Comprehensive Psychiatric Evaluation Bulimia Nervosa Paper
Description
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For this assignment, students will create a written comprehensive psychiatric evaluation of a patient with Bulimia Nervosa seen in the clinic. Each student will use the “Psychiatric SOAP Note Template” SEE ATTACHED, to create a detailed psychiatric evaluation document.
S Subjective data: Patients Chief Complaint (CC); History of the Present Illness (HPI)/ Demographics; that includes the presenting problem and the 8 dimensions of the problem (OLDCARTS); Review of Systems (ROS)
O |
Objective data: Medications; Allergies; Past medical history; Family history; Past surgical history; Psychiatric history, Social history; Labs and screening tools; Vital signs; Physical exam, (Focused), and Mental Status Exam. |
| A | Assessment: Primary Diagnosis and two differential diagnoses including ICD-10 and DSM5 codes. |
| P | Plan: Pharmacologic and Nonpharmacologic treatment plan; diagnostic testing/screening tools, patient/family teaching, referral, and follow up |
Other:?Incorporate current clinical guidelines research articles, and the role of the PMHNP in your presentation.
Reminder: It is important that you complete this assessment using your critical thinking skills. You are expected to synthesize your clinical assessment, formulate a psychiatric diagnosis, and develop a treatment plan independently. It is not acceptable to document “my preceptor made this diagnosis.” An example of the appropriate descriptors of the clinical evaluation is listed below. It is not acceptable to document within normal limits.
IMORTANT:
Client is a 19-year-old American female with Bulimia Disorder. She visits the care facility and says, “I am not feeling well with my body, I want to lose weight and every time I eat, I induced myself to vomit”
Thank you!
