Discuss the diagnosis of Oppositional defiant disorder, MDD.

Wk11 RUBRIC. Please address all elements listed below.

In 450–500 words, address the following:

Learning From Experiences

· Revisit the goals and objectives from your Practicum Experience Plan.

· Explain the degree to which you achieved each during the practicum experience.

· Reflect on the 3 most challenging patients you encountered during the practicum experience.

· What was most challenging about each?

· What did you learn from this experience?

· What resources were available?

· What evidence-based practice did you use for the patients?

· What would you do differently?

· How are you managing patient flow and volume? How can you apply your growing skillset to be a social change agent within your community?

*NOTE: These were MY SET GOALS and OBJECTIVE DURING PRACTICUM

1. Goal: To be able to demonstrate gained skills to my preceptor by the end of my clinical rotation.

a. Objective: To utilize critical thinking skills to analyze presenting patient problems

b. Objective: To independently participate in all patient teaching and clinical activities

c. Objective: To ask questions for clarification in order to come up with the best decision

2. Goal: To independently perform clinical task by the end of the clinical rotation

a. Objective: Independently perform patient assessment and evaluation

b. Objective: Independently participate in patient education and planning

c. Objective: Providing patient privacy by ensuring patient integrity and document with biased judgement.

3. Goal: To independently provide patient education and adequate coping skills by the end of the clinical rotation.

a. Objective: Educate on identified gaps and provide coping skills to help improve functioning.

b. Objective: Identity lapses and teach to promote self-care awareness and independence

c. Objective: Promote community referrals and integrate healthy behaviors.

4. Goal: To be knowledgeable with treatment recommendation, diagnosis and medication prescriptions by the end of this clinical rotation.

a. Objective: Effectively making appropriate recommendation/referrals after identifying areas of need.

b. Objective: Evaluation and diagnosing presenting problems utilizing required clinical tools

c. Objective: Confidently prescribe medication accordingly and safely

*NOTE Here are the 3 Difficult clients during my practicum

1. The Patient is a 14 y.o. male with current diagnosis of Oppositional defiant disorder, MDD, previous SA by gunshot wound to the head, subsequent TBI p/w depression and agitation. Patient was admitted to inpatient hospital and was discharged after three weeks. Patient came in with mom for medication management as needed due to his last exacerbation of aggression and lack of inhibition along with poor coping skills and poor frustration tolerance.

2. The Patient is a 14 y.o. male with a history of Oppositional defiant disorder for 4 years, who came in with mom after being referred to continue care with outpatient psychiatrist. He has history of inpatient hospitalization for SI and aggression. Patient reports he is minimally participating in the school activities. States that “I don’t really care about anything.” Patient able to put mask on after being advised. Regarding future goals, patient states “I don’t know.” States I hope to learn how to mow lawns. No physical symptoms reported. Denies current suicidal ideations, homicidal ideations, auditory/visual hallucinations, and not exhibiting delusional symptoms. Patient reports sleep has improved.

3 The Patient is a 14 year-old male who has a past medical history of Anxiety, Consciousness loss, transient, Depression, and Head trauma for 3 years. Who was seen previously, presented for depression with suicidal ideations and homicidal ideations. Patient got into argument with grandmother, non-complaint with behavior at home, laughed at her when she got injured. Prior to hospitalization endorsed SI with plan to shoot himself in head. Patient with hx of suicide attempt shooting himself in the head. Patient’s presentation is consistent with major depressive disorder. Due to risk of suicide and aggressive behavior recommend Patient be taken to the emergency room for possible inpatient hospitalization for symptom stabilization and medication management. Patient is currently on Lexapro 10mg daily for depression/anxiety, Depakote 500mg BID for mood/depression and Seroquel 300mg nightly for mood/depression

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