List 8  PROGRESS NOTES in SOAP format of the . Describe the   activities you completed during this   time   period with patients. NOTE: ( The progress notes has to be related with what the         Psychiatric Mental Health Nurse Practitioner do with Adult and Older adult  with different psychiatric conditions). 8 different     notes     with different patients scenarios. NOTE: BELLOW IS ATTACHED A DOCUMENT AS AN EXAMPLE OF PROGRESS NOTES

Progress Note #1

Patient: John Doe
Age: 35
Psychiatric Condition: Major Depressive Disorder

Date: 20th March 2020

Subjective:
Mr. Doe presented with feelings of sadness and hopelessness during today’s session. He reported decreased energy levels and loss of interest in activities he once enjoyed. He mentioned difficulty in sleeping and experiencing frequent thoughts of death. Mr. Doe expressed a lack of motivation to engage in daily tasks and described a general feeling of emptiness.

Objective:
Physical examination revealed decreased psychomotor activity, slumped posture, and lack of eye contact. Mr. Doe appeared disheveled and had a sad affect. He reported a significantly decreased appetite and unintentional weight loss. Mental status examination indicated depressed mood, slowed speech, and poor concentration.

Assessment:
Based on the symptoms presented, Mr. Doe’s primary diagnosis is Major Depressive Disorder. The severity of his symptoms suggests a moderate depressive episode. The patient’s lack of energy, decreased appetite, and significant weight loss are consistent with the diagnostic criteria for depression.

Plan:
1. Medication management: Initiate treatment with a selective serotonin reuptake inhibitor (SSRI) to help alleviate the symptoms of depression. Monitor for any side effects and adjust dosage as necessary.
2. Psychotherapy: Recommend individual therapy sessions to address Mr. Doe’s underlying thoughts and feelings contributing to his depressive symptoms. Cognitive-behavioral therapy (CBT) will be explored as a potential treatment modality.
3. Safety assessment: Assess Mr. Doe’s suicidality and establish appropriate interventions. Collaborate with the patient’s support system to ensure he has a strong safety plan in place.
4. Follow-up: Schedule a follow-up appointment in two weeks to monitor medication effectiveness, assess for any adverse effects, and evaluate progress in therapy.

Progress Note #2

Patient: Jane Smith
Age: 65
Psychiatric Condition: Generalized Anxiety Disorder

Date: 25th March 2020

Subjective:
Ms. Smith reported excessive worry and chronic restlessness during today’s session. She described feeling on edge and experiencing difficulty controlling her worry. Ms. Smith admitted that her anxiety often interferes with her ability to perform daily activities and causes significant distress.

Objective:
Physical examination revealed increased muscle tension and fidgeting. Ms. Smith exhibited an anxious facial expression and reported difficulty sitting still. She complained of trouble falling asleep and staying asleep, leading to feelings of fatigue and irritability. Mental status examination indicated a heightened vigilance and excessive worrying.

Assessment:
Based on the symptoms presented, Ms. Smith’s primary diagnosis is Generalized Anxiety Disorder. Her persistent worry, restlessness, and difficulty concentrating are consistent with the diagnostic criteria for this condition.

Plan:
1. Medication management: Initiate treatment with a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI) to help manage Ms. Smith’s anxiety symptoms. Monitor for any side effects and adjust dosage as necessary.
2. Psychoeducation: Educate Ms. Smith about the nature of generalized anxiety disorder, including the cycle of worry and ways to manage anxiety symptoms. Discuss relaxation techniques and coping mechanisms to help her better regulate her emotions.
3. Therapy referral: Refer Ms. Smith to a cognitive-behavioral therapist specializing in anxiety disorders for further evaluation and treatment. Collaborate with the therapist to create a treatment plan tailored to Ms. Smith’s needs.
4. Follow-up: Schedule a follow-up appointment in four weeks to assess the effectiveness of medication and therapy interventions. Evaluate any changes in symptoms and adjust the treatment plan accordingly.

Progress Note #3

Patient: David Johnson
Age: 50
Psychiatric Condition: Bipolar I Disorder

Date: 1st April 2020

Subjective:
Mr. Johnson reported experiencing a noticeable change in his mood during today’s session. He described feeling excessively energetic, talkative, and impulsive. Mr. Johnson stated that he has been sleeping less and experiencing racing thoughts. He also revealed engaging in risky behaviors, such as overspending and promiscuity.

Objective:
Physical examination revealed increased psychomotor activity, pressured speech, and a grandiose demeanor. Mr. Johnson appeared euphoric and displayed a flight of ideas. Mental status examination indicated an elated mood, decreased need for sleep, and inflated self-esteem.

Assessment:
Based on the symptoms presented, Mr. Johnson’s primary diagnosis is Bipolar I Disorder, currently in a manic episode. His elevated mood, increased energy, decreased need for sleep, and impulsivity are consistent with the diagnostic criteria for this condition.

