NURS 6670: Psychiatric Mental Health Nurse Practitioner Role

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NURS 6670: Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults

NURS 6670 Entire Course Weekly Discussions And Assignments

NURS 6670 Week 1: Psychiatric Assessment of the Adult and Older Adult

Many assessment principles are the same for children and adults; however, with adults/older adults, consent for participation in the assessment comes from the actual client and not parents or guardians. The exception to this is adults/older adults who have been determined incapacitated by a court of competent jurisdiction. Some adults may be easier to assess than children/adolescents as they are more psychologically minded. That is, they have better insights into themselves and their motivations than children/adolescents (although this is not universally true).

Older adults present some of their own unique assessment challenges in that they may have higher levels of stigma associated with seeking psychiatric care. Additionally, there are higher rates of neurocognitive disorders superimposed on other clinical conditions such as depression or anxiety, which creates additional diagnostic challenges.

This week, you will develop your own personal format for initial interviews of mental health clients. You also will explore the restrictions and limitations for practice as a PMHNP in your home state and create a plan for passing the national certification exam.

Despite what you may believe (or may have been told), there is no such thing as one “right” way to do an interview. In fact, there are numerous books written about the various ways of conducting the clinical interview. In actual clinical practice, you will find the format that “works” best for you and addresses your unique strengths and the needs of the client.

In this Discussion, you will practice finding the interview format that works for you and share those ideas with your colleagues for feedback.

Learning Objectives

Students will:

  • Develop formats for initial interviews of mental health clients

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. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

  • Review the Learning Resources.
  • Develop an interview format you would use for an initial interview of a client.

By Day 3

Post:

  • Attach the interview format document you would use for an initial interview of a client.
  • Describe what interview format your preceptor uses for the initial interview of a client.
  • Describe which element of your interview format is most helpful in your practice.

By Day 6

Respond to at least two of your colleagues by constructively critiquing their interview format and providing feedback.

NURS 6670: Psychiatric Mental Health Nurse Practitioner Role

Assignment 1: Week 1 Practicum Journal Entry: Certification Plan

Psychiatric/mental health nurse practitioners currently have only one choice for certification, which is through the American Nurses Credentialing Center (ANCC). The ANCC offers the “psychiatric/mental-health nurse practitioner (across the lifespan)” board certification (PMHNP-BC). In many states, board certification is needed as a prerequisite to being granted an NP license. Even if board certification is not a requirement for state licensure, it may be a requirement to receive privileges in various hospitals and other health care facilities. It may also be required by malpractice insurance providers prior to issuing coverage to NPs.

In this Practicum Journal Assignment, you will develop a plan, which will serve as the road map for you to follow to attain your certification.

Learning Objectives

Students will:

  • Analyze state restrictions or limitations for practice
  • Compare PMHNP practice environments in various states
  • Analyze clinical practice issues
  • Create plans for passing national certification exams

**Assigned in Week 1 but submitted in Week 4

To prepare for this Practicum Journal:

  • Review the interactive nurse practitioner (NP) scope of practice law guide in your Learning Resources.
  • Review your state regulations and a neighboring state or state in which you would like to practice.
  • Reflect on how to approach relocating licensure from one state to another.
  • Review certification exam requirements for PMHNPs.

Write a 2- to 3-page paper in which you do the following:

  • Describe the PMHNP practice environment for your home state, highlighting restrictions or limitations for practice.
  • Compare the PMHNP practice environment in your home state with a neighboring state or a state in which you would like to practice.
  • Describe a professional and/or clinical practice issue a new PMHNP will need to consider and address with the certification, licensure, credentialing, or relocation process.
  • Develop a checklist for passing the national certification exam, including a detailed timeline that includes academic preparation (study plan), registration, financial preparation, etc.

By Day 7

Submit by Day 7 of Week 4.

