NRNP 6635 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

Sample Answer for NRNP 6635 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Included After Question

By Day 7 of Week 4

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? 
  • Objective: What observations did you make during the psychiatric assessment?  
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

A Sample Answer For the Assignment: NRNP 6635 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

Title: NRNP 6635 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

Subjective:

CC (chief complaint): “I fear telling others about my sexuality”

HPI: the patient is Mr. Ralph Newsome, a 19-year-old male that came to the psychiatric clinic for psychiatric assessment. The patient is a former military personnel and currently works part time in construction. The patient reports difficulties in telling others about his sexuality. The patient reports that he has been weighing about the benefits and disadvantages of revealing his sexuality as a gay. He fears the ridicule that he would experience from other soldiers after knowing about his sexuality.

The patient reports that he has never told anyone about his sexuality, except the psychiatrist. The patient reports that he fears that others will not be comfortable being around him after he tells them his sexuality. The patient denies sexual thoughts about men but reports interest in close relationship with them as well as women. He also acknowledges fear of rejection from others following his disclosure. He reports suicidal thoughts when he was young but denies any recent thoughts, plans, or intention.

Past Psychiatric History: The patient denied any history of psychiatric illnesses

  • General Statement: I fear telling others about my sexuality
  • Caregivers (if applicable):none
  • Hospitalizations: the client denies any history of hospitalization
  • Medication trials: The client denies any history of medication trials
  • Psychotherapy or Previous Psychiatric Diagnosis: The client denies any history of psychotherapy or previous psychiatric diagnosis

Substance Current Use and History: The client denies any current or previous use of alcohol, smoking, and other substance use or abuse

Family Psychiatric/Substance Use History: The client denies any history of psychiatric or substance abuse history in the family

Psychosocial History: The client lives alone with his dog. He is the only child in his family. He currently works part time in construction. He has been recalled to Iraq to work as a soldier. The patient reports that his family is his source of social support. He denies any stress. However, he fears telling others about his sexuality.

Medical History: The patient denied any history of hospitalization or surgeries.

  • Current Medications: The patient is not currently using an medications.
  • Allergies:The patient reported that he is allergic to Penicillin. He denied food and environmental allergies.
  • Reproductive Hx:The patient is single. He is not in a relationship. He denies dysuria, frequency and urgency. He also denies any history of sexually transmitted infections or abuse.

ROS:

GENERAL: The patient is dressed appropriately for the occasion. There is no evidence of weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: The patient denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: He also denies hearing loss, sneezing, congestion, runny nose, or sore throat.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS NRNP 6635 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD:

SKIN: The patient denies rash or itching.

CARDIOVASCULAR: The patient denies chest pain, chest pressure, or chest discomfort. He also denies palpitations or edema.

RESPIRATORY: The patient denies shortness of breath, cough, or sputum.

GASTROINTESTINAL: The patient denies anorexia, nausea, vomiting, or diarrhea. He also denies abdominal pain or blood.

GENITOURINARY: The patient denies burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: The patient denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. He also denies change in bowel or bladder control.

MUSCULOSKELETAL: The patient denies muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: The patient denies anemia, bleeding, or bruising.

LYMPHATICS: The patient denies enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: The patient denies reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Objective:

Physical exam:

Vital signs: BP 119/76 P 68 T 36.7 SPO2 98% at room air, RR 20 beats per minute, regular

Respiratory: Presence of clear lung sounds and absence of wheezing, cough, and nasal flaring.

Cardiovascular: Presence of S1 and S2 heart sounds. Absence of adventitious heart sounds and body edema.

Diagnostic results: None

Assessment:

Mental Status Examination: The patient is dressed appropriately for the occasion. He appears of the appropriate weight for his age and gender. He denies fever, fatigue, or chills. The patient is alert and oriented to self, others, time, and events. The thought process is intact and future oriented. The patient maintains normal eye contact during the assessment. He demonstrates speech of normal tone and rate. The patient does not demonstrate abnormal mannerism such as tremors and tics. The patient denies illusions, delusions, and hallucinations. His mood is anxious. The patient denies suicidal thoughts, plans, or attempts.

