NU665 2021 September Complete Course Latest (Full)

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 1 Discussion

Growth and Development Assessment, Biopsychosocial Profile and Screening

Look at the Chart of Erickson’s Stages on page 169 in the Sadock, Sadock and Ruiz (2015) text. Pick a psychosocial stage, discuss the associated virtue and positive and negative forerunners of identity. Explain the importance of incorporating the evaluation of developmental vulnerabilities within your holistic, psychosocial assessment and treatment plan documentation.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 2 Discussion

Change Theory Versus Motivational Interviewing

For this discussion, compare and contrast principles of Change Theory and Motivational Interviewing and how these principles inform therapeutic interventions. You will gain a greater understanding of the theoretical underpinnings of the use of Change Theory and Motivational Interviewing used in clinical practice situations.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 4 Discussion

Care for a Client Diagnosed with a Substance Use Disorder

In a Word document, address the following prompts:

Elaborate on etiology, stressors, problems of addiction, dependence, and relapse in the U.S. currently.

Identify potential physical and mental findings when examining a client with a substance use disorder. Note your rationales.

Describe possible triggers to compulsive substance use or behavioral addiction.

Discuss the neurobiological mechanisms that underlie addictive behavior.

What are the medication-assisted treatments (MATs) and psychotherapeutic interventions for monitoring (for alcohol and for opioid abuse)?

Post your completed Word document to this discussion forum.

Use APA format with reference list (two to three books and/or articles).

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 5 Discussion

Pair Presentation on Selected Topic

Complete this assignment according to the Week 5 Pair Presentation assignment instructions.

Please refer to the Grading Rubric for details on how this activity will be graded. Please remember that you and your partner must each submit the assignment, even if it is the same file, so that you both receive feedback and credit.

You may view each other’s submission and comment if you would like. Reply posts are optional for this assignment and students will only be graded on the Pair Presentation that they submit.

During Week 3, you and your partner will be paired by choosing the same presentation topic after completing the Week 5 Pair Presentation: Select a Topic activity. The topic groups are also listed below. Together, you will create a 15-slide PowerPoint narrated presentation collaborating with your method of choice (by Skype for Business, email, phone or any other option you choose). Although you will work together, you and your partner will EACH turn in the assignment as individuals. In other words, even if your partner submits the assignment, you will only receive credit if you also submit the assignment, even if it is the same file.

Topics:

ADHD, Autism Spectrum Disorder (ASD), Social Communication Disorder, self-injurious behavior, oppositional defiant disorder, traumatic loss/grief, gender dysphoria, bipolar, depression, generalized anxiety disorder, OCD, separation anxiety disorder / social anxiety disorder, movement disorder, reactive attachment disorder, feeding disorder

Your PowerPoint should be a voice-over (narrated) presentation. It should adhere to current standards of professional development for PowerPoints. (If the website doesn’t work please search the Internet for “best practices for PowerPoint presentations”.)

Pretend you are teaching a group of students about your chosen topic. Create two to three learning objectives for your PowerPoint.

The following should be included in your presentation:

Definitions

Biopsychosocial, cultural, developmental assessment and screening tools with validity and reliability

DSM-5 criteria

Psychotherapeutic options

Psychopharmaceutical management with detailed pharmacological analysis

Current evidence (not published more than three years ago) related to topic

Legal/ethical considerations

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 6 Discussion

Little Girl Leaving

Overview

When you are a psychiatric mental health provider you may experience encounter horrific encounters of many varieties. Experiences of childhood abuse and neglect are known antecedents to developing many mental health and substance use disorders. There is no real way to prepare for these. However, beginning to explore your understanding of abuse, your needs (if and when you encounter abuse), as well as how to create a self-care plan to avoid caregiver burnout is essential.

Initial Post

After you complete the readings and watch the video, pick two questions to answers in your initial post and reply thoughtfully to two classmates. Your discussion post should address two of the following prompts:

Discuss child abuse. What is the definition of abuse? Are there different types of abuse? How many types of abuse did these children suffer?