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NURS 6670: Psychiatric Mental Health Nurse Practitioner Role

NURS 6670 Week 2: Depressive Disorders

I have no one. My wife died suddenly 4 years ago and I know it was my fault. She had been complaining she was sick for a year, but the doctors kept saying it was nothing. When they finally found the cancer, it had spread throughout her body. I should have listened to her. She might have survived and I would not be alone. I seem to cry for no reason and my children don’t understand why I don’t want to go out of the house. This is where her memories are. Why would I want to leave?

Jose, age 75

The National Institutes of Mental Health acknowledges that depression is one of the most common mental disorders in the United States. It is associated with significant disability, fiscal impact, and considerable personal suffering. It may have significant impact on the individual, their family, and their social network. The PMHNP must be capable of providing comprehensive care for depressive disorders, including both psychotherapy and psychopharmacologic approaches.

This week, you will become “captain of the ship” as you take full responsibility for a client with a depressive disorder. You will recommend psychopharmacologic treatment and psychotherapy, identify medical management needs and community support, and recommend follow-up plans. You will also explore how to obtain a DEA license and the responsibilities for safe prescribing and prescription monitoring.

As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role.

In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder.

Learning Objectives

Students will:

  • Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with depression disorders
  • Recommend psychotherapy based on therapeutic endpoints for clients with depression disorders
  • Identify medical management needs for clients with depression disorders
  • Identify community support resources for clients with depression disorders
  • Recommend follow-up plans for clients with depression disorders

To prepare for this Assignment:

  • Select an adult or older adult client with a depressive disorder you have seen in your practicum.

In 3–4 pages, write a treatment plan for your client in which you do the following:

  • Describe the HPI and clinical impression for the client.
  • Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
  • Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
  • Identify medical management needs, including primary care needs, specific to this client.
  • Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
  • Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

By Day 7

Submit your Assignment.

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Assignment 2: Week 2 Practicum Journal: Safe Prescribing

There is probably no greater responsibility that the psychiatric mental health nurse practitioner assumes than the responsibility of prescribing medications. While someone can be harmed by psychotherapy, the level and intensity of the harm generally does not come to the same level of harm that can occur from improper prescribing. The PMHNP must understand his/her responsibility both at a state and federal level when it comes to prescribing medications.

In this Practicum Journal Assignment, you will explore the legalities associated with prescribing controlled substances, as well as what a DEA number is, how to obtain one, and, most importantly, how to prescribe controlled substances in your state.

Learning Objectives

Students will:

  • Analyze roles of the Drug Enforcement Administration
  • Analyze PMHNP responsibilities when issued a DEA number
  • Analyze DEA number application procedures
  • Analyze state requirements for safe prescribing and prescription monitoring
  • Analyze PMHNP responsibilities for safe prescribing and prescription monitoring
  • Analyze Schedule II-V drug levels

** Assigned in Week 2 and submitted in Week 4.

To prepare for this Practicum Journal:

  • Review the Learning Resources.

In 2-3 pages:

  • Describe the role of the Drug Enforcement Administration (DEA) as it pertains to the PMHNP.
  • Explain your responsibilities when having a DEA number.
  • Explain how you apply for a DEA number.
  • Explain your state’s requirements for a safe prescribing and prescription monitoring program. Explain your responsibility as a PMHNP to follow these requirements.
  • Provide an example of a drug you may prescribe from each of the Schedule II-V drug levels.

By Day 7

Submit by Day 7 of Week 4.

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NURS 6670 Week 3: Personality Disorders

I cannot believe these people. Don’t they know who I am? I deserve better treatment than this. That hostess should have seated me immediately, but I had to wait for 10 minutes and then she put me at this table right by the kitchen. I see an empty table right in the middle where I should be. I am just going to get up and move there. I don’t care what the hostess says, rules don’t apply to me.

Ashley, age 25

Personality disorders represent perhaps the most challenging disorders that the psychiatric mental health nurse practitioner will have to address in their professional careers. Personality disorders can co-occur in every mental health disorder and, in some cases, can mask as disorder . Although difficult to treat, the PMHNP must be able to identify personality disorders and endeavor to work with the client to not only recognize the disorder, but to treat a disorder that clients often do not believe they have.

