NUR620 wk6 discussion & responses

Patient Care

After studying Module 1: Lecture Materials & Resources, discuss the following:
The unlawful restraint of a patient can be a legal pitfall for the PMHNP. K.W. was found
eating hamburgers out of a Mcdonald’s dumpster and drinking water from an old water
hose. She had not taken a bath in weeks. She refused to live in an apartment because
she wants to “live off the fat of the land.”
1. Cite the Baker Act law to defend your position.

2. Find one newspaper article written in the last 5 years that supports your
position. Summarize the details of the case and the laws cited

Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)

• All replies must be constructive and use literature where possible.
Patient Information
After studying Module 2: Lecture Materials & Resources, discuss the following:
It is very important for all mental health professionals to take very detailed and
thorough historical information from their patients. This information should include an
adequate social history, complete medical history, and a full mental status examination
with a probable treatment plan.
• Describe three reasons it is important to gather detailed and extensive
information from any patient before you counsel him/her or make
medication suggestions. Use evidence-based research to support your
position.
• Define malingering. Discuss two ways to differentiate between malingering and
a DSM5 diagnosis. Use evidence-based research to support your position.

Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)

• All replies must be constructive and use literature where possible.
Anxiety Case
After studying Module 3: Lecture Materials & Resources, discuss the following:

Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)

• All replies must be constructive and use literature where possible.

1. Discussion Post
Elvira Angelica Silva de Vera – Teacher
Sep 30, 10:53am

Reply from Elvira Angelica Silva de Vera
Given Ms. Richardson’s overlapping symptoms suggestive of both delirium and dementia with psychosis, what clinical tools or assessments would you prioritize to accurately differentiate these conditions in the acute hospital setting, and how would this distinction impact your immediate treatment approach?

2. Reply from PHG

Psychiatric Case Study: Ms. Richardson

Clinical Summary
Ms. Richardson is a 74-year-old African American female brought to the emergency department by police after reports from neighbors of wandering, self-neglect, and confusion. On arrival, she was unkempt, malodorous, and disoriented to time and place, though she knew her name and address. She was minimally responsive, with a flat affect, poor eye contact, and limited insight. She reported generalized weakness, shoulder pain, difficulty swallowing, and not eating for three days. She recalled her dog being tranquilized and erroneously believed it was in “the shop,” showing signs of confusion. She denied hallucinations or prior psychiatric hospitalizations but mentioned seeing a psychiatrist for insomnia in the past. Her home environment was severely unsanitary, with feces and clutter, suggesting severe self-neglect.

She was also noted to have uncontrolled diabetes, dehydration, and malnutrition.

• Subjective data includes weakness, shoulder pain, and not eating for three days.
• Objective data includes unkempt appearance, malodorous, disoriented to time and place, impaired insight, poor judgment, unsafe environment, uncontrolled diabetes, difficulty swallowing, dehydration, and poor nutritional intake.

Her presentation suggests acute cognitive decline with possible chronic neurocognitive disorder (Tusaie, 2023, pp. 328–351).

Primary Diagnosis
F05 – Delirium due to Another Medical Condition (DSM-5-TR Code: 293.0; ICD-10 F05)

Ms. Richardson’s presentation is most consistent with delirium due to another medical condition. According to the DSM-5-TR, delirium is defined as an acute disturbance in attention and awareness that develops over a short period, fluctuates in severity, and is associated with additional cognitive impairments such as memory deficits, disorientation, or perceptual disturbances. It must be attributable to a physiological cause such as a medical illness, substance intoxication, or metabolic imbalance (American Psychiatric Association [APA], 2022).

According to Tusaie (2023), such presentations in older adults often reflect delirium, a reversible condition commonly triggered by metabolic disturbances or infections. Her risk factors include advanced age, poor glucose control, nutritional deficiency, and social isolation, aligning with known etiologies of delirium (pp. 328–351).

Two Differential Diagnoses

1. Major Neurocognitive Disorder (NCD), Unspecified Type (DSM-5-TR Code: 294.20; ICD-10: F03.90)
   DSM-5-TR defines major NCD as a significant cognitive decline in one or more domains including memory, executive function, attention, and language that interferes with independence (APA, 2022). Ms. Richardson’s functional decline and neglect could suggest an underlying dementia, which may have been masked by acute delirium. Delirium may occur superimposed on major NCD, and evaluation should be repeated after medical stabilization (Tusaie, 2023, pp. 328–351).
2. Depressive Disorder with Cognitive Impairment (Pseudodementia) (DSM-5-TR Code: 311; ICD-10: F32.9)
   Late-life depression may manifest as cognitive slowing, poor concentration, apathy, and self-neglect, mimicking dementia (APA, 2022). Ms. Richardson’s flat affect and limited responsiveness may represent depressive features. Distinguishing pseudodementia through mood assessment and improvement with antidepressant therapy can help differentiate it from degenerative cognitive disorders (Tusaie, 2023, pp. 328–351).

Pharmacological Treatment
The primary pharmacologic goal in Ms. Richardson’s case is to treat the underlying medical cause of delirium. According to NICE (2023) guidelines, management should begin with intravenous fluids and electrolyte correction to address dehydration, along with insulin therapy based on ADA (2023) standards to stabilize hyperglycemia. Nutritional supplements including multivitamins and thiamine help to correct deficiencies contributing to cognitive impairment.

If Ms. Richardson develops behavioral agitation or perceptual disturbances, low-dose haloperidol (0.25–0.5 mg PO/IM every 4–6 hours as needed) may be administered, with ECG monitoring for potential QT prolongation. Haloperidol is often recommended for short-term symptom management in delirium when nonpharmacologic interventions are insufficient (APA, 2023). If cognitive symptoms persist after medical stabilization and a major neurocognitive disorder (NCD) is confirmed, pharmacologic agents such as donepezil (5 mg daily) or memantine (5 mg daily) may be initiated to support cognitive function (Tusaie, 2023, pp. 328–351).

Nonpharmacological Treatment
Nonpharmacological treatment is important in delirium management. The primary goal is to restore orientation, ensure safety, and address modifiable risk factors through environmental and behavioral interventions. Ms. Richardson should be placed in a quiet, well-lit environment with visible clocks, calendars, and familiar objects to enhance orientation and reduce confusion. Consistent caregivers and family involvement can provide reassurance and emotional stability.

Reorientation strategies, including frequent verbal reminders of time, place, and situation, can be used throughout the day. To support physiological stability, she should maintain adequate hydration and nutrition. Sleep hygiene is another critical component; nighttime noise and interruptions should be minimized to promote restorative sleep. Collectively, these multicomponent interventions have been shown to reduce both the severity and duration of delirium while promoting functional recovery (Tusaie, 2023, pp. 328–351).

Health Promotion Intervention
Health promotion for Ms. Richardson should focus on chronic disease management, safety, and social support to prevent recurrence of delirium and enhance overall well-being. Education on diabetes self-management is essential, following the American Diabetes Association (2023) standards. This includes teaching her how to monitor blood glucose, adhere to prescribed insulin therapy, and maintain a balanced diet.

Given her unsafe home environment and self-neglect, referrals to Adult Protective Services (APS) and home health nursing are warranted for supervision and support. Social services can assist in arranging community resources such as Meals on Wheels, senior day programs, and transportation to reduce isolation and improve access to care. If a major neurocognitive disorder or depression is identified, appropriate long-term treatment can be initiated (Tusaie, 2023, pp. 328–351).