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

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

Walden University NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

Whether one passes or fails an academic assignment such as the Walden University NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

The introduction for the Walden University NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

After the introduction, move into the main part of the NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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

 

Subjective:

CC (chief complaint): ‘I am afraid to go to the rehab.’

HPI: Lisa Pittman is a 29-year-old female that has come to the unit for treatment for Hep C+ and needs to get clean first. She is thinking of going for long-term rehab but is fearful of what people will say and the perception that they are dirty. Lisa has been smoking crack cocaine, approximately $1000 daily, cannabis 1-2 times weekly, and 2-3 alcoholic drinks weekly. She also has a history of theft convictions and drug possessions and is on a 2-year probation with randomized drug screens. Her laboratory values have demonstrated abnormal results in ALT, AST, bilirubin, albumin, GGT, and positive for cocaine. She has a history of sexual abuse as a child, with perpetrator being her father who was imprisoned for the offence and drug charges. Lisa is currently in a relationship with Jeremy, who also abuses drugs and alcohol. She has a daughter who lives with her friends.

Past Psychiatric History:

  • General Statement: I am afraid of going to the rehab
  • Caregivers (if applicable): none
  • Hospitalizations: Lisa denied any history of hospitalizations
  • Medication trials: Lisa denied any history of medication trials
  • Psychotherapy or Previous Psychiatric Diagnosis: Lisa denied any history of psychotherapy or previous psychiatric diagnosis

Substance Current Use and History: Lisa currently abuses cannabis 1-2 times weekly, smokes crack cocaine, and drinks 2-3 alcoholic drinks weekly

Family Psychiatric/Substance Use History: There is history of substance abuse in Lisa’s family. Her father was imprisoned for sexually abusing her and drug offenses. Her mother has a history of benzodiazepine use. Her older brother has history of opioid abuse. Her mother has a history of anxiety.

Psychosocial History: Lisa is not married. She is in a relationship with Jeremy. She current works and struggles to remain clean so that people do not talk about her. She has a daughter who stays with her friends.

Medical History: Lisa denied any history of hospital admission, surgeries, or blood transfusion.

 

  • Current Medications: Lisa is not currently using any medications
  • NRNP 6635 Assessing and Diagnosing Patients With Substance Related and Addictive DisordersAllergies: She is allergic to Amoxicillin. She denied other forms of allergies.
  • Reproductive Hx: Her menarche was when she was 15 years. Her last menstrual period was one week ago. She is currently not using any contraceptive method. She denies any menstrual problems. She is sexually active. She does not use any protection when engaging in sexual intercourse. She has one child. She denied any history of pregnancy loss. She denied history of sexually transmitted infections. She denied dysuria, urgency, and frequency. She was sexually abused when she was aged 5-7 by her father.

ROS:

  • GENERAL: Lisa appears poorly groomed for the occasion. She is slightly underweight for her age. She does not demonstrate restlesses, agitation, and denies fever
  • HEENT: Eyes: Lisa denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: She also denies hearing loss, sneezing, congestion, runny nose, or sore throat.
  • SKIN: Lisa denies rash or itching. There are evident needle prick marks on the arms.
  • CARDIOVASCULAR: Lisa denies chest pain, chest pressure, or chest discomfort. She also denies palpitations or edema.
  • RESPIRATORY: Lisa denies shortness of breath, cough, or sputum.
  • GASTROINTESTINAL: She denies anorexia, nausea, vomiting, or diarrhea. She also denies abdominal pain or blood. She reports decline in appetite. She prefers getting higher to eating.
  • GENITOURINARY: Lisa denies burning on urination, urgency, hesitancy, odor, odd color
  • NEUROLOGICAL: Lisa denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. She also denies change in bowel or bladder control.
  • MUSCULOSKELETAL: Lisa denies muscle, back pain, joint pain, or stiffness.
  • HEMATOLOGIC: Lisa denies anemia, bleeding, or bruising.
  • LYMPHATICS: She denies enlarged nodes. No history of splenectomy.
  • ENDOCRINOLOGIC: She denies reports of sweating, cold, or heat intolerance. She also denies polyuria or polydipsia.