Discuss mental instability, substance use and generational transmission. Why do you think this girl’s father abused her? Why do you think her mother did not believe her? Why do you think her brother behaved as he did?

Discuss abandonment. Should her mother or grandmother have done something? Was her mother's inaction as injuring as the abuse perpetrated by her father?

Discuss survival and resiliency theory. What do you think her periods of depersonalization and foggy thinking provided her? How did she utilize her strengths and resilient traits to survive? What is the significance of her conception of God, Mary and Jesus?

Why are the rates of children seen in Emergency Rooms with sexual abuse increasing? How can public health initiatives to prevent child sexual abuse make an impact?

What psychiatric and substance use disorders are associated with histories of child sexual abuse? How do symptoms of dissociation develop?

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 7 Discussion

Counseling Therapies

You should have chosen one therapy during Week 6. Please follow the instructions for posting your pair's assignment to this submission page.

You will apply each therapy to the care of an individual with PTSD from the following age groups:

child

adolescent

adult

older adult

One student from each discussion pair is to submit the pair’s counseling therapies to this submission page. Remember, the assignment should be a three-to-four-page Word document in APA format.

 

 

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 9 Discussion

Sleep Disorders

In a Word document, respond (agree or disagree) to each of the following statements succinctly, but with detail.

Sleep disorders come in two kinds, one related to sleep apnea and the other related to the failure to stay awake due to stress.

The use of over-the-counter sleep aids should be encouraged over prescription sleep aids as they are safer and are not habit forming.

Menopause has no impact on insomnia.

As a backup to over-the-counter sleep aids, benzodiazepines are most useful and first line.

Discuss best practice for insomnia assessment.

Use the appropriate APA formatting as listed in the syllabus.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 12 Discussion

LGBTQI Topic Presentation

Using your chosen topic, your group should develop a 10-minute creative, informational presentation which you will record and upload to this discussion. You may use PowerPoint, Prezi, or another type of presentation medium as desired, and you may insert videos or other media.

Record your group presenting your presentation using the Zoom Tutorial; your presentation should include voice-over or audio from all group members. Once you have recorded your presentation, Create an Unlisted YouTube video. You will need to submit the YouTube video URL to this discussion. The best way to do this is to copy and paste the website/URL for the YouTube video into a Word document and upload your Word document. Do not upload a video file (mp4).

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 13 Discussion

Covid Pandemic

Reflect on your own experiences in your clinical work and workplace related to the COVID-19 pandemic. Discuss the ways that this pandemic can be compared to disaster medicine.

How has the pandemic affected clients with severe mental illnesses ability to access mental health treatment and substance use disorder treatment? In conclusion, clarify the PMHNP’s role in these situations.

 

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 14 Discussion

Assessing for Grief

Identify the symptoms of the client in the video that you watched, taking into consideration culture.

Assess if the client in the video that you watched has a psychiatric illness or if their symptoms are within an adaptive range for grieving for that group/culture.

Support and substantiate your information with evidence.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 15 Discussion

Policy and Practice Issues

Identify one policy issue related to barriers to accessing psychiatric and mental healthcare that is currently being addressed by your national professional organization and discuss how NPs can become policy-aware, as well as act as patient advocates.

Attach a policy white-paper to support your statement.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 2 Assignment

Motivational Interviewing

Instructions

After you complete the readings and watch the videos for this week, select one of the videos and write an analysis which addresses the following:

Introduction: Overview of Motivational Interviewing:

Begin your paper by providing an overview of Motivational Interviewing (MI). Summarize the main components of MI, integrate MI principles important to building rapport, and analyze the use of MI to support coping across the lifespan.

Assessment Process:

Using the key components of MI, examine the role play videos for successful or unsuccessful integration of MI skills by critiquing the stages of conversation between provider and client.

