2. DEV CORDOBA: She thought you were going to help me be
better.
DR. JENNY: Yes, I am here to help you. Have you ever come to
see someone like me
before, or talked to someone like me before to help you with
your mood?
DEV CORDOBA: No, never.
DR. JENNY: OK. Well, I would like to start with getting to
know you a little bit better, if
that's OK. What do you like to do for fun when you're at home?
DEV CORDOBA: Oh, I have a dog. His name is Sparky. We
play policeman in my
room. And I have LEGOs, and I could build something if you
want.
DR. JENNY: I would love to see what you build with your
LEGOs. Maybe you can bring
that in for me next appointment. Who lives in your home?
DEV CORDOBA: My mom and my baby brother and Sparky.
DR. JENNY: Do you help your mom with your brother?
DEV CORDOBA: No. His breath smells like bad milk all the
time. [CHUCKLES] And he
cries a lot, and my mom spends more time with him.
4. you weren't asleep?
DEV CORDOBA: Oh, no. No. And I don't like the dark. My
mom puts me in a night light
with the door open, so I know she's really there.
DR. JENNY: That seems like that probably would help. Do you
like to go to school? Or
would you rather not go?
DEV CORDOBA: I worry about by mom and brother when I'm
at school. All I can think
about is what they're doing, and if they're OK. And besides,
nobody likes me there.
They call me Mr. Smelly.
DR. JENNY: Well. That's not nice at all. Why do you feel they
call you names?
DEV CORDOBA: I don't know. But my mom says it's because I
won't take my baths.
[SIGHS] She tells me to, and it-- and I have night accidents.
DR. JENNY: Oh, how does that make you feel?
DEV CORDOBA: Sad and really bad. They don't know how it
feels for their daddy to
never come home. What if my mom doesn't come home too?
DR. JENNY: Yes, you seem to worry about that a lot. Does this
6. now. We're going to work
together, and we're going to help you feel happier, less worried,
and be able to enjoy
school more. Is that OK?
DEV CORDOBA: Yes. Thank you.
MISS CORDOBA: Hi.
DR. JENNY: Thank you, Miss Cordoba, for bringing in Dev. I
feel we can help him. So
tell me, what is your main concerns for Dev?
MISS CORDOBA: [SIGHS] Well, he just seems so anxious and
worried all the time, silly
things like I'm going to die, or I won't pick him up from school.
He says I love his brother
more than him. He'll throw things around the house, and gets in
trouble at school for
throwing things.
He has a difficult time going to sleep. He wants his lights on,
doors open, gets up
frequently. And he's all the time wanting to come home from
school, claims stomach
aches, and headaches almost daily. He won't eat. He's lost three
pounds in the past
7. three weeks. Our pediatrician sent us to you because he doesn't
believe anything is
physically wrong.
Oh, and I almost forgot. He still wets the bed at night. [SIGHS]
We've tried everything.
His pediatrician did give him DDVAP, but it doesn't seem to
help.
DR. JENNY: Hmm. OK. Can you tell me, any blood relatives
have any mental health or
substance use issues?
MISS CORDOBA: No, not really.
DR. JENNY: What about his father? He said that he never came
home?
MISS CORDOBA: Oh, yes. His father was deployed with the
military when Dev was
five. I told Dev he was on vacation. I didn't know what to tell
him. I thought he was too
young to know about war. And his father was killed, so Dev
still doesn't understand that
his father didn't just leave him. [SIGHS] I just feel so guilty
that all of this is my fault.
DR. JENNY: Miss Cordoba, you did the right thing by bringing
in Dev. We can help you
9. · Allergies
· ROS
Read rating descriptions to see the grading standards!
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.
Read rating descriptions to see the grading standards!
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.
· Read rating descriptions to see the grading standards!
Reflect on this case. Include: 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.).
