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An important consideration when working with patients is their cultural background. Understanding an individuals culture and personal experiences provides insight into who the person is and where he or she may progress in the future. Culture helps to establish a sense of identity, as well as to set values, behaviors, and purpose for individuals within a society. Culture may also contribute to a divide between specific interpretations of cultural behavior and societal norms. What one culture may deem as appropriate another culture may find inappropriate. As a result, it is important for advanced practice nurses to remain aware of cultural considerations and interpretations of behavior for diagnosis, especially with reference to substance-related disorders. At the same time, PMHNPs must balance their professional and legal responsibilities for assessment and diagnosis with such cultural considerations and interpretations. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide. In the Subjective section, provide: · Chief complaint · History of present illness (HPI) · Past psychiatric history · Medication trials and current medications · Psychotherapy or previous psychiatric diagnosis · Pertinent substance use, family psychiatric/substance use, social, and medical history · Allergies · ROS · Read rating descriptions to see the grading standards! In the Objective section, provide: · Physical exam documentation of systems pertinent to the chief complaint, HPI, and history · Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses. · Read rating descriptions to see the grading standards! In the Assessment section, provide: · Results of the mental status examination, presented in paragraph form. · At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case . · Read rating descriptions to see the grading standards! Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations ( demonstrate critical thinking beyond confidentiality and consent for treatment !), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). (The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.) EXEMPLAR BEGINS HERE CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member. HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example: N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment. Or P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment. Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation. Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS. The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders. Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13. Caregivers are listed if applicable. Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors? Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it) Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both. Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures. Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form. Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include: Where patient was born, who raised the patient Number of brothers/sisters (what order is the patient within siblings) Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children? Educational Level Hobbies: Work History: currently working/profession, disabled, unemployed, retired? Legal history: past hx, any current issues? Trauma history: Any childhood or adult history of trauma? Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical) Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries. Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products. Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance. Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns ROS: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination! You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe. Example of Complete ROS: GENERAL: No weight loss, fever, chills, weakness, or fatigue. HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat. SKIN: No rash or itching. CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema. RESPIRATORY: No shortness of breath, cough, or sputum. GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood. GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness. HEMATOLOGIC: No anemia, bleeding, or bruising. LYMPHATICS: No enlarged nodes. No history of splenectomy. ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia. Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc. Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines). A ssessment Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form. He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.  Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case. Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently? Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). References (move to begin on next page) You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting. © 2021 Walden University Page 1 of 3 Rubric Detail Select Grid View or List View to change the rubrics layout. Content Name: NRNP_6635_Week8_Assignment_Rubric Grid View List View   Excellent Good Fair Poor Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. In the Subjective section, provide: • Chief complaint • History of present illness (HPI) • Past psychiatric history • Medication trials and current medications • Psychotherapy or previous psychiatric diagnosis • Pertinent substance use, family psychiatric/substance use, social, and medical history • Allergies • ROS Points: Points Range: 18 (18\%) - 20 (20\%) The response throughly and accurately describes the patients subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Feedback: Points: Points Range: 16 (16\%) - 17 (17\%) The response accurately describes the patients subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Feedback: Points: Points Range: 14 (14\%) - 15 (15\%) The response describes the patients subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. Feedback: Points: Points Range: 0 (0\%) - 13 (13\%) The response provides an incomplete or inaccurate description of the patients subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing. Feedback: In the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history • Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses. Points: Points Range: 18 (18\%) - 20 (20\%) The response thoroughly and accurately documents the patients physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. Feedback: Points: Points Range: 16 (16\%) - 17 (17\%) The response accurately documents the patients physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. Feedback: Points: Points Range: 14 (14\%) - 15 (15\%) Documentation of the patients physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies. Feedback: Points: Points Range: 0 (0\%) - 13 (13\%) The response provides incomplete or inaccurate documentation of the patients physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing. Feedback: In the Assessment section, provide: • Results of the mental status examination, presented in paragraph form. • At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case. Points: Points Range: 23 (23\%) - 25 (25\%) The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected. Feedback: Points: Points Range: 20 (20\%) - 22 (22\%) The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected. Feedback: Points: Points Range: 18 (18\%) - 19 (19\%) The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy. Feedback: Points: Points Range: 0 (0\%) - 17 (17\%) The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing. Feedback: Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). Points: Points Range: 9 (9\%) - 10 (10\%) Reflections are thorough, thoughtful, and demonstrate critical thinking. Feedback: Points: Points Range: 8 (8\%) - 8 (8\%) Reflections demonstrate critical thinking. Feedback: Points: Points Range: 7 (7\%) - 7 (7\%) Reflections are somewhat general or do not demonstrate critical thinking. Feedback: Points: Points Range: 0 (0\%) - 6 (6\%) Reflections are incomplete, inaccurate, or missing. Feedback: Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old). Points: Points Range: 14 (14\%) - 15 (15\%) The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making. Feedback: Points: Points Range: 12 (12\%) - 13 (13\%) The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study. Feedback: Points: Points Range: 11 (11\%) - 11 (11\%) Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification. Feedback: Points: Points Range: 0 (0\%) - 10 (10\%) Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based. Feedback: Written Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. Points: Points Range: 5 (5\%) - 5 (5\%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. Feedback: Points: Points Range: 4 (4\%) - 4 (4\%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80\% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. Feedback: Points: Points Range: 3.5 (3.5\%) - 3.5 (3.5\%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60\%–79\% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. Feedback: Points: Points Range: 0 (0\%) - 3 (3\%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60\% of the time. No purpose statement, introduction, or conclusion were provided. Feedback: Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation Points: Points Range: 5 (5\%) - 5 (5\%) Uses correct grammar, spelling, and punctuation with no errors Feedback: Points: Points Range: 4 (4\%) - 4 (4\%) Contains a few (one or two) grammar, spelling, and punctuation errors Feedback: Points: Points Range: 3 (3\%) - 3 (3\%) Contains several (three or four) grammar, spelling, and punctuation errors Feedback: Points: Points Range: 0 (0\%) - 2 (2\%) Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding Feedback: Show Descriptions Show Feedback Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. In the Subjective section, provide: • Chief complaint • History of present illness (HPI) • Past psychiatric history • Medication trials and current medications • Psychotherapy or previous psychiatric diagnosis • Pertinent substance use, family psychiatric/substance use, social, and medical history • Allergies • ROS-- Levels of Achievement: Excellent 18 (18\%) - 20 (20\%) The response throughly and accurately describes the patients subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Good 16 (16\%) - 17 (17\%) The response accurately describes the patients subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Fair 14 (14\%) - 15 (15\%) The response describes the patients subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. Poor 0 (0\%) - 13 (13\%) The response provides an incomplete or inaccurate description of the patients subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing. Feedback: In the Objective section, provide: • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history • Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.