2017). Training title 48 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-48
Training Title 50
Name: Harold Brown
Gender: male
Age:60 years old
T- 98.8 P- 74 R 18 134/70 Ht 5’10 Wt 170lbs Background:
Has bachelor’s degree in engineering. He dates casually, never married, no children. Has one younger brother. Sleeps 7 hours, appetite good. Denied legal issues; MOCA 28/30 difficulty with attention and delayed recall; ASRS-5 21/24; denied hx of drug use; enjoys one scotch drink on the weekends with a cigar. Allergies Dilaudid; history HTN blood pressure controlled with Cozaar 100mg daily, angina prescribed ASA 81mg po daily, valsartan 80mg daily. Hypertriglyceridemia prescribed fenofibrate 160mg daily, has BPH prescribed tamsulosin 0.4mg po bedtime.
Symptom Media. (Producer). (2017). Training title 50 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-50

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NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Example

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NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Example

NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation ExampleNRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation; Midterm Clinical Evaluation

NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Assignment Brief

Assignment Instructions Overview:

This assignment requires students to conduct a comprehensive psychiatric evaluation of a patient they have encountered in the last five weeks of their practicum. Using the provided template, the student must document the evaluation and present the case in a recorded video. The video should include the chief complaint, the history of present illness, and pertinent medical and psychiatric history, among other elements. Students should submit the written evaluation alongside the signed pages from their preceptor.

Understanding Assignment Objectives:

The objective of this assignment is to demonstrate the ability to assess a patient’s psychiatric health comprehensively. Students will apply their knowledge from the Learning Resources to analyze a patient case, develop a working diagnosis, and present a differential diagnosis. This assignment connects real-life practicum experience with academic learning, fostering critical thinking in psychiatric evaluation and diagnosis.

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The Student’s Role:

The student acts as the primary evaluator, documenting the patient’s case thoroughly, presenting clinical findings, and showcasing their diagnostic reasoning skills. The student must demonstrate professionalism, clinical competence, and the ability to synthesize patient information while adhering to ethical standards, including maintaining patient confidentiality as per HIPAA regulations.

Competencies Measured:

This assignment measures several competencies, including the ability to conduct a thorough psychiatric evaluation, utilize critical thinking for diagnosis, present cases professionally, and develop a comprehensive care plan. Students are also expected to apply scholarly resources to support their diagnostic and treatment decisions, reinforcing evidence-based practice.

You can also read other assignment examples for the NRNP 6635 – Psychopathology and Diagnostic Reasoning Course below:

NRNP 6635 Week 1: Competencies of Advanced Nursing Practice Paper Example

NRNP 6635 Week 1 Assignment 2: Clinical Skills Self-Assessment Paper Example

NRNP 6635 Week 2: Practicum Experience Plan (PEP) Paper Example

NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Paper Example

NRNP 6635 Week 4: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper Example

NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Example

NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Example

NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example

NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Example

Chief Complaint (CC):

  • A 36-year-old male presenting with restlessness, agitation, disorganized speech, impaired cognition, and periodic delusions.

History of Present Illness (HPI):

  • Symptoms have fluctuated over three weeks with episodes of restlessness alternating with lack of motivation and withdrawal. Delusions and hallucinations have persisted for four weeks.

Past Psychiatric History:

  • Diagnosed with bipolar disorder 10 years ago and schizophrenia at age 30. Non-adherence to medication is a noted issue.
  • History of one hospitalization following a suicide attempt.
  • Previous and current medications are detailed, including issues experienced with fluphenazine.

Substance Use History:

  • History of binge drinking, cigarette, and cannabis use since his undergraduate years. Still smokes cigarettes and drinks alcohol occasionally.

Family Psychiatric/Substance Use History:

  • Schizophrenia in the paternal grandfather and a family history of substance use (cigarette smoking, alcohol).

Psychosocial History:

  • Married with one child, working as a software engineer. History of violent behavior leading to arrest and imprisonment.

Medical History:

  • History of head injuries from violent behavior and a minor car accident, as well as past hospitalization for malaria.

Current Medications:

  • Sodium valproate, sertraline, alprazolam, and aripiprazole.

Allergies:

  • None.

Reproductive History:

  • Heterosexual, married with one child, sexually active with occasional withdrawal during symptom flares.

Review of Systems (ROS):

  • General: Weight gain.
  • HEENT: Normal.
  • Skin: Warm, normal turgor.
  • Cardiovascular: Normal BP and heart rate.
  • Respiratory: Normal.
  • Gastrointestinal: Normal.
  • Neurological: Tingling in limbs and difficulty moving feet.
  • Musculoskeletal: Stiffness in lower extremities.
  • Other systems are unremarkable.

