Assignment Prompt & Instructions
– ## NUR620responseswk6.pdf
– ## NUR620DISCUSSION17.pdf
**## NUR620responseswk6.pdf**
1.This is base on my discussion post on Psychiatric Case study
Elvira Angelica Silva de Vera
• TEACHER
Sep 30 10:53am
Reply from Elvira Angelica Silva de Vera
Given Ms. Richardson’s overlapping symptoms suggestive of both delirium and
dementia with psychosis, what clinical tools or assessments would you prioritize to
accurately differentiate these conditions in the acute hospital setting, and how would
this distinction impact your immediate treatment approach?
2. Reply from Anita Lucia Mohan
Psychiatric Case Study: Ms. Richardson
Clinical Summary
Ms. Richardson is a 74-year-old African American female brought to the emergency
department by police after reports from neighbors of wandering, self-neglect, and confusion. On
arrival, she was unkempt, malodorous, and disoriented to time and place, though she knew her
name and address. She was minimally responsive, with a flat affect, poor eye contact, and limited
insight. She reported generalized weakness, shoulder pain, difficulty swallowing, and not eating
for three days. She recalled her dog being tranquilized and erroneously believed it was in “the
shop,” showing signs of confusion. She denied hallucinations or prior psychiatric
hospitalizations but mentioned seeing a psychiatrist for insomnia in the past. Her home
environment was severely unsanitary, with feces and clutter, suggesting severe self-neglect. She
was also noted to have uncontrolled diabetes, dehydration, and malnutrition. Subjective data
includes weakness, shoulder pain, and not eating for three days,
Objective data includes unkempt appearance, malodorous, disoriented to time and place,
impaired insight, poor judgment, unsafe environment, uncontrolled diabetes, and difficulty
swallowing, dehydration and poor nutritional intake. Her presentation suggests acute cognitive
decline with possible chronic neurocognitive disorder (Tusaie, 2023, pp. 328–351).
Primary Diagnosis: F05- Delirium due to Another Medical Condition (DSM-5-TR
Code: 293.0; ICD-10 F05)
Ms. Richardson’s presentation is most consistent with delirium due to another medical
condition. According to the DSM-5-TR, delirium is defined as an acute disturbance in attention
and awareness that develops over a short period, fluctuates in severity, and is associated with
additional cognitive impairments such as memory deficits, disorientation, or perceptual
disturbances. It must be attributable to a physiological cause such as a medical illness, substance
intoxication, or metabolic imbalance (American Psychiatric Association [APA], 2022).
According to Tusaie (2023), such presentations in older adults often reflect delirium, a reversible
condition commonly triggered by metabolic disturbances or infections. Her risk factors include
advanced age, poor glucose control, nutritional deficiency, and social isolation, aligning with
known etiologies of delirium (pp. 328–351).
Two Differential Diagnosis
The first differential diagnosis is Major Neurocognitive Disorder (NCD), Unspecified
Type (DSM-5-TR Code: 294.20; ICD-10: F03.90). DSM-5-TR defines major NCD as a
significant cognitive decline in one or more domains to include memory, executive function,
attention, and language that interferes with independence (APA, 2022). Ms. Richardson’s
functional decline and neglect could suggest an underlying dementia, which may have been
masked by acute delirium. Delirium may occur superimposed on major NCD, and evaluation
should be repeated after medical stabilization (Tusaie, 2023, pp. 328–351).
The second differential diagnosis is Depressive Disorder with Cognitive Impairment
(Pseudodementia) (DSM-5-TR Code: 311, ICD-10: F32.9). Late-life depression may manifest as
cognitive slowing, poor concentration, apathy, and self-neglect, mimicking dementia (APA,
2022). Ms. Richardson’s flat affect and limited responsiveness may represent depressive features.
Distinguishing pseudodementia through mood assessment and improvement with antidepressant
therapy can help differentiates it from degenerative cognitive disorders (Tusaie, 2023, pp. 328–
351)..
Pharmacological Treatment
The primary pharmacologic goal in Ms. Richardson’s case is to treat the
underlying medical cause of delirium. According to NICE (2023) guidelines, management
should begin with intravenous fluids and electrolyte correction to address dehydration, along
with insulin therapy based on ADA (2023) standards to stabilize hyperglycemia. Nutritional
supplements including multivitamins and thiamine help to correct deficiencies contributing to
cognitive impairment.
If Ms. Richardson develops behavioral agitation or perceptual disturbances, low-dose
haloperidol (0.25–0.5 mg PO/IM every 4–6 hours as needed) may be administered, with ECG
monitoring for potential QT prolongation. Haloperidol is often recommended for short-term
symptom management in delirium when nonpharmacologic interventions are insufficient (APA,
2023). If cognitive symptoms persist after medical stabilization and a major neurocognitive
disorder (NCD) is confirmed, pharmacologic agents such as donepezil (5 mg daily) or
memantine (5 mg daily) may be initiated to support cognitive function (Tusaie, 2023
pp.328-351).
Nonpharmacological Treatment
Nonpharmacological treatment is important in delirium management. The primary
goal is to restore orientation, ensure safety, and address modifiable risk factors through
environmental and behavioral interventions. Ms. Richardson should be placed in a quiet, well-lit
environment with visible clocks, calendars, and familiar objects to enhance orientation and
reduce confusion. Consistent caregivers and family involvement can provide reassurance and
emotional stability. Reorientation strategies, including frequent verbal reminders of time, place,
and situation, can be used throughout the day. To support physiological stability, she should
maintain adequate hydration and nutrition. Sleep hygiene is another critical component;
nighttime noise and interruptions should be minimized to promote restorative sleep. Collectively,
these multicomponent interventions have been shown to reduce both the severity and duration of
delirium while promoting functional recovery (Tusaie, 2023, pp. 328–351).
Health Promotion Intervention
Health promotion for Ms. Richardson should focus on chronic disease management, safety,
and social support to prevent recurrence of delirium and enhance overall well-being. Education
on diabetes self-management is essential, following the American Diabetes Association (2023)
standards. This includes teaching her how to monitor blood glucose, adhere to prescribed insulin
therapy, and maintain a balanced diet. Given her unsafe home environment and self-neglect,
referrals to Adult Protective Services (APS) and home health nursing are warranted for
supervision and support would be recommended. Social services can assist in arranging
community resources such as Meals on Wheels, senior day programs, and transportation to
reduce isolation and improve access to care. If a major neurocognitive disorder or depression is
identified, appropriate long-term treatment can be initiated (Tusaie, 2023, pp. 328–351).
