Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

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Insurance coding and billing is complex, but it boils down to how to accurately apply a code, or CPT (current procedural terminology), to the service that you provided. The payer then reimburses the service at a certain rate. As a provider, you will have to understand what codes to use and what documentation is necessary to support coding.

For this Assignment, you will review evaluation and management (E/M) documentation for a patient and perform a crosswalk of codes from DSM-5 to ICD-10.

Photo Credit: Getty Images/Tetra images RF

To Prepare

  • Review this week’s Learning Resources on coding, billing, reimbursement.
  • Review the E/M patient case scenario provided.

The Assignment

  • Assign DSM-5 and ICD-10 codes to services based upon the patient case scenario.

Then, in 1–2 pages address the following. You may add your narrative answers to these questions to the bottom of the case scenario document and submit altogether as one document.

  • Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.
  • Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.
  • Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.
By Day 7 of Week 2

Submit your Assignment.

Pathways Mental Health

Psychiatric Patient Evaluation

Instructions

   Use the following case template to complete Week 2 Assignment 1. On page 5, assign DSM-5 and ICD-10 codes to the services documented. You will add your narrative answers to the assignment questions to the bottom of this template and submit altogether as one document.

Identifying Information

   Identification was verified by stating of their name and date of birth. Time spent for evaluation: 0900am-0957am

 

Chief Complaint

   “My other provider retired. I don’t think I’m doing so well.”

 

HPI

   25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD. Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors.

 

Diagnostic Screening Results

   Screen of symptoms in the past 2 weeks:  PHQ 9 = 0 with symptoms rated as no difficulty in functioning  Interpretation of Total Score  Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression  GAD 7 = 2 with symptoms rated as no difficulty in functioning  Interpreting the Total Score:  Total Score Interpretation ≥10 Possible diagnosis of GAD; confirm by further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe anxiety  MDQ screen negative PCL-5 Screen 32

 

Past Psychiatric and Substance Use Treatment

   Entered mental health system when she was age 19 after raped by a stranger during a house burglary. Previous Psychiatric Hospitalizations:  denied Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015 Previous psychotropic medication trials: sertraline (became suicidal), trazodone (worsened nightmares), bupropion (became suicidal), Adderall (began abusing) Previous mental health diagnosis per client/medical record: GAD, Unspecified Trauma, PTSD, Stimulant use disorder, ADHD confirmed by school records

 

Substance Use History

   Have you used/abused any of the following (include frequency/amt/last use): Substance Y/N Frequency/Last Use Tobacco products Y ½ ETOH Y last drink 2 weeks ago, reports drinks 1-2 times monthly one drink socially  Cannabis N Cocaine Y last use 2015 Prescription stimulants Y last use 2015 Methamphetamine N Inhalants N Sedative/sleeping pills N Hallucinogens N Street Opioids N Prescription opioids N Other: specify (spice, K2, bath salts, etc.) Y reports one-time ecstasy use in 2015 Any history of substance related:  Blackouts: +  Tremors:   – DUI: –  D/T’s: – Seizures: –  Longest sobriety reported since 2015—stayed sober maintaining sponsor, sober friends, and meetings

 

Psychosocial History

   Client was raised by adoptive parents since age 6; from Russian orphanage. She has unknown siblings. She is single; has no children. Employed at local tanning bed salon Education: High School Diploma Denied current legal issues.

 

Suicide / HOmicide Risk Assessment

   RISK FACTORS FOR SUICIDE: Suicidal Ideas or plans – no Suicide gestures in past – no Psychiatric diagnosis – yes Physical Illness (chronic, medical) – no Childhood trauma – yes Cognition not intact – no Support system – yes Unemployment – no Stressful life events – yes Physical abuse – yes Sexual abuse – yes Family history of suicide – unknown Family history of mental illness – unknown Hopelessness – no Gender – female Marital status – single White race Access to means Substance abuse – in remission PROTECTIVE FACTORS FOR SUICIDE: Absence of psychosis – yes Access to adequate health care – yes Advice & help seeking – yes Resourcefulness/Survival skills – yes Children – no Sense of responsibility – yes Pregnancy – no; last menses one week ago, has Norplant Spirituality – yes Life satisfaction – “fair amount” Positive coping skills – yes Positive social support – yes Positive therapeutic relationship – yes Future oriented – yes Suicide Inquiry: Denies active suicidal ideations, intentions, or plans. Denies recent self-harm behavior. Talks futuristically. Denied history of suicidal/homicidal ideation/gestures; denied history of self-mutilation behaviors Global Suicide Risk Assessment: The client is found to be at low risk of suicide or violence, however, risk of lethality increased under context of drugs/alcohol. No required SAFETY PLAN related to low risk