Objective:

Physical exam: if applicable

Diagnostic results: laboratory investigations were ordered. The labs were abnormal for ALT 168, AST 200, ALK 250, bilirubin 2.5, albumin 3.0, GGT 59, and UDS positive for cocaine. The labs were negative for alcohol or other drugs. BAL o; other labs within normal range.

Assessment:

Mental Status Examination: Lisa is poorly groomed for the occasion. She is oriented to self, time, place, and events. She maintains normal eye contact during the assessment. Her speech is normal in terms of tone, volume, and rate. She does not demonstrate tics or tremors during the assessment. She responds appropriately to questions. She denies illusion, delusion, and hallucinations. Her thought content is future oriented. She denies suicidal thoughts, attempts, or plans. Her mood is flat with constricted affect.

Differential Diagnoses:

Lisa’s primary diagnosis is substance use disorder. According to DSM5, substance use disorders are mental health problems that arise from the abuse of drugs that include alcohol, caffeine, cannabis, hallucinogens, opioids, hypnotics, stimulants, tobacco, and sedatives. Prolonged use of these drugs result in substance use disorders where patients continue using them despite experiencing problems associated with them (Jones & McCance-Katz, 2019). DMS5 has developed criteria that practitioners utilize in diagnosing patients with substance use disorders. One of them is an individual taking a substance in larger amounts and for longer periods than it was intended. It also includes individuals having the intention to stop or cut down using the substance but he/she is unable. The additional symptoms include spending a lot of time in acquiring, using, or recovering from the substance and having immense cravings and urges to use it. Substance use also affects the normal functioning of its users. In addition, the users continue abusing them even it they cause problems in their lives or relationships (Arterberry et al., 2020). Substance use disorder patients also require more of the drug to achieve the effect they want, develop withdrawal symptoms when they abstain, and continue using the substance even if they are experiencing adverse health problems. Overall, the above symptoms can be classified into broad categories that include social problems, impaired contro, risky substance use, and physical dependence (Basedow et al., 2020). Lisa’s problems align with the above. For example, she reports using crank cocaine, smoking, and alcohol despite knowing its effects. She also spends a significant amount and time to get the substances she needs. She also has developed tolerance since she has to take the substances for her to feel high. As a result, substance use disorder is her primary diagnosis.

One of Lisa’s secondary diagnoses is post-traumatic stress disorder. Post-traumatic stress disorder is a mental disorder that arises from one’s exposure or experience of a traumatic event. The trauma predisposes them to developing symptoms such avoidance behaviors, depressed mood, flashbacks, and nightmares about their experiences (Bryant-Genevier et al., 2021; Maercker et al., 2022). Lisa has a history of being abused sexually when she was a child. As a result, she is at a risk of developing post-traumatic stress disorder. However, it is the least likely diagnosis at this stage since she does not demonstrate symptoms of the disorder such as avoidance, flashbacks, and depressed mood among others.

The last potential diagnosis that should be considered for Lisa is major depression. Major depression is a mental disorder characterized by severly depressed mood, anhedonia, social withdrawal, feelings of hopelessness, and guilt. Patients also report changes in sleep, appetite, and weight, suicidal thoughts, attempts, or plans, and poorly functioning in their social and occupational roles. Depression may be attributed to causes such as social stressors as well as substance abuse (Rice et al., 2019). However, Lisa does not demonstrate the symptoms of major depression such as depressed mood, anhedonia, and feelings of guilt and hopelessness. Therefore, major depression is the least likely cause of her mental health problem.

