NRNP 6635 Week 5 Assignment: Comprehensive Psychiatric Evaluation of a 30 Year-Old Female with Schizophrenia

NRNP 6635 Week 5 Assignment: Comprehensive Psychiatric Evaluation of a 30 Year-Old Female with Schizophrenia

NRNP 6635 Week 5 Assignment: Comprehensive Psychiatric Evaluation of a 30 Year-Old Female with Schizophrenia

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.

ORDER A CUSTOMIZED, PLAGIARISM-FREE PAPER HERE

Good News For Our New customers . We can write this assignment for you and pay after Delivery. Our Top -rated medical writers will comprehensively review instructions , synthesis external evidence sources(Scholarly) and customize a quality assignment for you. We will also attach a copy of plagiarism report alongside and AI report. Feel free to chat Us

PATIENT:
Patient is a 30 year old female with a past medical history of 2 pregnancies and a history of substance abuse namely benzodiazpines….UDS positive for THC, patient admitted to the hospital after sister called crisis due to patient not sleeping, eating and becoming aggressive towards family members in the home. Patient assaulted mother knocking her front tooth out. Patient has been non compliant with after care post discharge from the hospital 6 mos ago. Patient has an extensive psychiatric history with multiple inpatient hospitalizations. Patient currently lives with family, and receives $900 a month through SS. Last grade completed was 11th grade. Patient currently has two children with live with her sister.
Patient diagnosis is Schizophrenia , rule out bipolar disorder with psychotic features.

To Prepare
Select a patient that you examined during the last 5 weeks. Review prior resources on the disorder this patient has.
It is recommended that you use the Kaltura Personal Capture tool to record and upload your assignment.
Review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura Personal Capture video. The Personal Capture Quickstart Guide will walk you through creating your video, uploading it to Blackboard and placing it into the assignment area.
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 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:
Stuff for presentation part:
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.

ORDER A CUSTOMIZED, PLAGIARISM-FREE PAPER HERE

A Sample Of This Assignment Written By One Of Our Top-rated Writers

 Comprehensive Psychiatric Evaluation of a 30 Year-Old Female with Schizophrenia

CC (chief complaint): The client was brought with complaint of “becoming aggressive” on family members, “not sleeping”, and not eating. For instance, she had already assaulted her mother and knocked her tooth off. There was also the complaint of not complying with treatment or medication after discharge from the hospital. She is also addicted to substance use and her urine drug screen had just revealed that she was also smoking marijuana (positive for tetrahydrocannabinol).

HPI: The client is a 30 year-old Caucasian female presenting with aggression, insomnia, and loss of appetite. She has an extensive previous history of mental illness and the symptoms. The onset of the current symptoms was a few months ago after she refused to comply with treatment post discharge from the hospital six months ago. The location of the symptoms is in her head, her thought process and thought content. The duration of the symptoms is constant as gthey do not go away intermittently. Characteristically, the symptoms are persistent and recalcitrant. The aggression and insomnia are aggravated by attention given to her and relieved by fatigue. The timing of he symptoms is day and night. On a scale of 1-10 the sister rates her symptoms at 8/10.

Past Psychiatric History:

• General Statement: This is a patient that has an extensive sychiatric history and who has been in and out of the hospital for the same. She is non-compliant to treatment most of the time and appears to have poor judgment and insight.
• Caregivers (if applicable): Indeed this patien t requires caregivers as she needs someone to make sure that she takes her medications and also takes care of her activities of daily living or ADLs.
• Hospitalizations: She has been admitted to the hospital with mental health conditions many times before.
• Medication trials: She has not participated in any medication trials but she has been taking (albeit erratically) psychopharmacologic preparations.
• Psychotherapy or Previous Psychiatric Diagnosis: She has a previous psychiatric diagnosis and has also been to psychotherapy for her condition before.

Substance Current Use and History: The patient is an abuser of benzodiazepines and also smokes marijuana as revealed by the urine drug screen (UDS) done on her. This means she has been using these substances (has a history of use) and is also currently actively using them.   

Family Psychiatric/Substance Use History: The immediate family does not have a history of psychiatric illness. However, the maternal grandfather had a history of psychosis and was treated severally for the same. Two maternal uncles were also smokers of marijuana and used other substances as well. They were also in and out of hospital for the treatment of their condition. The paternal grandfather was a heavy alcohol drinker and actually died of liver cirrhosis. The sister denies any current substance or drug use by the members of the nuclear family.

