NRNP 6665 Week 4 Assignment

NRNP 6665 Week 4 Assignment – Step-by-Step Guide

The first step before starting to write the NRNP 6665 Week 4 Assignment: Assessing, Diagnosing, and Treating Adults with Mood Disorders – Case Study: Petunia Park, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NRNP 6665 Week 4 Assignment

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. 

Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NRNP 6665 Week 4 Assignment

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NRNP 6665 Week 4 Assignment

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NRNP 6665 Week 4 Assignment

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NRNP 6665 Week 4 Assignment

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NRNP 6665 Week 4 Assignment

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

An Example NRNP 6665 Week 4 Assignment Follows:

Case Study: Petunia Park

Subjective:

Chief Complaint: Mental Health Assessment

History of Present Illness (HPI.): Ms. P.P appears to be a young Mexican woman, age 19, present for mental health assessment. Ms. Park stated her birth date is July 1, 1995. She has no current medication presently. She has a history of taking drugs and then stopping them. Ms. Park stated, “I don’t think I need them. I feel like the medication squash who I am”. The patient continues to have anxiety, depression, and manic episodes, with possible OCD and schizophrenia due to hearing voices and hospitalization. P.P. works at Aunt Bookstore once in a while. The patient stated she is in Voc-tech school for cosmetology. “I am going to do make-up for movie stars.

General Statement: I will get enough information to come up with a treatment plan and maybe find some medications that will make you feel better without you feeling so squashed and having negative side- effects, but help you able to function through the day.

Caregiver: Ms. P is her caretaker but lives with her boyfriend. She sometimes stays with her mom and brother when he gets mad for becoming promiscuous.

Hospitalization: Ms. Park stated: “When I was a teenager, my mother put me in the hospital after I went four or five days without sleeping. I think I may have been hearing things at that time”. [Chuckles]. Ms. Park stated she had been confined to hospitalization about four times. The last time was this past spring. No detox or residual rehab, though. One was in 2017. I overdosed on Benadryl, but I have not had those thoughts. Police picked her up and took her to the hospital once.

Medication trials: Ms. Park has taken Zoloft, which made her feel high and could not sleep; Risperidone, which made her mind race and gain a bunch of weight; Seroquel has increased importance as well; and Klonopin, which seemed to slow her down. I really cannot remember the others. “I think the one I just stopped helping.” It started with an “L,” I think. I do not reflect the name, but it squashed me in creativity.

Psychotherapy or Previous Psychiatric Diagnosis: Ms. Park stated depression, anxiety, and some bipolar and denies OCD. Not hearing or seeing things right now (schizophrenia). Sometimes, when I am not sleeping well, I listen to the voices telling me how great and wonderfully talented I am. It has been a couple of months since that happened.

Substance Current Use and History: Smokes about a pack a day; not going to quit for you either. Ms. P. drank alcohol at age 19, but it did not work well with me. Ms. Park denies using marijuana, cocaine, stimulants or methamphetamines, or any huffing or inhalant. Dismiss any sedative medications such as Klonopin or Xanax and hallucinogenics like LSD, PCP, or mushrooms. Ms. P. does not use pain pills, opiate medications, or anything prescribed or from the streets. Dismiss any synthetics like spice, ecstasy, Bath Salts, and Mollies. Ms. Park denies any seizures or blackouts from drug or alcohol use.

Family Psychiatric/Substance Use History: The mother perceives to be crazy. I think she had bipolar or something. My father went to prison for drugs, and I have not heard or seen from him since in eight or ten years. My brother, I think, is a little “schizo,” but he has never seen a doctor. My mother attempted to commit suicide. Ms. Park tried to cut herself and kill herself. There was abuse by their father, and him being hard on her, yelling a lot. Ms Park denied any sexual abuse or physical abuse. 

There was emotional and possible mental abuse in the yelling and her behavior.

Medical History: Ms. Park states she has thyroid issues and polycystic ovaries, loves sex, and loves to explore sex with different men.

