NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders

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NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders – Step-by-Step Guide

The first step before starting to write the NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders Instructions

It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.

In this Assignment you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder. Have a look at NRNP 6665 Week 5 Assignment: Patient Education for Children and Adolescents.

TO PREPARE

  • Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood 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: Petunia Park. 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.
  • Consider patient diagnostics missing from the video: 

Provider Review outside of interview:

Temp 98.2  Pulse  90 Respiration 18  B/P  138/88

Laboratory Data Available: Urine drug and alcohol screen negative.  CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)

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 symptomatology 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 to lowest priority. Compare the DSM-5-TR 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.
  • 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: 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 that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

BY DAY 7 OF WEEK 4

Submit your Focused SOAP Note.

Video Case Study: Petunia Park Transcript

DR. MOORE: Hi. Good afternoon. My name is Dr. Moore. Am I understanding you’re here

for a mental health assessment today?

 PETUNIA PARK: That’s right.

 DR. MOORE: OK. So, to make sure I have the right patient and the right chart, can you tell me your name and your date of birth?

 PETUNIA PARK: Yes. I’m Petunia Park. My birthday is July 1, 1995.

 DR. MOORE: And can you tell me what today’s date is?

PETUNIA PARK: So, it’s December 1.

 DR. MOORE: Do you know the year?

PETUNIA PARK: 2020.

 DR. MOORE: And what day of the week is this?

PETUNIA PARK: It’s Tuesday.

[CHUCKLING] DR. MOORE: And do you know where we are today?

PETUNIA PARK: Yes, I am here in the beautiful, sunny office at the clinic.

DR. MOORE: OK, great. Thank you. So, can you tell me a little bit about why you’re here today? What brings you here today?

PETUNIA PARK: Yes. So, I have a history of taking medications and then stopping them. I don’t think I need them. I really feel like the medication squashes who I am. DR. MOORE: OK, OK. So, I’m going to be able to help you with that. But to begin, I’m going to ask you some questions about your family. I’m going to ask you some history-type questions. I’m going to ask you some symptoms that you might be having. And all of these questions are going to help me work with you on a treatment plan, OK? So, I would like to begin with, when was the first time that you ever had any mental health or substance use treatment in your life?

… Continues

NRNP 6665 Week 4 Assignment: Assessing, Diagnosing and Treating Adults with Mood Disorders Example

Subjective:

CC (chief complaint): “I have a history of taking medications and then stopping them. I don’t think I need them. I really feel like the medication squashes who I am.”

HPI: P.P. is a 25-year-old Caucasian woman seeking a mental health evaluation due to a history of inconsistent medication use and ongoing mood issues. She has been referred for assessment because of persistent depressive symptoms and intermittent high-energy phases that disrupt her daily life. Currently, she is not on any prescribed psychotropic medications, having recently discontinued one that she found somewhat beneficial but felt it stifled her creativity.

An analysis of her symptoms indicates a pattern of mood fluctuations marked by episodes of heightened energy, decreased sleep, hyperactivity, racing thoughts, and increased creativity. These episodes typically last about a week and occur several times a year. During these high-energy phases, P.P. engages in impulsive behaviors, such as excessive sexual activity, and experiences pressured speech and disorganized thoughts. She describes these times as feeling “high, high, high,” which contributes to her reluctance to pursue medication, as she fears it may diminish her creative expression. Following these energetic episodes, she often experiences significant depressive phases lasting four to five days, characterized by extreme fatigue, lack of motivation, feelings of worthlessness, and excessive sleeping. P.P. notes that these depressive episodes often follow periods of reduced sleep, during which she is highly productive in her creative endeavors, such as writing, painting, and music. She admits that her depressive symptoms have caused her to miss work at her aunt’s bookstore as she struggles to get out of bed or find motivation.

P.P. does not express any current thoughts of suicide or intentions to harm herself, although she does mention a previous suicide attempt in 2017 involving an overdose of Benadryl. She also states that she is not engaging in self-harm or having thoughts of harming others. Occasionally, she experiences auditory hallucinations, specifically hearing voices that commend her abilities, but she clarifies that these episodes occur only during times of sleep deprivation and are not present at the moment. Additionally, P.P. reports no signs of anxiety, panic attacks, obsessive-compulsive behaviors, or substance abuse, aside from her daily habit of smoking one pack of cigarettes.