This week, you will explore the many personality disorders and use the DSM-5 criteria for diagnosing individuals with specific personality disorders. You will use the Decision Tree format to diagnose and treat a client with a personality disorder. You also will complete the Fitzgerald University Exit Comprehensive Exam to determine your readiness for the certification exam.

Personality disorders occur in 10–20% of the population. They are difficult to treat as individuals with personality disorders are less likely to seek help than individuals with other mental health disorders. Treatment can be challenging as they do not see their symptoms as painful to themselves or others.

In this Discussion, you will explore personality disorders in greater detail and discuss treatment options using evidence-based research.

Learning Objectives

Students will:

  • Analyze diagnostic criteria for personality disorders
  • Analyze evidence-based psychotherapy and psychopharmacologic treatments for personality disorders
  • Analyze clinical features of clients with personality disorders
  • Align clinical features with DSM-5 criteria
  • Compare differential diagnostic features of personality disorders

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. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

  • By Day 5 of Week 2, your Instructor will have assigned you a personality disorder, which will be your focus for your initial post for this Discussion.
  • Review the Learning Resources.

By Day 3

Post:

  • Explain the diagnostic criteria for your assigned personality disorder.
  • Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned personality disorder.
  • Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.
  • Support your rationale with references to the Learning Resources or other academic resources.

By Day 6

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned. What are their similarities and differences? How might you differentiate the two diagnoses?

NURS 6670: Psychiatric Mental Health Nurse Practitioner Role

Assignment 1: 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 adult and older adult 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

** Assigned in Week 3 and submitted in Week 4

Examine Case 1: 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 family.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

By Day 7

Submit by Day 7 of Week 4.

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NURS 6670: Psychiatric Mental Health Nurse Practitioner Role

NURS 6670 Week 4: Substance-Related and Addictive Disorders

I can’t believe that stupid horse lost! My inside man told me it was a sure bet at 20:1 odds. I thought for sure that I would be able to make back the money I lost yesterday. What am I going to tell my wife? That was the money for the mortgage payment…well, the last three mortgage payments. She does not know I have been spending my days at the track. I lost my job at the company because a few hundred dollars went missing. I just need a break. I know this next horse will be my winner!

Michael, age 37

Substance abuse and addiction affects persons in all walks of life; every ethnic and economic group is affected in some way by addiction or substance abuse. In your practice as a PMHNP, you will encounter patients with substance abuse and dependence. Some of the people who present for treatment are at a low point in their lives and want to turn things around. They may present for other conditions such as depression or bipolar disorder, anxiety, PTSD, or personality disorders. One of the most common ways of self-medicating a mental illness is with alcohol and illicit drugs. Marijuana is a common substance used by clients to treat various symptoms. To effectively treat clients with addictive disorders and substance use disorders, the provider needs to examine their own values and thoughts about the use of substances.

This week, you will analyze clients presenting for treatment of substance-related and addictive disorders and evaluate effectiveness of therapeutic approaches for clients diagnosed with substance-related and addictive disorders.

Substance use disorders are complicated psychiatric and medical conditions that involve physical addiction as well as psychological or emotional dependence. Substance use disorders are some of the most difficult to treat. It takes a great deal of patience on the part of the provider and the client. It may take several attempts before a client is successfully able to “kick the habit.” Your guidance and patience can help the client to persevere through difficult times during the journey to recovery.

Clinical Supervision is an essential component of your development as a psychiatric mental health nurse practitioner. It provides an opportunity for professional collaboration as you share experiences with and gain insights from colleagues. For this Clinical Supervision, consider a client with a substance abuse disorder whom you do not think is adequately progressing according to expected clinical outcomes.