-- Levels of Achievement: Excellent 18 (18\%) - 20 (20\%) The response thoroughly and accurately documents the patients physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. Good 16 (16\%) - 17 (17\%) The response accurately documents the patients physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. Fair 14 (14\%) - 15 (15\%) Documentation of the patients physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies. Poor 0 (0\%) - 13 (13\%) The response provides incomplete or inaccurate documentation of the patients physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing. Feedback: In the Assessment section, provide: • Results of the mental status examination, presented in paragraph form. • At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.-- Levels of Achievement: Excellent 23 (23\%) - 25 (25\%) The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected. Good 20 (20\%) - 22 (22\%) The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected. Fair 18 (18\%) - 19 (19\%) The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy. Poor 0 (0\%) - 17 (17\%) The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing. Feedback: Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).-- Levels of Achievement: Excellent 9 (9\%) - 10 (10\%) Reflections are thorough, thoughtful, and demonstrate critical thinking. Good 8 (8\%) - 8 (8\%) Reflections demonstrate critical thinking. Fair 7 (7\%) - 7 (7\%) Reflections are somewhat general or do not demonstrate critical thinking. Poor 0 (0\%) - 6 (6\%) Reflections are incomplete, inaccurate, or missing. Feedback: Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).-- Levels of Achievement: Excellent 14 (14\%) - 15 (15\%) The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making. Good 12 (12\%) - 13 (13\%) The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study. Fair 11 (11\%) - 11 (11\%) Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification. Poor 0 (0\%) - 10 (10\%) Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based. Feedback: Written Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.-- Levels of Achievement: Excellent 5 (5\%) - 5 (5\%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. Good 4 (4\%) - 4 (4\%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80\% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. Fair 3.5 (3.5\%) - 3.5 (3.5\%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60\%–79\% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. Poor 0 (0\%) - 3 (3\%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60\% of the time. No purpose statement, introduction, or conclusion were provided. Feedback: Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation-- Levels of Achievement: Excellent 5 (5\%) - 5 (5\%) Uses correct grammar, spelling, and punctuation with no errors Good 4 (4\%) - 4 (4\%) Contains a few (one or two) grammar, spelling, and punctuation errors Fair 3 (3\%) - 3 (3\%) Contains several (three or four) grammar, spelling, and punctuation errors Poor 0 (0\%) - 2 (2\%) Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding Feedback: Total Points: 100 Name: NRNP_6635_Week8_Assignment_Rubric BEGIN TRANSCRIPT:  Training Title 82 LISA: Well, I had to be here in this hospital if that answers your question.  CAMERA: Yes, thank you. Can I get you a drink of water or something else to drink? Anything?  LISA: A drink isnt going to convince me, right? Youre going to have to convince me.  OFF CAMERA: What is you want me to persuade you to do?  LISA: Going to rehab.  OFF CAMERA: What worries you about going to rehab?   LISA: Everything.  OFF CAMERA: Okay. I tell you what lets go back a little bit and tell me about how youre feeling today.  LISA: Scared.  OFF CAMERA: Can you tell me more about that feeling of being scared?  LISA: Well, I dont want to be. I dont want to be what people say I am because if I say it and Im not going to say it because I aint going to change. I cant.  OFF CAMERA: What do people say you are?  LISA: And Im not.  OFF CAMERA: What dont you want to be?  LISA: An addict.  OFF CAMERA: Do you use drugs and alcohol?  LISA: Yeah, sometimes I have a drink. You know with friends [inaudible] but it doesnt matter. Im in control.  OFF CAMERA: Do you feel in control now?  LISA: Maybe I could just get that drink [inaudible].  OFF CAMERA: Sure. Sure. Here you go.  LISA: Thank you.   LISA: you know what I just think I should leave.  OFF CAMERA: You keep saying you should leave. You said that earlier but do you really want to leave?  LISA: No.  OFF CAMERA: Okay. Tell me why you are here.  LISA: Because Im scared.  OFF CAMERA: You said that earlier. You think if you could -- then I could figure out together why youre scared and maybe we can come up to a plan. Up with a plan and if we do that, then maybe your fears will disappear.  LISA:No not these fears [inaudible] because its over.  OFF CAMERA: Whats over?  LISA: Everything. The business.  OFF CAMERA What do you mean?  LISA: Jeremy.  OFF CAMERA: Who is Jeremy?  LISA: He’s, my boyfriend. I saw him naked with Alisa [assumed spelling] with the same fucking name as me. We now have the same fucking boyfriend. In my office, he was screwing that fucking cunk.  OFF CAMERA: So youre the one who caught Jeremy cheating?  LISA: Yeah. Cheating? Yeah, thats a clever word shrinks use.  OFF CAMERA: So you and Jeremy share an office?  LISA: Yeah, we do commercials for local businesses, you know, build websites, that kind of stuff. We started a business together. He moved in with me.  OFF CAMERA: How long ago was that?  LISA: Nine months.  OFF CAMERA: Do you have any children?  LISA: Not with that fucking asshole.   