NRNP 6635 WEEK 8 Assignment Sample Solution

NRNP 6635 WEEK 8 Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorder

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 establish a sense of identity and set values, behaviors, and purposes 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, advanced practice nurses must remain aware of cultural considerations and interpretations of behavior for diagnosis, especially concerning 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.  Remember to consider the patient’s cultural background in this and all cases.

To Prepare: Review this week’s Learning Resources and consider the insights they provide. Review the Comprehensive Psychiatric Evaluation template you will use to complete this Assignment.

By Day 1 of this week, select a specific video case study 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 a 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, from highest priority to lowest priority.  

Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rule 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.).

NRNP 6635 WEEK 8 Assignment Sample Solution

NRNP 6635 Week 8: Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders

Subjective: Name: Ally Dean

Gender: Female

Age: 48 years old

CC (chief complaint): The client’s supervisor, “Ms. Ally’s alcohol consumption is getting out of hand.  I suspect a potential substance use.”

HPI: Ally is a 48-year-old female undergoing psychiatric assessment after a referral from the school EAP counselor due to her substance abuse probability.  The client has been late for classes for 22 days due to excessive alcohol consumption and was referred to facilitate getting her help and retaining her at the school.  The patient reports being late to work on the interview day since she attended a party the previous evening and drank too much.  She initially denies that she got intoxicated and passed out but later admits it.  The client reports that she drinks too much every night.  She states that she mostly drinks alone but occasionally goes to a bar with her friends or drinks at school functions, where the alcohol supply is liberal.  She also reports taking 5-6 glasses of wine and several mixed drinks when her students give her a rough time. The client attributes the excessive drinking to the stress she experiences at school due to students’ indiscipline.  She admits to taking too much alcohol but states it affects her differently.  She admits to passing out severally when drunk.  Students and parents have complained that Ally has severally gotten to class to teach while drunk, but she denies the claims.  According to her students, she goes to class drunk and orders them to read from their textbook or copy notes from the board while sleeping with her head on the desk.  Her drinking behavior risks losing her teaching job, and the Board of Education may dismiss her if she does not cooperate during the psychiatric evaluation. Past Psychiatric History:

• General Statement: No psychiatric history.
• Caregivers: None
• Hospitalizations: No history of psychiatric hospitalization.
• Medication trials: None
• Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: She has had a history of alcohol consumption since she was a teenager.  Alcohol consumption has increased over the years.  She reveals taking on average 5 wine glasses alongside some mixed drinks to get high.  She takes 5-6 glasses of wine and a handful of mixed drinks to get intoxicated.

Family Psychiatric/Substance Use History: The client’s father was an alcoholic.  He got into Alcohol Anonymous and quit alcohol. Psychosocial History: Ally was born alone, and her parents raised her in the San Francisco area of California.  She possesses a PhD in Biology, and a master’s in high school education.  Her current employment is in high school.  Ally reports being currently in a relationship. Medical History:

• Current Medications: None
• Allergies: No food or drug allergies.
• Reproductive Hx: Para 0+0; No history of gynecologic disorders.  LMP-3 weeks ago.

ROS:

• GENERAL: Lacks chills, fever, fatigue, or weight changes.
• HEENT: Denies traumatic head injury, eye pain, blurred vision, ear discharge, hearing loss, sneezing, nasal discharge, sore throat, or hoarse voice.
• SKIN: Negative for skin rashes, itching, bruises, or lesions.
• CARDIOVASCULAR: Denies palpitations, chest pain, SOB on exertion, orthopnea, or edema
• RESPIRATORY: Does not have a cough, sputum production, dyspnea, or chest pain.
• GASTROINTESTINAL: Denies rectal bleeding, vomiting, nausea, constipation, abdominal discomfort, or diarrhea.
• GENITOURINARY: Negative for pelvic pain, excessive or malodorous vaginal discharge, dysuria, or urine color changes.
• NEUROLOGICAL: Negative for headache, fatigue, drowsiness, LOC, or burning sensations.
• MUSCULOSKELETAL: Denies muscle pain, joint pain/stiffness, or joint enlargement.
• HEMATOLOGIC: Denies bruising or history of blood transfusion.
• LYMPHATICS: Does not have a history of lymph node enlargement.
• ENDOCRINOLOGIC: Rejects excessive hunger, polyuria, thirst, or excessive sweating.