Diagnostic Results:

  • Head CT scan showed no physical injury.
  • Blood tests revealed positive for alcohol, cigarette, and cannabis use.

Mental Status Examination:

  • Appropriately dressed, aware of time and occasion.
  • Admitted to suicidal ideation.

Differential Diagnoses:

  • Schizophrenia, Bipolar Disorder, Major Depressive Disorder.
  • Schizophrenia is diagnosed based on DSM-5 criteria.

Reflections:

  • The diagnosis of schizophrenia requires careful assessment, supported by symptom clusters and appropriate diagnostics. The case reinforced the need for a compassionate approach to psychiatric care, emphasizing public education on modifiable risk factors like substance abuse.

Detailed Assessment Instructions for the NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Assignment

Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation 

Photo Credit: Pexels

Comprehensive psychiatric evaluations are a way to reflect on your practicum experiences and connect the experiences to the learning you gain from your weekly Learning Resources. Comprehensive notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.

For this Assignment, you will document information about a patient that you examined during the last 5 weeks, using the Comprehensive Psychiatric Evaluation Template provided. You will then use this note to develop and record a case presentation for this patient.

To Prepare

  • Select a patient that you examined during the last 5 weeks. Review prior resources on the disorder this patient has. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
  • Conduct a Comprehensive Psychiatric Evaluation on this patient using the template provided in the Learning Resources. There is also a completed exemplar document in the Learning Resources so that you can see an example of the types of information a completed evaluation document should contain. All psychiatric evaluations must be signed, and each page must be initialed by your Preceptor. When you submit your document, you should include the complete Comprehensive Psychiatric Evaluation as a Word document, as well as a PDF/images of each page that is initialed and signed by your Preceptor. You must submit your document using SafeAssign.Please Note:Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Late Policies.
  • Develop a video case presentation, based on your progress note of this patient, that includes chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis, including differentials that were ruled out.
  • Include at least five (5) scholarly resources to support your assessment and diagnostic reasoning.
  • Ensure that you have the appropriate lighting and equipment to record the presentation.

Assignment

Record yourself presenting the complex case for your clinical patient. In your presentation:

  • Dress professionally with a lab coat and present yourself in a professional manner.
  • Display your photo ID at the start of the video when you introduce yourself.
  • Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
  • Present the full case. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis, including differentials that were ruled out.
  • Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.

Be succinct in your presentation, and do not exceed 8 minutes. Address the following:

  • Subjective: What details did the patient provide regarding their personal and medical history? What are their symptoms of concern? How long have they been experiencing them, and what is the severity? How are their symptoms impacting their functioning?
  • Objective: What observations did you make during the interview and review of systems?
  • Assessment:What were your differential diagnoses? Provide a minimum of three (3) possible diagnoses. List them from highest to lowest priority. What was your primary diagnosis, and why?
  • Reflection notes:What would you do differently in a similar patient evaluation?

By Day 7

Submit your Video and Comprehensive Psychiatric Evaluation. You must submit two (2) files for the evaluation, including a Word document and scanned PDF/images of each page that is initialed and signed by your Preceptor.

Learning Resources

Required Readings (click to expand/reduce)

HSoft Corporation. (2020). Meditrek: Home. https://edu.meditrek.com/Default.html  Note: Use this website to log into Meditrek to report your clinical hours and patient encounters.

HYPERLINK “https://class.content.laureate.net/1e563a49109e04e68af6cce117ed2d58.doc” \o “Comprehensive Psychiatric Evaluation Template”

Document: Comprehensive Psychiatric Evaluation Template (Word document)

HYPERLINK “https://class.content.laureate.net/feb2627c3a7610b39580d603c1c9a879.doc” \o “Comprehensive Psychiatric Evaluation Exemplar”

Document: Comprehensive Psychiatric Evaluation Exemplar (Word document)

Recommended Resources

American Psychiatric Association. (2013). Disruptive, impulse-control, and conduct disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm15

American Psychiatric Association. (2013). Dissociative disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm08

 

American Psychiatric Association. (2013). Somatic symptom and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm09

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.