Reflections: I agree with the preceptor’s assessment and diagnostic impression. Lisa’s diagnosis of substance use disorder is accurate based on the criteria developed by DSMV. I learned some aspects related to mental health practice from this case study. One of them is conducting comprehensive patient assessment and psychiatric assessment. I also learned about the consideration of potential differential diagnoses and narrowing to a specific diagnosis that relates to the patient’s problem. Ethical considerations such as patient autonomy, justice, confidentiality, and privacy should guide the treatment of psychiatric patients. Social determinants such as socioeconomic status should be investigated to understand their influence on mental health problems.

References

Arterberry, B. J., Boyd, C. J., West, B. T., Schepis, T. S., & McCabe, S. E. (2020). DSM-5 substance use disorders among college-age young adults in the United States: Prevalence, remission and treatment. Journal of American College Health, 68(6), 650–657. https://doi.org/10.1080/07448481.2019.1590368

Basedow, L. A., Kuitunen-Paul, S., Roessner, V., & Golub, Y. (2020). Traumatic Events and Substance Use Disorders in Adolescents. Frontiers in Psychiatry, 11. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00559

Bryant-Genevier, J., Rao, C. Y., Lopes-Cardozo, B., Kone, A., Rose, C., Thomas, I., Orquiola, D., Lynfield, R., Shah, D., Freeman, L., Becker, S., Williams, A., Gould, D. W., Tiesman, H., Lloyd, G., Hill, L., & Byrkit, R. (2021). Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic—United States, March–April 2021. Morbidity and Mortality Weekly Report, 70(26), 947–952. https://doi.org/10.15585/mmwr.mm7026e1

Jones, C. M., & McCance-Katz, E. F. (2019). Co-occurring substance use and mental disorders among adults with opioid use disorder. Drug and Alcohol Dependence, 197, 78–82. https://doi.org/10.1016/j.drugalcdep.2018.12.030

Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., & Bohus, M. (2022). Complex post-traumatic stress disorder. The Lancet, 400(10345), 60–72. https://doi.org/10.1016/S0140-6736(22)00821-2

Rice, F., Riglin, L., Lomax, T., Souter, E., Potter, R., Smith, D. J., Thapar, A. K., & Thapar, A. (2019). Adolescent and adult differences in major depression symptom profiles. Journal of Affective Disorders, 243, 175–181. https://doi.org/10.1016/j.jad.2018.09.015

 

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Sample Answer 2 for NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

Subjective:

CC (chief complaint): “I am scared.”

HPI: Lisa Tremblay is a 33-year-old female in a detox facility. She states that she fears getting into rehab because of what other people will think about her. She fears that people will think of her as a person with an addiction. She also worries about her business, which she says is over after operating for nine months. According to Lisa, the business collapsed because of her boyfriend, Jeremy, who took money from the account. The boyfriend spent the money to pay cocaine debts, and this caused the business to lose $ 80,000. Lisa was introduced to cocaine by her boyfriend, who made her believe it was non-addictive. However, she developed a cocaine addiction. Lisa reports that she feels uneasy if she does not smoke cocaine. Smoking cocaine makes her feel good, and she usually wants to smoke more when the feeling of highness reduces. According to Lisa, she does not need help because Jeremy promised her that she would be okay, and she believes him because she loves him.

Past Psychiatric History:

  • General Statement: No psychiatric history.
  • Caregivers (if applicable): None
  • Hospitalizations: None
  • Medication trials: None
  • Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History:

Take opiates worth about $100 daily.

Uses cannabis 1–2 times weekly.

Drinks 1/2 gallon of vodka daily. She reports drinking with her friends but states that she is in control of her alcohol consumption.

Family Psychiatric/Substance Use History:  The patient’s mother has a history of agoraphobia and benzodiazepine abuse.

The father was imprisoned due to drug abuse.

The patient’s older brother has a history of opioid use.

