Antipsychotics and management of neurocognitive disorder wit…

674 Unit 8 Assignment Antipsychotics Course Outcomes practiced in this unit: -Construct a consistent approach to the assessment, evaluation, and management of mental health disorders and conditions for adult/geriatric patients, and patients across the lifespan, presenting in the acute and/or primary care setting. – Design age-appropriate mental health and physical health maintenance screening plans for adult/geriatric patients, and patients across the lifespan, for psychiatric mental health disorders. Case Study 8: Mrs. Julie presents with mood symptoms and is at risk for suicide Your writing assignment should: follow the conventions of Standard English (correct grammar, punctuation, etc.); be well ordered, logical, and unified, as well as original and insightful; display superior content, organization, style, and mechanics; and; use APA formatting and citation style. Assignment Directions Case Study Scenario: You are a PMHNP working on an inpatient geriatric psychiatry unit. Your new admission today is Mr. Dennis., a 72-year-old single male resident from an assisted living facility. He was brought to the emergency department with physical aggression and bizarre behaviors. Mr. Dennis. has no known premorbid psychiatric history. Two years ago, he was diagnosed with a mild neurocognitive disorder, major depressive disorder, and generalized anxiety disorder. He is unmarried with no children and lived independently in an apartment until 6 months ago. His recent symptoms of depression and anxiety were attributed to his transition to retirement from teaching at age 65. He had worked as a high school mathematics teacher for 3 decades and was highly active in his local church. Following his retirement, his cognitive decline progressed, and he subsequently began to experience progressive Parkinsonian symptoms, including mild intention tremor, cogwheeling rigidity, and bradykinesia. Recurrent falls and functional decline led to his eventual admission to the assisted living facility, as he required assistance with bathing, dressing, cooking, and medication management. He was seen by the facilitys physician and referred to a neurology service to evaluate his Parkinsonian symptoms. Assisted living staff members report that he appears intermittently confused and disoriented and endorses visual hallucinations of insects and children in his room. He was initially insightful regarding these perceptual disturbances and easily reassured by staff. He was often seen in his room contentedly interacting with hallucinatory figures. Over the past month, he has expressed concerns that someone in the facility wants to harm him and that nothing is real. With no apparent trigger, he has repeatedly become increasingly volatile and physically aggressive toward co-residents. At other times he appears entirely lucid and engages appropriately with staff and co-residents. His sleep is erratic, and he has been observed thrashing his legs in his bed on nightly rounds. He is eating well, has normal bowel and bladder function, and denies any pain. There are no intercurrent medical illnesses and no infectious symptoms noted. There is no known family psychiatric history. Past medical history is significant for dyslipidemia treated with a statin. He otherwise does not have any vascular risk factors. There is no history of traumatic brain injury. He is a non-smoker and a nondrinker with no illicit drug use. His current medications include atorvastatin 40 mg po daily and risperidone 0.5 mg po qhs, which the facilitys physician recently started for psychosis. There are no known drug allergies. On physical examination in the emergency department, Mr. Dennis. presented as afebrile with normal vital signs, and worsening Parkinsonian symptoms were noted. The emergency physician noted that he appeared perplexed and endorsed visual hallucinations of small animals running around the ward. Mental status examination revealed a casually dressed and mildly disheveled older male who seemed his stated age. He presented as confused but was able to tolerate a short interview. The speech was of normal rate, rhythm, and volume. The mood was described as not bad, and the affect was slightly blunted. Thoughts were disorganized, and perceptions revealed prominent visual hallucinations. He denied suicidality and homicidal. Insight and judgment were impaired due to confusion. Brief cognitive testing showed a MoCA of 21 out of 30, with deficits in visuospatial and executive function. Laboratory investigations showed dehydration and mild leukocytosis, with urine culture positive for E. coli bacteriuria. He was started on intravenous fluids and an antibiotic. Use the SOAP note template to complete the documentation with the information provided. Formulate appropriate diagnoses and design a treatment plan. Explain what further information you will explore to aid in accurate diagnosis. What treatment management is recommended for this patient, including pharmacological management? Discuss any need for referral. Discuss evidence-based treatment approaches for a client with neurocognitive disorder. Rubric Demonstrates a well-articulated understanding of the subject matter in a clear, complex, and informative manner Develops content and theories well Links content to the paper requirements and practical experience Includes relevant material that fulfills all objectives of the paper Uses scholarly resources that were not provided in the course materials Completes all instruction requirements Objective data is complete and consistently presented in an organized manner Assessment, including differential and/or diagnosis (if appropriate), is complete and appropriate to the client. Diagnostics are complete and appropriate to the client. Provides critical analysis in an accurate, clear, concise, and complete presentation of the required content Synthesizes information from scholarly resources Provides new information or insight related to the context of the assignment with both supportive and alternative information or viewpoints Completes all instruction requirements Assessment, including differential and/or diagnosis (if appropriate), is complete and appropriate to client. Diagnostics are complete and appropriate to client. Offers a multidisciplinary approach via scholarly resources Applies practice that is accurate and plausible Supports practice