Assignment: Practicum: Decision Tree (Due in Week 10)<\/p>\n
For this Assignment, as you examine the client case study in this week\u2019s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.
\nThe Assignment:
\nLearning Objectives
\nStudents will:
\n\u2022\tEvaluate clients for treatment of mental health disorders
\n\u2022\tAnalyze decisions made throughout diagnosis and treatment of clients with mental health disorders
\nExamine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client\u2019s diagnosis and treatment.
\nAt each Decision Point, stop to complete the following:
\n\u2022\tDecision #1: Differential Diagnosis
\no\tWhich Decision did you select?
\no\tWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.
\no\tWhat were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
\no\tExplain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
\n\u2022\tDecision #2: Treatment Plan for Psychotherapy
\no\tWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.
\no\tWhat were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
\no\tExplain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
\n\u2022\tDecision #3: Treatment Plan for Psychopharmacology
\no\tWhy did you select this Decision? Support your response with evidence and references to the Learning Resources.
\no\tWhat were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
\no\tExplain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
\n\u2022\tAlso include how ethical considerations might impact your treatment plan and communication with clients and their family.<\/p>\n
Case #3
\nNeurocognitive Disorders<\/p>\n
BACKGROUND
\nMr. Charles Wingate is a 76-year-old Caucasian male who presents to your office for an initial psychiatric evaluation. He is accompanied by his eldest son, Mark, who lives with Mr. Wingate. Mr. Wingate was referred to you by his primary care provider who has performed an extensive diagnostic workup to rule out an organic basis for his changes in cognition. Mr. Wingate\u2019s son Mark has verbalized a concern that Mr. Wingate may have Alzheimer\u2019s disease. When questioned, Mr. Wingate states that he is unaware of anyone in his family ever having been diagnosed with Alzheimer\u2019s disease.<\/p>\n
SUBJECTIVE
\nMr. Wingate states that he has always been \u201ca little bit forgetful,\u201d but he noticed that in his 60s and 70s, it got worse. Mark states that \u201cfor the past 2 years, it has been getting worse. He doesn\u2019t even notice how bad his memory has become.\u201d On at least two occasions, Mr. Wingate has gotten lost when he was driving to the grocery store. Mr. Wingate protested his disagreement with this accusation stating, \u201cbut they were doing road construction, anyone could have gotten mixed up!\u201d While his son conceded to this, he pointed out that Mr. Wingate\u2019s memory has caused some other problems, such as errors with paying his monthly utility bills (at one point, the electric company threatened to shut off his electricity due to his nonpayment of the bill).
\nHis son Mark also pointed out that the family is concerned for Mr. Wingate\u2019s safety as he twice left his keys hanging in the door and just two evenings ago, put food in oven and forgot about it until the smoke detector in the kitchen began to alarm.
\nMr. Wingate also has had a few issues with managing his medications. Specifically, he took too many Norvasc tablets a few months ago, which resulted in hypotension and a fall. Since that time, Mark\u2019s wife has been setting up Mr. Wingate\u2019s pills in pill boxes, but recently, multiple \u201cmissed doses\u201d have been noted.
\nMr. Wingate states: \u201cbut those are my night pills that I miss\u2014I\u2019m always better at remembering things in the morning.\u201d Mark agrees, stating that Mr. Wingate\u2019s cognition does vary throughout the course of the day and appears to worsen in the evening. He also reports that his father seems much less alert in the evenings, and more alert in the mornings.
\nMr. Wingate reports that he has had poor sleep for \u201ca long time now.\u201d He does report that over the past few months, he has been having what he describes as \u201cvery vivid nightmares.\u201d His son states that sometimes he is awakened by his father\u2019s yelling during nightmares, and enters his father\u2019s room, and sees his father swinging or kicking in his sleep.
\nHe reports that his appetite is \u201calright\u201d and that his energy levels do fluctuate throughout the course of the day. He states: \u201csometimes, I can concentrate really well; other times I can\u2019t \u2026 it is very frustrating!\u201d Specific to substance use, Mr. Wingate notes that he used to enjoy a glass of wine or two with dinner, but states that it just doesn\u2019t interest him, anymore. Plus, he stated that he notices that when he does drink, he develops slow muscle contractions.
\nMr. Wingate\u2019s son also shares a concern about his father\u2019s abnormal movements. He states that for about the last 6 months, his father has had problems with coordination. He states that he raised these concerns with the family doctor who suggested it may be \u201clate onset Parkinson\u2019s disease.\u201d However, he was not treated because the symptoms were \u201cnot that bad.\u201d<\/p>\n
OBJECTIVE
\nMr. Wingate was overall calm and pleasant during the clinical interview. Throughout the clinical interview, you notice that Mr. Wingate is not really involved in the discussion. He seems somewhat indifferent to the assessment and does not seem very concerned with what is being discussed. He only protested when discussing how he got lost on his way to the supermarket and his evening medication dose.
\nReview of systems and screening physical assessment were unremarkable, with the exception of fine resting tremors noted in both of Mr. Wingate\u2019s hands. The psychiatric\/mental health nurse practitioner (PMHNP) also reviewed laboratory studies that were sent from Mr. Wingate\u2019s primary care provider; they were within normal limits with the exception of a serum sodium level of 130 mEq\/L.<\/p>\n
MENTAL STATUS EXAM
\nMr. Wingate is alert. He is oriented to person, place, and partially oriented to time (he knows that it is morning, but cannot tell the hour). His speech is clear, coherent, goal directed, and spontaneous. Mr. Wingate\u2019s self-reported mood is \u201cok.\u201d Affect is somewhat constricted. His eye contact is fleeting throughout the clinical interview. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes appreciated. Judgment seems well preserved, but insight appears impaired as he is having trouble understanding why his son brought him to this appointment. Concentration and attention also appear impaired, which prompts the PMHNP to perform a mini-mental status exam (MMSE) on Mr. Wingate.
\nRESULTS OF MMSE
\nScore of 17, with primary deficits in orientation; calculation; recall (he was unable to recall any of the three items presented after 5 minutes); and he was unable to perform serial 7\u2019s or spell the word \u201cWORD\u201d in reverse, despite the fact that he is a high school graduate and attended 1 year of college. He also needed prompting with the three-step command. His score suggests severe cognitive impairment.
\nAt this point, please discuss any additional diagnostic tests you would perform on Mr. Wingate.
\nDecision Point One
\nBASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC\/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO MR. WINGATE?
\nIn your write-up of this case, be certain to link specific symptoms presented in the case to DSM\u20135 criteria to support your diagnosis.<\/p>\n
Major frontotemporal neurocognitive disorder (FTNCD)<\/p>\n
Major neurocognitive disorder due to Alzheimer\u2019s disease<\/p>\n
Major neurocognitive disorder with Lewy bodies<\/p>\n
Major frontotemporal neurocognitive disorder (FTNCD) click to see options it will take you to decision point two and three.<\/p>\n
Major neurocognitive disorder due to Alzheimer\u2019s disease click to see options it will take you to decision point two and three.<\/p>\n
Major neurocognitive disorder with Lewy bodies click to see options it will take you to decision point two and three.<\/p>\n
All references require creditable sources, nothing less than 5 years. References require APA 7th edition http\/\/. Please add conclusion. Please make sure that APA format is correct, thank you.<\/p>\n","protected":false},"excerpt":{"rendered":"
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