 

Mental Status Examination

   She is a 25 yo Russian female who looks her stated age. She is cooperative with examiner. She is neatly groomed and clean, dressed appropriately. There is mild psychomotor restlessness. Her speech is clear, coherent, normal in volume and tone, has strong cultural accent. Her thought process is ruminative. There is no evidence of looseness of association or flight of ideas. Her mood is anxious, mildly irritable, and her affect appropriate to her mood. She was smiling at times in an appropriate manner. She denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. She denies any current suicidal or homicidal ideation. Cognitively, She is alert and oriented to all spheres. Her recent and remote memory is intact. Her concentration is fair. Her insight is good.

 

Clinical Impression

   Client is a 25 yo Russian female who presents with history of treatment for PTSD, ADHD, Stimulant use Disorder, in remission. Moods are anxious and irritable. She has ongoing reported symptoms of re-experiencing, avoidance, and hyperarousal of her past trauma experiences; ongoing subsyndromal symptoms related to her past ADHD diagnosis and exacerbated by her PTSD diagnosis. She denied vegetative symptoms of depression, no evident mania/hypomania, no psychosis, denied anxiety symptoms. Denied current cravings for drugs/alcohol, exhibits no withdrawal symptoms, has somatic concerns of GI upset and headaches. At the time of disposition, the client adamantly denies SI/HI ideations, plans or intent and has the ability to determine right from wrong, and can anticipate the potential consequences of behaviors and actions. She is a low risk for self-harm based on her current clinical presentation and her risk and protective factors.

 

Diagnostic Impression

   [Student to provide DSM-5 and ICD-10 coding] Double click inside this text box to add/edit text. Delete placeholder text when you add your answers.

 

Treatment Plan

   Medication: Increase fluoxetine 40mg po daily for PTSD #30 1 RF Continue with atomoxetine 80mg po daily for ADHD. #30 1 RF Instructed to call and report any adverse reactions. Future Plan: monitor for decrease re-experiencing, hyperarousal, and avoidance symptoms; monitor for improved concentration, less mistakes, less forgetful Education: Risks and benefits of medications are discussed including non-treatment. Potential side effects of medications discussed. Verbal informed consent obtained. Not to drive or operate dangerous machinery if feeling sedated. Not to stop medication abruptly without discussing with providers. Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Praised and Encouraged ongoing abstinence. Maintain support system, sponsors, and meetings. Discussed how drugs/ETOH affects mental health, physical health, sleep architecture. Patient was educated about therapy and services of the MHC including emergent care. Referral was sent via email to therapy team for PET treatment. Patient has emergency numbers: Emergency Services 911, the national Crisis Line 800-273-TALK, the MHC Crisis Clinic. Patient was instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. Time allowed for questions and answers provided. Provided supportive listening. Patient appeared to understand discussion and appears to have capacity for decision making via verbal conversation. RTC in 30 days Follow up with PCP for GI upset and headaches, reviewed PCP history and physical dated one week ago and include lab results Patient is amenable with this plan and agrees to follow treatment regimen as discussed.

 
 

Narrative Answers

 

[In 1-2 pages, address the following:

· Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

· Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

· Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.]

 

Add your answers here. Delete instructions and placeholder text when you add your answers.

 

 

References

[Add APA-formatted citations for any sources you referenced]

 

Delete instructions and placeholder text when you add your citations.

Page | 2 Walden University, LLC
   

 

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Assignment 2: Clinical Skills Self-Assessment

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PLEASE FOLLOW INSTRUCTION BELOW, ZERO PLAGIARISM, FIVE REFERENCE NOT MORE THAN FIVE YEARS

Before embarking on any professional or academic activity, it is important to understand the background, knowledge, and experience you bring to it. You might ask yourself, “What do I already know? What do I need to know? And what do I want to know?” This critical self-reflection is especially important for developing clinical skills such as those for advanced practice nursing.

The PMHNP Clinical Skills List and PMHNP Clinical Skills Self-Assessment Form provided in the Learning Resources can be used to celebrate your progress throughout your practicum and identify skills gaps. The skills list covers all necessary skills you should demonstrate during your practicum experiences.