Coping and Strengths:

Identify positive coping mechanisms and strengths. How could you use MI to support coping? Provide rationales.

Discriminatory Analysis Section:

What would you do differently or similarly to the provider in the video? Discuss age appropriateness of MI interventions used. Provide specific rationales in detail.

Summary and Plan Development, and Conclusion:

Base your plan of care on the case in the video. Integrate evidence-based interventions in your plan and summary of the scenario you watched (opioid or alcohol). How does the concept of coping play out in the scenario you watched? Integrate coping psychotherapeutic skills. Discuss the role of teaching and education in MI, in your plan and summary.

Paper Requirements

Your paper should be four to five pages in length, excluding a required cover sheet and references page that includes one to two textbooks and two to three scholarly articles (that were published no longer than three years ago). Use APA formatting for all components of your paper.

Please refer to the Grading Rubric for details on how this activity will be graded.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 3 Assignment

Complicated Pregnancy

Instructions

You are caring for a 37-year-old female who is pregnant with her second child. Her first pregnancy was traumatic as she experienced a pelvic fracture during delivery causing excruciating pain. The anxiety from this memory plagues her into this pregnancy. She has been prescribed an antidepressant/antianxiety. Her husband is a pharmacist and has attended most visits with the psychiatric-mental health NP for counseling and psychopharmaceutical drug management.

What would be your initial approach to assessment and diagnosis with this woman/family?

Would you prescribe an antidepressant, and which one? What are possible adverse reactions to placing a woman on antidepressants in the post-partum phase?

Explain the pharmacodynamics, pharmacokinetics, contraindications, pregnancy related issues, legal/ethical considerations, testing (if applicable), side effects and relationship to trimester.

What would be your plan of care including the strengths and weaknesses of the family functioning and supporting attachment? (Be succinct.) Consider supervision/collaboration/type of psychotherapy or complementary modality you might use.

Criteria for this paper:

Answer these questions succinctly but completely, integrating resources to provide rationale for all decisions.

Use APA formatting for all components of your paper.

Your paper should be approximately three to four pages long and in APA format.

Your paper length should not include the reference page.Use at least one nursing journal reference from CINAHL (available through the library) to support your rationale.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 5 Assignment

Pair Presentation Evaluation

Now that you have completed the Week 5 Pair Presentation assignment, please fill out the Peer Evaluation Form (word) and submit it to this assignment.

Peer and Self Work Group Evaluation Form

Directions:  In the space below, honestly evaluate the work of other students in your group by answering the following questions.  The answers are yes / no or use a 3-point Likert scale: 1 indicating poor, 2 indicating average, and 3 indicating above average.

For this exercise, it is important that you are honest about your peers and yourself.  Group projects can be trying and sometimes difficult, but as nurses and providers, we are responsible to and for our patients and this requires diplomacy, open mindedness, empathy and working together.

Evaluators Name:  _________________________       Date:  ________________

Group Member 1:  ______________________________________

1.            Did this group member complete their assigned task(s) for the group?                                                   Yes                         No

1= Poor      2= Average   3= Above average

2.            How would you rate the quality of this person’s work?                                                                  1              2              3

3.            How would you rate the timeliness of the completion of the work?                                         1              2              3

4.            How would you rate the accuracy of the work?                                                                                  1              2              3

5.            Overall, how would you rank this group member’s performance in the group?                   1              2              3

6.            What would you say was this person’s greatest asset to the team?                                          1              2              3

7.            What would you say was this person’s greatest detriment (if any) to the team?

8.            Would you want to work this person again?                                                                                        Yes                         No

a.            Explain why:

Group Member 2:  ______________________________________

1.            Did this group member complete their assigned task for the group?                                                       Yes                         No

1= Poor      2= Average   3= Above average

2.            How would you rate the quality of this person’s work?                                                                  1              2              3

3.            How would you rate the timeliness of the completion of the work?                                         1              2              3