with additional scholarly resources Answers all questions posed within the assignment in a well-developed manner with citations for validation Completes all instruction requirements Provides well-organized content with a clear and complex purpose statement and content argument Provides concise writing with a logical flow of ideas Plan includes all relevant measures 95% to 100% Pharmacologic Nonpharmacologic Education Referral Follow-up Includes no more than three grammatical, spelling, or punctuation errors that do not interfere with the readability Meets the assignment length requirements Case incorporates three evidence-based practice articles from the past 5 years. Name: Pt. Encounter Number: Date: Age: Sex: SUBJECTIVE CC: Reason given by the patient for seeking medical care in quotes HPI: Describe the course of the patients illness, including when it began, character of symptoms, location where the symptoms began, aggravating or alleviating factors, pertinent positives and negatives, other related diseases, past illnesses, and surgeries or past diagnostic testing related to the present illness. Medications: (List with reason for med ) Allergies: (List with reaction) Medication Intolerances: Past Medical History: Chronic Illnesses/Major traumas Hospitalizations/Surgeries Have you ever been told that you have diabetes, HTN, peptic ulcer disease, asthma, lung disease, heart disease, cancer, TB, thyroid problems, kidney problems, or psychiatric diagnosis? Family History Does your mother, father, or siblings have any medical or psychiatric illnesses? Is anyone diagnosed with: lung disease, heart disease, HTN, cancer, TB, DM, or kidney disease? Social History Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, and marijuana. Safety status ROS Student to ask each of these questions to the patient: Have you had any….. General Weight change, fatigue, fever, chills, night sweats, and energy level Cardiovascular Chest pain, palpitations, PND, orthopnea, and edema Skin Delayed healing, rashes, bruising, bleeding or skin discolorations, and any changes in lesions or moles Respiratory Cough, wheezing, hemoptysis, dyspnea, pneumonia hx, and TB Eyes Corrective lenses, blurring, and visual changes of any kind Gastrointestinal Abdominal pain, N/V/D, constipation, hepatitis, hemorrhoids, eating disorders, ulcers, and black, tarry stools Ears Ear pain, hearing loss, ringing in ears, and discharge Genitourinary/Gynecological Urgency, frequency burning, change in color of urine. Contraception, sexual activity, STDs Female: last pap, breast, mammo, menstrual complaints, vaginal discharge, pregnancy hx Male: prostate, PSA, urinary complaints Nose/Mouth/Throat Sinus problems, dysphagia, nose bleeds or discharge, dental disease, hoarseness, and throat pain Musculoskeletal Back pain, joint swelling, stiffness or pain, fracture hx, and osteoporosis Breast SBE, lumps, bumps, or changes Neurological Syncope, seizures, transient paralysis, weakness, paresthesias, and black-out spells Heme/Lymph/Endo HIV status, bruising, blood transfusion hx, night sweats, swollen glands, increase thirst, increase hunger, and cold or heat intolerance Psychiatric Depression, anxiety, sleeping difficulties, suicidal ideation/attempts, and previous dx OBJECTIVE Weight BMI Temp BP Height Pulse Resp General Appearance Healthy-appearing adult female in no acute distress. Alert and oriented; answers questions appropriately. Slightly somber affect at first and then brighter later. Skin Skin is brown, warm, dry, clean, and intact. No rashes or lesions noted. HEENT Head is normocephalic, atraumatic, and without lesions; hair evenly distributed. Eyes: PERRLA. EOMs intact. No conjunctival or scleral injection. Ears: Canals patent. Bilateral TMs pearly gray with positive light reflex; landmarks easily visualized. Nose: Nasal mucosa pink; normal turbinates. No septal deviation. Neck: Supple. Full ROM; no cervical lymphadenopathy; no occipital nodes. No thyromegaly or nodules. Oral mucosa, pink and moist. Pharynx is nonerythematous and without exudate. Teeth are in good repair. Cardiovascular S1, S2 with regular rate and rhythm. No extra sounds, clicks, rubs, or murmurs. Capillary refills two seconds. Pulses 3+ throughout. No edema. Respiratory Symmetric chest wall. Respirations regular and easy; lungs clear to auscultation bilaterally. Gastrointestinal Abdomen obese; BS active in all the four quadrants. Abdomen soft, nontender. No hepatosplenomegaly. Breast Breast is free from masses or tenderness, no discharge, no dimpling, wrinkling, or discoloration of the skin. Genitourinary Bladder is nondistended; no CVA tenderness. External genitalia reveals coarse pubic hair in normal distribution; skin color is consistent with general pigmentation. No vulvar lesions noted. Well estrogenized. A small speculum was inserted; vaginal walls are pink and well rugated; no lesions noted. Cervix is pink and nulliparous. Scant clear to cloudy drainage present. On bimanual exam, cervix is firm. No CMT. Uterus is antevert and positioned behind a slightly distended bladder; no fullness, masses, or tenderness. No adnexal masses or tenderness. Ovaries are nonpalpable. (Male: Both testes are palpable, no masses or lesions, no hernia, and no uretheral discharge.) (Rectal as appropriate: No evidence of hemorrhoids, fissures, bleeding, or massesMales: Prostrate is smooth, nontender, and free from nodules, is of normal size, and sphincter tone is firm). Musculoskeletal Full ROM seen in all four extremities as the patient moved about the exam room. Neurological Speech clear. Good tone. Posture erect. Balance stable; gait normal. Psychiatric Alert and oriented. Dressed in clean slacks, shirt, and coat. Maintains eye contact. Speech is soft, though clear and of normal rate and cadence; answers questions appropriately. Lab Tests Urinalysispoint of care test done today in the office- results positive for nitrites and blood, negative for leukocytes. Urine culture collected in officepending results, sent to lab Wet prep collected in officepending results, sent to lab Assessment o Include at least three differential diagnoses Provide rationale for each differential diagnosis o Final diagnosis Pathophysiology of primary and rationale for choosing as final Plan o Medications o Non-pharmacological recommendations o Diagnostic tests o Patient education o Culture considerations o Health promotion o Referrals o Follow up