 

Walden University. (2020). College of Nursing practicum manual: Master of science in nursing (MSN) and post-master’s certificate programs. https://academicguides.waldenu.edu/fieldexperience/son/formsanddocuments

HYPERLINK “https://academicguides.waldenu.edu/fieldexperience/son/home” \o “College of Nursing” \t “_blank”

Walden University Field Experience. (2020a). Field experience: College of Nursing. https://academicguides.waldenu.edu/fieldexperience/son/home  

HYPERLINK “https://academicguides.waldenu.edu/StudentPracticum/NP_StudentOrientation” \o “Student practicum resources: NP student ” \t “_blank”

Walden University Field Experience. (2020b). Student practicum resources: NP student orientation. https://academicguides.waldenu.edu/StudentPracticum/NP_StudentOrientation

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NRNP 6635 Week 4: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper Example

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NRNP 6635 Week 4: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper Example

NRNP 6635 Week 4: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper ExampleAssignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

NRNP 6635 Week 4: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Assignment Brief

Assignment Instructions Overview:

This assignment focuses on developing the skills necessary for assessing and diagnosing anxiety disorders, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). Students are required to conduct a thorough psychiatric evaluation using a comprehensive approach. The evaluation should include both subjective and objective data, along with critical-thinking steps that guide diagnostic decision-making based on DSM-5 criteria.

The goal is to apply clinical knowledge and diagnostic tools to assess the severity, duration, and impact of symptoms, as well as differentiate between possible diagnoses.

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Understanding Assignment Objectives:

The main objectives of this assignment are to:

  • Evaluate patients presenting with symptoms of anxiety, PTSD, and OCD.
  • Use DSM-5 criteria to guide diagnostic decisions.
  • Develop a differential diagnosis process by comparing symptoms and identifying the most accurate primary diagnosis.
  • Apply ethical considerations and health promotion strategies during patient evaluation.
  • Through this assignment, students will gain experience in recognizing various anxiety-related disorders and trauma-related conditions while practicing the art of patient-centered care.

The Student’s Role:

Students are expected to assume the role of a healthcare provider conducting a psychiatric assessment. This involves gathering a comprehensive history, performing mental status examinations, and documenting observations. Students will need to consider the patient’s background, experiences, and presenting symptoms when determining a differential diagnosis and developing an appropriate care plan.

The role also includes reflecting on the patient interaction, considering alternative approaches, and addressing any legal, ethical, or cultural factors that could influence diagnosis and treatment.

Competencies Measured:

This assignment will assess the following competencies:

  • Clinical Evaluation: Ability to gather detailed subjective and objective data from patient history and psychiatric assessments.
  • Diagnostic Reasoning: Application of DSM-5 criteria to identify and rule out potential mental health disorders.
  • Critical Thinking: Development of a structured thought process in diagnosing anxiety disorders, PTSD, and OCD, supported by evidence-based practice.
  • Ethical Considerations: Understanding of the legal and ethical dimensions of mental health treatment, including consent, confidentiality, and culturally competent care.
  • Health Promotion: Integration of health promotion strategies into patient care, considering factors like age, ethnicity, and socioeconomic status that may impact diagnosis and treatment planning.

You can also read other assignment examples for the NRNP 6635 – Psychopathology and Diagnostic Reasoning Course below:

NRNP 6635 Week 1: Competencies of Advanced Nursing Practice Paper Example

NRNP 6635 Week 1 Assignment 2: Clinical Skills Self-Assessment Paper Example

NRNP 6635 Week 2: Practicum Experience Plan (PEP) Paper Example

NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Paper Example

NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Example

NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Example

NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example

NRNP 6635 Week 4: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper Example

Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

Subjective:

Chief Complaint (CC):

The patient reports that he “cannot handle negative situations.”

History of Present Illness (HPI):

Sergeant Berry Sullivan, a 27-year-old male, has presented for a mental health evaluation following an eight-year service in the military, during which he completed three extended tours in various war zones. He describes a challenging transition to civilian life after his military discharge, which occurred less than a year ago. During his service, Mr. Sullivan was exposed to multiple traumatic events, though he has refrained from providing detailed descriptions of these incidents. He reports that his symptoms, including an inability to cope with negative situations, have progressively worsened since leaving active duty. He denies experiencing flashbacks or nightmares, but notes feelings of irritability and hypervigilance. Additionally, he discloses a troubled childhood marked by an abusive, alcoholic father. Despite these stressors, he has never engaged in substance use due to his father’s alcoholism. Mr. Sullivan denies any prior history of psychiatric disorders, stating that he has never experienced anxiety, PTSD, or major depressive disorder (MDD) symptoms before his recent struggles.

Past Psychiatric History:

General Statement:

The patient was raised in a low-income family with an abusive, alcoholic father. After high school, he joined the military, where he served for eight years, experiencing combat in multiple war zones. He has no documented psychiatric history, but mentions that his paternal grandfather also served in the military and suffered from depression.

 

Hospitalizations:

No history of psychiatric hospitalizations or mental health treatment.

Medication Trials:

Mr. Sullivan has not undergone any medication trials for mental health conditions.