Objective: Physical exam: BP: 122/76; HR- 84; RR-20; Temp- 98.24 Ht- 5’4; Wt- 138 lbs.

Diagnostic results: No labs or imaging tests were ordered.

Assessment: Mental Status Examination: The client is neat and dressed appropriately for the weather and function.  She is alert but appears confused and anxious and maintains limited eye contact.  Her speech is clear at a normal rate, but the volume increases when she gets provoked.  She demonstrates a congruent thought process.  No hallucinations, delusions, obsessions, homicidal, or suicidal ideations were noted.  She is oriented to time, person, and place and also manifests good judgment.  Memory is intact.  Insight is present.

Differential Diagnoses: Alcohol Use Disorder Alcohol use disorder (AUD) is defined as a maladaptive pattern associated with substance use that leads to an individual’s clinical impairment or distress.  According to the DSM-V, specific symptomatology such as extended alcohol use in large amounts, inability to reduce alcohol intake, expending time on alcohol-related activities, and craving for alcohol indicate the condition (APA, 2013).  Moreover, using alcohol recurrently, thus impairing social and economic functions, and the usage of alcohol despite its social detriments also lend to the presence of alcohol use disorder (Yang et al., 2018).  Besides, fundamental occupational, social, or recreational activities are given up or reduced due to imbibing alcohol.  Lastly, obsession with alcohol does not reduce despite its exacerbation of physical or psychological manifestations. AUD is a differential diagnosis based on the client’s history of taking large amounts of alcohol; Spending lots of time taking alcohol; recurrent alcohol use failing to carry out her teaching obligations, and continuing to take alcohol despite it causing problems in her relationships.

Generalized Anxiety Disorder The client could have GAD based on her report of stress due to student indiscipline at school.  The alcohol intake could result from GAD since she reports taking alcohol when her students take the edge off the day (McHugh & Weiss, 2019).  Besides, the client appears anxious and is inattentive during the interview, which is consistent with GAD.

Major Depressive Disorder Major depressive disorder (MDD) is a differential diagnosis based on the client’s history of losing interest in her job.  The client’s alcohol problem could be secondary to depression (McHugh & Weiss, 2019).  However, she does not demonstrate other symptoms of MDD.

Reflections: If I were to conduct the session again, I would assess the client’s history of using other drugs and substances to rule out the presence of a substance abuse disorder.  I would also order a urine test to evaluate if the client has been using other illicit drugs (Kranzler & Soyka, 2018).  Legal and ethical considerations for this client include autonomy, beneficence, nonmaleficence, and confidentiality.  The PMHNP should respect the client’s decision regarding her care to uphold autonomy.  Beneficence and nonmaleficence should be upheld by choosing treatment interventions to promote the best possible health outcomes and not harm the client.  In addition, the PMHNP should ensure that the client’s information is not shared with other persons without the client’s consent.  The client’s health promotion strategies should reduce alcohol consumption and help her return to normal functioning.

References

American Psychiatric Association.  (2013). Diagnostic and statistical manual of mental disorders (DSM-5®).  American Psychiatric Pub. Kranzler, H. R., & Soyka, M. (2018).  Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review. JAMA, 320(8), 815–824.  https://doi.org/10.1001/jama.2018.11406 McHugh, R. K., & Weiss, R. D. (2019).  Alcohol Use Disorder and Depressive Disorders. Alcohol research: current reviews, 40(1), arcr.v40.1.01.  https://doi.org/10.35946/arcr.v40.1.01 Yang, P., Tao, R., He, C., Liu, S., Wang, Y., & Zhang, X. (2018).  The Risk Factors of the Alcohol Use Disorders-Through Review of Its Comorbidities. Frontiers in neuroscience, 12, 303.  https://doi.org/10.3389/fnins.2018.00303

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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