4.            How would you rate the accuracy of the work?                                                                                  1              2              3

5.            Overall, how would you rank this group member’s performance in the group?                   1              2              3

6.            What would you say was this person’s greatest asset to the team?

7.            What would you say was this person’s greatest detriment to the team?

8.            Would you want to work this person again?                                                                                        Yes                         No

a.            Explain why:

Group Member 3 (if assigned):  ______________________________________

1.            Did this group member complete their assigned task for the group?                                                       Yes                         No

1= Poor      2= Average   3= Above average

2.            How would you rate the quality of this person’s work?                                                                  1              2              3

3.            How would you rate the timeliness of the completion of the work?                                         1              2              3

4.            How would you rate the accuracy of the work?                                                                                  1              2              3

5.            Overall, how would you rank this group member’s performance in the group?                   1              2              3

6.            What would you say was this person’s greatest asset to the team?                                          1              2              3

7.            What would you say was this person’s greatest detriment to the team?

8.            Would you want to work this person again?                                                                                        Yes                         No

a.            Explain why:

Self – Assessment of your participation

1.            Did YOU complete YOUR assigned task(s) for the group?                                                                                               Yes                         No

1= Poor      2= Average   3= Above average

2.            How would you rate the quality of YOUR work?                                                                                 1              2              3

3.            How would you rate the timeliness of the completion of YOUR work?                                    1              2              3

4.            How would you rate the accuracy of YOUR work?                                                                                             1              2              3

5.            Overall, how would you rate YOUR performance in the group?                                                  1              2              3

6.            What would you say was YOUR greatest asset to the team?                                                        1              2              3

7.            What would you say was YOUR greatest detriment to the team?

8.            What could you have done better?                                       

a.            Explain why:

9.            What would you give yourself as a score for your participation in this project          _______ / 100

Remember:  Make your submission as complete as possible.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 6 Assignment

Pediatric Case Study

Instructions

In this assignment, you will review the Pediatric Case Study and analyze the data to determine the health status of the patient. You will need a minimum of two scholarly references to support your work.

Use the NU665C Pediatric Case Study Questions (Word) document to complete the case study assignment.

Follow the requirements posted in the rubric.

Interactive case studies should be five to seven pages depending on the complexity of the case. This is excluding title and references pages.

All papers must conform to the most recent APA standards.

Please refer to the Grading Rubric for details on how this activity will be graded.

Pediatric Case Study Assignment

Katy is a six-year-old girl, the second of two children of a middle-class family living in a suburban area of a northwest city. Katy has one sister that is two years older than her. Her mother’s pregnancy was normal and Katy’s birth was normal. Katy had colic the first three months, cried extensively and was difficult to comfort. After three months she became passive and cried very little with comfort from her mother. Her growth and development appeared to be normal. She met all the developmental milestones her first three years. She interacted normally with her sister and parents, except that she would become tearful and anxious when her parents would get a babysitter.

At age four, she was in nursery school and appeared to function normally except during the first month when Katy had difficulty when her father would drop her off at school. The nursery school was a small private school with a lot of personal attention given to each child. Although shy, she made friends and liked going to nursery school after she became adjusted to the new setting. Her parents liked the school so much that they decided to keep Katy in kindergarten at this school with her same teachers and friends. However, tuition at the school became a problem after Katy’s mother became sick with lupus and was unable to work.

At age six, Katy’s parents enrolled her in first grade at the public elementary school in their neighborhood. For the last two weeks, she has refused to go to school and has missed six school days. She is awake almost all night worrying about going to school. As the start of the school day approaches, she cries and screams that she cannot go, chews holes in her shirt, pulls her hair, digs at her face, punches the wall, throws herself on the floor, as well as experiences headaches, stomachaches, and vomiting. Over the past two weeks, she has become gloomy, has stopped reading for fun, and frequently worries about her mother's Lupus and that she may die. In addition, Katy is phobic of dogs, avoids speaking and writing in public, and wets the bed every night.

