NSG6420 – Unintentional weight loss

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NSG6420 – Unintentional weight loss

For this assignment, you will review the case study below and post a discussion for the class answering the noted questions.

You are evaluating a 78 year old white male who comes to your office today with unintentional weight loss of 10lb in the last year, self-reported exhaustion weakness based on grip strength, and slow walking speed, and low physical activity. Notes that he has been feeling worse over the past 6 months and just does not have the strength to do anything anymore. The patient states they are not currently on any medications except a multivitamin.

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He notes that he lives alone and does not want to leave his house. Answer the following questions with supportive rationale:

What questions should you as the patient/family to further assess?

What screening tools would be appropriate in this case?

Do you have concerns with fraility in this patient? If so why?

What referrals should be made if any on this patient?

Payer–patient mix for a health care organization case study

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Payer–patient mix for a health care organization case study

Search course materials, including your text and the Internet, to find a spreadsheet program that will assist you in completing this assignment. The spreadsheet and calculations are to be attached at the end of the paper as an appendix after the Reference page.

Case Study: You are assessing the payer–patient mix for a health care organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care, and 5% self-pay patients. Complete the following:

  • Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).
  • Using the same CPT code, 99214, determine the reimbursement for Medicaid (fee schedules should be available from the individual state).
  • Using the same CPT code, 99214, create at least 3 other traditional indemnity insurance reimbursements. If possible, use the actual reimbursement from the insurance carrier. It may be possible to obtain actual reimbursement information from your personal insurance carrier. If the information is not available, assume reimbursement by traditional indemnity insurance is usually 200% reimbursed more than Medicare and Medicaid, and managed care is usually 133% more than Medicare and Medicaid.

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  • Compose an accounts receivable benchmark from this information showing columns for current, 30–60, 61–90, 90–120, and greater than 120 days.

  • Assess the information for areas of improved reimbursement of at least 20% or more.
  • Evaluate the options available to change the payer–patient mix with consideration of related legal and ethical issues.
  • Propose a best strategy with justification and rationale based on effective decision-making tenets.

The body of the resultant paper should be 10–12 pages. Spreadsheets demonstrating the accounts receivable analysis will be attached as appendices, and there will be at least 7 relevant peer-reviewed academic or professional references published within the past 5 years. Also attach appropriate fee schedules.

Search course materials, including your text and the Internet, to find a spreadsheet program that will assist you in completing this assignment. The spreadsheet and calculations are to be attached at the end of the paper as an appendix after the Reference page.

Case Study: You are assessing the payer–patient mix for a health care organization. Currently, your payer mix is 40% Medicare, 10% Medicaid, 25% traditional indemnity insurance, 20% managed care, and 5% self-pay patients. Complete the following:

  • Using the most common office visit, CPT code 99214, determine the reimbursement from the Centers for Medicare and Medicaid Services (online fee schedule available for Medicare).
  • Using the same CPT code, 99214, determine the reimbursement for Medicaid (fee schedules should be available from the individual state).
  • Using the same CPT code, 99214, create at least 3 other traditional indemnity insurance reimbursements. If possible, use the actual reimbursement from the insurance carrier. It may be possible to obtain actual reimbursement information from your personal insurance carrier. If the information is not available, assume reimbursement by traditional indemnity insurance is usually 200% reimbursed more than Medicare and Medicaid, and managed care is usually 133% more than Medicare and Medicaid.
  • Compose an accounts receivable benchmark from this information showing columns for current, 30–60, 61–90, 90–120, and greater than 120 days.
  • Assess the information for areas of improved reimbursement of at least 20% or more.
  • Evaluate the options available to change the payer–patient mix with consideration of related legal and ethical issues.
  • Propose a best strategy with justification and rationale based on effective decision-making tenets.

The body of the resultant paper should be 10–12 pages. Spreadsheets demonstrating the accounts receivable analysis will be attached as appendices, and there will be at least 7 relevant peer-reviewed academic or professional references published within the past 5 years. Also attach appropriate fee schedules.

Payer–patient mix for a health care organization case study

shadow health tina jones mental health assessment Subjective Data

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Subjective Data Collection: 44 of 44 (100.0%)

Hover To Reveal…

Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.

  • Found:

    Indicates an item that you found.

  • Available:

    Indicates an item that is available to be found.

Category

Scored Items

Experts selected these topics as essential components of a strong, thorough interview with this patient.

Patient Data

Not Scored

A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

Chief Complaint


  • Finding:

    Established chief complaint


  • Finding:

    Reports difficulty sleeping and “feeling nervous”

    (Found)

    Pro Tip: Foundational questions to open an interview will help the patient tell you what’s bothering her in her own words.

    Example Question:

    What brings you in today?

  • Finding:

    Reports seeking treatment because she has an upcoming exam and feels “too foggy to study”

    (Found)

    Pro Tip: Foundational questions will help the patient tell you what’s bothering her in her own words. It is important to ask Tina why she sought treatment to get an understanding of any recent changes with her complaint that could have made it more severe or urgent, prompting her to come in.

    Example Question:

    Why did you decide to seek treatment?

  • Finding:

    Reports excessive worry and “racing thoughts” before bed

    (Available)

    Pro Tip: Foundational questions to open an interview will help the patient tell you what’s bothering her in her own words. Tina says that she “feels nervous” before bed, and it is interfering with her sleep. It is important to ask a follow-up question to gain more details about what feeling nervous means to her. shadow health tina jones mental health assessment Subjective Data.

    Example Question:

    How do you feel just before bed?

History of Present Illness


  • Finding:

    Asked about onset and duration of symptoms


  • Finding:

    Reports difficulty sleeping began 3 1/2 weeks ago

    (Found)

    Pro Tip: Determining if the onset of a complaint was gradual or acute is important for diagnosis. In Tina’s case, you will need this information to assess what could be causing her sleep disturbance.

    Example Question:

    How long have you been having trouble sleeping?

  • Finding:

    Reports sleep difficulties have been occurring regularly during past 3 1/2 weeks

    (Found)

    Pro Tip: Knowledge of the duration of a complaint will help you assess if the issue is recent or chronic. In Tina’s case, you will need this information to assess if she is suffering from chronic insomnia or a more acute sleep disturbance.

    Example Question:

    How long have your sleeping difficulties lasted?

  • Finding:

    Asked about frequency of symptoms


  • Finding:

    Reports difficulty sleeping at least four or five times a week

    (Found)

    Pro Tip: A precise question the number of occurrences of the issue in an allotted span of time will give you the most accurate estimation of frequency. In Tina’s case, it is important to know that she is suffering sleep disturbances for the majority of nights in a given week.

    Example Question:

    How many nights a week do you have trouble sleeping?

  • Finding:

    Asked about aggravating factors


  • Finding:

    Reports sleeping becomes more difficult when she can not redirect her thoughts from the things she is worried about

    (Available)

    Pro Tip: An open question about aggravating factors can be used to assess what could be exacerbating the patient’s complaint, as well as her knowledge of those factors. For Tina, it is important to understand what she thinks makes it more difficult for her to fall asleep.

    Example Question:

    What makes it harder to sleep?

  • Finding:

    Denies naps during the day

    (Found)

    Pro Tip: A closed question about factors that are known to aggravate the complaint will help you to eliminate the most salient possibilities. Though one short nap a day is fine, frequent or extended naps could have been making it more difficult for Tina to fall asleep, and could also indicate an inability to stay awake during her activities of daily living.

    Example Question:

    Do you take naps?

  • Finding:

    Reports drinking caffeine to stay alert

    (Available)

    Pro Tip: A closed question about factors that are known to aggravate the complaint will help you to eliminate the most salient possibilities. Though caffeine helps Tina to stay alert, drinking too much caffeine could interfere with her sleep.

    Example Question:

    Do you drink caffeine?

  • Finding:

    Reports stopping caffeine use after 4 P.M.

    (Available)

    Pro Tip: This follow-up question is needed to assess how likely it is that caffeine consumption is interfering with sleep. If Tina were drinking caffeine late in the afternoon or at night, it would very likely be aggravating, or even causing, her sleep disturbance.

    Example Question:

    When do you usually have your last caffeinated drink?

  • Finding:

    Denies alcohol use before bed

    (Available)

    Pro Tip: A closed question about factors that are known to aggravate the complaint will help you to eliminate the most salient possibilities. Alcohol consumption before bed has been shown to interfere with homeostasis, which regulates sleep, and can even lead to insomnia, so it is important to know if Tina is drinking it to fall asleep.

    Example Question:

    Do you drink alcohol before bed?

  • Finding:

    Denies drug use before bed

    (Available)

    Pro Tip: A closed question about factors that are known to aggravate the complaint will help you to eliminate the most salient possibilities. It is important to know if Tina is using drugs to help her fall asleep because they could, in fact, be contributing to her sleep disturbance.