(The FOCUSED SOAP psychiatric evaluation is typically the
follow-up visit patient note. You will practice writing this type
of note in this course. You will be focusing more on the
symptoms from your differential diagnosis from the
comprehensive psychiatric evaluation narrowing to your
diagnostic impression. You will write up what symptoms are
10. present and what symptoms are not present from illnesses to
demonstrate you have indeed assessed for illnesses which could
be impacting your patient. For example, anxiety symptoms,
depressive symptoms, bipolar symptoms, psychosis symptoms,
substance use, etc.)
EXEMPLAR BEGINS HERE
Subjective:
CC (chief complaint): A brief statement identifying why the
patient is here. This statement is verbatim of the patient’s own
words about why presenting for assessment. For a patient with
dementia or other cognitive deficits, this statement can be
obtained from a family member.
HPI: Begin this section with patient’s initials, age, race, gender,
purpose of evaluation, current medication and referral reason.
For example:
N.M. is a 34-year-old Asian male presents for medication
management follow up for anxiety. He was initiated sertraline
last appt which he finds was effective for two weeks then
symptoms began to return.
Or
P.H., a 16-year-old Hispanic female, presents for follow up to
discuss previous psychiatric evaluation for concentration
difficulty. She is not currently prescribed psychotropic
medications as we deferred until further testing and screening
was conducted.
Then, this section continues with the symptom analysis for your
note. Thorough documentation in this section is essential for
patient care, coding, and billing analysis.
Paint a picture of what is wrong with the patient. First what is
bringing the patient to your follow up evaluation? Document
symptom onset, duration, frequency, severity, and impact. What
has worsened or improved since last appointment? What
stressors are they facing? Your description here will guide your
differential diagnoses into your diagnostic impression. You are
seeking symptoms that may align with many DSM-5 diagnoses,
narrowing to what aligns with diagnostic criteria for mental
11. health and substance use disorders.
Substance Use History: This section contains any history or
current use of caffeine, nicotine, illicit substance (including
marijuana), and alcohol. Include the daily amount of use and
last known use. Include type of use such as inhales, snorts, IV,
etc. Include any histories of withdrawal complications from
tremors, Delirium Tremens, or seizures.
Current Medications: Include dosage, frequency, length of time
used, and reason for use. Also include OTC or homeopathic
products.
Allergies:Include medication, food, and environmental allergies
separately. Provide a description of what the allergy is (e.g.,
angioedema, anaphylaxis). This will help determine a true
reaction vs. intolerance.
Reproductive Hx:Menstrual history (date of LMP), Pregnant
(yes or no), Nursing/lactating (yes or no), contraceptive use
(method used), types of intercourse: oral, anal, vaginal, other,
any sexual concerns
ROS: Cover all body systems that may help you include or rule
out a differential diagnosis. Please note: THIS IS DIFFERENT
from a physical examination!
You should list each system as follows: General:Head: EENT:
etc. You should list these in bullet format and document the
systems in order from head to toe.
Example of Complete ROS:
GENERAL: No weight loss, fever, chills, weakness, or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision, or
yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing,
congestion, runny nose, or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure, or chest
discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough, or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting, or
diarrhea. No abdominal pain or blood.
GENITOURINARY: Burning on urination, urgency, hesitancy,
12. odor, odd color
NEUROLOGICAL: No headache, dizziness, syncope, paralysis,
ataxia, numbness, or tingling in the extremities. No change in
bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain, or
stiffness.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat
intolerance. No polyuria or polydipsia.
Objective:
Diagnostic results: Include any labs, X-rays, or other
diagnostics that are needed to develop the differential diagnoses
(support with evidenced and guidelines).
Assessment:
Mental Status Examination: For the purposes of your courses,
this section must be presented in paragraph form and not use of
a checklist! This section you will describe the patient’s
appearance, attitude, behavior, mood and affect, speech, thought
processes, thought content, perceptions (hallucinations,
pseudohallucinations, illusions, etc.)., cognition, insight,
judgment, and SI/HI. See an example below. You will modify to
include the specifics for your patient on the above elements—
DO NOT just copy the example. You may use a preceptor’s way
of organizing the information if the MSE is in paragraph form.
