Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD NRNP 6635
NRNP 6635 Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD
Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD NRNP 6635
Assignment Assessing and Diagnosing Patients with Anxiety Disorders PTSD and OCD
Subjective:
CC (chief complaint): “My fiancé demanded that I have an appointment.”
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HPI:
Sergeant Berry Sullivan is a 27-year-old veteran who came to the psychiatric clinic after his fiancé demanded that he gets a psychiatric appointment. This was after Berry got scared to a level of escaping after hearing fireworks when they attended a county fair three nights ago. Berry states that the sounds of the firework reminded him of the days when he was at war. He felt like he had been returned to the middle of enemy fire. The client also reports being startled by loud noises since they take him back to the combat days. In addition, he states that he hates the smell of diesel fuel, chopper, and something being grilled. The smell of something burning reminds him of his colleagues who were burnt alive when their Humvee was blown in combat.
Berry mentions that he dreams about the traumatic combat events every night and wishes not to sleep or close his eyes. He also states that he hates busy downtown traffic because it makes him nervous. He visualizes a person throwing an IED under his car and blowing him like what happened to his colleagues and two other vehicles he witnessed in combat. The client also reports that he gets irritated when his fiancé argues with her mother, which did not bother him before. Furthermore, he tries to run away from any negative situation and avoids public places. He stays in his room the whole day and avoids sleeping because he is afraid of nightmares.
Substance Current Use: Denies history of alcohol or illicit drug use.
Medical History:
Current Medications: None
Allergies: Positive for service-connected asthma and seasonal allergies.
Reproductive Hx: None
Family Psychiatric/Substance Use History:
Berry’s father has a history of alcoholism that made him abusive. The father has DM, cirrhosis, and HTN and still drinks alcohol. The paternal grandfather was also a veteran and suffered from depression every so often.
Psychosocial History:
Berry is a veteran and joined the military after high school. He underwent three long tours of duty in war zones. He resigned from active duty in the Marines less than a year ago after eight years of military service. Berry is engaged and plans to get married in eight months and get kids someday. He is currently enrolled in an online college for accounting, where he is using his GI Education Bill. He has one younger brother and one older sister. He lives in a different state from his parents and siblings, about five hours from the family home. He moved with his fiancé after resigning from active military duty because the fiancé got a better opportunity.
ROS:
GENERAL: Negative for low energy levels, fever, chills, or weight gain/loss.
HEENT: Negative for blurred vision, eye pain, ear pain/discharge, hearing loss, nasal discharge, sneezing, or sore throat.
SKIN: Negative for rash, discoloration, or bruises.
CARDIOVASCULAR: Positive for breathlessness when anxious. Negative for chest pain, edema, or palpitations.
RESPIRATORY: Positive for breathlessness when anxious. Negative for cough, sputum, or chest pain.
GASTROINTESTINAL: Positive for nausea and abdominal pain. Negative for vomiting, epigastric pain, or bowel changes.
GENITOURINARY: Negative for dysuria, penile discharge, or urinary frequency/urgency.
NEUROLOGICAL: Negative for headache, dizziness, fatigue, muscle weakness, or tingling sensations.
MUSCULOSKELETAL: Negative for muscle pain, joint stiffness, or joint pain.
HEMATOLOGIC: Negative for bruising.
LYMPHATICS: Negative for enlarged lymph nodes.
ENDOCRINOLOGIC: Positive for excessive sweating when anxious. Negative for cold/heat intolerance, excessive thirst, hunger, or urine production.
Objective:
Vital Signs: Temp- 98.8; P- 86; R-18; BP-122/70; Ht-5’8; Wt-160lbs
Diagnostic results: No test results available.
Assessment:
Mental Status Examination:
Male client in his 20’s. He is alert but appears anxious. He is well-groomed and appropriately dressed. He maintains adequate eye contact during the session, has positive body language, and uses facial expressions appropriately. The self-reported mood is nervous, and the affect is constricted. His speech is clear and goal-directed, but the volume and rate increase when discussing traumatic combat events. He has a logical and goal-directed thought process. No delusions, hallucinations, obsessions, or suicidal ideations/thoughts were observed. His short-term and long-term memory is intact, and he has a clear judgment.