    Example Question:

    Do you use drugs before bed?

  • Finding:

    Reports respiratory problems are controlled and not interfering with sleep

    (Available)

    Pro Tip: A closed question about factors that are known to aggravate the complaint will help you to eliminate the most salient possibilities. Tina has asthma, and it is important to rule out respiratory issues as a contributing factor to, or even because of, her sleep disturbance. Tina also has an albuterol prescription, which, if she were using it before bed, could be aggravating or causing her anxiety.

    Example Question:

    Do you think your sleep problems could be due to breathing issues?

  • Finding:

    Asked about relieving factors


  • Finding:

    Reports sleeping more easily if she can distract herself from her “racing thoughts”

    (Found)

    Pro Tip: An open question about alleviating factors can be used to assess what brings relief to the patient, as well as her knowledge of those factors. For Tina, it is important to understand what she thinks makes it easier for her to fall asleep.

    Example Question:

    What helps you sleep?

  • Finding:

    Reports no exercise

    (Found)

    Pro Tip: A closed question about factors known to alleviate the complaint will help you diagnose and treat the issue. Exercise is known to improve sleep, so it is important to assess Tina’s exercise level.

    Example Question:

    Do you exercise?

  • Finding:

    Asked about impact of sleeping problems on daily living


  • Finding:

    Reports feeling tired and “out of it” most of the time during the day due to lack of sleep

    (Found)

    Pro Tip: An open question about the effects of the complaint on a patient’s daily life will help you to get a general idea of the severity of the issue as well as allow you to understand how the patient is dealing with and affected by it. In Tina’s case, though her focus and energy is hampered by her sleep disturbance, she is able to perform all of her usual activities of daily living, meaning her insomnia is not severe, but it is debilitating.

    Example Question:

    How does your lack of sleep affect your daily life?

  • Finding:

    Reports no increased chance of drifting off during the day despite lack of sleep

    (Found)

    Pro Tip: A closed question about a specific effect on daily life commonly seen with a patient’s complaint can help you to assess severity, diagnose, and treat it. If Tina were falling asleep without intending to, it could indicate a more severe sleep disorder as well as a more debilitating effect on her daily life.

    Example Question:

    Have you been falling asleep when you didn’t mean to?

  • Finding:

    Followed up about patient’s experience feeling “out of it”


  • Finding:

    Reports feeling slowed down and tired, having trouble focusing, and generally feeling “less sharp”

    (Found)

    Pro Tip: When a patient uses phrasing that is unclear or not specific enough, it is important to ask a follow-up to ensure your understanding of the issue. Asking Tina what she means by “out of it” will help you to gain a more detailed idea of her state of mind during the day, and how it is affected by her sleep disturbance.

    Example Question:

    What do you mean when you say you feel out of it?

  • Finding:

    Asked about anxiety symptoms


  • Finding:

    Reports feelings of anxiety as “thoughts she can’t turn off” and “being on edge”

    (Available)

    Pro Tip: If a patient may have anxiety, asking about symptoms will aid diagnosis and determine severity. An open question about how Tina’s anxiety feels will help you to get a general idea of its character.

    Example Question:

    Can you tell me about how your anxiety feels?

  • Finding:

    Reports worry about the future, but no sense of impending doom

    (Available)

    Pro Tip: If a patient may have anxiety, a sense of impending doom could indicate a panic disorder. Asking Tina about this will help you to come to a diagnosis and to determine severity.

    Example Question:

    Do you ever have a sense of impending doom?

  • Finding:

    Reports no panic attacks

    (Found)

    Pro Tip: If a patient may have anxiety, it is important to determine if she is having panic attacks. Asking Tina about this will help you to come to a diagnosis and to determine severity, especially if she is experiencing panic before bed.

    Example Question:

    Have you been having panic attacks?

  • Finding:

    Reports difficulty concentrating due to fatigue from lack of sleep

    (Available)

    Pro Tip: Difficulty concentrating is an important indicator of generalized or situational anxiety. Asking Tina about this will help you to come to a diagnosis and to determine severity.

    Example Question:

    Have you been having trouble concentrating?

  • Finding:

    Reports only restlessness occurs just before bed

    (Available)

    Pro Tip: Restlessness is an important indicator of generalized or situational anxiety. Asking Tina about this will help you to come to a diagnosis and to determine severity.

    Example Question:

    Do you feel restless?

  • Finding:

    Reports slight irritability due to fatigue

    (Available)

    Pro Tip: Irritability is an important indicator of generalized or situational anxiety. Asking Tina about this will help you to come to a diagnosis and to determine severity.

    Example Question:

    Do you feel irritable?

  • Finding:

    Asked about impact of anxiety on daily living


  • Finding:

    Reports stress only interferes with daily life because it interrupts her sleep

    (Found)

    Pro Tip: The effects of any complaint on a patient’s daily life are important. Asking Tina about the effects of her anxiety on her daily life will help you to come to a diagnosis and to determine severity.

    Example Question:

    How does your anxiety interfere with your daily life?

  • Finding:

    Reports stress does not prevent her from completing her usual activities

    (Found)

    Pro Tip: The effects of any complaint on a patient’s daily life are important. Asking Tina about the effects of her anxiety on her daily life will help you to come to a diagnosis and to determine severity.

    Example Question:

    Does your anxiety prevent you from completing your usual activities?

  • Finding:

    Asked about sleep quality


  • Finding:

    Reports falling asleep often takes more than an hour

    (Available)

    Pro Tip: Sleep disorders may manifest in different ways, including difficulty falling asleep. In Tina’s case, it is important to know that falling asleep takes more than an hour, while normal sleep latency is only 15-20 minutes.

    Example Question:

    How long does it take you to fall asleep?

  • Finding:

    Reports waking up two or three times during the night for “at least ten minutes”

    (Available)

    Pro Tip: Sleep disorders may manifest in different ways, including frequent awakenings. In Tina’s case, it is important to know how often she is waking often during the night, as well as how long it takes her to fall back asleep. shadow health tina jones mental health assessment Subjective Data.

    Example Question:

    How often do you wake during the night?

  • Finding:

    Reports waking in the morning feeling “out of it” and not rested

    (Available)

    Pro Tip: In assessing the severity of a sleep disorder, it is important to determine how rested a patient feels when she wakes up in the morning. Tina is waking up feeling tired and “out of it,” meaning her sleep disturbance is having a noticeable effect on her quality of sleep.

    Example Question:

    How do you feel when you wake up in the morning?

  • Finding:

    Asked about sleep habits


  • Finding:

    Reports going to bed “around midnight,” but feeling “too nervous” to sleep

    (Found)

    Pro Tip: A specific question about a patient’s bed time will elicit the information you need about when they try to fall asleep. In Tina’s case, it is important to know that she is getting into bed long before she falls asleep.

    Example Question:

    When do you go to bed?

  • Finding:

    Reports actually falling asleep at 2 or 3 AM

    (Available)

    Pro Tip: A specific question about when a patient falls asleep will determine sleep latency as well as how much sleep the patient is actually getting. In Tina’s case, it is important to know that she often falls asleep long after she gets into bed.

    Example Question:

    When do you fall asleep?

  • Finding:

    Reports reading before bed

    (Found)

    Pro Tip: A specific question about what a patient does before bed will help you to assess whether something she is doing could be contributing to the sleep disturbance. In Tina’s case, it is important to know that she reads before bed rather than immediately trying to fall asleep.

    Example Question:

    What do you usually do before bed?

  • Finding:

    Reports no screen use (television or computer) before bed

    (Available)

    Pro Tip: The use of electronics before bed has been shown to stimulate brain activity, which can disturb sleep, and the artificial light from most screens may also affect melatonin levels, which regulate sleep cycles. It is important to know that Tina does not watch television or use a computer before bed to eliminate screen use as a possible contributing factor to her sleep disorder.

    Example Question:

    Do you watch television or use the computer before bed?

  • Finding:

    Reports average wake time of 8 AM

    (Available)

    Pro Tip: A specific question about when a patient wakes up can determine if their sleep disturbance is causing early awakening. It is important to know that Tina is waking up at 8 AM, and that it is due to her schedule, not a result of sleep disturbance.

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    Example Question:

    When do you usually wake up?

  • Finding:

    Reports sleeping an average of 4 or 5 hours a night

    (Available)

    Pro Tip: Asking for the average number of hours of sleep a patient gets in one night will elicit the specific information you need to assess the severity of her sleep disorder. In Tina’s case, she is getting less sleep per night than is considered healthy.

    Example Question:

    How many hours of sleep do you get a night?

