Select a patient for whom you conducted psychotherapy for an impulse control or conduct disorder during the last 6 weeks. Create a Comprehensive Psychiatric Evaluation Note on this patient using the template provided in the Learning Resources.

Comprehensive Psychiatric Evaluation Note and Patient Case Presentation

Psychiatric notes are a way to reflect on your practicum experiences and connect the experiences to the learning you gain from your weekly Learning Resources. Comprehensive psychiatric evaluation 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 at your practicum site, using the Comprehensive Psychiatric Evaluation Note Template provided. You will then use this note to develop and record a case presentation for this patient. 

To Prepare

· Review this week’s Learning Resources and consider the insights they provide about impulse-control and conduct disorders. 

· Select a patient for whom you conducted psychotherapy for an impulse control or conduct disorder during the last 6 weeks. Create a Comprehensive Psychiatric Evaluation Note on this patient using the template provided in the Learning Resources. There is also a completed template provided as an exemplar and guide. All psychiatric evaluation notes must be signed, and each page must be initialed by your Preceptor. When you submit your note, you should include the complete comprehensive evaluation note as a Word document and pdf/images of each page that is initialed and signed by your Preceptor. You must submit your note 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 Grading Policy.

· Then, based on your evaluation of this patient, develop a video presentation of the case. Plan your presentation using the Assignment rubric and rehearse what you plan to say. Be sure to review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.

· Include at least five scholarly resources to support your assessment and diagnostic reasoning.

· Ensure that you have the appropriate lighting and equipment to record the presentation.

The Assignment

Record yourself presenting the complex case study 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 complex case study. Be succinct in your presentation, and do not exceed 8 minutes. Include subjective and objective data; assessment from most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; current psychotherapeutic plan (include one health promotion activity and one patient education strategy you provided); and patient progress toward treatment goals.

· Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What was 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 in order of highest to lowest priority and explain why you chose them. What was your primary diagnosis and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and is supported by the patient’s symptoms. 

· Plan: What was your plan for psychotherapy (including one health promotion activity and one patient education strategy)? What was your plan for treatment and management, including alternative therapies? Include nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. 

· Reflection notes: What would you do differently with this patient if you could conduct the session again? 

Describe your acculturation experience as a new graduate to the culture of the nursing profession.

Describe your acculturation experience as a new graduate to the culture of the nursing profession. How is it similar or different from the acculturation experience of a new nursing colleague who joined your team within the past year?

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
  • All replies must be constructive and use literature where possible.
  • Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
  • You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Identify leadership strengths. Discuss your strengths and how they match these leadership strengths.

Identify leadership strengths. Discuss your strengths and how they match these leadership strengths. Explore a potential plan to enhance areas that you identify in yourself as weak.  

  • One full page typed and double spaced is equivalent to 250 words (your minimum required)
  • References and citations should be scholarly, peer-reviewed (no blogs, WIKI, or other school of nursing website) written in Current APA Style

What interventions do expect to be ordered for Mr. Sweet? Why?

Directions:

Mr. Sweet, 38 years old, is brought to the Emergency Department unresponsive. He has a history of Type 1 diabetes and has been sick for the last 3 days. On admission his Blood sugar is 532, Potassium is 7.2 and ABG results include pH 7.08, Bicarb 12, and CO2 28. His VS are HR 116, BP 107/64, RR 36 Deep and rapid, and Temp 101.5. Answer the following questions:

  1. What interventions do expect to be ordered for Mr. Sweet? Why?
  2. What type of acid-base disturbance does he have?
  3. What do you think is Mr. Sweet’s Medical Diagnosis?

Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.

Each initial discussion post should be a minimum of 2 paragraphs with 5 sentences per paragraph

Initial discussion posts are due on Tuesday 2359 of the week they are assigned

2 Responses to your peers’ posts are due on Saturday 2359 of the week they are assigned

Each Response post should be a minimum of 1 paragraph with 5 sentences

Each discussion post (initial and response) should have a minimum of 1 citation and reference

A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital. The NP should:

Question 1: A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital. The NP should:

a. use an existing guideline from a leading research hospital.

b. follow the guideline provided by a third-party payer to help ensure reimbursement.

c. review expert opinion and experimental, anecdotal, correlational study data.

d. write the guideline to adhere to long-standing practice protocols already in use

Question 2: A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour release, for a patient with chronic stable angina. The NP should teach the patient to:

a. change the patch four times daily.
b. use the patch as needed for angina pain.
c. use two patches daily and change them every 12 hours.
d. apply one patch daily in the morning and remove in 12 hours.