Psychotherapy or Previous Psychiatric Diagnosis:

The patient denies having previously received any form of psychotherapy or psychiatric diagnosis.

Substance Use History:

Mr. Sullivan has abstained from alcohol and illicit drugs throughout his life due to his father’s severe alcoholism.

Family Psychiatric/Substance Use History:

Paternal History:

The patient’s father is an alcoholic and exhibited abusive behavior during his childhood. His paternal grandfather, also a military veteran, reportedly suffered from depression but never sought professional help.

Psychosocial History:

Mr. Sullivan was raised in a low-income household, and his upbringing was deeply affected by his father’s alcoholism and abuse. His mother remains in good health, but his father suffers from diabetes, liver cirrhosis, and hypertension (HTN). Mr. Sullivan has two siblings, an older sister and a younger brother. He lives with his fiancée and expresses a desire to have children in the future. He is currently unemployed and finding it difficult to adjust to civilian life, contributing to his increased stress and anxiety.

Medical History:

Current Medications:

Mr. Sullivan takes medication for asthma, a condition exacerbated by seasonal allergies, which he attributes to his time in the military.

Allergies:

The patient denies any known allergies.

Reproductive History (Hx):

Mr. Sullivan is not currently a parent, but he and his fiancée hope to have children.

Review of Systems (ROS):

General:

The patient is alert and oriented, with an appropriate appearance and demeanor for the interview. He does not appear to be in any acute distress.

HEENT (Head, Eyes, Ears, Nose, Throat):

No reports of trauma or injury.

Skin:

No rashes or skin irritations.

Cardiovascular:

Denies chest pain or discomfort, no evidence of edema in extremities.

Respiratory:

Reports shortness of breath and occasional difficulty breathing, which he attributes to his asthma and military-related allergies.

Gastrointestinal:

The patient has experienced occasional nausea and vomiting.

Genitourinary:

Denies any genitourinary symptoms, including abnormal urination.

Neurological:

No reported neurological symptoms such as numbness or tingling.

Musculoskeletal:

Denies joint or muscle pain, and no visible signs of swelling or discomfort.

Hematologic:

No history of unusual bruising, bleeding, or blood disorders.

Lymphatic:

Denies enlarged lymph nodes.

Endocrinologic:

No symptoms of polyuria, polydipsia, or polyphagia.

Objective:

Physical Examination:

Temperature (T): 98.8°F

Pulse (P): 86 beats per minute

Respiratory Rate (R): 18 breaths per minute

Blood Pressure (BP): 122/78 mmHg

Height (Ht): 5’8”

Weight (Wt): 160 lbs

Diagnostic Results:

A comprehensive psychiatric assessment is recommended, including standardized tools for evaluating depression, anxiety, and PTSD. Blood work should also be conducted to assess thyroid function (thyroid-stimulating hormone) and rule out any underlying medical conditions that could contribute to psychiatric symptoms.

Assessment:

Mental Status Examination (MSE):

Appearance: The patient appeared well-groomed, with appropriate hygiene for the situation.

Eye Contact: Eye contact was fair throughout the interview.

Speech: Speech was clear and normal in tone, rhythm, and volume.

Behavior: Cooperative and calm demeanor.

Psychomotor Activity: No evidence of involuntary movements.

Mood: Reported feeling “depressed.”

Thought Process: Thought processes were logical, goal-directed, and organized.

Thought Content: No delusions or evidence of psychosis. Denied suicidal ideation.

Perception: No hallucinations were reported or observed.

Cognition: The patient was alert and oriented to person, place, time, and situation.

Memory: Both short-term and long-term memory appeared intact based on the patient’s recollection of events.

Insight: Insight into his condition appeared fair.

Judgment: Judgment was assessed as fair.

Differential Diagnoses:

Post-Traumatic Stress Disorder (PTSD):

Mr. Sullivan exhibits several hallmark symptoms of PTSD, including hypervigilance, irritability, and difficulty adjusting to civilian life following traumatic combat experiences. His military history suggests prolonged exposure to traumatic events, making PTSD a highly likely diagnosis. PTSD is defined by the DSM-5 as occurring after exposure to actual or threatened death, serious injury, or sexual violence, either directly or indirectly. Symptoms may include intrusive memories, avoidance behaviors, negative mood changes, and hyperarousal.

Generalized Anxiety Disorder (GAD):

Anxiety disorders are common among veterans, especially those transitioning back into civilian life. Mr. Sullivan has reported difficulty coping with negative situations and has shown signs of persistent worry, which could indicate generalized anxiety disorder. According to the DSM-5, GAD is characterized by excessive worry about various events or activities for at least six months, along with symptoms such as restlessness, fatigue, difficulty concentrating, irritability, and muscle tension.