LISA, I have a daughter, Sarah. Gosh, shes beautiful. She stays with some friends. Shes not related to Jeremy, thank God.  OFF CAMERA: And where are you staying?  LISA: Im renting a place far away from here. You know I ran down to the bank to empty both our bank accounts.  OFF CAMERA: Business accounts?  LISA: Yeah. And do you know that asshole has been draining them for 4 months? I swear.  OFF CAMERA: Taking money out of your account without your knowledge.  LISA: Yeah. For his buys.  OFF CAMERA: Buys?  LISA: Yeah, to pay off his debts with my money.  OFF CAMERA: Or crack cocaine?  LISA: Yeah for crack.  OFF CAMERA: How long have you know hes been smoking crack?  LISA: Ever since I saw him with that -- ever since I saw with her naked. The both of them naked.  OFF CAMERA: What was that like seeing Jeremy and Alisa naked and smoking crack?  LISA: Well have you ever seen someone you love naked smoking crack?  OFF CAMERA: No.  LISA: Yeah, no I didnt think so.  OFF CAMERA: So, what has that been like for you knowing Jeremys smoking crack?  LISA: Well, Ive never seen him do drugs before. You know he drinks a lot, smokes weed, but crack cocaine. I mean God have mercy.  OFF CAMERA: What are you thinking about?  LISA: Everyones going to know.  OFF CAMERA: Know what?  LISA: That I was getting high to stay in this hospital and get cleaned up.  OFF CAMERA: You mean rather than go to rehab.  LISA: Rehab, man theyre fucking dirty places and Im sick and tired of dirty places.  OFF CAMERA: No, no, no this rehab place is very clean. Ive seen it. There are a lot of nice people there. People who feel like they get much better help than here in the hospital. In fact, I can call someone for you and let you talk with them.  LISA: No, no, no, no, no, no, no, no, dont do that.  OFF CAMERA: Youre really fearful of going to rehab.  LISA: Well, if everyone finds out that Ive been to rehab, I wont get a job. I wont be hired anyway.  OFF CAMERA: Plus, if people are fearful of the stigma and fearful of what people will think of them.  LISA: Yeah, but he says that Im not addicted. Its just -- you know something wrong with my personality.  OFF CAMERA: Who says theres something wrong with your personality?  LISA: Jeremy.  OFF CAMERA When did he tell you that?  LISA: Lots of times.  OFF CAMERA: I thought you said you and Jeremy split up after you caught him cheating.  LISA: I --  OFF CAMERA: Its okay. Take your time.  LISA: Well yeah, he moved back in.  OFF CAMERA: Into your new home?  LISA: Yeah. What changed that you two decided to get back together?  OFF CAMERA: Well, he said he was sorry and he begged me. Hes done it before so I took him back.  LISA: And how has that been being back with Jeremy?  OFF CAMERA Well I love Jeremy. I do and dont want to go out and find another boyfriend. I mean we lost 80,000 dollars on that business. And he promised me that he would make it all back.  LISA So is that why you took him back? Has Jeremy continued smoking crack?  OFF CAMERA: Yeah, a little but hes not addicted. He says that it calms him down. Me too.  LISA: You too?  OFF CAMERA: So, do you smoke crack with Jeremy?  LISA: Yeah, we -- he made me try it.   [ Crying]  LISA: And then he tried just once. We did it together. [Inaudible] I could.  [ Crying]  LISA: Hit me like a bullet. And it felt so good. I felt so good. And real fast.   LISA: Have you ever felt like you were dancing with butterflies?  OFF CAMERA: Dancing with butterflies? No, I have not.  LISA: But he says its not addictive, Jeremy.  OFF CAMERA: What do you think?  LISA: Well, I know I cant get enough.  [ Crying]  LISA: And I know I dont want to go back to feeling horrible again because when I dont smoke it I get worse. And when I have it, I feel good. And then its gone. And then I know that Im going to be needing another hit.  OFF CAMERA: That sounds a lot like addiction.  LISA: Yeah, but I know I dont want it to be.  OFF CAMERA: It sounds like you are very scared of getting help and yet at the same very time, it sounds like you know you need that help.  LISA, I know I dont need help. I dont need anything. Jeremy promised me that everything is going to be okay. And when you love someone like I do, you got to believe him. Right?  END TRANSCRIPT  BEGIN TRANSCRIPT:  Training Title 114 ALLY (ph) Really, come on. Im missing first period. And now you want me to be late for my second class. Can we do this during my third period break?  UNKNOWN I… Im sorry, Ally(ph) but principal Michaels requested that you and I take some time this morning and talk. I… I know we worked together before right now, Im going to have to put on my professional app.  ALLY (ph) Thats ridiculous. Why?  UNKNOWN Well, maybe you can tell me why.  ALLY (ph) I have a class waiting for me.  UNKNOWN Well, you been frequently late for your classes. In fact, lets say uh… 22 days so far this year?  ALLY (ph) It has not been 22 days.  UNKNOWN Yes, it has, something not right here at school or something not right at home.  ALLY (ph) My personal life is fine. And personal.  UNKNOWN I know you havent changed addresses so it cant be the traffic.  ALLY (ph) Jesus. The History Department had a party last night a Darrels(ph). Why dont you bring him in here and question him?  UNKNOWN So are you saying the Darrels(ph) party is the reason that you were late? That was last night? I dont understand.  ALLY (ph) Okay. Alcohol was served. We had a bit much to drink. Not just me. Were adults here. And I mean, the… the school host of social hour on campus every month.  