Current Medications: None. Ms. P had tried several medications; her recent history of taking and then stopping them is a reliving problem. Ms. P. is on birth control pills for polycystic ovaries. Her medications were Zoloft, which made her feel high, she could not sleep, and her mind was racing; Risperidone, which gained much weight; and Seroquel, which also gained weight. Klonopin: that seems to slow me down. The last one begins with an “L.” I do not remember, but that squashes me in creativity.

Allergies: No allergies stated to medication, food, or pollen.

Reproductive History: On birth control pills, denies being pregnant. Have regular menus. Being promiscuous but declares being safe. Menses was sometime last month, and I would not give a specific date. Ms. P.P. identifies herself as a woman. Ms. P. states she has polycystic ovaries. 

R.O.S.

General: The patient appears in good health, is height/ weight proportionate, she appears slightly older than she stated. Vital signs typical, no fever. No malaise or weight

HEENT: No blurred vision, visual loss, or yellow sclera. Ears, Nose, Throat: No hearing loss, nasal drainage/congestions, headaches, or sore throat.

SKIN: No wounds, flushing, rashes, redness, or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or discomfort. No palpitations or edema. 

RESPIRATORY: No shortness of breath, difficulty breathing, cough, sputum, or cyanosis. 

GASTROINTESTINAL: No anorexia, nausea, vomiting, diarrhoea, or constipation. No abdominal pain or discomfort. No blood.

GENITOURINARY: No burning on urination, urgency, hesitancy, pain, or discomfort. Denies any odor or odd color in urine. No alteration in the bladder.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. The gate appears even and smooth.

MUSCULOSKELETAL: No muscle or joint pain, weakness, back pain, stiffness, or reduction of range of motion.

HEMATOLOGIC: No excessive bleeding, anemia, clotting, or bruising. LYMPHATICS: No enlarged painful nodes. No history of splenectomy. ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance, hair loss, excess urination, fatigue, or polydipsia. She has thyroid issues.

OBJECTIVE:

Diagnostic results: Vital signs are within normal range: Temp: 98.2; Pulse: 90; Respiration: 18; Blood Pressure: 138/88. 

Laboratory Test: Urine drug and alcohol screen negative. CBC within normal ranges, CMP within normal ranges. Lipid panels are within normal ranges. Prolactin Levels 8; TSH 6.3 (H). The CMP and CBC can help determine the general health of the patient. Still, TSH and PRL are necessary due to the relationship between reproductive hormones, thyroid disease, and depression in women. The prolactin is normal but on the low side. Hypothyroidism and medication can create Hypo- prolactinoma levels (Jacobson, 2012; Petruzzelli et al., 2020). TSH levels can cause an increased risk for readmission secondary to exacerbated depressive symptoms when thyroid disease is untreated (Yang et al., 2021).

Assessment:

Mental Status Examination:

The patient appears alert but not orientated. Ms. P. stated her birthday is July 1, 1995, and today’s date, the patient said December 1^st, 2020, which makes her only five years old. Ms. P’s developmental age appears a lot older than that. She seems to be about 19 years of age, a Mexican American young woman who looks much older than her age. She is semi-cooperative. She is neatly groomed and clean and dressed appropriately. There is no evidence of any abnormal motor activity. 

Her speech is clear, presently coherent during the interview, and standard in volume and tone. The thought process is incongruent with her goals directed and logic. Her logic was fair to poor, and insight was noted. Documented delusional thought process and pattern, but no AVH during the time of interview. Her mood is euphoric, and her affect is appropriate to her spirit. There is some evidence of loss of association or flight of ideas. The patient’s eye contact is good; the patient’s body position is closed, with legs crossed in the chair.

Presently, the patient denies thoughts of suicide/harm but has had thoughts in the past. She was chucking at inappropriate times. She denies any auditory or visual hallucinations at this time. Cognitively, she is alert and oriented. Her recent and remote memory is semi-intact all the way. She could not remember the drugs, dosage, and last time taken. Her hospitalization was unknown dates, where, and when or durations. Her concentration appears fair. Her insight is acceptable to the poor. She smokes and drinks, and she is highly promiscuous.

