NURS 6630 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Essay

NURS 6630 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Essay

NURS 6630 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Essay

NURS 6630 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Sample

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WEEK 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

Subjective:

CC (chief complaint):“I am scared of going to rehab”

HPI: L.T., a 33-year-old woman of Caucasian ethnicity, is currently residing in a detoxification facility located in Naples, Florida. L.T. is contemplating the possibility of engaging in a long-term rehabilitation program. Nevertheless, she is apprehensive about proceeding with this action. The patient experiences significant fear and apprehension regarding the prospect of being unsuccessful in securing employment, as well as the potential criticism that may be directed toward her by her peers. She regularly consumes cocaine daily, alongside her partner, for $100 per instance. In addition, she procures marijuana through the utilization of her medical card and a valid prescription, subsequently consuming it via smoking approximately biweekly. She also persists in the consumption of alcohol, specifically consuming approximately 1.89 liters of vodka daily. The patient claims to possess a criminal record, which encompasses convictions related to theft and possession of drugs. She successfully circumvents the random drug tests during her two-year probationary period by abstaining from drug use while engaged in telephone conversations for her subsequent appointments. The patient was subjected to sexual abuse by her father, who is currently incarcerated and is facing additional drug-related charges, during the period spanning from approximately 6 to 9 years of age. Common accompanying symptoms include decreased appetite and insomnia, experienced regularly.

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Past Psychiatric History:

  • General Statement: The patient is deciding whether to enter rehab to address her drug use problem while getting treatment at a community detox clinic.
  • Caregivers (if applicable):She patient now lives with her drug-using boyfriend in the same house.
  • Hospitalizations: The patient states that while she has never been hospitalized, her criminal history made regular drug testing necessary throughout her two-year period of probation.
  • Medication trials: She denies using any psychiatric drugs to manage her substance misuse.
  • Psychotherapy or Previous Psychiatric Diagnosis:has a drug addiction diagnosis and is a participant at a community detox center.

Substance Current Use and History:She used opiates daily, spending around $100. She acknowledges that she sometimes uses medical marijuana and that she consumes a half gallon of vodka every day.

Family Psychiatric/Substance Use History: Her mother has abused benzodiazepines and has a history of GAD. The dad is presently in jail for narcotics possession and defiling his kid. She is coping with the opiate addiction of her older brother.

Psychosocial History: Up until her father was imprisoned, the patient was raised by both parents in a family of four that also included a younger brother. Her father was charged with defiling her daughter and having drugs. The patient’s father sexually assaulted her while she was between the ages of six and 9 years old. Currently, the patient lives with her drug-using boyfriend. They are employed by a company that deals with small, local businesses. She asserts that because of her criminal history, she will be subject to random drug testing for the duration of her two years of probation. complaints of frequent sleep deprivation.

Medical History: Reports of positive Hepatitis C virus testing.

 

  • Current Medications: She enies using any medications for the present or former medical diagnosis.
  • Allergies:Reporting no environmental or dietary sensitivities, the patient’s allergy is brought on by amoxicillin (penicillin).
  • Reproductive Hx:The Last Menstrual Period (LMP) occurred on July 12, 2023.Menstrual cycles occur at regular intervals. Cohabitating as a heterosexual couple with a monogamous sexual relationship. a negative result from an HIV test conducted on April 2, 2022.

ROS:

  • GENERAL: Denies having a fever, being worn out, having chills, recently changing her weight, having trouble sleeping, having headaches, or losing consciousness.
  • HEENT: Head: Denies headache or trauma symptoms. Hearing loss, tinnitus, irritability, discomfort, or exudates are denied by the ears. Denies having excessive tears, double or blurred vision, inflammation, itching, or the necessity for corrective lenses for the eyes. denies having sinusitis, congestion, itching, or throat discomfort. denies experiencing a toothache, inflamed gums, or swallowing issues.
  • SKIN: Warm and moist. denies any redness, itchiness, rashes, hives, or lumps.
  • CARDIOVASCULAR: Denies experiencing cyanosis, arrhythmias, chest discomfort, palpitations, or paroxysmal dyspnea.
  • RESPIRATORY: Denies having a cough, sneeze, runny nose, congestion, chest pain, trouble breathing, or sputum production.
  • GASTROINTESTINAL: Denies experiencing diarrhea, constipation, stomach pain, a hernia, or any other symptoms of nausea or vomiting.
  • GENITOURINARY: regular menstrual cycles. denies unusual vaginal discharge. There is no bruised sensation while urinating or copulating. denies having ever had HIV or an STD.
  • NEUROLOGICAL: Denies experiencing dizziness, headache, syncope, ataxia, numbness, abnormalities in bladder or bowel control, or ataxia.
  • MUSCULOSKELETAL: Demonstrates the easy full range of mobility in all joints of the body. Denies any muscular or joint stiffness, pain, or edema.
  • HEMATOLOGIC: Denies bruising easily. Denies having anemia, blood from the nose, or any other hematological conditions.
  • LYMPHATICS: Denies undergoing a splenectomy or having lymphadenopathy.
  • ENDOCRINOLOGIC: Denies polyuria, increased hunger, or polydipsia as well as heat or cold intolerance.

