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

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


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.


  • 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.


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.


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.


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.

Basedow, L. A., Kuitunen-Paul, S., Roessner, V., & Golub, Y. (2020). Traumatic Events and Substance Use Disorders in Adolescents. Frontiers in Psychiatry, 11.

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.

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.

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.

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.


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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.

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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