Cora is a seven-year-old girl, the second of two children of a middle-class family living in a suburban area of a northwest city
Cora is a seven-year-old girl, the second of two children of a middle-class family living in a suburban area of a northwest city. Cora has one sister that is two years older than her. Her mother’s pregnancy was normal, with no complications and Cora’s birth was normal. Cora had colic the first three months, cried extensively, and was difficult to comfort. After three months she became passive and cried very little with comfort from her mother. Her growth and development appeared to be normal. She met all the developmental milestones in her first three years. She interacted normally with her sister and parents, except that she would become tearful and anxious when her parents would get a babysitter.
At age four, she was in nursery school and appeared to function normally except during the first month when Cora had difficulty when her father would drop her off at school. The nursery school was a small private school with a lot of personal attention given to each child. Although shy, she made friends and liked going to nursery school after she became adjusted to the new setting. Her parents liked the school so much that they decided to keep Cora in kindergarten at this school with her same teachers and friends. However, tuition at the school became a problem after Cora’s mother became sick with lupus and was unable to work.
At age six, Cora’s parents enrolled her in first grade at the public elementary school in their neighborhood. For the last two weeks, she has refused to go to school and has missed six school days. She began routinely brushing her hair before bed and insisted on making sure each side was brushed with an even number of strokes. She also had her mother tuck her in bed on the right side and her father come after on the left side each night. She would become very tearful and upset if the routine was not followed. She is awake almost all night worrying about going to school and asks the same questions over and over about the environment, teachers, and other students. As the start of the school day approaches, she cries and screams that she cannot go, chews holes in her shirt, pulls her hair, digs at her face, punches the wall, throws herself on the floor, as well as experiences headaches, stomachaches, and vomiting. Over the past two weeks, she has become gloomy, has stopped reading for fun, and frequently worries about her mother’s Lupus and that she may die. She asks her every night if she has dreamed about her funeral. In addition, Cora is phobic of dogs, avoids speaking and writing in public, and wets the bed every night.
Her parents immediately made an appointment to see her PCP. Her doctor conducted a thorough physical exam, found no physical abnormalities, and then referred her to you, a Family PMHNP.
Family history of mental health includes the following: mother has a history of panic disorder; her father has a history of treatment with medications for ADHD as a child, and she has a cousin diagnosed with Asperger’s syndrome.
Instructions
For your assignment, write a 4-5 page paper that addresses the following prompts using evidence-based references to support your answers:
1. Summarize the case.
2. What is your provisional diagnosis, as well as the possible differentials?
3. Justify your answer with DSM-5 criteria (be short, brief, and to the point).
4. Is Cora too young to diagnose, or is there a basis for early identification and intervention?
5. What psychiatric scales or assessment tools might you use with this patient? With the parents? List and describe briefly.
6. What would be your treatment plan for medications, if any? If you do choose to offer medication as part of the treatment plan, please address the following medications issues:
1. Target symptoms
2. Receptors affected
3. Psychiatric and system effects
4. Possible parental concerns
7. What would be your school-based treatment plan, if any?
8. What would be the implications for the families of children and adolescents with these diagnostic pictures?
9. How does the mother’s health play into the picture of Cora’s diagnosis? What type of therapy would you recommend for Cora (and her family) to work through her issues?
10. Identify resources for patients/families with this diagnosis in the form of community groups, web-sites, advocacy, as well as treatment resources available in your service area.
11. What are you worried about (if anything)? Consider this question in terms of treatment, assessment, alliance, compliance, effectiveness, safety, and other factors.
Complete this assignment and submit it to this assigment dropbox by Sunday at 11:59 pm CT.
Estimated time to complete: 6 hours
Course Description
This purpose of this course is to provide students further studies related psychiatric/mental health care management of patients across the life span to include underlying acute and chronic psychiatric/mental health disorders. Clinical opportunities will be utilized to apply concepts in primary and acute care settings with adults and families.
Program: Graduate Nursing
Semester Credit Hours: 4.0
Contact Hours: 30/0/90/120 (Lecture Hours/Lab Hours/Clinical Hours/Total Hours)
Prerequisites: NU 672 Counseling and Psychotherapy.