Substance Current Use: The individual has been using tobacco for an unspecified length of time, consuming approximately one pack daily. In the past, she consumed alcohol but ceased at the age of 19 for reasons that are not clearly defined. She experimented with marijuana once but decided to stop due to experiencing paranoid thoughts. She states that her substance use has not resulted in any legal issues with law enforcement or drug enforcement agencies. Additionally, she denies any use of heroin, cocaine, methamphetamines, hallucinogens, or the misuse of any sedative medications.

Medical History: The patient’s medical history is significant for hypothyroidism, which is being treated with medication, and polycystic ovarian syndrome (PCOS), for which she is using birth control pills. She reports no other major medical issues or recent injuries.

  • Current Medications: She takes Levothyroxine at a dosage of 75 mcg daily for her hypothyroidism, a treatment she has been on for three years. Additionally, she has been using oral contraceptives for PCOS for the past two years and takes an over-the-counter multivitamin daily.
  • Allergies:Regarding allergies, she has a known reaction to penicillin, which causes a rash, but reports no food allergies. She is also sensitive to seasonal pollen, which leads to sneezing and nasal congestion.
  • Reproductive Hx: Reproductive History: The last menstrual period occurred three weeks ago, with cycles being regular. The pt is not currently pregnant and is not nursing or lactating. They are using oral contraceptive pills for birth control. There are concerns regarding impulsive sexual behaviors that arise during periods of high energy, which are causing strain in relationships.
ROS:
  • GENERAL: No fever, fatigue, weight loss, or night sweats.
  • HEENT: The patient reports no headaches, blurry vision, or double vision
  • SKIN: No skin rash, itchiness, on swellings
  • CARDIOVASCULAR: No chest pain, pressure, or discomfort, or palpitation
  • RESPIRATORY: No pain, tightness, difficulty breathing, shortness of breath, or cough
  • GASTROINTESTINAL: No reports of abdominal pain, diarrhea, constipation, vomiting, or jaundice.
  • GENITOURINARY: There are no genital itchiness, discharge, bleeding, pain, or ulcers, and the patient does not experience urinary incontinence or retention
  • NEUROLOGICAL: There are no symptoms of numbness, weakness, paralysis, vertigo, or fainting
  • MUSCULOSKELETAL: No muscle pains, no joint weakness,
  • HEMATOLOGIC: No easy bruising or anemia
  • LYMPHATICS: No limb swelling, no pain
  • ENDOCRINOLOGIC: There is no reported intolerance to cold in the endocrine evaluation
Objective:

Diagnostic results: No diagnostic tests have been requested at this time. Conducting a series of assessments is crucial to gain a clearer understanding of the patient’s health. First, thyroid function tests are advisable to evaluate thyroid health, as imbalances can affect metabolism. A complete blood count (CBC) will provide information on red and white blood cell levels and overall blood health.

Testing serum vitamin B12 levels is crucial to identify potential deficiencies that can lead to anemia and neurological issues. Additionally, measuring serum ferritin levels will help assess the body’s iron stores.

Finally, evaluating serum levels of sodium, potassium, chloride, and creatinine is essential for assessing kidney function and electrolyte balance. Together, these tests will offer valuable insights into the patient’s overall well-being and rule out organic causes of her psychiatric illness. General examination showed no signs of tremors, jaundice, pallor, dehydration, or respiratory distress. The patient’s blood pressure is recorded at 128/78 mmHg.

Assessment:

Mental Status Examination: Petunia Park, a 26-year-old Caucasian woman, appears to be of her stated age. She is fully alert and oriented across all areas. Petunia maintains strong eye contact and engages cooperatively with the physician. Her facial expressions are appropriately responsive to the conversation, although she can easily distract. She is well-groomed and dressed suitably for the setting.