  • Finding:

    Reports sleeping alone in a quiet room

    (Available)

    Pro Tip: A patient’s sleep environment can interfere with sleep. It is important to know that Tina has a quiet bedroom to herself to rule out anything from her environment that could be interrupting her sleep with or without her knowledge.

    Example Question:

    Can you describe where you sleep?

  • Finding:

    Asked about stress quality


  • Finding:

    Reports feeling nervous and worrying about the future, with racing thoughts

    (Found)

    Pro Tip: Stress can mean different things to different patients, so understanding how a patient experiences stress is essential. In Tina’s case, gathering details about her stress can help you to understand if it is situational or chronic, and how it could be aggravating or causing her sleep disturbance.

    Example Question:

    How do you feel when you are stressed?

Medical History


  • Finding:

    Confirmed use of medications


  • Finding:

    Confirms medications (no new medications reported)

    (Found)

    Pro Tip: Even if you have seen a patient before, it is important to ask about medications in case they have changed since the last visit. In Tina’s case, a new medication she is taking could be causing or aggravating her sleep disturbance.

    Example Question:

    Are you taking any new medications?

  • Finding:

    Followed up about sleep medication use


  • Finding:

    Denies taking OTC sleep medications

    (Found)

    Pro Tip: Even if you have seen a patient before, it is important to ask about medications in case they have changed since the last visit, especially if they are taking anything to treat their chief complaint. In Tina’s case, asking about over the counter sleep medications is important in understanding possible alleviating factors as well as if an over the counter sleep medication could be contributing to her drowsiness during the day.

    Example Question:

    Have you been taking over the counter medications to help you sleep?

  • Finding:

    Denies taking prescription sleep medications

    (Found)

    Pro Tip: Even if you have seen a patient before, it is important to ask about medications in case they have changed since the last visit, especially if they are taking anything to treat their chief complaint. If Tina were taking prescription sleep medication, it could indicate that she has seen someone else about her sleep disturbance or that she has been treated for this problem in the past.

    Example Question:

    Have you been taking prescribed medication to help you sleep?

  • Finding:

    Confirmed allergies


  • Finding:

    Confirms allergies (no new allergies reported)

    (Found)

    Pro Tip: It’s best practice to ask a patient about her allergies each visit, even with an established patient, to uncover any new allergy triggers or symptoms.

    Example Question:

    Have you had any new allergies?

  • Finding:

    Asked about history of sleep problems


  • Finding:

    Reports usually falls asleep very easily and “sleeps like a log”

    (Found)

    Pro Tip: Assessing the history of a patient’s present illness is essential to diagnosis and treatment of the complaint. Knowing that until recently Tina hadn’t had similar sleep issues will help you narrow down possible causes.

    Example Question:

    Do you have a history of sleep problems?

  • Finding:

    Reports only past sleep problems occurred for a few months after her father died, but they resolved on their own

    (Found)

    Pro Tip: Assessing the history of a patient’s present illness is essential to diagnosis and treatment of the complaint. Knowing that Tina had similar sleep problems during a difficult time in her life, and that the problem resolved itself, is integral to diagnosis and treatment.

    Example Question:

    Have you had difficulty falling asleep before?

Psychological History


  • Finding:

    Asked about history of psychiatric illness


  • Finding:

    Denies history of depression

    (Found)

    Pro Tip: Differentiating between depression and anxiety can sometimes be difficult, and often a patient will have both. Depression is also often a contributing factor in sleep disturbance, and sleep disturbance can also often contribute to depression. If Tina had a history of depression, it could be contributing to her sleep issues.

    Example Question:

    Have you ever had depression?

  • Finding:

    Denies history of anxiety

    (Found)

    Pro Tip: Anxiety is a common cause of sleep disturbance, and lack of sleep can also contribute to anxiety issues. If Tina had a history of anxiety, it could be causing or aggravating her current sleep disturbance.

    Example Question:

    Do you have a history of anxiety?

  • Finding:

    Denies current psychiatric illness

    (Available)

    Pro Tip: When performing a mental health assessment, it is essential to do a complete mental status exam. However, asking a patient about possible current psychiatric illness in order to understand her mental health status is also important. In Tina’s case, you should ask her generally about her mental health, and you should also ask about specific psychiatric disorders to rule them out. shadow health tina jones mental health assessment Subjective Data.

    Example Question:

    Do you have a psychiatric illness?

  • Finding:

    Denies history of psychiatric illness

    (Available)

    Pro Tip: As with any patient interview, it is important to ask about any relevant medical history. Tina is here for her mental health, so asking about her history of psychiatric illness is essential.

    Example Question:

    Do you have a history of psychiatric illness?

  • Finding:

    Denies bipolar disorder

    (Available)

    Pro Tip: When performing a mental health assessment, it is essential to do a complete mental status exam. However, asking a patient about possible current psychiatric illness in order to understand her mental health status is also important. In Tina’s case, you should ask her generally about her mental health, and you should also ask about bipolar disorder to rule it out.

    Example Question:

    Do you have bipolar disorder?

  • Finding:

    Denies schizophrenia

    (Available)

    Pro Tip: When performing a mental health assessment, it is essential to do a complete mental status exam. However, asking a patient about possible current psychiatric illness in order to understand her mental health status is also important. In Tina’s case, you should ask her generally about her mental health, and you should also ask about schizophrenia to rule it out.

    Example Question:

    Do you have schizophrenia?

  • Finding:

    Denies obsessive compulsive disorder

    (Available)

    Pro Tip: When performing a mental health assessment, it is essential to do a complete mental status exam. However, asking a patient about possible current psychiatric illness in order to understand her mental health status is also important. In Tina’s case, you should ask her generally about her mental health, and you should also ask about obsessive compulsive disorder to rule it out.

    Example Question:

    Do you have obsessive compulsive disorder?

  • Finding:

    Denies past psychiatric treatment

    (Available)

    Pro Tip: Even if a patient has not been diagnosed with a psychiatric illness, she could have seen a counselor, therapist, psychologist, or psychiatrist in the past. Asking Tina about past treatment could give you important context for diagnosis.

    Example Question:

    Do you have a history of psychiatric illness?

  • Finding:

    Denies past psychotropic medications

    (Available)

    Pro Tip: Knowledge of past medications is integral to the history of the present illness. Tina is here for a mental health assessment, so it is important to ask her about any past medications for psychiatric illness.

    Example Question:

    Have you ever taken psychotropic medication?

  • Finding:

    Asked about symptoms to determine depression risk


  • Finding:

    Reports belief she does not have depression symptoms

    (Available)

    Pro Tip: While a patient with depression does not always know she has it, it is important to ask. If Tina had depression, it could be contributing to her sleep disturbance, or her sleep disturbance could be causing or aggravating or depression.

    Example Question:

    Do you have symptoms of depression?

  • Finding:

    Reports no difficulty making decisions

    (Found)

    Pro Tip: Difficulty making decisions is an important indicator of depression. Asking Tina about this will help you to come to a differential diagnosis and determine severity.

    Example Question:

    Do you have difficulty making decisions?

  • Finding:

    Reports slightly decreased energy due to lack of sleep

    (Available)

    Pro Tip: An uncharacteristic lack of energy is an important indicator of depression. Asking Tina about this will help you to come to a differential diagnosis and determine severity.

    Example Question:

    Have you had less energy than usual?

  • Finding:

    Denies feelings of guilt or worthlessness

    (Available)

    Pro Tip: Feelings of guilt or worthlessness are important indicators of depression. Asking Tina about this will help you to come to a differential diagnosis and determine severity.

    Example Question:

    Have you been feeling guilty for no reason?

  • Finding:

    Denies feelings of hopelessness

    (Found)

    Pro Tip: Feelings of hopelessness are important indicators of depression. Asking Tina about this will help you to come to a differential diagnosis and determine severity.

    Example Question:

    Have you been feeling hopeless?

  • Finding:

    Denies loss of enjoyment in activities usually found enjoyable

    (Available)

    Pro Tip: A loss of enjoyment in activities usually found enjoyable is an important indicator of depression. Asking Tina about this will help you to come to a differential diagnosis and determine severity.

    Example Question:

    Have you had trouble enjoying your usual activities?

  • Finding:

    Reports slightly less appetite because she feels “a little queasy” from lack of sleep

    (Available)

    Pro Tip: An unusual increase or decrease in appetite is an important indicator of depression. Asking Tina about this will help you come to a differential diagnosis and determine severity.

    Example Question:

    Have you had a change in appetite?

  • Finding:

    Denies feelings of sadness

    (Available)

    Pro Tip: Feeling sad is an important indicator of depression. Asking Tina about this will help you to come to a differential diagnosis and determine severity.

    Example Question:

    Have you been feeling sad?

