NRNP 6635 Assignment Diagnosing Patients With Addictive Disorders

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NRNP 6635 Assignment Diagnosing Patients With Addictive Disorders

NRNP 6635 Assignment Diagnosing Patients With 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.

NRNP 6635 Assignment Diagnosing Patients With Addictive Disorders

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.

 

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

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.
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 diagnostic

criteria for each differential diagnosis and explain what DSM-5 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 and Grading Information
To submit your completed Assignment for review and grading, do the following:
 Please save your Assignment using the naming convention “WK8Assgn+last name+first
initial.(extension)” as the name.
 Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
 Click the Week 8 Assignment link. You will also be able to “View Rubric” for grading criteria from
this area.
 Next, from the Attach File area, click on the Browse My Computer button. Find the document
you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
 If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my
paper(s) to the Global Reference Database.
 Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:
Week 8 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:
Submit your Week 8 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 8

To participate in this Assignment:
Week 8 Assignment
Rubric Detail

Select Grid View or List View to change the rubric's layout.
Name: NRNP_6635_Week8_Assignment_Rubric

Exit

 Grid View
 List View
Excellent Good Fair Poor
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

18 (18%) – 20 (20%)
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.

16 (16%) – 17 (17%)
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.

14 (14%) – 15 (15%)
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.

0 (0%) – 13 (13%)
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.

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

18 (18%) – 20 (20%)
The response thoroughly and
accurately documents the
patient's physical exam for
pertinent systems. Diagnostic
tests and their results are
thoroughly and accurately
documented.

16 (16%) – 17 (17%)
The response accurately
documents the patient's
physical exam for pertinent
systems. Diagnostic tests and
their results are accurately
documented.

14 (14%) – 15 (15%)
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.

0 (0%) – 13 (13%)
The response provides
incomplete or inaccurate
documentation of the patient's
physical exam. Systems may
have been unnecessarily
reviewed, or, objective
documentation is missing.

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

23 (23%) – 25 (25%)
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.

20 (20%) – 22 (22%)
The response accurately
documents the results of the
mental status exam.

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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.

18 (18%) – 19 (19%)
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.

0 (0%) – 17 (17%)
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.

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!), 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.).

9 (9%) – 10 (10%)
Reflections are thorough,
thoughtful, and demonstrate
critical thinking.

8 (8%) – 8 (8%)
Reflections demonstrate
critical thinking.

7 (7%) – 7 (7%)
Reflections are somewhat
general or do not demonstrate
critical thinking.

0 (0%) – 6 (6%)
Reflections are incomplete,
inaccurate, or missing.

Provide at least three
evidence-based, peer-
reviewed journal articles or

14 (14%) – 15 (15%)
The response provides at least
three current, evidence-based

12 (12%) – 13 (13%)
The response provides at least
three current, evidence-based

11 (11%) – 11 (11%)
Three evidence-based
resources are provided to

0 (0%) – 10 (10%)
Two or fewer resources are
provided to support

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).

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.

resources from the literature
that appropriately support the
assessment and diagnosis of
the patient in the assigned
case study.

support assessment and
diagnosis of the patient in the
assigned case study, but they
may only provide vague or
weak justification.

assessment and diagnosis
decisions. The resources may
not be current or evidence
based.

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 (5%) – 5 (5%)
Paragraphs and sentences
follow writing standards for
flow, continuity, and clarity.
A clear and comprehensive
purpose statement,
introduction, and conclusion
are provided that delineate all
required criteria.

4 (4%) – 4 (4%)
Paragraphs and sentences
follow writing standards for
flow, continuity, and clarity
80% of the time.
Purpose, introduction, and
conclusion of the assignment
are stated, yet they are brief
and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences
follow writing standards for
flow, continuity, and clarity
60%–79% of the time.
Purpose, introduction, and
conclusion of the assignment
is vague or off topic.

0 (0%) – 3 (3%)
Paragraphs and sentences
follow writing standards for
flow, continuity, and clarity
less than 60% of the time.
No purpose statement,
introduction, or conclusion
were provided.

Written Expression and
Formatting—English writing
standards:
Correct grammar,
mechanics, and punctuation

5 (5%) – 5 (5%)
Uses correct grammar,
spelling, and punctuation with
no errors

4 (4%) – 4 (4%)
Contains a few (one or two)
grammar, spelling, and
punctuation errors

3 (3%) – 3 (3%)
Contains several (three or
four) grammar, spelling, and
punctuation errors

0 (0%) – 2 (2%)
Contains many (≥ five)
grammar, spelling, and
punctuation errors that
interfere with the reader’s
understanding

Total Points: 100
Name: NRNP_6635_Week8_Assignment_Rubric

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