A 74-year-old African American woman, Ms. Richardson
| A 74-year-old African American woman, Ms. Richardson, was brought to the hospital emergency room by the police. She is unkempt, dirty, and foul-smelling. She does not look at the interviewer and is apparently confused and unresponsive to most of his questions. She knows her name and address, but not the day of the month. She is unable to describe the events that led to her admission. The police reported that they were called by neighbors because Ms. Richardson had been wandering around the neighborhood and not taking care of herself. The medical center mobile crisis unit went to her house twice but could not get in and presumed she was not home. Finally, the police came and broke into the apartment, where they were met by a snarling German shepherd. They shot the dog with a tranquilizing gun and then found Ms. Richardson hiding in the corner, wearing nothing but a bra. The apartment was filthy, the floor littered with dog feces. The police found a gun, which they took into custody. The following day, while Ms. Richardson was awaiting transfer to a medical unit for treatment of her out-of-control diabetes, the psychiatric provider attempted to interview her. Her facial expression was still mostly unresponsive, and she still didn’t know the month and couldn’t say what hospital she was in. She reported that the neighbors had called the police because she was “sick,” and indeed she had felt sick and weak, with pains in her shoulder; in addition, she had not eaten for 3 days. She remembered that the police had shot her dog with a tranquilizer and said the dog was now in “the shop” and would be returned to her when she got home. She refused to give the name of a neighbor who was a friend, saying, “he’s got enough troubles of his own.” She denied ever being in a psychiatric hospital or hearing voices but acknowledged that she had at one point seen a psychiatrist “near downtown” because she couldn’t sleep. He had prescribed medication that was too strong, so she didn’t take it. She didn’t remember the name, so the interviewer asked if it was Thorazine. She said no, it was “allal.” ‘Haldol?”, ask the interviewer. She nodded. The interviewer was convinced that was the drug, but other observers thought she might have said yes to anything that sounded remotely like it, such as “Elavil.” When asked about the gun, she denied, with some annoyance, that it was real and said it was a toy gun that had been brought to the house by her brother, who had died 8 years ago. She was still feeling weak and sick, complained of pain in her shoulder, and apparently had trouble swallowing. She did manage to smile as the team left her bedside. | |
| Questions: | Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers.Summarize the clinical case including the significant subjective and objective data.Generate a primary and two differential diagnoses. Use the DSM5 to support the assessment. Include the DSM5 and ICD 10 codes.Discuss a pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment.Discuss non-pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment.Describe a health promotion intervention that would be appropriate for this patient. |
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.
- Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
- Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
- You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.
Grading Rubric
Your assignment will be graded according to the grading rubric, which is found by clicking the three dots in the upper right-hand corner and selecting \\”show rubric\\” from the menu.PMHNP Discussion Rubric
| Criteria | Ratings | Pts | |
|---|---|---|---|
| This criterion is linked to a Learning OutcomeIdentification of Main Issues, Problems and Concepts | 4 to >3.0 ptsDistinguishedPost substantively accurate. Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts surrounding the assignment. Provides exceptional and thought-provoking analysis that directly addresses details and/or examples of the main topic.3 to >2.0 ptsExcellentPost is mostly related to the topic. Demonstrates understanding of most of the issues, problems, and concepts surrounding the assignment. It provides some supporting details and/or examples. Analyses not as clear as they could be.2 to >0.0 ptsFairDemonstrate limited understanding of most of the issues, problems, and concepts surrounding the assignment. No details and/or examples are given.0 ptsPoorPost is off-topic, incorrect and/or irrelevant to the issues, problems, and concepts surrounding the assignment. Analyses are not well organized or clear. | 4 pts | |
| This criterion is linked to a Learning OutcomeAPA Formatting Guidelines | 2 ptsDistinguishedThe reference page contains at least the required current scholarly academic reference and text reference. Follows APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent and in-text citations.1 ptsExcellentReferences page contains one current scholarly academic resource and text reference. Follows most APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations.0.5 ptsFairReferences page contains one current or outdated scholarly academic resource. Many errors of APA guidelines: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations0 ptsPoorReferences page contains no current scholarly academic resources, only internet webpages or no reference page. Lack of APA guidelines for references provided or in-text citations. | 2 pts | |
| This criterion is linked to a Learning OutcomeWriting Mechanics | 2 ptsFull MarksRules of grammar, usage and punctuation are followed; spelling is correct.1 ptsExcellentFew grammatical errors, but sentences could be clearer and more precise.0.5 ptsFairPaper contains few grammatical, punctuation and spelling errors.0 ptsPoorPaper contains numerous grammatical, punctuation, and spelling errors. | 2 pts | |
| This criterion is linked to a Learning OutcomeResponse to Peers | 2 ptsDistinguishedConstructively responded to two other posts and either extended, expanded, or provided a rebuttal to each.1 ptsExcellentConstructively responded to one other post and either extended, expanded, or provided a rebuttal.0 ptsPoorProvided no response to a peer\\\’s post. | 2 pts | |
| Total Points: 10 |
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