NRNP 6635 Week 3 Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Assignment

NRNP 6635 Week 3 Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders Assignment

Subjective:

Biodata

Name S.H.

Sex: 11years

Informant: Mother

CC (chief complaint): “`My daughter has trouble paying attention and usually misplaces things”

HPI:

The mother reports that her daughter usually complains that the daughter has trouble paying attention both at school and at home. In school when instructions are given on assignments, she usually forgets about the assignments or even loses the list of assignments that she writes down. She therefore seldom completes her assignment, repeatedly makes careless mistakes in the assignment and her school performance have continuously been deteriorating. Even at home, she misplaces her items including her bracelet and at school, she loses her books and pencils. She is also finding it hard to sit still in the classroom and may not read a book for more than five minutes even when the book is interesting. Her troubles began when she was in kindergarten and have persisted ever since. She however reportedly enjoys playing video games and playing with Conley, her dog pet. The child has never been on care for any chronic illness and there is no history of trauma to the head preceding the complaints. She has also been experiencing difficulty in falling asleep and her sleep lasts only for 6 hours although it was lasting for 8-10hours before the onset of symptoms.

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Past Psychiatric History:

General Statement: this is the first time this child is visiting a psychiatrist. The mother is worried because of her inability to concentrate and forgetfulness.
Caregivers (if applicable): the mother and the father
Hospitalizations: no history of hospital admissions or management for chronic illnesses
Medication trials: has never been on psychiatric medications
Psychotherapy or Previous Psychiatric Diagnosis: no prior psychiatric diagnosis and has never undergone psychotherapy.

Substance Current Use and History: No history of substance use

Family Psychiatric/Substance Use History: the father takes a bottle of Vodka a week but has no history of taking other illicit drugs or cigarettes. The mother denies a history of using alcohol, cigarette, or other illicit drugs of abuse.

Psychosocial History: she is the third born in a family of 4. She only has brothers who are aged 20, 15, and 8 years but have no chronic illnesses. The father, 52years old is a high school teacher and the mother 47years old is a housewife; with no chronic illnesses. She lives with all her siblings and her parents who love her dearly and provides for her needs including emotional assurance. There is no family history of chronic illness or malignancy. No family history of psychiatric illnesses.

Medical History:

Current Medications: Not currently taking any medications
Allergies: NKFDA

Reproductive Hx: she has not had her menarche and she is sexually inactive

ROS:

GENERAL: no weight changes, no fever
HEENT: no runny nose, no headache, no ear pain, no reduced vision, no red eye or eye pain
SKIN: there are no skin ulcers or skin color changes
CARDIOVASCULAR: no leg swelling, no orthopnea, no awareness of heartbeat
RESPIRATORY: denies wheezing, chest pain, or difficulty in breathing
GASTROINTESTINAL: reduced appetite but no pain in the abdomen, nausea, vomiting, or diarrhea
GENITOURINARY: no pain during urination, no hematuria, no abnormal discharges per vaginal, and denies menses
NEUROLOGICAL: reduced sleep and difficulty in falling asleep, occasionally loses temper, and has forgetfulness but denies seizures, loss of consciousness, or headache.
MUSCULOSKELETAL: denies muscle pain, joint swelling, or changes in gait
HEMATOLOGIC: denies ease of bruising, paleness, and easy fatigability
LYMPHATICS: no lymph node enlargement
ENDOCRINOLOGIC: no polyuria, polydipsia, heat intolerance, or cold intolerance

Objective:

Physical exam: BP- 91/48, RR- 18, P- 55, Temp- 98.7F, HT- 51 in, WT- 50 lbs.,

General- Young girl sitting in the bed without respiratory distress or pain, not pale, no jaundice, no cyanosis, no lymphadenopathy, or lower limb edema. There are no neck swellings

Psychiatric- she has a congruent mood, and responds appropriately and courteously to the question, however unable to concentrate for long. Plays with the bracelet but cooperates with the examiner.

Diagnostic results:

Laboratory tests were ordered to assess for lead metal poisoning which may be for behavioral changes and reduced intelligence which are similar to the patient’s complaints. With lead poisoning, the neurodevelopmental status of the child would be affected and they would be more likely to experience reduced performance and even antisocial behavior (Sachdeva et al., 2018).

A complete blood count was also ordered to rule out infections that may present with forgetfulness and inability to pay attention in addition to other patient symptoms. It would also help to identify anemia that is usually experienced by patients with Attention Deficit Hyperactivity Disorder (ADHD) (Wang et al., 2018).

Swanson, Nolan, and Pelham version IV scale teacher form or SNAP-IV to help in screening for ADHD using the 90-question questionnaire (Wang et al., 2018).

Assessment:

Mental Status Examination:

The patient 11year old appears appropriate for her age and is well-groomed appropriate for the weather and of good hygiene. Her hair is well kept. She cooperates with the examiner but does not maintain appropriate direct eye contact with the examiner. Her speech rate is good although the volume is appropriate with questions asked and well-articulated. No flight of ideas or circumstantiality was identified. On inspection of her face, there are no abnormal movements although she is fidgeting and plays with her bracelet most of the time. Her mood is stable and congruent, affect is normal with no flat or overreactions. She has no delusions, or intrusive thoughts although she reports occasional daydreaming.