Major Depressive Disorder (MDD):

Mr. Sullivan’s report of a depressed mood, feelings of hopelessness, and loss of interest in activities could suggest a diagnosis of MDD. According to the DSM-5, MDD is characterized by a two-week period of pervasive low mood and anhedonia, with associated symptoms like changes in appetite, sleep disturbances, fatigue, and difficulty concentrating.

Reflection:

In reflecting on this case, I would ensure a more thorough exploration of Mr. Sullivan’s emotional responses to his traumatic experiences, particularly focusing on any potential avoidance behaviors or emotional numbing. Additionally, I would ask more specific questions about his daily functioning and relationships, which could provide further insight into the severity of his PTSD symptoms. Legal and ethical considerations include the importance of addressing the stigma associated with mental health in military populations and ensuring that the patient feels supported in seeking treatment. Culturally sensitive care is also essential, considering the patient’s background and military service.

References

Bryant, R. A. (2019). Post‐traumatic stress disorder: A state‐of‐the‐art review of evidence and challenges. World Psychiatry, 18(3), 259-269.

Chin, D. L., & Zeber, J. E. (2020). Mental health outcomes among military service members after severe injury in combat and TBI. Military Medicine, 185(5-6), e711-e718.

Koyuncu, A., İnce, E., Ertekin, E., & Tükel, R. (2019). Comorbidity in social anxiety disorder: Diagnostic and therapeutic challenges. Drugs in Context, 8.

Smith, G. P., & Hartelius, G. (2020). Resolution of dissociated ego states relieves flashback-related symptoms in combat-related PTSD: A brief mindfulness-based intervention. Military Psychology, 32(2), 135-148.

Waitzkin, H., Cruz, M., Shuey, B., Smithers, D., Muncy, L., & Noble, M. (2018). Military personnel who seek health and mental health services outside the military. Military Medicine, 183(5-6), e192-e200.

Detailed Assessment Instructions for the NRNP 6635 Week 4: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper Assignment

Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

Description

Fear,” according to the DSM-5, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2013). All anxiety disorders contain some degree of fear or anxiety symptoms (often in combination with avoidant behaviors), although their causes and severity differ. Trauma-related disorders may also, but not necessarily, contain fear and anxiety symptoms, but their primary distinguishing criterion is exposure to a traumatic event. Trauma can occur at any point in life. It might not surprise you to discover that traumatic events are likely to have a greater effect on children than on adults. Early-life traumatic experiences, such as childhood sexual abuse, may influence the physiology of the developing brain. Later in life, there is a chronic hyperarousal of the stress response, making the individual vulnerable to further stress and stress-related disease.

Photo Credit: Hill Street Studios / Blend Images / Getty Images

For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5 criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5 criteria. 

To Prepare:

  • Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.
  • Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document. 
  • By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Identify at least three possible differential diagnoses for the patient.

By Day 7 of Week 4

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology 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 priority 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.
  • Reflection notes:What would you do differently with this client if you could conduct the session over? 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.).

https://ezp.waldenulibrary.org/login?qurl=https://video.alexanderstreet.com/watch/training-title-21?account_id=14872&usage_group_id=95102

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NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Paper Example

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NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Paper Example

NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Paper ExampleNRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Assignment

NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Assignment Brief

Assignment Instructions Overview:

In this assignment, students are required to assess and diagnose patients with mood disorders, focusing on accurate diagnostic methods and critical thinking. The assignment highlights the complexities of diagnosing depressive and bipolar disorders, considering that these conditions often present with periodic and cyclic symptomology. Diagnosis may also be influenced by external stressors and cultural backgrounds, potentially impacting the client’s treatment-seeking behavior.

Students are expected to utilize the Comprehensive Psychiatric Evaluation Template to conduct a thorough evaluation, incorporating subjective and objective data, differential diagnoses, and a reflective analysis of the patient’s case.

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Understanding Assignment Objectives:

The primary objective of this assignment is to develop a detailed understanding of mood disorders through practical assessment and diagnosis. Students will evaluate patients via case studies, identifying patterns and symptoms of mood disorders such as major depressive disorder (MDD) and bipolar disorder. This task also aims to enhance students’ ability to apply diagnostic criteria from the DSM-5-TR and to navigate the complexities of mental health treatment with cultural sensitivity and ethical awareness.

The Student’s Role:

Students are responsible for:

  • Selecting and reviewing a video case study.
  • Gathering and analyzing a patient’s subjective and objective history.
  • Conducting a comprehensive psychiatric evaluation.
  • Formulating at least three differential diagnoses using the DSM-5-TR.
  • Explaining the reasoning behind the primary diagnosis.
  • Reflecting on the diagnostic process and identifying areas for improvement.