Psychosocial History: The patient is clearly dysfunctional in terms of occupation, self care, and interpersonal relationships. She has two children but is not married and lives with her family of birth. The children live with her sister. She dropped out of school in the 11^th grade since she already started having mental health issues at that early age. At the present time, she is receiving every month a sum of $900 from the social services for her upkeep and that of the children. However, this is also where the source of funding for her addictions comes from.  

Medical History:

• Current Medications: This patient has been in and out of the hospital several times and is currently on the following medications that she erratically takes with noncompliance.

1. Clozapine (Clozaril) 50 mg by mouth every day.
2. Aripiprazole (Abilify) 25 mg by mouth every day (Stahl, 2017).

• Allergies: The patient has no known allergies to medications, food items, or environmental irritants.

• Reproductive Hx: She is ehetrosexual and fertile. She has a history of two pregnancies and has two surviving children with none dead or aborted/ miscarried. At present she does not have a boyfriend and has also never been married before.

ROS:

• GENERAL: She denies fever, chills, fatigue, weight loss, or malaise.
• HEENT: She is negative for headaches, photohobia, tearing, otorrhea, tinnitus, rhinorrhea, sneezing, and sore throat.
• SKIN: She is negative for rashes, eczema, or itching.
• CARDIOVASCULAR: She denies any chest pains or chest discomfort as well as peripheral edema.
• RESPIRATORY: She is negative for dyspnea, wheezing, or coughing.
• GASTROINTESTINAL: She denies having any abnormalmbowel movements. She is negative for nausea, vomiting, or diarrhea.
• GENITOURINARY: She is negative for vagina discharge or lesions. She also denies usrinary retention, hesitancy, frequency of micturition, or the passing of cloudy urine.
• NEUROLOGICAL: She denies having paraesthesia, loss of bladder and bowel control, hemiparesis, or hemiplegia.
• MUSCULOSKELETAL: She denies having myalgia or arthralgia and states that she has a full range of motion around her joints.
• HEMATOLOGIC: She is negative for blood and clotting disorders. She also denies unusual bruises around her body.
• LYMPHATICS: Negative for lymphadenopathy or splenectomy.
• ENDOCRINOLOGIC: Denies hormonal therapy, polydipsia, pyphagia, heat intolerance, cold intolerance, or excessive diaphoresis.

Physical exam:

Vital signs: BP 120/70 regular cuff and sitting; P 65, regular; T 98.30°F; RR 15, non-labored; BMI 23.6 kg/m² (normal BMI).

General: The patient is alert and oriented in space and person. She is however disoriented in time and event. She is dressed inappropriately for the time of the day and year and looks clearly disheveled. Her speech is not goal-directec and appears disjointed and tangential with clear flight of ideas. All through the interview the client is fidgety and avoids to maintain eye contact. She sems far away and occasionally mentions things that are not even related to the psychiatric interview.

HEENT: The head is normocephalic and atraumatic. Both pupils are equal, spherical, and react to light and accommodation in the same way (PERRLA). Extra-ocular movement is unaffected (EOMI). Both tympanic membranes are not ruptured, and the external ear lobes are intact. On bilateral otoscopy, no fluid level is visible. The turbinates in the nose are not inflamed, and the septum is symmetrically situated medially. There is no sneezing or rhinorrhea. Her throat is neither erythematous but nor inflamed, and there is no exudate.

Neck: She does not have jugulo-venous distension or cervical lymphadenopathy.

Pulmonary: On auscultation there is no evidence of rhonchi, wheezing, crepitations, or rales.

Cardiovascular: HS1 and HS2 are audible on auscultation and normal in rate and rhythm. She does not have a gallop, a bruit, a rub, or a murmur.

Diagnostic results:

• Normal MRI and CT scans of the head
• A normal chest X-ray (AP)
• Normal full blood count and differentials with no anemia
• A positive and negative symptom scale (PANSS) score of 10 indicating moderate to severe schizophrenia (Leucht et al., 2019).