Differential Diagnoses:
Post Traumatic Stress Disorder (PTSD)
PTSD is a syndrome characterized by recurrent, disturbing recollections of an overwhelmingly traumatic event. The recollections last more than one month and start within six months of the event. The symptoms of PTSD are subdivided into: intrusions, negative alterations in cognition and mood, avoidance, and alterations in arousal and reactivity (Miao et al., 2018). Individuals frequently have undesired memories replaying the traumatic event, and nightmares of the incidents are common. Persons with PTSD avoid stimuli connected with the trauma, often feel emotionally numb, and lack interest in daily activities (Miao et al., 2018).
PTSD is a presumptive diagnosis owing to the client’s positive features of intrusions, avoidance, and alterations in arousal and reactivity. The client reports having intrusive thoughts about the traumatic combat events and has nightmares about them. Besides, he avoids stimuli associated with combat, like avoiding traffic and public places. Alterations in arousal and reactivity are evident, with the client getting startled and aroused by fireworks, loud noises, and diesel, chopper, and burn smells (Miao et al., 2018). The client also has negative alterations in mood, as seen by getting nervous in situations that remind him of combat and getting irritated with his fiancé’s arguments.
Panic Disorder:
Panic disorder is diagnosed based on the presence of recurring panic attacks. A panic attack is a sudden period of extreme fear or discomfort accompanied by at least four of the following symptoms: Palpitations, Sweating, Trembling or shaking, Feeling of shortness of breath, Chest pain, dizziness, feeling of choking, Numbness or tingling sensation, chills, hot flashes, nausea, or abdominal pains (Manjunatha & Ram, 2022). Patients usually adopt maladaptive responses to panic attacks, like avoiding social situations.
The client presents with panic disorder symptoms, including episodes of intense anxiety, where he experiences profuse sweating, shaking, and breathlessness. He also reports feeling nauseated, abdominal discomfort, and general body numbness (Kim, 2019). The anxiety episodes have led to the client’s avoidance of public places. However, the client’s anxiety episodes are related to intrusive memories of traumatic combat events, which make Panic disorder an unlikely primary diagnosis.
Social Phobia:
Social phobia is characterized by marked and persistent fear of social or performance situations in which a person is exposed to potential scrutiny by others. The fear is intense to a level of impairing one’s occupational and social performance. Besides, exposure to social or performance situations often results in fear or anxiety (Leigh & Clark, 2018). The client reports avoiding public places since he gets extremely anxious and thus prefers to stay in his room the whole day. Nevertheless, the anxiety in social places is due to the client avoiding triggers of combat events, making social phobia an unlikely primary diagnosis.
Reflections:
From this assessment, I learned that situations likely to trigger PTSD are those that invoke feelings of helplessness, fear, or horror. I learned that PTSD is only diagnosed after one month has passed since the traumatic event. It is considered acute stress disorder if the symptoms occur in the first month. In a different situation, I would assess the patient for depression, anxiety disorders, and substance use since they are common among persons with chronic PTSD (Watkins et al., 2018). The PMHNP should uphold ethical and legal factors by ensuring the treatment interventions selected for the patient are established to promote the best outcomes with minimal or no adverse effects on the patient (Watkins et al., 2018). The PMHNP should also involve the client in developing the treatment plan to uphold the patient’s right to autonomy.
References
Kim, Y. K. (2019). Panic Disorder: Current Research and Management Approaches. Psychiatry investigation, 16(1), 1–3. https://doi.org/10.30773/pi.2019.01.08
Leigh, E., & Clark, D. M. (2018). Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995). Clinical child and family psychology review, 21(3), 388–414. https://doi.org/10.1007/s10567-018-0258-5
Manjunatha, N., & Ram, D. (2022). Panic disorder in general medical practice- A narrative review. Journal of family medicine and primary care, 11(3), 861–869. https://doi.org/10.4103/jfmpc.jfmpc_888_21
Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, pp. 12, 258. https://doi.org/10.3389/fnbeh.2018.00258
“Fear,” according to the DSM-5, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2013). All anxiety disorders contain some degree of fear or anxiety symptoms (often in combination with avoidant behaviors), although their causes and severity differ. Trauma-related disorders may also, but not necessarily, contain fear and anxiety symptoms, but their primary distinguishing criterion is exposure to a traumatic event. Trauma can occur at any point in life. It might not surprise you to discover that traumatic events are likely to have a greater effect on children than on adults. Early-life traumatic experiences, such as childhood sexual abuse, may influence the physiology of the developing brain. Later in life, there is a chronic hyperarousal of the stress response, making the individual vulnerable to further stress and stress-related disease.