Learning Objectives

Students will:

  • Analyze clients presenting for treatment of substance-related and addictive disorders
  • Evaluate effectiveness of therapeutic approaches for clients diagnosed with substance-related and addictive disorders
  • Recommend treatment plans

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. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

  • Review this week’s Learning Resources concerning treating patients with substance-related and addictive disorders.
  • Reflect on a client you are currently counseling or have previously counseled at your practicum site who has been diagnosed with substance-related and addictive disorders.

By Day 3

Post a 3- to 5-minute Kaltura video in which you do the following:

  • Describe the client. Note: Do not use the client’s actual name.
  • Explain your therapeutic approach with the client, including the perceived effectiveness of your approach.
  • Identify any additional information about this client that may potentially impact expected outcomes.
  • Provide specific recommendations for the client to help them in determining why they are not progressing and what your suggested treatment plan consists of. It is useful to consult the Prochaska and DiClement model.

Note: Nurse practitioners must have strong oral communication skills. This Discussion is designed to help you hone these skills. When filming your Kaltura video, be sure to dress and speak in a professional manner.

View a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues by suggesting an alternate therapeutic approach. Support your feedback with evidence-based literature and/or your own experiences with clients.

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NURS 6670 Week 5: Bipolar Disorders

I am finally doing everything right. I stayed up all night studying for my final exams and even managed to clean out my closet and order a whole new bedroom from the Internet. I know I will ace all my exams. Nothing can go wrong like they did a few months ago. I was so low and was sleeping all the time. I did not think I would ever be happy again, but now I know I can do anything.

Jessica, age 22

Bipolar disorder is relatively rare with around only 3% of the population diagnosed with one of them. Although being relatively rare in terms of lifetime prevalence, bipolar disorder is burdensome to the individual and health care system because of its early onset, severity, and chronic nature. The average age of onset is around 25 and affects men and women equally. The importance of evidence-based intervention for treatment in persons with bipolar disorder cannot be underestimated. Unstable mood can result in repeat chronic hospitalizations. Developing a good rapport and relationship with the client can make a difference in the course, symptom management, and stability of the person with bipolar disorder.

This week, you will once again become “cCaptain of the Sship” as you take full responsibility for a client with a bipolar disorder by recommending psychopharmacologic treatment and psychotherapy, identifying medical management needs and community support, and recommending follow-up plans. You will use the decision tree format to justify your rationale for diagnosis, pharmacological treatment, and psychotherapy of a patient with a mental illness. You also will evaluate the results of your Fitzgerald University Exit Comprehensive Exam and, based on those results, develop a plan of action to prepare for the certification exam.

Bipolar disorders are severe disorders of mood that include both depressive episodes and expansive, grandiose, or manic episodes. During these times, the person may engage in activities with little awareness of the consequences because of accompanying psychosis. A diagnosis of bipolar disorder includes periods of mania or hypomania and periods of depression where the mood is down, hopeless, and suicidal. The neurovegetative symptoms of bipolar depression can be incapacitating. It is also important to differentiate the psychosis of bipolar disorder from schizophrenia.

In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a bipolar disorder.

Learning Objectives

Students will:

  • Recommend psychopharmacologic treatments based on therapeutic end points for clients with bipolar disorders
  • Recommend psychotherapy based on therapeutic end points for clients with bipolar disorders
  • Identify medical management needs for clients with bipolar disorders
  • Identify community support resources for clients with bipolar disorders
  • Recommend follow-up plans for clients with bipolar disorders

To prepare for this Assignment:

  • Select an adult or older adult client with a bipolar disorder that you have seen in your practicum.

In 3-4 pages, write a treatment plan for your client. In which you do the following:

  • Describe the HPI and clinical impression for the client.
  • Recommend psychopharmacologic treatments and describe specific and therapeutic end points for your psychopharmacologic agent. (This should relate to HPI and clinical impression.).
  • Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
  • Identify medical management needs, including primary care needs, specific to this client.
  • Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
  • Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

By Day 7

Submit your Assignment.

