NRNP/PRAC 6665 & 6675 Comprehensive Focused SOAP Psychiatric Evaluation Template

Week 5: Mood and Anxiety Disorders in Children and Adolescents

School and going out with my friends used to be fun, but not anymore. Mom keeps telling me just to go out and have fun, but I don’t see the point of trying. All my friends are better than I am. I keep having these headaches and just feel worthless. I used to get As and Bs in school, but not anymore. I can’t concentrate at school. I would rather be at home sleeping.

—Madison, age 16

Mood and anxiety disorders can be particularly challenging to address in childhood and adolescence for many reasons. Children may not be able to fully express or understand their feelings and behaviors. Parents may misattribute or not recognize signs and symptoms. The symptoms of disorders also vary when present in children as opposed to adults. The PMHNP needs to know how to diagnose these conditions and must understand the importance of integrating medication management strategies with both individual and family therapy to optimize treatment outcomes.

Learning Objectives

Students will:

· Explain signs and symptoms of mood and anxiety disorders in children and adolescents

· Explain the pathophysiology of mood and anxiety disorders in children and adolescents

· Explain diagnosis and treatment methods for mood and anxiety disorders in children and adolescents

· Develop patient education materials for mood and anxiety disorders in children and adolescents

Learning Resources

Required Readings (click to expand/reduce)

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

· Chapter 3, “Common Clinical Concerns”

· Chapter 7, “A Brief Version of DSM-5″

· Chapter 8, “A stepwise approach to Differential Diagnosis”

· Chapter 10, “Selected DSM-5 Assessment Measures”

· Chapter 11, “Rating Scales and Alternative Diagnostic Systems”

Shoemaker, S. J., Wolf, M. S., & Brach, C. (2014). The patient education materials assessment tool (PEMAT) and user’s guide. Agency for Healthcare Research and Quality. https://www.ahrq.gov/sites/default/files/publications/files/pemat_guide.pdf

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

· Chapter 60, “Anxiety Disorders”

· Chapter 61, “Obsessive Compulsive Disorder”

· Chapter 62, “Bipolar Disorder in Childhood”

· Chapter 63, “Depressive Disorders in Childhood and Adolescence” 

Required Media (click to expand/reduce)

Center for Rural Health. (2020, May 18). Disruptive mood dysregulation disorder & childhood bipolar disorder [Video]. YouTube. https://youtu.be/tSfYXkst1vM

Mood Disorders Association of BC. (2014, November 20). Children in depression [Video]. YouTube. https://youtu.be/Qg-BBKB1nJc

Psych Hub Education. (2020, January 7). LGBTQ youth: Learning to listen. [Video]. YouTube. https://www.youtube.com/watch?v=Wn4AVjMMYX4

Medication Review

Review the FDA-approved use of the following medicines related to treating mood and anxiety disorders in children and adolescents.

Bipolar depression	Bipolar disorder
lurasidone (age 10–17) olanzapine-fluoxetine combination (age 10–17)	aripiprazole (age 10–17) asenapine  (for mania or mixed episodes, age 10–17) lithium (for mania, age 12–17) olanzapine (age 13–17) quetiapine (age 10–17) risperidone (age 10–17)
Generalized anxiety disorder	Depression
duloxetine (age 7–17)	escitalopram (age 12–17) fluoxetine (age 8–17)

Obsessive-compulsive disorder

clomipramine (age 10–17) fluoxetine (age 7–17) fluvoxamine (age 8–17) sertraline (age 6–17)

Assignment: Patient Education for Children and Adolescents

Patient education is an effective tool in supporting compliance and treatment for a diagnosis. It is important to consider effective ways to educate patients and their families about a diagnosis—such as coaching, brochures, or videos—and to recognize that the efficacy of any materials may differ based on the needs and learning preferences of a particular patient. Because patients or their families may be overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly outline the information that patients need to know.

Photo Credit: Getty Images

For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked with explaining important information about an assigned mental health disorder in language appropriate for child/adolescent patients and/or their caregivers. 

To Prepare

· By Day 1, your Instructor will assign a mood or anxiety disorder diagnosis for you to use for this Assignment.