  • Finding:

    Asked about suicidal tendencies


  • Finding:

    Denies suicidal thoughts

    (Found)

    Pro Tip: When assessing mental health risk factors, it is important to rule out your patient as a suicide risk. Tina would be considered a suicide risk if she had been thinking about or planning to commit suicide.

    Example Question:

    Have you ever had suicidal thoughts?

  • Finding:

    Denies suicidal behaviors

    (Available)

    Pro Tip: When assessing mental health risk factors, it is important to rule out your patient as a suicide risk. Tina would be considered a suicide risk if she had ever engaged in suicidal behavior.

    Example Question:

    Have you ever done something that could end your life?

  • Finding:

    Denies past suicide attempts

    (Available)

    Pro Tip: When assessing mental health risk factors, it is important to rule out your patient as a suicide risk. Tina would be considered a suicide risk if she had attempted suicide recently or in the past.

    Example Question:

    Have you attempted suicide in the past?

  • Finding:

    Asked about self-harm


  • Finding:

    Denies history of self-harm

    (Found)

    Pro Tip: Self-harm is an indicator of psychiatric disorders as well as a potential risk for suicide. Knowing if Tina has engaged in self-harm is important to assessing her mental health and her safety.

    Example Question:

    Have you ever intentionally hurt yourself?

  • Finding:

    Asked about past trauma


  • Finding:

    Denies past trauma

    (Found)

    Pro Tip: Recurring traumatic memories could indicate post-traumatic stress disorder, a significant aspect of a patient’s mental health and well-being. If Tina had traumatic memories, it would be important to assess PTSD as a risk factor.

    Example Question:

    Have you ever had repeated, disturbing memories of a stressful experience from the past?

  • Finding:

    Asked about history of violent thoughts


  • Finding:

    Denies angry outbursts

    (Available)

    Pro Tip: Difficulty controlling anger is an indicator of psychiatric illness as well as a potential risk to others. Asking Tina about anger is important in assessing her mental health and safety.

    Example Question:

    Have you ever had angry outbursts?

  • Finding:

    Denies past violent behavior

    (Found)

    Pro Tip: Violence is an indicator of psychiatric illness as well as a potential risk to others. Asking Tina about violence is important in assessing her mental health and safety.

    Example Question:

    Have you ever behaved violently?

  • Finding:

    Denies desire to harm others

    (Available)

    Pro Tip: Homicidal ideation or a desire to harm others is an indicator of psychiatric illness as well as a potential risk to others. Asking Tina about any potential desire to harm other people is important in assessing her mental health and safety.

    Example Question:

    Have you ever wanted to hurt someone else?

Social History – Education and Work


  • Finding:

    Asked about employment status


  • Finding:

    Currently employed

    (Found)

    Pro Tip: It is important to know whether or not a patient is employed when assessing her mental status. In Tina’s case, a change in her employment status could be a result of her mental health, or could be affecting it. The fact that she is employed lets you know she is financially secure, but it could also mean work is a source of her stress.

    Example Question:

    Are you employed?

  • Finding:

    Works for a shipping company

    (Found)

    Pro Tip: A patient’s employment can be an indicator of financial stability, education level, personal interests, and level of responsibility. In Tina’s case, a different workplace could signal instability in her life, which could be a source of her stress. The fact that she is still employed by the same company indicates stability in this area of her life.

    Example Question:

    Where do you work?

  • Finding:

    Works 32 hours a week

    (Available)

    Pro Tip: A patient’s work schedule is an indicator of her financial situation, as well as how demanding her employment may be on her time. In Tina’s case, her work schedule could be contributing to her stress levels.

    Example Question:

    How many hours a week do you work?

  • Finding:

    Reports rarely missing work

    (Available)

    Pro Tip: Mental health issues can cause a patient to miss work; anxiety and depression, for instance, can make a patient less able to perform her daily responsibilities. If Tina were missing work lately, it could be an important indicator of a change in her mental health status.

    Example Question:

    How often do you miss work?

  • Finding:

    Asked about education and learning ability


  • Finding:

    About to receive B.A. in Accounting

    (Found)

    Pro Tip: A patient’s educational history can be an important indicator of economic and mental status, as well as her personal history and interests and any past developmental issues she may have had. In Tina’s case, she is about to achieve an educational milestone, which is a partial source of her stress, so it is especially important to ask her about it.

    Example Question:

    What is your highest education level?

  • Finding:

    Denies past special education courses

    (Available)

    Pro Tip: A patient’s past developmental issues can be important indicators of mental status. Asking Tina about past specialized education is an important part of understanding her development. shadow health tina jones mental health assessment Subjective Data.

    Example Question:

    Did you ever take special education classes?

  • Finding:

    Denies learning disabilities

    (Available)

    Pro Tip: A patient’s past learning issues can be important indicators of mental status. Asking Tina about learning differences is an important part of understanding her development.

    Example Question:

    Do you have any learning differences?

  • Finding:

    Denies speech problems

    (Available)

    Pro Tip: A patient’s speech development can be an important indicator of mental status. Asking Tina about speech difficulties is an important part of understanding her development.

    Example Question:

    Do you have difficulties with speech?

  • Finding:

    Denies hearing problems

    (Available)

    Pro Tip: A patient’s hearing ability can be an important indicator of her mental status. Asking Tina about her hearing is an important part of understanding her development.

    Example Question:

    Do you have hearing difficulties?

  • Finding:

    Asked about hobbies


  • Finding:

    Hobbies are reading and watching television

    (Found)

    Pro Tip: A patient’s hobbies can help you to get to know her personality and interests better. Any recent change in hobbies, or a loss of interest in them, could indicate a change in mental health. Asking Tina about hobbies is also important in assessing her stress levels and the demands of her current schedule.

    Example Question:

    What do you do for fun?

  • Finding:

    Asked about legal history


  • Finding:

    Denies past legal issues

    (Found)

    Pro Tip: Recent or past legal issues are considered a significant indicator of mental status. If Tina had had any recent legal issues, it could indicate an important change in her mental health.

    Example Question:

    Have you ever had a legal problem?

  • Finding:

    Asked about military service


  • Finding:

    Denies military service

    (Found)

    Pro Tip: The demands and experiences of military service can have a profound effect on a patient’s mental health. If Tina had a history of military service, it would be an important part of understanding her feelings of stress and anxiety, and would indicate a need to explore the possibility of PTSD and other trauma.

    Example Question:

    Have you served in the military?

Social History – Housing and Support Network


  • Finding:

    Asked about living situation


  • Finding:

    Lives in a house

    (Found)

    Pro Tip: A patient’s housing is an indicator of finances and comfort. If Tina had recently undergone a change in housing, it could be contributing to her stress.

    Example Question:

    Can you tell me about your housing?

  • Finding:

    Lives at home with mother and sister

    (Found)

    Pro Tip: A patient who lives with friends or family has a definite support system, so it is important to ask her about her living situation. If Tina had recently stopped living with her mother and sister, or if living with family were causing problems, this could be contributing to her stress.

    Example Question:

    Do you live with anyone?

  • Finding:

    Asked about family dynamics


  • Finding:

    Has a brother and a sister

    (Available)

    Pro Tip: A patient’s siblings can form part or all of her support network, and her relationship with them can indicate mental health status and/or childhood experiences, so asking about them is important. Tina lives with her sister and sees her brother often, which means they could be a source of support or stress for her.

    Example Question:

    Do you have siblings?

  • Finding:

    Father died in a car accident almost two years ago

    (Available)

    Pro Tip: A patient’s parents can form part or all of her support network, and her relationship with them can indicate mental health status and/or child experiences, so asking about them is important. Tina lost her father almost two years ago, so assessing her feelings about that loss is important to assessing her mental health. Tina also lives with her mother, so their relationship could be an important source of support or stress.

    Example Question:

    Can you tell me about your parents?

  • Finding:

    Reports family is “tight knit” and gets along well

    (Found)

    Pro Tip: How a patient gets along with family is an important indicator of the existence of a support network, childhood experiences, and/or mental health. Tina sees her family as her responsibility, but also as a source of support, so it is important to ask her about them in order to assess if they could be contributing to her stress.

    Example Question:

    Does your family get along well?

  • Finding:

    Asked about support network


  • Finding:

    Reports close group of friends from middle and high school as well as from church

    (Found)

    Pro Tip: It is important to ask a patient about her support network, including her friends. Asking Tina about her relationships with her friends is also important in assessing her stress levels and the demands of her current schedule.

    Example Question:

    Who are your friends?

  • Finding:

    Spends time with friends “a few times a month,” though less so with her recent schedule

    (Available)

    Pro Tip: It is important to ask a patient about her support network, including her friends. Asking Tina about her relationships with her friends is also important in assessing her stress levels and the demands of her current schedule.

    Example Question:

    How often do you spend time with friends?