Assignment 3:
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 adult and older adult 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

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 family.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

By Day 7 of Week 7

Submit your Assignment.

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NURS 6670 Week 6: Anxiety Disorders, PTSD, and Related Disorders

Oh no! It is happening again. I am having a heart attack… I know it. My heart is racing, I can’t breathe, and I am shaking all over. I can’t go to the ER again. They will say what they always say… I am not having a heart attack. It is all in my head.

Barbara, age 68

The anxiety disorders provide us a good opportunity to take a close look at the nature/nurture debate as well as the gene/environment interactions that influence the nervous system and neurochemistry. A significant part of most of Sigmund Freud’s theories, the concept of anxiety has been debated and discussed over many years in the psychiatric literature. While Freud’s theories focused on the “mind” and the unconscious, another way to look at anxiety is with Hans Selye’s concept of “fight or flight” in which the sympathetic nervous system is activated as a response to stress. As you explore the concept of anxiety, you will notice that no two cases of anxiety are the same.

This week, you will explore evidence-based treatment methods for clients with anxiety disorders. You will complete a midterm exam and analyze reimbursement rates for treatment of mental health disorders.

Anxiety disorders are common in both primary care and psychiatric practice. Clients with anxiety disorders including generalized anxiety disorders, agoraphobia, and other specific phobias will present to the PMHNP’s office with a significant level of distress. Successful recognition and treatment of anxiety disorders includes an accurate diagnostic assessment with a treatment plan that includes a combination of psychopharmacology and psychotherapy. Although psychoanalytic theories are based on the concept of anxiety, the more recent standard of care is with the cognitive-behavioral therapies.

In this Discussion, you will analyze evidence-based treatment plans for clients with anxiety disorders.

Learning Objectives

Students will:

  • Analyze differences between adjustments disorders and anxiety disorders
  • Analyze diagnostic criteria for anxiety disorders
  • Analyze evidence-based psychotherapy and psychopharmacologic treatment for anxiety disorders
  • Compare differential diagnostic features of anxiety disorders

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. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

  • By Day 5 of Week 5, your Instructor will have assigned you an anxiety disorder, which will be your focus for your initial post for this Discussion.
  • Review the Learning Resources.

By Day 3

Post:

  • Explain the difference between an adjustment disorder and anxiety disorder. Provide examples to illustrate your rationale.
  • Explain the diagnostic criteria for your assigned anxiety disorder.
  • Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned anxiety disorder.
  • Support your rationale with references to the Learning Resources or other academic resource.

By Day 6

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.

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NURS 6670 Week 7: Obsessive-Compulsive Disorders

It is getting embarrassing to go to my hair stylist. She always comments on the bald patches on my head. They keep getting bigger as I continue to pull out one strand of hair at a time. I even do it in my sleep. I can’t help myself. It all started when I was in high school when I would pull just from the back. Now I have to wear my hair a specific way so the bald patches don’t show. I don’t even color my hair anymore. I don’t want anyone to notice me.

Michelle, age 27

Although actual statistics vary, obsessive-compulsive disorder impacts approximately 1.2% of the population in the United States (APA, 2013, p. 239). It is characterized by the presence of obsessive thoughts, which are manifested as persistent thoughts, images, or even “urges.” The only way that the individual can disperse the anxiety of these persistent thoughts/images or urges is to perform a behavior (the compulsion). The compulsion could be checking things, counting, reciting a silent prayer, or repeating a number of phrases. The disorder becomes so pervasive that the person can spend a significant amount of time each day attending to the compulsion in order to relieve the anxiety caused by the obsession.

This week, you will, once again, become “captain of the ship” as you take full responsibility for a client with an obsessive-compulsive disorder by recommending psychopharmacologic treatment and psychotherapy, identifying medical management needs and community support, and recommending follow-up plans. You also will evaluate your progress in completing your certification plan.

In earlier weeks, you were introduced to the concept of the “captain of the ship.” In this Assignment, you become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with an obsessive-compulsive disorder.