· Research signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.

The Assignment

In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals. Although you are not required to respond to colleagues, collegial discussion is welcome. 

Week 5: Mood and Anxiety Disorders in Children and Adolescents

School and going out with my friends used to be fun, but not anymore. Mom keeps telling me just to go out and have fun, but I don’t see the point of trying. All my friends are better than I am. I keep having these headaches and just feel worthless. I used to get As and Bs in school, but not anymore. I can’t concentrate at school. I would rather be at home sleeping.

—Madison, age 16

Mood and anxiety disorders can be particularly challenging to address in childhood and adolescence for many reasons. Children may not be able to fully express or understand their feelings and behaviors. Parents may misattribute or not recognize signs and symptoms. The symptoms of disorders also vary when present in children as opposed to adults. The PMHNP needs to know how to diagnose these conditions and must understand the importance of integrating medication management strategies with both individual and family therapy to optimize treatment outcomes.

Learning Objectives

Students will:

· Explain signs and symptoms of mood and anxiety disorders in children and adolescents

· Explain the pathophysiology of mood and anxiety disorders in children and adolescents

· Explain diagnosis and treatment methods for mood and anxiety disorders in children and adolescents

· Develop patient education materials for mood and anxiety disorders in children and adolescents

Learning Resources

Required Readings (click to expand/reduce)

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

· Chapter 3, “Common Clinical Concerns”

· Chapter 7, “A Brief Version of DSM-5″

· Chapter 8, “A stepwise approach to Differential Diagnosis”

· Chapter 10, “Selected DSM-5 Assessment Measures”

· Chapter 11, “Rating Scales and Alternative Diagnostic Systems”

Shoemaker, S. J., Wolf, M. S., & Brach, C. (2014). The patient education materials assessment tool (PEMAT) and user’s guide. Agency for Healthcare Research and Quality. https://www.ahrq.gov/sites/default/files/publications/files/pemat_guide.pdf

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

· Chapter 60, “Anxiety Disorders”

· Chapter 61, “Obsessive Compulsive Disorder”

· Chapter 62, “Bipolar Disorder in Childhood”

· Chapter 63, “Depressive Disorders in Childhood and Adolescence” 

Required Media (click to expand/reduce)

Center for Rural Health. (2020, May 18). Disruptive mood dysregulation disorder & childhood bipolar disorder [Video]. YouTube. https://youtu.be/tSfYXkst1vM

Mood Disorders Association of BC. (2014, November 20). Children in depression [Video]. YouTube. https://youtu.be/Qg-BBKB1nJc

Psych Hub Education. (2020, January 7). LGBTQ youth: Learning to listen. [Video]. YouTube. https://www.youtube.com/watch?v=Wn4AVjMMYX4

Medication Review

Review the FDA-approved use of the following medicines related to treating mood and anxiety disorders in children and adolescents.

Bipolar depression	Bipolar disorder
lurasidone (age 10–17) olanzapine-fluoxetine combination (age 10–17)	aripiprazole (age 10–17) asenapine  (for mania or mixed episodes, age 10–17) lithium (for mania, age 12–17) olanzapine (age 13–17) quetiapine (age 10–17) risperidone (age 10–17)
Generalized anxiety disorder	Depression
duloxetine (age 7–17)	escitalopram (age 12–17) fluoxetine (age 8–17)

Obsessive-compulsive disorder

clomipramine (age 10–17) fluoxetine (age 7–17) fluvoxamine (age 8–17) sertraline (age 6–17)

Assignment: Patient Education for Children and Adolescents

Patient education is an effective tool in supporting compliance and treatment for a diagnosis. It is important to consider effective ways to educate patients and their families about a diagnosis—such as coaching, brochures, or videos—and to recognize that the efficacy of any materials may differ based on the needs and learning preferences of a particular patient. Because patients or their families may be overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly outline the information that patients need to know.

Photo Credit: Getty Images

For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked with explaining important information about an assigned mental health disorder in language appropriate for child/adolescent patients and/or their caregivers. 

To Prepare

· By Day 1, your Instructor will assign a mood or anxiety disorder diagnosis for you to use for this Assignment.

