NRNP 6665: PMHNP Care Across the Lifespan I Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

NRNP 6665: PMHNP Care Across the Lifespan I Assignment: Assessing, Diagnosing, and Treating Adults With Mood Disorders

Subjective:

CC (chief complaint): “I have a history of taking medications and then stopping them. I don’t feel like I need them. The medication squashes who I am.”

HPI: The patient took different medications and had a history of taking and then stopping since they squash who she is and therefore does not need them. Still, they have not effectively managed the clinical symptoms, and she is unwilling to continue with the medication.

Substance Current Use: Currently consumes a cigarette pack every day and has no plans to change her habit. Denies current alcohol or illicit drugs use.

Medical History:

 Polycystic ovarian syndrome

Hypothyroidism

• Current Medications: hypothyroidism medication (pt cannot remember the name), oral contraceptive pills.
• Allergies: NKA
• Reproductive Hx: Reports being sexually active, multiple partners. LMP one month ago.

ROS:

• GENERAL: Denies fever, fatigue, chills, or headache.
• HEENT: Denies headache, vision problems, eye pain, hearing changes, or ear pain. Denies nasal problems, sinus pain, dysphagia,or throat problems.
• SKIN: Denies rash, lesions, or itching.
• CARDIOVASCULAR: Denies chest pain, palpitations, or edema
• RESPIRATORY: Denies shortness of breath, cough, or respiratory distress.
• GASTROINTESTINAL: Denies nausea or vomiting, abdominal pain, diarrhea, or constipation.
• GENITOURINARY: Denies hesitancy, pain on urination, hematuria, or incontinence
• NEUROLOGICAL: Denies vertigo, sense of imbalance, or numbness or tingling.
• MUSCULOSKELETAL: Denies mucle pain, back pain, or joint pain.
• HEMATOLOGIC: Denies bleeding, easy brusing, or anemia
• LYMPHATICS: Denies painful or swollen lymph nodes.
• ENDOCRINOLOGIC: Reports having hypothyroidism

Objective:

Diagnostic results: Diagnostic tests not done at this time.

Assessment:

Mental Status Examination: Patient is alert and oriented x4. She is properly attired for the occasion and well-groomed. Her appearance is consistent with the age that she claims to be. Her articulation is appropriate in terms of clarity, suitability of tone and tempo, and coherence. During the course of the interview, she demonstrated excellent communication abilities and responded thoughtfully to each question. Her affect is poised and cheerful at all times. She is in a euthymic mood. She has intact long-term and short-term memory. She makes certain delusional claims, like selling her paintings to Movie stars. Denies having any homicidal or suicidal thoughts or ideas. Denies having visual, auditory, or other types of hallucinations. Because she has bipolar disorder, she has periods of both manic and depressed behavior. Her medical choices and sexual decisions both show that she has poor judgment.

Diagnostic Impression:

Bipolar Disorder, moderate (F31.2)

A mental disease called bipolar disorder is characterized by severe mood fluctuations that may range from manic to depressive episodes. One must have either manic or depressive episodes, together with or without psychosis, in order to meet the DSM-5 criteria for this disease. Individuals who are experiencing a Bipolar episode could exhibit overly verbose speech, a sense of haughtiness, extended periods of sleepiness, and poor vitality. They may also have an exaggerated sense of self-worth, psychomotor restlessness, rapid mental processes, and a propensity toward reckless conduct like irresponsible sexual behaviour or wasteful spending (Bobo,2017). Both drug usage and other health conditions are ruled out as causes of these symptoms. Patient described having racing thoughts and times of “creativity.” She defines these times as high moods when she sleeps 3 hours a day without feeling fatigued. Additionally, she says she has depression episodes from time to time, during which she feels useless, lacks drive, and has low energy.

Attention-Deficit Hyperactivity Disorder (F90.1) 

This is a chronic disorder that includes difficulties paying attention, being hyperactive, and acting impulsively. Patients who take it report feeling unable to exert self-control, sitting still, and paying attention to what is going on around them. In order to get a diagnosis of ADHD, individuals need to exhibit symptoms over a period of at least six months. Impairments in academic and social functioning are common in this disorder, as are disruptive tendencies like constant interr