  • Finding:

    Asked about spirituality


  • Finding:

    Identifies as Baptist

    (Found)

    Pro Tip: Spirituality can be a significant factor in a patient’s mental status and coping strategies. Tina is a lifelong Baptist and regularly attends church, so it is important to ask her about her spirituality in order to assess her mental health.

    Example Question:

    What are your religious beliefs?

  • Finding:

    Reports attending Baptist church regularly since childhood

    (Found)

    Pro Tip: Spirituality can be a significant factor in a patient’s mental status and coping strategies. Tina is a lifelong Baptist and regularly attends church, so it is important to ask her about her spirituality in order to assess her mental health.

    Example Question:

    Do you attend church regularly?

Social History – Substance Use


  • Finding:

    Asked about substance use


  • Finding:

    Reports past marijuana use

    (Found)

    Pro Tip: Substance abuse can be an indicator of, or a contributing factor to, psychiatric illness. Assessing Tina’s history of drug use is important to understanding her risk factors.

    Example Question:

    Have you ever used drugs?

  • Finding:

    Denies current substance use

    (Found)

    Pro Tip: Substance abuse can be an indicator of, or a contributing factor to, psychiatric illness. Assessing Tina’s current drug use is important to understanding her risk factors.

    Example Question:

    Do you currently use drugs?

  • Finding:

    Followed up on past marijuana use


  • Finding:

    Reports smoking marijuana for “five or six years”

    (Available)

    Pro Tip: How long a patient used drugs can help you to assess any possibilities of addiction or relapse, as well as any potential negative effects on her physical or mental health. Asking Tina how long she smoked marijuana could help you to understand how her past drug use fits into her psychiatric history.

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    Example Question:

    How long did you smoke marijuana?

  • Finding:

    Reports last smoked marijuana when she was “20 or 21” years old

    (Found)

    Pro Tip: Any past substance use can be considered a risk factor, but if a patient had recently stopped using drugs it could indicate a potential for relapse or that drug use could still be affecting her mental health. Asking Tina how long ago she stopped smoking marijuana could help you to understand how her past drug use fits into her psychiatric history.

    Example Question:

    When did you stop smoking marijuana?

  • Finding:

    Reports quitting marijuana because it “just wasn’t fun anymore” and was bad for her asthma

    (Available)

    Pro Tip: A patient may have stopped using substances due to adverse effects on her mental and physical wellbeing. Asking Tina why she stopped smoking marijuana could help you to understand how her substance use affected her mentally and physically.

    Example Question:

    Why did you stop smoking marijuana?

  • Finding:

    Reports marijuana use was for recreation, not to treat or mitigate specific symptoms

    (Available)

    Pro Tip: A patient may use substances as a form of self-medication for psychiatric illness. Asking Tina why she smoked marijuana could help you to understand how her past drug use fits into her psychiatric history.

    Example Question:

    Why did you smoke marijuana?

  • Finding:

    Asked about alcohol use


  • Finding:

    Confirms alcohol use

    (Found)

    Pro Tip: Alcohol abuse can be an indicator of, or a contributing factor to, psychiatric illness. Tina’s alcohol use could be a risk factor, so it is important to assess her alcohol consumption in order to rule out addiction or dependency.

    Example Question:

    Do you drink alcohol?

  • Finding:

    Reports going out “a couple times a month”

    (Found)

    Pro Tip: Alcohol abuse can be an indicator of, or a contributing factor to, psychiatric illness. Tina drinks alcohol, so it is important to ask her follow-up questions in order to rule out dependency and addiction when assessing her mental health. Knowing how often she drinks alcohol will help you to asses if her use of it is a risk factor.

    Example Question:

    How often do you drink alcohol?

  • Finding:

    Reports having “a few drinks” when she goes out

    (Found)

    Pro Tip: Alcohol abuse can be an indicator of, or a contributing factor to, psychiatric illness. Tina drinks alcohol, so it is important to ask her follow-up questions in order to rule out dependency and addiction when assessing her mental health. Knowing how much alcohol she drinks will help you to asses if her use of it is a risk factor.

    Example Question:

    How much alcohol do you drink?

  • Finding:

    Reports 10-12 alcoholic drinks per month

    (Found)

    Pro Tip: Alcohol abuse can be an indicator of, or a contributing factor to, psychiatric illness. Tina drinks alcohol, so it is important to ask her follow-up questions in order to rule out dependency and addiction when assessing her mental health. It is essential, when checking for risk of alcohol dependency, to ask specific questions in order to discern exactly how many drinks she has per month. shadow health tina jones mental health assessment Subjective Data.

    Example Question:

    How many drinks do you have per month?

  • Finding:

    Reports drinking to “relax and blow off steam”

    (Available)

    Pro Tip: Alcohol abuse can be an indicator of, or a contributing factor to, psychiatric illness. Asking Tina why she drinks alcohol can help you to rule out self-medication and/or dependency.

    Example Question:

    Why do you drink alcohol?

  • Finding:

    Denies that anyone has asked her to stop drinking

    (Available)

    Pro Tip: Alcohol abuse can be an indicator of, or a contributing factor to, psychiatric illness. If people close to Tina had asked her to stop drinking, it would be an important indicator of possible alcohol dependency.

    Example Question:

    Has anyone asked you to stop drinking?

  • Finding:

    Denies guilt associated with drinking

    (Available)

    Pro Tip: Alcohol abuse can be an indicator of, or a contributing factor to, psychiatric illness. If Tina felt guilty after drinking, it could indicate she was drinking too much, and/or engaging in risky or uncharacteristic behavior when under the influence, which would be an important indicator of possible alcohol dependency.

    Example Question:

    Do you ever feel guilty after drinking?

  • Finding:

    Asked about drinking and driving


  • Finding:

    Reports that she and her friends “usually take a cab”

    (Found)

    Pro Tip: Driving under the influence is dangerous, and it can indicate alcohol dependency. If Tina were driving drunk, or riding in cars with a drunk driver, it would indicate alcohol dependency as a risk factor.

    Example Question:

    How do you get home when you have been drinking?

  • Finding:

    Asked about tobacco use


  • Finding:

    Denies history of tobacco use

    (Found)

    Pro Tip: Tobacco can affect mental health, so it is important to ask a patient about her tobacco use. Asking Tina about tobacco is recommended because it can contribute to stress and feelings of anxiety.

    Example Question:

    Have you ever used tobacco?

  • Finding:

    Denies current tobacco use

    (Found)

    Pro Tip: Tobacco can affect mental health, so it is important to ask a patient about her tobacco use. Asking Tina about tobacco use is recommended because tobacco can contribute to stress and feelings of anxiety.

    Example Question:

    Do you use tobacco?

  • Finding:

    Asked about prescription drug abuse


  • Finding:

    Denies prescription drug abuse

    (Found)

    Pro Tip: Abuse of prescription drugs can be an indicator of, or a contributing factor to, psychiatric illness. If Tina were abusing prescription drugs it would be a definite risk factor for her mental health.

    Example Question:

    Have you taken drugs not prescribed to you?

Social History – Relationship and Sexual History


  • Finding:

    Asked about relationship status


  • Finding:

    Currently single

    (Found)

    Pro Tip: Romantic and sexual relationships are an important part of a patient’s support system, but they can also be a source or indicator of stress. If Tina were in a relationship, it would be important to follow-up for more details on the nature and quality of that relationship.

    Example Question:

    Are you in a relationship?

  • Finding:

    Asked about relationship history


  • Finding:

    Reports past relationships

    (Found)

    Pro Tip: Understanding a patient’s relationship history is integral to assessing her mental health. In Tina’s case, a change in her relationship status could be a source of her current stress.

    Example Question:

    Have you been in a relationship in the past?

  • Finding:

    Last relationship ended three years ago

    (Found)

    Pro Tip: Understanding a patient’s relationship history is integral to assessing her mental health. In Tina’s case, a change in her relationship status could be a source of her current stress.

    Example Question:

    When was your last relationship?

  • Finding:

    Most recent relationship lasted three years

    (Available)

    Pro Tip: Understanding a patient’s relationship history is integral to assessing her mental health. In Tina’s case, a change in her relationship status could be a source of her current stress.

    Example Question:

    How long was your last relationship?

  • Finding:

    Reports she has never been married

    (Available)

    Pro Tip: Understanding a patient’s marital history is integral to assessing her mental health. If Tina had been married, it could be a current source of her stress.

    Example Question:

    Have you ever been married?

  • Finding:

    Asked about sexual history


  • Finding:

    Reports past sexual relationships

    (Available)

    Pro Tip: Understanding a patient’s sexual history and experiences is integral to assessing her mental health. If Tina had anxiety about her sexual history, it could indicate past trauma, or if Tina had a recent change in her sexual pattern it could indicate a change in her mental status.