She is conscious, oriented×4. There is a gross abnormality in attention and concentration. She was unable to concentrate fully and was playing with the bracelet most of the time and admiring the pictures on the wall. Most of the time, the examiner repeated the questions to draw an answer from her. Her remote memory was equally poor as she couldn’t remember most of the questions that had been asked during the examination as was inquired upon by the examiner. Her intellect is good, she has good as she recognized that she had a problem although her judgment was poor as evidenced by the zoo incident.

Diagnosis Considerations:

S.H. is an 11years old child who presents with the complaint of inattention and misplacing things. In the course of the interview, the mother reveals that her teachers are also complaining about her inability to complete class assignments which has led to the deterioration of her class performance. Other signs and symptoms include difficulty in sitting still for long, impatience in turn-taking during conversations, poor memory, sleep difficulty, and trouble concentrating for long. In giving her a diagnosis, the DSM-V is applied to assess the symptoms, duration of illness, and other associated factors. The diagnosis that is most consistent with her symptoms is severe ADHD with the combined presentation because her symptoms that have been presenting for more than six months meet criteria 1 (inattention) and criteria 2 (hyperactivity-impulsivity). The reduced performance is therefore considered a result of inattention thus meeting criteria 1 (American Psychiatric Association, 2013).

Other diagnoses that have been considered include oppositional defiant disorder in which the patient’s symptoms are regarded to be resulting from personal defiance. However according to the American Psychiatric Association ( 2013, this diagnosis should only be made when the patient’s symptoms meet the diagnostic criteria of oppositional defiant disorder with at least four symptoms of argumentative/defiant behavior, angry/irritable mood, or vindictiveness which S.H did not present with. Another diagnosis that was also considered to explain her difficulty in paying attention and reduced class performance is Autism spectrum disorder. However, this diagnosis was also unlikely because its diagnostic criteria according to American Psychiatric Association ( 2013) require at least 2 features of persistent deficits in social communication or 3 features consistent with stereotyped movements which S.H did not present with.

Differential Diagnoses:

Severe ADHD with combined presentation (314.01[F90.2]): the presents with symptoms that meet criteria 1 and 2 for diagnosis of ADHD. She makes careless mistakes in classwork, reports difficulty in concentrating in reading for more than 5 minutes, is easily distracted during the examination, loses things at school and home, and reports being forgetful (American Psychiatric Association, 2013). These symptoms that have lasted for more than 6months have affected her school performance and are consistent with features of inattention. The other presentations such as fidgeting, leaving seats, and inappropriate actions at the zoo are however features of impulsivity and hyperactivity (Bélanger et al., 2018). This diagnosis is therefore most probable and is characterized as severe due to numerous signs and symptoms that the patient presented with (American Psychiatric Association, 2013).

Oppositional defiant disorder (ODD) (F91.3): The patient’s difficulty in completing class assignments may be due to the personal defiance that is consistent with Oppositional defiant disorder diagnosis. However ODD is usually associated with at least four symptoms of argumentative/defiant behavior, angry/irritable mood, or vindictiveness that S.H did not present with (American Psychiatric Association, 2013). Further, this diagnosis of ODD is less probable as it does not explain the forgetfulness and impulsivity reported by the patient.

Autism spectrum disorder (ASD) (299.00 [F84.0]): ASD might have presented with learning disabilities that S.H could report as failure to complete assignments. However, ASD diagnosis is only made when patient with 2 features of persistent deficits in social communication or 3 features consistent with stereotyped movements (American Psychiatric Association, 2013). S.H has no problem with communication, engages in playgroups, has no stereotyped movements and only occasionally becomes aggressive thus inconsistent with ASD (Hodges et al., 2020). It is therefore unlikely diagnosis.

Reflections:

The S.H case has enlightened me on how ADHD may present. Although most healthcare practitioners and even parents expect that patients with ADHD would present with an inability to sit for a longer time or difficulty in paying attention, it is worth noting that sometimes the patients present with the complications of ADHD. For instance, the young girl in the case study presented because of the careless mistakes in the exams that had led to the reduced accomplishment of class assignments as well as deterioration in overall performance. It is, therefore, necessary to highlight to the patient that the patient did not have an intellectual disability but rather could not pay attention which has affected their performance. It should therefore be emphasized that treatment of ADHD may result in better patient performance.

I have also learned of the mimics of ADHD such as lead poisoning that may present with similar manifestations as ADHD. A patient who presents with the symptoms, therefore, requires thorough investigation to rule out such poisoning. Further, the patient assessment should identify complications of ADHD such as malnutrition and anemia that may be addressed separately to promote the patient’s wellbeing.

