| Course | NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum |
|---|---|
| Week | 2 |
| Paper type | Initial psychiatric evaluation note |
| Length | About 1,100 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Psychiatric-Mental Health Nurse Practitioner (PMHNP) |
| Updated | October 2026 |
Free sample paper for NR 605 Week 2
Initial Evaluation Note: T.N., 34, Night-Shift Warehouse Supervisor With Low Mood, Broken Daytime Sleep and Panic Attacks, Written Backwards From the Plan
Student Name
College of Nursing, Chamberlain University
NR 605: Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum
Instructor Name
Month Day, Year
Initial Evaluation Note: T.N., 34, Night-Shift Warehouse Supervisor With Low Mood, Broken Daytime Sleep and Panic Attacks, Written Backwards From the Plan
Identifying Information and Reason for Visit
T.N., 34, self-referred after a panic attack at work. Runs the overnight crew at a warehouse, ten at night until half past six, Monday through Friday. Lives with a partner and a 6-year-old child. "I can't sleep, I can't think, and I'm scared to go back on the dock."
History of Present Illness
Three months of low mood most days, worse on waking in the afternoon. Lost interest in cooking and in weekend football with friends. Sleeps four to five broken hours, 08:00 to 14:00, waking to traffic noise and the child's school pickup. Appetite poor, weight down 3 kilograms. Tired and slow at work, making counting errors. Panic attacks about twice a week for six weeks: sudden pounding heart, tight chest, shaking, fear of collapsing, peaking within ten minutes. The first was on the loading dock; T.N. has since asked to stay in the office and has called in sick twice.
Past Psychiatric History
One previous depressive episode in 2019, after a parent's death, treated by a primary care physician with sertraline titrated to 100 mg. Mood partly improved by about six weeks. Stopped at four months because of delayed orgasm and low libido. No therapy then. No hospitalizations, no suicide attempts, no history of mania or psychosis.
Substance Use
Alcohol: about ten to twelve beers spread over three post-shift nights each week, "to wind down so I can sleep." AUDIT-C score 6, above the threshold suggesting hazardous drinking (Bush et al., 1998). No cannabis, no other drugs. Caffeine: three energy drinks a shift. Nicotine: none.
Medical History and Medicines
Hypertension, untreated, last reading 142/88 at an urgent care visit. No seizures, no heart disease, no liver disease. No current prescriptions. Takes ibuprofen now and then for back pain. Allergies: none known.
Family History
Parent with depression; sibling with alcohol use disorder.
Safety Assessment
Columbia Suicide Severity Rating Scale screen: in the past month, T.N. has wished to be dead ("some afternoons I'd rather just not wake"), but denies any thought of ending life, and reports no method chosen, no intention, no plan and nothing done in preparation. No lifetime suicide attempts. A hunting rifle is kept at home, unloaded, with ammunition stored separately; T.N. agreed to ask the partner to keep the key to the cabinet. Protective factors: the child, the partner, a job T.N. values, no previous attempts. Risk formulation: low acute risk, with chronic risk raised by depression, alcohol use and firearm access. The scale's screening questions have been shown to identify suicide risk across clinical settings (Posner et al., 2011).
Mental Status Examination, Observed
Appearance: work uniform, unshaven, dark circles under the eyes. Behavior: sat forward, hands clasped, eye contact brief but returned. Speech: normal rate, low volume, short answers. Mood: "flat and wired at the same time." Affect: constricted, tearful once when speaking about the child. Thought process: goal-directed. Thought content: preoccupied with work errors and fear of another attack; passive death wish as above; no delusions. Perception: no hallucinations. Cognition: alert, oriented, recalled 3 of 3 words. Insight: good. Judgment: fair, given the drinking.
Measures
PHQ-9: 17, in the moderately severe range (Kroenke et al., 2001). GAD-7: 13. Panic attacks: about 2 a week by T.N.'s count.
Impression
Major depressive disorder, recurrent episode, moderate, with anxious distress. Supported by two weeks or more of depressed mood and anhedonia with sleep, appetite, energy and concentration changes, and a prior episode in 2019. Panic attacks are present and are recorded as a specifier pattern for now; whether they meet panic disorder will be clearer once mood improves. Alcohol use is hazardous by the AUDIT-C but does not appear to meet use disorder criteria on this history. Insomnia is partly from depression and partly from shift work.
The impression is held briefly. The plan below follows from it.
Differential Considered
Bipolar disorder was considered and is unlikely: no past spells of unusually high mood, of going days on little sleep without tiring, or of reckless spending or behavior, and no relative known to have bipolar illness. Asked directly about periods of feeling unusually high or needing little sleep without tiredness, T.N. described none. This matters because, in bipolar illness, an antidepressant given alone may tip a patient into mania.
A medical cause was considered: no thyroid symptoms, but thyroid-stimulating hormone and a complete blood count were ordered because fatigue and weight loss can come from both.
Alcohol-induced depressive disorder was considered: the low mood began before the drinking increased, by T.N.'s account, and the 2019 episode occurred without heavy drinking.
Shift work sleep disorder contributes to the insomnia but does not explain the anhedonia or the panic.
Left for Later Visits
A full trauma history was deferred, beyond a screening question that T.N. answered no to, or for a detailed review of childhood development. Both will be revisited in therapy if they become relevant, and the therapist has been told they were not covered, so that neither topic falls between the two clinicians. A urine drug screen was not done, since T.N. reported no drug use and the history was consistent; it would be considered if the picture changed.