    Example Question:

    Have you had sex in the past?

  • Finding:

    Reports three previous sexual partners

    (Available)

    Pro Tip: Understanding a patient’s sexual history and experiences is integral to assessing her mental health. If Tina had anxiety about her sexual history, it could indicate past trauma, or if Tina had a recent change in her sexual pattern it could indicate a change in her mental status.

    Example Question:

    How many sexual partners have you had?

  • Finding:

    Reports last sexual encounter was with boyfriend three years ago

    (Available)

    Pro Tip: Understanding a patient’s sexual history and experiences is integral to assessing her mental health. If Tina had anxiety about her sexual history, it could indicate past trauma, or if Tina had a recent change in her sexual pattern it could indicate a change in her mental status.

    Example Question:

    When did you last have sex?

  • Finding:

    Asked about abuse history


  • Finding:

    Denies history of abuse

    (Found)

    Pro Tip: A history of abuse can have an enormous effect on a patient’s mental health. If Tina had suffered abuse, it could mean her feelings of stress and anxiety were related to that past trauma.

    Example Question:

    Do you have a history of abuse?

  • Finding:

    Denies past physical abuse

    (Found)

    Pro Tip: Physical abuse can have an enormous effect on a patient’s mental health. If Tina had suffered abuse, it could mean her feelings of stress and anxiety were related to that past trauma.

    Example Question:

    Have you ever been physically abused?

  • Finding:

    Denies past verbal abuse

    (Found)

    Pro Tip: Verbal abuse can have an enormous effect on a patient’s mental health. If Tina had suffered abuse, it could mean her feelings of stress and anxiety were related to that past trauma.

    Example Question:

    Have you ever been verbally abused?

Social Determinants of Health


  • Finding:

    Asked about stress causes


  • Finding:

    Reports feeling stressed about studying and the future

    (Found)

    Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

    Example Question:

    What seems to be causing your stress?

  • Finding:

    Reports CPA professional qualifying exam in one month

    (Found)

    Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

    Example Question:

    What test are you trying to study for?

  • Finding:

    Reports upcoming graduation from college and need to secure employment

    (Found)

    Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

    Example Question:

    What about the future is causing you stress?

  • Finding:

    Asked about stress coping


  • Finding:

    Reports coping with stress by going to church

    (Found)

    Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

    Example Question:

    How do you cope with stress?

  • Finding:

    Reports coping with stress by staying organized

    (Found)

    Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

    Example Question:

    How do you manage stress?

  • Finding:

    Reports coping with stress by talking to friends and family

    (Found)

    Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

    Example Question:

    Who do you talk to about stress?

  • Finding:

    Reports usual stress coping strategies are less effective

    (Found)

    Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

    Example Question:

    Do your coping strategies help your stress?

Family History


  • Finding:

    Asked about relevant family history


  • Finding:

    Denies psychiatric illness in the family

    (Found)

    Pro Tip: Many psychiatric illnesses are hereditary, so knowing the patient’s family psychiatric history is essential to assessing her mental health. In Tina’s case, a family history of anxiety or depression could be significant in reaching a diagnosis.

    Example Question:

    Has anyone in your family had a psychiatric illness?

  • Finding:

    Reports uncle has a “problem with alcohol”

    (Available)

    Pro Tip: Substance abuse and addiction often runs in families, so knowing the patient’s family history of substance abuse is essential to assessing her mental health. In Tina’s case, a significant family history of addiction could be considered a risk factor.

    Example Question:

    Do you have a family history of alcohol dependency?

  • Finding:

    Denies family history of drug addiction

    (Available)

    Pro Tip: Substance abuse and addiction often runs in families, so knowing the patient’s family history of substance abuse is essential to assessing her mental health. In Tina’s case, a significant family history of addiction could be considered a risk factor. shadow health tina jones mental health assessment Subjective Data.

    Example Question:

    Do you have a family history of drug addiction?

  • Finding:

    Denies family history of suicide

Psychotherapy has biological basis Essay

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Psychotherapy has biological basis Essay

Psychotherapy has biological basis, for instance, an individual might suffer from depression because they are overweight. For this client, a weight loss regimen might be incorporated into therapy. During researching articles, the article about anorexia nervosa and its treatment plan grasped my attention. According to Wozniak et al. (2012) “The treatment approach combination of behavior therapy and supportive psychotherapy. It is very important the approaching way of the person, in order to develop positive behavior. This includes the learning of behavior, and then follows the learning and relearning, without seeking the causes of the previous pathologic behavior. The aim of this behavior treatment is to restore the normal way of eating”.  The disorder is caused by both biological and social culture factors. The biological factors includes hypothalamus dysfunction, over secretion of cortisol, and heredity.

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Culture, religion, and socioeconomic can negatively impact an individual value of psychotherapy treatment. Some individuals might assume that they will be viewed as being crazy for seeking treatment. As far as culture, the individual can be afraid of being an outcast or viewed in a negative way. Furthermore, some religions view mental illness as being possessed or as evil spirits. However, some religions can be a support system to the client.Educating the public is important to eliminate negative views and to let individuals know that they are not the only ones that are suffering from a particular disorder. With rapid treatment and therapy, death rates can be decreased. “Therapists need to be aware and enquire about the patient’s self-perceptions and attributions regarding ethnicity, race, social class and religion. While there is evidence that ethnicity per se does not impact on psychotherapy referral and compliance and that culturally sensitive psychotherapy has refuted many cultural stereotypes, there is a need to integrate knowledge of the unique cultural and religious values and beliefs during assessments and planning of therapy” Jacob &  Kuruvilla (2012). When individuals are educated and feel included in their care, their value of psychotherapy will increase.

Jacob, K. S., & Kuruvilla, A. (2012). Psychotherapy across  cultures: the form-content dichotomy. Clinical Psychology & Psychotherapy, 19(1), 91-95. doi:10. 1002/cpp.736

Wozniak, G., Rekleiti, M., & Roupa, Z. (2012). Contribution of  social and family factors in anorexia nervosa. Health

Science Journal, 6(2), 257-269

Psychotherapy has biological basis Essay

Assessment and Diagnosis in Psychotherapy

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Assessment and Diagnosis in Psychotherapy

“A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.”

—Pamela Bjorklund, clinical psychologist

Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation.

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This week, as you explore assessment and diagnosis in psychotherapy, you examine assessment tools, including their psychometric properties and appropriate use. You also develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients.

mental health shadow health assessment Education & Empathy

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Education & Empathy: 4 of 4 (100.0%)

During the patient interview, there are a number of opportunities to provide patient education and empathy. The opportunities listed below are those identified by nursing experts to be of particular importance to this patient. A Model Statement is provided as an example of an appropriate response to each opportunity.

  • Opportunities marked as Not Encountered are opportunities that were not elicited in the interview
  • Opportunities marked as Not Followed Up are missed opportunities that were present in the interview, but where no statements were made
  • Opportunities marked as Followed Up were followed up by students, and include the dialogue between student and patient. mental health shadow health assessment Education & Empathy

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1 Symptoms
Followed Up

Description: Tina describes problems sleeping and stress-symptoms like racing thoughts.
This is your avatar.

What brings you in today?

Question
07:26 PM CDT
Tina Jones

I decided to come in because I’m tired all the time now. . . I have this really important exam coming up, and I’m stressed and too foggy to study most of the time. I really need help sleeping so I can focus on preparing for my exam.
This is your avatar.

I’m sorry to hear about your trouble sleeping and stress. I’m glad you came in today. let me learn more about what you’re experiencing, and i will try to help

Empathize
07:31 PM CDT
Tina Jones

I appreciate you saying that.

Model Statement: “I’m sorry to hear about your trouble sleeping and stress. I’m glad you came in. Let me learn more about what you’re experiencing, and I will try to help.”
2 Stress
Followed Up

Description: Tina describes how busy she is with school and work.
This is your avatar.

What is causing the stress

Question
07:43 PM CDT
Tina Jones

I’m stressed now because I can’t sleep, but I can’t sleep because I keep worrying about all this other stuff, like graduating, and passing this exam that’s coming up, and getting a job, and finding my own place to live. . . it’s a lot.
This is your avatar.

It sounds like you have a lot on your plate. I am sorry you are dealing with so much stress

Empathize
07:44 PM CDT
Tina Jones

I appreciate you telling me that.

Model Statement: “It sounds like you have a lot on your plate. I’m sorry you’re dealing with so much stress.”
3 Sleep
Followed Up

Description: Tina describes her sleep hygiene and routine.
This is your avatar.

What is causing the stress

Question
07:43 PM CDT
Tina Jones

I’m stressed now because I can’t sleep, but I can’t sleep because I keep worrying about all this other stuff, like graduating, and passing this exam that’s coming up, and getting a job, and finding my own place to live. . . it’s a lot.
This is your avatar.

