Assignment: Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders

Psychotic disorders change one’s sense of reality and cause abnormal thinking and perception. Patients presenting with psychotic disorders may suffer from delusions or hallucinations or may display negative symptoms such as lack of emotion or withdraw from social situations or relationships. Symptoms of medication-induced movement disorders can be mild or lethal and can include, for example, tremors, dystonic reactions, or serotonin syndrome.

For this Assignment, you will complete a focused SOAP note for a patient in a case study who has either a schizophrenia spectrum, other psychotic, or medication-induced movement disorder. 

To Prepare

Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating schizophrenia spectrum, other psychotic, and medication-induced movement disorders.

Photo Credit: Getty Images/Wavebreak Media

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: Sherman Tremaine. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.

Consider what history would be necessary to collect from this patient.

Consider what interview questions you would need to ask this patient.

The Assignment

Develop a focused SOAP note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? 

Objective: What observations did you make during the 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, and list them in order from highest priority to lowest priority. Compare the DSM-5 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: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

Five Reference of not more than 5 years.

Medication Review

Review the FDA-approved use of the following medicines related to treating schizophrenia-spectrum and other psychotic disorders:

   

Psychosis

Schizoaffective    disorder

 

alprazolam (adjunct)
  amisulpride
  aripiprazole
  asenapine
  blonanserin
  carbamazepine (adjunct)
  chlorpromazine
  clonazepam (adjunct)
  clozapine
  cyamemazine
  flupenthixol
  fluphenazine
  haloperidol
  iloperidone
  lamotrigine (adjunct)
  lorazepam (adjunct)
  loxapine
  lurasidone

mesoridazine
  molindone
  olanzapine
  paliperidone
  perospirone
  perphenazine
  pimozide
  pipothiazine
  quetiapine
  risperidone
  sertindole
  sulpiride
  thioridazine
  thiothixene
  trifluoperazine
  valproate (divalproex) (adjunct)
  ziprasidone
  zotepine
  zuclopenthixol

amisulpride
  aripiprazole
  asenapine
  carbamazepine (adjunct)
  chlorpromazine
  clozapine
  cyamemazine
  flupenthixol
  haloperidol
  iloperidone
  lamotrigine (adjunct)
  l-methylfolate (adjunct)
  loxapine
  lurasidone
  mesoridazine
  molindone
  olanzapine
  paliperidone

perospirone
  perphenazine
  pipothiazine
  quetiapine
  risperidone
  sertindole
  sulpiride
  thioridazine
  thiothixene
  trifluoperazine
  valproate (divalproex) (adjunct)
  ziprasidone
  zotepine
  zuclopenthixol

  

Schizophrenia

Cataplexy syndrome

Catatonia

Extrapyramidal side    effects

 

amisulpride
  aripiprazole
  asenapine
  carbamazepine (adjunct)
  chlorpromazine
  clozapine
  cyamemazine
  flupenthixol
  haloperidol
  iloperidone
  lamotrigine (adjunct)
  l-methylfolate (adjunct)
  loxapine
  lurasidone
  mesoridazine
  molindone
  olanzapine
  paliperidone
  perospirone

perphenazine
  pipothiazine
  quetiapine
  risperidone
  sertindole
  sulpiride
  thioridazine
  thiothixene
  trifluoperazine
  valproate (divalproex) (adjunct)
  ziprasidone
  zotepine
  zuclopenthixol
  Seasonal affective disorder
  bupropion
  Sedation-induction
  hydroxyzine
  midazolam

clomipramine
  imipramine
  sodium oxybate

alprazolam
  chlordiazepoxide
  clonazepam
  clorazepate
  diazepam
  estazolam
  flunitrazepam
  flurazepam
  loflazepate
  lorazepam
  midazolam
  oxazepam
  quazepam
  temazepam
  triazolam

benztropine
  diphenhydramine
  trihexyphenidyl

           

 

Propose a change to one aspect of your local or regional health care system or program that would improve outcomes. Then, conduct a comparative analysis of other, non-U.S. health care systems, focusing on the proposed change. Summarize the proposed change and your comparative analysis in a 4-5 page report.

Introduction

Note: Complete the assessments in the order in which they are presented.

Health care systems around the world provide useful models for analysis. Familiarity with different models and approaches to health care enables leaders to identify what works and what does not, as the basis for proposing a change. As we continue to evaluate the complex and fragmented system in the United States, it is important for nurse leaders to become familiar with the programs and systems that provide evidence-based quality care that is affordable and focused on continual improvement.