**## NUR620DISCUSSION17.pdf**
Patient Care
After studying Module 1: Lecture Materials & Resources, discuss the following:
The unlawful restraint of a patient can be a legal pitfall for the PMHNP. K.W. was found
eating hamburgers out of a Mcdonald's dumpster and drinking water from an old water
hose. She had not taken a bath in weeks. She refused to live in an apartment because
she wants to “live off the fat of the land.”
1. Cite the Baker Act law to defend your position.
2. Find one newspaper article written in the last 5 years that supports your
position. Summarize the details of the case and the laws cited
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
[https://stu.instructure.com/courses/47926/pages/module-1-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-1-lecture-materials-and-resources)
Patient Information
After studying Module 2: Lecture Materials & Resources, discuss the following:
It is very important for all mental health professionals to take very detailed and
thorough historical information from their patients. This information should include an
adequate social history, complete medical history, and a full mental status examination
with a probable treatment plan.
• Describe three reasons it is important to gather detailed and extensive
information from any patient before you counsel him/her or make
medication suggestions. Use evidence-based research to support your
position.
• Define malingering. Discuss two ways to differentiate between malingering and
a DSM5 diagnosis. Use evidence-based research to support your position.
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
[https://stu.instructure.com/courses/47926/pages/module-2-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-2-lecture-materials-and-resources)
Anxiety Case
After studying Module 3: Lecture Materials & Resources, discuss the following:
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
Case
Study
Ms. JN is a 24-year-old law student who presents to an outpatient
psychiatry clinic accompanied by her husband. She feels “worried about
everything!” She is “stressed out” about her academic workload and
upcoming exams. She feels fatigued and has difficulty concentrating on
her assignments. She also complains of frequent headaches and
associated neck muscle spasms, as well as difficulty falling asleep.
The patient’s husband describes her as “a worrier. She’ll worry about me
getting into an accident, losing my job, not making enough money—the
list goes on and on.”
Ms. JN reports that she has always had some degree of anxiety, but
previously found that it motivated her. Over the last year, her symptoms
have become debilitating and beyond her control.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case
2. Formulate
3. Create a list of the patient’s problems and prioritize them.
4. Which pharmacological treatment would you prescribe? Include
the rationale for this treatment.
5. Which non-pharmacological treatment would you prescribe?
Include the rationale for this treatment.
6. Include an assessment of treatment’s appropriateness, cost,
effectiveness, safety, and potential for patient adherence.
[https://stu.instructure.com/courses/47926/pages/module-3-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-3-lecture-materials-and-resources)
Depression Case
After studying Module 4: Lecture Materials & Resources, discuss the following:
Case
Study
Ms. Z is a 28-year-old assistant store manager who arrives at your
outpatient clinic complaining of sadness after her boyfriend of 6 months
romantic relationships, and says, “I don’t do well with breakups.” Ms. Z
reports that, although she has no prior psychiatric treatment, she
was urged by her employer to seek therapy. Ms. Z has arrived late to
work on several occasions because of oversleeping. She also has
difficulty in getting out of bed stating, “It’s difficult to walk; it’s like my
legs weigh a ton.” She feels fatigued during the day despite spending
over 12 hours in bed and is concerned that she might be suffering from
a serious medical condition. She denies any significant changes in
appetite or weight since these symptoms began.
Ms. Z reports that, although she has not missed workdays, she
has difficulty concentrating and has become tearful in front of clients
while worrying about not finding a significant other. She feels
tremendous guilt over “not being good enough to get married,” and says
that her close friends are concerned because she has been spending her
weekends in bed and not answering their calls. Although during your
evaluation Ms. Z appeared tearful, she brightened up when talking about
her newborn nephew and her plans of visiting a college friend next
summer. Ms. Z denied suicidal ideation.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-4-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-4-lecture-materials-and-resources)
Bipolar Case
After studying Module 5: Lecture Materials & Resources, discuss the following:
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
Case
Study
Jill, a 24 y/o Hispanic female arrives in the emergency room where her
parents brought her for evaluation. They are worried because she is
giving away all of her possessions and says she is planning to move to
the South Pole so she can "save the world." Her parents say that she has
hardly been sleeping at all for the last 7 days, but she seems very
energetic. They say she has appeared to be "in a frenzy" lately. When
you interview Jill you notice that she speaks very rapidly and is laughing
uncontrollably. It is hard to get her to be quiet long enough for you to ask
questions. She seems agitated and has difficulty sitting still.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-5-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-5-lecture-materials-and-resources)
Psychiatric Case
After studying Module 6: Lecture Materials & Resources, discuss the following
Case Study A 74-year-old African American woman, Ms. Richardson, was brought to
the hospital emergency room by the police. She is unkempt, dirty, and
foul-smelling. She does not look at the interviewer and is apparently
confused and unresponsive to most of his questions. She knows her
name and address, but not the day of the month. She is unable to
describe the events that led to her admission.
The police reported that they were called by neighbors because Ms.
Richardson had been wandering around the neighborhood and not
taking care of herself. The medical center mobile crisis unit went to her
house twice but could not get in and presumed she was not home.
Finally, the police came and broke into the apartment, where they were
met by a snarling German shepherd. They shot the dog with a
tranquilizing gun and then found Ms. Richardson hiding in the corner,
wearing nothing but a bra. The apartment was filthy, the floor littered
with dog feces. The police found a gun, which they took into custody.
The following day, while Ms. Richardson was awaiting transfer to a
medical unit for treatment of her out-of-control diabetes, the psychiatric
provider attempted to interview her. Her facial expression was still
mostly unresponsive, and she still didn’t know the month and couldn’t
say what hospital she was in. She reported that the neighbors had
called the police because she was “sick,” and indeed she had felt sick
and weak, with pains in her shoulder; in addition, she had not eaten for 3
days. She remembered that the police had shot her dog with a
tranquilizer and said the dog was now in “the shop” and would be
returned to her when she got home. She refused to give the name of a
neighbor who was a friend, saying, “he’s got enough troubles of his
own.” She denied ever being in a psychiatric hospital or hearing voices
but acknowledged that she had at one point seen a psychiatrist “near
downtown” because she couldn’t sleep. He had prescribed medication
that was too strong, so she didn’t take it. She didn’t remember the
name, so the interviewer asked if it was Thorazine. She said no, it was
“allal.” ‘Haldol?”, ask the interviewer. She nodded.