It sounds like you have a lot on your plate. I am sorry you are dealing with so much stress

Empathize
07:44 PM CDT
Tina Jones

I appreciate you telling me that.
This is your avatar.

What were you thinking about when you couldn’t sleep?

Question
07:46 PM CDT
Tina Jones

Mostly I start out worrying about this exam I have coming up, and how much I need to study, and then I start thinking about what happens if I don’t pass the exam, and even if I do, whether I’ll actually be able to find an accounting job once I graduate, and then if I do find a job, what if I’m bad at it. . . it just sort of builds on itself like that, just, like, worry upon worry.
This is your avatar.

what are your sleep patterns (Clarified to: What are your sleep habits?)

Question
07:47 PM CDT
Tina Jones

Well. . . I usually get into bed around midnight, but at that point I feel too nervous to sleep, so I’ll read to try and wind down for maybe an hour, sometimes longer. Then I turn out the light and try to sleep. If it takes a really long time, then sometimes I’ll turn the light back on and read a little more until I feel sleepier. (Clarified to: what my sleep habits are)
This is your avatar.

It”s hard to function at our best when we don’t get enough sleep. I know you are busy with work and school, but let’s talk about some strategies to help you get more sleep and make sure you’re getting good quality sleep.

Empathize
07:49 PM CDT
Tina Jones

Thanks.

Model Statement: “It’s hard to function at our best when we don’t get enough sleep. I know you’re very busy with work and school, but let’s talk about some strategies to help you get more sleep and make sure you’re getting good quality sleep.”
4 Coping and Support Systems
Followed Up

Description: Tina describes her coping mechanisms and support systems.
This is your avatar.

Do you get along with your family

Question
07:57 PM CDT
Tina Jones

Things are pretty good between all of us–we’re a tight knit family. I think we’re pretty special, the way we all get along.
This is your avatar.

Do you have religious preference?

Question
07:58 PM CDT
Tina Jones

Yeah. We go to First Baptist, and we do a lot with our church community. We socialize before and after church, and I go to Bible study on Wednesdays, too.
This is your avatar.

does your family support you

Question
07:59 PM CDT
Tina Jones

Yeah, definitely. We’re all pretty tight knit. I think we’re a pretty special family, the way we all get along. My brother moved in with his fiance, but we still see him once a week at least, and I eat dinner with my mom and sister as much as possible, plus they always go to church with me on Sundays.
This is your avatar.

It sounds like you have a healthy support system through your family and friends which is great. it sounds like you work hard to manage your time effectively, too. remember to take out to relax or take a walk

Empathize
08:04 PM CDT
Tina Jones

Thanks for understanding.

Model Statement: “It sounds like you have healthy support systems through your family and friends, which is great. It sounds like you work hard to manage your time effectively, too. Remember to take time out to relax or take a walk.”

Sophia Haddad Pediatric GAS Pharyngitis shadow health Patient Teaching

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Patient Teaching Score: 9 out of 10

Greet the patient’s guardian

Topics priorized for patient teaching

Education Items

  • Greet the patient’s guardian and explain why you need to educate them.

Greet the patient’s guardian and explain why you need to educate them.

Your avatar

Sophia’s test came back positive.

Statement
10/3/2020 7:17:20 AM
Omar Haddad

Alright. Thank you.
Model Statement: Hi, Omar. We’re going to be going over how to safely give Sophia her medication.
amoxicillin
6.5 out of 7

Model Plan

  • (1 point) Only use the dosing instrument that comes with medication
  • (1 point) Shake medication well before use
  • (1 point) Check to make sure you are administering the correct dose
  • (1 point) Give your child rewards and incentives for taking medication
  • (1 point) Take the full course of antibiotics
  • (1 point) Contact a health provider if symptoms do not improve
  • (1 point) Discontinue if you see signs of amoxicillin allergy

Topics priorized for patient teaching

Education Items

  • (1 point) Only use the dosing instrument that comes with medication
  • (1 point) Keep medication in a safe pace, out of reach of the child
  • (1 point) Check to make sure you are administering the correct dose
  • (1 point) Symptoms should improve in a few days
  • (1 point) Take the full course of antibiotics
  • (0.5 points) Look for signs of thrush
  • (1 point) Discontinue if you see signs of amoxicillin allergy

Only use the dosing instrument that comes with medication

Your avatar

Follow the instructions on the medication

Statement
10/3/2020 7:17:48 AM
Omar Haddad

I’ll be sure to do that.
Model Statement: It’s important to give Sophia the precise dose prescribed to her. Only use the dosing instrument that came with medication and never use a kitchen utensil like a spoon.

Keep medication in a safe pace, out of reach of the child

Your avatar

Keep medication in safe place, out of children reach

Statement
10/3/2020 7:18:11 AM
Omar Haddad

Good call. I don’t think she’d pour it out or something, but—oh, you mean she might drink it. Right, that too.
Model Statement: Keep medication in a safe pace, where Sophia can’t reach it.

Check to make sure you are administering the correct dose

Your avatar

Check to be sure the dose is correct

Statement
10/3/2020 7:18:35 AM
Omar Haddad

I bet it’s really dangerous to give a kid too much medicine. Better be careful.
Model Statement: Check carefully to make sure you are administering the correct dose of medication using age-appropriate weight-based calculations.

Symptoms should improve in a few days

Your avatar

Symptoms should improve in a couple of days

Statement
10/3/2020 7:19:05 AM
Omar Haddad

That’s really good to hear. I hate to see her like this.
Model Statement: Sophia’s symptoms should begin to improve in a few days.

Take the full course of antibiotics

Your avatar

Sophia will be able to return to school in 3 days

Statement
10/3/2020 7:19:24 AM
Omar Haddad

Yeah, I can do that. Make sure Sophia takes all of her medicine. No matter how much she doesn’t want to. Make her do the thing she doesn’t want to do. I got it.
Model Statement: If Sophia doesn’t take the full course of antibiotics, she could get sick again. Make sure she takes all of her medicine just like the instructions say.

Look for signs of thrush

Your avatar

Looks for a rash in here mouth

Statement
10/3/2020 7:19:47 AM
Omar Haddad

Oh, thrush is terrible. I’ll let you know right away if I see any signs of it.
Model Statement: Contact your clinician if you see signs of thrush in Sophia’s mouth and throat.

Discontinue if you see signs of amoxicillin allergy

Your avatar

Stop the medication of you see any signs of an allergic reaction, like difficulty breathing

Statement
10/3/2020 7:20:34 AM
Omar Haddad

Sophia already has some of those things because of the strep. How do I know if she’s also having a reaction to the amoxicillin?
Your avatar

Hives and if your daughter cant breathe

Statement
10/3/2020 7:21:04 AM
Omar Haddad

Understood.
Model Statement: Discontinue if you see signs of an allergic reaction to amoxicillin, which includes swelling, rash, and queasiness.
Symptoms and Care
2.5 out of 3

Model Plan

  • (1 point) Throw away toothbrush after 48 hours
  • (1 point) Give child ibuprofen or acetaminophen to treat fever
  • (1 point) Give Sophia a lot of liquids to keep her hydrated

Topics priorized for patient teaching

Education Items

  • (1 point) Throw away toothbrush after 48 hours
  • (0.5 points) When she can return to school
  • (1 point) Give Sophia a lot of liquids to keep her hydrated

Throw away toothbrush after 48 hours

Your avatar

change the toothbrush

Statement
10/3/2020 7:21:15 AM
Omar Haddad

She’s pretty attached to her butterfly toothbrush, but I’m sure we can find another one . . . probably . . .
Model Statement: Throw away Sophia’s toothbrush after 48 hours. Strep can linger on the toothbrush, and potentially reinfect her.

When she can return to school

Your avatar

she can return to school in 3 days

Statement
10/3/2020 7:21:49 AM
Omar Haddad

That’s good to know. Thanks.
Model Statement: Sophia can return to school after 48 hours, if her symptoms have improved.

Give Sophia a lot of liquids to keep her hydrated

Your avatar

She can drink plenty of water

Statement
10/3/2020 7:22:19 AM
Omar Haddad

Sophia’s pretty good about drinking water. Normally I’d go for tea, but I don’t think I need a caffeinated Sophia stuck at home from school. Bad times for everybody.
Model Statement: Make sure that Sophia drinks plenty of liquids so she stays hydrated.
Say Goodbye

Topics priorized for patient teaching

Education Items

  • Educate the patient’s guardian on anything else and say goodbye

Educate the patient’s guardian on anything else and say goodbye

Your avatar

Have a good day

Statement
10/3/2020 7:22:43 AM
Omar Haddad

Ok. See you later.