Sitting upright in her chair, she exhibits good posture and a normal gait, with no signs of abnormal psychomotor activity. Her speech is clear and of adequate volume, though somewhat more intense than usual. Petunia’s mood is elevated, and her affect aligns well with this mood. There are no indications of hallucinations, delusions, or irrational beliefs. Her thought processes are logical, and the content of her thoughts is neither suicidal nor homicidal. She demonstrates sound judgment and intact insight, with both recent and long-term memory functioning well.

Diagnostic Impression:
  1. Bipolar I disorder, current episode mixed, moderate severity: P.P.’s evaluation indicates a strong likelihood of bipolar I disorder, currently presenting as a mixed episode of moderate severity. This assessment is reinforced by the episodic characteristics of her mood fluctuations, which feature clear phases of heightened mood accompanied by impulsive actions, such as increased sexual activity, reduced sleep requirements, and racing thoughts, juxtaposed with significant depressive episodes characterized by hypersomnia, lack of pleasure, fatigue, and diminished self-esteem. These manifestations are consistent with the DSM-5 criteria for bipolar I disorder, which necessitates the presence of at least one manic episode for a formal diagnosis (American Psychiatric Association, 2013). The rationale for this diagnostic impression includes several key observations. Notably, P.P. experiences episodes of elevated mood marked by hyperactivity, heightened energy, impulsivity, and a reduced need for sleep, typically lasting around a week. In contrast, her depressive episodes, which last approximately 4 to 5 days, are accompanied by hypersomnia, fatigue, and a decline in functioning. Importantly, there is no reported history of substance use that could account for her mood disturbances, normal thyroid function rules out hypothyroidism as a factor, and there is no current evidence of generalized anxiety, panic attacks, or obsessive-compulsive behaviors that might suggest an alternative diagnosis.
  2. Cyclothymic Disorder: Cyclothymic Disorder was dismissed because the patient exhibits distinct depressive episodes that fulfill the criteria for a major depressive episode, along with manic symptoms that persist longer than the milder, shorter episodes typical of cyclothymia (Brancati et al., 2021). Cyclothymic temperament is characterized by a pattern of frequent, mild mood swings that do not reach the severity of full-blown episodes. These mood changes are marked by sudden transitions between different emotional states and are linked to both personal experiences and observable behaviors. This temperament is relevant to the periods between episodes and before the onset of more serious mood disorders.
  3. Schizoaffective Disorder: This differential was also ruled out since the psychotic symptoms, specifically auditory hallucinations, are only present during manic phases and do not persist outside of these mood episodes (Paul et al., 2021). Bipolar disorder and schizoaffective disorder are both mental health conditions that exhibit some similarities, yet they also have distinct differences. The overlap in symptoms can make it challenging to achieve an accurate diagnosis.
  4. Major Depressive Disorder with Mixed Features: This differential includes individuals who satisfy the criteria for Major Depressive Disorder while also exhibiting concurrent subsyndromal hypomanic or manic symptoms. This diagnosis was excluded as the patient has experienced complete manic episodes, which contradicts this diagnosis. The presence of manic features in individuals suffering from depression has been acknowledged for over a hundred years, and in contemporary DSM classifications, this phenomenon is referred to as mixed episodes (Zimmerman & Mackin, 2023).
Reflections:

After reflecting upon this case, I maintain my diagnosis of bipolar I disorder, current episode mixed, moderate severity. The patient’s fluctuating mood states, which shift between manic and depressive episodes, are consistent with the DSM-5 criteria for this condition. Her history of impulsivity, sleep disturbances, and difficulties in functioning further support the clinical assessment.

A significant challenge in this case is the patient’s aversion to medication, stemming from her belief that it stifles her creativity, which complicates efforts to encourage treatment adherence. This experience has underscored the need to align symptom management with the patient’s values, especially when their sense of self and professional goals are intertwined with their unaddressed symptoms. In future cases, I would consider adjusting the timing and approach of psychoeducation, focusing on how effective treatment can enhance rather than inhibit creativity to foster greater patient engagement.