UNKNOWN So what are you saying? Are you saying that you were drunk?  ALLY (ph) I drank, but no.  UNKNOWN Were you intoxicated enough that you passed out?  UNKNOWN I woke up and Darrels(ph) cash responding. And, and fuck him for not waking me. He came to school on time but lets be there lying on the couch.  UNKNOWN Have you passed out other times?  ALLY (ph) We have all passed out at times. Im sure Ive seen you drunk at those parties.  UNKNOWN Are you still feeling intoxicated this morning?  ALLY (ph) No, Course not.  UNKNOWN Have you ever been drunk? While you were here teaching?  ALLY (ph) No.  UNKNOWN Im asking that because weve had complaints.  ALLY (ph) Complaints from who?  UNKNOWN Students, parents.  ALLY (ph) Well, bring him in. Let them tell that to my face because its totally not true.  UNKNOWN Theyve complained that at different times you came into class and then you ordered the kids to read from their textbook or you ordered the kids to copy notes from the board while you were sleeping with your head on the desk.  ALLY (ph) You have to be kidding me.  UNKNOWN Several students and several parents have complained.  ALLY (ph) Exactly who, Alexis? Do you know how many problems shes created for the teachers at the school?  UNKNOWN But you were drinking last night. And it sounds like you drank enough that you passed out and had to sleep on Darrels(ph) couch?  ALLY (ph) Yes. I mean, I did.  UNKNOWN So, is there something going on in your personal life?  ALLY (ph) No.  UNKNOWN Hows Ryan?  ALLY (ph) Ryan? First time Ive known you to travel slow here. We split up before the school year started. Last summer.  UNKNOWN What happened?  ALLY (ph) Im really, really uncomfortable sharing anything about my relationships with you.  UNKNOWN Okay, thats fair. That is your personal life.  ALLY (ph) Is there any reason I just cant walk out of this office right now?  UNKNOWN Well, I dont know the specifics of what the Board of Education would decide if you dont cooperate, but Im guessing at something pretty serious.  ALLY (ph) This is unbelievable.  UNKNOWN Wait, wait. Wait a minute. The administration asked me to speak with you. The school wants to work with you if youll cooperate. And as someone who really likes you. I am warning to understand. Im hoping to help you. So just, okay, thank you. Good. Now, whats going on?  ALLY (ph) I dont know.  UNKNOWN Okay. How much did you drink last night?  ALLY (ph) Too much.  UNKNOWN How often do you drink too much?  ALLY (ph) I dont know.  UNKNOWN How much would you estimate that you drink in a typical week?  ALLY (ph) Every night.  UNKNOWN Do you drink with friends, family, by yourself?  ALLY (ph) Alone. Once in a while Ill go to a bar with my friends or drink at school functions. Where I might add they do supply alcohol liberally.  UNKNOWN Yes.  ALLY (ph) Theyre removing our social hours to downtown.  UNKNOWN Do you go out and drink other than with friends?  ALLY (ph) Occasionally.  UNKNOWN Do you drink alone at home?  ALLY (ph) Few glasses of wine while a grade takes the edge off the day.  UNKNOWN Takes the edge off.  ALLY (ph) Yes. The kids here are getting worse by the year. The teachers talk about it. We all know whats going on. They become they just become more… more vicious, more mean. Im talking about kids who have no hint of remorse, no empathy, no thoughtfulness for others. When was the last time you try teaching them?  UNKNOWN I have to admit it has been a while.  ALLY (ph) Just last week, I caught Alexis filming me on her phone. I was bent over picking up trash a student through on the floor. It was not flattering. And you know what she did?  UNKNOWN No.  ALLY (ph) Send it out to the whole grade adding a really obscene title.  UNKNOWN Was she punished?  ALLY (ph) Do the kids here ever get punished? All she caught was a bucking set down with their neuter principal. And then her mom comes threaten Sue again and naturally our fearless leader backs down. Michaels humiliated me. Did the administration tell you that?  UNKNOWN No.  ALLY (ph) Humiliated me. I work for a place that has no backbone, no spine. Who runs this place here? The students or the teachers.  UNKNOWN Sounds horrible.  ALLY (ph) And it goes on day after day. Rich kids who have no respect while you struggle to teach. Im trying to pay bills here. Pay uh… pay the gas, driving shitty car, pay off student loans.  UNKNOWN That does sound like a lot of stress.  ALLY (ph) Sounds like.  UNKNOWN Do you like teaching?  ALLY: (ph) Once upon a time when it had meaning.  UNKNOWN: What about now?  ALLY: (ph) We arent supported.  UNKNOWN: Do you think all of this stress is contributing to your drinking?  ALLY: (ph) Of course it is.  UNKNOWN: Do you drink during the day?  ALLY: (ph) No, no, absolutely not.  UNKNOWN: When you do drink, how much do you drink?  ALLY: (ph) Enough.  UNKNOWN: Enough to pass out?  ALLY: (ph) If Im lucky.  UNKNOWN: How much do you have to drink to get that feeling of being intoxicated?  ALLY: (ph) Five or six glasses of wine, a couple of mixed drinks.  UNKNOWN: Do you think thats more than it takes most people to get intoxicated?  ALLY: (ph) I dont know, but… but I can.  UNKNOWN: So, so do you think alcohol affects your body differently than it affects your friends?  ALLY: (ph) Yes, alcohol affects. Yes.  UNKNOWN: Do you drink more than your friends and the other teachers?  ALLY: (ph) I… I drink, but… but youre not understanding it, it affects me differently.  UNKNOWN: Has it prevented you from doing things or interfered with relationships?  