NRNP 6635 WK 3 ASSIGNMENT 1 (Coursework Sample)

Week Three: Mood Disorders Student Name College of Nursing-PMHNP, Walden University NRNP 6635: Psychopathology and Diagnostic Reasoning Faculty Name Assignment Due Date Week Three: Mood Disorders Subjective: CC (chief complaint): At the healthcare facility patient complains of having insomnia, low mood, suicidal ideation along with feeling terrible about her susceptibility and inability to change the situation. HPI: A.T., a 27-year-old Caucasian female presents to the healthcare facility for her first psychiatric evaluation of depression after being convinced by her husband, although she does not consider such measures necessary. The patient is not under any psychiatric medications, and she denies having a psychiatric evaluation previously. The symptoms of depression started to manifest after she gave birth two months ago since the inability to afford a nanny after quitting her job made the patient do everything by herself, thus getting insufficient time to rest. Although she feels worse when the baby is crying, A.T. cannot provide proper care and ends up crying herself. She is afraid to admit these problems to her husband for fear of disappointing him. The patient acknowledges considering suicide but denies any intention of acting on it. Past Psychiatric History: * General Statement: The patient visited the healthcare facility for psychological assessment for the first time. * Hospitalizations: The patient has not been hospitalized for any psychological disorder, claiming it is her first visit to seek psychological help. * Medication trials: The patient has not taken any psychiatric medications before, and her PCP would first refer her to undergo psychiatric tests for diagnosis before administering any medications. * Psychotherapy or Previous Psychiatric Diagnosis: The patient has not been previously diagnosed with any psychiatric disorder. Substance Current Use and History: The patient denies any substance or alcohol abuse in the present and in the past. Family Psychiatric/Substance Use History: The case study does not mention any person with psychiatric disorders in the patient’s family. Nonetheless, her brother was addicted to methamphetamines before committing suicide via GSW. Psychosocial History: After the parents divorced when she was 16, the patient had lived with her mother. She has two sisters who currently live in Troy, Alabama. She studied for the bachelor’s degree and majored in English literature which enabled her to secure a job in a library. One of her hobbies is writing, but she confesses she has not been writing since the delivery due to the child’s constant needs, which distract her. She had worked in the library for five years before quitting her job after being granted maternity leave. Since the patient has given birth, she has only seen her friends when they visited the baby, and she is not in a position to go out with them anymore due to her responsibilities. The patient has no violence or legal history. Medical History: Hypertension * Current Medications: Trandate 100mg twice daily. * Allergies: Penicillin. * Reproductive Hx: The patient is heterosexual and she had her first child two months ago. ROS: * GENERAL: The patient reveals she has insomnia, low moods, low appetite, and episodes of suicidal ideation. * HEENT: A.T. denies double or blurred vision, pain or discomfort in the ears, neck, nose, and throat. * SKIN: Indicates she has lines on her face. * CARDIOVASCULAR: No history of cardiovascular illness. * RESPIRATORY: Denies history of any respiratory illness. * GASTROINTESTINAL: Admits a reduced appetite but denies changes in bowel movements. Nausea, diarrhea, and vomiting are not experienced. * GENITOURINARY: The patient is heterosexual and denies history of STDs/STIs. * NEUROLOGICAL: Accepts having abnormal sleeping habits, insomnia, lack of motivation and energy, and suicidal ideation. * MUSCULOSKELETAL: Dismisses back and joint discomfort and pain. * HEMATOLOGIC: Denies history of lesion removal and blood transfusion. * LYMPHATICS: Has normally-sized lymph nodes. * ENDOCRINOLOGIC: Denies abnormal endocrine secretions. Objective: Physical exam: T – 98.6, P – 88, R – 18, BP – 154/92, Ht – 5’1”, Wt – 230 lbs. GENERAL: The patient is obese with a BMI of 43.5kg/m2. NEUROLOGICAL: The patient’s memory is intact, A & O *3, motor and sensations are intact. Diagnostic results: The PCP utilized a depression scale and a major depressive inventory self-rating scale. The patient answered nine questions on the scale positively and the other six negatively. The PCP marked all five indicators of depression on the scale. The patient score on the major depression inventory self-rating scale was 34. Assessment: Mental Status Examination: The patient was neatly groomed and dressed appropriately for the weather. She cooperated with the PCP during the interview and examinations. Her regrets and thoughts during the whole process were voiced as wishing to make everything better for herself and her family. The patient accepted having suicidal ideation but denied visual and auditory hallucinations. Her concentration was average due to the distractions from her thoughts during the conversation, which reduced her concentration. Differential Diagnoses: Major depressive disorder (ICD 10 – F33.1, recurrent, moderate) is a psychotic disorder characterized by severe and persistent depressed mood impairing daily life (Kennis et al., 2020). The pertinent positives in the patient’s subjective data that supported the diagnosis included lack of motivation and energy, suicidal ideation, lack of appetite, insomnia, and low moods, which are primary signs and symptoms of major depressive disorder. The diagnosis was also supported by objective data, namely the results from the two diagnostic tests the PCP conducted to assess the patient. Such symptoms as a depressed mood, loss of interest, weight gain, insomnia, suicidal ideation, and feeling worthless for more than two weeks, which were not caused by medical conditions or substance abuse, adhere to DSM-5-TR criteria for diagnosis of major depressive disorder (MdCalc, 2022). Bipolar disorder (ICD 10 – F31.3, Depression episodes, mild or moderate severity) is a mental disorder characterized by mood changes ranging from maniac highs and depressive lows (Vieta et al., 2018). The pertinent positive exhibited by the patient was symptoms of mania whereas the pertinent negative was lack of tests after the patient failed to fulfil the DSM-5 criteria for diagnosing bipolar disorder. The DSM-5 criteria require a patient to experience hypomania and mania at least once. The patient fulfilled the criteria for mania as it is similar to that of major depressive disorder (Truschel, 2020). However, the patient did not experience any hypomania symptoms for at least a week continuously. The diagnosis was ruled out since it did not meet the DSM-5 criteria. Borderline personality disorder (ICD 10 – F60.3) is a mental disorder characterized by unstable relationships, behavior, and moods. According to Gunderson et al. (2018), the disorder hinders a person from proper functioning. The pertinent positives in patient’s subjective data revealed the presence of feelings of worthlessness, emotional instability, and impaired social relationships. The DSM-5 criteria for diagnosing the disorder require a patient to portray impaired personality, interpersonal traits and pathological personality qualitie...