Corequisites: NU 673 Psychiatric Mental Healthcare I with 3.0 GPA or Program Chair permission.
Program Outcomes
Students are expected to meet all the core MSN program outcomes as well as the Psychiatric Mental Health program outcomes.
Upon completion of their program, the student should be able to:
1. Demonstrate critical thinking and holistic caring as an advanced practice
2. Analyze scientific literature for application to selected diagnoses and treatment
3. Synthesize ethical principles into the management and evaluation of healthcare delivery concerns in culturally diverse care settings.
4. Articulate a personal philosophy and framework acknowledging professional and accrediting agency competencies relating to the role and scope of practice of the psychiatric mental health nurse practitioner.
5. Implement the role of the psychiatric mental health nurse practitioner in selected clinical settings
Course Learning Objectives
By the end of this course, you will be able to:
3. Apply knowledge, with mentor supervision and minimal prompting, of chronic and acute psychiatric mental health disorders using the current edition of the Diagnostic and Statistical Manual for Mental Disorders diagnostic criteria to assess, diagnose and manage the patient populations across the lifespan including a focus on vulnerable populations at risk for mental health disorders.
4. Integrate, with mentor supervision and minimal prompting, complete mental health assessment, interview, history and physical exam data collection with the knowledge of pathophysiology and psychopathology of psychiatric mental health disorders across the life span to form differential diagnoses and implement therapeutic, patient-centered treatment plans and interventions for patient populations across the lifespan.
5. Merge, with mentor supervision and minimal prompting, traditional and complementary pharmacological/non-pharmaceutical interventions into the treatment and management of psychiatric mental health disorders for patient populations across the lifespan.
6. Examine, evaluate, and demonstrate, with mentor supervision and minimal prompting, professional development in the role of the nurse practitioner in the diagnosis and management of health and wellness as well as acute and chronic psychiatric mental health disorders illnesses for patient populations across the lifespan as a member of an interprofessional team.
7. Integrate, with mentor supervision and minimal prompting, cultural, spiritual, and social competencies into therapeutic patient-centered treatment plans in connection with evidence-based findings to the diagnosis and management of individuals, groups and families across the lifespan with acute, complex, and chronic psychiatric mental health disorders illnesses for patient populations across the lifespan as a member of an interprofessional team.
8. Analyze, with mentor supervision and minimal prompting, professional values and core ethical/legal standards into the practice of the Psychiatric Mental Health Nurse Practitioner role with relation to patient/staff safety, quality indicators, and health outcome improvement in the delivery of quality psychiatric mental health care to patients.
9. Identifies, with mentor supervision and minimal prompting, the highest level of professionalism and accountability for the PMHNP role for transition into clinical practice.
Resources
Required
American Psychological Association. (2019). Publication manual of the American Psychological Association (7th ed.). Washington, DC: APA Press. ISBN 9781433832161
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders text revision (5th ed. -TR) (DSM-5 -TR). APA. ISBN: 978-0-89042-576-3
Carlat, D. J. (2023). The psychiatric interview (5th ed.). Philadelphia, PA: Wolters Kluwer. ISBN: 9781975212971
Johnson, K., & Vanderhoef, D. (2016). Psychiatric mental health nurse practitioner review manual (4th ed.). Silver Spring, MD: American Nurses Association. ISBN: 978-1-935213- 79-6
Joseph Boland, Verduin, M. L., Ruiz, P., Arya Shah, & Sadock, B. J. (2021). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (12th ed.). Philadelphia, PA: Lippincott Williams, and Wilkins. ISBN: 9781975145569
Recommended
Dulcan’s Textbook of Child and Adolescent Psychiatry (3rd ed.) by Dulcan, Mina K. M.D. ISBN 9781615373277, 1615373276
Stahl, S. M. (2022). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press. ISBN: 978-1-108-97163-8
Stahl, S. M. (2021). Prescriber’s guide: Stahl’s essential psychopharmacology (7th ed.). Cambridge University Press. ISBN: 978-1-108-97163-8
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