Assignment 1 Practicum Decision Tree
For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.
Learning Objectives
Students will:
Evaluate clients for treatment of mental health disorders
Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
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The Assignment:
Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. Practicum: Decision Tree.
At each Decision Point, stop to complete the following:
Decision #1: Differential Diagnosis
Which Decision did you select?
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
Decision #2: Treatment Plan for Psychotherapy
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Practicum: Decision Tree.
Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
Decision #3: Treatment Plan for Psychopharmacology
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Practicum: Decision Tree.
Also include how ethical considerations might impact your treatment plan and communication with clients and their families.
BACKGROUND
Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well caredfor.
Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street.
His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.” Practicum: Decision Tree.
Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.
OBJECTIVE
During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders.
When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.
MENTAL STATUS EXAM
Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.
Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters. Practicum: Decision Tree.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis. Practicum: Decision Tree.
Decision Point One
Obsessive Compulsive Disorder
Decision Point Two
Begin Fluvoxamine immediate release 25 mg orally at bedtime
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall.
She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while. Practicum: Decision Tree.
Decision Point Three
Increase Fluvoxamine to 50 mg orally at bedtime
Guidance to Student
In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this.
Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime.
At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects.
Atypical antipsychotics are typically not used in the treatment of OCD. There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen.
Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has social anxiety disorder, CBT is effective in treating this condition as well. Practicum: Decision Tree.
P(5.u)
Can I Push Back Time? A Realistic Approach to Reducing Ageing Effects
Can I Push Back Time? A Realistic Approach to Reducing Ageing Effects
No one likes to grow old, especially when it means that your appearance will change, sometimes drastically. Although ageing is a natural process and we should accept it and grow old gracefully, it is difficult. Some people age quicker than others and some people are blessed with great genes, and then there are those who go to great lengths to slow down the ageing process. This module teaches you what happens to your skin as it ages and what physical signs to expect as you grow older. You will also get a better insight on how you can prevent through a careful skincare regime. This module includes the following items: Practicum: Decision Tree.
7.1. What Happens when your Skin ages?
7.2. How your Skin Changes with Each Birthday
7.3. Ethnicity and Ageing
7.4. Ingredients to Look for in Anti-Ageing Products
7.5. Botox versus Facelift
7.1. What Happens when your Skin ages?
As a person gets older, their body produces less collagen and elastin, thus leading to the appearance of fine lines and wrinkles. If you add gravity and sun exposure to that equation, the result will be saggy skin that appears leathery and old.
As you grow older, your skin continues to change. It becomes thinner, much drier, and even more fragile as the dermis of the skin begins to thin out. The fatty areas in your chin, cheeks, and nose begin to disappear, again making the skin sag more. More facial hair is evident in women as their bodies go through a number of different hormonal changes, sometimes making the skin more prone to acne and blackhead breakouts. Practicum: Decision Tree.
People, who suffer from oilier skin, will continue to have breakouts; however, there is a positive side to this – the oilier the skin is, the longer it will remain moist and smooth.
Using a good moisturiser over the years is one way that a person can lessen the impact of wrinkles and premature ageing.
Also with age, your body’s ability to attack free radicals that damage your cells and collagen slows down.
Consciously consuming foods with more antioxidants will protect your skin against free radicals and also improve its appearance, which is why vitamins A, C and E are often found in anti-ageing supplements.
7.2. How your Skin changes with each Birthday
Your 30s
Between the ages of 30-35 is the most common time when women give birth to children. Pregnancy is good for a woman’s skin because there is a normal healthy production of the hormonesoestrogen and progesterone. Some women break out in spots due to the overgrowth of blood vessels caused by too much oestrogen. It is also common for the texture of a woman’s skin to become tougher and drier while she is pregnant because the baby takes up so many of its mother’s nutrients. Practicum: Decision Tree.
Some other common features of a woman’s skin in their 30s include:
Drier and duller in colour due to the slowing down of the production of a person’s skin cells.
Visible fine lines appear around eyes and mouth.
Smile lines do not disappear.
Collagen and elastin start to become weaker.
Smoking accentuates fine lines.
May begin to lose part of your skin tone due to the weakening of the lymph glands that are responsible for flushing out all of the body’s toxins.
Skin’s appearance is less bright.
Tendency to put on more weight with more visible cellulite due to hormonal changes.
Stretch marks are more evident through pregnancy or slimming.
Your 40s
When a person is in their 40s their lymphatic system begins to steadily slow down resulting in puffiness in and around the eye and cheek areas. This is a period when a person, especially a woman will notice visible physical differences in their appearance due to their age.
People in their 40s will notice:
More susceptible to the environment around them, such as smoky or polluted places due to the skin’s waxy protective coating being weaker. It is weaker due to the body’s lower sebum production.
Oestrogen production slows down resulting in duller skin.
Evidence of sagging and wrinkles around the neck and chest areas.
Increased cellulite and fat deposits around the hip and thigh areas.
Practicum: Decision Tree
50 +
More visible signs of ageing can be seen on other parts of the body other than the face in a person’s 50s. Pigmentation patches on the skin are common as are age spots. Excesses over the years, such as drinking, smoking, and sun worshipping will begin to show in damaged skin like spider veins caused by damaged blood vessels caused by the sun.
People in their 50s will notice:
Increased pore size.
Flakier skin.
Wrinkles become more apparent due to dehydration of the skin caused by weaker skin cells.
Eyelids may become hooded and wrinkled.
Break down of skin’s elasticity.
Menopause begins in women and the decreased oestrogen levels slow down the production of sebum resulting in drier skin.
Facial hair in women is not uncommon due to hormone imbalances brought on by menopause.
Skin is more likely to dry out and crack.
Loss of muscle tone and definition.
7.3. Ethnicity and Ageing
A lot of how you age is related to the colour of your skin and your ethnicity.
White Skin/Caucasian
The paler or fairer you are, the more you will have to do to protect it from ageing prematurely externally. Naturally, your melanin levels are lower, which means that the harmful UVA/UVB rays can penetrate much deeper into your skin thus causing photo-ageing and contributing to your skin’s break down of elastin and collagen.
For white complexions, the most important anti-ageing weapon would be a broad spectrum SPF 30 sun cream which has both UVA and UVB protection. Apply this daily, even when it is cloudy to every bit of your skin that is exposed, especially your face and neck.
Keep your skin nice and soft with its natural oils intact by using a gentle cleanser. After cleansing, apply your broad-spectrum cream and then your make-up.
Fairer skin tones have less collagen bundles than darker skin tones, which results in getting fine lines earlier than other ethnicities.
Use night creams that contain retinoids to boost the skin-cell turnover and thicken your thinning skin to make it feel and appear smoother. Look out for products that contain antioxidants such as soy, vitamins C and E to help nourish the skin and repair it.
When fairer skin is damaged by the sun, it causes the skin to develop an uneven skin tone. To overcome this, replace your harsher facial and body scrubs with natural enzyme-based scrubs and exfoliants. If you find that retinol creams are toosevere for your face, try peptides instead as they act as a great collagen booster.
Olive Skin
Because you have a warmer skin tone, it is likely you will show signs of ageing with fine lines and wrinkles later than people that have fairer skin.
Your skin haslower melanin content than those people with darker skin, but more than people with lighter skin. Your risk of sun damage compared to the fairer skinned person is significantly lower, but there is still a risk, which is why it is important to still always wear a broad-spectrum sun cream.
Generally, olive skin tans well, but at the same time it is more susceptible to melasma, which are darker brown patches of skin on the forehead, upper lip, cheeks, and chin areas. It is possible to fade these darker patches using certain creams and lotions that contain hydroquinone, azelaic acid or kojic acid. The combination of antioxidants in the above ingredients will help protect the skin from further damage; it will also help even out the skin tone, and strengthen the skin’s outer layer to help it retain its moisture. Continue wearing a high SPF sun cream that has zinc oxide or titanium dioxide.
Olive skin tones are prone to hypigmentation as they grow older. To help combat this, use a gentle foaming cleanser to get rid of the excess oil and then follow up by applying a serum which is rich in vitamin C.
People with olive skin are also more prone to an under-the-eye hollowness as they get older. To firm up the sagging skin in these areas use a night cream that contains peptides.
Middle Eastern and Asian Skin
Middle Eastern and Asian ethnicities do not begin to show signs of ageing until their mid-forties. However, although wrinkles tend to come later, these ethnicities are more prone to getting an uneven skin tone and darker patchy areas due to hormones, irritation and too much sun exposure.
Because of the excess pigment in the skin, Asians and those from the Middle East are prone to darker circles under the eyes. These bags under the eyes are often accentuated by the loss of volume under this area as a person ages. These ethnicities also suffer from more water retention when their hormones change, which again worsens the appearance under the eyes.
To try and reduce any signs of ageing underneath the eyes, you need to apply an eye cream that has cucumber extract, caffeine, or vitamin E to make the skin plumper and fresher looking.
Cleanse your skin gently with a face cloth and lukewarm water. After cleansing, use a serum that contains kokic acid to help fade the darker areas of the skin caused by hyperpigmentation and sun damage.
The moisturiser you use should be nourishing and rich. It should also contain salicylic acid, which will prevent your pores from getting too clogged.
Black / Dark Skin
Due to the high melanin levels in darker skin, they will not see any signs of ageing until their late 40’s or even 50’s. However, over time, darker skin loses its density and could result in sagging. To fight the sagging, opt for creams containing peptides as they help the body produce more collagen.
Darker skin tones also tend to suffer from uneven skin tones. You cannot scrub this away, so to reduce the severity of this, use a gentle cleanser together with an electric brush and glycolic toner to help stimulate your skin’s collagen and fade the darker patchy areas while regulating the skin’s oil production at the same time.
Moisturise in the morning with a cream that is rich in vitamin C. This will help brighten your skin and even out the patchier areas. In the evening, use creams that contain retinol, peptides and ceramides to hydrate the skin and prevent sagging.
Some people with darker skin benefit from semi-regular microdermabrasion treatments. This treatment is done by licensed professionals and gently buffs the skin, getting rid of all the dead skin cells to help even out and soften the skin with reduced pores.
7.4. Ingredients to Look for in Anti-Ageing Products
Retinol
Retinol comes from vitamin A. Although it may take a few weeks to start seeing results, it is the most effective anti-ageing ingredient bought over the counter. It helps smooth out the face’s wrinkles and unclogs the pores. Additionally, it helps improve the skin’s texture and lightens superficial dark spots. Retinol is quite potent, which results in some people suffering from skin irritation, especially when they come into contact with direct sunlight. Use retinol-based anti-ageing products at nighttime on dry skin and make sure you apply an SPF moisturiser in the morning.
Niacinamide
If you suffer from darker uneven spots that have been caused by acne scars, old age, or sun damage, you can use a product that contains niacinamade, which comes from vitamin B3 to lighten them and prevent melanin from rising to the skin’s surface. As a result your skin’s moisture and collagen production will improve and slowly over time reverse the damage from the sun.
Hyaluronic Acid
Hyaluronic acid is a form of humectants, which means that it draws water from both the air and dermis. Lotions with hyaluronic acid have excellent hydrating qualities and sometimes help improve collagen production to firm up sagging skin.
Alpha Hydroxyl Acid
Alpha hydroxyl acids (AHAs) work as exfoliators. They help remove dead skin cells and encourage new cell turnover revealing more youthful skin. When you exfoliate your skin, you will also allow serums, moisturisers, and other skin treatments to absorb and penetrate the skin more effectively. Look for a product that has 8% or less AHAs – when there are high concentrations of AHAs, you will help reduce and fade brown marks, spots and fine lines, but it will also make you more vulnerable and sensitive to the sun.
L-ascorbic Acid
L-ascorbic acid is another word for vitamin C. It helps build your skin’s collagen, helps to reduce any inflammation, and at the same time it plumps up the skin and promotes elasticity.
Avobenzone
This is a common chemical ingredient found in sun creams and sun blocks. Usually, this is found in combination with oxybenzone or benzophenone-3 to help block UVB rays. Use this before applying your regularmoisturiser or serum.
Antioxidants
Antioxidants help to prevent more damage happening and they also help repair your body’stissue and cell damage. They neutralise the free radicals and promote cell grown. Popular antioxidants found in anti-ageing products include vitamins C and E, green tea, berry extracts, and pomegranate.
7.5. Botox versus Facelift
While Botox and facelifts are more extreme measures for looking young, they are not uncommon and it is becoming increasingly common for people, especially in the 40s and 50s, to go under the knife whereas the popularity of Botox is waning slightly.
When a person’s age begins to show from their many years of excessive sun exposure, pollutants, daily life stress, and smoking, they begin to suffer from wrinkles, some of which are deeper creases than others. It is also common for a person to suffer from sagging skin around the jaw line and neck area, which often makes them appear older than they really are.
No person really enjoys the idea of having an invasive facelift, otherwise known as rhytidectomysurgergy and the long hard recovery process that follows, but it does not stop people, especially in the US where 13 million people undergo surgery for anti-ageing purposes alone each year.
Can you explain the difference between Botox and facelifts?
A facelift is an invasive surgical procedure while Botox are injections and are non-surgical.
Some people opt for Botox because it is non-surgical; however, it really depends on the specific problems you have to know which anti-ageing beauty procedure is the right one for you. The important thing to remember is that facelifts and Botox are completely different and they are used for completely different purposes – they do complement each other, but it is essential to remember that they do not produce the same results.
Facelift
People have facelifts usually to reshape their deep facial structures. Additionally, they are used to try and remove extra skin tissue which results in a more youthful appearance; these saggy skin tissues are usually located in the lower region of the face, neck, and jowls. If a person has a lot of sagging skin, there is nothing that can be done to reduce it significantly. To reduce the skin, it needs to be removed, repositioned, and repaired. Some facelift surgeries might involve eyelid surgery, a neck lift, or a forehead lift to improve the appearance and age of a person.
Facelift surgery helps correct the following problems:
Deep under-the-eye creases and wrinkles
Deep forehead wrinkles and creases
Droopy eyebrows
Lowered cheek pads
Deep creases, folds or wrinkles along the nose
Saggy jowls
Double chin
Botox
Botox is a form of botulinum toxin. It is directed at a person’s overactive muscles to help alleviate expression lines, wrinkles, and crows’ feet. Usually Botox is used mostly in the upper parts of a person’s face,in the corners of a person’s eyes, forehead creases, and lines and wrinkles that form between the eyebrows. The muscles absorb the Botox and help them relax more. Botox injections do not really have any impact on the skin and Botox is often referred to as a “non-surgical facelift.” However, it cannot really be called a facelift because it does not involve any kind of skin removal or lifting. However, the Botox injections can help the skin’s appearance look smoother, softer, and more youthful.
Botox helps correct the following problems:
Fine facial lines and wrinkles
Expression lines e.g. laughter lines
Crows’ feet
Furrows between the eyebrows
Fine forehead lines and wrinkles
Neck bands
Scenario for Week 7 Case: You are a PMHNP
Scenario for Week 7 Case:
You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?
The Assignment (2–3 pages):
Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?
Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not.
Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.
If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.
If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.
Scenario for Week 7 Case: You are a PMHNP
Scenario for Week 7 Case:
You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?
The Assignment (2–3 pages):
Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?
Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not.
Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.
If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.
If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.
Assignment 1: Practicum: Decision Tree
For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.
Learning Objectives
Students will:
· Evaluate clients for treatment of mental health disorders
· Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
The Assignment:
Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
· Decision #1: Differential Diagnosis
· Which Decision did you select?
· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
· Decision #2: Treatment Plan for Psychotherapy
· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
· Decision #3: Treatment Plan for Psychopharmacology
· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
· Also include how ethical considerations might impact your treatment plan and communication with clients and their families.
BACKGROUND
Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for.
Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street.
His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.”
Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.
OBJECTIVE
During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders.
When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.
MENTAL STATUS EXAM
Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.
Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.
Decision Point One
Obsessive Compulsive Disorder
Decision Point Two
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/05/mm/decision_tree/img/pill-blue.pngBegin Fluvoxamine immediate release 25 mg orally at bedtime
RESULTS OF DECISION POINT TWO
· Client returns to clinic in four weeks
· Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall.
· She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while.
Decision Point Three
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/05/mm/decision_tree/img/pill-red.pngIncrease Fluvoxamine to 50 mg orally at bedtime Practicum: Decision Tree.
Guidance to Student
In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this. Practicum: Decision Tree.
Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime.
At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects. Practicum: Decision Tree.
Atypical antipsychotics are typically not used in the treatment of OCD. There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen.
Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has social anxiety disorder, CBT is effective in treating this condition as well. Practicum: Decision Tree.
NURS 660 Week 4: Trauma and Stressor-Related Disorders in Childhood
“He was drunk again, so I should have known better. I should have stayed away from the house, but that would have made him madder. He has done this before, but not nearly this bad. He broke my wrist as I was protecting my mom. The neighbor heard the screaming and called the cops. They hauled him away, but I know he will be back. She always lets him come back.”
Avery, age 14
In August of 2005, thousands of children lost their homes in Hurricane Katrina. On December 14, 2012, the students at Sandy Hook Elementary School experienced the death of 20 of their classmates and six of their teachers. Every day, children experience physical and sexual abuse and neglect by their parents or caregivers. These types of trauma have a lifelong impact on the children involved and those witnessing the events. As much as we try to prevent unwanted childhood trauma and stressors, the phenomena are present in our culture. Practicum: Decision Tree. Childhood trauma is a significant contributor to both physical and mental health problems in children and adults.
This week, you examine several cases of child abuse and neglect, and you recommend strategies for assessing for abuse. You analyze influences of media and social media on mental health and evaluate the need for mandatory reporting of abuse. You also submit your Practicum Journal and Assignments. Practicum: Decision Tree.
Photo Credit: StaffordStudios / Getty Images
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
· Chapter 31, “Child Psychiatry” (pp. 1216–1226)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
· “Trauma- and Stressor-related Disorders”
Note: You will access this book from the Walden Library databases.
Pfefferbaum, B., & Shaw, J. A. (2013). Practice parameter on disaster preparedness. Journal of the American Academy of Child & Adolescent Psychiatry, 52(11), 1224–1238. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00550-9/pdf Practicum: Decision Tree
American Psychiatric Nurses Association. (2017). Childhood and adolescent trauma. Retrieved from http://www.apna.org/i4a/pages/index.cfm?pageID=4545
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
Optional Resources
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.
· Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)
· Chapter 58, “Disorders of Attachment and Social Engagement Related to Deprivation” (pp. 795–805)
· Chapter 59, “Post Traumatic Stress Disorder” (pp. 806–821)
· Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)
Discussion: Treating Childhood Abuse
In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Practicum: Decision Tree. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse.
In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse.
Learning Objectives
Students will:
· Recommend strategies for assessing for abuse
· Analyze influences of media and social media on mental health
· Evaluate the need for mandatory reporting of abuse
To Prepare for this Discussion:
· Read the Learning Resources concerning treating childhood abuse.
· Read the Child Abuse Case Study in the Learning Resources. See Child Abuse Case Study
Assignment Question to be addressed Practicum: Decision Tree
· What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.
· How might exposure to the media and/or social media affect the patient?
· What type of mandatory reporting (if any) is required in this case? Why?
Child Abuse Case Study
NURS 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child
and Adolescent
Child Abuse Case Study
NURS 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent
Morgan, a 19-year-old male comes to your office to discuss his current mood and symptoms. This is his first visit to a mental health clinic. “I’ve had 26 jobs in the last 2years; I finally have a job that I like and I want to make it work.” As you begin to get to know him, he tells you that his mood is down and that he also has times where he has “more energy and motivation”: “That’s when I am able to get a new job.” Practicum: Decision Tree. He says that he has difficulty interacting with coworkers. “I feel like I can’t talk to them.” If it wasn’t for his supportive girlfriend, he wouldn’t be able to function. “She understands me and accepts me; she knows what I have been through.”
As the PMHNP listens to the client and explores what he means by some of his statements, you try to put together his story. He mentions that he has been having nightmares and is not sleeping well. He says he startles easily. He becomes withdrawn when he begins to talk about the reason for the nightmares.“This all started a few weeks ago when a cousin of mine got out of jail.” He haltingly tells the story of his parents’ mental illness and how he had to live with various relatives. “One cousin who I stayed with a lot took advantage of me. He molested me.” They found out he also molested other children and he went to jail. “It gives me the creeps that he is out of jail. I have to face what he did to me.” Morgan asks about his diagnosis. The PMHNP tells him that he has some symptoms that sound like depression and anxiety, and that when a child has a traumatic experience, it can reoccur and stay with a person for many years. He acknowledges that he thought about PTSD but wasn’t sure what the symptoms look like.
As you think about Morgan’s story, consider the following questions: Where did he fall between the cracks? Are there agencies who advocate for children like him? There are thousands of children like Morgan. They were in a vulnerable family situation and the “responsible” adult was not able to care for the child. Sometimes it takes yearsfor clients to remember and disclose the abuse. Practicum: Decision Tree
Week 4: Trauma and Stressor-Related Disorders in Childhood
“He was drunk again, so I should have known better. I should have stayed away from the house, but that would have made him madder. He has done this before, but not nearly this bad. He broke my wrist as I was protecting my mom. The neighbor heard the screaming and called the cops. Practicum: Decision Tree. They hauled him away, but I know he will be back. She always lets him come back.”
Avery, age 14
In August of 2005, thousands of children lost their homes in Hurricane Katrina. On December 14, 2012, the students at Sandy Hook Elementary School experienced the death of 20 of their classmates and six of their teachers. Every day, children experience physical and sexual abuse and neglect by their parents or caregivers. These types of trauma have a lifelong impact on the children involved and those witnessing the events. Practicum: Decision Tree. As much as we try to prevent unwanted childhood trauma and stressors, the phenomena are present in our culture. Childhood trauma is a significant contributor to both physical and mental health problems in children and adults.
This week, you examine several cases of child abuse and neglect, and you recommend strategies for assessing for abuse. You analyze influences of media and social media on mental health and evaluate the need for mandatory reporting of abuse. You also submit your Practicum Journal and Assignments.
Note:
To access this week’s required library resources, please click on the link to the Course Readings List, found in the
Course Materials
section of your Syllabus. Practicum: Decision Tree.
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 31, “Child Psychiatry” (pp. 1216–1226)
American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
“Trauma- and Stressor-related Disorders”
Note:
You will access this book from the Walden Library databases.
Pfefferbaum, B., & Shaw, J. A. (2013). Practice parameter on disaster preparedness.
Journal of the American Academy of Child & Adolescent Psychiatry
,
52
(11), 1224–1238. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00550-9/pdf Practicum: Decision Tree.
American Psychiatric Nurses Association. (2017).
Childhood and adolescent trauma.
Retrieved from http://www.apna.org/i4a/pages/index.cfm?pageID=4545
Document:
Childhood Abuse Case Study (PDF)
Stahl, S. M. (2014).
Prescriber’s Guide: Stahl’s Essential Psychopharmacology
(5th ed.). New York, NY: Cambridge University Press.
Note:
All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. Practicum: Decision Tree.
To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
Posttraumatic stress disorder
citalopram
clonidine
desvenlafaxine
escitalopram
fluoxetine
fluvoxamine
mirtazapine
nefazodone
paroxetine
prazosin (nightmares)
propranolol (prophylactic)
sertraline
venlafaxine
Note:
Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.” Practicum: Decision Tree.
Optional Resources
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015).
Rutter’s child and adolescent psychiatry
(6th ed.). Hoboken, NJ: Wiley Blackwell.
Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)
Chapter 58, “Disorders of Attachment and Social Engagement Related to Deprivation” (pp. 795–805)
Chapter 59, “Post Traumatic Stress Disorder” (pp. 806–821)
Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)
Discussion: Treating Childhood Abuse
In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). Practicum: Decision Tree. The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse.
In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse. Practicum: Decision Tree.
Learning Objectives
Students will:
Recommend strategies for assessing for abuse
Analyze influences of media and social media on mental health
Evaluate the need for mandatory reporting of abuse
To Prepare
for this Discussion:
Read the Learning Resources concerning treating childhood abuse.
Read the Child Abuse Case Study in the Learning Resources.
Note:
For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously Practicum: Decision Tree. Please check your post carefully before clicking
Submit
!
By Day 3
Post:
What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.
How might exposure to the media and/or social media affect the patient?
What type of mandatory reporting (if any) is required in this case? Why?
By Day 6
Respond
to at least
two
of your colleagues by providing at least two ways that their strategies may be expanded or improved.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 4 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 4 Discussion
Assignment 1: Practicum: Week 1 Practicum Journal
By Day 7
Submit
your Assignment. Refer to Week 1 for additional guidance.
Submission and Grading Information NURS 6660 Trauma and Stressor-Related Disorders
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK4Assgn1+last name+first initial.(extension)” as the name. NURS 6660 Trauma and Stressor-Related Disorders
Click the
Week 4 Assignment 1 Rubric
to review the Grading Criteria for the Assignment.
Click the
Week 4 Assignment 1
link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the
Browse My Computer
button. Find the document you saved as “WK4Assgn1+last name+first initial.(extension)” and click
Open
.
If applicable: From the Plagiarism Tools area, click the checkbox for
I agree to submit my paper(s) to the Global Reference Database
. Practicum: Decision Tree.
Click on the
Submit
button to complete your submission.
Grading Criteria
To access your rubric:
Week 4 Assignment 1 Rubric NURS 6660 Trauma and Stressor-Related Disorders
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 4 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 7
To submit your Assignment:
Week 4 Assignment 1
Assignment 2: Practicum: Week 3 Decision Tree
By Day 7 NURS 6660 Trauma and Stressor-Related Disorders
Submit
your Assignment. Refer to Week 3 for additional guidance.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK4Assgn2+last name+first initial.(extension)” as the name.
Click the
Week 4 Assignment 2 Rubric
to review the Grading Criteria for the Assignment.
Click the
Week 4 Assignment 2
link. You will also be able to “View Rubric” for grading criteria from this area. Practicum: Decision Tree.
Next, from the Attach File area, click on the
Browse My Computer
button. Find the document you saved as “WK4Assgn2+last name+first initial.(extension)” and click
Open
.
If applicable: From the Plagiarism Tools area, click the checkbox for
I agree to submit my paper(s) to the Global Reference Database
.
Click on the
Submit
button to complete your submission.
Grading Criteria
To access your rubric: NURS 6660 Trauma and Stressor-Related Disorders
Week 4 Assignment 2 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 4 Assignment 2 draft and review the originality report.
Submit Your Assignment by Day 7
To submit your Assignment:
Week 4 Assignment 2 NURS 6660 Trauma and Stressor-Related Disorders
Assignment 3: Board Vitals
This week you will be responding to twenty Board Vitals questions that cover a broad review of your Nurse Practitioner program courses up to this point.
These review questions will provide practice that is critical in your preparation for the national certification exam that’s required to certify you to practice as a nurse practitioner. These customized test questions are designed to help you prepare for your Nurse Practitioner certification exam. It is in your best interest to take your time, do your best, and answer each question to the best of your ability. NURS 6660 Trauma and Stressor-Related Disorders
You can access Board Vitals through the link sent to you in email or by following the link below:
By Day 7 NURS 6660 Trauma and Stressor-Related Disorders
Complete the Board Vitals questions.
Practicum Reminder
Time Logs
You are required to keep a log of the time you spend related to your practicum experience
and enter every patient you see each day
. You can access your time log from the Welcome Page in your Meditrek account. You track time individually for each patient you work with. Please make sure to continuously input your hours throughout the term.
Making Connections
This week, you examined several cases of child abuse and neglect and recommended strategies for assessing for abuse. You analyzed influences of media and social media on mental health and evaluated the need for mandatory reporting of abuse. You also submitted your Practicum Journal and Assignments. Practicum: Decision Tree.
Next week, you analyze case studies to determine the diagnosis and treatment of anxiety disorders.
NURS 6660 Midterm and Final Exam Study Guide Questions and Answers
Working from a lifespan approach, this course introduces child and adolescent psychiatry. Emphasis is placed on the psychiatric and/or mental health disorders that begin in childhood and adolescence. Topics include psychiatric assessment; differential diagnosis; and application of diagnostic criteria, appropriate diagnostic testing, and diagnostic formulation. The learner will select a combination of psychotherapeutic modalities coupled with psychopharmacologic approaches to treat common psychiatric mental health conditions of children and adolescents. The focus of the practicum experience is on application of didactic concepts to actual patient care situations. Legal and ethical considerations for working with children and adolescents will be addressed. NURS 6660 Midterm and Final Exam Study Guide Questions and Answers Practicum: Decision Tree
BUY NURS 6600 EXAM HERE
Assignments and Projects
An Assignment or Project often is a writing assignment submitted to the Instructor for evaluation. Complete Assignment or Project directions are in the
Assignments
or
Projects
areas, including how and where to submit the Assignment or Project and the due date. Please note that you should keep copies of your Assignments and Projects on your computer in case of any technical difficulties. NURS 6660 Midterm and Final Exam Study Guide Questions and Answers
Information on scholarly writing may be found in the APA manual and at the Walden Writing Center website.
Please refer to the APA Guide or visit the Walden University Online Writing Center at
http://writingcenter.waldenu.edu/
.
Walden University expects you to act with integrity and honesty in your academic courses. Refer to the
Guidelines and Policies
and
Academic Integrity
areas for more details.
Check the
Course Information
area for any rubrics relating to the Assignments and Projects.
All assignments must be completed to pass the course. NURS 6660 Midterm and Final Exam Study Guide Questions and Answers Practicum: Decision Tree
Practicum Activities
The practicum experience in this course will assist your transition from the role of learner to that of scholar-practitioner. To achieve this transition, you will engage in a relationship with a clinical instructor and preceptor, focusing on roles and role functions and the achievement of individualized learning objectives. The primary objective of your practicum is to provide you with the basic skills necessary to serve as a mid-level provider of primary care to selected populations and prepare you to take the appropriate national certification exam. NURS 6660 Midterm and Final Exam Study Guide Questions and Answers
The practicum component of the course will be graded as Satisfactory or Unsatisfactory. In order to pass the course, you must earn a grade of Satisfactory on all required practicum activities including journal entries and time logs.
At the end of the course, you must also ensure that your practicum preceptor submits an online evaluation of your performance. You will also complete an online evaluation of your practicum experience at the end of the course. These evaluations will not only provide information about the progress of individual students, but also help program leadership to continuously work on the course review and improvements. You will receive an Incomplete (I) as a grade if any of the above evaluations are not received by the posted deadlines. NURS 6660 Midterm and Final Exam Study Guide Questions and Answers Practicum: Decision Tree
Time Logs:
Students are required to keep a log of the time spent related to their practicum experience and enter every patient they see each day. Students can access their time log from the Welcome Page in their Meditrek account. Students will track time individually for each patient they work with. Students are required to continuously input their hours throughout the term. Logs are reviewed by instructors in Weeks 4, 7, and 10. Please print and keep your completed Meditrek Log at the end of your clinical experiences for future use as a component of your portfolio. NURS 6660 Midterm and Final Exam Study Guide Questions and Answers
Week 1
Comprehensive Integrated Psychiatric Assessment
Learning Resources
Required Readings
Required Media
Optional Resources
Discussion
Comprehensive Integrated Psychiatric Assessment
Assignment
Practicum Journal Entry: Analyzing an Ethical Decision
Making Connections
Looking Ahead
Didactic Assignments
Practicum Assignments
Week 2
Assessment in Child and Adolescent Psychiatry Practicum: Decision Tree
Learning Resources
Required Readings
Optional Resources
Discussion
Working With Children and Adolescents Versus Adults
Assignment 1
Practicum: Cover Letter, Resume, and Portfolio
Assignment 2
Board Vitals
Making Connections
Looking Ahead
Week 3
Autism Spectrum Disorder, ADHD, ODD, and ICD
Learning Resources
Required Readings
Required Media
Optional Resources
Discussion
Parent Guide
Assignment 1
Practicum: Decision Tree
Assignment 2
Board Vitals
Making Connections
Week 4
Trauma and Stressor-Related Disorders in Childhood
Learning Resources
Required Readings
Optional Resources
Discussion
Treating Childhood Abuse
Assignment 1
Practicum: Week 1 Practicum Journal
Assignment 2
Practicum: Week 3 Decision Tree
Assignment 3
Board Vitals
Practicum Reminder
Practicum: Decision Tree
Making Connections
Week 5
Anxiety Disorders in Childhood and Adolescence
Learning Resources
Required Readings
Required Media
Optional Resources
Discussion
Clinical Supervision
Assignment 1
Practicum: Decision Tree
Assignment 2
Board Vitals
Making Connections
Looking Ahead
Week 6
Emergency Psychiatric Care in Childhood and Adolescence
Learning Resources
Required Readings
Optional Resources
Discussion
Treatment of Psychiatric Emergencies in Children Versus Adults
Assignment 1
Midterm Exam
Assignment 2
Board Vitals
Making Connections
NURS 6660 Midterm and Final Exam Study Guide Questions and Answers
Looking Ahead
Week 7
Learning and Motor Disorders in Childhood
Learning Resources
Required Readings
Optional Resources
Discussion
Parent Guide
Assignment 1
Practicum Journal: Voluntary and Involuntary Commitment
Assignment 2
Practicum: Week 5 Decision Tree
Assignment 3
Board Vitals
Practicum Reminder
Time Logs
Making Connections
NURS 6660 Midterm and Final Exam Study Guide Questions and Answers
Week 8
Mood Disorders Practicum: Decision Tree
Learning Resources
Required Readings
Optional Resources
Discussion
Pediatric Bipolar Depression Disorder Debate
Assignment
Board Vitals
Making Connections
Looking Ahead
NURS 6660 Midterm and Final Exam Study Guide Questions and Answers
Week 9
Early-Onset Schizophrenia
Learning Resources
Required Readings
Required Media
Optional Resources
Assignment 1
Early Onset Schizophrenia
Assignment 2
Practicum: Decision Tree
Assignment 3
Board Vitals
Making Connections
Week 10
Feeding, Eating, and Elimination Disorders in Childhood
Learning Resources
Required Readings
Optional Resources
Discussion
Parent Guide
Assignment 1
Practicum: Week 2 Cover Letter, Resume, and Portfolio
Assignment 2
Practicum: Week 9 Decision Tree
Assignment 3
Board Vitals
Practicum Reminder
Time Logs
Making Connections
Week 11
Special Topics in Child and Adolescent Psychiatry
Learning Resources
Required Readings
Optional Resources
Discussion
Special Topics in Child and Adolescent Psychiatry
Assignment 1
Final Exam
Assignment 2 NURS 6660 Midterm and Final Exam Study Guide Questions and Answers
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology. Academic Pediatrics, 16(6), 508-518.
Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60-72.
Kaltiala-Heino, R. (2010). Involuntary commitment and detainment in adolescent psychiatric inpatient care. Social Psychiatry Epidemiology, 45, 785-793. doi: 10.1007/s00127-009-0116-3.
Lindsey, M. A., Joe, S., Muroff, J., & Ford, B. E. (2010). Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth. General Hospital Psychiatry, 32, 300-309. doi:10.1016/j.genhosppsych.2010.01.007
McClelland, M., Crombez, M., Crombez, C., Wenz, C., Lisius, M., Mattia, A., & Marku, S. (2015). Implications for advanced practice nurses when pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is suspected: A qualitative study. Journal of Pediatric Healthcare, 29(5), 442-452. doi:10.1016/j.pedhc.2015.03.005
McGavey, E. L., Leon-Verdin, M., Wancheck, T. N., & Bonnie, R. J. (2013). Decisions to initiate involuntary commitment: The role of intensive community services and other factors. Psychiatric Services, 64(2), 120-126.
Practicum: Decision Tree