NRNP 6635 Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders
Walden University NRNP 6635 Assignment: 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 Assignment: 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 Assignment: 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 Assignment: 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 Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders
The introduction for the Walden University NRNP 6635 Assignment: 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 Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders
After the introduction, move into the main part of the NRNP 6635 Assignment: 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 Assignment: 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 Assignment: 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 Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders
Subjective:
CC (chief complaint):
HPI:
Ally Patel is a 48-year-old female client on psychiatric evaluation. Her school’s EAP counselor referred her for psychiatric intervention following concerns about the client’s potential substance use. Ally has been late for classes for about 22 days after engaging in excessive alcohol intake. She was referred for psychiatric care to get help for her drinking behavior and retain her in school. The client states that she was late to work on the interview day because she had attended a party the previous evening and took too much alcohol. Initially, she denies that she got drunk and passed out but admits it afterward. She admits to drinking too much alcohol every night. She mostly drinks by herself, but once in a while, she goes to a bar accompanied by her friends or drinks during school functions, where they supply alcohol liberally. Furthermore, she states that she takes 5-6 glasses of wine and several mixed drinks when she has it rough with her students.
Ally attributes the excessive alcohol consumption to the stress she experiences at school caused by her students’ indiscipline. She takes too much alcohol but and it affects her differently, including passing out on several occasions when drunk. Students and parents have complained that the client has on several occasions taught while drunk, but she denies the allegations. Her students have complained that Ally goes to class drunk and instructs them to read from their textbook or copy notes from the board while sleeping with her head on the desk. The client’s drinking behavior is a threat to her job, and the Board of Education may dismiss her if she fails to cooperate with the psychiatric evaluation.
Past Psychiatric History:
- General Statement: No pertinent psychiatric history.
- Caregivers (if applicable): None
- Hospitalizations: No history of psychiatric hospitalization.
- Medication trials: None
- Psychotherapy or Previous Psychiatric Diagnosis: None
Substance Current Use and History: Ally started drinking alcohol when she was a teenager. Her alcohol intake has increased over the years. She takes 5-6 glasses of wine and mixed drinks every night to get intoxicated.
Family Psychiatric/Substance Use History: Ally’s father was an alcoholic. He got into Alcohol Anonymous, which helped to get sober.
Psychosocial History:
The client is an only child and was raised by parents in San Francisco, CA. She has a Ph.D. in biology and a master’s degree in high school education. She is currently a high school teacher. She is currently in a relationship.
Medical History:
- Current Medications: None
- Allergies: No known food or drug allergies.
- Reproductive Hx: Para 0+0; No history of gynecologic disorders.
ROS:
- GENERAL: Denies fever, chills, weight gain/loss, or fatigue.
- HEENT: Denies blurred vision, eye pain, hearing loss, ear discharge, rhinorrhea, hoarse voice, or sore throat.
- SKIN: Denies skin rashes, itching, or bruises.
- CARDIOVASCULAR: Denies palpitations, chest pain, or SOB on exertion.
- RESPIRATORY: Denies chest pain, cough, SOB, or sputum production.
- GASTROINTESTINAL: No nausea, vomiting, abdominal pain, diarrhea/ constipation, or tarry stools.
- GENITOURINARY: Denies pelvic pain, abnormal vaginal discharge, dysuria, or abnormal urine color.
- NEUROLOGICAL: Denies headache, drowsiness, fatigue, LOC, or tingling sensations.
- MUSCULOSKELETAL: No muscle pain, joint pain or stiffness, or joint enlargement.
- HEMATOLOGIC: No bruising or history of anemia.
- LYMPHATICS: Denies lymph node enlargement.
- ENDOCRINOLOGIC: Denies excessive sweating, heat/cold intolerance, polyuria, excessive hunger, or acute thirst.
Objective:
Physical exam:
Vital signs: BP: 122/76; HR- 84; RR-20; Temp- 98.24
Ht- 5’4; Wt- 138 lbs.
Diagnostic results: No diagnostic tests requested.
Assessment:
Mental Status Examination:
The patient is well-groomed and appropriately dressed for the weather. She is alert but appears confused and anxious. She maintains minimal eye contact throughout the interview. Her speech is clear, but she raises the volume when provoked. She exhibits a coherent and logical thought process. No delusions, hallucinations, obsessions, homicidal, or suicidal ideations were noted. She is oriented to person, place, and time and demonstrates good judgment. Her long-term and short-term memory is intact.
Differential Diagnoses:
Alcohol Use Disorder (AUD)
AUD is characterized by a maladaptive pattern of alcohol use that leads to clinically significant impairment or distress. Persons with AUD usually take alcohol in large amounts and over a longer period than intended (APA, 2013). There is a persistent desire or futile efforts to minimize or control alcohol use. Much time is spent in activities that seek to obtain alcohol, drink alcohol, or recover from its impact, and persons have cravings or a strong urge to take alcohol (APA, 2013). The recurrent alcohol use results in an inability to carry out duties at home, work, or school. Individuals reduce or give up important occupational, social, and recreational activities due to alcohol intake.