The assignment also requires students to demonstrate clinical judgment, legal/ethical considerations, and awareness of health promotion strategies tailored to individual patients’ socioeconomic, cultural, and medical backgrounds.

Competencies Measured:

  • Clinical Reasoning & Critical Thinking: Ability to apply psychiatric assessment skills to real-world case studies and generate differential diagnoses.
  • Diagnostic Proficiency: Knowledge of DSM-5-TR criteria and its application in assessing mood disorders.
  • Cultural Competence & Ethical Awareness: Sensitivity to cultural factors influencing mood disorders and adherence to ethical standards in psychiatric practice.
  • Patient-Centered Care: Designing treatment plans that address mental health issues while considering broader aspects of patient health and well-being, including prevention strategies.

You can also read other assignment examples for the NRNP 6635 – Psychopathology and Diagnostic Reasoning Course below:

NRNP 6635 Week 1: Competencies of Advanced Nursing Practice Paper Example

NRNP 6635 Week 1 Assignment 2: Clinical Skills Self-Assessment Paper Example

NRNP 6635 Week 2: Practicum Experience Plan (PEP) Paper Example

NRNP 6635 Week 4: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper Example

NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Example

NRNP 6635 Week 6: Neurocognitive, Neurodevelopmental, Eating, and Somatic Symptom-Related Disorders Example

NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example

NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Paper Example

Comprehensive Psychiatric Evaluation

Patient Information:

  • Name: A.M.
  • Age: 34
  • Gender: Male
  • Race: African-American
  • Marital Status: Divorced

Chief Complaint (CC):

“I feel like I’m always in a bad mood, and it’s hard for me to concentrate or enjoy anything. It’s been like this for months.”

History of Present Illness (HPI):

A.M. is a 34-year-old African-American male who presents with complaints of persistent low mood, lack of interest in daily activities, and difficulty concentrating. These symptoms began approximately eight months ago, following his divorce, and have progressively worsened. He reports feeling “exhausted all the time” despite sleeping excessively, yet he continues to wake up feeling fatigued. He mentions that his appetite has decreased, resulting in an unintentional weight loss of about 10 pounds over the past three months. His mood is often irritable, and he finds himself getting easily frustrated with family members and coworkers.

A.M. denies any suicidal ideation or previous suicide attempts but admits to occasional fleeting thoughts of death. He reports that these thoughts are not persistent or distressing enough to act upon. His symptoms have negatively impacted his performance at work, leading to several warnings from his supervisor about his reduced productivity and absenteeism.

He reports no previous history of mood disorders and has never sought psychiatric treatment before. He occasionally uses alcohol to “calm down,” drinking approximately 4–5 drinks per night for the past six months, which began after his divorce.

Past Psychiatric History:

  • Previous Diagnosis: None reported.
  • Previous Hospitalizations: None.
  • Previous Treatments: None.
  • Previous Medications: None.

Substance Use History:

  • Alcohol: Drinks 4–5 alcoholic beverages per night, daily for the past six months. Denies drinking in the mornings or at work. He has not experienced withdrawal symptoms, but he acknowledges that he drinks to cope with stress and sadness.
  • Drugs: Denies the use of illicit drugs or recreational drugs.
  • Tobacco: Non-smoker.
  • Caffeine: Drinks two cups of coffee daily.

Family Psychiatric/Substance Use History:

  • Mother: Diagnosed with Major Depressive Disorder at age 45. Currently on medication.
  • Father: No history of psychiatric illness.
  • Siblings: Younger brother diagnosed with Generalized Anxiety Disorder.
  • Substance Use: No history of substance use disorders in the immediate family.

Social History:

A.M. was born and raised in a middle-class African-American family. He is the eldest of three siblings and maintains a good relationship with them, although he is currently estranged from his ex-wife. He has a 7-year-old daughter from his marriage and shares custody with his ex-wife. A.M. completed college and has been working as a sales manager at a tech company for the past five years.

His divorce, finalized eight months ago, was contentious, and he describes the relationship as “emotionally draining.” He currently lives alone in an apartment and has limited social interactions outside of work and co-parenting responsibilities. He reports that he stopped engaging in his hobbies, such as playing basketball and attending social events, around the same time his symptoms began.

A.M. has no legal issues or history of trauma. He denies any history of physical or emotional abuse.

Medical History:

  • Current Medical Conditions: Mild hypertension, managed with a low-sodium diet. No medications.
  • Past Medical Conditions: None significant.
  • Surgical History: None.
  • Chronic Illnesses: None.
  • Allergies: No known drug allergies.

