Discussion: NRNP 6635 Diagnosing Patients With Neurocognitive Disorders

Discussion: NRNP 6635 Diagnosing Patients With Neurocognitive Disorders

Discussion: NRNP 6635 Diagnosing Patients With Neurocognitive Disorders

Assignment

Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from the very specific to a general or global impairment, and often co-occur (APA, 2022). They include specific learning and language disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and intellectual disabilities. Neurocognitive disorders, on the other hand, represent a decline in one or more areas of prior mental function that is significant enough to impact independent functioning. They may occur at any time in life and be caused by factors such brain injury; diseases such as Alzheimer’s, Parkinson’s, or Huntington’s; infection; or stroke, among others.

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For this Assignment, you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder.

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Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

American Psychiatric Association. (2022). Neurocognitive disorders. In Diagnostic and statistical manual of mental disorders

Links to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x17_Neurocognitive_Disorders

American Psychiatric Association. (2022). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders

Links to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x01_Neurodevelopmental_Disorders

Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Chapter 3, “Neurocognitive Disorders”

Chapter 2- sections 2.1 “Intellectual Disability”, 2.2 “Communication Disorders”, 2.3 Autism Spectrum Disorder, 2.4 Attention-Deficit Disorder, 2.5 “Specific Learning Disorder”, 2.6 “Motor Disorders”

Chapter 26 “Level of Care”

Chapter 29 “End-of-Life Issues and Palliative Care

Document: Comprehensive Psychiatric Evaluation Template

Download Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation Exemplar

Download Comprehensive Psychiatric Evaluation Exemplar

Required Media

Classroom Productions. (Producer). (2016). Neurocognitive disorders

Links to an external site. [Video]. Walden University.

Classroom Productions. (Producer). (2016). Neurodevelopmental disorders

Links to an external site. [Video]. Walden University.

MedEasy. (2016). Progressive neurocognitive disorders. | USMLE & COMLEX

Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=KdcjyHvaAuQ

Video Case Selections for Assignment

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Symptom Media. (Producer). (2017). Training title 48

Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-48

Symptom Media. (Producer). (2017). Training title 50

Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-50

Document: Case History Reports

Download Case History Reports

To Prepare:

Review this week’s Learning Resources and consider the insights they provide. Consider how neurocognitive impairments may have similar presentations to other psychological disorders.

Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.

By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.

Consider what history would be necessary to collect from this patient.

Consider what interview questions you would need to ask this patient.

Identify at least three possible differential diagnoses for the patient.

By Day 7 of Week 10

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

Objective: What observations did you make during the psychiatric assessment? 

Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

To submit your completed assignment, save your Assignment as WK10Assgn_LastName_Firstinitial

Then, click on Start Assignment near the top of the page.

Next, click on Upload File and select Submit Assignment for review.

Rubric

NRNP_6635_Week10_Assignment_Rubric

NRNP_6635_Week10_Assignment_Rubric
Criteria Ratings Pts

This criterion is linked to a Learning Outcome 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

20 to >17.0 pts

Excellent

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

17 to >15.0 pts

Good

The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

15 to >13.0 pts

Fair

The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.

13 to >0 pts

Poor

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.

20 pts

This criterion is linked to a Learning Outcome In the Objective section, provide:• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

20 to >17.0 pts

Excellent

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

17 to >15.0 pts

Good

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

15 to >13.0 pts

Fair

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

13 to >0 pts

Poor

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.

20 pts

This criterion is linked to a Learning Outcome In the Assessment section, provide: • Results of the mental status examination, presented in paragraph form. • At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

25 to >22.0 pts

Excellent

The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

22 to >19.0 pts

Good

The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

19 to >17.0 pts

Fair

The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.

17 to >0 pts

Poor

The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.

25 pts

This criterion is linked to a Learning Outcome Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, 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.).

10 to >8.0 pts

Excellent

Reflections are thorough, thoughtful, and demonstrate critical thinking.

8 to >7.0 pts

Good

Reflections demonstrate critical thinking.

7 to >6.0 pts

Fair

Reflections are somewhat general or do not demonstrate critical thinking.

