Assessment and Diagnosis of the Psychiatric Patient

A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.

—Pamela Bjorklund, clinical psychologist

Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation.

This week, as you explore assessment and diagnosis of patients in mental health settings, you examine assessment tools, including their psychometric properties and appropriate uses. You also familiarize yourself with the DSM-5 classification system.

Reference: Bjorklund, P. (2013). Assessment and diagnosis. In K. Wheeler (Ed.), Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.) (pp. 95–168). Springer Publishing Company.

Learning Objectives

Students will:

•  Evaluate elements of the psychiatric interview, history, and examination

•  Analyze psychometric properties of psychiatric rating scales

• Justify appropriate use of psychiatric rating scales in advanced practice nursing

Learning Resources

https://dsm-psychiatryonline-org.ezp.waldenulibrary.org/doi/full/10.5555/appi.books.9780890425596.Section1

Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.

• Chapter 34, Writing Up the Results of the Interview

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

   

• Chapter 5, Examination and Diagnosis of the Psychiatric Patient

• Chapter 6, Classification in Psychiatry

• Chapter 31, Child Psychiatry (Sections 31.1 and 31.2 only)

American Academy of Child and Adolescent Psychiatry (1995). Practice parameters for the assessment and treatment of children and adolescents. https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Classification in psychiatry. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed., pp. 1–8). Wolters Kluwer.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed., pp. 9–15). Wolters Kluwer.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Medical assessment and laboratory testing in psychiatry. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed., pp. 16–21). Wolters Kluwer.

   

Required Media (click to expand/reduce)

https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=20

https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=39

https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=53

https://ezp.waldenulibrary.org/login?qurl=https://video.alexanderstreet.com/watch/diagnostic-criteria

https://www.youtube.com/watch?v=U5KwDgWX8L8

https://www.youtube.com/watch?v=IRiCntvec5U

Getting Started With the DSM-5

This is not unlike what has occurred in the process of classifying mental disorders. A system that provides enough specificity to appropriately classify a large variety of mental disorders while also attempting to include all of the possible symptoms, many of which can change over time, is a daunting task when used by a variety of specialists, doctors, and other professionals with varied experience, cultures, expertise, and beliefs. The DSM has undergone many transformations since it was first published in 1952. Many of these changes occurred because the uses for the DSM changed. However, the greatest changes began with the use of extensive empirical research to guide the creation of the classification system and its continued revisions.

In order to assess and diagnose patients, you must learn to use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, usually abbreviated as the DSM-5, to render a diagnosis. In this second week of the course, you will examine how DSM-5 is organized and how clinicians use it to render diagnoses. 

Review the Learning Resources this week, with special emphasis on viewing the Diagnostic Criteria video. This video explains the purpose and organization of the DSM-5 classification system, the purpose of the ICD-10 coding system, their relationship to one another, and the importance to the PMHNP role. 

Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

To Prepare:

• Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.

• Consider the elements of the psychiatric interview, history, and examination.

• Consider the assessment tool assigned to you by the Course Instructor.

By Day 3 of Week 2

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

Diagnostic Tool

Beck Depression Inventory, 2nd Revision   

At least 3 citations

   

hi dear,

 can help me to finish this assignment with good quality and be on time please?

A Personal Physical Activity Plan Paper (CLO #2 and CLO #7)

This assignment has THREE steps. Each step builds on the next. You will need to complete and submit all four parts for full credit.

STEP 1 

For the next seven days, record:

· The number of minutes of moderate-intensity physical activity (3-5.9 METS) you accumulate daily.

· Vigorous-intensity physical activity (>6 METS) you accumulate daily.

· You will note the amount of time you spend in sedentary activity (sitting) other than sleeping.

· The normal week would be reflective of your regular lifestyle.

For the week that you choose to record, be honest. Do not do extra (beyond normal) physical activity or exercise than usual.

The information will be submitted in a chart format. It can be a word document chart. The chart is attached.

Once you have determined the total minutes of moderate and vigorous physical activity and exercise along with total minutes accumulated per week, go to the 2018 Physical Activity Guidelines and answer the following questions:

1. What are the minimum physical activity recommendations for adults ages 18-65? Include citations/references.

2. Did you achieve or exceed the minimum recommendations for adults ages 18 to 65 during the week?

3. Why were you able to achieve or not achieve the guidelines?

4. Was this a typical week for you? Why or why not?

STEP 2 

Now that you have assessed your current physical activity levels, develop and describe a personalized plan to meet the minimal levels of the guidelines to become or remain physically active in the future.

Complete the following information requested and use the 2018 guidelines (see pages 23-36 in the text for more) to help you develop a personal physical activity and exercise plan if you do not have experience doing so.

1. Describe and list your personal health goals (Improve cardiorespiratory health, maintain weight, reduce risk of or control diabetes, etc..)

2. Aerobic activity goals (Frequency, intensity, duration per day, total minutes per week, etc…)

3. Muscle-strengthening activity goals (Frequency, muscle groups used, number of sets and repetitions, type (amount) of resistance used)

STEP THREE

Write up a 3-4 page APA report which describes your plan to continue to be physically active to meet the 2018 physical activity guidelines and also evaluate your success/failure to achieve/maintain the physical activity plan you set for yourself. Answer the following questions:

1. What was your personal activity and exercise plan? Provide a detailed explanation. Include health, aerobic, and muscle-strengthening activity goals.