Her parents immediately made an appointment to see her PCP. Her doctor conducted a thorough physical exam, found no physical abnormalities and then referred her to you, a Family PMHNP.Family history of mental health includes the following: mother has a history of panic disorder; her father has a history of treatment with medications for ADHD as a child; and she has a cousin diagnosed with Asperger’s syndrome.

For your assignment, write a paper that addresses the following prompts using evidence-based references to support your answers:

1.            What is your provisional diagnosis, as well as the possible differentials?

2.            Justify your answer with DSM-5 criteria (be short, brief and to the point).

3.            Is Katy too young to diagnose, or is there a basis for early identification and intervention?

4.            What psychiatric scales or assessment tools might you use with this patient? With the parents? List and describe briefly.

5.            How would the typical symptom patterns and phases be manifested in children this age? In adolescents?

6.            What would be your treatment plan for medications, if any? If you do choose to offer medication as part of the treatment plan, please address the following medications issues:

a.            Target symptoms

b.            Receptors affected

c.             Psychiatric and system effects

d.            Possible parental concerns

7.            What would be your school-based treatment plan, if any?

8.            What would be the implications for the families of children and adolescents with these diagnostic pictures?

9.            How does the mother’s health play into the picture of Katy’s diagnosis? What type of therapy would you recommend for Katy (and her family) to work through her issues?

10.          Identify resources for patients/families with this diagnosis in the form of community groups, web-sites, advocacy, as well as treatment resources available in your service area.

11.          What are you worried about (if anything)? Consider this question in terms of treatment, assessment, alliance, compliance, effectiveness, safety, and other factors.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 8 Assignment

Anorexia—A Mental Illness?

After completing the readings and watching the videos for this week, complete this assignment.

Using the DSM-5 diagnostic criteria and evidence-based scholarly articles, address the following:

Explain the neurology of anorexia. Does the characterization of anorexia as a mental illness surprise you? What are your thoughts on the personal and/or cultural implications of classifying anorexia in this way, as opposed to a lifestyle choice or a matter of willpower? How might you support a family (or client) who is resistant to this seeing anorexia as a mental illness?

Describe and discuss changes in personality and social behavior that might be seen with anorexia. How would you assess for these changes?

Provide an overview of the health consequences and medical complications of anorexia.

Create a treatment plan for a client with anorexia using family-based therapy or other evidence-based therapy.

Criteria for this paper:

Answer these questions succinctly, integrating resources to provide rationale for all decisions.

You may use narrative, bullets, or a table format for various sections of this discussion assignment.

Your paper should be two to three pages long, not including the reference page.

Use at least one reference from CINAHL (available through the library) to support your rationale.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 10 Assignment

Geriatric Case Study

Instructions

In this assignment, you will review the Geriatric Case Study and analyze the data to determine the health status of the patient. You will need a minimum of two scholarly references to support your work.

Use the NU665C Geriatric Case Study Questions (Word) document to complete the case study assignment.

Follow the requirements posted in the rubric.

Interactive case studies should be five to seven pages depending on the complexity of the case. This is excluding title and references pages.

All papers must conform to the most recent APA standards.

Please refer to the Grading Rubric for details on how this activity will be graded.

Geriatric Case Study Assignment

E.J. is a 62-year-old Caucasian male who initially presented with new-onset symptoms of psychosis and mood liability thought to be connected with high-dose Prednisone treatment for poison ivy exposure. He was brought to an emergency room by his grandson approximately 11 months ago with extreme agitation. Evaluation of E.J. at that time revealed auditory hallucinations. E.J. noted that the whispering voices had a persecutory tone. He also expressed feelings of paranoia, saying that the voices were plotting against him and that he would not let them win. The patient is currently residing in the secure wing of an assisted living facility.

