Psychosocial Assessment (written – Maximum 15 pages including title page,
reference list and appendices).20%
a. Introduction
In the introduction provide an account of the patient and his/her illness from his/her perspective. Briefly describe how he has dealt with the diagnosis/treatment and how he has lived in the past/ present.
b.Complete a full bio-psychosocial assessment including the mental
status assessment. (See Chapter in Boyd, The Psychiatric Nursing
Process). Include a genogram of family relationships.
c. Present the results of a Mini Mental Status Examination (MMSE) or
any appropriate psychiatric assessment tool (CAGE, MAST, SANS, etc…) conducted during a one-to-one interview with the client.
d.Identify client’s DSM V diagnoses and current treatment including
medication regimen. Describe the observed behaviors that meet the DSM criteria.
e. Identify nursing diagnoses and list in order greatest to least in
priority.
f.Develop a care plan for the top three nursing diagnoses.
g. Perform a literature review that summarizes four to six references:
etiology, S/S, manifestations of the psychiatric diagnosis and nursing
interventions pertaining to nursing diagnoses. One article should be a meta-analysis pertaining to either nursing or psychiatric
diagnosis/treatment. For all research articles, provide a description of the purpose, sample, methodology, findings, implications for
practice, and author’s (s’) conclusions. State rationale for selecting each article, including a statement of how it applies to patient’s
psychiatric diagnosis, nursing diagnoses and/ or treatment.Cite all references in APA format.
Students are advised to submit the paper to Safe Assign in order to avoid incorrect referencing that violates the University policy on plagiarism and that is subject to receiving zero credit for the assignment which represents 20% of the clinical grade.
Patient details are as follows:
Patient( J. D. W) is a 60 year old Caucasian American diagnosed with bipolar disorder. He has a beard and mustache accompanied with untrimmed fingernails. He was admitted to spring Groove hospital on the January 24, 2019. He has history of multiple assault charges and has no deformities. He has intermittent psychosis and mania but stable at this time. he denies no mood symptoms , has poor memory, completed 10th grade, has hearing problem, vision loss in the right eye. patient takes lithium, clozapine, lactulose, divalproex sodium, Chlorpromazine. Patient weighs 192 and height is 6.2. He is constipated and is allergic to shellfish/seafood. patient’s HGB/HCT(14.2/41.4). BUN/Creatinine 12/0.71. His cholesterol/TG (139/141), FBS 19,Albumin 3.7 and other H. He has a history of alcohol and has regular diet. Patient mental status is alert and oriented and cooperative. He complains of pain when he moves the shoulder.
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