For this Assignment (just as you did in PRAC 6645), you assess where you are now in your clinical skill development and make plans for this practicum. Specifically, you will identify strengths and opportunities for improvement regarding the required practicum skills. In this practicum experience, when developing your goals and objectives, be sure to keep assessment and diagnostic reasoning in mind. As you complete your self-assessment this week, you may wish to look back over your self-assessments from prior practicums to reflect on your growth.

PRAC 6665/6675 Clinical Skills 

Self-Assessment Form

Desired Clinical Skills for Students to Achieve Confident (Can complete independently) Mostly confident (Can complete with supervision) Beginning (Have performed with supervision or needs supervision to feel confident) New (Have never performed or does not apply)
Comprehensive psychiatric evaluation skills in: 
Recognizing clinical signs and symptoms of psychiatric illness across the lifespan        
Differentiating between pathophysiological and psychopathological conditions        
Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies)        
Performing and interpreting a mental status examination        
Performing and interpreting a psychosocial assessment and family psychiatric history        
Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).        
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list        
Formulating diagnoses according to DSM 5 based on assessment data        
Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes        
Pharmacotherapeutic skills in:
Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management)        
Evaluating patient response and modify plan as necessary        
Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)        
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalities across the lifespan        
Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation)        
Applies age appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers        
Develop an age appropriate individualized plan of care        
Provide psychoeducation to individuals and/or any caregivers        
Promote health and disease prevention techniques        
Self-assessment skill:
Develop SMART goals for practicum experiences        
Evaluating outcomes of practicum goals and modify plan as necessary        
Documenting and reflecting on learning experiences        
Professional skills:
Maintains professional boundaries and therapeutic relationship with clients and staff        
Collaborate with multi-disciplinary teams to improve clinical practice in mental health settings        
Identifies ethical and legal dilemmas with possible resolutions        
Demonstrates non-judgmental practice approach and empathy        
Practices within scope of practice        
Selecting and implementing appropriate screening instrument(s), interpreting results, and making recommendations and referrals:
Demonstrates selecting the correct screening instrument appropriate for the clinical situation        
Implements the screening instrument efficiently and effectively with the clients        
Interprets results for screening instruments accurately        
Develops an appropriate plan of care based upon screening instruments response        
Identifies the need to refer to another specialty provider when applicable        
Accurately documents recommendations for psychiatric consultations when applicable

     

 

Summary of strengths:

 

 

 

 

 

 

 

 

 

Opportunities for growth:

 

 

 

 

 

 

 

 

 

 

Now, write three to four (3–4) possible goals and objectives for this practicum experience. Ensure that they follow the SMART Strategy, as described in the Learning Resources.

1. Goal:

a. Objective:

b. Objective:

c. Objective:

 

2. Goal:

a. Objective:

b. Objective:

c. Objective:

 

3. Goal:

a. Objective:

b. Objective:

c. Objective:

 

4. Goal:

a. Objective:

b. Objective:

c. Objective:

 

 

 

 

 

 

Signature:

Date:

Course/Section:

Medical Coding And Billing Unit 10 Q Question

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Medical Coding ICD-10

 

1. This 60-year-old patient was admitted with emphysematous nodules.  A thoracoscopic wedge resection was performed in the left lung to remove the lung nodules.  A resection was done in the upper and lower lobes.  Which of the following answers is correct? (Points : 2)

J98.4, 32666, 32667        J43.9, 32666        J98.4, 32505        J43.9, 32666, 32667

 

 

Question 2. 2. A neonatal patient is brought to the operating room for repair of complete transposition of the great arteries under cardiopulmonary bypass. The infant is in critical condition and may not survive. Assign the correct diagnosis codes and CPT codes to report the administration of anesthesia, including physical status, Level I and II modifiers, and qualifying conditions for this procedure. (Points : 2)

Q20.3, 00562–AA–23, 99100        Q20.1, 00561–AD–P5, 99140        Q20.3, 00561–AA–P5        Q20.3, 00563–AA–P5, 99100, 99140

 

 

Question 3. 3. A 69-year-old patient was hit by a car, causing intra-thoracic trauma and hemorrhage.  The patient was taken directly from the Emergency Department to the operative suite where the chest was opened and hemorrhage was controlled, but the patient’s heart stopped.  Open heart massage was performed but the patient expired before the patient could be admitted.  Assign the appropriate CPT code(s) and any required modifier(s) to report this service. (Points : 2)

32110-CA        32110, 32160        32160-CA        32110-CA, 32160-CA

 