· Research signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.

The Assignment

In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals. Although you are not required to respond to colleagues, collegial discussion is welcome. 

© 2021 Walden University Page 1 of 3

Response must be at least 510 words written in current APA format with at least two academic references cited. References must be within the last five years. 

1. Discuss the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
2. Utilizing the five assessment domains, which ones would you utilize on your patients in conducting a comprehensive nutritional assessment.
3. Discuss the functional anatomy and physiology of a psychiatric mental health patient. Which key concepts must a nurse know in order to assess specific functions?

Patient is a 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle. He came in for an annual physical. Patient has no past medical or surgical history, has no known drug allergies, and isn’t currently taking any medication.

He has a family history of diabetes, hypertension, and alcoholism. No recent weight gains of losses, fatigue, fever, or chills. No chest discomfort or palpitations, history of eczema, no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements. Patient’s vital signs are as followed: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6.

Patient developed and well-nourished. He is anxious – pacing in the room and fidgeting, but in no acute distress.

Choose one diagnosis from the Anxiety Disorders group 

· American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Inc. 

· Scan Pages 189-233 

Overview  

As you will learn throughout the program, the diagnosis of a variety of psychiatric illnesses is not always an easy or straightforward process. Multiple observations and assessment methods are often employed to reach a diagnosis. This approach can include the use of standardized assessment instruments.  This then aids you in defining a treatment plan and choosing specific treatment plans to use in the care of your clients.  

You are tasked with identifying a standardized assessment instrument/tool to measure the disorders listed for each week. You will keep these instruments in the form of a “portfolio” that you can use in your clinical practice to assess clients who present with a variety of symptoms.  

Instructions:  

Instrument/ Tool criteria:  

For each assessment, you are tasked with selecting, you will identify an instrument and:  

1. List what DSM diagnosis the tool/instrument is used for  

2. Identify an assessment/diagnosis instrument 

3. Appraise a scholarly, peer-reviewed article that addresses the use of the instrument to support your choice as an evidence-based instrument for practice.  

4. Evaluate the instrument’s appropriateness for diagnosing the condition it is designed to assess or if the developers of the instrument reported that the instrument is only part of a comprehensive assessment for the disorder.  

5. Describe whether or not the instrument can be used to measure patient response to therapy/treatment or if it is strictly for assessment and diagnosis.  

6. Discuss the psychometrics/scoring of the instrument, including reliability and validity.  

7. Discuss any limitations associated with the use of the instrument. 

8. Include a link to view the assessment if possible.

Use the following template in completing your portfolio assignments. Your information can be in bulleted format or just a couple of sentences for each criterion listed above. However, you must use APA citations.  You are NOT required to write this in a paper format.  Turn in one document for each week’s topics.  (However, create a file on your desktop to compile your portfolio as you move through the term.)  This will ensure you can have easy access to show the full portfolio and once you begin clinicals and practice.  Throughout the program, you will continue to add to the portfolio in each course. 

he purpose of this assignment is to examine how publicly reported data influence internal quality improvement initiatives.

Identify a specific health care organization of your choice. Review its Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and Hospital Acquired Infections (HAIs) reports.

In a 1,250-1,500-word paper, discuss your findings on the HCAHPS scores and HAIs for the health care organization you selected. Include the following in your paper:

Describe the health care organization you have selected.

Discuss the role of HCAHPS and HAIs in creating quality indicators and how they contribute to the quality improvement process.

Discuss how the HCAHPS and HAIs data of your selected organization compare to national benchmarks.

Discuss the role of consumer satisfaction in quality improvement.

Describe the intent and outcomes of public reporting.

Discuss what actions leadership could take at your selected organization based on the reported HCAHPS and HAIs data.

This assignment requires four to six scholarly resources.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

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 LopesWrite. A link to the LopesWrite Technical Support Articles is located in Class Resources if you need assistance.

Rubric

A description of the selected health care organization is thorough.

A discussion of the role of HCAHPS and HAIs in creating quality indicators and how they contribute to the quality improvement process is thorough.