6 to >0 pts

Poor

Reflections are incomplete, inaccurate, or missing.

10 pts

This criterion is linked to a Learning Outcome Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

15 to >13.0 pts

Excellent

The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.

13 to >11.0 pts

Good

The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

11 to >10.0 pts

Fair

Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

10 to >0 pts

Poor

Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.

15 pts

This criterion is linked to a Learning Outcome Written Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 pts

Excellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. … A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.5 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. … Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5 to >3.0 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. … Purpose, introduction, and conclusion of the assignment is vague or off topic.

3 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. … No purpose statement, introduction, or conclusion were provided.

5 pts

This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation
5 to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

4 to >3.0 pts

Good

Contains a few (one or two) grammar, spelling, and punctuation errors

3 to >2.0 pts

Fair

Contains several (three or four) grammar, spelling, and punctuation errors

2 to >0 pts

Poor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5 pts

Total Points: 100

Discussion: NRNP 6635 Diagnosing Patients With Neurocognitive Disorders Sample

Subjective:

CC (chief complaint): “Trouble paying attention.”

HPI: Sarah Higgins is an 11-year-old female accompanied by her mother for psychiatric assessment due to problems with paying attention. Sarah has exhibited challenges with remembering things and often loses her items. Sarah’s mother, Mrs. Higgins, has brought along two completed questionnaires on attention deficit hyperactivity disorder, one filled by her and the other by Sarah’s teacher. Sarah always forgets the assignments given at school, and the teacher has to write a list, which she misplaces daily. According to the mother, Sarah’s troubles with forgetting and losing things started in kindergarten. In addition, Sarah often fidgets and, at times, gets into trouble in school for fidgeting and not remaining still in her chair. She rarely remains still when reading books and only stays for five minutes if the book is interesting. Sarah admits that she often forgets what she reads and what the teacher reads for her. She often makes mistakes in her schoolwork. She reports that she often gets angry when her teacher instructs her to do a task, and she does not hear them. Furthermore, she often daydreams in school about playing with her dog and often misses her mother, who they are currently separated. According to Mrs. Higgins, Sarah was more uncontrollable when she was younger, but this has improved.

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Past Psychiatric History:

  • General Statement: No significant psychiatric history.
  • Caregivers (if applicable): Grandmother
  • Hospitalizations: None
  • Medication trials: None
  • Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: None

Family Psychiatric/Substance Use History: No psychiatric or SUDs in the family.

Psychosocial History: Sarah lives with her grandmother and is separated from her parents. She has a younger brother who lives with her parents in Washington, D.C. She sleeps 9-10 hours/night. Her PCP states that she has proper nutrition. However, she has difficult meal times and hardly sits down to take her meals. She loves playing video games, art, and museums.

Medical History: No chronic illnesses. Immunizations are current.

 

  • Current Medications: None
  • Allergies: NKDFA
  • Reproductive Hx: N/A

ROS:

  • GENERAL: Denies fever, chills, weight loss/gain, or fatigue.
  • HEENT: Denies head trauma, excessive tearing, blurred/double vision, ear pain/discharge, nasal congestion, sneezing, or sore throat.
  • SKIN: Denies itching or lesions.
  • CARDIOVASCULAR: Negative for edema, palpitations, dyspnea, or chest pain.
  • RESPIRATORY: Denies cough, wheezing, or sputum.
  • GASTROINTESTINAL: Negative for nausea, vomiting, abdominal pain, bowel changes, or rectal bleeding.
  • GENITOURINARY: Denies dysuria or vulvar irritation.
  • NEUROLOGICAL: Denies headache, dizziness, paralysis, or tingling sensations.
  • MUSCULOSKELETAL: Denies joint pain, stiffness, or muscle pain.
  • HEMATOLOGIC: Denies bleeding.
  • LYMPHATICS: Denies enlarged lymph nodes.
  • ENDOCRINOLOGIC: Denies excessive sweating, hot/cold intolerance, or polyuria.