AUD is a differential diagnosis based on a positive history of excessive alcohol consumption and spending much time drinking alcohol. Besides, the client’s alcohol use has led to failure in carrying out her occupational obligations. She continues to take alcohol even though it causes problems at work and in her relationships.
Generalized Anxiety Disorder
GAD presents with excessive and unrealistic worry or anxiety. Other symptoms include: Restlessness or feeling keyed up or on edge, concentration difficulties, easy fatigue, muscle tension, irritability, and sleep disturbance (Bandelow et al., 2017). The patient’s history of being stressed due to student indiscipline at school could be a sign of GAD. Besides, GAD could cause excessive alcohol intake since the client takes alcohol when having a rough day with students to help her take the edge off the day (Bandelow et al., 2017). She appears anxious and is inattentive during the MSE, which are signs of GAD.
Major Depressive Disorder (MDD)
MDD presents with a depressed mood, loss of interest in activities, or both. MDD is a differential based on the patient’s report of losing interest in her job. Besides, her alcohol problem could be caused by depression (McHugh & Weiss, 2019). Nonetheless, she does not exhibit other symptoms of MDD, making an unlikely diagnosis.
Reflections:
If I were to conduct the assessment again, I would inquire if the patient uses other drug substances to identify if she has a substance abuse disorder(Kranzler & Soyka, 2018). Ethical considerations for this client include beneficence, nonmaleficence, and confidentiality. Beneficence and nonmaleficence should be maintained by implementing evidence-based treatment interventions to promote the best possible health outcomes (Bipeta, 2019). Besides, the interventions should be evaluated beforehand to ensure they are safe and not harm the client. Confidentiality is crucial, and the mental health provider should uphold it by seeking the client’s consent before sharing her information with others (Bipeta, 2019). Health promotion should center on educating the client on interventions she should take to lower her alcohol intake.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
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
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
Sample Answer 2 for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders
Subjective:
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 https://doi.org/10.1001/jama.2018.11406Disorder: A Review. JAMA, 320(8), 815–824.
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 3 for NRNP 6635 Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders
CC (chief complaint): “I have come for a prescription for oxycodone.”
HPI: Daniela Petrov is a 47-year-old Russian female who presented to her family physician for an oxycodone prescription to alleviate elbow pain. The family physician referred her for psychiatric evaluation due to concerns that the oxycodone can interact with some drugs Daniela is taking. The client states that the elbow pain is only alleviated by oxycodone, which also relieves her headaches. Daniela reports that other pain medications were ineffective, including Ibuprofen, acetaminophen, morphine, codeine, and Dilaudid. Non-pharmacological approaches like massage, Yoga, and meditation are also ineffective. She reports that she dislikes taking multiple medications because they are not good for her body and prefers taking one medication. The client has never been prescribed oxycodone and has been taking her boyfriend’s prescription, which he uses for shoulder and back pain.
Past Psychiatric History:
- General Statement: The patient first presented for psychiatric assessment following concerns about misusing oxycodone.
- Caregivers (if applicable): None
- Hospitalizations: None
- Medication trials: Previously used Klonopin, Ativan, and Xanax for Anxiety.
- Psychotherapy or Previous Psychiatric Diagnosis: None
Substance Current Use and History:
The client takes alcohol on special occasions average twice a week and on special occasions. She uses Marijuana 2-4 times a week since it helps alleviate headaches. Besides, she used cocaine about two months ago to ease anxiety and get closer to her boyfriend. The patient has used Ecstasy and LSD 1-2 times in the past year. She smokes tobacco 2PPD and takes lots of caffeine. She occasionally takes stimulants, like Adderall and Xana bars, to ease anxiety.
Family Psychiatric/Substance Use History: No history of mental health or substance use disorders in the family.
Psychosocial History:
Daniela was born in Russia and moved to Everett, WA, with her parents when she was 16. She has three older sisters and one younger brother. She has a part-time job as a cashier at Save A Lot Grocery Store. She studied up to 10th grade and dropped out after that. The client has one son who currently lives with the ex-husband’s parents. She lost her son’s custody after her boyfriend was detained for selling marijuana to an undercover cop. She averagely sleeps 5–6 hours and has a good appetite. She has a legal history because of over-speeding while under the influence of alcohol and using marijuana.
Medical History:
- Current Medications: Oxycodone and Vitamin supplements.
- Allergies: Allergic to Codeine- causes flushing.
- Reproductive Hx: Regular menses; uses condoms for contraception.
ROS:
- GENERAL: Denies fever or weight changes.
- HEENT: Denies vision change, eye pain, hearing loss, rhinorrhea, or sore throat SKIN: No rashes, discoloration, or lesions.
- CARDIOVASCULAR: No palpitations, chest pain, edema, or breathlessness.
- RESPIRATORY: No breathlessness, wheezing, or productive cough.
