NUR 620: | Nursing

Clinical Requirement:

NUR620responseswk6.pdf 1.This is base on my discussion post on Psychiatric Case study Elvira Angelica Silva de Vera • TEACHER Sep 30 10:53am Reply from Elvira Angelica Silva de Vera Given Ms. Richardson’s overlapping symptoms suggestive of both delirium and dementia with psychosis, what clinical tools or assessments would you prioritize to accurately differentiate these conditions in the acute hospital setting, and how would this distinction impact your immediate treatment approach? 2. Reply from Anita Lucia Mohan   Psychiatric Case Study: Ms. Richardson Clinical Summary Ms. Richardson is a 74-year-old African American female brought to the emergency department by police after reports from neighbors of wandering, self-neglect, and confusion. On arrival, she was unkempt, malodorous, and disoriented to time and place, though she knew her name and address. She was minimally responsive, with a flat affect, poor eye contact, and limited insight. She reported generalized weakness, shoulder pain, difficulty swallowing, and not eating for three days. She recalled her dog being tranquilized and erroneously believed it was in “the shop,” showing signs of confusion. She denied hallucinations or prior psychiatric hospitalizations but mentioned seeing a psychiatrist for insomnia in the past. Her home environment was severely unsanitary, with feces and clutter, suggesting severe self-neglect. She was also noted to have uncontrolled diabetes, dehydration, and malnutrition. Subjective data includes weakness, shoulder pain, and not eating for three days, Objective data includes unkempt appearance, malodorous, disoriented to time and place, impaired insight, poor judgment, unsafe environment, uncontrolled diabetes, and difficulty swallowing, dehydration and poor nutritional intake. Her presentation suggests acute cognitive decline with possible chronic neurocognitive disorder (Tusaie, 2023, pp. 328–351). Primary Diagnosis: F05- Delirium due to Another Medical Condition (DSM-5-TR Code: 293.0; ICD-10 F05) Ms. Richardson’s presentation is most consistent with delirium due to another medical condition. According to the DSM-5-TR, delirium is defined as an acute disturbance in attention and awareness that develops over a short period, fluctuates in severity, and is associated with additional cognitive impairments such as memory deficits, disorientation, or perceptual disturbances. It must be attributable to a physiological cause such as a medical illness, substance intoxication, or metabolic imbalance (American Psychiatric Association [APA], 2022). According to Tusaie (2023), such presentations in older adults often reflect delirium, a reversible condition commonly triggered by metabolic disturbances or infections. Her risk factors include advanced age, poor glucose control, nutritional deficiency, and social isolation, aligning with known etiologies of delirium (pp. 328–351). Two Differential Diagnosis The first differential diagnosis is Major Neurocognitive Disorder (NCD), Unspecified Type (DSM-5-TR Code: 294.20; ICD-10: F03.90). DSM-5-TR defines major NCD as a significant cognitive decline in one or more domains to include memory, executive function, attention, and language that interferes with independence (APA, 2022). Ms. Richardson’s functional decline and neglect could suggest an underlying dementia, which may have been masked by acute delirium. Delirium may occur superimposed on major NCD, and evaluation should be repeated after medical stabilization (Tusaie, 2023, pp. 328–351). The second differential diagnosis is Depressive Disorder with Cognitive Impairment (Pseudodementia) (DSM-5-TR Code: 311, ICD-10: F32.9). Late-life depression may manifest as cognitive slowing, poor concentration, apathy, and self-neglect, mimicking dementia (APA, 2022). Ms. Richardson’s flat affect and limited responsiveness may represent depressive features. Distinguishing pseudodementia through mood assessment and improvement with antidepressant therapy can help differentiates it from degenerative cognitive disorders (Tusaie, 2023, pp. 328– 351).. Pharmacological Treatment The primary pharmacologic goal in Ms. Richardson’s case is to treat the underlying medical cause of delirium. According to NICE (2023) guidelines, management should begin with intravenous fluids and electrolyte correction to address dehydration, along with insulin therapy based on ADA (2023) standards to stabilize hyperglycemia. Nutritional supplements including multivitamins and thiamine help to correct deficiencies contributing to cognitive impairment. If Ms. Richardson develops behavioral agitation or perceptual disturbances, low-dose haloperidol (0.25–0.5 mg PO/IM every 4–6 hours as needed) may be administered, with ECG monitoring for potential QT prolongation. Haloperidol is often recommended for short-term symptom management in delirium when nonpharmacologic interventions are insufficient (APA, 2023). If cognitive symptoms persist after medical stabilization and a major neurocognitive disorder (NCD) is confirmed, pharmacologic agents such as donepezil (5 mg daily) or memantine (5 mg daily) may be initiated to