 

Question 4. 4. A non-Medicare patient with carcinoma of the oral cavity and lower lip is receiving daily intramuscular injections of the interferon alfa-2a (3 million units) in the outpatient cancer center.  Which of the following will be reported for this service?  The payer does accept HCPCS Level II codes for drugs. (Points : 2)

Z51.12, I49.8, 96401, J9213        C14.8, 96372, J9213        C06.9, C00.2, 96372        Z51.12, 96549

 

 

Question 5. 5. An elderly patient has an abscess formation around a pacemaker pocket on his chest wall that requires that the device be removed and the pocket reformed in another location.  Which of the following code sets is appropriate for this outpatient surgical service?  (Points : 2)

T82.7XXA, L02.219, 33222        L02.219, 33222        T82.7XXA, 33223        T82.857A, L02.219, 33999

 

 

Question 6. 6. Assign the appropriate ICD-10-CM diagnosis code for aspiration pneumonia due to inhalation of food. (Points : 2)

J15.9        J69.0        J18.9        J69.1

 

 

Question 7. 7. A hospital-based pediatric clinic is treating a newborn with talipes equinovarus by manipulation and short leg casting. Which of the following code sets is reported for a visit where the condition is evaluated with a -problem-focused history and examination and parents’ questions are answered, followed by foot and ankle manipulation and replacement of the plaster cast? (Points : 2)

Q66.6, 29450        M21.549, 29405        Q66.0, 29405        Q66.0, 99212–25, 29450

 

 

Question 8. 8. A 32-year old female has recently had surgery for melanoma of the right lower leg, Clark level IV>  She had no other signs of metastasis or adenopathy.  Under general anesthesia, a sentinel node biopsy of the deep axillary nodes was performed with a gamma counter probe.  An injection of isosulfan blue dye was performed and the nodes followed carefully to the single-bright-blue node.  This node was excised and sent for frozen section, which proved to be negative for melanoma.  Before the procedure, the radiologist performed a lymphoscintigraphy.  Which of the following code sets would the surgeon report. (Points : 2)

C44.691, 38525        C4A.71, 38525, 38792        C4A.71, 38525, 38792–51, 78195        C43.9, 38525, 38790–51

 

 

Question 9. 9. What code(s) is/are assigned for a patient receiving home care after a kidney transplant? (Points : 2)

Z48.29        Z48.298, Z94.0        N18.6        Z94.0

 

 

Question 10. 10. What would be the appropriate ICD-10-CM code for lumbar stenosis? (Points : 2)

M48.00        M48.06        M48.07        M48.26

 

 

Question 11. 11. Dr. Smith sent a patient to observation care at the local hospital following his visit to the nursing facility.  The patient was admitted for observation to rule out stoke due to a change in mental status.  The next morning, Dr. Smith left town, and his partner, Dr., Johnson, admitted the patient to inpatient care because of sudden worsening symptoms.  The patient expired later the same day.  Assuming documentation guidelines were met, how would E/M services for these two physician be coded? (Points : 5)

Dr. Smith: 99315; 99219; Dr. Johnson:  99236        Dr. Smith: 99219; Dr. Johnson:  99217, 99236        Dr. Smith: 99219; Dr. Johnson:  99236        Dr. Smith: 99315; 99222; Dr. Johnson:  99238

 

 

Question 12. 12. The following documentation is from the health record of a 3-year-old child.  Parents bring their 3-year-old boy, who was born with hydrocephalus, to the pediatric neurology clinic at Unive3rsity Hospital to have the child evaluated by the pediatric neurologist and have his VP shunt lengthened to accommodate a growth spurt.  Their pediatrician requested a consultation to evaluate the shunt and replace the peritoneal catheter if needed.  Outpatient surgery had been previously scheduled tentatively pending this evaluation for the afternoon.  The catheter used in the shunt was removed and replaced in the outpatient surgery suite following a follow-up consultation, which included a detailed interim history, a detailed examination, and medical decision making of moderate complexity.  Findings documented in the consultation include “Assessment: Shunt valve malfunction requiring replacement”.  The VP shunt valve was replaced along with a new peritoneal catheter in a longer length.  Which of the following code sets will be reported for this service? (Points : 5)

Z45.41, 62230        T8503XA, Q03.9, 62230        Q03.9, Z45.41, 62225        Q03.9, 62230

 

 

Question 13. 13.

