Intermittent explosive disorder NURS 6665

Intermittent explosive disorder

Assignment 2: Focused SOAP Note and Patient Case Presentation

 

 PRAC_6665_Week7_Assignment2_Rubric

For this Assignment, you will document information about a patient that you examined during the last 3 weeks, using the Focused SOAP Note Template provided. You will then use this note to develop and record a case presentation for this patient. Be sure to incorporate any feedback you received on your Week 3 and Week 7 case presentations into this final presentation for the course.

To Prepare
Review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
Select a child or adolescent patient that you examined during the last 3 weeks who presented with a disorder for which you have not already created a Focused SOAP Note in Weeks 3 or 7. (For instance, if you selected a patient with anorexia nervosa in Week 7, you must choose a patient with another type of disorder for this week.)
Create a Focused SOAP Note on this patient using the template provided in the Learning Resources. There is also a completed Focused SOAP Note Exemplar provided to serve as a guide to assignment expectations.

Please Note:
All SOAP notes must be signed, and each page must be initialed by your Preceptor. Note: Electronic signatures are not accepted.
When you submit your note, you should include the complete focused SOAP note as a Word document and PDF/images of each page that is initialed and signed by your Preceptor.
You must submit your SOAP note using SafeAssign.

Note: If both files are not received by the due date, faculty will deduct points per the Walden Grading Policy.
Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice your presentation before you record.
Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.
Ensure that you have the appropriate lighting and equipment to record the presentation.

The Assignment
Record yourself presenting the complex case study for your clinical patient. In your presentation:

Dress professionally in a lab coat and professionally present yourself.
Display your photo ID at the start of the video when you introduce yourself.
Ensure that you do not include any information that violates the principles of HIPAA (i.e., do not use the patient’s name or any other identifying information).
Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, or family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.
Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide:

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

Objective: What observations did you make during the psychiatric assessment?

Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and is supported by the patient’s symptoms.

Plan: What was your plan for psychotherapy (include one health promotion activity and patient education)? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.

Reflection notes: What would you do differently with this patient if you could conduct the session over? If you can follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow-up, discuss what your next intervention would be.

Solution

 

Week (enter week #): (Enter assignment title)

 

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6665: PMHNP Care Across the Lifespan I

Faculty Name

Assignment Due Date 

 

Subjective:

CC (chief complaint): Patient C.P presents to the clinic with a history of verbal outbursts and rage

HPI: The 17 year of Caucasian female presents to the office for showing emotional and verbal outbursts to people near her. She asserts that she can barely control her outbursts which have resulted in strained relationships with her family and friends in school.

Substance Current Use: Patient C.P confirms using nicotine

Medical History:

Current Medications: vitamin c supplements, birth control pills

Allergies: No reported allergies

Reproductive Hx: The patient is sexually active and has a regular menstrual cycle

ROS:

GENERAL: No significant weight gain or loss, no fever, fatigue, or chills

HEENT: No vision changes, no hearing loss, no sour taste, no runny nose, no sore throat or sneezing or congestion

SKIN: Skin is warm to touch, no itching or rash

CARDIOVASCULAR: No palpations, denies chest pain or chest tightness,

RESPIRATORY: Denies cough, no shortness of breath, or wheezing

GASTROINTESTINAL: No anorexia, no diarrhea, no constipation or abdominal pain, appetite tends to vary with mood

GENITOURINARY: no changes in urine pattern, no color change, no incontinence

NEUROLOGICAL: Denies dizziness, tingling, no headache, no paralysis, no tingling or even confusion

MUSCULOSKELETAL: No weakness, no pain, or stiffness on the joints

HEMATOLOGIC: has no history of anemia, bruising, or bleeding

LYMPHATICS: has no swollen lymph nodes and has no splenectomy

ENDOCRINOLOGIC: Has no history of heat or cold intolerance

PSYCHIATRIC: impulsive emotional outbursts and rage

Objective:

Vitals: Temp 96.8, Pulse 88, Respiration rate 18, B/P130/88

Diagnostic results: The DSM-5 diagnostic criteria indicates that the patient has an intermittent explosive disorder which is characterized by recurrent behavioral and verbal outbursts which are impulsive and not premeditated (American Psychiatric Association, 2013).

Laboratory results: CBC within normal range.

Assessment:

Mental Status Examination: The patient is a 17-year-old Caucasian female who appears her age. She seems disoriented and impatient with the interview. She is oriented to time and place. She is dressed in oversized sweat pants and with unkempt hair. She has normal motor activity and uses correct facial expressions and body movements during the interview. Has no signs of hallucinations and has a good memory.

Diagnostic Impression: The patient’s diagnostic impression is intermittent explosive disorder. The differential diagnoses include antisocial personality disorder, borderline personality disorder, conduct disorder, and attention deficit hyperactivity disorder.

Differential Diagnoses

Intermittent explosive disorder

Intermittent explosive disorder refers to a psychiatric condition that involves sudden episodes of aggressive and impulsive behavior and verbal outbursts. Some of the signs and symptoms of the condition include verbal abuse, throwing and breaking of objects, and temper tantrums the condition is likely to result in significant distress, and at the same time harm a person’s relationships at work or school.