support cognitive function (Tusaie, 2023 pp.328-351). Nonpharmacological Treatment Nonpharmacological treatment is important in delirium management. The primary goal is to restore orientation, ensure safety, and address modifiable risk factors through environmental and behavioral interventions. Ms. Richardson should be placed in a quiet, well-lit environment with visible clocks, calendars, and familiar objects to enhance orientation and reduce confusion. Consistent caregivers and family involvement can provide reassurance and emotional stability. Reorientation strategies, including frequent verbal reminders of time, place, and situation, can be used throughout the day. To support physiological stability, she should maintain adequate hydration and nutrition. Sleep hygiene is another critical component; nighttime noise and interruptions should be minimized to promote restorative sleep. Collectively, these multicomponent interventions have been shown to reduce both the severity and duration of delirium while promoting functional recovery (Tusaie, 2023, pp. 328–351). Health Promotion Intervention Health promotion for Ms. Richardson should focus on chronic disease management, safety, and social support to prevent recurrence of delirium and enhance overall well-being. Education on diabetes self-management is essential, following the American Diabetes Association (2023) standards. This includes teaching her how to monitor blood glucose, adhere to prescribed insulin therapy, and maintain a balanced diet. Given her unsafe home environment and self-neglect, referrals to Adult Protective Services (APS) and home health nursing are warranted for supervision and support would be recommended. Social services can assist in arranging community resources such as Meals on Wheels, senior day programs, and transportation to reduce isolation and improve access to care. If a major neurocognitive disorder or depression is identified, appropriate long-term treatment can be initiated (Tusaie, 2023, pp. 328–351). NUR620DISCUSSION17.pdf Patient Care After studying Module 1: Lecture Materials & Resources, discuss the following: The unlawful restraint of a patient can be a legal pitfall for the PMHNP.  K.W. was found eating hamburgers out of a Mcdonald's dumpster and drinking water from an old water hose.  She had not taken a bath in weeks. She refused to live in an apartment because she wants to “live off the fat of the land.”   1. Cite the Baker Act law to defend your position.   2. Find one newspaper article written in the last 5 years that supports your position.  Summarize the details of the case and the laws cited    Submission Instructions: • Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points. • You should respond to at least two of your peers by extending, refuting/ correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)  • All replies must be constructive and use literature where possible. https://stu.instructure.com/courses/47926/pages/module-1-lecture-materials-and-resources Patient Information After studying Module 2: Lecture Materials & Resources, discuss the following: It is very important for all mental health professionals to take very detailed and thorough historical information from their patients. This information should include an adequate social history, complete medical history, and a full mental status examination with a probable treatment plan. • Describe three reasons it is important to gather detailed and extensive information from any patient before you counsel him/her or make medication suggestions.  Use evidence-based research to support your position. • Define malingering.  Discuss two ways to differentiate between malingering and a DSM5 diagnosis.  Use evidence-based research to support your position.   Submission Instructions: • Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points. • You should respond to at least two of your peers by extending, refuting/ correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)  • All replies must be constructive and use literature where possible.   https://stu.instructure.com/courses/47926/pages/module-2-lecture-materials-and-resources Anxiety Case After studying Module 3: Lecture Materials & Resources, discuss the following:   Submission Instructions: • Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points. • You should respond to at least two of your peers by extending, refuting/ correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)  • All replies must be constructive and use literature where possible. Case Study Ms. JN is a 24-year-old law student who presents to an outpatient psychiatry clinic accompanied by her husband. She feels “worried about everything!” She is “stressed out” about her academic workload and upcoming exams. She feels fatigued and has difficulty concentrating on her assignments. She also complains of frequent headaches and associated neck muscle spasms, as well as difficulty falling asleep. The patient’s husband describes her as “a worrier. She’ll worry about me getting into an accident, losing my job, not making enough money—the list goes on and on.” Ms. JN reports that she has always had some degree of anxiety, but previously found that it motivated her. Over the last year, her symptoms have become debilitating and beyond her control. Question s: Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers.  1. Summarize the clinical case 2. Formulate  3. Create a list of the patient’s problems and prioritize them.   4. Which pharmacological treatment would you prescribe? Include the rationale for this treatment. 