Objective:

Physical exam:Vitals: Temp- 100.0 Pulse- 108 RR 20 B.P 180/110 Ht 5’6 Wt 146lbs BMI 23.56 

Diagnostic results:The patient exhibits positive Hepatitis C status, along with elevated levels of GGT (59), ALT (168), ALK (250), AST (200), and bilirubin (2.5). The drug tests yielded positive results for the presence of cocaine and cannabis (THC). Unfavorable outcomes are described for alcohol (ROH). A combination of a cranial X-ray and computed tomography (CT) scan should be performed to exclude any indications of trauma or injury. To help with the development of the differential diagnosis, the Alcohol Use Disorder Identification Test and the Drug Abuse Screening Test were used as additional screening tools (Arterberry et al., 2019). 

Assessment:

Mental Status Examination: The patient, a 33-year-old female, exhibits appropriate grooming and attire as she proceeds toward the examination room. She exhibits proficient spatial and temporal orientation skills. She demonstrates cooperative behavior by engaging in polite communication and employing a consistent vocal tone and manner throughout the interview. Her facial expression is consistent with her state of depression. Her cognitive development is commensurate with her chronological age. She demonstrates a logical cognitive process. She possesses an average level of cognitive ability. Both her short-term and long-term memory remains fully operational. She possesses a correct viewpoint. Denies the potential for harm to oneself or others, alongside the occurrence of delusion, hallucination, delirium, and suicidal ideation.

Differential Diagnoses:

  1. Substance Use Disorder (SUD):According to the DSM-V, SUD is characterized by continued drug use notwithstanding its negative effects on the user (Marmet et al., 2019). There are 11 criteria in all, but a patient only has to satisfy three of them to be given this diagnosis (Leza et al., 2021). The patient takes more drugs than they intended to, tests positive for drug use, finds it difficult to stop using them despite their best attempts, has problems with cravings, uses drugs often, and has difficulties falling asleep as a consequence of using drugs. She is qualified to get this diagnosis.
  2. Substance-Induced Anxiety Disorder: As per the DSM-V, this condition is distinguished by the manifestation of anxiety or panic episodes in conjunction with drug use, intoxication, or withdrawal (Blaney et al., 2019). The patient’s anxiety assessment yields positive results as she contemplates the prospect of entering a rehabilitation program.
  3. Co-occurring PTSD and SUD:According to Back et al. (2019), there is evidence indicating that a majority of individuals diagnosed with PTSD may develop substance use disorder (SUD) as a result of utilizing medications as a means to alleviate the distressing symptoms associated with their PTSD. Consequently, to receive a diagnosis of PTSD, a patient must have experienced a traumatic event like the one in the provided case study who was sexually abused by her father.

Reflections:Based on the patient’s medical history, it is evident that her primary concern revolves around her struggle with drug addiction. However, the main objective of her current visit is to confront the intense fear and anxiety she experiences when contemplating admission into a rehabilitation facility. The PMHNP demonstrated proficiency in assessing the patient’s drug utilization history. The inclusion of supplementary historians, such as the patient’s significant other or relatives, could potentially contribute to a more comprehensive understanding of the patient’s behavior both within the domestic sphere and in public contexts (Castillo-Carniglia et al., 2019). This will facilitate the identification of any additional comorbidities that may be contributing to the experience of distress and anxiety. The patient, nonetheless, possesses a legal entitlement to confidentiality and privacy (Mohamed et al., 2020). Consequently, the healthcare professional is obligated to seek the patient’s informed consent and respect her autonomy in the event of a refusal.  To facilitate informed decision-making by the patient, it would be beneficial for the PMHNP to further emphasize the benefits associated with participating in a rehabilitation program.

References

Arterberry, B. J., Boyd, C. J., West, B. T., Schepis, T. S., & McCabe, S. E. (2019). DSM-5 Substance use disorders among college-age young adults in the United States: Prevalence, remission, and treatment. Journal of American College Health, 1–8. https://doi.org/10.1080/07448481.2019.1590368

Back, S. E., Killeen, T., Badour, C. L., Flanagan, J. C., Allan, N. P., Ana, E. S., Lozano, B., Korte, K. J., Foa, E. B., & Brady, K. T. (2019). Concurrent Treatment of Substance Use Disorders and PTSD using Prolonged Exposure: A Randomized Clinical Trial in Military Veterans. Addictive Behaviors, 90, 369–377. https://doi.org/10.1016/j.addbeh.2018.11.032

Blaney, D., Jackson, A. K., Toy, O., Fitzgerald, A., & Piechniczek-Buczek, J. (2019). Substance-Induced Anxiety and Co-occurring Anxiety Disorders. Substance Use and the Acute Psychiatric Patient, 125–144. https://doi.org/10.1007/978-3-319-23961-3_8

