NRNP-6635 Week 8 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.

• 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.

 

Solution: NRNP-6635 Week 8 Assignment

Subjective:

CC (chief complaint): “I don’t know. How much would you estimate that you drink in a typical week?” AC: “Every night.”

HPI: AC is a 44-year-old Asian American female presenting for evaluation of potential substance use disorder per request of her supervisor due to concerns about her frequent tardiness and behavior suggesting possible intoxication at work. She is not currently taking any medications. AC reports drinking “a few glasses of wine” every night to “take the edge off” from the stress of her job as a high school teacher. She states that she occasionally drinks alone at home and sometimes goes to bars alone as well. On the night before this evaluation, she reports drinking heavily at a party with coworkers to the point of passing out and oversleeping at a friend’s house, causing her to be late for work again. She estimates needing 5-6 glasses of wine or a couple of mixed drinks to feel intoxicated, suggesting a high tolerance. AC states her alcohol use has increased compared to earlier in her life. She denies ever drinking during the day or while at work. The onset of her increased drinking is unclear but seems related to high levels of work stress. The frequency is nightly, with occasional heavier drinking episodes. Her drinking causes interference with her job performance and personal life. She reports a family history of her father struggling with alcoholism when she was young.

Past Psychiatric History:

• General Statement: No previous psychiatric diagnoses or treatment reported.
• Caregivers (if applicable): NA
• Hospitalizations: None reported.
• Medication trials: None reported.
• Psychotherapy or Previous Psychiatric Diagnosis: Patient does not have a history of formal psychotherapy. She has no reported previous psychiatric diagnoses.

Substance Current Use and History: AC reports drinking alcohol nightly, typically “a few glasses of wine” to help cope with stress from her job. She estimates needing around 5-6 glasses of wine or a couple of mixed drinks to feel intoxicated, suggesting high tolerance. She denies ever drinking during the day or while at work. The night before this evaluation she reports drinking heavily at a party with coworkers to the point of passing out. She denies any history of withdrawal symptoms or complications like tremors, delirium tremens, or seizures. No reported use of nicotine, illicit drugs, or other substances.

Family Psychiatric/Substance Use History: AC reports her father struggled with alcoholism when she was young and was involved with Alcoholics Anonymous, suggesting a family history of alcohol use disorder. No other psychiatric or substance use issues in her family were mentioned.

Psychosocial History: The patient was born and raised in Philadelphia as an only child by her parents. She is currently divorced with one 4-year-old son who lives primarily with his father. She lives alone. She obtained her PhD in Biology and Masters in Secondary Education. Currently she works full time as a high school biology teacher. In her free time she reports having no significant hobbies currently beyond drinking daily. She reports one past DUI arrest at age 21 but no other legal issues. She denied any history of physical, sexual, or emotional abuse either as a child or adult. She also denied any safety concerns or history of violent behavior.

Medical History:

 

• Current Medications: None
• Allergies: None

• Reproductive Hx: She is divorced, has a 4-year-old son.

ROS:

• GENERAL: Denies fever, chills, weakness, fatigue, or weight change.
• HEENT: Denies headaches, vision changes, hearing problems, sore throat, or mouth sores.
• SKIN: Denies rashes, lesions, or itching.
• CARDIOVASCULAR: Denies chest pain, palpitations, or edema.
• RESPIRATORY: Denies cough, shortness of breath, or wheezing.
• GASTROINTESTINAL: Denies abdominal pain, nausea, vomiting, diarrhea, constipation, melena, or hematochezia…………………………….Please click purchase button below to get full answer for $10

Related: (Solution) NRNP-6635 Week 8 Assignment

Subjective:

CC (chief complaint): “Not very well. They have to write her down a list. Sometimes I lose the list” (Symptom Media, 2017).

HPI: SH is an 11-year-old African American female presenting for evaluation of attention and behavior problems. She is not currently taking any medications. She was referred by her primary care physician for assessment of possible Attention Deficit Hyperactivity Disorder (ADHD). The chief complaint, per mother’s report, is that SH has had long-standing issues with inattention, distractibility, forgetfulness, and hyperactive behavior since starting school in kindergarten. SH has significant difficulty paying attention in class, remembering and following through on assignments unless they are written down for her. She frequently loses things like books, bracelet. She has trouble sitting still in her chair and fidgets excessively. Her concentration is very poor as he cannot sit and read for more than 5 minutes and has trouble remembering what she has read or what the teacher has read to the class. She daydreams frequently about playing with her dog or missing her mother. She makes careless mistakes on her schoolwork despite trying hard. She has trouble waiting her turn and has some impulsive behaviors like sticking her hand near zoo animal enclosures when younger, though her mother reports this has improved now. These symptoms of inattention, hyperactivity, and impulsivity have been longstanding since an early age, occur across multiple settings like home and school, and are causing significant impairment in SH’s academic functioning. There is no reported history of head trauma or other neurological conditions.

Past Psychiatric History:

• General Statement: No prior history of mental health treatment reported.
• Caregivers (if applicable): Sarah lives with her parents, though they mention being currently separated with plans to get back together soon.
• Hospitalizations: No prior psychiatric hospitalizations.
• Medication trials: She has not been on any psychiatric medications previously.
• Psychotherapy or Previous Psychiatric Diagnosis: She has not received any psychotherapy services or carried a previous psychiatric diagnosis based on the information provided.

Substance Current Use and History: No history of smoking, alcohol, illicit drug, or caffeine use reported.

Family Psychiatric/Substance Use History: No significant family history of psychiatric or substance use disorders reported. The patient was raised in a stable home by her biological parents.

Psychosocial History: The patient was born in Washington, D.C. and has lived there her whole life. She currently resides with her biological parents and younger brother in a single-family home. Her parents remain married. She is the oldest of two children. In school, she is in the 6th grade and enjoys art classes but struggles with academics due to attentional problems. Outside of school she enjoys playing with her dog. The patient is 11 years old and not of working age. No legal or trauma histories reported. Parents deny any concerns about safety at home, in the community, or experiences of past trauma or violence

Medical History:

 

• Current Medications: The patient reports taking no regular or as-needed medications.
• Allergies: No known drug or environmental allergies.

• Reproductive Hx: Pre-menarche at age 11 years. No pregnancy history……..Please click purchase button below to get full answer for $10

Related: (Solution) NRNP-6635 week 10 Assignment

 

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