5. Which non-pharmacological treatment would you prescribe?   Include the rationale for this treatment. 6. Include an assessment of treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence. https://stu.instructure.com/courses/47926/pages/module-3-lecture-materials-and-resources Depression Case After studying Module 4: Lecture Materials & Resources, discuss the following: Case Study Ms. Z is a 28-year-old assistant store manager who arrives at your outpatient clinic complaining of sadness after her boyfriend of 6 months ended their relationship 1 month ago. She describes a history of failed romantic relationships, and says, “I don’t do well with breakups.” Ms. Z reports that, although she has no prior psychiatric treatment, she was urged by her employer to seek therapy. Ms. Z has arrived late to work on several occasions because of oversleeping. She also has difficulty in getting out of bed stating, “It’s difficult to walk; it’s like my legs weigh a ton.” She feels fatigued during the day despite spending over 12 hours in bed and is concerned that she might be suffering from a serious medical condition. She denies any significant changes in appetite or weight since these symptoms began. Ms. Z reports that, although she has not missed workdays, she has difficulty concentrating and has become tearful in front of clients while worrying about not finding a significant other. She feels tremendous guilt over “not being good enough to get married,” and says that her close friends are concerned because she has been spending her weekends in bed and not answering their calls. Although during your evaluation Ms. Z appeared tearful, she brightened up when talking about her newborn nephew and her plans of visiting a college friend next summer. Ms. Z denied suicidal ideation. Question s: Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers.  1. Summarize the clinical case including the significant subjective and objective data. 2. Generate a primary and two differential diagnoses.  Use the DSM5 to support the assessment.  Include the DSM5 and ICD 10 codes. 3. Discuss a pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment. 4. Discuss non-pharmacological treatment would you prescribe?  Use the clinical guidelines to support the rationale for this treatment. 5. Describe a health promotion intervention that would be appropriate for this patient. https://stu.instructure.com/courses/47926/pages/module-4-lecture-materials-and-resources Bipolar Case After studying Module 5: Lecture Materials & Resources, discuss the following:   Submission Instructions: • Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points. • You should respond to at least two of your peers by extending, refuting/ correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)  Case Study Jill, a 24 y/o Hispanic female arrives in the emergency room where her parents brought her for evaluation. They are worried because she is giving away all of her possessions and says she is planning to move to the South Pole so she can "save the world." Her parents say that she has hardly been sleeping at all for the last 7 days, but she seems very energetic. They say she has appeared to be "in a frenzy" lately. When you interview Jill you notice that she speaks very rapidly and is laughing uncontrollably. It is hard to get her to be quiet long enough for you to ask questions. She seems agitated and has difficulty sitting still. Question s: Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers.  1. Summarize the clinical case including the significant subjective and objective data. 2. Generate a primary and two differential diagnoses.  Use the DSM5 to support the assessment.  Include the DSM5 and ICD 10 codes. 3. Discuss a pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment. 4. Discuss non-pharmacological treatment would you prescribe?  Use the clinical guidelines to support the rationale for this treatment. 5. Describe a health promotion intervention that would be appropriate for this patient. https://stu.instructure.com/courses/47926/pages/module-5-lecture-materials-and-resources Psychiatric Case  After studying Module 6: Lecture Materials & Resources, discuss the following Case Study A 74-year-old African American woman, Ms. Richardson, was brought to the hospital emergency room by the police.  She is unkempt, dirty, and foul-smelling.  She does not look at the interviewer and is apparently confused and unresponsive to most of his questions.  She knows her name and address, but not the day of the month. She is unable to describe the events that led to her admission.   The police reported that they were called by neighbors because Ms. Richardson had been wandering around the neighborhood and not taking care of herself.  