Review of Systems (ROS):

  • General: Reports feeling fatigued and weak. Unintentional weight loss of 10 pounds in the last three months.
  • Cardiovascular: No chest pain, palpitations, or shortness of breath.
  • Respiratory: No cough or difficulty breathing.
  • Gastrointestinal: Reduced appetite; no nausea or vomiting.
  • Neurological: No headaches, dizziness, or seizures.
  • Musculoskeletal: No joint or muscle pain.
  • Endocrine: No changes in temperature tolerance, no excessive thirst or urination.
  • Psychiatric: Persistent low mood, loss of interest in previously enjoyable activities, feelings of worthlessness, irritability, concentration difficulties, occasional thoughts of death.

Mental Status Examination (MSE):

  • General Appearance: A.M. is a well-groomed, appropriately dressed male who appears his stated age. He has good hygiene and maintains eye contact throughout the interview.
  • Behavior: Cooperative but reserved during the interview. Fidgeted with his hands.
  • Mood: Reports feeling “down” and “numb.”
  • Affect: Blunted, restricted range of emotional expression.
  • Speech: Normal rate and tone, though answers are brief and monotone.
  • Thought Process: Linear but slowed; no evidence of flight of ideas or loose associations.
  • Thought Content: No delusions, hallucinations, or paranoia. Denies current suicidal ideation but acknowledges occasional passive thoughts of death without intent or plan.
  • Cognition: Alert and oriented to person, place, and time. Mild difficulty with concentration and focus during the interview.
  • Insight: Fair; acknowledges that his mood is affecting his work and personal life but feels unsure about treatment options.
  • Judgment: Intact; able to make reasonable decisions regarding his care.

Diagnostic Results:

No lab results were available at the time of the psychiatric evaluation. However, routine labs, including thyroid function tests (TFTs) and a complete blood count (CBC), were ordered to rule out any medical conditions contributing to his depressive symptoms.

Assessment:

Differential Diagnoses:

Major Depressive Disorder (MDD):

  • Supporting Evidence: A.M. presents with a depressed mood, loss of interest or pleasure in activities (anhedonia), fatigue, sleep disturbances (hypersomnia), weight loss, and concentration difficulties. These symptoms have persisted for more than two weeks, meeting the DSM-5-TR criteria for MDD.
  • DSM-5 Criteria Met: Depressed mood most of the day, nearly every day; markedly diminished interest in activities; significant weight loss without dieting; insomnia or hypersomnia; fatigue or loss of energy; diminished ability to think or concentrate; feelings of worthlessness.
  • Ruled Out Factors: No manic or hypomanic episodes present, ruling out bipolar disorders.

Adjustment Disorder with Depressed Mood:

  • Supporting Evidence: A.M. experienced a significant life stressor (divorce), which may have triggered his symptoms. However, the severity and duration of his symptoms extend beyond what is typically seen in adjustment disorder, and he meets more criteria for MDD.
  • DSM-5 Criteria Met: Emotional or behavioral symptoms in response to an identifiable stressor. However, A.M.’s symptoms are more severe and persistent than what is typically seen in Adjustment Disorder.

Alcohol Use Disorder:

  • Supporting Evidence: A.M. reports using alcohol daily to cope with stress, and this behavior has persisted for six months. However, he does not meet the full criteria for Alcohol Use Disorder at this time as his alcohol use has not resulted in significant impairment or distress. It is important to monitor his alcohol consumption as it may exacerbate his depressive symptoms.
  • DSM-5 Criteria Not Met: He does not exhibit loss of control over drinking or significant negative consequences directly attributed to alcohol use.

Plan:

Pharmacological:

  • Initiate fluoxetine (Prozac) 20 mg PO daily, given its favorable side effect profile and effectiveness in treating MDD.
  • Educate the patient on the potential side effects of fluoxetine, including gastrointestinal disturbances, headaches, and sexual side effects.

Therapy:

  • Refer to Cognitive Behavioral Therapy (CBT) to address negative thought patterns and promote healthy coping strategies.

Substance Use Monitoring:

  • Encourage a reduction in alcohol consumption, as it may worsen depressive symptoms. A referral to substance use counseling or Alcoholics Anonymous should be offered if drinking escalates.

Follow-Up:

  • Schedule follow-up in two weeks to assess medication efficacy and monitor for side effects.
  • Obtain lab results to rule out any medical causes of depression.