Question 3: A patient is diagnosed with asthma. The primary care nurse practitioner (NP) prescribes an inhaled corticosteroid and an inhaled bronchodilator medication and provides education about how to use inhalers. At a follow-up visit 2 weeks later, the patient’s pulmonary function tests are worse. The NP should:

a. provide a detailed written asthma action plan for the patient.
b. ask the patient to describe how the medications have been used.
c. review the symptoms of an acute asthma exacerbation with the patient.
d. teach the patient to use the albuterol more often and order an oral steroid.

Question 4: A patient who will undergo surgery in implant a biosynthetic heart valve asks the primary care NP whether any medications will be necessary postoperatively. The NP should tell the patient that it will be necessary to take:

a. daily low-dose aspirin for 1 year.
b. heparin injections as needed based on activated partial thromboplastin time levels.
c. lifelong warfarin combined with enoxaparin as needed.
d. warfarin for 3 months postoperatively plus long-term aspirin.

Question 5: A patient has a BMI of 35, a fasting plasma glucose of 120 mg/dL, elevated triglycerides, and a history of myocardial infarction. The primary care NP plans to initiate dietary and lifestyle counseling and should consider prescribing:

a. ephedra.
b. orlistat (Xenical).
c. phentermine (Adipex-P).
d. phentermine and topiramate (Onexa).

Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months. She has a positive family history of breast cancer. The primary care NP should recommend:

Question 1. Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months. She has a positive family history of breast cancer. The primary care NP should recommend:

a. testosterone therapy.
b. estrogen-only therapy.
c. nonhormonal drugs for osteoporosis.
d. estrogen-progesterone therapy for 1 to 2 years.

Question 2. A woman is in her first trimester of pregnancy. She tells the primary care nurse practitioner (NP) that she continues to have severe morning sickness on a daily basis. The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior. The NP should consult an obstetrician and prescribe:

a. aprepitant (Emend).
b. ondansetron (Zofran).
c. scopolamine transdermal.
d. prochlorperazine (Compazine).

Question 3. A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The primary care NP orders thyroid function tests. The tests show TSH is decreased and T4 is increased. The NP should consult with an endocrinologist and order:

a. thyrotropin.
b. methimazole.
c. levothyroxine.
d. propylthiouracil.

Question 4.(2pts): A 55-year-old patient with no prior history of hypertension has a blood pressure greater than 140/90 on three separate occasions. The patient does not smoke, has a body mass index of 24, and exercises regularly. The patient has no known risk factors for cardiovascular disease. The primary care NP should:

a. prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.
b. perform a careful cardiovascular physical assessment.
c. counsel the patient about dietary and lifestyle changes.
d. order a urinalysis and creatinine clearance and begin therapy with a b-blocker.

Question 5. A patient reports fatigue, weight loss, and dry skin. The primary care nurse practitioner (NP) orders thyroid function tests. The patient’s thyroid stimulating hormone (TSH) is 40 microunits/mL, and T4 is 0.1 ng/mL. The NP should refer the patient to an endocrinologist and prescribe:

a. methimazole.
b. liothyronine.
c. levothyroxine.
d. propylthiouracil.

A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital. The NP should:

Version 1

Question 1: A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital. The NP should:

a. use an existing guideline from a leading research hospital.

b. follow the guideline provided by a third-party payer to help ensure reimbursement.

c. review expert opinion and experimental, anecdotal, correlational study data.

d. write the guideline to adhere to long-standing practice protocols already in use

Question 2: A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour release, for a patient with chronic stable angina. The NP should teach the patient to:

a. change the patch four times daily.
b. use the patch as needed for angina pain.
c. use two patches daily and change them every 12 hours.
d. apply one patch daily in the morning and remove in 12 hours.

Question 3: A patient is diagnosed with asthma. The primary care nurse practitioner (NP) prescribes an inhaled corticosteroid and an inhaled bronchodilator medication and provides education about how to use inhalers. At a follow-up visit 2 weeks later, the patient’s pulmonary function tests are worse. The NP should:

a. provide a detailed written asthma action plan for the patient.
b. ask the patient to describe how the medications have been used.
c. review the symptoms of an acute asthma exacerbation with the patient.
d. teach the patient to use the albuterol more often and order an oral steroid.

