ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS NRNP 6635
Sample Answer for ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS NRNP 6635 Included After Question
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
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.
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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
ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS NRNP 6635 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
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A Sample Answer For the Assignment: ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS NRNP 6635
Title: ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS NRNP 6635
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:
- 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.
- 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.
- 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
ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS NRNP 6635 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 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 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 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 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). |
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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. |
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5 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation |
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5 pts | ||||
| Total Points: 100 | ||||||