Learning Objectives

Students will:

  • Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with obsessive-compulsive disorders
  • Recommend psychotherapy based on therapeutic endpoints for clients with obsessive-compulsive disorders
  • Identify medical management needs for clients with obsessive-compulsive disorders
  • Identify community support resources for clients with obsessive-compulsive disorders
  • Recommend follow-up plans for clients with depression disorders

To prepare for this Assignment:

  • Select an adult or older adult client with an obsessive-compulsive disorder you have seen in your practicum.

In 3–4 pages, write a treatment plan for your client in which you do the following:

  • Describe the HPI and clinical impression for the client.
  • Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
  • Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
  • Identify medical management needs, including primary care needs, specific to this client.
  • Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
  • Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

By Day 7

Submit your Assignment.

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NURS 6670 Week 8: Neurocognitive Disorders

My mother used to be a teacher—an elementary school teacher. We were all so proud of her when she completed her PhD when she was 50. Now she is 75 and has begun to have times when she does not know what day it is. We found her wandering around the neighborhood because she could not find her way home. Once, she forgot where she parked her car at the grocery store. She thought someone had stolen it. The manager was so kind to drive her around the parking lot until she recognized her car. We are afraid she might get hurt or lost.

Gary, age 50, son of Dorothy, age 75

The neurocognitive disorders are unique among the other psychiatric disorders you have studied in that the diseases that are to blame for the neurocognitive manifestations that have been extensively studied. Additionally, these conditions are also acquired and represent a decline from a previous level of functioning. The neurocognitive disorders present a diagnostic challenge to the PMHNP in that many of the signs and symptoms overlap.

This week, you will explore evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders. You will complete your final Decision Tree as you rationalize and justify your diagnosis and treatment of a patient with a mental health disorder.

Neurocognitive disorders (NCD) such as delirium, dementia, and amnestic disorders are more prevalent in older adults. As the population ages and as life expectancy in the United States continues to increase, the incidence of these disorders will continue to increase. Cognitive functioning such as memory, language, orientation, judgment, and problem solving are affected in clients with NCDs. Caring for someone with a neurocognitive disorder is not only challenging for the clinician, but also stressful for the family. The PMHNP needs to consider not only the client but also the “family as client.” Collaboration with primary care providers and specialty providers is essential. Anticipatory guidance also becomes extremely important.

In this Discussion, you will integrate several sources of knowledge specific to NCDs as you discuss evidenced-based therapies used to treat these disorders.

Learning Objectives

Students will:

  • Analyze diagnostic criteria for neurocognitive disorders
  • Analyze evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders
  • Evaluate benefits and risks of neurocognitive therapies
  • Compare differential diagnostic features of neurocognitive disorders

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. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

  • By Day 5 of Week 7, your Instructor will have assigned you a neurocognitive disorder, which will be the focus for your initial post for this Discussion.
  • Review the Learning Resources.

By Day 3

Post:

  • Explain the diagnostic criteria for your assigned neurocognitive disorder.
  • Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned neurocognitive disorder.
  • Identify the risks of different types of therapy and explain how the benefits of the therapy that might be achieved might outweigh the risks.
  • Support your rationale with references to the Learning Resources or other academic resource.

By Day 6

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.

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 adult and older adult clients presenting symptoms of a mental health disorder.

The Assignment:

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

Examine Case 3: 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 family.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

By Day 7 of Week 10

Submit your Assignment.

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NURS 6670 Week 9: Schizophrenia Spectrum and Other Psychotic Disorders

I am being followed. They are even in my home. I am crouched in the corner of my apartment, but they know I am here and are just waiting to get me. I have a secret and they are trying to get it. The secret is hidden in my brain and they are going to open my skull to get it out. I have to block them from getting into my brain. Hiding in the closet, behind all the clothes, they will not see me….

