Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders.
Week 8 NRNP 6635: Psychopathology and Diagnostic Reasoning
Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders.
An important consideration when working with patients is their cultural background. Understanding an individual’s culture and personal experiences provides insight into who the person is and where he or she may progress in the future. Culture helps to establish a sense of identity, as well as to set values, behaviors, and purpose for individuals within a society. Culture may also contribute to a divide between specific interpretations of cultural behavior and societal norms. What one culture may deem as appropriate another culture may find inappropriate. As a result, it is important for advanced practice nurses to remain aware of cultural considerations and interpretations of behavior for diagnosis, especially with reference to substance-related disorders. At the same time, PMHNPs must balance their professional and legal responsibilities for assessment and diagnosis with such cultural considerations and interpretations.
For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background.
To Prepare:
Review this week’s Learning Resources and consider the insights they provide.
Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.
By Day 7 of Week 8
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
Objective: What observations did you make during the psychiatric assessment?
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Week 8 Substance-Related and Addictive Disorders
Training Title 82
Name: Lisa Pittman
Gender: female
Age: 29 years old
T- 99.8 P- 101 R 20 178/94 Ht 5’6 Wt 140lbs
Background: Lisa is in a West Palm Beach, FL detox facility thinking about long term rehab. She has been smoking crack cocaine, approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”), and 2–3 alcohol drinks once weekly. She has past drug possession and theft convictions; currently on 2 yr probation with randomized drug screens. She tries to find the pattern for the calls in order not to test dirty urine. Her admission labs abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS positive for cocaine, THC. Negative for alcohol or other drugs. BAL 0; other labs within normal ranges. She reports sexual abuse as child ages 5–7, perpetrator being her father who went to prison for the abuse and drug charges. She is estranged from him. Mother lives in Alabama, hx of anxiety, benzodiazepine use. Older brother has not contact with family in last 10 years, hx of opioid use. Sleeps 4-5 hrs, appetite decreased, prefers to get high instead of eating. Allergies: amoxicillin
She is considering treatment for her Hep C+ but needs to get clean first.
Symptom Media. (Producer). (2017). Training title 82 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-82
Training Title 114
Name: Ally Patel
Gender: female
Age: 48 years old
Background: Only child, raised by parents in San Francisco, CA. Has PhD in biology and master’s degree in high school education (8–12). Her supervisor has asked the school EAP
counselor to intervene with concerns regarding potential substance use in effort to facilitate getting her help and be able to retain her.
Symptom Media. (Producer). (2018). Training title 114-2 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-114-2
Training Title 151
Name: Katarina Bykov
Gender: female
Age:41 years old
T- 97.4 P- 74 R 120 100/70 Ht 5’8 Wt 117lbs
Background: Moved to Washington State from Russia with her parents when she was 12 years old. She has 2 brothers, 2 sisters. Denied family mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx; Menses regular. Has chronic pain issues. She works part time cashier at Aldi Grocery Store. Dropped out of high school in 11th grade. Sleeps 4–9 hours on average, appetite good.
Symptom Media. (Producer). (2018). Training title 151 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-151
Week 10 Neurocognitive and Neurodevelopmental Disorders
Training Title 48
Name: Sarah Higgins
Gender: female
Age: 9 years old
T- 97.4 P- 62 R 14 95/60 Ht 4’5 Wt 63lbs
Background: no history of treatment, developmental milestones met on time, vaccinations up to date. Sleeps 9hrs/night, meals are difficult as she has hard time sitting for meals, she does get proper nutrition per PCP.
Symptom Media. (Producer). (2017). Training title 48 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-48
Training Title 50
Name: Harold Griffin
Gender: male
Age:58 years old
T- 98.8 P- 86 R 18 134/88 Ht 5’11 Wt 180lbs
Background:
Has bachelor’s degree in engineering. He is homosexual and dates casually, never married, no children. Has one younger sister. Sleeps 4-6 hours, appetite good. Denied legal issues; MOCA 27/30 difficulty with attention and delayed recall; ASRS-5 20/24; denied hx of drug use; enjoys one scotch drink on the weekends with a cigar. Allergies Morphine; history HTN blood pressure controlled with losartan 100mg daily, angina prescribed ASA 81mg po daily, metoprolol 25mg twice daily. Hypertriglyceridemia prescribed fenofibrate 160mg daily, has BPH prescribed tamsulosin 0.4mg po bedtime.
Symptom Media. (Producer). (2017). Training title 50 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-50
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