Differential Diagnoses:

Social anxiety disorder: Social anxiety disorder is the client’s primary diagnosis. Social anxiety disorder is a mental health disorder that is characterized by significant anxiety or fear about social situations that a patient is exposed to potential scrutiny by others. Patients may have fear or anxiety in talking about or being observed in social situations involving others. The social situation or encounter often results in fear or anxiety, which are beyond the actual threat associated with the situation and to its sociocultural context. The fear and anxiety results in avoidance of situations that predispose the patient to the problem.

There is also the impairment in social or occupational functioning and distress. The symptoms persist for at least six months and cannot be attributed to causes such as medications use, mental health problems, or substance use and abuse (Koyuncu et al., 2019; Rose & Tadi, 2023). The patient in the case study has significant fear and anxiety towards revealing his sexuality. He fears rejection and the unknown reaction by his colleagues. The fear affects his interaction with others in his work as a soldier. Therefore, social anxiety disorder qualifies as the primary diagnosis.

NRNP 6635 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD
NRNP 6635 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

Generalized anxiety disorder: Generalized anxiety disorder is the client’s secondary diagnosis. Generalized anxiety disorder is a mental disorder that is characterized by excessive fear or worrying about things or events. The fear and worry are beyond the patient’s control. Patients may also report accompanying symptoms such as restlessness, fatigue, and difficulty in concentrating among others.

The patient in the case study demonstrates excessive fear towards revealing his sexuality. He fears the repercussions associated with his decision to inform others about his sexualty. The fear the patient has cannot be attributed to medication use, a medical condition or substance abuse (DeMartini et al., 2019). However, the client does not have the accompanying symptoms such as restlessness, making generalized anxiety disorder a secondary diagnosis.  

Post-traumatic stress disorder: Post-traumatic stress disorder is the other differential diagnosis that may be considered for the patient. Patients with this disorder experience avoidance, fear, and anxiety symptoms (Lewis et al., 2020). However, it is the least likely cause of the client’s problem since the client does not have any related traumatic experiences or exposures.

Obsessive compulsive disorder: The other secondary diagnosis to be considered for the patient is obsessive compulsive disorder. Patients diagnosed with obsessive compulsive disorders often experience obsessive thoughts that result in compulsions and repetitive behaviors (Goodman et al., 2021). However, this is a least likely cause of the patient’s problem because of the lack of obsessions, compulsions, and repetitive behaviors.

Panic disorder: Panic disorder is the last potential diagnosis that should be considered for the patient. Panic disorder is a mental health disorder characterized by experiences of intense panic or fear towards situations. Panic disorder is the least likely cause of the client’s problem because of the lack of sudden, intense fear or panic and associated symptoms such as shortness or breath or palpitations (Breilmann et al., 2019).

Reflections:I agree with the nurse preceptor’s diagnosis. The symptoms the client has are similar to those seen among patients diagnosed with social anxiety disorder. One of the things that I would do differently should I experience a similar situation is initiating a patient with social anxiety disorder on treatments such as group or individual posychotherapy. Psychotherapy would help the patient to develop effective coping strategies against the triggers of the disorder. I am interested in researching more about the effect of sociocultural factors on the decisions of the patients to reveal their sexuality.

References

Breilmann, J., Girlanda, F., Guaiana, G., Barbui, C., Cipriani, A., Castellazzi, M., Bighelli, I., Davies, S. J., Furukawa, T. A., & Koesters, M. (2019). Benzodiazepines versus placebo for panic disorder in adults. Cochrane Database of Systematic Reviews, 3. https://doi.org/10.1002/14651858.CD010677.pub2

DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized Anxiety Disorder. Annals of Internal Medicine, 170(7), ITC49–ITC64. https://doi.org/10.7326/AITC201904020

Goodman, W. K., Storch, E. A., & Sheth, S. A. (2021). Harmonizing the Neurobiology and Treatment of Obsessive-Compulsive Disorder. American Journal of Psychiatry, 178(1), 17–29. https://doi.org/10.1176/appi.ajp.2020.20111601

Koyuncu, A., İnce, E., Ertekin, E., & Tükel, R. (2019). Comorbidity in social anxiety disorder: Diagnostic and therapeutic challenges. Drugs in Context, 8, 212573. https://doi.org/10.7573/dic.212573

Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633. https://doi.org/10.1080/20008198.2020.1729633

Rose, G. M., & Tadi, P. (2023). Social Anxiety Disorder. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK555890/

A Sample Answer 2 For the Assignment: NRNP 6635 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

Title: NRNP 6635 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

Subjective:

CC (chief complaint): “ I Can’t even begin to describe what I am feeling, sadness, fear, I guess.”