Diagnostic Impression:

The patient has multiple diagnoses. She does not meet all the criteria for Schizoaffective. According to the American Psychiatric Association (2013), schizoaffective disorder is based on assessing an uninterrupted period of illness during which the individual continues to display active or residual symptoms of psychotic illness such as schizophrenia. She hears the voices when she is manic and lacks sleep. There are some overlapping symptoms, but she does not meet all criteria (Baryshnikov et al., 2020). She may meet the criteria for Bipolar Disorder with an introductory presentation of mania and depression (American Psychiatric Association, 2013). 

Manic has inflated self-esteem, decreased need for sleep, and flights of ideas. MDD is depression most of the day, insomnia, fatigue, feelings of worthlessness, or excessive or inappropriate guilt (Chen et al., 2021; Sadock et al., 2015). The third possible diagnosis is a personality disorder. Diagnosis of borderline personality. It is a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity (American Psychiatric Association, 2013; Bateman et al., 2015). She does meet these criteria because of her sexually risky behavior, unstable interpersonal relationships, unstable self-image, self-cutting, and suicide attempts. This diagnosis will be deferred until it is collected and until other diagnoses are explored (Choukas-Bradley et al., 2020; Bateman et al., 2015).

Reflection:

In reflection on this case in question, questions regarding the extent, nature and frequency of her sexual risky behavior, suicide attempts, mania and depression. The trauma that occurred during her childhood needs to be further studied and how it affected her. The information must differentiate between bipolar and personality disorder fully. Currently, the behavior could point to personality disorder, specifically borderline personality, with a possible dual diagnosis of bipolar. The hearing of voices comes when she’s manic and lack of sleep, which fits the diagnosis of bipolar. I do not think schizoaffective disorder is the appropriate diagnosis. Medication is not first-line treatment, if she has borderline personality disorder. Psychosocial intervention is the primary treatment (Bateman et al., 2015). With comorbidity as in this case, Bipolar, medication would help and could be treated.

Case Formation and Treatment Plan

Ms. P. tried so many medications, and she has a history of taking drugs and then stopping them; also, she has thyroid disease. My most significant concern is her risky behavior, mania, suicide attempts, and depression. Order labs and EKG to monitor the OT intervals, daily weight, Rapid plasma regains (RPR) and genetic marker for the family. I would like to see a PCP to start her on Synthroid, plus consider Topiramate 50 mg B.I.D for mood and sleep (Stahl, 2017; Kantojarvi et al., 2020).

I will slowly titrate medication while assessing for side effects and efficacy over the next several months in an outpatient setting. The following medication would be Citalopram 20mg daily, which is an SSRI, and S- RI, I would use this for mood stabilization (Stahl, 2017; Onishi et al., 202; Kantojarvi et al., 2020). I will be slowly titrating up medication while assessing for side effects and efficacy over the next several months.

I would start therapy to explore the nature of her risky sexual behavior, her ineffective coping mechanism, and her instability interpersonal relationships. She will need support in identifying cognitive distortions, addressing stuck points in her trauma, creating a safety plan, and identifying positive coping skills. Ms. P. will have appointments for therapy and psychiatry services.

NRNP 6665 Week 4 Assignment References

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

Baryshnikov, I., Sund, R., Marttunen, M., Svirskis, T., Partonen, T., Pirkola, S., & Isometsä, E. T. (2020). Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15‐year register study on 43 495 inpatients. Bipolar Disorders. https://doi.org/10.1111/bdi.12929

Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385(9969), 735–743. https://doi.org/10.1016/s0140-6736(14)61394-5

Case Study: Petunia Park. (2021). class.waldenu.edu. Walden University Blackboard.

