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 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation 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:
- 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.
- 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.
- 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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