Psychosocial History: The patient lives with her boyfriend, Jeremy, whom she reports having a strained relationship with after he cheated on her. She has a daughter with an ex-boyfriend, and the girl lives with her friends. Lisa and her boyfriend had started a web design business, which collapsed after he withdrew money to pay cocaine debts. The patient has a legal history of arrest after being found in possession of drugs. She was sexually abused by her estranged father when she was 6-9 years old. The father was incarcerated for sexual abuse and drug charges. Lisa’s mother lives in Maine. She has not heard from her older brother for ten years. She reports sleeping 5-6 hours/day, and her appetite increases when high.

Medical History: The patient has Hepatitis C. She is considering treatment for Hep C+ but needs detox first.

 

  • Current Medications: None
  • Allergies: Allergic to Azithromycin.
  • Reproductive Hx: None

ROS:

  • GENERAL: Denies fever, chills, weight changes, or malaise.
  • HEENT: Denies eye pain, ear pain, discharge, rhinorrhea, or sore throat.
  • SKIN: Denies rashes, lesions, or discoloration.
  • CARDIOVASCULAR: Denies dyspnea, edema, chest pain, or palpitations.
  • RESPIRATORY: Denies wheezing, cough, SOB, or sputum.
  • GASTROINTESTINAL: Positive for reduced appetite. Denies abdominal pain or bowel changes.
  • GENITOURINARY: Denies dysuria or abnormal PV discharge.
  • NEUROLOGICAL: Denies dizziness, paralysis, or tingling sensations.
  • MUSCULOSKELETAL: Denies muscle/joint pain or limitations in movement.
  • HEMATOLOGIC: Denies bruising or bleeding.
  • LYMPHATICS: Denies lymph node swelling.
  • ENDOCRINOLOGIC: Denies excessive sweating, increased hunger, acute thirst, or polyuria.

Objective:

Physical exam: if applicable

Vital signs: BP-180/110; T- 100.0; P- 108; R-20; Ht- 5’6; Wt-146lbs

Diagnostic results:

ALT-168

AST-200

ALK-250

Bilirubin-2.5

Albumin-3.0;

GGT-59

Urine drug test positive for opiates, THC, and alcohol

BAL-308

Assessment:

Mental Status Examination:

The patient appears nervous and constantly fidgets and looks out through the window. She is alert and oriented to person, place, and time. Her self-reported mood is ‘worried,’ and her affect is broad. She has clear and coherent speech. Her thought process is coherent and goal-oriented. She exhibits no hallucinations, delusions, or suicidal/homicidal ideations. Memory, abstract thought, and judgment are intact. Insight is present.

Differential Diagnoses:

Substance Use Disorder (SUD): The DSAM-V criteria for diagnosing SUD include four basic categories: Physical dependence, Impaired control, Social problems, and risky use (American Psychiatric Association, 2022; Livne et al., 2021). The patient is physically dependent on cocaine and usually feels terrible when she has not smoked it. She gets high to trigger her appetite and has developed a cocaine addiction. She also has impaired control and cannot stop using cocaine. She continues to use cocaine despite causing social problems like problems with her boyfriend and her business collapsing. Lisa spends lots of money on opiates, about $100 daily. Furthermore, she uses opiates in risky settings and has been arrested for possessing drugs.

Alcohol Use Disorder (AUD): AUD is characterized by a problematic pattern of alcohol use that results in clinically significant impairment or distress (American Psychiatric Association, 2022; Palmer et al., 2019). The patient presents with clinical features of AUD, like taking large amounts of alcohol. She reports taking 1/2 gallon of vodka daily. Besides, her urine drug test is positive for alcohol, making AUD a differential diagnosis.

Generalized Anxiety Disorder (GAD): GAD is diagnosed based on excessive, unjustified anxiety or worry, which interferes with essential activities of daily living (Boland et al., 2022; Szuhany & Simon, 2022). Lisa reports being worried about going to rehab because people will think she has an addiction. This may interfere with her treatment and recovery of opiate addiction and abuse.