The interviewer was convinced that was the drug, but other observers
thought she might have said yes to anything that sounded remotely like
it, such as “Elavil.” When asked about the gun, she denied, with some
annoyance, that it was real and said it was a toy gun that had been
still feeling weak and sick, complained of pain in her shoulder, and
apparently had trouble swallowing. She did manage to smile as the
team left her bedside.
[https://stu.instructure.com/courses/47926/pages/module-6-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-6-lecture-materials-and-resources)
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
Questions: Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
Schizophrenia Spectrum Case
After studying Module 7: Lecture Materials & Resources, discuss the following:
Case
Study
Mr. T is a 21-year-old man who is brought to the ER by his mother after
he began talking about “aliens” who were trying to steal his soul. Mr. T
reports that aliens left messages for him by arranging sticks outside his
home and sometimes send thoughts into his mind.
On exam, he is guarded and often stops talking while in the middle
of expressing a thought. Mr. T appears anxious and frequently scans the
room for aliens, which he thinks may have followed him to the hospital.
He denies any plan to harm himself but admits that the
aliens sometimes want him to throw himself in front of a car, “as this
will change the systems that belong under us.”
The patient’s mother reports that he began expressing these ideas a few
months ago, but that they have become more severe in the last
few weeks. She reports that during the past year, he has become
isolated from his peers, frequently talks to himself, and has stopped
going to community college. He has also spent most of his time reading
science fiction books and creating devices that will prevent aliens from
hurting him. She reports that she is concerned because the patient’s
father, who left while the patient was a child, exhibited similar symptoms
many years ago and has spent most of his life in a psychiatric hospital.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the DSM5
to support the assessment. Include the DSM5 and ICD 10 codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-7-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-7-lecture-materials-and-resources)
**## NUR620DISCUSSION17.pdf**
Patient Care
After studying Module 1: Lecture Materials & Resources, discuss the following:
The unlawful restraint of a patient can be a legal pitfall for the PMHNP. K.W. was found
eating hamburgers out of a Mcdonald's dumpster and drinking water from an old water
hose. She had not taken a bath in weeks. She refused to live in an apartment because
she wants to “live off the fat of the land.”
1. Cite the Baker Act law to defend your position.
2. Find one newspaper article written in the last 5 years that supports your
position. Summarize the details of the case and the laws cited
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
[https://stu.instructure.com/courses/47926/pages/module-1-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-1-lecture-materials-and-resources)
Patient Information
After studying Module 2: Lecture Materials & Resources, discuss the following:
It is very important for all mental health professionals to take very detailed and
thorough historical information from their patients. This information should include an
adequate social history, complete medical history, and a full mental status examination
with a probable treatment plan.
• Describe three reasons it is important to gather detailed and extensive
information from any patient before you counsel him/her or make
medication suggestions. Use evidence-based research to support your
position.
• Define malingering. Discuss two ways to differentiate between malingering and
a DSM5 diagnosis. Use evidence-based research to support your position.
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
[https://stu.instructure.com/courses/47926/pages/module-2-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-2-lecture-materials-and-resources)
Anxiety Case
After studying Module 3: Lecture Materials & Resources, discuss the following:
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
Case
Study
Ms. JN is a 24-year-old law student who presents to an outpatient
psychiatry clinic accompanied by her husband. She feels “worried about
everything!” She is “stressed out” about her academic workload and
upcoming exams. She feels fatigued and has difficulty concentrating on
her assignments. She also complains of frequent headaches and
associated neck muscle spasms, as well as difficulty falling asleep.
The patient’s husband describes her as “a worrier. She’ll worry about me
getting into an accident, losing my job, not making enough money—the
list goes on and on.”
Ms. JN reports that she has always had some degree of anxiety, but
previously found that it motivated her. Over the last year, her symptoms
have become debilitating and beyond her control.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case
2. Formulate
3. Create a list of the patient’s problems and prioritize them.
4. Which pharmacological treatment would you prescribe? Include
the rationale for this treatment.
5. Which non-pharmacological treatment would you prescribe?
Include the rationale for this treatment.
6. Include an assessment of treatment’s appropriateness, cost,
effectiveness, safety, and potential for patient adherence.
[https://stu.instructure.com/courses/47926/pages/module-3-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-3-lecture-materials-and-resources)
Depression Case
After studying Module 4: Lecture Materials & Resources, discuss the following:
Case
Study
Ms. Z is a 28-year-old assistant store manager who arrives at your
outpatient clinic complaining of sadness after her boyfriend of 6 months
romantic relationships, and says, “I don’t do well with breakups.” Ms. Z
reports that, although she has no prior psychiatric treatment, she
was urged by her employer to seek therapy. Ms. Z has arrived late to
work on several occasions because of oversleeping. She also has
difficulty in getting out of bed stating, “It’s difficult to walk; it’s like my
legs weigh a ton.” She feels fatigued during the day despite spending
over 12 hours in bed and is concerned that she might be suffering from
a serious medical condition. She denies any significant changes in
appetite or weight since these symptoms began.
Ms. Z reports that, although she has not missed workdays, she
has difficulty concentrating and has become tearful in front of clients
while worrying about not finding a significant other. She feels
tremendous guilt over “not being good enough to get married,” and says
that her close friends are concerned because she has been spending her
weekends in bed and not answering their calls. Although during your
evaluation Ms. Z appeared tearful, she brightened up when talking about
her newborn nephew and her plans of visiting a college friend next
summer. Ms. Z denied suicidal ideation.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-4-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-4-lecture-materials-and-resources)
Bipolar Case
After studying Module 5: Lecture Materials & Resources, discuss the following:
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
Case
Study
Jill, a 24 y/o Hispanic female arrives in the emergency room where her
parents brought her for evaluation. They are worried because she is
giving away all of her possessions and says she is planning to move to
the South Pole so she can "save the world." Her parents say that she has
hardly been sleeping at all for the last 7 days, but she seems very
energetic. They say she has appeared to be "in a frenzy" lately. When
you interview Jill you notice that she speaks very rapidly and is laughing
uncontrollably. It is hard to get her to be quiet long enough for you to ask
questions. She seems agitated and has difficulty sitting still.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-5-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-5-lecture-materials-and-resources)
Psychiatric Case
After studying Module 6: Lecture Materials & Resources, discuss the following
Case Study A 74-year-old African American woman, Ms. Richardson, was brought to
the hospital emergency room by the police. She is unkempt, dirty, and
foul-smelling. She does not look at the interviewer and is apparently
confused and unresponsive to most of his questions. She knows her
name and address, but not the day of the month. She is unable to
describe the events that led to her admission.
The police reported that they were called by neighbors because Ms.
Richardson had been wandering around the neighborhood and not
taking care of herself. The medical center mobile crisis unit went to her
house twice but could not get in and presumed she was not home.
Finally, the police came and broke into the apartment, where they were
met by a snarling German shepherd. They shot the dog with a
tranquilizing gun and then found Ms. Richardson hiding in the corner,
wearing nothing but a bra. The apartment was filthy, the floor littered
with dog feces. The police found a gun, which they took into custody.
The following day, while Ms. Richardson was awaiting transfer to a
medical unit for treatment of her out-of-control diabetes, the psychiatric
provider attempted to interview her. Her facial expression was still
mostly unresponsive, and she still didn’t know the month and couldn’t
say what hospital she was in. She reported that the neighbors had
called the police because she was “sick,” and indeed she had felt sick
and weak, with pains in her shoulder; in addition, she had not eaten for 3
days. She remembered that the police had shot her dog with a
tranquilizer and said the dog was now in “the shop” and would be
returned to her when she got home. She refused to give the name of a
neighbor who was a friend, saying, “he’s got enough troubles of his
own.” She denied ever being in a psychiatric hospital or hearing voices
but acknowledged that she had at one point seen a psychiatrist “near
downtown” because she couldn’t sleep. He had prescribed medication
that was too strong, so she didn’t take it. She didn’t remember the
name, so the interviewer asked if it was Thorazine. She said no, it was
“allal.” ‘Haldol?”, ask the interviewer. She nodded.
The interviewer was convinced that was the drug, but other observers
thought she might have said yes to anything that sounded remotely like
it, such as “Elavil.” When asked about the gun, she denied, with some
annoyance, that it was real and said it was a toy gun that had been
still feeling weak and sick, complained of pain in her shoulder, and
apparently had trouble swallowing. She did manage to smile as the
team left her bedside.
[https://stu.instructure.com/courses/47926/pages/module-6-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-6-lecture-materials-and-resources)
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
Questions: Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
Schizophrenia Spectrum Case
After studying Module 7: Lecture Materials & Resources, discuss the following:
Case
Study
Mr. T is a 21-year-old man who is brought to the ER by his mother after
he began talking about “aliens” who were trying to steal his soul. Mr. T
reports that aliens left messages for him by arranging sticks outside his
home and sometimes send thoughts into his mind.
On exam, he is guarded and often stops talking while in the middle
of expressing a thought. Mr. T appears anxious and frequently scans the
room for aliens, which he thinks may have followed him to the hospital.
He denies any plan to harm himself but admits that the
aliens sometimes want him to throw himself in front of a car, “as this
will change the systems that belong under us.”
The patient’s mother reports that he began expressing these ideas a few
months ago, but that they have become more severe in the last
few weeks. She reports that during the past year, he has become
isolated from his peers, frequently talks to himself, and has stopped
going to community college. He has also spent most of his time reading
science fiction books and creating devices that will prevent aliens from
hurting him. She reports that she is concerned because the patient’s
father, who left while the patient was a child, exhibited similar symptoms
many years ago and has spent most of his life in a psychiatric hospital.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the DSM5
to support the assessment. Include the DSM5 and ICD 10 codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-7-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-7-lecture-materials-and-resources)
**## NUR620responseswk6.pdf**
1.This is base on my discussion post on Psychiatric Case study
Elvira Angelica Silva de Vera
• TEACHER
Sep 30 10:53am
Reply from Elvira Angelica Silva de Vera
Given Ms. Richardson’s overlapping symptoms suggestive of both delirium and
dementia with psychosis, what clinical tools or assessments would you prioritize to
accurately differentiate these conditions in the acute hospital setting, and how would
this distinction impact your immediate treatment approach?
2. Reply from Anita Lucia Mohan
Psychiatric Case Study: Ms. Richardson
Clinical Summary
Ms. Richardson is a 74-year-old African American female brought to the emergency
department by police after reports from neighbors of wandering, self-neglect, and confusion. On
arrival, she was unkempt, malodorous, and disoriented to time and place, though she knew her
name and address. She was minimally responsive, with a flat affect, poor eye contact, and limited
insight. She reported generalized weakness, shoulder pain, difficulty swallowing, and not eating
for three days. She recalled her dog being tranquilized and erroneously believed it was in “the
shop,” showing signs of confusion. She denied hallucinations or prior psychiatric
hospitalizations but mentioned seeing a psychiatrist for insomnia in the past. Her home
environment was severely unsanitary, with feces and clutter, suggesting severe self-neglect. She
was also noted to have uncontrolled diabetes, dehydration, and malnutrition. Subjective data
includes weakness, shoulder pain, and not eating for three days,
Objective data includes unkempt appearance, malodorous, disoriented to time and place,
impaired insight, poor judgment, unsafe environment, uncontrolled diabetes, and difficulty
swallowing, dehydration and poor nutritional intake. Her presentation suggests acute cognitive
decline with possible chronic neurocognitive disorder (Tusaie, 2023, pp. 328–351).
Primary Diagnosis: F05- Delirium due to Another Medical Condition (DSM-5-TR
Code: 293.0; ICD-10 F05)
Ms. Richardson’s presentation is most consistent with delirium due to another medical
condition. According to the DSM-5-TR, delirium is defined as an acute disturbance in attention
and awareness that develops over a short period, fluctuates in severity, and is associated with
additional cognitive impairments such as memory deficits, disorientation, or perceptual
disturbances. It must be attributable to a physiological cause such as a medical illness, substance
intoxication, or metabolic imbalance (American Psychiatric Association [APA], 2022).
According to Tusaie (2023), such presentations in older adults often reflect delirium, a reversible
condition commonly triggered by metabolic disturbances or infections. Her risk factors include
advanced age, poor glucose control, nutritional deficiency, and social isolation, aligning with
known etiologies of delirium (pp. 328–351).
Two Differential Diagnosis
The first differential diagnosis is Major Neurocognitive Disorder (NCD), Unspecified
Type (DSM-5-TR Code: 294.20; ICD-10: F03.90). DSM-5-TR defines major NCD as a
significant cognitive decline in one or more domains to include memory, executive function,
attention, and language that interferes with independence (APA, 2022). Ms. Richardson’s
functional decline and neglect could suggest an underlying dementia, which may have been
masked by acute delirium. Delirium may occur superimposed on major NCD, and evaluation
should be repeated after medical stabilization (Tusaie, 2023, pp. 328–351).
The second differential diagnosis is Depressive Disorder with Cognitive Impairment
(Pseudodementia) (DSM-5-TR Code: 311, ICD-10: F32.9). Late-life depression may manifest as
cognitive slowing, poor concentration, apathy, and self-neglect, mimicking dementia (APA,
2022). Ms. Richardson’s flat affect and limited responsiveness may represent depressive features.
Distinguishing pseudodementia through mood assessment and improvement with antidepressant
therapy can help differentiates it from degenerative cognitive disorders (Tusaie, 2023, pp. 328–
351)..
Pharmacological Treatment
The primary pharmacologic goal in Ms. Richardson’s case is to treat the
underlying medical cause of delirium. According to NICE (2023) guidelines, management
should begin with intravenous fluids and electrolyte correction to address dehydration, along
with insulin therapy based on ADA (2023) standards to stabilize hyperglycemia. Nutritional
supplements including multivitamins and thiamine help to correct deficiencies contributing to
cognitive impairment.
If Ms. Richardson develops behavioral agitation or perceptual disturbances, low-dose
haloperidol (0.25–0.5 mg PO/IM every 4–6 hours as needed) may be administered, with ECG
monitoring for potential QT prolongation. Haloperidol is often recommended for short-term
symptom management in delirium when nonpharmacologic interventions are insufficient (APA,
2023). If cognitive symptoms persist after medical stabilization and a major neurocognitive
disorder (NCD) is confirmed, pharmacologic agents such as donepezil (5 mg daily) or
memantine (5 mg daily) may be initiated to support cognitive function (Tusaie, 2023
pp.328-351).
Nonpharmacological Treatment
Nonpharmacological treatment is important in delirium management. The primary
goal is to restore orientation, ensure safety, and address modifiable risk factors through
environmental and behavioral interventions. Ms. Richardson should be placed in a quiet, well-lit
environment with visible clocks, calendars, and familiar objects to enhance orientation and
reduce confusion. Consistent caregivers and family involvement can provide reassurance and
emotional stability. Reorientation strategies, including frequent verbal reminders of time, place,
and situation, can be used throughout the day. To support physiological stability, she should
maintain adequate hydration and nutrition. Sleep hygiene is another critical component;
nighttime noise and interruptions should be minimized to promote restorative sleep. Collectively,
these multicomponent interventions have been shown to reduce both the severity and duration of
delirium while promoting functional recovery (Tusaie, 2023, pp. 328–351).
Health Promotion Intervention
Health promotion for Ms. Richardson should focus on chronic disease management, safety,
and social support to prevent recurrence of delirium and enhance overall well-being. Education
on diabetes self-management is essential, following the American Diabetes Association (2023)
standards. This includes teaching her how to monitor blood glucose, adhere to prescribed insulin
therapy, and maintain a balanced diet. Given her unsafe home environment and self-neglect,
referrals to Adult Protective Services (APS) and home health nursing are warranted for
supervision and support would be recommended. Social services can assist in arranging
community resources such as Meals on Wheels, senior day programs, and transportation to
reduce isolation and improve access to care. If a major neurocognitive disorder or depression is
identified, appropriate long-term treatment can be initiated (Tusaie, 2023, pp. 328–351).
**## NUR620DISCUSSION17.pdf**
Patient Care
After studying Module 1: Lecture Materials & Resources, discuss the following:
The unlawful restraint of a patient can be a legal pitfall for the PMHNP. K.W. was found
eating hamburgers out of a Mcdonald's dumpster and drinking water from an old water
hose. She had not taken a bath in weeks. She refused to live in an apartment because
she wants to “live off the fat of the land.”
1. Cite the Baker Act law to defend your position.
2. Find one newspaper article written in the last 5 years that supports your
position. Summarize the details of the case and the laws cited
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
[https://stu.instructure.com/courses/47926/pages/module-1-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-1-lecture-materials-and-resources)
Patient Information
After studying Module 2: Lecture Materials & Resources, discuss the following:
It is very important for all mental health professionals to take very detailed and
thorough historical information from their patients. This information should include an
adequate social history, complete medical history, and a full mental status examination
with a probable treatment plan.
• Describe three reasons it is important to gather detailed and extensive
information from any patient before you counsel him/her or make
medication suggestions. Use evidence-based research to support your
position.
• Define malingering. Discuss two ways to differentiate between malingering and
a DSM5 diagnosis. Use evidence-based research to support your position.
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
[https://stu.instructure.com/courses/47926/pages/module-2-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-2-lecture-materials-and-resources)
Anxiety Case
After studying Module 3: Lecture Materials & Resources, discuss the following:
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
Case
Study
Ms. JN is a 24-year-old law student who presents to an outpatient
psychiatry clinic accompanied by her husband. She feels “worried about
everything!” She is “stressed out” about her academic workload and
upcoming exams. She feels fatigued and has difficulty concentrating on
her assignments. She also complains of frequent headaches and
associated neck muscle spasms, as well as difficulty falling asleep.
The patient’s husband describes her as “a worrier. She’ll worry about me
getting into an accident, losing my job, not making enough money—the
list goes on and on.”
Ms. JN reports that she has always had some degree of anxiety, but
previously found that it motivated her. Over the last year, her symptoms
have become debilitating and beyond her control.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case
2. Formulate
3. Create a list of the patient’s problems and prioritize them.
4. Which pharmacological treatment would you prescribe? Include
the rationale for this treatment.
5. Which non-pharmacological treatment would you prescribe?
Include the rationale for this treatment.
6. Include an assessment of treatment’s appropriateness, cost,
effectiveness, safety, and potential for patient adherence.
[https://stu.instructure.com/courses/47926/pages/module-3-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-3-lecture-materials-and-resources)
Depression Case
After studying Module 4: Lecture Materials & Resources, discuss the following:
Case
Study
Ms. Z is a 28-year-old assistant store manager who arrives at your
outpatient clinic complaining of sadness after her boyfriend of 6 months
romantic relationships, and says, “I don’t do well with breakups.” Ms. Z
reports that, although she has no prior psychiatric treatment, she
was urged by her employer to seek therapy. Ms. Z has arrived late to
work on several occasions because of oversleeping. She also has
difficulty in getting out of bed stating, “It’s difficult to walk; it’s like my
legs weigh a ton.” She feels fatigued during the day despite spending
over 12 hours in bed and is concerned that she might be suffering from
a serious medical condition. She denies any significant changes in
appetite or weight since these symptoms began.
Ms. Z reports that, although she has not missed workdays, she
has difficulty concentrating and has become tearful in front of clients
while worrying about not finding a significant other. She feels
tremendous guilt over “not being good enough to get married,” and says
that her close friends are concerned because she has been spending her
weekends in bed and not answering their calls. Although during your
evaluation Ms. Z appeared tearful, she brightened up when talking about
her newborn nephew and her plans of visiting a college friend next
summer. Ms. Z denied suicidal ideation.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-4-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-4-lecture-materials-and-resources)
Bipolar Case
After studying Module 5: Lecture Materials & Resources, discuss the following:
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
Case
Study
Jill, a 24 y/o Hispanic female arrives in the emergency room where her
parents brought her for evaluation. They are worried because she is
giving away all of her possessions and says she is planning to move to
the South Pole so she can "save the world." Her parents say that she has
hardly been sleeping at all for the last 7 days, but she seems very
energetic. They say she has appeared to be "in a frenzy" lately. When
you interview Jill you notice that she speaks very rapidly and is laughing
uncontrollably. It is hard to get her to be quiet long enough for you to ask
questions. She seems agitated and has difficulty sitting still.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-5-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-5-lecture-materials-and-resources)
Psychiatric Case
After studying Module 6: Lecture Materials & Resources, discuss the following
Case Study A 74-year-old African American woman, Ms. Richardson, was brought to
the hospital emergency room by the police. She is unkempt, dirty, and
foul-smelling. She does not look at the interviewer and is apparently
confused and unresponsive to most of his questions. She knows her
name and address, but not the day of the month. She is unable to
describe the events that led to her admission.
The police reported that they were called by neighbors because Ms.
Richardson had been wandering around the neighborhood and not
taking care of herself. The medical center mobile crisis unit went to her
house twice but could not get in and presumed she was not home.
Finally, the police came and broke into the apartment, where they were
met by a snarling German shepherd. They shot the dog with a
tranquilizing gun and then found Ms. Richardson hiding in the corner,
wearing nothing but a bra. The apartment was filthy, the floor littered
with dog feces. The police found a gun, which they took into custody.
The following day, while Ms. Richardson was awaiting transfer to a
medical unit for treatment of her out-of-control diabetes, the psychiatric
provider attempted to interview her. Her facial expression was still
mostly unresponsive, and she still didn’t know the month and couldn’t
say what hospital she was in. She reported that the neighbors had
called the police because she was “sick,” and indeed she had felt sick
and weak, with pains in her shoulder; in addition, she had not eaten for 3
days. She remembered that the police had shot her dog with a
tranquilizer and said the dog was now in “the shop” and would be
returned to her when she got home. She refused to give the name of a
neighbor who was a friend, saying, “he’s got enough troubles of his
own.” She denied ever being in a psychiatric hospital or hearing voices
but acknowledged that she had at one point seen a psychiatrist “near
downtown” because she couldn’t sleep. He had prescribed medication
that was too strong, so she didn’t take it. She didn’t remember the
name, so the interviewer asked if it was Thorazine. She said no, it was
“allal.” ‘Haldol?”, ask the interviewer. She nodded.
The interviewer was convinced that was the drug, but other observers
thought she might have said yes to anything that sounded remotely like
it, such as “Elavil.” When asked about the gun, she denied, with some
annoyance, that it was real and said it was a toy gun that had been
still feeling weak and sick, complained of pain in her shoulder, and
apparently had trouble swallowing. She did manage to smile as the
team left her bedside.
[https://stu.instructure.com/courses/47926/pages/module-6-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-6-lecture-materials-and-resources)
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
Questions: Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
Schizophrenia Spectrum Case
After studying Module 7: Lecture Materials & Resources, discuss the following:
Case
Study
Mr. T is a 21-year-old man who is brought to the ER by his mother after
he began talking about “aliens” who were trying to steal his soul. Mr. T
reports that aliens left messages for him by arranging sticks outside his
home and sometimes send thoughts into his mind.
On exam, he is guarded and often stops talking while in the middle
of expressing a thought. Mr. T appears anxious and frequently scans the
room for aliens, which he thinks may have followed him to the hospital.
He denies any plan to harm himself but admits that the
aliens sometimes want him to throw himself in front of a car, “as this
will change the systems that belong under us.”
The patient’s mother reports that he began expressing these ideas a few
months ago, but that they have become more severe in the last
few weeks. She reports that during the past year, he has become
isolated from his peers, frequently talks to himself, and has stopped
going to community college. He has also spent most of his time reading
science fiction books and creating devices that will prevent aliens from
hurting him. She reports that she is concerned because the patient’s
father, who left while the patient was a child, exhibited similar symptoms
many years ago and has spent most of his life in a psychiatric hospital.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the DSM5
to support the assessment. Include the DSM5 and ICD 10 codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-7-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-7-lecture-materials-and-resources)
**## NUR620responseswk6.pdf**
1.This is base on my discussion post on Psychiatric Case study
Elvira Angelica Silva de Vera
• TEACHER
Sep 30 10:53am
Reply from Elvira Angelica Silva de Vera
Given Ms. Richardson’s overlapping symptoms suggestive of both delirium and
dementia with psychosis, what clinical tools or assessments would you prioritize to
accurately differentiate these conditions in the acute hospital setting, and how would
this distinction impact your immediate treatment approach?
2. Reply from Anita Lucia Mohan
Psychiatric Case Study: Ms. Richardson
Clinical Summary
Ms. Richardson is a 74-year-old African American female brought to the emergency
department by police after reports from neighbors of wandering, self-neglect, and confusion. On
arrival, she was unkempt, malodorous, and disoriented to time and place, though she knew her
name and address. She was minimally responsive, with a flat affect, poor eye contact, and limited
insight. She reported generalized weakness, shoulder pain, difficulty swallowing, and not eating
for three days. She recalled her dog being tranquilized and erroneously believed it was in “the
shop,” showing signs of confusion. She denied hallucinations or prior psychiatric
hospitalizations but mentioned seeing a psychiatrist for insomnia in the past. Her home
environment was severely unsanitary, with feces and clutter, suggesting severe self-neglect. She
was also noted to have uncontrolled diabetes, dehydration, and malnutrition. Subjective data
includes weakness, shoulder pain, and not eating for three days,
Objective data includes unkempt appearance, malodorous, disoriented to time and place,
impaired insight, poor judgment, unsafe environment, uncontrolled diabetes, and difficulty
swallowing, dehydration and poor nutritional intake. Her presentation suggests acute cognitive
decline with possible chronic neurocognitive disorder (Tusaie, 2023, pp. 328–351).
Primary Diagnosis: F05- Delirium due to Another Medical Condition (DSM-5-TR
Code: 293.0; ICD-10 F05)
Ms. Richardson’s presentation is most consistent with delirium due to another medical
condition. According to the DSM-5-TR, delirium is defined as an acute disturbance in attention
and awareness that develops over a short period, fluctuates in severity, and is associated with
additional cognitive impairments such as memory deficits, disorientation, or perceptual
disturbances. It must be attributable to a physiological cause such as a medical illness, substance
intoxication, or metabolic imbalance (American Psychiatric Association [APA], 2022).
According to Tusaie (2023), such presentations in older adults often reflect delirium, a reversible
condition commonly triggered by metabolic disturbances or infections. Her risk factors include
advanced age, poor glucose control, nutritional deficiency, and social isolation, aligning with
known etiologies of delirium (pp. 328–351).
Two Differential Diagnosis
The first differential diagnosis is Major Neurocognitive Disorder (NCD), Unspecified
Type (DSM-5-TR Code: 294.20; ICD-10: F03.90). DSM-5-TR defines major NCD as a
significant cognitive decline in one or more domains to include memory, executive function,
attention, and language that interferes with independence (APA, 2022). Ms. Richardson’s
functional decline and neglect could suggest an underlying dementia, which may have been
masked by acute delirium. Delirium may occur superimposed on major NCD, and evaluation
should be repeated after medical stabilization (Tusaie, 2023, pp. 328–351).
The second differential diagnosis is Depressive Disorder with Cognitive Impairment
(Pseudodementia) (DSM-5-TR Code: 311, ICD-10: F32.9). Late-life depression may manifest as
cognitive slowing, poor concentration, apathy, and self-neglect, mimicking dementia (APA,
2022). Ms. Richardson’s flat affect and limited responsiveness may represent depressive features.
Distinguishing pseudodementia through mood assessment and improvement with antidepressant
therapy can help differentiates it from degenerative cognitive disorders (Tusaie, 2023, pp. 328–
351)..
Pharmacological Treatment
The primary pharmacologic goal in Ms. Richardson’s case is to treat the
underlying medical cause of delirium. According to NICE (2023) guidelines, management
should begin with intravenous fluids and electrolyte correction to address dehydration, along
with insulin therapy based on ADA (2023) standards to stabilize hyperglycemia. Nutritional
supplements including multivitamins and thiamine help to correct deficiencies contributing to
cognitive impairment.
If Ms. Richardson develops behavioral agitation or perceptual disturbances, low-dose
haloperidol (0.25–0.5 mg PO/IM every 4–6 hours as needed) may be administered, with ECG
monitoring for potential QT prolongation. Haloperidol is often recommended for short-term
symptom management in delirium when nonpharmacologic interventions are insufficient (APA,
2023). If cognitive symptoms persist after medical stabilization and a major neurocognitive
disorder (NCD) is confirmed, pharmacologic agents such as donepezil (5 mg daily) or
memantine (5 mg daily) may be initiated to support cognitive function (Tusaie, 2023
pp.328-351).
Nonpharmacological Treatment
Nonpharmacological treatment is important in delirium management. The primary
goal is to restore orientation, ensure safety, and address modifiable risk factors through
environmental and behavioral interventions. Ms. Richardson should be placed in a quiet, well-lit
environment with visible clocks, calendars, and familiar objects to enhance orientation and
reduce confusion. Consistent caregivers and family involvement can provide reassurance and
emotional stability. Reorientation strategies, including frequent verbal reminders of time, place,
and situation, can be used throughout the day. To support physiological stability, she should
maintain adequate hydration and nutrition. Sleep hygiene is another critical component;
nighttime noise and interruptions should be minimized to promote restorative sleep. Collectively,
these multicomponent interventions have been shown to reduce both the severity and duration of
delirium while promoting functional recovery (Tusaie, 2023, pp. 328–351).
Health Promotion Intervention
Health promotion for Ms. Richardson should focus on chronic disease management, safety,
and social support to prevent recurrence of delirium and enhance overall well-being. Education
on diabetes self-management is essential, following the American Diabetes Association (2023)
standards. This includes teaching her how to monitor blood glucose, adhere to prescribed insulin
therapy, and maintain a balanced diet. Given her unsafe home environment and self-neglect,
referrals to Adult Protective Services (APS) and home health nursing are warranted for
supervision and support would be recommended. Social services can assist in arranging
community resources such as Meals on Wheels, senior day programs, and transportation to
reduce isolation and improve access to care. If a major neurocognitive disorder or depression is
identified, appropriate long-term treatment can be initiated (Tusaie, 2023, pp. 328–351).
**## NUR620DISCUSSION17.pdf**
Patient Care
After studying Module 1: Lecture Materials & Resources, discuss the following:
The unlawful restraint of a patient can be a legal pitfall for the PMHNP. K.W. was found
eating hamburgers out of a Mcdonald's dumpster and drinking water from an old water
hose. She had not taken a bath in weeks. She refused to live in an apartment because
she wants to “live off the fat of the land.”
1. Cite the Baker Act law to defend your position.
2. Find one newspaper article written in the last 5 years that supports your
position. Summarize the details of the case and the laws cited
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
[https://stu.instructure.com/courses/47926/pages/module-1-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-1-lecture-materials-and-resources)
Patient Information
After studying Module 2: Lecture Materials & Resources, discuss the following:
It is very important for all mental health professionals to take very detailed and
thorough historical information from their patients. This information should include an
adequate social history, complete medical history, and a full mental status examination
with a probable treatment plan.
• Describe three reasons it is important to gather detailed and extensive
information from any patient before you counsel him/her or make
medication suggestions. Use evidence-based research to support your
position.
• Define malingering. Discuss two ways to differentiate between malingering and
a DSM5 diagnosis. Use evidence-based research to support your position.
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
[https://stu.instructure.com/courses/47926/pages/module-2-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-2-lecture-materials-and-resources)
Anxiety Case
After studying Module 3: Lecture Materials & Resources, discuss the following:
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
Case
Study
Ms. JN is a 24-year-old law student who presents to an outpatient
psychiatry clinic accompanied by her husband. She feels “worried about
everything!” She is “stressed out” about her academic workload and
upcoming exams. She feels fatigued and has difficulty concentrating on
her assignments. She also complains of frequent headaches and
associated neck muscle spasms, as well as difficulty falling asleep.
The patient’s husband describes her as “a worrier. She’ll worry about me
getting into an accident, losing my job, not making enough money—the
list goes on and on.”
Ms. JN reports that she has always had some degree of anxiety, but
previously found that it motivated her. Over the last year, her symptoms
have become debilitating and beyond her control.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case
2. Formulate
3. Create a list of the patient’s problems and prioritize them.
4. Which pharmacological treatment would you prescribe? Include
the rationale for this treatment.
5. Which non-pharmacological treatment would you prescribe?
Include the rationale for this treatment.
6. Include an assessment of treatment’s appropriateness, cost,
effectiveness, safety, and potential for patient adherence.
[https://stu.instructure.com/courses/47926/pages/module-3-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-3-lecture-materials-and-resources)
Depression Case
After studying Module 4: Lecture Materials & Resources, discuss the following:
Case
Study
Ms. Z is a 28-year-old assistant store manager who arrives at your
outpatient clinic complaining of sadness after her boyfriend of 6 months
romantic relationships, and says, “I don’t do well with breakups.” Ms. Z
reports that, although she has no prior psychiatric treatment, she
was urged by her employer to seek therapy. Ms. Z has arrived late to
work on several occasions because of oversleeping. She also has
difficulty in getting out of bed stating, “It’s difficult to walk; it’s like my
legs weigh a ton.” She feels fatigued during the day despite spending
over 12 hours in bed and is concerned that she might be suffering from
a serious medical condition. She denies any significant changes in
appetite or weight since these symptoms began.
Ms. Z reports that, although she has not missed workdays, she
has difficulty concentrating and has become tearful in front of clients
while worrying about not finding a significant other. She feels
tremendous guilt over “not being good enough to get married,” and says
that her close friends are concerned because she has been spending her
weekends in bed and not answering their calls. Although during your
evaluation Ms. Z appeared tearful, she brightened up when talking about
her newborn nephew and her plans of visiting a college friend next
summer. Ms. Z denied suicidal ideation.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-4-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-4-lecture-materials-and-resources)
Bipolar Case
After studying Module 5: Lecture Materials & Resources, discuss the following:
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
Case
Study
Jill, a 24 y/o Hispanic female arrives in the emergency room where her
parents brought her for evaluation. They are worried because she is
giving away all of her possessions and says she is planning to move to
the South Pole so she can "save the world." Her parents say that she has
hardly been sleeping at all for the last 7 days, but she seems very
energetic. They say she has appeared to be "in a frenzy" lately. When
you interview Jill you notice that she speaks very rapidly and is laughing
uncontrollably. It is hard to get her to be quiet long enough for you to ask
questions. She seems agitated and has difficulty sitting still.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-5-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-5-lecture-materials-and-resources)
Psychiatric Case
After studying Module 6: Lecture Materials & Resources, discuss the following
Case Study A 74-year-old African American woman, Ms. Richardson, was brought to
the hospital emergency room by the police. She is unkempt, dirty, and
foul-smelling. She does not look at the interviewer and is apparently
confused and unresponsive to most of his questions. She knows her
name and address, but not the day of the month. She is unable to
describe the events that led to her admission.
The police reported that they were called by neighbors because Ms.
Richardson had been wandering around the neighborhood and not
taking care of herself. The medical center mobile crisis unit went to her
house twice but could not get in and presumed she was not home.
Finally, the police came and broke into the apartment, where they were
met by a snarling German shepherd. They shot the dog with a
tranquilizing gun and then found Ms. Richardson hiding in the corner,
wearing nothing but a bra. The apartment was filthy, the floor littered
with dog feces. The police found a gun, which they took into custody.
The following day, while Ms. Richardson was awaiting transfer to a
medical unit for treatment of her out-of-control diabetes, the psychiatric
provider attempted to interview her. Her facial expression was still
mostly unresponsive, and she still didn’t know the month and couldn’t
say what hospital she was in. She reported that the neighbors had
called the police because she was “sick,” and indeed she had felt sick
and weak, with pains in her shoulder; in addition, she had not eaten for 3
days. She remembered that the police had shot her dog with a
tranquilizer and said the dog was now in “the shop” and would be
returned to her when she got home. She refused to give the name of a
neighbor who was a friend, saying, “he’s got enough troubles of his
own.” She denied ever being in a psychiatric hospital or hearing voices
but acknowledged that she had at one point seen a psychiatrist “near
downtown” because she couldn’t sleep. He had prescribed medication
that was too strong, so she didn’t take it. She didn’t remember the
name, so the interviewer asked if it was Thorazine. She said no, it was
“allal.” ‘Haldol?”, ask the interviewer. She nodded.
The interviewer was convinced that was the drug, but other observers
thought she might have said yes to anything that sounded remotely like
it, such as “Elavil.” When asked about the gun, she denied, with some
annoyance, that it was real and said it was a toy gun that had been
still feeling weak and sick, complained of pain in her shoulder, and
apparently had trouble swallowing. She did manage to smile as the
team left her bedside.
[https://stu.instructure.com/courses/47926/pages/module-6-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-6-lecture-materials-and-resources)
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
Questions: Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
Schizophrenia Spectrum Case
After studying Module 7: Lecture Materials & Resources, discuss the following:
Case
Study
Mr. T is a 21-year-old man who is brought to the ER by his mother after
he began talking about “aliens” who were trying to steal his soul. Mr. T
reports that aliens left messages for him by arranging sticks outside his
home and sometimes send thoughts into his mind.
On exam, he is guarded and often stops talking while in the middle
of expressing a thought. Mr. T appears anxious and frequently scans the
room for aliens, which he thinks may have followed him to the hospital.
He denies any plan to harm himself but admits that the
aliens sometimes want him to throw himself in front of a car, “as this
will change the systems that belong under us.”
The patient’s mother reports that he began expressing these ideas a few
months ago, but that they have become more severe in the last
few weeks. She reports that during the past year, he has become
isolated from his peers, frequently talks to himself, and has stopped
going to community college. He has also spent most of his time reading
science fiction books and creating devices that will prevent aliens from
hurting him. She reports that she is concerned because the patient’s
father, who left while the patient was a child, exhibited similar symptoms
many years ago and has spent most of his life in a psychiatric hospital.
Question
s:
Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the DSM5
to support the assessment. Include the DSM5 and ICD 10 codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
[https://stu.instructure.com/courses/47926/pages/module-7-lecture-materials-and-resources](https://stu.instructure.com/courses/47926/pages/module-7-lecture-materials-and-resources)
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