ALLY: (ph) Are you specifically talking about Ryan here?  UNKNOWN: Yeah.  ALLY: (ph) Okay, Ryan did not leave me because I drink.  UNKNOWN: Okay.  ALLY: (ph) Im seeing someone new. We werent even together for a year.  UNKNOWN: Is drinking wine, beer, other alcoholic drinks in the evenings. Is that something new for you? Or was that something typical than your past?  ALLY: (ph) No. Look, my father was an alcoholic growing up. When I was really little he drank. He got into AA and got sober. Mom was very supportive of him, but extremely strict with us in drinking.  UNKNOWN: How did you feel about her being so strict with alcohol?  ALLY: (ph) As a teenager it sucked. I went out with my friends I got drunk. And then freshman year was a huge vendor. Eventually I just I mellowed out.  UNKNOWN And after college?  ALLY: (ph) In grad school I drank here and there but not much.  UNKNOWN: Do you think your alcohol intake is less that when you were in college or is it gone the other way? Has it increased recently?   ALLY: (ph) More.  END TRANSCRIPT  Training Title 151 00:00:15>> I see in your chart that you asked 00:00:15 your family physician to 00:00:20 prescribe oxycodone for your elbow pain, 00:00:20 and that your family physician 00:00:25 is worried that some of other medications, 00:00:30 drugs you may use may interact with the oxycodone? 00:00:35 >> Oxycodone is thats the same as OxyContin? 00:00:35 >> Yeah. Oxycodone is the generic name. 00:00:40 >> Yeah, I did ask for OxyContin, 00:00:45 but I dont take any other medications or drugs. 00:00:50 Im opposed to putting anything unhealthy in my body. 00:00:55 >> Okay. What else have you tried? 00:01:00 >> Nothing else works. 00:01:00 >> Ibuprofen, acetaminophen? 00:01:00 >> Not even close. 00:01:05 >> No? 00:01:05 >> Yeah. I mean, 00:01:05 Im allergic to codeine. 00:01:05 >> Allergic? 00:01:05 >> Yeah, like in Tylenol three. 00:01:10 A little while back, my friend 00:01:10 was in a motorcycle accident and had some leftover, 00:01:15 and I tried one of those, 00:01:15 and I was way allergic. 00:01:20 >> What was the allergic response you had? 00:01:25 >> My face flushed like real bad, 00:01:25 besides it didnt work. 00:01:30 >> Have you tried morphine? 00:01:30 >> Well, thats addictive, isnt it? 00:01:35 >> Yeah, well all the pain medications 00:01:35 or most of them are addictive. 00:01:35 Anti-inflammatory medications are not usually addictive. 00:01:45 >> Yeah, I tried morphine and the codeine, didnt work. 00:01:5 >> Okay. 00:01:50 >> Yeah, I get headaches too, 00:01:55 so ideally I need something that works for both. 00:02:00 Id rather not take two medications if I dont have to. 00:02:05 Less medications the better, 00:02:05 thats what grandma always said. 00:02:05 >> Grandma? Okay. 00:02:05 >> Yeah. 00:02:10 >> Have you ever tried Dilaudid? 00:02:10 >> Yeah. They gave that to me in the ER once, 00:02:15 but just made me dizzy and constipated. 00:02:20 Constipated for like a month. 00:02:25 >> Oh, wow. 00:02:25 >> I almost had to go back to 00:02:25 the hospital for constipation. 00:02:25 Can you imagine having to go to 00:02:25 the hospital for constipation? 00:02:30 >> Oh my goodness. 00:02:30 >> Yeah, thats how bad it was. 00:02:30 >> Have you tried Demerol? 00:02:35 >> Yeah, it kind of worked for my headache. 00:02:40 It comes in a shot, right? 00:02:40 >> Yeah. An injection. 00:02:45 >> Yeah, they gave that to me at the hospital. 00:02:45 But thats the thing, you 00:02:50 can only get it at the hospital, 00:02:50 so its not like its going to work for me every day. 00:02:55 It didnt do anything for my elbow. 00:02:55 OxyContin its the only thing that works for both. 00:03:00 The only thing that works for both. 00:03:00 >> You do seem set on the oxycodone? 00:03:00 >> Because it works. 00:03:05 >> What else have you tried other than medications? 00:03:10 >> Other than medications? 00:03:10 >> Yeah. 00:03:10 >> Yoga. 00:03:10 >> Okay. 00:03:10 >> Yeah. Tried that. Other kinds of meditation. 00:03:20 I mean, thats the thing with meditation is, 00:03:20 it works while youre doing it, 00:03:25 but then as soon as you stop, zilch. Biofeedback. 00:03:30 >> Good. 00:03:30 >> One doc tried that, same thing. 00:03:30 Works while youre doing it, 00:03:35 but then when you stop doesnt help at all. What else? 00:03:40 Like warm, hot compresses, 00:03:45 candles, long walks on the beach, massages. 00:03:50 >> Wow. 00:03:50 >> My boyfriend is really good at massages actually. 00:03:55 Hes studied with this guru in India. 00:03:55 >> Oh, wow. 00:03:55 >> Yeah, swear to God 00:04:00 >> You have tried a lot of solutions. 00:04:00 Let me ask you more about your medication history. 00:04:05 >> I only take stuff for my headache and my elbow. 00:04:10 >> Okay. 00:04:15 >> Like I said, I dont like 00:04:15 putting unhealthy things in my body. 00:04:15 Vitamins, I take vitamins. 00:04:20 >> Yeah? Okay. 00:04:20 >> Like fish oils, some supplements, 00:04:20 but nothing corporate, nothing pharmaceutical. 00:04:25 I dont want to put that in me. 00:04:30 Even coming here today, 00:04:35 asking for this, it goes against my values. 00:04:35 >> I see. Okay. 00:04:35 >> But I got to function. 00:04:40 >> Do you drink alcohol? 00:04:40 >> On special occasions 00:04:45 like weddings, funerals, birthdays. 00:04:50 I got a ton of friends, so 00:04:50 whenever we have a birthday were going to drink. 00:04:55 Let me think, like holidays, 00:04:55 New Years, and Christmases. 00:05:00 Theres Christmas and then we also celebrate 00:05:05 Russian Orthodox Christmas on January 7th. 00:05:10 >> How often on the average? 