References

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

Bélanger, S. A., Andrews, D., Gray, C., & Korczak, D. (2018). ADHD in children and youth: Part 1-Etiology, diagnosis, and comorbidity. Paediatrics & Child Health, 23(7), 447–453. https://doi.org/10.1093/pch/pxy109

Hodges, H., Fealko, C., & Soares, N. (2020). Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Translational Pediatrics, 9(Suppl 1), S55–S65. https://doi.org/10.21037/tp.2019.09.09

Sachdeva, C., Thakur, K., Sharma, A., & Sharma, K. K. (2018). Lead: Tiny but mighty poison. Indian Journal of Clinical Biochemistry: IJCB, 33(2), 132–146. https://doi.org/10.1007/s12291-017-0680-3

Wang, L.-J., Yu, Y.-H., Fu, M.-L., Yeh, W.-T., Hsu, J.-L., Yang, Y.-H., Chen, W. J., Chiang, B.-L., & Pan, W.-H. (2018). Attention deficit–hyperactivity disorder is associated with allergic symptoms and low levels of hemoglobin and serotonin. Scientific Reports, 8(1). https://doi.org/10.1038/s41598-018-28702-5

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Assignment: Assessing and Diagnosing Patients With Neurocognitive and Neurodevelopmental Disorders
Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from the very specific to a general or global impairment, and often co-occur (APA, 2022). They include specific learning and language disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and intellectual disabilities. Neurocognitive disorders, on the other hand, represent a decline in one or more areas of prior mental function that is significant enough to impact independent functioning. They may occur at any time in life and be caused by factors such brain injury; diseases such as Alzheimer’s, Parkinson’s, or Huntington’s; infection; or stroke, among others.
For this Assignment, you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder.

To Prepare:
• Utilize the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation.
• Utilize the video case study below for this Assignment, view your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.
• Identify at least three possible differential diagnoses for the patient.
• Utilize SafeAssign Drafts for originality report. Similarity report must be under 35%, you will be asked to revise assignment if percentage is too high.
• Utilize at least 3 peer reviewed, scholarly sources.

*Please note that the video cases may not have all the necessary information needed for your evaluation. Supplementary case histories are provided. Rather than write “not provided” in your evaluations, be sure to use the fact sheets to fill in gaps. For any information still missing, explain what information is needed and why it is important.
The Physical Exam portion will rarely to never be “non-applicable.” Please READ YOUR RUBRIC CAREFULLY.
**Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a 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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.).

Link fot Video Case to use for assignment
https://video.alexanderstreet.com/embed/training-title-48

Case History Report for Video Case

Training Title 48

Name: Sarah Higgins
Gender: female
Age: 11 years old
T- 97.4 P- 58 R 14 98/62 Ht 4’5 Wt 65lbs
Background: no history of treatment, developmental milestones met on time, vaccinations up to
date. Sleeps 9-10hrs/night, meals are difficult as she has hard time sitting for meals, she does get
proper nutrition per PCP. she has a younger brother. lives with her parents in Washington,
D.C. No hx of head trauma.
Symptom Media. (Producer). (2017). Training title 48 [Video].

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Name: NRNP_6635_Week3_Assignment_Rubric

Show Descriptions Show Feedback

Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.

In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS–

Levels of Achievement:

Excellent 18 (18.00%) – 20 (20.00%)

Good 16 (16.00%) – 17 (17.00%)

Fair 14 (14.00%) – 15 (15.00%)

Poor 0 (0.00%) – 13 (13.00%)

In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.–

Levels of Achievement:

Excellent 18 (18.00%) – 20 (20.00%)

Good 16 (16.00%) – 17 (17.00%)

Fair 14 (14.00%) – 15 (15.00%)

Poor 0 (0.00%) – 13 (13.00%)

In the Assessment section, provide:
• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.–

Levels of Achievement:

Excellent 23 (23.00%) – 25 (25.00%)

Good 20 (20.00%) – 22 (22.00%)

Fair 18 (18.00%) – 19 (19.00%)

Poor 0 (0.00%) – 17 (17.00%)

Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, 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.).–

Levels of Achievement:

Excellent 9 (9.00%) – 10 (10.00%)

Good 8 (8.00%) – 8 (8.00%)

Fair 7 (7.00%) – 7 (7.00%)

Poor 0 (0.00%) – 6 (6.00%)

Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).–

Levels of Achievement:

Excellent 14 (14.00%) – 15 (15.00%)

Good 12 (12.00%) – 13 (13.00%)

Fair 11 (11.00%) – 11 (11.00%)

Poor 0 (0.00%) – 10 (10.00%)

Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.–

Levels of Achievement:

Excellent 5 (5.00%) – 5 (5.00%)

Good 4 (4.00%) – 4 (4.00%)

Fair 3.5 (3.50%) – 3.5 (3.50%)

Poor 0 (0.00%) – 3 (3.00%)

Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation–

Levels of Achievement:

Excellent 5 (5.00%) – 5 (5.00%)

Good 4 (4.00%) – 4 (4.00%)

Fair 3 (3.00%) – 3 (3.00%)

Poor 0 (0.00%) – 2 (2.00%)

Name:NRNP_6635_Week3_Assignment_Rubric