He is an 8-year-old African American male who looks his stated
age. He is cooperative with examiner. He is neatly groomed and
clean, dressed appropriately. There is no evidence of any
abnormal motor activity. His speech is clear, coherent, normal
in volume and tone. His thought process is goal directed and
logical. There is no evidence of looseness of association or
flight of ideas. His mood is euthymic, and his affect appropriate
to his mood. He was smiling at times in an appropriate manner.
He denies any auditory or visual hallucinations. There is no
evidence of any delusional thinking. He denies any current
suicidal or homicidal ideation. Cognitively, he is alert and
13. oriented. His recent and remote memory is intact. His
concentration is good. His insight is good.
Diagnostic Impression:You must begin to narrow your
differential diagnosis to your diagnostic impression. You must
explain how and why (your rationale) you ruled out any of your
differential diagnoses. You must explain how and why (your
rationale) you concluded to your diagnostic impression. You
will use supporting evidence from the literature to support your
rationale. Include pertinent positives and pertinent negatives for
the specific patient case.
Also included in this section is the reflection. Reflect on this
case and discuss whether or not you agree with your preceptor’s
assessment and diagnostic impression of the patient and why or
why not. What did you learn from this case? What would you do
differently?
Also include in your reflection a discussion related to
legal/ethical considerations (demonstrating 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.).
Case Formulation and Treatment Plan
Includes documentation of diagnostic studies that will be
obtained, referrals to other health care providers, therapeutic
interventions including psychotherapy and/or
psychopharmacology, education, disposition of the patient, and
any planned follow-up visits. Each diagnosis or condition
documented in the assessment should be addressed in the plan.
The details of the plan should follow an orderly manner. *See
an example below. You will modify to your practice so there
may be information excluded/included. If you are completing
this for a practicum, what does your preceptor document?
Risks and benefits of medications are discussed including non-
treatment. Potential side effects of medications discussed (be
detailed in what side effects discussed). Informed client not to
14. stop medication abruptly without discussing with providers.
Instructed to call and report any adverse reactions. Discussed
risk of medication with pregnancy/fetus, encouraged birth
control, discussed if does become pregnant to inform provider
as soon as possible. Discussed how some medications might
decreased birth control pill, would need back up method
(exclude for males).
Discussed risks of mixing medications with OTC drugs, herbal,
alcohol/illegal drugs. Instructed to avoid this practice.
Encouraged abstinence. Discussed how drugs/alcohol affect
mental health, physical health, sleep architecture.
Initiation of (list out any medication and why prescribed, any
therapy services or referrals to specialist):
Client was encouraged to continue with case management and/or
therapy services (if not provided by you)
Client has emergency numbers: Emergency Services 911, the
Client's Crisis Line 1-800-_______. Client instructed to go to
nearest ER or call 911 if they become actively suicidal and/or
homicidal. (only if you or preceptor provided them)
Reviewed hospital records/therapist records for collaborative
information; Reviewed PMP report (only if actually completed)
Time allowed for questions and answers provided. Provided
supportive listening. Client appeared to understand discussion.
Client is amenable with this plan and agrees to follow treatment
regimen as discussed. (this relates to informed consent; you will
need to assess their understanding and agreement)
Follow up with PCP as needed and/or for:
Labs ordered and/or reviewed (write out what diagnostic test
17. WK3 ASSIGN1 NRNP 6675
Learning Resources
Required Readings (click to expand/reduce)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan &
Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
(For review as needed)
· Chapter 9, “Anxiety Disorders”
· Chapter 10, “Obsessive-Compulsive and Related Disorders”
· Chapter 11, “Trauma- and Stressor-Related Disorders”
· Chapter 12, “Dissociative Disorders”
· Chapter 26, “Physical and Sexual Abuse of Adults”
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M.