Plan:
1. Medication management: Adjust Mr. Johnson’s mood stabilizer dosage to help manage his manic symptoms and stabilize his mood. Monitor for any adverse effects and assess the patient’s compliance with medication regimen.
2. Safety assessment: Evaluate the risk of self-harm or harm to others due to Mr. Johnson’s impulsivity and engage in collaborative safety planning. Involve the patient’s support system in monitoring his activities and providing additional support during this challenging time.
3. Psychoeducation: Educate Mr. Johnson and his family members about the nature of bipolar disorder, including the presentation of manic episodes and the importance of adhering to medication regimens. Discuss coping strategies to manage symptoms and prevent relapse.
4. Follow-up: Schedule a follow-up appointment in one week to assess Mr. Johnson’s response to medication adjustments and monitor for any emerging depressive symptoms. Evaluate the efficacy of the treatment plan and make adjustments as necessary.

Progress Note #4

Patient: Mary Thompson
Age: 75
Psychiatric Condition: Dementia with Behavioral Disturbances

Date: 5th April 2020

Subjective:
Ms. Thompson’s daughter reported significant behavioral changes in her mother’s condition during today’s session. She mentioned that her mother has been increasingly agitated, wandering aimlessly, and exhibiting aggressive behaviors towards family members and caregivers. The daughter expressed concern about her own and her mother’s safety.

Objective:
Observations of Ms. Thompson’s behavior confirmed increased restlessness, agitation, and aggression. She appeared confused and displayed difficulty following instructions. Mental status examination indicated impaired cognitive functioning, including memory deficits and disorientation to time and place.

Assessment:
Based on the symptoms presented, Ms. Thompson is diagnosed with Dementia with Behavioral Disturbances. The observed behavioral changes, cognitive impairment, and disorientation are consistent with this condition.

Plan:
1. Medication management: Review and adjust Ms. Thompson’s current medication regimen to alleviate her behavioral disturbances. Consider prescribing a low-dose atypical antipsychotic medication to manage her agitation and aggression. Monitor for any adverse effects and regularly reassess the need for ongoing medication use.
2. Environmental modifications: Collaborate with the patient’s caregivers to create a safe and structured environment that minimizes triggers for agitation. Implement strategies such as regular routines, visual cues, and reduced environmental stimulation.
3. Behavioral interventions: Introduce behavioral interventions, including redirection techniques, validation therapy, and reminiscence therapy, to help manage Ms. Thompson’s behavioral disturbances. Provide education and support to family members and caregivers on implementing these strategies.
4. Support services: Refer the patient’s family to community resources, such as support groups and respite care services, to alleviate caregiver burden and provide additional support during this challenging period.
5. Follow-up: Schedule a follow-up appointment in four weeks to evaluate the effectiveness of medication and behavior management strategies. Assess any changes in behavioral disturbances and adjust the treatment plan accordingly.

Progress Note #5

Patient: Robert Wilson
Age: 40
Psychiatric Condition: Substance Use Disorder (Alcohol)

Date: 10th April 2020

Subjective:
Mr. Wilson reported struggling with alcohol dependence during today’s session. He admitted difficulties in controlling his alcohol consumption and experiencing withdrawal symptoms when attempting to quit. Mr. Wilson expressed feelings of guilt, shame, and remorse related to his drinking behavior.

Objective:
Physical examination revealed evidence of alcohol intoxication, including slurred speech, unsteady gait, and flushed complexion. Mr. Wilson appeared anxious and restless. Mental status examination indicated a dysphoric mood, poor concentration, and impaired insight into the consequences of his alcohol use.

Assessment:
Based on the symptoms presented, Mr. Wilson’s primary diagnosis is Substance Use Disorder (Alcohol). His inability to control alcohol consumption and the presence of withdrawal symptoms are consistent with this diagnosis.

Plan:
1. Detoxification and withdrawal management: Refer Mr. Wilson to an accredited detoxification facility for medically supervised withdrawal management. Collaborate with the facility’s healthcare team to ensure a safe and supportive detoxification process.
2. Medication-assisted treatment: Discuss the option of integrating a medication-assisted treatment approach, such as the use of disulfiram or naltrexone, to support Mr. Wilson’s recovery from alcohol dependence. Monitor for any adverse effects and evaluate the patient’s motivation and readiness for medication interventions.
3. Psychotherapy: Initiate individual therapy sessions focused on addressing the underlying factors contributing to alcohol dependence. Utilize interventions such as Motivational Interviewing and Cognitive-Behavioral techniques to explore the patient’s motivations for change and help develop coping strategies.
4. Support groups: Encourage Mr. Wilson’s engagement in Alcoholics Anonymous or other relevant support groups to foster a sense of community and provide ongoing support throughout his recovery journey.
5. Follow-up: Schedule a follow-up appointment in two weeks to evaluate the patient’s progress in detoxification and withdrawal management. Assess the need for ongoing medication intervention and therapy sessions.