Collateral
With T.N.'s permission, the partner joined the last ten minutes by phone and confirmed the low mood, the poor sleep and the drinking pattern, adding that T.N. had become "short-tempered with everyone." The partner agreed to hold the firearm cabinet key.
How the History Leads to the Plan
The 2019 sertraline trial and its side effects argue against another SSRI. The insomnia and panic argue against an activating medicine. The drinking argues against medicines that lower the seizure threshold and for a direct conversation about alcohol. The untreated hypertension matters for any medicine that can raise blood pressure. The avoidance of the loading dock argues for therapy aimed at panic. Each section above was included because it changes what comes next.
Plan (Summary; Full Plan in the Treatment Plan Write-Up)
Mirtazapine 15 mg at the start of the main sleep period. Cognitive behavioral therapy, weekly. Brief intervention for alcohol. Safety plan written together today, including the firearm cabinet key. Blood pressure follow-up with primary care. Return in 2 weeks.
References
Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158(16), 1789-1795. https://doi.org/10.1001/archinte.158.16.1789
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704
What the NR 605 Week 2 assignment asks for
The Week 2 note should read as though written backwards from the plan. Include each part of the history because it closes or opens an option: previous medication trials and how they ended, current substances, sleep, medical conditions, interacting medicines, safety and other factors that change prescribing. Record the mental status as observed, not summarized. Give one impression, briefly defended. State risk in words. Most rubrics mark down a careful note with a plan that could have been written without reading it, a missing safety assessment, a mental status written as impressions and no record of prior trials. Ask directly about mania before choosing an antidepressant, and record collateral where the patient agrees.
How the NR 605 Week 2 example is put together
The sample opens with the reason for the visit in the patient's words. The presenting illness covers mood, sleep, appetite, concentration and panic attacks beginning on a loading dock. The 2019 sertraline trial and its sexual side effects are recorded. Alcohol is scored by AUDIT-C. Medical history includes untreated hypertension. The safety assessment uses the Columbia screen, records a passive death wish and agrees that a partner will hold the firearm cabinet key. The mental status examination records observations. Measures, a differential that rules out bipolar disorder and others, items left for later, collateral from the partner and an impression follow, with a section showing how each history item leads to the plan.
NR 605 Week 2 rubric: what full points look like
The costliest loss is a careful note with a plan that ignores it; this note ends with a section linking each history item to a plan decision. A missing safety assessment is treated by many rubrics as a floor, and here safety is stated in words with firearm access addressed. A mental status written as impressions costs a row, while each domain here is observed. No record of prior trials leaves any first choice unarguable, and the 2019 trial is detailed. A differential that rules out bipolar disorder before an antidepressant earns credit, and collateral strengthens the history.
NR 605 Week 2 help from the desk
Weak NR 605 Week 2 notes collect a full history and then add a plan that does not use it. Others skip or shorten the safety assessment. Many write the mental status examination as a summary such as pleasant and cooperative. Prior medication trials are often missing. Bipolar disorder is rarely ruled out before an antidepressant is chosen. Ask about every previous trial and how it ended, assess safety in words including access to means, observe and record the mental status and link each history item to what it changes in the plan. For your own patient, gather every prior trial and the safety findings first; an evaluation note in this order can then be drafted with you.
Get a NR 605 Week 2 example written to your instructions
Send the evaluation template your section uses together with the case details you were handed. A custom note built on that template returns within 24 to 48 hours, free for a first request. Coursework resting on a case supplied in class is exactly what this covers, and the example comes back finished.
More NR 605 papers and PMHNP samples
- NR 605 Week 1: Defended First Choice Post
- NR 605 Week 3: Treatment Plan Write-up
- NR 605 Week 4: Case Analysis
- NR 605 Week 5: Psychotherapy Rationale
- NR 605 Week 6: Follow Up Note
- NR 605 Week 7: Outcome Measure Plan
- NR 605 Week 8: Management Case Paper
- NR 548 Week 2: Interview Technique Write-Up
- NR 547 Week 2: Criteria Mapping Write-Up
- NR 546 Week 2: Receptor Mechanism Write-Up
NR 605 Week 2 questions, answered
Does any of this cover practicum hours or the log?
No. The clinical hours, the logbook and whatever your preceptor signs stay entirely with you, and none of that is ever written for anybody. Where an example helps is in showing a finished evaluation note built on a case handed out in class, so that the writing itself has stopped being the obstacle by the time your own patients are in front of you.
How long should the note be?
Long enough that nothing in the plan is unexplained and short enough to read straight through. Most templates produce two to four pages once filled honestly. Padding the history to reach a length usually shows, since the extra material has no plan element pointing at it, and readers of these notes are practiced at spotting paragraphs doing no work.
What if the case is thin on detail?
State what you would ask and why it matters to the decision. A note saying that a first choice depends on a prior trial history the case never gives, and naming the answer that would change the plan, reads as clinical thinking. Inventing the detail instead is the alternative, and it is obvious to anyone holding the same case.
Where can I find a free NR 605 Week 2 sample paper?
The full initial evaluation note for a night-shift worker with depression and panic attacks is published on this page.
How is safety handled in the NR 605 Week 2 note?
A Columbia screen found a passive death wish without plan or intent, risk was formulated in words and the partner agreed to hold the firearm cabinet key.