J., & Taylor, E. A. (Eds.). (2015). Rutter’s child and adolescent
psychiatry (6th ed.). Wiley Blackwell.
· Chapter 26, “Psychosocial Adversity”
· Chapter 27, “Resilience: Concepts, Findings, and Clinical
Implications”
· Chapter 29, “Child Maltreatment”
· Chapter 30, Child Sexual Abuse”
· Chapter 58, “Disorders of Attachment and Social engagement
Related to Deprivation”
· Chapter 59, “Post Traumatic Stress Disorder”
Zakhari, R. (2021). The psychiatric-mental health nurse
practitioner certification review manual. Springer Publishing
Company.
· Chapter 6, “Physical Assessment, Diagnostic Tests, and
Differential Diagnosis”
· Chapter 12, “Anxiety Disorders”
Centers for Disease Control and Prevention. (2020, April 3).
18. Adverse childhood experiences (ACEs) [Video].
https://www.cdc.gov/violenceprevention/aces/index.html
Dartmouth Films. (2018, September 25). Resilience [Video].
YouTube. https://www.youtube.com/watch?v=bAXZVYDNURY
NCTSN. (2007). The promise of trauma-focused therapy for
childhood sexual abuse [Video].
https://www.nctsn.org/resources/promise-trauma-focused-
therapy-childhood-sexual-abuse-video
Walden University. (2021). Case study: Dev Cordoba. Walden
University Blackboard. https://class.waldenu.edu
Accessible player --Downloads--Download Video
w/CCDownload AudioDownload Transcript
Medication Review
Review the FDA-approved use of the following medicines
related to treating anxiety disorders, OCD, PTSD, and related
disorders:
Anxiety
Generalized anxiety disorder
Panic disorder
alprazolam
amitriptyline
amoxapine
buspirone
chlordiazepoxide
citalopram
clomipramine
clonazepam
clonidine
clorazepate
cyamemazine
desipramine
diazepam
dothiepin
22. In assessing patients with anxiety, obsessive-compulsive, and
trauma and stressor-related disorders, you will continue the
practice of looking to understand chief symptomology in order
to develop a diagnosis. With a differential diagnosis in mind,
you can then move to a treatment and follow-up plan that may
involve both psychopharmacologic and psychotherapeutic
approaches.
Photo Credit: Photographee.eu / Adobe Stock
In this Assignment, you use a case study to develop a focused
SOAP note based on evidence-based approaches. To Prepare
· Review this week’s Learning Resources. Consider the insights
they provide about assessing and diagnosing anxiety, obsessive
compulsive, and trauma-related disorders.
· Review the Focused SOAP Note template, which you will use
to complete this Assignment. There is also a Focused SOAP
Note Exemplar provided as a guide for Assignment
expectations.
· Review the video, Case Study: Dev Cordoba. You will use this
case as the basis of this Assignment. In this video, a Walden
faculty member is assessing a mock patient. The patient will be
represented onscreen as an avatar.
· Consider what history would be necessary to collect from this
patient.
· Consider what interview questions you would need to ask this
patient.The Assignment
Develop a Focused SOAP Note, including your differential
diagnosis and critical-thinking process to formulate a 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
23. 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-TRcriteria 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.
· Plan: What is your plan for psychotherapy? What is your plan
for treatment and management, including alternative therapies?
Include pharmacologic and nonpharmacologic treatments,
alternative therapies, and follow-up parameters, as well as a
rationale for this treatment and management plan. Also
incorporate one health promotion activity and one patient
education strategy.
· Reflection notes: What would you do differently with this
patient if you could conduct the session again? Discuss what
your next intervention would be if you could follow up with this
patient. 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.).
· 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).