Existential-Humanistic Therapy Essay Assignments

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Existential-Humanistic Therapy Essay Assignments

“It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried.”

–Carl Rogers, from On Becoming a Person

This client-centered perspective is the cornerstone of existential-humanistic therapy, which requires therapists to “attempt to receive clients with curiosity and openness, endeavor to grasp their subjective world, and believe that clients are the experts on their own experience” (Wheeler, 2014, p. 373). As the psychiatric mental health nurse practitioner, it is important to understand that the effectiveness of this approach is dependent on your relationship with clients, as well as your beliefs on holism and human nature.

This week, as you explore existential-humanistic therapy, you assess clients and consider the appropriateness of various therapeutic approaches. You also develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients.

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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 whom you do not think is adequately progressing according to expected clinical outcomes.

Existential-Humanistic Therapy Essay Assignments Learning Objectives

Students will:
  • Assess clients presenting for psychotherapy
  • Evaluate effectiveness of therapeutic approaches for clients receiving psychotherapy
  • Apply existential-humanistic therapy to clients with psychiatric disorders

To prepare:

  • Review this week’s media and consider the insights provided.
  • Reflect on the clients you are currently counseling at your practicum site.

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!

By Day 3

Post a 3- to 5-minute Kaltura video that addresses the following:

  • Describe a client you are counseling whom you do not think is adequately progressing according to expected clinical outcomes.

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.

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 providing feedback based on an existential-humanistic therapeutic perspective. Support your feedback with evidence-based literature and/or your own experiences with clients.

Note about uploading media: Refer to the Kaltura Media Uploader instructions document, which provides guidance on how to upload media for the Clinical Supervision Discussions.

Existential-Humanistic Therapy Essay Assignments: Practicum – Week 8 Journal Entry

This week, you complete a two-part journal entry.

Learning Objectives

Students will:
  • Develop diagnoses for clients receiving psychotherapy*
  • Evaluate efficacy of existential-humanistic therapy for clients*
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders*
  • Analyze clinical supervision experiences*

* The Existential-Humanistic Therapy Essay Assignments related to this Learning Objective is introduced this week and submitted in Week 10.

For Part 1, select a client whom you observed or counseled this week (other than the client used for this week’s Discussion). Then, address the following in your Practicum Journal:

  • Describe the client and identify any pertinent history or medical information, including prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for this client.
  • Explain whether existential-humanistic therapy would be beneficial with this client. Include expected outcomes based on this therapeutic approach.
  • Explain any legal and/or ethical implications related to counseling this client.
  • Support your approach with evidence-based literature.

For Part 2, reflect on your clinical supervision experiences. Then, address the following in your Practicum Journal:

  • How often are you receiving clinical supervision from your preceptor?
  • What are the sessions like?
  • What is the preceptor bringing to your attention?
  • How are you translating these sessions to your clinical practice?

 

Existential-Humanistic Therapy Essay Assignments Week in Review

  • Assessed clients presenting for psychotherapy
  • Evaluated the effectiveness of therapeutic approaches for clients receiving psychotherapy
  • Applied existential-humanistic therapy to clients with psychiatric disorders
  • Developed diagnoses for clients receiving psychotherapy
  • Evaluated the efficacy of existential-humanistic therapy for clients
  • Analyzed legal and ethical implications of counseling clients with psychiatric disorders
  • Analyzed clinical supervision experiences

Existential-Humanistic Therapy Essay Assignments

Psychotherapy With Children and Adolescents Essay Assignment Papers

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Psychotherapy With Children and Adolescents Essay Assignment Papers

Approximately 1 in 5 children and adolescents have a mental health disorder, which may lead to issues at home, school, and other areas of their lives (Prout & Fedewa, 2015). When working with this population, it is important to recognize that children and adolescents are not “mini adults” and should not be treated as such. Psychotherapy with these clients is often more complex than psychotherapy with the general adult population, particularly in terms of communication. As a result, strong therapeutic relationships are essential to success.

This week, as you explore psychotherapy with children and adolescents, you assess clients presenting with disruptive behaviors. You also examine therapies for treating these clients and consider potential outcomes. Finally, you develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients.

The adolescent population is often referred to as “young adults,” but in some ways, this is a misrepresentation. Adolescents are not children, but they are not yet adults either. This transition from childhood to adulthood often poses many unique challenges to working with adolescent clients, particularly in terms of disruptive behavior. In your role, you must overcome these behaviors to effectively counsel clients. For this Discussion, as you examine the Disruptive Behaviors media in this week’s Learning Resources, consider how you might assess and treat adolescent clients presenting with disruptive behavior.

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Psychotherapy With Children and Adolescents Essay Assignment Papers Learning Objectives

Students will:
  • Assess clients presenting with disruptive behavior
  • Analyze therapeutic approaches for treating clients presenting with disruptive behavior
  • Evaluate outcomes for clients presenting with disruptive behavior

To prepare: Psychotherapy With Children and Adolescents Essay Assignment Papers

  • Review this week’s Learning Resources and reflect on the insights they provide.
  • View the media, Disruptive Behaviors. Select one of the four case studies and assess the client.
  • For guidance on assessing the client, refer to pages 137-142 of the Wheeler text in this week’s Learning Resources.

Note: To complete this Discussion, you must assess the client, but you are not required to submit a formal Comprehensive Client Assessment.

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!

By Day 3

Post an explanation of your observations of the client in the case study you selected, including behaviors that align to the criteria in DSM-5. Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate. Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.

Assignment: Practicum – Week 9 Journal Entry – Psychotherapy With Children and Adolescents Essay Assignment Papers

Learning Objectives

Students will:
  • Develop diagnoses for clients receiving psychotherapy*
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders*

* The Assignment related to this Learning Objective is introduced this week and submitted in Week 10.

Select a child or adolescent client whom you observed or counseled this week. Then, address the following in your Practicum Journal:

  • Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for this client.
  • Explain any legal and/or ethical implications related to counseling this client.
  • Support your position with evidence-based literature.

Psychotherapy With Children and Adolescents Essay Assignment Papers Week in Review

  • Assessed clients presenting with disruptive behavior
  • Analyzed therapeutic approaches for treating clients presenting with disruptive behavior
  • Evaluated outcomes for clients presenting with disruptive behavior
  • Developed diagnoses for clients receiving psychotherapy
  • Analyzed legal and ethical implications of counseling clients with psychiatric disorders

Psychotherapy With Children and Adolescents Essay Assignment Papers

Essay Assignment Papers: Psychotherapy With Personality Disorders

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Essay Assignment Papers: Psychotherapy With Personality Disorders

Since personality represents who someone is at the deepest level, it is understandable that many people with personality disorders resist the idea that they have a fundamental dysfunction with their personality. Even when clients acknowledge that their personality problems are at the heart of their interpersonal problems, they often find it difficult to change. As the mental health professional, how do you overcome this challenge and effectively counsel these clients?

This week, as you explore psychotherapy with personality disorders, you examine therapeutic approaches to treating clients with personality and interpersonal problems. You also develop a client termination summary for a client who may be ready to complete therapy.

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Clients with personality disorders often find it difficult to overcome their problems and function in daily life. Even when these clients are aware that they have a dysfunction with their personality and are open to counseling, treatment can be challenging for both the client and the therapist. For this Discussion, as you examine personality disorders, consider therapeutic approaches you might use with clients.

Essay Assignment Papers: Psychotherapy With Personality Disorders Learning Objectives

Students will:
  • Analyze therapeutic approaches to treating clients with personality disorders

To prepare:

  • Review this week’s Learning Resources and reflect on the insights they provide.
  • Select one of the personality disorders from the DSM-5.

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!

By Day 3

Post a description of the personality disorder you selected. Explain a therapeutic approach (including psychotropic medications if appropriate) you might use to treat a client presenting with this disorder, including how you would share your diagnosis of this disorder to the client in order to avoid damaging the therapeutic relationship. Support your approach with evidence-based literature.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.

Quiz: Final Exam – Essay Assignment Papers: Psychotherapy With Personality Disorders

Learning Objectives

Students will:
  • Assess knowledge of concepts, principles, and theories related to the psychotherapy of individuals

This exam will cover the following topics from the Wheeler textbook, which relate to psychotherapy of individuals:

  • Supportive and Psychodynamic Psychotherapy
  • Interpersonal Psychotherapy
  • Humanistic-Existential and Solution-Focused Approaches to Psychotherapy
  • Psychotherapy With Children
  • Psychotherapy With Older Adults
  • Termination and Outcome Evaluation

By Day 7

Complete the Final Exam. Prior to starting the exam, you should review all of your materials. There is a 2-hour time limit to complete this 75-question exam. You may only attempt this exam once. Essay Assignment Papers: Psychotherapy With Personality Disorders.