HPI: Mr. D.J. is a nineteen-year-old male patient who came to the facility for a psychiatric visit after developing symptoms of fear and sadness after he realized that he is being activated with the Navy Reserves through a stop-loss policy. These symptoms have been there for the last one and half months. He confesses to being discontent with having to listen to gay comments while serving as a soldier since he is gay. However, he fears sharing regarding his sexuality with people since he is not sure how they would react. He fears and is scared that some would be surprised and walk away from him and never come back to his side. The patient also indicates that he fears rejection and feels like he wants to die when he thinks about it. He confesses to having suicidal thoughts before but not in recent times. The patient has had delusions related to the men he works with and hopes that he can move away from such delusions.

Past Psychiatric History:

  • General Statement: The patient is generally healthy but is of late sad and has fear after realizing he has been activated with the Navy Reserves
  • Caregivers (if applicable): The patient lives with both parents as the only child
  • Hospitalizations: no cases of hospitalizations recorded
  • Medication trials: No cases of medical trials reported
  • Psychotherapy or Previous Psychiatric Diagnosis: No previous psychiatric history.

Substance Current Use and History: The patient has not used or is not using any substances, alcohol, or cigarette

Family Psychiatric/Substance Use History: There is no substance use or family psychiatric history.

Psychosocial History: D.J is a nineteen-year-old patient who lives with both parents in Minneapolis. The patient has no partner currently and works at Starbucks as a part-timer. The patient’s MOS is an SK1 storekeeper

Medical History:

  • Current Medications: The patient is currently not using any medications
  • Allergies: No known allergies
  • Reproductive Hx:The patient has no partner currently. He confirms that he is gay and has known his sexual identity since the age of eight.

ROS:

  • GENERAL:  The patient is calm and cooperative
  • HEENT: The head is normal. No eye infection, double vision, double vision, or visual loss. No ear infections or hearing loss. No nose congestion or sneezing. No sore throat
  • SKIN: no rashes, itchiness, or irritation
  • CARDIOVASCULAR: No chest discomfort, pressure, or pain was reported
  • RESPIRATORY: NO congestion, no breathing problems
  • GASTROINTESTINAL: no eating disorders, no abdominal ailments
  • GENITOURINARY: no pain passing urine, no urge for frequent urination
  • NEUROLOGICAL: Reports being sad and having fear. He is also scared and anxious
  • MUSCULOSKELETAL: No glutes, no muscle or back pain
  • HEMATOLOGIC: No blood infections were reported
  • LYMPHATICS: No swelling was noted
  • ENDOCRINOLOGIC: has no abnormal sweating or excessive thirst

Objective:

 Vitals: T- 98.8, P- 89, R 18 110/62 Ht 5’7 Wt 133lbs.

Physical exam: if applicable

Diagnostic results: none was conducted

Assessment:

Mental Status Examination:

D.J is a nineteen-year-old male patient who visited the clinic with the claims of fear and sadness. The patient is well-dressed and groomed. He is keen to participate in the psychiatric examination and assessment. He has normal speech with consistent volume and normal tone. The patient confirms delusional thoughts. He confirms to have had suicidal thoughts sometimes back to not anymore. The patient’s thought process is intact. His short-term and long-term memory are both intact. His mood is sad, and he feels scared to be rejected by people.