Jamie, age 26

There are many disorders that result in the development of “positive” symptoms, such as hallucinations and delusions, but not all of these conditions represent schizophrenia. When treating schizophrenia spectrum and other psychotic disorders, emphasis should be placed not only on treating the positive symptoms but the negative and residual symptoms as well.

This week, you will explore a wide variety of disorders along the schizophrenia spectrum as you become “captain of the ship” once again. You also will analyze issues involved with state practice agreements.

In earlier weeks, you were introduced to the concept of the “captain of the ship.” In this Assignment, you become the “captain of the ship” once again as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a schizophrenia spectrum/other psychotic disorder.

Learning Objectives

Students will:

  • Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with schizophrenia spectrum and other psychotic disorders
  • Recommend psychotherapy based on therapeutic endpoints for clients with schizophrenia spectrum and other psychotic disorders
  • Identify medical management needs for clients with schizophrenia spectrum and other psychotic disorders
  • Identify community support resources for clients with schizophrenia spectrum and other psychotic disorders
  • Recommend follow-up plans for clients with schizophrenia spectrum and other psychotic disorders

To prepare for this Assignment:

  • Select an adult or older adult client with a schizophrenia spectrum and other psychotic disorder you have seen in your practicum.

In 3–4 pages, write a treatment plan for your client in which you do the following:

  • Describe the HPI and clinical impression for the client.
  • Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
  • Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
  • Identify medical management needs, including primary care needs, specific to this client.
  • Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
  • Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

By Day 7

Submit your Assignment.

Assignment 2:
Week 9 Practicum Journal: State Practice Agreements

In many states, nurse practitioners are completely autonomous professionals. In other states, however, NPs have a wide range of “restrictive” practice ranging from requirements for a “supervising” physician to requirements for a “collaborative” agreement with a physician.

In this Practicum Journal Assignment, you will examine the requirements of your own state in order to prepare yourself for the realities of practice upon graduation.

Learning Objectives

Students will:

  • Analyze state PMHNP practice agreements
  • Analyze physician collaboration issues
  • Analyze barriers to PMHNP independent practice
  • Create plans for addressing state PMHNP practice issues

**Assigned in Week 9 and submitted in Week 10

To Prepare for this Practicum Journal:

  • Review practice agreements in your state.
  • Identify at least two physician collaboration issues in your state.

For this Practicum Journal:

  • Briefly describe the practice agreements for PMHNPs in your state.
  • Explain the two physician collaboration issues that you identified.
  • Explain what you think are the barriers to PMHNPs practicing independently in your state.
  • Outline a plan for how you might address PMHNP practice issues in your state.

By Day 7 of Week 10

Submit your Practicum Journal.

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NURS 6670: Psychiatric Mental Health Nurse Practitioner Role

NURS 6670 Week 10: Sleep/Wake Disorders and Parasomnias

Tick, tock, and here we go again. I have been in bed trying to go to sleep for three hours now. I have not gotten more than a few hours of sleep a night in months. My work is being affected and so is my relationship with my wife. She’s over there sleeping like a baby and cannot understand why I can’t sleep. ‘Just close your eyes and relax’, she says. When I close my eyes, all I see is all the work I have to do.

Riley, age 34

Sleep is essential for a healthy mind and body, and lack of quality sleep can cause distress during the daytime. Sleep disorders can involve difficulties with quality, timing, and amount of sleep and frequently accompany other disorders, especially depression, anxiety, and PTSD. Obtaining a good sleep history is essential to diagnosing sleep disorders, prescribing a treatment plan, and monitoring the plan’s effectiveness. Understanding and managing sleep problems frequently leads to improvement in other mental health disorders that the patient is experiencing.

This week, you will analyze the diagnostic criteria and treatment options of insomnia, hypersomnolence, narcolepsy, sleep apnea, non-rapid eye movement, nightmare disorder, sleep behavior disorder, and other DSM-5 sleep and parasomnic disorders.