This 21-month old male presents to the Emergency Department with nausea and vomiting since 10 pm last night, at least 8 times, which is nonbloody but bilious.  Temp of 39.8 since last night.  He has a history of Tetralogy of Fallot, s/p repair 2 months ago.  He has known immunodeficiency, laryngomalacia, and a gastrostomy tube.  After examination, working differential diagnoses are acute gastroenteritis, bacteremia, or possible septicemia.  Symptoms similar to episode about 1 month ago that was determined to be bacteremia with G-tube site infection.  The patient is treated with Zofran 2 mg IV, followed by Ceftriaxone 600 mg IV.  The patient is discharged after resolution of vomiting and fever.  Diagnosis listed as acute gastroenteritis.

Assign the correct ICD-10-CM codes for the facility services provided today.

(Points : 5)

D84.9, K52.9, Q31.5, Z87.74, Z93.1        D84.9, K52.9, Q31.5, Z98.89, Z93.1        D84.9, K52.9, Q33.5, Z84.74, Z98.89, Z93.1        D84.9, K52.9, Q31.5, Z84.74, Z98.89

 

 

Question 14. 14. A 48-year-old man came in to the emergency department complaining of vomiting material resembling coffee grounds several times within the past hour.  He has abdominal pain and has been unable to eat for the past 24 hours.  He is dizzy and lightheaded.  Two stools today have been black and tarry.  While in the emergency department, he vomited bright-red blood and some material resembling coffee grounds.  A nasogastric tube was inserted by the ED physician and attached to suction.  An abdominal exam showed a fluid wave consistent with ascites.  CBC and clotting studies were drawn.  A detailed history and physical exam with high-complexity medical decision making were documented.  A GI consultant was called and the patient was taken to the Endoscopy for further evaluation of upper GI bleeding.  Diagnosis:  Hematemesis, rule out esophageal varices; blood loss anemia, acute; ascites.  Which of the follow is the correct diagnosis and CPT procedure assignment for the independent ED physician? (Points : 5)

K92.0, D62, R18.8, 99285, 43752         K92.0, R10.9, R42, 99284-25, 91105         R18.0, K92.0, D50.0, 99284, 43752         K92.0, D62, R18.8, 99284-25, 43752

 

 

Question 15. 15. The following documentation is from the health record of a 39-year-old female patient.  This 39-year-old female was diagnosed with breast cancer 2 years ago.  At that time she had a mastectomy performed, with no evidence of metastases to the lymph nodes.  About 8 months ago, metastases were found in her liver.  The patient was given chemotherapy.  She has been losing weight and developing increased fatigue.  Patient was referred to hospice care program, with a life expectancy of 4 to 6 months.  Progressive weight loss due to loss of appetite led to cachexia and program of home intravenous hyperalimentation.  Progressive, unrelenting abdominal pain led to chronic use of analgesics.  Patient is awake, alert, and desires to spend more time with family.  Progressive weakness and dropping hemoglobin led to the decision to transfuse the patient every 2 weeks with 2 units of packed cells.  Patient is stable and more comfortable on this regimen.  What are the correct diagnosis codes assigned in this case? (Points : 5)

D63.0, D64.81, C78.7, Z85.3, T45.1X5        D64.9, C78.7, Z85.3, T45.1X5         D63.0, C78.7, Z85.3, T45.1X5         D64.9, C78.7, Z85.3

 

 

Question 16. 16. The patient is a four-year-old male with acute lymphocytic leukemia who has had a fever for the last 24 hours.  It has been nine days since his last chemotherapy, which was his first.  A comprehensive history is documented.  On examination, the skin over his Hickman site is extremely red and starting to break down.  No other abnormal findings are noted in the comprehensive exam.  Labs show that the patient is not neuropenic.  The physician lists the diagnoses as :  ALL not in remission, infected Hickman.  The patient is given 770 mg of Ceptz over 10 minutes through a new peripheral IV site and admitted for continued treatment.  Medical decision making is moderate. What code set is reported for the services of the emergency physician? (Points : 5)

C91.00, T827XXA, R50.9, 99284-25, 96374        T80218A, Y83.8, 99284        C91.00, T8579XA, R50.81, 99285        C91.00, T80219A, 99285-25, 96374

 

 

0

 

-715317765

 

MultipleChoice

 

-715317773

 

4

 

0

 

-715317764

 

MultipleChoice

 

2

 

0

 

MultipleChoice

 

-715317763

 

MultipleChoice

 

15

 

0

 

-715317762

 