00:05:15 >> When you add it all up, 00:05:15 once, maybe twice a week, I guess. 00:05:20 >> Will you drink enough to get intoxicated? 00:05:20 >> Depends on who Im drinking with. 00:05:25 As Zane, thats my boyfriend, 00:05:30 he drinks a lot, so 00:05:30 I drink a little more when Im with him. 00:05:30 >> Any legal problems from the drinking? 00:05:35 >> Once. So dumb. 00:05:40 Yeah, just one little charge for drinking. 00:05:45 I was the tiniest little bit over the limit. 00:05:45 So yeah, I got that and I had to take that course, 00:05:50 that stupid, boring course. 00:05:50 But I learned my lesson. If youre 00:05:55 a little bit over the limit, 00:05:55 stick to the back roads. 00:05:55 >> So you will still drive? 00:06:00 >> Well, yeah, but Im super careful. 00:06:00 >> You think after youve been drinking, 00:06:05 thats an okay idea to drive? 00:06:05 >> Its better than letting Zano drive. 00:06:10 >> Zano? 00:06:10 >> Zane, Zano, same person. 00:06:15 Yeah. He doesnt even have his license anymore. 00:06:15 Not that it stops him. 00:06:20 >> What about marijuana? 00:06:20 >> Do I use it? 00:06:25 >> Yeah. 00:06:25 >> Marijuana medically helps with my headaches, 00:06:30 so yeah, I use it. 00:06:35 Its my right. Yeah, its 00:06:35 your right. Its everybodys right. 00:06:40 >> How often? 00:06:40 >> Not often. 00:06:45 Two, four times a week, sometimes none. 00:06:50 Its expensive. Then when you do get some, 00:06:55 suddenly everybody is your best friend and you 00:06:55 got to share, you know how it is. 00:06:55 >> Do you ever grow marijuana? 00:07:00 >> I used to. But then we 00:07:05 moved and its not legal in this backward state. 00:07:05 Where we live its pretty public, 00:07:10 its not really private. 00:07:10 >> Do you ever have any side effects 00:07:15 from using marijuana like memory problems? 00:07:15 >> I was born with memory problems, 00:07:20 Doc, I dont think its from the marijuana. 00:07:20 >> Any legal trouble with the marijuana? 00:07:25 >> Once. I mean, Im super careful. 00:07:30 But Zano, he went away for 00:07:30 a year for selling 00:07:35 the tiniest little bit to an undercover cop, 00:07:35 which is total entrapment, 00:07:40 which is how I lost custody of Camper. 00:07:40 >> Camper? 00:07:45 >> My son. 00:07:45 >> Oh. 00:07:45 >> Yeah. Hes staying with 00:07:45 my ex-husband’s parents right now. 00:07:50 They take good care of him. 00:07:50 >> How long have you been divorced? 00:07:55 >> Oh no, I never married that guy. 00:07:55 >> Oh. 00:07:55 >> No way I would marry that jerk. 00:08:00 No, I dont know. 00:08:00 Its been like four years since Ive even seen him. 00:08:05 Something like that, four years. 00:08:05 >> What happened? 00:08:10 >> Lucas, my ex, 00:08:10 he freaked out because he caught 00:08:15 me doing just a few lines of coke, 00:08:15 but everybody was doing it back then. 00:08:20 Anyway, his mom found the mirror, 00:08:25 and the razors, and Lucas said I had to quit. 00:08:30 For whatever I lied, 00:08:35 and when he caught me, 00:08:35 I know it was bad to lie about that, 00:08:40 but I dont know its in the past. 00:08:45 Water under the bridge. You live, you learn, you move on. 00:08:45 >> Right. Do you use cocaine now? 00:08:50 >> No, hardly ever. 00:08:55 I dont know, its been like a month maybe, 00:08:55 or two months or something since I have. 00:08:55 >> Any legal problems from using cocaine? 00:09:05 >> No, we hardly ever do it. 00:09:10 >> Have you thought about stopping altogether? 00:09:15 >> I hardly ever do it. 00:09:15 Hardly even counts. 00:09:20 I dont know, when I do it, 00:09:20 its just to relieve tension 00:09:20 or its this thing Zano 00:09:25 and I do to bring each other closer together, 00:09:30 but I could quit anytime I wanted, easy. 00:09:35 >> Does your boyfriend have children? 00:09:35 >> Yeah, hes got two kids. 00:09:40 Yeah, but we dont see them much. 00:09:45 His other with his ex. 00:09:45 >> Oh? 00:09:50 >> Shes a real snobby type. You know the type? 00:09:50 It is a freaking tragedy 00:09:55 because I see his two kids 00:09:55 just going down that same path. 00:10:00 Theyre just two little snobs. 00:10:00 Its a real shame. 00:10:05 Were not allowed to see them anymore though, 00:10:10 so I guess like whats the difference? 00:10:10 She went to court and said we were unsuitable. 00:10:15 Not suitable. 00:10:20 Says it all real nice in court, 00:10:20 and then not so nice over the phone, 00:10:20 if you know what I mean? 00:10:25 Shes a real bitch. 00:10:25 >> Any other drugs? 00:10:25 Ecstasy? LSD? 00:10:35 >> This is going to make me sound like Im 00:10:35 some 1970s hippy, druggo person. 00:10:40 Ive tried ecstasy twice, 00:10:45 just twice, and LSD once, last year. 00:10:50 That was a bad trip. I am not doing that again. 00:10:55 >> Anything else? 00:10:55 >> Like what? 00:11:00 >> Stimulants? 00:11:00 >> Like power drinks if I need to stay up? 00:11:05 >> Sure 00:11:05 >> Caffeine, I drink a lot of coffee. 00:11:10 I dont know if cigarettes, 00:11:10 do they count as stimulants? 00:11:10 >> Yeah. 00:11:10 >> Yeah, Im trying to cut back. 00:11:15 Two packs a day. 00:11:15 >> Ritalin, Dexedrine? 00:11:20 >> Oh, stimulants? 