This assessment provides an opportunity to examine a local or regional health care issue from a global perspective.

Preparation

Your organization, in collaboration with the key stakeholders from the community, is funding an initiative to investigate potential improvements in the local or regional health care system. As a nurse leader attuned to the effects of health care policy and finance on the provision of affordable, high-quality care, you have been asked to join the task force conducting the study.

You know that an examination of other countries’ health care systems can provide a solid, evidence-based foundation for evaluating outcomes and identifying benchmarks. Consequently, you have decided to undertake an analysis of selected, non-U.S. health care systems and compare them to each other and to the existing local or regional U.S. system to help inform decision making as the task force considers proposed changes.

In this assessment, you will propose a change to one aspect of your local or regional health care system or program. Conduct a comparative analysis of different health care systems and summarize your proposed change and findings from your analysis in a report to executive leaders. To prepare for your assessment, you are encouraged to begin thinking about the non-U.S. health care systems you might like to examine. In addition, you may wish to:

• Review the assessment requirements and scoring guide to ensure that you understand the work you will be asked to complete.
• Review Guiding Questions: Proposing Evidence-Based Change [DOCX], which includes questions to consider and additional guidance on how to successfully complete the assessment.

 

Requirements

Complete this assessment in three steps:

1. Propose a change to one aspect of your local or regional health care system or program that would improve outcomes.
2. Conduct a comparative analysis of different health care systems, focusing on one aspect of the system you are proposing to change.
3. Summarize your proposed change and the results of your comparative analysis in a report to executive leaders.

The summary report requirements outlined below, correspond to the grading criteria in the scoring guide for Proposing Evidence-Based Change, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed. The Guiding Questions: Proposing Evidence-Based Change document provides additional considerations that may be helpful in completing your assessment. In addition, be sure to note the requirements below for document format and length and for citing supporting evidence.

• Identify an aspect of a local or regional health care system or program that should be a focus for change.
• Define desirable outcomes, including who will pay for care and factors limiting achievement of those outcomes.
• Analyze two non-U.S. health care systems or programs that offer insight into a proposed change for a health care system or program in the United States.
  • Choose one of the following options for selecting the two systems or programs:
    • Option 1: Select two systems at opposite ends of the scale in terms of desirable outcomes for the issue reflected in your proposed change.
    • Option 2: Select two systems that both produce positive outcomes but take unique or innovative approaches to the problem.
  • Compare the outcomes in each non-U.S. system with each other and with present outcomes in your local or regional health care system.
• Explain why specific changes will lead to improved outcomes.
• Determine the financial and health implications associated with the proposed changes.
  • Address the implications of making the changes.
  • Address the implications of not making the changes.
• Write clearly and concisely in a logically coherent and appropriate form and style.
• Support assertions, arguments, propositions, and conclusions with relevant and credible evidence.

Document Format and Length

• Use the Summary Report Template. This APA Style Paper Tutorial [DOCX] can help you in writing and formatting your assessment. If you would like to use a different worksheet for your community health assessment, obtain prior approval from faculty.
• Your summary report should be 4–5 pages in length, not including the title page and references page.
• Be sure to apply correct APA formatting to all source citations and references.

Supporting Evidence

Cite 3–5 credible sources from peer-reviewed journals or professional industry publications to support your comparative analysis.

Additional Requirements

Be sure to delete all directions from the template before submitting your summary report. In addition, proofread your report to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your analysis.

Portfolio Prompt: You may choose to save your summary report to your ePortfolio.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Identify the challenges and opportunities facing health care.
  • Identify an aspect of a local or regional health care system or program that should be a focus for change.
• Competency 2: Compare the effects of different health care finance models and policy frameworks on resources and patient outcomes.
  • Define desirable outcomes, including who will pay for care and factors limiting achievement of those outcomes.
  • Analyze two non-U.S. health care systems or programs that offer insight into a proposed change for a health care system or program in the United States.
• Competency 3: Evaluate the positive and negative influences of leaders on health care processes and outcomes.
  • Determine the financial and health implications of making—and not making—proposed changes to a health care system or program.
• Competency 4: Develop proactive strategies to change the culture of the organization by incorporating evidence-based practices.
  • Explain why specific changes will lead to improved outcomes.
• Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style consistent with applicable organizational, professional, and scholarly standards.
  • Write clearly and concisely in a logically coherent and appropriate form and style.
  • Support assertions, arguments, propositions, and conclusions with relevant and credible evidence.