 

Reflections: SUD is the appropriate diagnosis for this patient since she presented with a pattern of symptoms associated with using cocaine. In a different situation, I would inquire if the patient has a history of domestic violence since women who abuse substances face violence in their relationships. Legal considerations related to this patient include privacy and confidentiality. The clinician should assure the patient of confidentiality of what she says and what is recorded. Health promotion should aim to educate the patient on the effects of alcohol, cannabis, and cocaine use on her overall health.

 

References

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

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

Livne, O., Shmulewitz, D., Stohl, M., Mannes, Z., Aharonovich, E., & Hasin, D. (2021). Agreement between DSM-5 and DSM-IV measures of substance use disorders in a sample of adult substance users. Drug and alcohol dependence, 227, 108958. https://doi.org/10.1016/j.drugalcdep.2021.108958

Palmer, R. H. C., Brick, L. A., Chou, Y. L., Agrawal, A., McGeary, J. E., Heath, A. C., Bierut, L., Keller, M. C., Johnson, E., Hartz, S. M., Schuckit, M. A., & Knopik, V. S. (2019). The etiology of DSM-5 alcohol use disorder: Evidence of shared and non-shared additive genetic effects. Drug and alcohol dependence, pp. 201, 147–154. https://doi.org/10.1016/j.drugalcdep.2018.12.034

Szuhany, K. L., & Simon, N. M. (2022). Anxiety Disorders: A Review. JAMA, 328(24), 2431–2445. https://doi.org/10.1001/jama.2022.22744

Sample Answer 3 for NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

Subjective:

Name: Ally Patel

Gender: Female

Age: 48 years old

CC (chief complaint): Client’s supervisor, “Ms. Ally’s alcohol consumption, is getting out of

hand. I suspect a potential substance use.”

HPI:

Ally is a 48-year-old female who is undergoing psychiatric assessment after a referral from the school EAP counselor as a result of her substance abuse probability. The client has been late for classes for 22 days due to excessive alcohol consumption and was referred to facilitate getting her help and retaining her at the school. The patient reports that she was late to work on the interview day since she attended a party the previous evening and drank too much. She initially denies that she got intoxicated and passed out but later admits it. The client reports that she drinks too much every night. She states that she mostly drinks alone but occasionally goes to a bar with her friends or drink at school functions, where the alcohol supply is liberal. She also reports taking 5-6 glasses of wine and several mixed drinks when her students give her a rough time.

The client attributes the excessive drinking to the stress she experiences at school due to students’ indiscipline. She admits to taking too much alcohol but states that it affects her differently. She admits to passing out severally when drunk. Students and parents have complained that Ally has severally gotten to class to teach while drunk, but she denies the claims. According to her students, she goes to class drunk and orders them to read from their textbook or copy notes from the board while sleeping with her head on the desk. Her drinking behavior puts her at risk of losing her teaching job, and the Board of Education may dismiss her if she does not cooperate during the psychiatric evaluation.

Past Psychiatric History:

  • General Statement: No psychiatric history.
  • Caregivers: None
  • Hospitalizations: No history of psychiatric hospitalization.
  • Medication trials: None
  • Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History:

She has a history of alcohol consumption since she was a teenager. Alcohol consumption has increased over the years. She reveals taking on average 5 wine glasses alongside some mixed drinks in order to get high. She takes 5-6 glasses of wine and a handful of mixed drinks to get intoxicated.

Family Psychiatric/Substance Use History: The client’s father was an alcoholic. He got into Alcohol Anonymous and quit alcohol.

Psychosocial History:

Ally was born alone and her parents raised her within the San Francisco area in Carlifonia. She possesses a PhD majoring in Biology while also having a Masters in high school education. Her current employment is in high school. Ally reports being currently in a relationship.

Medical History:

 

  • Current Medications: None
  • Allergies: No food or drug allergies.
  • Reproductive Hx: Para 0+0; No history of gynecologic disorders. LMP-3 weeks ago.