History

E.J. has a past medical history that includes hypertension, hyperlipidemia, coronary artery disease, chronic obstructive pulmonary disease, peptic ulcer disease, and peripheral artery disease (with stents), but no prior psychiatric history. His mother was diagnosed with schizophrenia.

Assignment Instructions

For your assignment, complete the following information based on the patient information you have been given. Include at least one Internet source and two evidence-based articles in addition to the assigned texts to support your recommendation(s).

1.            Diagnoses, Differentials, and ICD Code(s):

Provide your recommendations for each (include rule-outs, neurocognitive disorders, dementia and dilerium).

2.            Medications:

Provide your recommended drug therapy, including common side effects and potential or actual adverse drug responses (ADR), common drug and/or food interactions, and key monitoring points.

3.            Psychosocial Issues:

Discuss the psychosocial issues and circumstance(s) surrounding this case.

4.            Variables Related to Aging and Mental Health:

Describe unique patient variables and developmental stages that are involved in the patient’s response to aging and mental health.

5.            Recommendations:

Include non-pharmacological interventions. List any changes in care approaches you would suggest.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 11 Assignment 1

Personality Disorders

Instructions

Using your practicum experience, choose a client you’ve seen with personality disorder.

Download the Biopsychosocial Template (Word) to write about that client for this assignment.

Use the template to create an evidence-based treatment plan using all of the components within the template. Include the Personality Disorder Cluster in the DSM-5. Follow HIPAA guidelines to avoid providing information that identifies the patient.

Criteria for this paper:

Answer template questions, integrating resources to provide rationale for all decisions.

Use APA formatting for all components of your paper.

Your paper should be two to three pages in length not including the reference page.

Use at least one nursing journal reference from CINAHL (available through the library) to support your rationale.

Please refer to the Grading Rubric for details on how this activity will be graded.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 11 Assignment 2

Personal Assumptions

Instructions

The thoughts and opinions you have about clients will influence your treatment of them. To discover your assumptions about those with mental health disorders, download the Assignment 11.1 Personal Assumptions (Word) document and answer the questions it contains based on your own thoughts and opinions. This is an ungraded assessment since there are no right or wrong answers, but insights from your answers, as well as instructor feedback should be valuable to you.

Assignment 11.1: Personal Assumptions

Our tacit assumptions about human nature unquestionably influence how we view and serve individuals who seek psychological services.

—M.J. Mahoney

The thoughts and opinions you have about clients will influence your treatment of them. To discover your own assumptions about those with mental health disorders, answer the following questions based on your own thoughts and opinions. There are no right or wrong answers.

1.            What causes the movement on the adaptive–maladaptive mental health continuum? That is, what motivates people to exhibit maladaptive behaviors?

2.            How will you measure therapeutic success? Take into account the degree of maladaptation possible.

3.            Describe your thoughts/beliefs about the following:

a.            Mental illness

b.            Depression

c.             Cutting

d.            Anorexia

e.            Hoarding

f.             Anxiety

g.            Rumination

h.            Manipulation

i.              Passive aggression

j.             Bullying

4.            Are humans trustworthy? Are clients with mental illness trustworthy?

5.            Are clients with mental illness generally self-centered and selfish or do they have the ability to empathize and show concern for others? Take into account the degree of maladaptation.

6.            Can clients with mental illness change? Again, take into account the degree of maladaptation present.

7.            Do you believe that mental illness is prevalent? Why or why not?

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 12 Assignment

Care Plan for LGBTQI Client

Grading Category: Assignments

After you complete the readings, choose a topic related to LGBTQI behavioral/mental health. Examples include trauma, abuse, homelessness, or bipolar disorder.

In a Word document, write a synthesis paper that addresses the following sections:

Introduction to topic

Epidemiology and economic costs

Overview of the assessment/tools to assess/DSM-5

Pharmacological interventions with specifics to dynamics, kinetics, contraindications, side effects, and so on

Plan of care to include collaborative interventions and psychotherapeutic options.