2. Was each of your goals easy, moderate or difficult to achieve? Can you continue these goals long-term?

1. How did you try to achieve your goals? Explain in detail.

2. If you were unable to achieve your goals, explain why you think this happened. 

3. What are your personal recommendations for achieving/maintaining these goals in the future?

1. Provide evidence-based advice for achieving the goal if the goal was not attained.

2. Provide evidence-based advice/support for continuing the goals or increasing the goals.

View a student example paper , is attached.

here

  Points for spelling, grammar, APA

Submit each step together as one single document. Each step is needed to complete the assignment. 

RESOURCES:

MET Calculator: http://lamb.cc/calories-burned-calculator/ PA Intensity Table: https://www.cdc.gov/nccdphp/dnpa/physical/pdf/PA_Intensity_table_2_1.pdf Measure PA Overview: https://www.cdc.gov/physicalactivity/basics/measuring/index.html Measuring – Heart Rate: https://www.cdc.gov/physicalactivity/basics/measuring/heartrate.htm Measuring – Perceived Exertion: https://www.cdc.gov/physicalactivity/basics/measuring/exertion.htm PA Guideline Videos: https://www.cdc.gov/physicalactivity/basics/videos/index.htm PA Glossary: https://www.cdc.gov/physicalactivity/basics/glossary/index.htm

Struggling to find evidence to support your population choice for your presentation? Remember to check out the 2018 Physical Activity Guidelines Part F. The Science Base.

 

Consider the below case study:

Margret Spinner-Ramirez is a 66 y/o female Hispanic-American who speaks both Spanish and English fluently. She is retired, lives alone, and has Medicaid as her primary insurance.  Ms. Spinner-Ramirez was scratched by a stray cat that she feeds on her back porch daily. She has been cleaning the wound daily; however, after 2 days she went to her local ER for increased pain, redness, and swelling in her left lower leg wound where she was scratched by the stray cat.  Ms. Spinner-Ramirez explained she recently had her left knee replaced about 6 months ago and verbalized new difficulty with baring weight on that extremity to the point that she was having to use her cane again. Her vital signs at the ER visit were stable.  Her left leg wound was cleaned and redressed.  After 5 hours in the ER, Ms. Spinner-Ramirez was discharged to home on oral Keflex for her left lower leg infection and was instructed to call her primary care physician for a follow-up appointment. Five days later Ms. Spinner-Ramirez was taken back to the same ER via ambulance.  Her neighbor found her lethargic, short of breath, and was experiencing difficulty being able to move. A CT scan and blood work revealed that Ms. Spinner-Ramirez’s knee replacement in her left leg was infected secondary to the cat scratch. She was admitted as an inpatient for sepsis. She needed to have a second left knee replacement surgery with wound irrigation and debridement, which extended her inpatient stay to 3 weeks.  Once she was discharged to home she required six weeks of IV antibiotics, extensive rehab, and home health. 

If you were in charge of a healthcare insurance company:

• Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs, readmissions, or death (mortality) from a hospital-acquired infection or medical error. Support your why or why not? 
• Describe two ways (initiatives) healthcare quality can be improved to help reduce errors and improve patient safety. 
• Discuss how creating incentives for providers (healthcare organizations) can improve quality and reimbursements (payments) for services/care.

Textbook and other resources:

• Understanding Health Insurance
• What’s Behind the Health Insurance Rankings
• Hospitals will have to Pay for their Mistakes
• Medical Errors: Focusing More on What and Why, Less on Who
• National Business Coalition on Health: Health Care Purchaser Toolkit
• Agency for Healthcare Research and Quality

The Challenge and Potential for Assuring Quality Health Care for the 21s…

The Challenge and Potential for Assuring Quality Health Care for the 21st Century

All submissions must have a minimum of two scholarly references to support your work. 

Examples of work to show mastery:

• 2-3 page paper – APA format

 

Write a paper (2,000-2,500 words) in which you apply the concepts of   epidemiology and nursing research to a communicable disease. Refer to   “Communicable Disease Chain,” “Chain of   Infection,” and the CDC website for assistance completing this assignment.

Communicable Disease Selection

Choose one communicable disease from the following list:

1. Chickenpox
2. Tuberculosis
3. Influenza
4. Mononucleosis
5. Hepatitis B
6. HIV
7. Ebola
8. Measles
9. Polio
10. Influenza

Epidemiology Paper Requirements

Address the following:

1. Describe the communicable disease (causes, symptoms, mode of     transmission, complications, treatment) and the demographic of     interest (mortality, morbidity, incidence, and prevalence). Is this     a reportable disease? If so, provide details about reporting time,     whom to report to, etc.
2. Describe the determinants of health     and explain how those factors contribute to the development of this   disease.
3. Discuss the epidemiologic triangle as it relates to     the communicable disease you have selected. Include the host     factors, agent factors (presence or absence), and environmental     factors. (The textbook describes each element of the epidemiologic     triangle). Are there any special considerations or notifications for     the community, schools, or general population?
4. Explain the     role of the community health nurse (case finding, reporting, data     collecting, data analysis, and follow-up).
5. Identify at     least one national agency or organization that addresses the     communicable disease chosen and describe how the organization(s)     contributes to resolving or reducing the impact of disease.
6. Discuss a global implication of the disease. How is this     addressed in other countries or cultures? Is this disease endemic to     a particular area? Provide an example.

A minimum of three peer-reviewed or professional references is required.

Prepare this assignment according to the guidelines found in the APA   Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to   beginning the assignment to become familiar with the expectations for   successful completion. 

You are required to submit this assignment to Turnitin. Please refer   to the directions in the Student Success Center.

NRS427V-RS-CommunicableDiseaseChain.doc