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For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5 criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5 criteria.
To Prepare:
Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.
Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
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. Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD NRNP 6635
By Day 7 of Week 4
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 diagnostic criteria for each differential diagnosis and explain what DSM-5 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.).
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 4 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 4 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 4
To participate in this Assignment:
Week 4 Assignment
What’s Coming Up in Week 5?Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will continue to practice your assessment and diagnosis skills, focusing on disruptive, impulse-control, conduct, dissociative, and somatic symptom-related disorders.
Midterm Exam
You should also begin studying for your midterm exam, which is completed in Week 6. This will be a 100-question, multiple-choice exam covering all topics in Week 1–Week 6 of the course. The exams in your MSN program are designed to test your knowledge in preparation for your certification exam and to simulate the certification exam environment. Accordingly, no outside resources, including books, notes, websites, or any other type of resource, may be used to help you complete the exams in your courses.
Photo Credit: [Vergeles_Andrey]/[iStock / Getty Images Plus]/Getty Images
Next Week
To go to the next week:
Week 5
Week 4: Anxiety Disorders, PTSD, and OCD
Your own experiences might tell you that expectations from family, friends, and work—as well as your own expectations regarding achievement, success, and happiness—can create stress. Stressors are a normal part of life, and stress traditionally has been viewed as an adaptive function with a set of physiological responses to a stressor. In a situation where stress is perceived, the organism is physiologically prepared to attack or flee from the threat. Those with effective fight or flight responses tended to survive long enough to reproduce, so we are descended from those who are genetically hardwired for self-protection. When you experience stress, your biology, emotions, social support, motivation, environment, attitude, immune function, and wellness all feel the ripple effect.
This stress response is an adaptive response the human body has to threats; however, stress can also be difficult to handle and—depending upon the nature and intensity of the stress—can result in anxiety disorders, obsessive-compulsive disorders, or trauma- and stressor-related disorders. This week, you will focus on these disorders and explore strategies to accurately assess and diagnose them.
Learning Objectives
Students will:
Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
Formulate differential diagnoses using DSM-5 criteria for patients with anxiety disorders, PTSD, and OCD across the lifespan
Learning Resources
Required Readings (click to expand/reduce)
American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm05
Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD NRNP 6635 American Psychiatric Association. (2013). Obsessive compulsive and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm06
American Psychiatric Association. (2013). Trauma- and stressor-related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm07
Sadock, B. J., Sadock, V. A., and Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
Chapter 9, Anxiety Disorders
Chapter 10, Obsessive-Compulsive and Related Disorders
Chapter 11, Trauma- and Stressor-Related Disorders
Chapter 31.11 Trauma-Stressor Related Disorders in Children
Chapter 31.13 Anxiety Disorders in Infancy, Childhood, and Adolescence
Chapter 31.14 Obsessive-Compulsive Disorder in Childhood and Adolescence
Document: Comprehensive Psychiatric Evaluation Template
Document: Comprehensive Psychiatric Evaluation Exemplar
Required Media (click to expand/reduce)
Classroom Productions. (Producer). (2015). Anxiety disorders [Video]. Walden University.
Classroom Productions. (Producer). (2012). The neurobiology of anxiety [Video]. Walden University.
Classroom Productions. (Producer). (2015). Obsessive-compulsive disorders [Video]. Walden University.
Classroom Productions. (Producer). (2015). Trauma, PTSD, and Trauma-Informed Care [Video]. Walden University.
MedEasy. (2017). Anxiety, OCD, PTSD and related psychiatric disorders | USMLE & COMLEX [Video]. YouTube. https://www.youtube.com/watch?v=-BwzQF9DTlY
Video Case Selections for Assignment (click to expand/reduce)
Select oneof 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 15 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-15
Symptom Media. (Producer). (2016). Training title 21 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-21
Symptom Media. (Producer). (2016). Training title 37 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-37
Symptom Media. (Producer). (2016). Training title 40 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-40
Symptom Media. (Producer). (2017). Training title 55 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-55
Symptom Media. (Producer). (2017). Training title 85 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-85
Symptom Media. (Producer). (2018). Training title 95 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-95
Document: Case History Reports
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NRNP_6635_Week4_Assignment_Rubric
Grid View
List View
Excellent Good Fair Poor
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.
In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS
18 (18%) – 20 (20%)
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medic