This case also brings to light various legal, ethical, and social determinants of health that must be considered. From a legal standpoint, it is crucial to document the patient’s risk of future suicide attempts and continuously assess her risk to ensure both liability protection and patient safety. Ethically, addressing her impulsive sexual behaviors and the strain in her relationships requires a careful approach that avoids reinforcing stigma while providing appropriate care.

Additionally, her socioeconomic status and current job aspirations may limit her access to necessary mood-stabilizing medications and therapy. Health promotion strategies should also incorporate support for smoking cessation, given her daily habit, which heightens her risk for cardiovascular and respiratory issues. Customizing interventions to reflect her age, cultural context, and personal goals will be essential in enhancing her mental health outcomes and overall quality of life.

Case Formulation and Treatment Plan: 

Ongoing assessment of thyroid levels will be conducted to eliminate any possible links to mood fluctuations (Norman et al., 2024). A psychiatrist will be consulted for medication management to alleviate her mood-related symptoms, with mood stabilizers such as lamotrigine or lithium likely being considered. A detailed discussion will cover the advantages and disadvantages of these medications, including possible side effects such as tremors and weight changes, as well as the necessity for regular blood tests if lithium is used (Collins et al., 2024). Education will be provided on the importance of adhering to medication regimens and how to enhance creativity rather than suppress it.

Therapeutic strategies will involve weekly psychotherapy (CBT) sessions aimed at improving impulse control, addressing relationship issues, and developing coping strategies for mood instability (Özdel et al., 2021). Additionally, referrals to a smoking cessation program will be made to lower cardiovascular risks and enhance overall well-being. Birth control counseling will be emphasized, particularly regarding the need for dual protection due to possible interactions with psychotropic medications. Emergency contact details, including crisis hotline numbers, will be shared, and she will be advised to seek immediate help if she has thoughts of self-harm or harming others.

Patient education will stress the importance of not abruptly stopping medications, being aware of interactions with over-the-counter drugs or alcohol, and understanding the dangers of untreated bipolar disorder. Initial follow-up appointments will be scheduled every two weeks to evaluate the effectiveness of the treatment and manage any side effects. This holistic strategy is designed to stabilize her symptoms, enhance her daily functioning, and reduce the likelihood of requiring more intensive care.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)). American Psychiatric Association Publishing.

Brancati, G. E., Barbuti, M., Schiavi, E., Colombini, P., Moriconi, M., Pallucchini, A., Maiello, M., Menculini, G., & Perugi, G. (2021). Comparison of emotional dysregulation features in cyclothymia and adult ADHD. Medicina (Kaunas, Lithuania), 57(5), 489. https://doi.org/10.3390/medicina57050489

Collins, J. C., Wheeler, A. J., McMillan, S. S., Hu, J., El-Den, S., Roennfeldt, H., & O’Reilly, C. L. (2024). Side effects of psychotropic medications experienced by a community sample of people living with severe and persistent Mental Illness. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 27(6), e70122. https://doi.org/10.1111/hex.70122

Norman, S. J., Carney, A. C., Algarin, F., Witt, B., Witzel, I. M., Rodriguez, P. M., & Mohyeldin, M. (2024). Thyroid dysfunction and bipolar disorder: A literature review integrating neurochemical, endocrine, and genetic perspectives. Cureus, 16(9), e69182. https://doi.org/10.7759/cureus.69182

Özdel, K., Kart, A., & Türkçapar, M. H. (2021). Cognitive Behavioral Therapy in treatment of Bipolar Disorder. Noro Psikiyatri Arsivi, 58(Suppl 1), S66–S76. https://doi.org/10.29399/npa.27419

Paul, T., Javed, S., Karam, A., Loh, H., & Ferrer, G. F. (2021). A misdiagnosed case of schizoaffective disorder with bipolar manifestations. Cureus, 13(7), e16686. https://doi.org/10.7759/cureus.16686

Zimmerman, M., & Mackin, D. (2023). Identifying the DSM-5 mixed features specifier in depressed patients: A comparison of measures. Journal of Affective Disorders, 339, 854–859. https://doi.org/10.1016/j.jad.2023.07.102