Your paper should be two to three pages long (not counting the cover sheet or APA references list) and follow APA formatting for all components.

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 13 Assignment

Suicide Case Study

Instructions

In this assignment, you will review the Suicide Case Study and analyze the data to determine the health status of the patient. You will need a minimum of two scholarly references to support your work.

Use the NU665C Suicide Case Study Questions (Word) document to complete the case study assignment.

Follow the requirements posted in the rubric.

Interactive case studies should be five to seven pages depending on the complexity of the case. This is excluding title and references pages.

All papers must conform to the most recent APA standards.

Please refer to the Grading Rubric for details on how this activity will be graded.

Suicide Case Study Assignment

Case History

Mr. C is a 35-year-old Hispanic male with a long-standing history of mental illness. He was admitted to an inpatient psychiatric facility following a severe suicide attempt. He stated that he had been feeling progressively more depressed during the past three months and had been having an increase in suicidal thoughts over the past week. He felt tired most of the time and had problems concentrating. He felt hopeless about his life, found his job and personal life unfulfilling, and worried a lot about his critical financial situation. He was unable to think about reasons to continue living even though he has an extensive family living close by and several children from other partners. A few days prior to his admission, he went to a local casino for the first time in a few years and lost a significant amount of money. He then went back home, drank eight beers, and slit his wrists. He was found by a friend who stopped by the patient’s house to ask him to pay back some money he’d loaned the patient.

The patient was brought to the hospital by ambulance, was medically stabilized, and was sent to the psychiatric unit. He reported passive suicidal ideation but felt safe in the hospital. Denied any homicidal ideation, thought, or plan, as well as any psychotic symptoms. Denied recent use of illicit drugs but admitted to having weed once every six months and drinking two beers and a couple shots of whiskey per day on a regular basis. Denied any past history of withdrawal symptoms.

Psych Hx: Some elementary school problems with bullying and resulting encounters with school counselor. Also showed increasing problems with lying and stealing as a youngster. Recommended mental health counseling, but parents never followed up.

One previous suicide attempt at age 27 resulting in three-day hospital stay. Intermittently compliant with outpatient treatment. Stopped taking escitalopram 20mg several months ago because of sexual side effects.

Substances: Extensive abuse of cocaine since age 16. Drinking since age 14-15, mostly beer and whiskey. Has tried rehab several times but relapses shortly afterwards. No history of withdrawal. Currently doesn’t see his alcohol use as a problem and denies using any cocaine for the past two years, saying “it costs too much.”

Legal: Two DUIs. Served six months for robbing a convenience store. Frequent arguments and fights which have necessitated police involvement but no arrests. Denies significant problems with gambling except for most recent event, during which he lost a lot of money.

Family Psych Hx: Mother diagnosed with bipolar and somatization disorder; father has history of alcoholism.

Social Hx: Third of four boys. Parents divorced when he was 5 years old. Inconsistent contact with father after that. Remembers father as drunk and physically abusive much of the time. Some trouble in school; kicked out after cheating incident. Never returned and only finished 11th grade. Never married, but many relationships, often short-lived, with three children that he knows of. Little contact with any of them. Works as truck driver. Has moved to several different places, often as a result of “trouble with paying back debts.”

Medical Hx: Overweight, denies any medical issues. ED visit following accidental overdose of cocaine. Thought he was having an MI.

Labs

•             Total Cholesterol: 220

•             Triglycerides: 172

•             SGOT (AST): 48

•             SGPT (ALT): 36

•             HGB: 16.5gm/dl

•             HCT: 45%

•             Na: 134

•             K: 3.2

•             Free T4: 1.1

•             TSH: 3.2

During his hospital stay, the patient presented as rather calm and charming with other patients. Always agreeable but gave little history about himself. Would not participate in divulging personal details of his life or talk about ways in which he might change in order to live a happier life. Seemed to always redirect the conversation to irrelevant subjects unrelated to his treatment. Mood and affect improved significantly over the course of his stay.