Question 4: A patient who will undergo surgery in implant a biosynthetic heart valve asks the primary care NP whether any medications will be necessary postoperatively. The NP should tell the patient that it will be necessary to take:

a. daily low-dose aspirin for 1 year.
b. heparin injections as needed based on activated partial thromboplastin time levels.
c. lifelong warfarin combined with enoxaparin as needed.
d. warfarin for 3 months postoperatively plus long-term aspirin.

Question 5: A patient has a BMI of 35, a fasting plasma glucose of 120 mg/dL, elevated triglycerides, and a history of myocardial infarction. The primary care NP plans to initiate dietary and lifestyle counseling and should consider prescribing:

a. ephedra.
b. orlistat (Xenical).
c. phentermine (Adipex-P).
d. phentermine and topiramate (Onexa).

African American patients seem to have a negative reaction to which of the following asthma medications?

Question 1:  Which of the following is a crucial element of developing a guideline?

a. Creating a physician expert panel
b. Reviewing the literature with ratings of available evidence
c. Conducting an external review of a guideline
d. Developing evidence-based tables

Question 2:  African American patients seem to have a negative reaction to which of the following asthma medications?

a. Inhaled corticosteroids 

b. Long-term beta-agonist bronchodilators 

c. Leukotriene receptor agonist
d. Oral corticosteroid

Question 3:  Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean?

a. The tumor size cannot be evaluated, the cancer has not spread to the lymph nodes, and the distant spread cannot be evaluated.
b. The cancer is in situ, it is spreading into the lymph nodes, but the spread otherwise cannot be evaluated.
c. The cancer is less than 2 cm in size and has not spread to the lymph nodes or other parts of the body.
d. The cancer is about 5 cm in size, nearby lymph nodes cannot be evaluated, and there is no evidence of distant spreading.

Question 4:  Sondra’s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear?

a. Meclizine
b. Diphenhydramine
c. Diamox
d. Promethazine

Question 5:  Mandy presents with a cauliflower-like wart that is in her anogenital region. You suspect it was sexually transmitted and document this as a:
a. Filiform/digitate wart. 

b. Dysplastic cervical lesion. 

c. Condyloma accuminata.
d. Koilocytosis.

In an outpatient setting, what is the most common reason for a malpractice suit?

Question 1: In an outpatient setting, what is the most common reason for a malpractice suit?

a. Failure to treat a condition
b. Failure to diagnose correctly
c. Ordering the wrong medication
d. Failure to manage care

Question 2: How often should the clinician examine the feet of a person with diabetes?

a. Once a year
b. Every 6 months
c. Every 3 months
d. Every visit

Question 3: Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis?

a. Cholinesterase inhibitors
b. Anxiolytics
c. Antidepressants
d. Atypical antipsychotics

Question 4: Which of the following medications is the treatment of choice for trichomonas?

a. Metranidazole 

b. Ceftriaxone 

c. Diflucan
d. Doxycycline

Question 5: Most adult poisonings are:

a. intentional and self-inflicted.
b. accidental.
c. caused by someone wishing to do harm to the person.
d. not attributed to any reason.

Women are at the highest risk for developing postpartum depression for up to how long after childbirth?

Question 1: Women are at the highest risk for developing postpartum depression for up to how long after childbirth?

2 weeks

1 month

3 months

6 months

Question 2: CPT coding offers the uniformed language used for reporting medical services and procedures performed by physician and nonphysician practitioners. Clinicians are paid based on calculated resource costs that are calculated based on practice components.

a. Clinician education loans
b. Clinician practice liability and malpractice expense
c. Clinician reported cost reduction efforts
d. Clinician volume of patients treated

Question 3: Janet is a 30-year-old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression.
Which of the following is a sign or symptom of cauda equina compression?
a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks

Question 4: A 58-year-old woman who had a total abdominal hysterectomy at the age of 45 is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment?
a. Conjugated estrogen 0.625 mg/day oral
b. Estradiol 7.5 mcg/24 hr vaginal ring
c. Medroxyprogesterone 10 mg/day oral
d. Conjugated estrogen 0.3 mg + medroxyprogesterone 1.5 mg/day oral 

Question 5: Which of the following is a specific test for multiple sclerosis (MS)?

a. Magnetic resonance imaging (MRI)
b. Computed tomography (CT) scan
c. A lumbar puncture
d. There is no specific test.