MultipleChoice

 

13

 

8

 

0

 

-715317761

 

MultipleChoice

 

18

 

0

 

-715317760

 

MultipleChoice

 

14

 

0

 

-715317759

 

MultipleChoice

 

12

 

0

 

-715317772

 

MultipleChoice

 

10

 

0

 

-715317771

 

MultipleChoice

 

9

 

0

 

-715317770

 

MultipleChoice

 

7

 

0

 

-715317769

 

MultipleChoice

 

6

 

0

 

-715317768

 

MultipleChoice

 

3

 

0

 

-715317767

 

MultipleChoice

 

5

 

0

 

0

 

-715317766

 

MultipleChoice

 

11

Identify strengths that Karen has for progress in personal growth.

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Case Study, Mohr

CHAPTER 1, Introduction to Psychiatric–Mental Health Nursing In completing the case study, students will be addressing the following learning objectives: Explain elements that contribute to mental health.

Review trends, problems, and goals related to the delivery of mental health care and treatment of mental illness.

1. Karen is a 25-year-old white woman who lives alone in an apartment with her dog. Karen has been divorced for 2 years and is taking Prozac prescribed by her psychiatrist for depression.  Karen and her boyfriend had been discussing marriage until he told her that he wanted to end their relationship.  Karen became even more depressed and could not work for a week.  Karen returned to work, refusing to discuss her issues with family, friends, or coworkers. She did, however, make an appointment to see a psychiatric nurse practitioner.  Karen told the nurse that she was making some changes in her life.  Karen said that she and a girlfriend were joining a gym program for workouts and a social group for young men and women.  Karen stated that she realizes that her former boyfriend had not been committed to her, and she anticipates meeting and dating other young men from the adult social group.  Karen also said that she thinks that the gym exercise will be beneficial to her mentally and physically.

Learning Objectives: 1, 4)

  • How will the psychiatric nurse assess if Karen has made progress toward self-realization?
  • Identify strengths that Karen has for progress in personal growth.

Karen has been seeking treatment for her depression. Analyze the factors that might contribute to Karen’s reluctance to discuss her depression with others.

Case Study, Mohr:  CHAPTER 2, Neuroscience: Biology and Behavior

In completing the case study, students will be addressing the following learning objectives:

Discuss neuroplasticity and how this concept relates to mental health and mental illness.

Briefly explain the importance of interaction between genes and environment, the role of endophenotypes, and the stress-diathesis model of psychiatric illness.

1. Michael is a 22-year-old college senior whose GPA has declined with this semester’s grades.  Michael plans to apply to medical school and thinks that the lower GPA may prevent his acceptance to medical school.  For the last 2 weeks, Michael has skipped most classes because he has insomnia and fatigue.  Michael is now very depressed and has been thinking of suicide.  He took a loaded gun from his father’s gun cabinet and then wrote a suicide note to his family.  At the last moment, he telephoned 911 and told them of his suicide plan.  The police came, took the gun away, and then took Michael to the city hospital to be admitted for psychiatric treatment.   In the admission interview with the psychiatric nurse, Michael said that his pastor thought that only weak-willed people experienced depression and that it was a punishment for personal sins and the sins of one’s ancestors.  Michael told the nurse that he must be weak-willed and will never be able to accomplish anything.  The psychiatric nurse explained that multiple factors are the cause of depression.  The nurse told Michael that one theory holds that an imbalance of neurotransmitters, or chemical messengers of the brain, occurs in depression.  Neurotransmitters influence the individual’s emotions, thoughts, and subsequent behavior.  Recent research implies that neurobiology, heredity, as well as Psychological and environmental factors may be involved in the development and progression of depression.

(Learning Objectives: 5, 6)

a. Will Michael think that the psychiatric nurse’s explanation for the cause of depression is more correct than that of his pastor?

b. Michael asks the nurse why he has to have psychotherapy. He states that he only needs to take a couple of pills to get better. How should the nurse respond to Michael’s question and comment?

c. Develop an assessment question for each of the following possible causes of Michael’s    development of depression:

Genetic, Environment and Stress.

Case Study, Mohr

CHAPTER 3, Conceptual Frameworks and Theories:

In completing the case study, students will be addressing the following learning objective:

Give examples of behavioral and cognitive-behavioral interventions.