Assignment Instructions

Based on the case history, answer the following questions. Use APA format with a minimum of three evidence-based journal articles to support your answers and reference accordingly. Your analysis of this case should be in depth and demonstrate advanced understanding of the psychodynamic, psychobiological, and psychosocial factors relevant in this case. Format your paper so that it is clearly noted which questions are being addressed. Per APA, please use headings.

1.            What is your diagnostic formulation? How does the diagnosis(es) meet DSM criteria?

2.            What are your rule-outs (differentials)?

3.            What screening/assessment tools would you use (if any) and why?

4.            Discuss the etiology of your major psychiatric diagnosis(es) and the psychological underpinnings.

5.            Discuss the epidemiology associated with your diagnostic formulation.

6.            Discuss medical concerns (if any) and suggested interventions.

7.            What would be your therapeutic interventions while the patient is in the hospital? Outpatient? Include both psychotherapeutic and psychopharmacologic interventions. Be specific and evidence based when determining your treatment strategies.

8.            Discuss key points that might be considered when interviewing this patient considering his diagnosis(es).

9.            What should you keep in mind about counter-transference issues that might come up with this type of client? How would you manage your feelings and minimize impact on the therapeutic process?

10.          Give the prognostic factors associated with your diagnostic formulation.

11.          Discuss the risk assessment for this gentleman.

12.          As a resource for nursing staff, what factors would you keep in mind when consulting with them around the care of this patient?

 

NU665 Primary Care of the Psychiatric Mental Health Client II

Week 15 Assignment

Case Study Analysis

For this assignment, you will apply what you have learned during the course to develop and present a case and treatment plan for a fictional or real client encountered in clinical practice. Your case analysis will be completed in three sections totaling five to seven pages (excluding title page and references) and will be graded using the case study grading rubric.

Part A: Clinical Assessment

Record your client assessment, diagnosis (medical and psychiatric differentials), medical and psychiatric history and psychosocial factors that impact the case. This information should be presented in the same format as your Wheeler (2014) textbook’s Sample Clinical Assessment Form, found on pages 143–145.

Conclude Part A with a one-page description of this fictional patient, including all the relevant information outlined in the clinical assessment form as well as relevant and realistic information acquired from your research. Refer to the APA Clinical Practice Guidelines.

Part B: Therapy Session

You will design a therapy session for your client based on his or her preceding clinical assessment. Part B of your assignment will be assessed on your demonstration of proper therapeutic communication. The empathy demonstrated should be consistent with the following operational definition: Empathy is a critical tool for establishing a trusting therapeutic relationship. Rather than parrot back what your client has said, good empathy reflects the thoughts and feelings of your client and notes the importance of what has been communicated. In doing so, it invites the client to self-explore. Empathic feedback avoids “why” questions. When appropriately relayed in a tentative manner, good therapeutic empathy also gives the client a chance to redirect or correct what the counselor has said.

For Part B, you can choose to either video a 10-minute therapy session with your client or write out your therapy session in a transcript. You can have someone off camera speak the lines of your "client" if you choose to do this part of the assignment as a video. It is your choice whether to provide a video of your therapy session or a written transcript.

Your session transcript should:

Use your personal experiences to replicate realistic patient responses as well as clinical responses.

Be a written transcript of more than 2,100 words (at least 15 minutes in length).

Evidence empathic feedback that adheres to the operational definition of empathy in the counselor’s responses to most of the client's remarks.

Part C: Therapeutic Intervention

Much of the information you learn through your research can help inform the development of your patient. Research evidence-based interventions involving both psychopharmacological and nonpharmacological services to individuals who have been assessed in a mental health setting.

There should be three to five evidence-based articles and interventions that encompass both medication and non-medication modalities. Be sure to include two different therapeutic approaches when discussing non-medication interventions. For example, when selecting therapeutic approaches, you can select client-centered and cognitive behavioral therapy.