- GASTROINTESTINAL: No anorexia, abdominal cramping, diarrhea, constipation, or tarry stools.
- GENITOURINARY: Regular menses. No vaginal or urinary symptoms.
- NEUROLOGICAL: Reports headache and memory loss. No fainting or numbness.
- MUSCULOSKELETAL: Reports elbow pain and fibromyalgia.
- HEMATOLOGIC: No bleeding or bruising.
- LYMPHATICS: No swelling of lymph nodes.
- ENDOCRINOLOGIC: No profuse sweating, polyphagia, polydipsia, polyuria, or heat/cold intolerance.
Physical exam:
Vital Signs: BP- 132/90; HR- 84; RR- 20; Temp-98.8; Ht 5’8; Wt 128lbs
Diagnostic results: No tests were ordered.
Assessment
Mental Status Examination:
A female client in her late 40’s; is alert, well-groomed, and dressed appropriately. The client has clear speech with normal volume, rate, and tone. She has a coherent and logical thought process. She has no hallucinations, delusions, phobias, obsessions, suicidal thoughts, or ideations. She is alert and oriented to person, place, time, and event. She has sound judgment and intact short-term memory.
Differential Diagnoses:
Opioid Use Disorder (OUD): OUD is the compelling, long-term self-administration of opioids for non-medical uses. Patients with OUD take opioids in large amounts or for a longer period than purposed. They constantly desire or unsuccessfully attempt to reduce opioid use, craving for opioids, and develop tolerance to opioids (Hoffman et al.,2019). Besides, they use opioids in physically hazardous conditions and repeatedly fail to meet social and occupational obligations due to opioids (Strang et al., 2020). OUD is a likely diagnosis considering the client’s history of self-prescribing oxycodone for elbow pain and headaches. She has persistently used oxycodone resulting in dependency and cannot benefit from other analgesics.
Cannabis Use Disorder: Cannabis Use Disorder is characterized by persistent use of cannabis in spite of impairment in physical, psychological, or social functioning. Patients often take cannabis in large amounts or over an extended period than intended and have cravings. They also use cannabis in physically hazardous environments and develop tolerance with the need for increased amounts of cannabis to get the intoxicated or desired effect (Hasin & Walsh, 2020). Cannabis Use Disorder is a differential owing to the patient’s increased use of Marijuana 2-4 times a week and misusing it to relieve headaches. Besides, she continues to use cannabis despite being previously arrested for using the substance.
Stimulant Use Disorder: This is a substance use disorder involving drug classes like methamphetamine, cocaine, and prescription stimulants. Patients lose control, evidenced by taking stimulants in large amounts or for extended periods than intended, and have cravings or a powerful desire to use stimulants. They also have risky use of stimulants like continued use, even with associated physical or psychological problems (Ronsley et al., 2020). The use often causes social impairment. The patient has a history of using cocaine, Adderall, LSD, and high amounts of caffeine, making Stimulant Use Disorder a likely diagnosis.
Reflections:
In a different scenario, I would order a drug screen test to identify the drug substances the patient has been using. I will also inquire if the patient develops withdrawal symptoms (Krist et al., 2020). In addition, I would assess the patient for anxiety disorder owing to her history of using substances to ease anxiety. The PMHNP should consider ethical factors of beneficence and nonmaleficence by ensuring treatment interventions are established to promote better outcomes and are safe in patients with substance use disorders. Health promotion should be tailored for this client to educate her adverse effects of substance use and the resources available to help individuals with SUDs(Krist et al., 2020). She should be educated about the risks of using substances for her mental and overall health and well-being.
References
Hasin, D., & Walsh, C. (2020). Cannabis use, cannabis use disorder, and comorbid psychiatric illness: a narrative review. Journal of Clinical Medicine, 10(1), 15. https://doi.org/10.3390/jcm10010015
Hoffman, K. A., Ponce Terashima, J., & McCarty, D. (2019). Opioid use disorder and treatment: challenges and opportunities. BMC health services research, 19(1), 884. https://doi.org/10.1186/s12913-019-4751-4
Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., … & US Preventive Services Task Force. (2020). Screening for unhealthy drug use: US Preventive Services Task Force recommendation statement. Jama, 323(22), 2301-2309. doi:10.1001/jama.2020.8020
Ronsley, C., Nolan, S., Knight, R., Hayashi, K., Klimas, J., Walley, A., Wood, E., & Fairbairn, N. (2020). Treatment of stimulant use disorder: A systematic review of reviews. PloS one, 15(6), e0234809. https://doi.org/10.1371/journal.pone.0234809
Strang, J., Volkow, N. D., Degenhardt, L., Hickman, M., Johnson, K., Koob, G. F., … & Walsh, S. L. (2020). Opioid use disorder. Nature reviews Disease primers, 6(1), 1-28. https://doi.org/10.1038/s41572-019-0137-5
Sample Answer 3 for NRNP 6635 Assignment: 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