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Differential Dx - ANSWER-Diagnostic reasoning is the process of questioning
one's thinking to determine if all possible avenues have been explored and if
the conclusions that are drawn are based on evidence. This is a critical step
for providers who are trying to uncover a cause, or diagnosis, for their
clients' signs and symptoms. The provider's initial hypothesis is known as the
differential diagnosis. The differential diagnosis, or differential, is a working
list of potential problems that can be associated with the initial or chief
complaint. Establishing a differential diagnosis is a critical step in providing
safe, quality care. This evolving process of clinical reasoning and decision
making involves examining the client's presentation, clinical data, and when
appropriate, screening and diagnostic test results to distinguish one disease
from another and arrive at the correct diagnosis. The Diagnostic and
Statistical Manual of Mental Disorders (DSM-5-TR)provides guidance for
identifying psychiatric diagnosest
,Medical History/Screening for General Medical Conditions - ANSWER-Do you
have a primary care provider?
Do you have any medical illnesses?
Are you currently taking any medications or herbal supplements?
Do you have any allergies to medications?
Have you ever been hospitalized for any reason?
Have you ever had surgery?
Family Psychiatric History - ANSWER-Has any relative of yours ever been
hospitalized for a mental health issue?
Has any blood relative of yours ever been diagnosed with a mental health
issue?
Has any blood relative of yours had a history of seizures or
dementia/Alzheimer's?
Social and Developmental History - ANSWER-Tell me a little bit about your
childhood and how you grew up.
How was your experience in school when you were younger? Did you enjoy
school?
How do you support yourself with your finances?
,Do you have a good support system? Are you currently in a relationship?
Where do you live? Who do you live with?
What do you do in your free time? What activities do you enjoy?
History of Present Illness - ANSWER-How long have you been feeling this
way?
Did something happen in your life that may have triggered these emotions?
How is this current situation impacting your life?
The Psychiatric History - ANSWER-Have you ever been hospitalized for any
mental health issues?
Have you ever had counseling or psychotherapy?
Have you ever taken medications for your mental health in the past?
Are you currently on any medications for mental health or sleep?
Which of the following should be included when providing client education
about medication regimens? Select all that apply. - ANSWER-A)Explain how
the medication targets the symptoms, specific benefits, and expected time
course. (Correct answer)
, B)Identify potential side effects, duration of side effects, and adverse effects.
(Correct answer)
C)Explain the instructions, dosing, and special requirements. (Correct
answer)
D)Use teach-back methods to ensure client understanding. (Correct answer)
Apply the Ask Suicide-Screening Questions (ASQ) Suicide Risk Screening Tool
(Links to an external site.) to the scenario below.
A 52-year-old client presents to the emergency department following a car
accident. The emergency department (ED) physician is concerned that the
client may have intentionally crashed her car and requests a stat PMHNP
consult. In speaking with the PMHNP, the client describes persistent feelings
of sadness and hopelessness. She states that she often wonders if her
husband would be happier if she wasn't around anymore since she's never
happy and sometimes thinks about what it would be like to just take a
handful of sleeping pills and go to sleep forever. The client reports a previous
suicide attempt when she was 16 but denies that she is considering killing
herself right now.
Based on the client's ASQ score, what is the most appropriate response?
A) No action is necessary as the client is not - ANSWER-B)Provide a brief
suicide safety assessment.