A discussion of how the HCAHPS and HAIs data of the selected organization compare to national benchmarks is thorough.

A discussion of the role of consumer satisfaction in quality improvement is thorough.

A description of the intent and outcomes of public reporting is thorough.

A discussion of the actions that leadership could take at the selected organization based on the reported HCAPHS and HAIs data is thorough.

Case 1

J.J is a nurse practitioner who works in a primary care facility. He believes that one of the most important aspects of his work is to foster a therapeutic relationship with his clients. He is using effective communication techniques.

Many of his clients have altered sensory perception such as blindness and deafness. Because of these conditions, He has to be extremely patient with his clients. J.J. also finds that the use of respect and humor help him bond more readily with his clients.

Questions for the case

For better results with his clients, J.J must secure trust with his patients. Discuss strategies that promote trust between patients and health care providers.

Once you received your case number; answer the specific question on the table above. Then, continue to discuss the 3 topics listed below for your case:

1. Moral distress is a frequent situation where health care providers should face. Please define and discuss a personal experience where you have faced Moral distress in your practice.
2. Discuss how health promotion relates to morality.
3. Discuss your insights about your own communication strengths and weaknesses. Identify situations in which it may be difficult for you to establish or terminate a therapeutic relationship.

Your initial post should be at least 550 words, formatted and cited in current APA style with support from at least 3 academic sources.

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Application Of Theories In Project Management

crazyjenny83

• MAIN

DNPnursingdiscussion post

 The importance of utilizing a theoretical framework in a dissertation study cannot be stressed enough. The theoretical framework is the foundation from which all knowledge is constructed (metaphorically and literally) for a research study. It serves as the structure and support for the rationale for the study, the problem statement, the purpose, the significance, and the research questions. The theoretical framework provides a grounding base, or an anchor, for the literature review, and most importantly, the methods and analysis. 

There are many theories that apply to project management as well as the dissertation process; therefore, it is important to understand the theories to determine which might most apply to your nursing practice and research. The specific theories and models utilized not only drive a study, but they also shape how the reviewer will interpret the results.

For this Discussion, you will explore various theories or models related to change theory and systems thinking in your healthcare organization or nursing practice. You will consider how the tenets of these theories might apply to your organization and practice, as well as consider how these theories might solve potential practice gaps.

Reference:
Grant, C., & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research: Creating the blueprint for your “house.” Administrative Issues Journal, 4(2), 12–26. doi:10.5929/2014.4.2.9

To Prepare

• Review this week’s Lewin’s change theory media resource.
• Consider the importance of change theory, as well as reflect on the application of these theories to your healthcare organization or nursing practice.
• Research and select two additional theories or models related to change theory and systems thinking to focus on for this Discussion.

By Day 4 of Week 4

Post a response to each of the following:

• Describe the importance and application of Change Theory and Systems Thinking for healthcare organizations and nursing practice. Be specific.
• List two additional theories or models that you selected and explain how these might be applied in research. Be specific and provide examples.
• Explain how theories and models provide a framework to guide projects, including your DNP Project or dissertation.

Assignment: Analyzing Group Techniques

Group therapy can alleviate feelings of isolation and foster a supportive and collaborative environment for sharing difficult feelings in order to facilitate healing. For many people, being part of a group that has a shared understanding of a struggle provides a unique opportunity to gain understanding of their own experiences.

As you examine one of the group therapy demonstrations from this week’s Learning Resources, consider the role and efficacy of the leader and the reasons that specific therapeutic techniques were selected.

To prepare:

· Select one of the group therapy video demonstrations from this week’s required media Learning Resources.

The Assignment

In a 3- to 4-page paper, identify the video you selected and address the following:

· What group therapy techniques were demonstrated? How well do you believe these techniques were demonstrated?

· What evidence from the literature supports the techniques demonstrated? 

· What did you notice that the therapist did well?

· Explain something that you would have handled differently.

· What is an insight that you gained from watching the therapist handle the group therapy?

· Now imagine you are leading your own group session. How would you go about handling a difficult situation with a disruptive group member? How would you elicit participation in your group? What would you anticipate finding in the different phases of group therapy? What do you see as the benefits and challenges of group therapy?  

· Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Submit your Assignment. 

Reminde r  The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

NB: THE VIDEO IS ON YOUTUBE. YOU CAN TYPE THE BELOW YOUTUBE CHANNEL TO GET THE VIDEO.

Gerber, B. (2013, November 21). Psychotherapy group for schizophrenia [Video]. YouTube. https://www.youtube.com/watch?v=t8Dzus8WGqA

Not only do these diagnostic tests affect adults, but body measurements can also provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process. Explore how you could effectively gather information and encourage parents and caregivers to be proactive about their health and weight.

For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. 

Adult Assessment Tools or Diagnostic Tests.

The assigned Assessment Tool/Diagnostic Test is Colonoscopy

THE QUESTION:

• Description how the assessment tool or diagnostic test you were assigned is used in healthcare.
  • What is the purpose of Colonoscopy?
  • How is Covid Colonoscopy conducted?
  • What information does it gather?
• Based on your research, evaluate the test or the tool’s validity and reliability, and explain any      issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.

Not only do these diagnostic tests affect adults, but body measurements can also provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process. Explore how you could effectively gather information and encourage parents and caregivers to be proactive about their health and weight.

For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. 

Adult Assessment Tools or Diagnostic Tests.

The assigned Assessment Tool/Diagnostic Test is Colonoscopy

THE QUESTION:

• Description how the assessment tool or diagnostic test you were assigned is used in healthcare.
  • What is the purpose of Colonoscopy?
  • How is Covid Colonoscopy conducted?
  • What information does it gather?
• Based on your research, evaluate the test or the tool’s validity and reliability, and explain any      issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

2

PLEASE USE THIS PICOT, OBJECTVE, AND STATEMENT BELOW TO CPMPLETE THE ATTACHED TEMPLATE

Question 1: PICOT

P= The research will use secondary research conducted within the last 10 years.

I= A systematic research review method will be applied to provide a review of the existing research regarding the topic.

C= Comparison between the mortality rates between active smokers and non-smokers who quit smoking before age 4

O= Determine impacts of smoking on mortality rates of individuals.

T= The time needed for the research is one and half months to complete an adequate review of existing research.

Question 2: Objective

Determine the risks of smoking and advantages of ceasing the habit.

Statement

Due to the persistence of the smoking behaviors within the contemporary society, there is an increase in awareness regarding the hazardousness of the behavior. The research aims at increasing advocacy against by incorporating various research results regarding adverse health impacts of smoking to provide a more generalizable result for reducing smoking behaviors, especially among the young populations.

Directions

1. Introduction: Provide an overview of what will be covered in the assignment. Introduction should include general statements on scope of practice, competencies, and leadership, and identification of the purpose of the assignment. 
2. APN Scope of Practice: Research the Nurse Practice Act and APN scope of practice guidelines for the state in which you intend to practice after graduation. (Example: Students who intend to practice in California must research the California Nurse Practice Act and relevant Board of Registered Nursing regulations, such as obtaining a DEA number, and prescriptive requirements).  Describe the educational, licensure, and regulatory requirements for that state in your own words. Identify whether your state allows full, limited, or restricted NP practice. Discuss NP prescriptive authority in your state. Provide support from at least one scholarly source. Source may be the regulatory body that governs nursing practice in your state. (Students who intend to practice in California, include the use of written standard procedures that guide nurse practitioner practice in the state and physician supervision ratios).
3. Nurse Practitioner (NONPF) Core Competencies: Review the NONPF Core Competencies. Describe two competency areas you believe to be personal strengths and two competency areas in which you have opportunities for growth. Discuss two scholarly activities you could do during the master’s program to help yourself achieve NP competencies. Provide support from at least one scholarly source. Source may be NONPF Core Competencies document provided via the link in the week 2 readings. 
4. Leadership Skills: Analyze three leadership skills required to lead as an NP within complex systems. Describe two strategies you could use to help you develop NP leadership skills. Provide support from at least one scholarly source. Textbooks are not considered scholarly sources. 
5. Conclusion: Provide a conclusion, including a of what you discussed in the assignment.