Assessment

Mental Status Examination (MSE)

The client is a Caucasian 30-year-old woman who is attentive and oriented to people and places but not to time or events. Her words are clear, yet they are not coherent or goal-oriented. Speech has lag and is monotonous. The volume is low, and the substance is sparse. She is inappropriately clothed for the time of day and the weather. She avoids eye contact, but she has no noticeable mannerisms, motions, or tics. The self-reported mood is “excellent,” yet the observed affect is dysphoric and out of sync with the self-reported mood. Perseverance and word salad are ancillary to the cognitive process. The substance of the thoughts reveals hallucinations, delusions, and reference notions. Both intuition and judgment are poor and compromised. However, there are no suicidal or homicidal thoughts. Her diagnosis is chizophrenia  whose DSM-5 diagnostic code is 295.90 (F20.9) (APA, 2013; Sadock et al., 2015).

ORDER A CUSTOMIZED, PLAGIARISM-FREE PAPER HERE

Differential Diagnoses

1. Schizophrenia – 90 (F20.9)

Schizophrenia is the most likely primary diagnosis for the 30-year-old mother of two. Because the symptomatology presented meets the DSM-5 diagnostic criteria for that psychotic disorder, this is the case. For example, to diagnose schizophrenia, (A) at least two of the following symptoms must be present: delusions, catatonic behavior, hallucinations, negative symptoms such as avolition, and incoherence or disorientation of speech; (B) the level of functioning in at least one area (self-care, interpersonal relations, or work) must have decreased significantly as a result of the symptoms in (A); (C) the disturbance must have persisted for a total of six months; (D) Other psychotic disorders with psychotic features, such as schizoaffective disorder and bipolar disorder with psychotic features, must be ruled out; (E) the symptoms must not be due to pharmacotherapy or substance abuse; and (F) the patient must not have had an autism spectrum disorder or a communication disorder as a child (Sadock et al., 2015; APA, 2013). This diagnosis was reached after applying critical thinking to the patient’s symptoms in relation to the DSM-5 diagnostic criteria. She satisfies all of the criteria, indicating that she is most likely suffering from schizophrenia as a psychotic condition.

2. Substance-Induced Psychotic Disorder – 292.9 (F19.259)

This is the first possible differential diagnosis for this female client. This draws from the fact that her history of substance misuse, which includes cannabis is long. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5, the symptomatology of this diagnostic closely mimics that of schizophrenia in every regard. In fact, cannabis usage, especially during youth and early adulthood, is a proven risk factor for later-life psychosis (APA, 2013; Sadock et al., 2015).

3. Bipolar Disorder with Psychotic Features

Bipolar disorder is characterized by alternation between mania and depression. It is during the manic phase that the symptomatology of bipolar disorder with mood-congruent psychotic features mimics schizophrenia. There will be hallucinations, delusions, invulnerability, grandiosity, paranoia, and suspiciousness amngst others (APA, 2013; Sadock et al., 2015). This is a condition that must be ruled out too as it is a viable differential diagnosis for this 30 year-old mother of two.

Reflections

I performed this psychiatric interview following all the recommended evidence-based approaches as per Carlat (2017). Given another opportunity, I would still do the exact same things  did at ths time. The client was treated resectfully and informed cnsent was still sought despite a lack of insight and poor judgment. This respected autonomy as an ethical principle (Haswell, 2019). Confidentiality was also observed at all times. Given the dysfunction in the patient, the family was educated on how to help her and also cope with her condition. The emphasis was placed on adherence to treatment and medications. Caution was given to the family (represented by the sister) to look out for the doses taken by the patient to prevent overdose. A follow-up plan was drawn to see the patient after a eriod of four weeks.

References

American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Carlat, D.J. (2017). The psychiatric interview, 4^th ed. Wolters Kluwer.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Leucht, S., Barabássy, Á., Laszlovszky, I, Szatmári, B., Acsai, K., Szalai, E., Harsányi, J., Earley, W., & Németh, G. (2019). Linking PANSS negative symptom scores with the Clinical Global Impressions Scale: Understanding negative symptom scores in schizophrenia. Neuropsychopharmacology, 44, 1589-1596. https://doi.org/10.1038/s41386-019-0363-2

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11^th ed. Wolters Kluwer.

Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6^th ed. Cambridge University Press.