The student nurse has been assigned a 37-year-old woman admitted to the psychiatric hospital with an anxiety disorder.  This morning, the student notices that the client has a tense facial expression and is walking constantly around the group room.   The student walked over to the client and used reflective communication by stating, “I see that you have a tense expression and are walking around almost all of the time.  Is there something that we could discuss?”  The client replied that she has talked on the telephone to her mother who was keeping her children while she was in the hospital.  The client said that her mother had told her that she was not a good mother, and then said, “I guess I am a bad mother, but I could never measure up to my mother’s expectations.”  The student has learned that negative self-talk can greatly aggravate anxiety and lead to depression.  The student decided to use a behavioral intervention with the client and asked the client who is a good artist and why the client liked the artist’s works. The student and the client then made a list of activities that the client liked. The student taught the client to engage in one of these activities when an unpleasant experience evoked negative thoughts.  The following day, the student decided that the client needed some cognitive restructuring for her relationship with her mother.  The student taught the client that during discussions with her mother, feelings of incompetence might be experienced when the mother made negative comments.  The client was instructed that if her mother made negative comments about parenting, she was to immediately tell her mother that she was a good parent to her children and terminate the conversation at the first opportunity.

(Learning Objective: 3)

a. Will the client be able to learn cognitive restructuring in her relationship with her mother?

b.    How will engaging in activities help the client with her anxiety?

Case Study, Mohr

CHAPTER 4, Evidence-Based Practice

In completing the case study, students will be addressing the following learning objective:

Define evidence-based care.

1. Jessica, a 17-year-old girl who came with her family from Romania to the United States 10 years ago, is brought to the mental health clinic by her mother.  At the admission psychiatric interview, the mother stated that Jessica has been saying for 6 months that aliens have been conducting experiments on her and will soon take her in a spaceship to their planet.  Jessica is often awake at night and roams the house with a hammer and sharp knife, searching for aliens. Jessica’s mother says that she fears that some night Jessica will harm a family member whom she believes to be an alien.  The mother then said that she did not bring Jessica for psychiatric care earlier because she had heard that much of mental health treatment was quackery and a waste of money. The psychiatric nurse explains to Jessica’s mother that all mental health treatment is based on scientific principles.

(Learning Objective: 3)

a. How would the nurse best explain that the care Jessica will receive at the psychiatric   facility is based on evidence? Give two examples of psychiatric evidence-based care, and explain the scientific evidence that supports your examples.

Case Study, Mohr

CHAPTER 5, Legal and Ethical Aspects: In completing the case study, students will be addressing the following learning objectives:  Identify the basic rights of people with mental illness. Describe the different types of commitments and states of competency.

1. Gerald, a 22-year-old black man, has a diagnosis of schizoaffective disorder.  Gerald has been living at home, but this afternoon he had a physical fight with the neighbors and set a fire in their garage to burn their house.  His father took him to the local psychiatric hospital and said that he wants an involuntary commitment for Gerald since he will not agree to the hospitalization.  The father expressed concern over Gerald’s legal rights.  The psychiatric nurse practitioner recommends to the father that he commit Gerald on involuntarily for emergency care for a period of 72 hours since he is clearly a danger to others. The nurse explains that Gerald will be evaluated to determine if he needs involuntary detention for observation and treatment for a longer period of time.  The nurse explains that Gerald will be periodically evaluated, and that when it is determined that he is no longer a danger to others or himself, Gerald will be released from the hospital.

(Learning Objectives: 4, 5)

a. What basic legal rights does Gerald have at the time of this illness?

b. Why can Gerald not make the decision for himself about being an involuntary emergency commitment to the hospital?

Case Study, Mohr

CHAPTER 6, Culture

In completing the case study, students will be addressing the following learning objective:

Describe skills essential to the implementation of culturally competent care.

1. Mrs. Maria Gonzalez is a Mexican National, age 58, who was brought to a health clinic by her adult son. She is complaining that she has had aches and pains all over her body for 2 days. Mrs. Gonzalez states that her neighbor is a witch who gave her the mal do ojo (evil eye) and cast a spell on her to cause her death. The clinic nurse takes an oral temperature and it is 101º F.  The clinic nurse refers Mrs. Gonzales to the clinic physician because she believes that the client has influenza.  Mrs. Gonzales is reluctant to see the doctor and states that the doctor cannot prevent her death.

(Learning Objective: 8)

a. How can the nurse provide culturally competent care to Mrs. Gonzalez and convince her to see the clinic doctor?

b. Can Mrs. Gonzalez be convinced that there is no spell cast on her to cause her death? Explain your answer.

