Neurodevelopmental Disorders Diagnostic Reasoning

Week 10: Neurodevelopmental Disorders Diagnostic Reasoning
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date
Subjective:
CC (chief complaint): Patient complains of difficulty concentrating at work due to accelerated deadlines.
HPI: The patient’s initials are H.B., a 58-year-old White male with a Bachelor’s Degree in Engineering. The patient visits with the appointment set by the supervisor. The patient complains of difficulty concentrating, which is important as he works at a large architectural engineering firm. The patient states that recently there have been accelerated deadlines for tasks, adding a lot of pressure. He notes that he is the only employee with issues with the accelerated deadlines as they all work without issues, while he cannot do the same job his colleagues are doing. For he was meant to install air ducts, which he describes as a simple task but designed them through a solid wall. This he states is a silly mistake that he does not normally commit. Another mistake he committed was drawing a window opening way too small, resulting in millions in cost.
H.B. states that concentration issues were present even in school. For instance, when everyone was busy studying for their finals, he would end up daydreaming and would not concentrate when someone was whispering next to him. Concentration issues at work also happened during seminars, where he would think of other things other than what the chief architect was saying. He also states that he has difficulty sitting still and listening for a sustained period. Other than this, he notes that he gets fixated on work assigned to others. H.B. notes that he is not organized, and describes his home as messy. He notes that he forgets easily, even on important dates and tasks such as paying bills. This has resulted in him paying penalties for paying bills late. In terms of hyperactivity, he states that he is more improved than when he was in school, where he climbed walls and had problems concentrating and staying focused. He notes that he drinks coffee.
Past Psychiatric History:
* General Statement: Concentration issues at school and work
* Caregivers (if applicable): Supervisor at work that set up the appointment
* Hospitalizations: Denies previous hospitalization
* Medication trials: None
* Psychotherapy or Previous Psychiatric Diagnosis: No previous diagnosis
Substance Current Use and History: Denies hx of drug use. Patient drinks one scotch drink and one cigar during the weekends. Drinks coffee on occasion.
Family Psychiatric/Substance Use History: No hx of psychiatric conditions or substance use.
Psychosocial History: The patient is not organized and describes his home as messy. Also has problems with colleagues by fixating on work not assigned to him. The patient dates casually and never had a marital partner. He reports having no offspring and having one younger brother. He sleeps for 7 hours and has no problems with appetite.
Medical History: Cozaar 100mg daily for HTN
ASA 81mg po daily for Angina
Valsartan 80mg daily for HTN
Fenofibrate 160mg daily for hypertriglyceridemia
Tamsulosin o.4mg po at bed...