The medical center mobile crisis unit went to her house twice but could not get in and presumed she was not home. Finally, the police came and broke into the apartment, where they were met by a snarling German shepherd.  They shot the dog with a tranquilizing gun and then found Ms. Richardson hiding in the corner, wearing nothing but a bra. The apartment was filthy, the floor littered with dog feces.  The police found a gun, which they took into custody. The following day, while Ms. Richardson was awaiting transfer to a medical unit for treatment of her out-of-control diabetes, the psychiatric provider attempted to interview her.  Her facial expression was still mostly unresponsive, and she still didn’t know the month and couldn’t say what hospital she was in.  She reported that the neighbors had called the police because she was “sick,” and indeed she had felt sick and weak, with pains in her shoulder; in addition, she had not eaten for 3 days.  She remembered that the police had shot her dog with a tranquilizer and said the dog was now in “the shop” and would be returned to her when she got home.  She refused to give the name of a neighbor who was a friend, saying, “he’s got enough troubles of his own.” She denied ever being in a psychiatric hospital or hearing voices but acknowledged that she had at one point seen a psychiatrist “near downtown” because she couldn’t sleep.  He had prescribed medication that was too strong, so she didn’t take it.  She didn’t remember the name, so the interviewer asked if it was Thorazine.  She said no, it was “allal.”  ‘Haldol?”, ask the interviewer. She nodded.   The interviewer was convinced that was the drug, but other observers thought she might have said yes to anything that sounded remotely like it, such as “Elavil.” When asked about the gun, she denied, with some annoyance, that it was real and said it was a toy gun that had been brought to the house by her brother, who had died 8 years ago.  She was still feeling weak and sick, complained of pain in her shoulder, and apparently had trouble swallowing.  She did manage to smile as the team left her bedside. https://stu.instructure.com/courses/47926/pages/module-6-lecture-materials-and-resources   Submission Instructions: • Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points. • You should respond to at least two of your peers by extending, refuting/ correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)  • All replies must be constructive and use literature where possible. Questions: Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers.  1. Summarize the clinical case including the significant subjective and objective data. 2. Generate a primary and two differential diagnoses.  Use the DSM5 to support the assessment.  Include the DSM5 and ICD 10 codes. 3. Discuss a pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment. 4. Discuss non-pharmacological treatment would you prescribe?  Use the clinical guidelines to support the rationale for this treatment. 5. Describe a health promotion intervention that would be appropriate for this patient. Schizophrenia Spectrum Case After studying Module 7: Lecture Materials & Resources, discuss the following:   Case Study Mr. T is a 21-year-old man who is brought to the ER by his mother after he began talking about “aliens” who were trying to steal his soul. Mr. T reports that aliens left messages for him by arranging sticks outside his home and sometimes send thoughts into his mind. On exam, he is guarded and often stops talking while in the middle of expressing a thought. Mr. T appears anxious and frequently scans the room for aliens, which he thinks may have followed him to the hospital. He denies any plan to harm himself but admits that the aliens  sometimes want him to throw himself in front of a car, “as this will change the systems that belong under us.” The patient’s mother reports that he began expressing these ideas a few months ago, but that they have become more severe in the last few weeks. She reports that during the past year, he has become isolated from his peers, frequently talks to himself, and has stopped going to community college. He has also spent most of his time reading science fiction books and creating devices that will prevent aliens from hurting him. She reports that she is concerned because the patient’s father, who left while the patient was a child, exhibited similar symptoms many years ago and has spent most of his life in a psychiatric hospital. Question s: Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers.  1. Summarize the clinical case including the significant subjective and objective data. 2. Generate a primary and two differential diagnoses. Use the DSM5 to support the assessment. Include the DSM5 and ICD 10 codes. 3. Discuss a pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment. 4. Discuss non-pharmacological treatment would you prescribe?  Use the clinical guidelines to support the rationale for this treatment. 5. Describe a health promotion intervention that would be appropriate for this patient. https://stu.instructure.com/courses/47926/pages/module-7-lecture-materials-and-resources