ROS:

  • GENERAL: Lacks chills, fever, fatigue or weight changes.
  • HEENT: Denies traumatic head injury, eye pain, blurred vision, ear discharge, hearing loss, sneezing, nasal discharge, sore throat, or hoarse voice.
  • SKIN: Negative for skin rashes, itching, bruises, or lesions.
  • CARDIOVASCULAR: Denies palpitations, chest pain, SOB on exertion, orthopnea, or edema
  • RESPIRATORY: Does not have cough, sputum production, dyspnea, or chest pain.
  • GASTROINTESTINAL: Denies rectal bleeding, vomiting, nausea, constipation, abdominal discomfort, or diarrhea.
  • GENITOURINARY: Negative for pelvic pain, excessive or malodorous vaginal discharge, dysuria, or urine color changes.
  • NEUROLOGICAL: Negative for headache, fatigue, drowsiness, LOC, or burning sensations.
  • MUSCULOSKELETAL: Denies muscle pain, joint pain/stiffness, or joint enlargement.
  • HEMATOLOGIC: Denies bruising or history of blood transfusion.
  • LYMPHATICS: Does not have a history of lymph node enlargement.
  • ENDOCRINOLOGIC: Rejects excessive hunger, polyuria, and thirst, or excessive sweating.

Objective:

Physical exam:

BP: 122/76; HR- 84; RR-20; Temp- 98.24

Ht- 5’4; Wt- 138 lbs.

Diagnostic results: No labs or imaging tests were ordered.

Assessment:

Mental Status Examination:

The client is neat and dressed appropriately for the weather and function. She is alert but appears a bit confused and anxious and maintains limited eye contact. Her speech is clear at a normal rate, but the volume increases when she gets provoked. She demonstrates a congruent thought process. No hallucinations, delusions, obsessions, homicidal, or suicidal ideations were noted. She is oriented to time, person, and place, and also manifests good judgment. Memory is intact. Insight is present.

Differential Diagnoses:

Alcohol Use Disorder

Alcohol use disorder (AUD) is defined to as a maladaptive pattern associated with substance use that leads to the clinical impairment or distress of an individual. According to the DSM-V, the presence of certain symptomatology such as extended alcohol use in large amounts, inability to reduce alcohol intake, expending time on alcohol related activities, and craving for alcohol indicate the condition (APA, 2013). Moreover, using the alcohol recurrently thus impairing social and economic functions and the usage of alcohol despite its social detriments also lend to the presence of alcohol use disorder (Yang et al., 2018). Besides, fundamental occupational, social, or recreational activities are given up or reduced due to imbibing on alcohol. Lastly, obsession with alcohol does not reduce despite its exacerbation of physical or psychological manifestations.

AUD is a differential diagnosis based on the client’s history of taking large amounts of alcohol; Spending lots of time taking alcohol; recurrent alcohol use resulting in failure to carry out her teaching obligations; and continuing to take alcohol despite it causing problems in her relationships.

Generalized Anxiety Disorder

The client could be having GAD based on her report of getting stressed due to student indiscipline at school. The alcohol intake could result from GAD since she reports taking alcohol when her students take the edge off the day (McHugh & Weiss, 2019). Besides, the client appears anxious and is inattentive during the interview, which is consistent with GAD.

Major Depressive Disorder

Major depressive disorder (MDD) is a differential diagnosis based on the client’s history of losing interest in her job. The client’s alcohol problem could be secondary to depression (McHugh & Weiss, 2019). However, she does not demonstrate other symptoms of MDD.