The power of sleep to heal the body cannot be underestimated. Most research indicates that 7–8 hours of sleep are a minimum that people need to stay healthy. Clients who come to the PMHNP’s office frequently complain of sleep problems. It is estimated that 10–20% of patients report some type of sleeping problem.

In this Discussion, you will analyze the diagnostic criteria and evidence-based psychotherapy and psychopharmacologic treatment for sleep/wake disorders.

Learning Objectives

Students will:

  • Analyze diagnostic criteria for sleep/wake disorders
  • Analyze evidence-based psychotherapy and psychopharmacologic treatment for sleep/wake disorders
  • Analyze criteria for referring clients to primary care physicians for treatment of sleep/wake disorders
  • Compare differential diagnostic features of sleep/wake disorders

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. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

  • By Day 5 of Week 9, your Instructor will have assigned you a sleep/wake disorder, which will be the focus of your original post for this Discussion.
  • Review the Learning Resources.

By Day 3

Post:

  • Explain the diagnostic criteria for your assigned sleep/wake disorder.
  • Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder.
  • Describe at what point you would refer the client to their primary care physician for an additional referral to a neurologist, pulmonologist, or physician specializing in sleep disorders and explain why.
  • Support your rationale with references to the Learning Resources or other academic resource.

By Day 6

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.

NURS 6670: Psychiatric Mental Health Nurse Practitioner Role

Assignment :
Week 10 Practicum Journal: Checkpoint for Certification Plan

Learning Objectives

Students will:

  • Evaluate progress on certification plans

Report your progress on the Certification Plan completed in Week 1 and submitted in Week 4.

  • What have you done to prepare for your certification?
  • Have you completed the scheduled tasks assigned on your timeline? If not, what are your plans to stay on schedule?

By Day 7

Submit your Assignment.

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NURS 6670: Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults | Week 11

I have been under a lot of stress lately. Between my job, the house and kids, and my wife complaining, I don’t seem to have the “staying power” I used to. Our sex life used to be perfect, but now I cannot perform as well or as often as I used to. My wife does not seem to understand and now I am feeling inadequate. I have a long life in front of me and I don’t want to live without feeling like a true man.”

Larry, age 40

This week’s topics include gender dysphoria, paraphilic disorders, and sexual dysfunction. The term gender dysphoria is the diagnosis describing those persons who experience incongruence between their gender assigned at birth and their experienced gender. Paraphilic disorders include pedophilia, exhibitionism, fetishism, and voyeurism, for example. Sexual dysfunction disorders include, most commonly, male erectile disorder, female orgasmic disorder, and other disorders. These diagnoses may be treated with pharmacologic and psychotherapy modalities.

This week, you will explore ways to assess and care for persons with gender dysphoria, paraphilic disorders, and sexual dysfunction disorders as outlined in the DSM-5.

NURS 6670: Psychiatric Mental Health Nurse Practitioner Role

Sexuality is an important part of each person’s quality of life. Research indicates that awareness of sexual identity and its importance may begin as early as age 3. However, individuals with varying diagnoses, disorders, or dysfunctions may grapple with issues related to their sexuality in their teen years, as well as into adulthood.

In this Discussion, you will explore the assessment and treatment of gender dysphoria, paraphilic disorders, and sexual dysfunction.

Learning Objectives

Students will:

  • Analyze diagnostic criteria for gender dysphoria, paraphilic disorders and sexual dysfunction
  • Analyze evidence-based psychotherapy and psychopharmacologic treatments for gender/sexual disorders
  • Compare differential diagnostic features of gender/sexual disorders

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. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

  • Select a gender dysphoria, paraphilic disorder, or sexual dysfunction that interests you.
  • Review the Learning Resources.

By Day 3

Post:

  • Explain the diagnostic criteria for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.
  • Explain the evidenced-based psychotherapy and psychopharmacologic treatment for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.
  • Support your rationale with references to the Learning Resources or other academic resource.

By Day 6

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you selected to the diagnostic features of the disorder your colleagues were assigned.

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