Antisocial personality disorder

Antisocial personality disorder refers to a health condition that is characterized by a disregard of other people. Signs and symptoms begin to show in childhood but cannot be diagnosed until adolescence or adulthood. Individuals diagnosed with the condition tend to break laws, lie as well as act impulsively and have a disregard for their safety and those of others (DeLisi et al., 2019). Behavioral symptoms include irresponsibility, manipulativeness, risk-taking behavior, impulsivity as well as lack of restraint. Mood symptoms may include anger, boredom, substance abuse.

Borderline Personality disorder

A borderline personality disorder is a mental health disorder that is characterized by unstable moods, relationships, and behavior (Dixon-Gordon et al., 2017). Some of the signs and symptoms of the condition include emotional instability, insecurity, impulsivity, and impaired social relationships. Additional behavioral symptoms may include hostility, irritability, risk-taking behavior, self-destructive behavior, self-harm, and lack of restrain. Mood symptoms may include anxiety, anger, general discontent, loneliness, and mood swings, individuals tend to experience suicidal thoughts.

Conduct disorder

Conduct disorder refers to a group of disorders that are repetitive and which present persistent and emotional problems among adolescents. Children and adolescents who are diagnosed with this disorder tend to have problems following rules, showing empathy, respecting the rights of others as well as behaving in a socially acceptable manner (Frick, 2016). Others tend to view them as delinquents. Some of the factors that lead to the development of this disorder include but are not limited to traumatic life experiences, brain damage, child abuse or neglect, school failure as well as genetic susceptibility.

Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is characterized by a pattern of inattention as well as hyperactivity and impulsivity with functioning and development (Keilow et al., 2018). Inattention means that individuals have difficulty sustaining focus,  Hyperactivity means that individuals seem to move about even in situations they should not be.  They may tend to fidget, tap, or have incoherent talk. Impulsivity means that individuals make hasty decisions and talks without thinking.

Reflections:

If I were to have another session with the patient I would ask questions related to how her health condition has affected her school life. I would seek to know if the patient is happy and content with her life at the moment or the changes that he would like to see in her life.  Because the patient is a minor, the entire experience would face some legal and ethical implications on issues like patient autonomy, as well as privacy and confidentiality as recommended by the Health Insurance Portability and Accountability Act. I would also educate her on the side effects of nicotine on her health at such an early age.

Case Formulation and Treatment Plan:

The therapeutic approach that worked with the patient was psychotherapy (Wheeler, n.d). Psychotherapy is a talk therapy that allows the patient to express themselves while at the same time identifying the harmful patterns which may result in impaired relationships with others. Psychotherapy results in better coping mechanisms, anger management education as well as relaxation techniques. Puberty is a sensitive stage in life where individuals need to be monitored closely and receive support from parents, peers, and the healthcare system.

Radwan & Coccaro (2020) claim that intermittent explosive disorder prevalence is at 7.8 percent during adolescence. The adolescents, therefore, need to be provided with a favorable environment that will boost their coping skills. Besides therapy, a patient presenting with the intermittent explosive disorder is likely to benefit from serotonin reuptake inhibitors such as fluoxetine which has been shown to lower impulse aggressive symptoms (Costa et al., 2018)

I would advise the patient to continue with therapy and medications as required to minimize relapse of the symptoms or better still suffering from adverse side effects due to the abrupt discontinuation of the medication.

The patient should seek immediate medical attention if they develop allergic reactions after administration of the medication.

Patient and nurse collaboration was facilitated and the patient was allowed to ask questions.

The patient was required to go back for follow-up four weeks.

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Costa, A. M., Medeiros, G. C., Redden, S., Grant, J. E., Tavares, H., & Seger, L. (2018). Cognitive-behavioral group therapy for intermittent explosive disorder: description and preliminary analysis. Revista Brasileira de Psiquiatria, (AHEAD), 0-0.

DeLisi, M., Drury, A. J., & Elbert, M. J. (2019). The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology. Comprehensive psychiatry, 92, 1-6.

Dixon-Gordon, K. L., Peters, J. R., Fertuck, E. A., & Yen, S. (2017). Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice. Journal of psychotherapy integration, 27(4), 425–438. https://doi.org/10.1037/int0000044

Frick, P. J. (2016). Current research on conduct disorder in children and adolescents. South African Journal of Psychology, 46(2), 160-174.

Keilow, M., Holm, A., & Fallesen, P. (2018). Medical treatment of Attention Deficit/Hyperactivity Disorder (ADHD) and children’s academic performance. PloS one, 13(11), e0207905.

Radwan, K., & Coccaro, E. F. (2020). Comorbidity of disruptive behavior disorders and intermittent explosive disorder. Child and Adolescent Psychiatry and Mental Health, 14(1), 1-10. doi: https://doi.org/10.1186/s13034-020-00330-w

Wheeler, K. (Ed.). Psychotherapy for the advanced practice psychiatric: A how-to guide for evidence-based practice (2nd ed.). New York: Springer Publishing Company