Reflections:

If I were to conduct the session again, I would assess the client’s history of using other drug substances to rule out the presence of a substance abuse disorder. I would also order a urine test to evaluate if the client has been using other illicit drugs (Kranzler & Soyka, 2018). Legal and ethical considerations for this client include autonomy, beneficence, nonmaleficence, and confidentiality. The PMHNP should respect the client’s decision regarding her care to uphold autonomy.  Beneficence and nonmaleficence should be upheld by choosing treatment interventions to promote the best possible health outcomes and not harm the client. In addition, the PMHNP should ensure that the client’s information is not shared with other persons without the client’s consent. The client’s health promotion strategies should focus on reducing alcohol consumption and help her return to normal functioning.

 

 References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Kranzler, H. R., & Soyka, M. (2018). Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review. JAMA, 320(8), 815–824. https://doi.org/10.1001/jama.2018.11406

McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol research: current reviews, 40(1), arcr.v40.1.01. https://doi.org/10.35946/arcr.v40.1.01

Yang, P., Tao, R., He, C., Liu, S., Wang, Y., & Zhang, X. (2018). The Risk Factors of the Alcohol Use Disorders-Through Review of Its Comorbidities. Frontiers in neuroscience, 12, 303. https://doi.org/10.3389/fnins.2018.00303

Sample Answer 4 for NRNP 6635 Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders

CC (chief complaint): “I want to be discharged to get back to my boyfriend and use crack.”

HPI: M.D is a 54-year-old white female on the psychiatry floor who wants to be discharged to get back to his boyfriend, Jeremy, and use crack. She started using crack about nine months ago after she was introduced to it by her boyfriend. The boyfriend started smoking crack with a mutual friend to M.D. Since then, Jeremy has drained M.D, and their company accounts to pay off his crack debt. M.D glorifies using crack and reports seeing people dancing in flowers and a need to get high again. She states that she is addicted to Jeremy and is willing to do whatever he wants to keep him. As a result, she now smokes crack to be with him. The patient states that she is not a junkie and can quit crack when she wants. However, she cannot finish a hospital stay because she wants to get a fix.

Past Psychiatric History:

  • General Statement: No significant psychiatric history.
  • Caregivers (if applicable): None
  • Hospitalizations: Currently hospitalized due to Cocaine abuse.
  • Medication trials: None
  • Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: The patient has a history of drinking alcohol and marijuana. She reports she smokes a pack of cigarettes daily. Currently uses crack.

Family Psychiatric/Substance Use History: The patient’s mother had a history of excessive alcohol consumption.

Psychosocial History: The patient lives with her boyfriend Jeremy, who she states that she is “addicted to.” The patient says that she has a web design business with her boyfriend, but she had to end the company due to insufficient money. The boyfriend drained the company accounts to pay off his crack debt. She reports that after draining the business money, she kicked her boyfriend out briefly, but he apologized and begged to have her back.

Medical History: No significant medical history.

 

  • Current Medications: No current medications.
  • Allergies: No known food or drug allergies.
  • Reproductive Hx: No history of gynecologic disorders. Para 0+0

ROS:

  • GENERAL: Denies chills, fever, weight changes, or fatigue.
  • HEENT: Denies headache, vision changes, hearing loss, nasal congestion, rhinorrhea, or swallowing difficulties
  • SKIN: Positive for itching skin
  • CARDIOVASCULAR: Positive history of HTN. Denies palpitations, chest pain, edema, or SOB on exertion.
  • RESPIRATORY: Denies cough, sputum, or SOB.
  • GASTROINTESTINAL: Denies anorexia, nausea, vomiting, abdominal discomfort, or altered bowel patterns.
  • GENITOURINARY: Denies abnormal genital discharge or urinary symptoms.
  • NEUROLOGICAL: Denies headache, dizziness, syncope, or tingling sensations.
  • MUSCULOSKELETAL: Denies limitations in movement.
  • HEMATOLOGIC: Denies easy bruising or bleeding.
  • LYMPHATICS: Denies enlarged lymph nodes.
  • ENDOCRINOLOGIC: Positive history of T2DM and Hypothyroidism.

Physical exam:

General: The patient is tearful but appears clean and put together.

Skin: Bruises on hands with patches of reddening.