Chen, H., Li, W., Cao, X., Liu, P., Liu, J., Chen, X., Luo, C., Liang, X., Guo, H., Zhong, S., Wang, X., & Zhou, J. (2021). The association between suicide attempts, anxiety, and childhood maltreatment among adolescents and young adults with first depressive episodes. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.745470

Choukas-Bradley, S., Hipwell, A. E., Roberts, S. R., Maheux, A. J., & Stepp, S. D. (2020). Developmental trajectories of adolescent girls’ borderline personality symptoms and sexual risk behaviors. Journal of Abnormal Child Psychology, 48(12), 1649–1658. https://doi.org/10.1007/s10802-020-00699-4

CrashCourse. (2014). Depressive and Bipolar Disorders: Crash Course Psychology #30. On YouTube. https://www.youtube.com/watch?v=ZwMlHkWKDwM

Jacobson, S. A., & American Psychiatric Publishing. (2012). Laboratory medicine in psychiatry and behavioral science. American Psychiatric Pub.

Kantojärvi, L., Hakko, H., Mukka, M., Käyhkö, A., Riipinen, P., & Riala, K. (2020). Psychotropic medication use among personality disordered young adults. A follow-up study among former adolescent psychiatric inpatients. Psychiatry Research, 293, 113449. https://doi.org/10.1016/j.psychres.2020.113449

Onishi, Y., Mikami, K., Kimoto, K., Watanabe, N., Takahashi, Y., Akama, F., Yamamoto, K., & Matsumoto, H. (2021). Second-generation antipsychotic drugs for children and adolescents. Journal of Nippon Medical School, 88(1), 10–16. https://doi.org/10.1272/jnms.jnms.2021_88-108

Petruzzelli, M. G., Marzulli, L., Giannico, O. V., Furente, F., Margari, M., Matera, E., & Margari, F. (2020). Glucose metabolism, thyroid function, and prolactin level in adolescent patients with first episode of schizophrenia and affective disorders. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00775

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.

Stahl, S.M. (2017). Essential Psychopharmacology: Prescriber’s Guide (6^th.). University Printing House.

Yang, L., Yang, X., Yang, T., Wu, X., Sun, P., Zhu, Y., Su, Y., Gu, W., Qiu, H., Wang, J., Chen, J., & Fang, Y. (2021). The effect of thyroid function on the risk of psychiatric readmission after hospitalization for major depressive disorder. Psychiatry Research, 305, 114205. https://doi.org/10.1016/j.psychres.2021.114205

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing.

That was such an insightful assignment. I hope the concepts have been clear to you. Moving on, you will next explore patient education for children and adolescents, which is coming up in week 5 of this class. Be ready.

Frequently Asked Questions (FAQs)

When approaching a 500-word essay, it’s essential to understand the nuances of this compact form of writing. These frequently asked questions will guide you through the process of crafting a concise and impactful essay.

How many pages is a 500-word essay typically?

A 500-word essay usually spans about one page if single-spaced or two pages when double-spaced, with standard margins and a 12-point font size.

Can you provide examples of a well-structured 500-word essay?

Certainly, to see the structure and flow of a well-written essay, you might want to take a look at a student’s writing guide that provides insights and examples.

Are there specific formatting guidelines for a 500-word essay?

Formatting guidelines typically involve using a legible font like Times New Roman or Arial, size 12, with double-spacing and one-inch margins on all sides. Check any specific requirements your instructor might have provided.

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For a personal essay, focus on a singular event or characteristic, ensuring your ideas are clear and you reflect on the significance of the subject matter. Use concise language and powerful imagery to maximize impact.

What topics are suitable for a concise 500-word essay?

Choose topics you can thoroughly address within the word limit, such as a personal anecdote, a critical analysis of a poem, or a focused argument on a singular point or issue.

How much time should you allocate to write a 500-word essay effectively?

Depending on your familiarity with the topic and writing proficiency, allocate anywhere from one to several hours for planning, drafting, and revising to ensure a well-presented essay.