Castillo-Carniglia, A., Keyes, K. M., Hasin, D. S., & Cerdá, M. (2019). Psychiatric comorbidities in alcohol use disorder. The Lancet Psychiatry, 6(12). https://doi.org/10.1016/s2215-0366(19)30222-6

Leza, L., Siria, S., López-Goñi, J. J., & Fernández-Montalvo, J. (2021). Adverse Childhood Experiences (ACEs) and Substance Use Disorder (SUD): A Scoping Review. Drug and Alcohol Dependence, 221, 108563. https://doi.org/10.1016/j.drugalcdep.2021.108563

Marmet, S., Studer, J., Bertholet, N., Grazioli, V. S., Daeppen, J.-B., & Gmel, G. (2019). Interpretation of DSM-5 alcohol use disorder criteria in self-report surveys may change with age. A longitudinal analysis of young Swiss men. Addiction Research & Theory, 27(6), 489–497. https://doi.org/10.1080/16066359.2018.1547817

Mohamed, I. I., Ahmad, H. E. K., Hassaan, S. H., & Hassan, S. M. (2020). Assessment of anxiety and depression among substance use disorder patients: a case-control study. Middle East Current Psychiatry, 27(1). https://doi.org/10.1186/s43045-020-00029-w

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‌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.

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

American Psychiatric Association. (2022). Substance related and addictive disorders. In Diagnostic and statistical manual of mental disorders

Links to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x16_Substance_Related_Disorders

Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Chapter 4, “Substance Use and Addictive Disorders”

Chapter 2 only section 2.17, “Adolescent Substance Abuse”

Chapter 27 “Ethics and Professionalism”

Chapter 28 “Forensic and Legal Issues”

Document: Comprehensive Psychiatric Evaluation Template

Download Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation Exemplar

Download Comprehensive Psychiatric Evaluation Exemplar

Required Media

Classroom Productions. (Producer). (2016). Addictive disorders

Links to an external site. [Video]. Walden University.

Complex Care Consulting. (2018, April 4). Addiction neuroscience 101

Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=bwZcPwlRRcc

Video Case Selections for Assignment

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Symptom Media. (Producer). (2017). Training title 82

Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-82

Symptom Media. (Producer). (2018). Training title 114-2

Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-114-2

Symptom Media. (Producer). (2018). Training title 151

Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-151

Document: Case History Reports

Download Case History Reports

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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.).

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

To submit your completed assignment, save your Assignment as WK8Assgn_LastName_Firstinitial

Then, click on Start Assignment near the top of the page.

Next, click on Upload File and select Submit Assignment for review.

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Rubric

NRNP_6635_Week8_Assignment_Rubric

NRNP_6635_Week8_Assignment_Rubric

Criteria Ratings Pts
This criterion is linked to a Learning Outcome Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. In the Subjective section, provide: • Chief complaint• History of present illness (HPI)• Past psychiatric history• Medication trials and current medications• Psychotherapy or previous psychiatric diagnosis• Pertinent substance use, family psychiatric/substance use, social, and medical history• Allergies• ROS
20 to >17.0 ptsExcellent

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

17 to >15.0 ptsGood

The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

15 to >13.0 ptsFair

The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.

13 to >0 ptsPoor

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.

20 pts
This criterion is linked to a Learning Outcome In the Objective section, provide:• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
20 to >17.0 ptsExcellent

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

17 to >15.0 ptsGood

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

15 to >13.0 ptsFair

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

13 to >0 ptsPoor

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.

20 pts
This criterion is linked to a Learning Outcome In the Assessment section, provide:• Results of the mental status examination, presented in paragraph form.• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.
25 to >22.0 ptsExcellent

The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

22 to >19.0 ptsGood

The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

19 to >17.0 ptsFair

The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.

17 to >0 ptsPoor

The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.

25 pts
This criterion is linked to a Learning Outcome Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, 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.).
10 to >8.0 ptsExcellent

Reflections are thorough, thoughtful, and demonstrate critical thinking.

8 to >7.0 ptsGood

Reflections demonstrate critical thinking.

7 to >6.0 ptsFair

Reflections are somewhat general or do not demonstrate critical thinking.

6 to >0 ptsPoor

Reflections are incomplete, inaccurate, or missing.

10 pts
This criterion is linked to a Learning Outcome Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
15 to >13.0 ptsExcellent

The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.

13 to >11.0 ptsGood

The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

11 to >10.0 ptsFair

Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

10 to >0 ptsPoor

Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.

15 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—Paragraph development and organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 ptsExcellent

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4 to >3.5 ptsGood

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.5 to >3.0 ptsFair

Purpose, introduction, and conclusion of the assignment is vague or off topic. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time.

3 to >0 ptsPoor

No purpose statement, introduction, or conclusion were provided. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation
5 to >4.0 ptsExcellent

Uses correct grammar, spelling, and punctuation with no errors

4 to >3.0 ptsGood

Contains a few (one or two) grammar, spelling, and punctuation errors

3 to >2.0 ptsFair

Contains several (three or four) grammar, spelling, and punctuation errors

2 to >0 ptsPoor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5 pts
Total Points: 100

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