Read the following nursing situation and answer the questions at the end of the nursing situation. APA style John was in his early 20’s, single, living with his mother and 2 younger siblings, Bobby who is 6 y/o and Julie who is 14. John graduated from high school 2 years ago with his GED and since that time he has worked at Publix in the stock room on the night shift. Last week his mother received a call from his employer and informed her that John had gotten in an argument with a fellow employee at work. John wanted the cans to be alphabetized and refused to change his shelves even at the request of his supervisor. His supervisor has requested that John is evaluated by a psychiatrist/PMHNP before coming back to work. Chief Complaint: “I don’t know why my mom wanted me to come and talk to you. My boss shouldn’t have called my mom. I don’t think he can do that, do you? I was right that other guy didn’t know how to stack shelves. The cans need to be alphabetical, just like the library.” HPI: John likes things to be in order. He always takes the #2 bus home from work and if the #3 bus comes, which would take him home too, he waits for the #2 bus. When asked to explain this, he said he likes #2 because it comes after #1. John was Baker Acted last year when he got in a fight at the computer store when he thought the owner accused him of something he did not do. Medication: risperidone 0.5 mg at bedtime. Family History: John lives with his mother and 2 siblings. He refuses to talk about his father and states, “he is dead”, although his mother reports she is divorced and her husband lives out of town and offers no support. He is unable to share much information regarding his siblings as he reports he stays in his room and doesn’t like to talk to them. He does not think they are his “real” siblings. PMHNP: John was very guarded in his sharing of information and requested that no information be shared with his mother or work supervisor. He insisted there was nothing wrong with him. He is not aware he was Baker Acted last year and is unable to explain why he was hospitalized. Reports that medication is to help him sleep at night. Denies any issues with sleeping, eats well but likes to eat at certain times of the day and only certain items (all white food). John appears tired, hair uncombed, clothes clean and appropriate to the weather. He scored 22 on the Mini-Mental Status Exam and 5 on the PHQ-9 (Many questions has to be repeated and clarified). The PMHNP assured John he did well on his screening tools and asked him to come back in a week to talk a little more about his hopes and dreams for his future. Questions to answer: Based on this nursing situation, what would you identify as • John’s diagnosis? • Does he meet the full criteria for your diagnosis? • What specifiers might you use with your diagnosis? • What differential diagnoses might you be thinking- include both a DSM-5 diagnosis and a Physical Diagnosis? • What other assessment tools would you recommend for use with this client? • What would you determine to be the essence of caring in this situation? • Incorporate scholarly articles to support your diagnosis and/or differential diagnoses and potential treatment plan.
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