00:11:20 >> Right 00:11:20 >> Oh, yeah. Not a lot. Week 8 Substance-Related and Addictive Disorders Training Title 82 Name: Lisa Pittman Gender: female Age: 29 years old T- 99.8 P- 101 R 20 178/94 Ht 5’6 Wt 140lbs Background: Lisa is in a West Palm Beach, FL detox facility thinking about long term rehab. She has been smoking crack cocaine, approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”), and 2–3 alcohol drinks once weekly. She has past drug possession and theft convictions; currently on 2 yr probation with randomized drug screens. She tries to find the pattern for the calls in order not to test dirty urine. Her admission labs abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS positive for cocaine, THC. Negative for alcohol or other drugs. BAL 0; other labs within normal ranges. She reports sexual abuse as child ages 5–7, perpetrator being her father who went to prison for the abuse and drug charges. She is estranged from him. Mother lives in Alabama, hx of anxiety, benzodiazepine use. Older brother has not contact with family in last 10 years, hx of opioid use. Sleeps 4-5 hrs, appetite decreased, prefers to get high instead of eating. Allergies: amoxicillin She is considering treatment for her Hep C+ but needs to get clean first. Symptom Media. (Producer). (2017). Training title 82 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-82 Training Title 114 Name: Ally Patel Gender: female Age: 48 years old Background: Only child, raised by parents in San Francisco, CA. Has PhD in biology and master’s degree in high school education (8–12). Her supervisor has asked the school EAP counselor to intervene with concerns regarding potential substance use in effort to facilitate getting her help and be able to retain her. Symptom Media. (Producer). (2018). Training title 114-2 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-114-2 Training Title 151 Name: Katarina Bykov Gender: female Age:41 years old T- 97.4 P- 74 R 120 100/70 Ht 5’8 Wt 117lbs Background: Moved to Washington State from Russia with her parents when she was 12 years old. She has 2 brothers, 2 sisters. Denied family mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx; Menses regular. Has chronic pain issues. She works part time cashier at Aldi Grocery Store. Dropped out of high school in 11th grade. Sleeps 4–9 hours on average, appetite good. Symptom Media. (Producer). (2018). Training title 151 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-151 ASSIGNMENT QUESTIONS An important consideration when working with patients is their cultural background. Understanding an individuals culture and personal experiences provides insight into who the person is and where he or she may progress in the future. Culture helps to establish a sense of identity, as well as to set values, behaviors, and purpose for individuals within a society. Culture may also contribute to a divide between specific interpretations of cultural behavior and societal norms. What one culture may deem as appropriate another culture may find inappropriate. As a result, it is important for advanced practice nurses to remain aware of cultural considerations and interpretations of behavior for diagnosis, especially with reference to substance-related disorders. At the same time, PMHNPs must balance their professional and legal responsibilities for assessment and diagnosis with such cultural considerations and interpretations. For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background. To Prepare: · Review this week’s Learning Resources and consider the insights they provide. · Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment. · Select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind. · Consider what history would be necessary to collect from this patient. · Consider what interview questions you would need to ask this patient. · Identify at least three possible differential diagnoses for the patient. Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis. Incorporate the following into your responses in the template: · Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?  · Objective: What observations did you make during the psychiatric assessment?   · Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case. · Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.). PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW: 1). ZERO (0) PLAGIARISM. 2). AT LEAST 5 REFERENCES, NO MORE THAN 5 YEARS (WITHIN 5YRS, OR LESS THAN 5YRS) 3). PLEASE SEE THE ATTACHED RUBRIC DETAILS, Comprehensive Psychiatric Evaluation Exemplar, Comprehensive Psychiatric Evaluation Template, Patient History Report, and transcripts. Assignment question. 4). Please review and follow the grading rubric details, and include each component in the assignment as required. Also, follow the APA 7 writing rules and style/Format. Thank you.   NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template Week (enter week #): (Enter assignment title) Student Name College of Nursing-PMHNP, Walden University NRNP 6635: Psychopathology and Diagnostic Reasoning Faculty Name Assignment Due Date Subjective: CC (chief complaint): HPI: Past Psychiatric History: · General Statement: · Caregivers (if applicable): · Hospitalizations: · Medication trials: · Psychotherapy or Previous Psychiatric Diagnosis: Substance Current Use and History: Family Psychiatric/Substance Use History: Psychosocial History: Medical History: · Current Medications: · Allergies: · Reproductive Hx: ROS: · GENERAL: · HEENT: · SKIN: · CARDIOVASCULAR: · RESPIRATORY: · GASTROINTESTINAL: · GENITOURINARY: · NEUROLOGICAL: · MUSCULOSKELETAL: · HEMATOLOGIC: · LYMPHATICS: · ENDOCRINOLOGIC: Objective: Physical exam: if applicable Diagnostic results: Assessment: Mental Status Examination: Differential Diagnoses: Reflections: References © 2021 Walden University Page 1 of 3