Differential Diagnoses:

  1. Social Anxiety Disorder: This is a type of anxiety disorder known to make individuals have symptoms such as excessive self-consciousness and anxiety in a social situation. According to the DSM-5 criteria, the diagnosis of a social anxiety disorder includes fear of anxiety unexplainable through substance abuse, medication use or substance use, and distress or anxiety which impairs daily life, avoidaing of anxiety-prodocing situations (Koyuncu et al.,2019). The other symptom is intense fear or anxiety regarding a particular social situation because of fear of being humiliated, embarrassed, or negatively judged (APA, 2022). The patient has displayed all these symptoms. He fears revealing his sexuality to workmates for fear of being judged; he also seems to avoid going to active duties since it is unpleasant to him hearing people make comments regarding gays. Therefore, this is likely to be the primary diagnosis.
  2. Generalized Anxiety disorder (GAD). This is a condition that may make an individual have extreme worry and fear about various aspects of life. A person may have a constant feeling of being overwhelmed, fearful, and excessive worry regarding various things (Sadock, 2015). The implication is that such individuals usually have problems controlling nervousness or worry (Crocq, 2022). The patient in this case study has displayed these symptoms. The patient has feelings of sadness and worry, which have been triggered by realizing that his active service is being extended. He also feels anxious and scared about revealing his sexuality to his workmates and fears that some may leave him, never to return.
  • Major Depressive Disorder: This is a type of depression where an individual displays intense depressive symptoms for more than a fortnight, hence interfering with normal functionality or everyday life (Mullen, 2018). The feelings may include hopelessness, being anxious, and feeling sad. According to the DSM-V criteria, an individual is diagnosed with a major depressive disorder when the individual displays symptoms such as feelings of worthlessness, low or sad most of the time for at least a fortnight, change in appetite, loss of interest in activities and sleep problems (Zimmerman et al.,2019). Even though the patient has shown symptoms such as anxiety and sadness, he sleeps well, eats well since he has a good appetite, and has not reported losing interest in activities. Therefore, this condition looks less likely, though it is considered a differential diagnosis.

Reflections:

This case study presented an opportunity to learn more about mental health conditions. This patient presented with fear and sadness resulting largely from his sexual identity. He finds it difficult to go back for active duties, which he has associated with unpleasant comments regarding being gay as he is also gay. The anxiety and fear regarding his sexual identity extend to the other workplace, where he is skeptical about telling others about his sexual identity for fear of being judged or left by others. If I was in the same position as the healthcare professional, there are various things I would have done differently. For example, I would have inquired more about his daily life and how he feels regarding his functionality. This would have led to a better insight into the physical impacts of the condition. The patient is so sensitive about his secrets being shared with other people; as such, I will endeavor to keep the information confidential (Sussman, N., & DeJong, 2018). One of the social determinants of health that is applicable in this case is social support. The patient is sad and has a fear of the extended active duty, as well as worries and fear concerning how to reveal his sexual identity. Therefore, the patient needs adequate social support to help him through the difficulties he is facing (Wang et al.,2018).

References

American Psychiatric Association. (2022). Trauma- and stressor-related disorders. In the Diagnostic and statistical manual of mental disorders

Crocq, M. A. (2022). The history of generalized anxiety disorder as a diagnostic category. Dialogues in Clinical Neuroscience. https://doi.org/10.31887/DCNS.2017.19.2/macrocq

Koyuncu, A., İnce, E., Ertekin, E., & Tükel, R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs In Context8. https://doi.org/10.7573%2Fdic.212573

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275

Sadock, B. J. (2015). Sadock’s synopsis of psychiatry: behavioral sciences. Rezaee F.(Persian translator). 11th ed. Tehran: Arjmand pub, 399-410.

Sussman, N., & DeJong, S. M. (2018). Ethical considerations for mental health clinicians working with adolescents in the digital age. Current Psychiatry Reports20(12), 1-8. https://doi.org/10.1007/s11920-018-0974-z

Wang, J., Mann, F., Lloyd-Evans, B., Ma, R., & Johnson, S. (2018). Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry18(1), 1–16. https://doi.org/10.1186/s12888-018-1736-5

Zimmerman, M., Martin, J., McGonigal, P., Harris, L., Kerr, S., Balling, C., … & Dalrymple, K. (2019). Validity of the DSM‐5 anxious distress specifier for major depressive disorder. Depression and Anxiety36(1), 31–38. https://doi.org/10.1002/da.22837