Objective:

Physical exam:

Vital signs: T- 97.4 P- 58 R 14 98/62 Ht 4’5 Wt 65lbs

Diagnostic results: No tests were requested.

Assessment:

Mental Status Examination:

The girl is well-groomed and appropriately dressed. She is alert but is distracted. She is oriented to person, place, and time. She constantly fidgets on her chair and maintains minimal eye contact. Her speech tone varies from low to normal, and she uses syllables. She has a coherent and logical thought process. No hallucinations, delusions, obsessions, or suicidal ideations were noted. Impaired recent memory and short attention span.

Differential Diagnoses:

Attention Deficit Hyperactivity Disorder (ADHD): ADHD is a childhood mental disorder characterized by inattention and/or hyperactive-impulsive behavior (Caye et al., 2019). Sarah presents with features of both inattention and hyperactivity. Features of inattention in the patient include difficulties with paying attention, being easily distracted, difficulties with tasks requiring sustained attention like reading, losing important items, making numerous mistakes in her school work, and forgetting her assignments (Caye et al., 2019). She also has features of hyperactivity like fidgeting, difficulty waiting for her turn, and difficulty remaining still in her seat.  

Pediatric Generalized Anxiety Disorder (GAD): This is characterized by excessive, hard-to-control, diffuse anxiety that is accompanied by concentration difficulties, easy distractibility, insomnia, irritability, fatigue, muscle tension, and somatic symptoms like headaches, abdominal pains, irregular heartbeat, and chest pain (Cho et al., 2019; Warner et al., 2023 ). The patient has concentration difficulties and is easily distracted. However, she does not present with anxiety as the primary symptom.

Conduct Disorder: The DSM-V criteria for Conduct disorder include at least three of the following symptoms in the past 12 months: Bullying, aggression to people and animals, threatening and intimidating, destruction of property, stealing, frequently fighting and assaulting others, sexually coercing, and serious violation of rules (Kerekes et al., 2020; Sagar et al., 2019).

Reflections: If I were to conduct the assessment again, I would ask Sarah’s mother about factors            that may have contributed to ADHD in the child. This includes prenatal toxic exposures, prematurity, prenatal mechanical insult to the nervous system, and psychosocial factors. Ethical considerations surrounding the patient’s case involve the principles of beneficence and nonmaleficence. The NP should provide interventions that promote the best outcomes for the patient without causing adverse effects. Health promotion for this patient should seek to educate the child’s caregivers on behavioral management techniques to learn how to manage the child (Schroer et al., 2021). They should be advised to add incentives and token rewards to reinforce behavioral management at home.

References

Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2019). Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Molecular psychiatry, 24(3), 390–408.

Cho, S., Przeworski, A., & Newman, M. G. (2019). Pediatric generalized anxiety disorder. In Pediatric anxiety disorders (pp. 251-275). Academic Press. https://doi.org/10.1016/B978-0-12-813004-9.00012-8

Kerekes, N., Zouini, B., Karlsson, E., Cederholm, E., Lichtenstein, P., Anckarsäter, H., & Råstam, M. (2020). Conduct disorder and somatic health in children: a nationwide genetically sensitive study. BMC psychiatry, 20(1), 595. https://doi.org/10.1186/s12888-020-03003-2

Sagar, R., Patra, B. N., & Patil, V. (2019). Clinical Practice Guidelines for the management of conduct disorder. Indian journal of psychiatry, 61(Suppl 2), 270–276. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_539_18

Schroer, M., Haskell, B., & Vick, R. (2021). Treating Child and Adolescent Attention-Deficit/Hyperactivity Disorder and Behavioral Disorders in Primary Care. The Journal for Nurse Practitioners, 17(1), 70–75. https://doi.org/10.1016/j.nurpra.2020.08.007

Warner, E. N., Ammerman, R. T., Glauser, T. A., Pestian, J. P., Agasthya, G., & Strawn, J. R. (2023). Developmental Epidemiology of Pediatric Anxiety Disorders. Child and Adolescent Psychiatric Clinics of North America, 32(3), 511–530. https://doi.org/10.1016/j.chc.2023.02.001

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