Case Study, Mohr

CHAPTER 7, Spirituality in Psychiatric Care

In completing the case study, students will be addressing the following learning objective: Explore reasons for the resurgence of interest in the spiritual aspects of healthcare.

  • Marta, a 16-year-old high school teenager, has been depressed over a recent break-up with her boyfriend.  Marta, accompanied by her mother, is seen in the community mental health clinic.  A mild antidepressant is prescribed for Marta with weekly counseling sessions.  Marta and her mother ask if it would be beneficial for Marta to attend a 1-week church camp to begin in 2 months.  Marta would like to reconnect with her religion and voices a belief that the camp experience will help her. The psychiatric nurse practitioner informs them that research reveals that involvement in religious activities has been helpful in social support and in coping with depression.  Marta appears relieved and said that she will register for the church camp.

(Learning Objective: 2)

a. Why might Marta want to reconnect with her religion, and how will attendance at the church camp benefit Marta?

b. If Marta attends the church camp, will this pose a problem to counseling sessions?

Case Study, Mohr

CHAPTER 8,- Nursing Values, Attitudes, and Self-Awareness

In completing the case study, students will be addressing the following learning objective:

Discuss how situational factors can potentially influence the behavior of healthcare professionals toward clients with mental illness.

1. Joe, a 26-year-old Caucasian man, is a client in a state prison system.  Joe is admitted to the prison clinic after being involved in a fight in which he sustained a stab wound to the chest that did not penetrate the lungs or major blood vessels.  The clinic doctor on duty was an employee of several years at the prison.  The doctor showed little compassion for Joe, stating, “He is a convicted criminal, and he is just getting back some of what he deserves.”  The new graduate nurse who was being oriented to the clinic thought that the doctor did not exhibit professional behavior toward Joe.  The clinic nursing supervisor later explained that the doctor was influenced by situational factors.

(Learning Objective: 3)

  • What is a situational factor, and how can this influence the behavior of healthcare workers? Provide an example where a situational factor impacted on your behavior while in a healthcare setting.

Case Study, Mohr

CHAPTER 9, the Nursing Process in Psychiatric–Mental Health Care

In completing the case study, students will be addressing the following learning objective:

Apply the nursing process to psychiatric–mental health nursing.

1. The student nurse is assigned to assist the psychiatric nurse with the admission interview of a client at the psychiatric hospital.  The nurse explains to the student that the interview is very important in obtaining a total health history of the client.  The nurse should be courteous and respectful of the client to obtain as much information from the client as possible.  Assessment information should include the subjective information from the client with the reason for needing treatment, the cause of the present problem(s), and the client’s expectation of the outcome of treatment regimen.  The nurse alerts the student to the need to be sensitive to both verbal and nonverbal behavior of the client and to focus on topics that seem important to the client.

(Learning Objective: 1)

a. How can attention to the client’s nonverbal cues be of value in an interview?

b. Why is the interview the most important aspect of the nursing process?

Case Study, Mohr

CHAPTER 10, the Interview and Assessment Process

In completing the case study, students will be addressing the following learning objective:

Describe essential elements to include in psychiatric interviews and the assessment process.

  • The student nurse is accompanying the psychiatric nurse during the nursing interview and assessment of a newly admitted patient.  The psychiatric nurse told the student that preparation with subjective and objective data collection is an important part of the process.  The nurse explains that assessment has reference to the interviewer’s interpretation and prioritization of all data for the client.  The nurse must have self-awareness and self-knowledge to be objective and avoid influencing the responses of the client.  Anxiety on the part of the nurse may limit the ability for thorough data collection and interpretation.  Anxiety in the nurse may evoke anxiety on the part of the client. The psychiatric nurse stressed that a process recording, or written analysis of the interaction between the client and nurse, is essential for nurses to recognize the effects of their communication style in the assessment process.  A review of the client’s history is important, and a private setting for the interview is necessary.  The content of the nursing assessment should include the ability and reliability of the client’s response to questions of the interviewer and the skill of the nurse in identification of relevant facts.  The nurse should discuss with the client prior health history, any present illness, and the reason for seeking healthcare at this time.  Medication history with compliance and allergies of the client require investigation.   Substance use by the client, past illnesses, and family history need exploration.

(Learning Objective: 2)

a   The student nurse asked the clinical psychiatric nurse practitioner to explain what she considered the most essential part of the assessment process. How should the psychiatric nurse respond to the student’s question? Explain your answer.