Grading Rubric:

1-  Identify an aspect of a local or regional health care system or program that should be a focus for change. 

Passing Grade:  Identifies an aspect of a local or regional health care system or program that should be a focus for change. Provides clear expectations for improvements substantiated by credible evidence. 

2-  Define desirable outcomes, including who will pay for care and factors limiting achievement of those outcomes. 

Passing Grade:  Defines desirable outcomes, including who will pay for care and factors limiting achievement of those outcomes. Provides well-reasoned justification for the definition and exhibits insight into optimal health care solutions. 

3-  Explain why specific changes will lead to improved outcomes. 

Passing Grade:  Explains why specific changes will lead to improved outcomes. Draws well-substantiated conclusions that are in line with reasonable expectations. 

4-  Analyze two non-U.S. health care systems or programs that offer insight into a proposed change for a health care system or program in the United States. 

Passing Grade:  Analyzes two non-U.S. health care systems or programs that offer insight into a proposed change for a health care system or program in the United States. Articulates insightful lessons learned from the analysis that have clear implications for U.S. health care. 

5-  Determine the financial and health implications of making—and not making—proposed changes to a health care system or program. 

Passing Grade:  Determines the financial and health implications of making—and not making—proposed changes to a health care system or program. Draws insightful, well-reasoned conclusions based on credible evidence. 

6-  Write clearly and concisely in a logically coherent and appropriate form and style. 

Passing Grade:  Writes clearly and concisely in a logically coherent and appropriate form and style. Main points, ideas, arguments, or propositions are well-developed and engaging. Adheres to all applicable disciplinary and scholarly writing standards and conventions. 

7-  Support assertions, arguments, propositions, and conclusions with relevant and credible evidence. 

Passing Grade:  Supports assertions, arguments, propositions, and conclusions with relevant, credible, and convincing evidence. Skillfully combines error-free source citations with a perceptive and accurate synthesis of the evidence. 

• Review the scope and standards of practice or competencies related to your chosen specialty in the resources for this module.
• Review the MSN specializations offered at Walden by viewing the module resource, Walden University. (n.d.). Master of Science in Nursing (MSN).
• Examine professional organizations related to the specialization you have chosen and identify at least one to focus on for this Assignment.
• Reflect on the thoughts you shared in the Discussion forum regarding your choice of a specialty, any challenges you have encountered in making this choice, and any feedback you have received from colleagues in the Discussion.

The Assignment:

Complete the following items and incorporate them into the final version of your Academic Success and Professional Development Plan.

• With the resources specific to the MSN specialization and the, Walden University. (n.d.). Master of Science in Nursing (MSN), shared in this module, write a paragraph or make a Nursing Specialty Comparison table, comparing at least two nursing specialties that include your selected specialization and second-preferred specialization.
• Write a 2- to 3-paragraph justification statement identifying your reasons for choosing your MSN specialization. Incorporate feedback you received from colleagues in this Module’s Discussion forum.
• Identify the professional organization related to your chosen specialization for this Assignment, and explain how you can become an active member of this organization.

MA3010 – Statistics for Health Professions

Discussion 03.1: Evaluating your Measurement Tool

 

Answer both of the following questions in your initial post:

1. Illness Prevalence:

The number of cases of illness in a population is referred to as its prevalence.  Comment on what a high illness prevalence does to the positive predictive value (PPV).  What about a low illness prevalence?

2. Study Feasibility:

In your research involving the BMI of fifth grade boys in the U.S., you will not only be collecting information on a child’s BMI, but also on his TV viewing habits, his eating habits, and his extracurricular activities.  You would like to make contact through the school systems to gather your information.  Discuss at least one factor that might affect the feasibility of this study.

 MYLAB STATISTICS WITH PEARSON E-TEXT 18 WEEK FOR Biostatistics for the Biological & Health Sciences

 Faculty Comments:  Faculty Comments: Points Description
Subjective
5 Chief complaint stated in patient’s own words.
10 HPI, PMH, PSH, Family History, Social Habits,
10 Contains all systems relevant information to make assessment with normal and abnormal findings.
20 Objective present and contains all pertinent objective information available (drug allergies, physical findings, drug list, etc)
20 Assessment presents justification for Main or Primary diagnosis
15 Assessment rules out other potential disorders
5 Plan contains discussion of therapy options with pros and cons of each. Also
10 Plan stated as directives (start, stop, non-pharmacologic and pharmacologic treatment etc)
5 Plan include monitoring and follow up 

 Comments: please explain the 3 differential dignosis in further notes