Diagnostic results: Awaits Drug urine test results.

Assessment

Mental Status Examination:

The patient appears clean and put together and is very standoffish. She is tearful and distressed. The self-reported mood is “sad and upset,” and affect is constricted. She is shaking and maintains poor eye contact throughout the interview. Speech and thought process are coherent. No hallucinations or delusions were noted. Short term and long term memory are intact. She is oriented to person, place, and time. Demonstrates good judgment. Insight is poor.

Differential Diagnoses:

Substance Use Disorder

The DSM V diagnostic criteria for Substance Use Disorder (SUD) include behaviors categorized into four groups: impaired control, Social impairment, Risky use, and Pharmacological indicators. Impaired control behaviors include: Taking a substance in larger amounts or for longer than intended to; Wanting to cut down or stop using a substance but being unsuccessful (APA, 2013). Individuals spend a lot of time getting, using, or recovering from use of the substance; and cravings and urges to use the substance (APA, 2013). Behaviors in social impairment include: Continue to use the substance despite problems with work, school, or family/social obligations; Continuing to use, even when it causes problems in relationships; and giving up or reducing important social, occupational, or recreational activities because of substance use.

Behaviors indicating risky use include: Repeatedly using the substance in physically dangerous situations; Continuing to use, even when if one is aware it is causing or worsening physical and psychological problems (APA, 2013). Pharmacological indicators include needing more of the substance to get the effect you want, known as tolerance. Developing withdrawal symptoms, which are relieved by taking more of the substance.

SUD is a differential diagnosis based on patient’s behaviors such as having cravings and urges to use Crack; Continuing to use crack despite problems with her business; Giving up her business activities because of crack; and developing withdrawal symptoms of a sad mood, tremors, and increased craving for crack.

Substance-induced depressive disorder

Substance-induced depressive disorder is a kind of depression caused by using alcohol, drugs, or medications. It can occur during intoxication or withdrawal (Revadigar & Gupta, 2020). During withdrawal, symptoms of depression are usually common (Revadigar & Gupta, 2020).  This is a differential diagnosis based on the findings of tearfulness and distress and a sad mood when the patient is in the stage of withdrawal.

Withdrawal Syndrome

Withdrawal syndrome is marked by symptoms that occur after discontinuation of a particular substance. Withdrawal symptoms of Cocaine are mild and not life-threatening (Gupta & Attia, 2019). They include marked depression, hunger, shakiness or tremor, excessive sleep, dysphoria, and severe psychomotor retardation (Gupta & Attia, 2019). Withdrawal syndrome is a differential diagnosis based on the patient’s shakiness, tearfulness, and sad mood after discontinuing crack.

Reflection

If I were to conduct the session over, I would assess the client for depressive and anxiety disorder, which are comorbidities of SUD. Legal and ethical considerations for this patient include confidentiality, beneficence, and nonmaleficence. The practitioner must maintain the confidentiality of the patient’s information, such as her substance use history (Bipeta, 2019). Beneficence is upheld by ensuring that the chosen treatment interventions will have the best possible outcome. Nonmaleficence is upheld by evaluating the treatment options to ensure that they do not harm the patient (Bipeta, 2019). The practitioner has to assess the best way to manage the patient, inpatient or outpatient, by considering the pros and cons of each. For instance, the patient may be a danger to herself and others if her request to be discharged is not granted. On the other hand, the patient will continue using crack if she is discharged. Consequently, the practitioner must explain to the patient which treatment option will be selected and obtain informed consent (Bipeta, 2019). Health promotion activities for this patient include introducing her to self-help groups and providing group therapy.

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

Gupta, M., & Attia, F. N. (2019). Withdrawal Syndromes. In StatPearls [Internet]. StatPearls Publishing.

Revadigar, N., & Gupta, V. (2020). Substance-Induced Mood Disorders. In StatPearls [Internet]. StatPearls Publishing.

Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource