NRNP 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD

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NRNP 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD – Step-by-Step Guide

The first step before starting to write the NRNP 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD, 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 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD

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 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD

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 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD

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 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD

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 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD

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 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD

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 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD Instructions

“Fear,” according to the DSM-5-TR, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2022). All anxiety disorders contain some degree of fear or anxiety symptoms (often in combination with avoidant behaviors), although their causes and severity differ. Trauma-related disorders may also, but not necessarily, contain fear and anxiety symptoms, but their primary distinguishing criterion is exposure to a traumatic event.

Trauma can occur at any point in life. It might not surprise you to discover that traumatic events are likely to have a greater effect on children than on adults. Early-life traumatic experiences, such as childhood sexual abuse, may influence the physiology of the developing brain. Later in life, there is a chronic hyperarousal of the stress response, making the individual vulnerable to further stress and stress-related disease. 

For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5-TR criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5-TR criteria. By now you should be preparing for the NRNP 6635 Midterm Exam.

TO PREPARE:

  • Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.
  • Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document. 
  • By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Identify at least three possible differential diagnoses for the patient.

BY DAY 7 OF WEEK 4

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

Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? 
  • Objective: What observations did you make during the psychiatric assessment?  
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-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.).

NRNP 6635 Week 4 Assignment: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD and OCD Example

Subjective:

Biodata

Name: Sergeant Berry Sullivan

Gender: Male

Age: 27 years

CC (chief complaint): “My fiancé demanded that I make an appointment. I’ve been feeling on edge and having trouble sleeping since I left the military.”

History of Presenting Illness (HPI)

Sergeant Berry Sullivan reports significant anxiety, hypervigilance, and sleep disturbances since leaving the military six months ago. Recently, he had a severe panic attack during a county fair triggered by unexpected fireworks, causing him to run and seek cover. Additionally, he reacts strongly to other loud noises, such as car backfires and sudden loud sounds. Certain smells, like diesel fuel and burning hair, evoke distressing memories related to traumatic events during his service.

Sergeant Berry Sullivan’s symptoms are further exacerbated by frequent nightmares and flashbacks, which contribute to his insomnia. He actively avoids situations that might trigger these distressing reactions. Specifically, Sullivan experiences severe anxiety in traffic, especially when he feels trapped, as it reminds him of the risk of improvised explosive device (IED) attacks. Additionally, he reports heightened irritability and a strong desire to isolate himself from social interactions. During stressful situations, he exhibits physical symptoms such as sweating, shaking, and nausea.

Past Psychiatric History:

  • General Statement: No prior history of psychiatric treatment or substance use.
  • Caregivers (if applicable): Not applicable
  • Hospitalizations: No prior history of hospitalization
  • Medication trials: Currently not on any medication
  • Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: Denies any history of drug use. Avoids alcohol due to his father’s history of abuse.

Family Psychiatric/Substance Use History:
  • Father: History of alcohol abuse, diabetes mellitus (DM), cirrhosis, hypertension (HTN).
  • Paternal grandfather: History of depression.
  • No psychiatric or substance use history in immediate siblings.
Psychosocial History:         

Sergeant Berry enlisted in the military after high school and served for eight years in the Marines. He completed three long tours in war zones. Recently engaged, he plans to marry in eight months. Currently, he is attending an online college for accounting. Berry relocated to a different state due to his fiancée’s job opportunity, and he looks forward to having children in the future.”

Medical History:

  • Current Medications: None listed
  • Allergies:Seasonal allergies
  • Reproductive Hx:Not applicable

ROS:

  • GENERAL: Reports feeling anxious and difficulty sleeping.
  • HEENT: Denies headaches, vision changes, hearing loss, or sinus issues.
  • SKIN: Denies rashes or any other skin abnormality
  • CARDIOVASCULAR: Denies chest pain or palpitations.
  • RESPIRATORY: Reports having service-connected asthma, managed with medication.
  • GASTROINTESTINAL: Reports nausea during stressful situations. Denies abdominal pain, diarrhea, or constipation.
  • GENITOURINARY: Denies dysuria, frequency, or hematuria.
  • NEUROLOGICAL: Denies dizziness, tingling, or weakness.
  • MUSCULOSKELETAL: Denies joint pain, muscle aches, or back pain.
  • HEMATOLOGIC: Denies easy bruising or bleeding.
  • LYMPHATICS: Denies swollen glands or lymph node issues.
  • ENDOCRINOLOGIC: Denies polyuria, polydipsia, or thyroid issues.

Objective:

Physical exam:

General: He is alert, cooperative, and well-groomed. However, during the interview, he exhibits slight fidgetiness and anxiety.

Vital Signs:

  • Temperature: 98.8°F
  • Pulse: 86 bpm
  • Respiratory Rate: 18 breaths per minute
  • Blood Pressure: 122/70 mmHg
  • Height: 5’8”
  • Weight: 160 lbs
  • BMI: 24.33 kg/m2

HEENT:

  • Head: Normocephalic, atraumatic.
  • Eyes: Pupils equal, round, and reactive to light and accommodation (PERRLA). No conjunctival injection or scleral icterus.
  • Ears: Tympanic membranes clear, no discharge or erythema.
  • Nose: No nasal discharge or polyps.
  • Throat: Oropharynx clear, no tonsillar hypertrophy or exudates.

SKIN:

  • No rashes, lesions, or signs of infection.

CARDIOVASCULAR:

  • Regular rate and rhythm, S1 and S2 present, no murmurs, rubs, or gallops. No jugular venous distention. Peripheral pulses 2+ bilaterally, no edema.

RESPIRATORY:

  • No use of accessory muscles. Clear to auscultation bilaterally, no wheezes, rales, or rhonchi.

GASTROINTESTINAL:

  • Abdomen soft, non-tender, no hepatosplenomegaly. Bowel sounds present in all quadrants. No masses or hernias.

GENITOURINARY:

  • No suprapubic tenderness. No costovertebral angle tenderness.

NEUROLOGICAL:

  • GCS 15/15. Alert and oriented to person, place, and time. Cranial nerves II-XII grossly intact. Motor strength 5/5 in all extremities. Sensation to light touch intact. Reflexes 2+ bilaterally. No tremors or involuntary movements.

MUSCULOSKELETAL:

  • Full range of motion in all extremities. No joint swelling or deformities. No muscle atrophy.

HEMATOLOGIC/LYMPHATIC:

  • No palpable lymphadenopathy. No signs of bruising or bleeding.

ENDOCRINOLOGIC:

  • No signs of thyroid enlargement or nodules. No evidence of gynecomastia.

Diagnostic results:

Complete Blood Count: Normal ranges of WBS, platelets, hemoglobin and red blood cells noted.

Random Blood Sugar (RBS): 87 mg/dL (normal range: 70-140 mg/dL)

HIV Screening: Negative

Urea Electrolytes and Creatinine (UECs):

  • Urea: 25 mg/dL (normal range: 10-50 mg/dL)
  • Sodium: 140 mmol/L (normal range: 135-145 mmol/L)
  • Potassium: 4.2 mmol/L (normal range: 3.5-5.0 mmol/L)
  • Creatinine: 0.9 mg/dL (normal range: 0.6-1.2 mg/dL)

Assessment:

Mental Status Examination:

Sergeant Berry Sullivan, a 27-year-old male, presents as neatly dressed and well-groomed. He remains alert and cooperative during the interview, though he exhibits signs of hypervigilance and slight fidgetiness, often scanning the room and being easily startled by sudden noises. His speech is clear, coherent, and of normal rate and volume, with occasional pauses to gather his thoughts, particularly when discussing traumatic experiences. Sullivan describes his mood as anxious, and his affect is constricted, displaying a limited range of emotions. His thought process is logical and goal-directed, with no signs of disorganized thinking.

No evidence of delusions or hallucinations; however, he does experience intrusive thoughts and distressing memories from his combat experiences, including pervasive nightmares and flashbacks. He is oriented to person, place, and time, with intact immediate and recent memory. Sullivan shows good insight into his condition, understanding the link between his symptoms and military experiences, and he recognizes the impact on his daily life, demonstrating a willingness to seek treatment. His judgment is intact as he makes appropriate decisions regarding his health and safety. Overall, Sullivan’s MSE reveals significant anxiety, hypervigilance, and symptoms consistent with post-traumatic stress disorder (PTSD).

Differential Diagnoses:

Post-Traumatic Stress Disorder (PTSD) [ICD-10 code: F43.10]: Sergeant Berry Sullivan’s symptoms strongly indicate PTSD. He experiences recurrent and distressing memories of combat and persistent nightmares and avoids trauma-related stimuli such as fireworks and loud noises. He also shows heightened arousal, such as hypervigilance and a strong startle response, and faces significant impairment in social and occupational functioning.

According to the DSM-5, PTSD is diagnosed when these symptoms last for more than one month after exposure to a traumatic event (American Psychiatric Association, 2013). Sullivan’s symptoms match the criteria well, especially his intrusive memories and physical reactions to trauma-related cues. His case history reinforces this diagnosis, as he clearly describes specific triggers and their significant, debilitating effects on his daily life.

Generalized Anxiety Disorder (GAD) [ ICD-10 code: F41.1]: GAD is considered due to Sullivan’s experiences of heightened worry and anxiety in many situations, not just those related to his trauma. According to the DSM-5, GAD is characterized by excessive anxiety and worry occurring more days than not for at least six months about various events or activities (Showraki et al., 2020). Sullivan’s anxiety in crowded places and fear of traffic situations fit this description. Additionally, he exhibits somatic symptoms like sweating and nausea, which further support the GAD diagnosis criteria.

However, Sullivan’s anxiety is primarily linked to specific trauma-related triggers, such as loud noises and certain smells that remind him of his combat experiences. He also suffers from recurrent nightmares and flashbacks, which are hallmark features of PTSD. These symptoms demonstrate the intensity and specificity typical of PTSD, making it a more appropriate diagnosis than GAD. While GAD accounts for some of Sullivan’s generalized anxiety, PTSD more accurately captures the depth and context of his distress, as outlined by the DSM-5 criteria for both disorders.

Adjustment Disorder (ICD-10 code: F43.2):

Considering Sullivan’s recent transition from military to civilian life and the stressors that come with such a significant change, adjustment disorder is a plausible diagnosis. The DSM-5 defines adjustment disorder as the development of emotional or behavioral symptoms in response to an identifiable stressor, occurring within three months of the onset of the stressor (Morgan et al., 2023). Sullivan’s symptoms, including anxiety, emotional distress, and avoidance behaviors, can be seen as reactions to the substantial life changes and the traumatic events he experienced during his military service.

His anxiety in crowded places, fear of traffic situations, and physical symptoms like sweating and nausea further support this consideration. However, it’s important to note that the DSM-5 criteria for adjustment disorder specify that these symptoms should not persist for more than six months after the stressor or its consequences have ceased (American Psychiatric Association, 2013). In Sullivan’s case, while his symptoms align with those of adjustment disorder, the persistence and intensity of his symptoms, particularly those related to his traumatic experiences, suggest that PTSD might be a more fitting diagnosis.

Reflection:

Sergeant Berry Sullivan’s case vividly illustrates the deep and lasting impact of trauma on mental health. His story highlights the significant difficulties and complexities that veterans, especially those with combat-related PTSD, encounter when transitioning from military to civilian life. The session underscored the importance of recognizing trauma’s extensive influence, not only as a mental health concern but also as a powerful force that affects relationships, daily activities, and overall well-being. Understanding these effects is crucial for providing comprehensive support to individuals like Sullivan.

From an ethical perspective, creating a safe and supportive space for individuals like Sullivan to share their experiences is essential. This approach fosters healing and helps reduce the stigma associated with seeking psychological help. Additionally, taking into account socio-cultural factors and personal histories, such as Sullivan’s family background and military service, is crucial for understanding his symptoms and customizing treatment plans. Looking ahead, it is vital to continue advocating for comprehensive support systems that address both the immediate psychological needs and long-term rehabilitation of veterans dealing with PTSD and related conditions.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425596

Morgan, M. A., PhD, MPS, O’Gallagher, K., Kelber, M. S., PhD, Garvey Wilson, A. L., PhD, MPH, Belsher, B. E., PhD, & Evatt, D. P., PhD. (2023). Adjustment disorder in U.S. service members: Factors associated with early separation. Military Medicine, 188(7–8), e1501–e1507. https://doi.org/10.1093/milmed/usac008

Showraki, M., Showraki, T., & Brown, K. (2020). Generalized anxiety disorder: Revisited. The Psychiatric Quarterly, 91(3), 905–914. https://doi.org/10.1007/s11126-020-09747-0