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

EB004 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

Evidence Level (I, II, or III)

Conceptual Framework

Design/Method

Sample/Setting

Major Variables Studied

Measurement

Data Analysis Statistical or Qualitative Findings

Findings and Recommendations

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:

• Critical Appraisal Worksheet

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

• *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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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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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 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.

2. 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.

3. 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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