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NRNP 6635 Assessing/Diagnosing Patients With Substance-Related and Addictive Disorders

NRNP 6635 Assessing/Diagnosing Patients With Substance-Related and Addictive Disorders

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Subjective:

CC (chief complaint): patient has been late to work 22 times this past year and according to complaints from students and parents, patient has been sleeping in the class, which prompted patient’s supervisor to 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.

HPI: A. P. is a 48 year old Asian woman from San Fransisco California who presents to the school’s EAP counselor’s office due to concerns regarding potential substance use. Sever students and parents have complained on different occasion that Ms. A. P. sleeps during classes. She was late to work today due to passing out from drinking at a collegues house after a party last night. Also, per school’s attendance record, Ms. A.P. has been late to work 22 times this past year. Ms. A.P. reports drinking nightly 5-6 glasses of wine along with a few mixed drinks to help her with the stress especially with grading papers. She reports frustration with students’ humiliating behavior at school and no support from management. Ms. A.P. first started drinking when she was a teen. Drinking increased during freshman year, but she mellowed down in grad school. However, reports that her drinking has gotten worst compared to college.

Past Psychiatric History:

  • General Statement:
  • Caregivers (if applicable): None
  • Hospitalizations: Provider should have asked
  • Medication trials: provider should have asked
  • Psychotherapy or Previous Psychiatric Diagnosis: Provider should have asked

Substance Current Use and History: Ms. A.P. first started drinking when she was a teen. Drinking increased during freshman year, but she mellowed down in grad school. However, reports that her drinking has gotten worst compared to college.

Family Psychiatric/Substance Use History: Father was an alcoholic when Ms. A.P. was very little, however, sobered up after starting AA. No other family substance use history available. Provider should ask.

Psychosocial History:

Ms. A.P. is the only child raised by parents in San Fransisco. Mother was very strict and father was an alcoholic growing up. She has PhD in biology and master’s degree in high school education (8–12). Patient spends most nights alone, drinking and occasionally goes out with friends. She is a teacher at her local high school. She recently broke up with her boyfriend of one year.

Medical History:

 

  • Current Medications: Provider should ask
  • Allergies: provider should ask
  • Reproductive Hx: currently has a boy friend. Provider should ask about sexual orientation, sexually active, any birth controls

ROS:

  • GENERAL: A.P. is alert, slightly disheveled with buttons of her sweater not aligned and hair tucked on one side and loose on the other.
  • HEENT: Provider should have asked
  • SKIN: Provider should have asked
  • CARDIOVASCULAR: Provider should have asked
  • RESPIRATORY: Provider should have asked
  • GASTROINTESTINAL: Provider should have asked
  • GENITOURINARY: Provider should have asked
  • NEUROLOGICAL: Provider should have asked
  • MUSCULOSKELETAL: Provider should have asked
  • HEMATOLOGIC: Provider should have asked
  • LYMPHATICS: Provider should have asked
  • ENDOCRINOLOGIC: Provider should have asked

Objective:

Physical exam: Provider should have taken vital signs, assessed for withdrawal symptoms, and CAGE.

Diagnostic results: Provider should have breathalyzed for blood alcohol level (BAL).

Assessment:

Mental Status Examination:

Appearance:  Client is slightly disheveled, but has appropriate clothing for age, weather, and occasion.

Eye contact: good

Speech: clear and coherent with normal rate, rhythm, but loud volume

Behavior: anxious

Psychomotor: Restless.

Mood: anxious, depressed, irritable.

Affect: restricted

Thought Process:  linear, goal directed

Thought Content: Provider should have asked for suicidal, homicidal, or self-harm ideation. Provider should have explored further for delusion thinking.

Perception:  No reaction to external or internal stimuli.

Attention/ Concentration: fair

Cognition:  Alert and oriented.

Memory:  Short-term and long-term memory are grossly intact as evidenced by their recall of narrative.

Insight: Poor

Judgment: poor

Fund of Knowledge:  consistent with age and education, as demonstrated by use of grammar, vocabulary, and sentence structure

Intelligence: consistent with age and education, as demonstrated by use of grammar, vocabulary, and sentence structure.

Provider should have assessed patient for depression using SIGECAPS: sleep, interest, guilt, energy level, concentration, appetite, psychomotor, suicidal ideation

 

Differential Diagnoses:

  1. Alcohol Dependence – Patient has been drinking since teenage and alcohol intake has gotten worse at age 48. She drinks every night 5-6 glasses of wine along with a few mixed drinks.
  1. Major Depression – even though provider did not assess for depression using SIGECAPS, patient appears depressed and sad. She used to go out with friends as a teenager, however, now she only hangs out with friends only occasionally. She needs alcohol to pass out “if I’m lucky”, conveying that she has trouble sleeping. Her energy level is low as evidenced by sleeping during classes. Disrupted or poor sleep increases the risk of depressive disorders (Hombali et al., 2019).
  2. Anxiety Disorder – patient is irritable, muscle tension is noticed, voiced feelings of apprehension about students and school, feeling on the edge and needing alcohol to take the edge off, difficulty getting sleep and requires alcohol to aid in sleeping. Easily fatigues as evidenced by sleeping in class.

NRNP 6635 Assessing/Diagnosing Patients With Substance-Related and Addictive Disorders

Reflections:

One in three individuals suffer from alcohol use disorder in the United States (Gowin, Sloan, Stangl, Vatsalya, & Ramchandani, 2017). Uncontrolled drinking or problematic alcohol ingestion leads to mental and physical health issues that further influence the users personal, social, and professional life (Gimeno et al., 2017). And anxiety disorders are frequently associated with alcohol use disorder, which makes the symptoms worse and treatment more challenging (Gimeno et al., 2017). As a provider I would have further assessed the client for co-existing depression and anxiety. A concern I had in this case scenario is that the client and the EAP counselor know each other at a personal level. This is an ethical concern and can possibly concede professional opinion (Sara et al., 2018).

References

Gimeno, C., Dorado, M. L., Roncero, C., Szerman, N., Vega, P., Balanzá-Martínez, V., & Alvarez, F. J. (2017). Treatment of comorbid alcohol dependence and anxiety disorder: Review of the scientific evidence and recommendations for treatment. Frontiers in psychiatry8, 173.

Gowin, J. L., Sloan, M. E., Stangl, B. L., Vatsalya, V., & Ramchandani, V. A. (2017). Vulnerability for alcohol use disorder and rate of alcohol consumption. American Journal of Psychiatry174(11), 1094-1101.

Hombali, A., Seow, E., Yuan, Q., Hui, S., Chang., S., Satghare, P., Kumar, S., Verma, S., Mok, Y., Chong, S., & Subramaniam, M. (2019). Prevalence and correlates of sleep disorder symptoms in psychiatric disorders. Psychiatry Research, (279):116-122.

Saha, T., Grant, B., Chou, S. P., Kerridge, B. T., Pickering, R. P., & Ruan, W. J. (2018). Concurrent use of alcohol with other drugs and DSM-5 alcohol use disorder comorbid with other drug use disorders: Sociodemographic characteristics, severity, and psychopathology. Drug and Alcohol Dependence, (187):261-269

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NRNP 6635 Assessing/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.

 

 

NRNP 6635 Assessing Diagnosing Patients With Substance-Related and Addictive Disorders

NRNP 6635 Assessing Diagnosing Patients With Substance-Related and Addictive Disorde

NRNP 6635 Assessing/Diagnosing Patients With Substance-Related and Addictive Disorders

 

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NRNP 6635 Assessing/Diagnosing Patients With Substance-Related and Addictive Disorders

 

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