NRNP 6675: PMHNP Care Across the Lifespan II
Career Planner Guide
24. Your Nurse Practitioner Professional Career Planner is due by
Day 7 of Week 10. It is highly recommended that you begin
planning and working on this Assignment as early in the quarter
as is feasible for you. The following checklists outline all of the
items you should include in your Career Planner. Additionally,
the resources below have been provided to assist you in its
development.
Refer to the Walden University Career Center website for
resources and information on how to create cover letters,
resumes, and professional portfolios. You may also choose to
make certain portions of your Career Planner accessible online
to members of your professional network or potential employers
through platforms such as LinkedIn. Sharing on social media is
a useful way to network for many, but it is not a requirement for
this assignment.
Checklist for Cover Letter
Cover letters are typically tailored to individual jobs and
companies. For this Assignment, you will select a job posting
you would like to or could potentially apply for and create a
cover letter for it. Your cover letter should be:
· Presented and formatted in professional business manner
· Addressed properly
· Clear and concise (no more than one page) and include:
· Content introduction
· Content body
· Content conclusion
· Written in a professional tone and include:
· Correct spelling, punctuation, and grammar
· Clear and accurate sentence structure
Checklist for Resume
Your resume should be clear, concise, and well organized, and
it should also include your:
25. · Name, location (city/town and state), business phone number,
and email address (centered at top of resume)
· Objective: 2–3 sentences describing your goal/objective for
employment
· Certifications & licenses
· Education
· Professional experience
· Honors/Awards (as applicable)
Checklist for Portfolio
Your Portfolio should be clear, concise, and well organized, and
it should also include your:
· Personal philosophy statement (1-page)
· Personal goals (short term and long term)
· Self-assessment
The following items do not have to be submitted but should be
available on request for employers:
· Achievements
· Letters of recommendation (2)
· References (list names, affiliation, and contact information)
(3)
· Certifications and licenses
· Prior degrees
· Transcripts (Note: An unofficial transcript will meet this
requirement.)
· Certificates of attendance for continuing education
· Publications
· Research
· Oral presentations and/or poster presentations
Learning Resources
Resume and Cover Letter Resources:
26. Canva. (n.d.). https://www.canva.com/
Canva has many resume templates and formats that may inspire
your creativity. (Using Canva is optional.)
Cover Letter Advice (n.d.). Nurse practitioner cover letter
sample 1. http://www.coverletter.us/nurse-practitioner-cover-
letter/
DeCapua, M. (2019). A nurse practitioner’s guide to the perfect
cover letter. Health eCareers.
https://www.healthecareers.com/article/healthcare-news/np-
cover-letter
Hicks, R. W., & Roberts, M. E. E. (2016). Curriculum vitae: An
important tool for the nurse practitioner. Journal of the
American Association of Nurse Practitioners, 28(7), 347–352.
Gibson, A. (n.d.). Nurse.org career guide series: Ultimate guide
to nursing resumes. Nurse.org.
https://nurse.org/resources/nursing-resume/
Walden University Career Services. (n.d.). Resumes & more.
https://academicguides.waldenu.edu/careerservicescenter/resum
esandmore
Portfolio Resources:
Chamblee, T. B., Dale, J. C., Drews, B., Spahis, J., & Hardin,
T. (2015). Implementation of a professional portfolio: A tool to
demonstrate professional development for advanced
practice. Journal of Pediatric Health Care, 29(1), 113–117.
Clarke, M. (2019). The importance of a professional nursing
portfolio. HealthLeaders.
https://www.healthleadersmedia.com/nursing/importance-
professional-nursing-portfolio
27. Nurse Practitioner Business Owner. (n.d.). This is why you want
to create your professional portfolio today!
https://npbusiness.org/professional-portfolio/
Portfolium. (n.d.). https://portfolium.com/
Portfolium is one example of portfolio software that you could
use to create a portfolio. You may choose your own tool, and it
may be online (Google Sites, Portfolium) or offline (Word,
pdf), as long as you can easily submit the portfolio files or link
to your Instructor.