Reflection:

In hindsight, I would have explored A.M.’s family history in more detail, particularly his relationship with his mother, who has a history of Major Depressive Disorder. This could provide insight into how family dynamics may influence his view on seeking mental health treatment. From an ethical perspective, discussing A.M.’s alcohol use in a non-judgmental manner was important, as there is a potential for substance use to worsen his mental health if left unaddressed. A culturally sensitive approach to discussing his alcohol use should be maintained, given the stigma that may be present in his community. Additionally, I would focus more on A.M.’s role as a father and how his mental health may affect his relationship with his daughter, aiming to incorporate this into health promotion and disease prevention discussions.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Beck, A. T., & Alford, B. A. (2020). Depression: Causes and treatment. University of Pennsylvania Press.

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.

Detailed Assessment Instructions for the NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Paper Assignment

NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders

Assignment: Assessing and Diagnosing Patients With Mood Disorders

Accurately diagnosing depressive disorders can be challenging given their periodic and, at times, cyclic nature. Some of these disorders occur in response to stressors and, depending on the cultural history of the client, may affect their decision to seek treatment. Bipolar disorders can also be difficult to properly diagnose. While clients with a bipolar or related disorder will likely have to contend with the disorder indefinitely, many find that the use of medication and evidence-based treatments have favorable outcomes.

To Prepare:

  • Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing mood disorders.
  • Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
  • By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Identify at least three possible differential diagnoses for the patient.

By Day 7 of Week 3

Complete and submit your Comprehensive Psychiatric Evaluation, 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 symptomology 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 priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Reflection notes: What would you do differently with this client if you could conduct the session over? 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.).

Consider what history would be necessary to collect from this patient.

Consider what interview questions you would need to ask this patient.

Identify at least three possible differential diagnoses for the patient. 

references x 3 to include

 American Psychiatric Association. (2022). Bipolar and related disorders. In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x03_Bipolar_and_Related_Disorders

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Draft

Video Case selections for the Assignment

https://video.alexanderstreet.com/p/XQ51BX9oA

https://video.alexanderstreet.com/p/LZP6O7Yw4

https://video.alexanderstreet.com/p/Og8VpmVGN

https://video.alexanderstreet.com/p/ywmrYzzQn

Required Media

https://video.alexanderstreet.com/p/Z8WOvJyZ6

https://video.alexanderstreet.com/p/nRO2pKBpY

https://video.alexanderstreet.com/p/GR9vAWjML

https://video.alexanderstreet.com/p/nROLX6Ppp

Submission and Grading Information

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

  • Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 3 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 3 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.

 NRNP_6635_Week3_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

 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.

 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.

 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.

 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.		 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.

 16 (16%) – 17 (17%)

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

 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.

 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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.		 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.

 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.

 18 (18%) – 19 (19%)

The response documents the results of the mental status exam with some vagueness or inaccuracy.

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 inaccuracy.

 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!), social determinates of health, 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.). 9 (9%) – 10 (10%)

Reflections are thorough, thoughtful, and demonstrate critical thinking.

 8 (8%) – 8 (8%)

Reflections demonstrate critical thinking.

 7 (7%) – 7 (7%)

Reflections are somewhat general or do not demonstrate critical thinking.

 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). 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.

 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.

NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders

 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.

 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.		 5 (5%) – 5 (5%)

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

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

 4 (4%) – 4 (4%)

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

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

 3.5 (3.5%) – 3.5 (3.5%)

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

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

 0 (0%) – 3 (3%)

No purpose statement, introduction, or conclusion were provided.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
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 (3%) – 3 (3%)

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

 0 (0%) – 2 (2%)

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Total Points: 100

Name: NRNP_6635_Week3_Assignment_Rubric

  

Week (enter week #): (Enter assignment title)

 

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6635: Psychopathology and Diagnostic Reasoning

Faculty Name

Assignment Due Date

 

Subjective:

CC (chief complaint):

HPI:

Past Psychiatric History:

  • General Statement:
  • Caregivers (if applicable):
  • Hospitalizations:
  • Medication trials:
  • Psychotherapy or Previous Psychiatric Diagnosis:

Substance Current Use and History:

Family Psychiatric/Substance Use History:

Psychosocial History:

NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders

Medical History:

 

  • Current Medications:
  • Allergies:
  • Reproductive Hx:

ROS:

  • GENERAL:
  • HEENT:
  • SKIN:
  • CARDIOVASCULAR:
  • RESPIRATORY:
  • GASTROINTESTINAL:
  • GENITOURINARY:
  • NEUROLOGICAL:
  • MUSCULOSKELETAL:
  • HEMATOLOGIC:
  • LYMPHATICS:
  • ENDOCRINOLOGIC:

Objective:

Physical exam: if applicable

Diagnostic results:

Assessment:

Mental Status Examination:

Differential Diagnoses:

Reflections:

References

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