ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

NRNP 6635 Week8 Assignment: ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background.

TO PREPARE:

• Review this week’s Learning Resources and consider the insights they provide.
• Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
• By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.
• Identify at least three possible differential diagnoses for the patient.

BY DAY 7 OF WEEK 8

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

• Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
• Objective: What observations did you make during the psychiatric assessment?
• Assessment:Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Reflection notes:What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

 

Training Title 151

 

Name: Daniela Petrov
Gender: female
Age:47 years old
T- 98.8 P- 84 R 20 B/P 132/90 Ht 5’8 Wt 128lbs
Background: Moved to Everett, Washington from Russia with her parents when she was 16 years
Currently lives in Boise, Idaho. She has younger 1 brother, 3 older sisters. Denied family
mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx;
Menses regular. uses condoms for birth control Has fibromyalgia. She works part time cashier at
Save A Lot Grocery Store. Dropped out of high school in 10th grade. Sleeps 5-6 hours on
average, appetite good.
Symptom Media. (Producer). (2018). Training title 151 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-151

 

 

00:03:55UNKNOWN Oh, wow.

00:03:55UNKNOWN Yeah, swear to God.

00:04:00UNKNOWN You have tried a lot of solutions. Let me ask you more about your medication history.

00:04:05UNKNOWN I mean, I only take stuff for my headache and my elbow.

00:04:10UNKNOWN Okay.

00:04:10UNKNOWN Yeah. I don’t… Like I said, you know, I don’t like putting unhealthy things in my body. Vitamins, I take vitamins.

00:04:20UNKNOWN Yeah? Okay.

00:04:20UNKNOWN Like fish oils, some supplements, but nothing corporate, nothing pharmaceutical. You know, I don’t… I don’t want to put that in me. You know, I mean, even coming here today, you know, asking for this, it goes against my values.

00:04:35UNKNOWN I see. Okay.

00:04:35UNKNOWN But I got to function.

00:04:40UNKNOWN Do you drink alcohol?

00:04:40UNKNOWN On, I don’t know, like special occasions, you know, like weddings, funerals, birthdays. I got a ton of friends, so, you know, whenever we have a birthday we’re going to drink. Let me think, like holidays, New Years, and Christmases. There’s Christmas and then we also celebrate Russian Orthodox Christmas on January 7th.

00:05:10UNKNOWN So how often on the average?

00:05:15UNKNOWN Oh, I don’t know. When you add it all up, once, maybe twice a week, I guess.

00:05:20UNKNOWN And will you drink enough to get intoxicated?

00:05:20UNKNOWN Depends on who I’m drinking with. As Zane, that’s my boyfriend, he drinks a lot, so I drink a little more when I’m with him.

00:05:35UNKNOWN Any legal problems from the drinking?

00:05:35UNKNOWN Once. So dumb. Yeah, just one little charge for drinking. I was like the tiniest little bit over the limit. So, yeah, I got that and I had to take that course, that like stupid, boring course. But I learned my lesson. You know, if you’re a little bit over the limit, stick to the back roads.

00:06:00UNKNOWN So you will still drive?

00:06:00UNKNOWN Well, yeah, but I’m super careful.

00:06:00UNKNOWN You think after you’ve been drinking, that’s an okay idea to drive?

00:06:05UNKNOWN It’s better than letting Zano drive.

00:06:10UNKNOWN Zano?

00:06:10UNKNOWN Zane, Zano, same person. Yeah. I mean, he doesn’t even have his license anymore. Not that it stops him.

00:06:20UNKNOWN Oh. What about marijuana?

00:06:20UNKNOWN Do I use it?

00:06:25UNKNOWN Yeah.

00:06:25UNKNOWN Marijuana medically helps with my headaches, so, yeah, I use it. Yeah. It’s my right. Yeah, it’s your right. It’s everybody’s right.

00:06:40UNKNOWN And how often?

00:06:40UNKNOWN Not often. Two, four times a week, sometimes none. It’s expensive. So, you know, and then, you know, when you do get some, suddenly everybody is your best friend and you got to share, you know how it is.

00:07:00UNKNOWN Do you ever grow marijuana?

00:07:00UNKNOWN I used to. But then we moved and it’s not legal in this backward state. And where we live it’s pretty public, it’s not really private.

00:07:10UNKNOWN Do you ever have any side effects from using marijuana like memory problems?

00:07:15UNKNOWN I was born with memory problems, Doc, I don’t think it’s from the marijuana.

00:07:20UNKNOWN Any legal trouble with the marijuana?

00:07:25UNKNOWN Once. I mean, I’m super careful. But Zano, he went away for a year for selling like the tiniest little bit to an undercover cop, which is total entrapment, which is how I lost custody of Camper.

00:07:40UNKNOWN Camper?

00:07:45UNKNOWN My son.

00:07:45UNKNOWN Oh.

00:07:45UNKNOWN Yeah. He’s staying with my ex-husband’s parents right now. They take good care of him.

00:07:50UNKNOWN How long have you been divorced?

00:07:55UNKNOWN Oh, no, I never married that guy.

00:07:55UNKNOWN Oh.

00:07:55UNKNOWN No way I would marry that jerk. No, no, I don’t know. It’s been like four years since I’ve even seen him. Something like that, four years.

00:08:05UNKNOWN What happened?

00:08:10UNKNOWN Lucas, my ex, he freaked out because he caught me doing just a few lines of coke, but like everybody was doing it back then. So I… Anyway, his mom found the mirror, and the razors, and Lucas said I had to quit. But… For whatever I lied, and when he caught me, I know it was bad to lie about that, but I don’t know it’s in the past. You know, like, water under the bridge. You live, you learn, you move on.

00:08:50UNKNOWN Right. Do you use cocaine now?

00:08:50UNKNOWN No, hardly ever. I don’t know, it’s been like a month maybe, or two months or something since I have.

00:09:00UNKNOWN Any legal problems from using cocaine or…?

00:09:05UNKNOWN No. No, I mean, we hardly ever do it. So, yeah.

00:09:10UNKNOWN Have you thought about stopping altogether?

00:09:15UNKNOWN I mean, I hardly ever do it. Like, hardly even counts. I don’t know, when I do it, it’s just to relieve tension or, you know, it’s this thing Zano and I do to bring each other closer together, you know, but, like I could quit anytime I wanted, easy.

00:09:35UNKNOWN Does your boyfriend have children?

00:09:35UNKNOWN Yeah, yeah, he’s got two kids. Yeah. Yeah, but we don’t see them much. You know, his other with his ex.

00:09:45UNKNOWN Oh?

00:09:50UNKNOWN She’s like a real snobby type. You know the type? And it is a freaking tragedy because I see his two kids just going down that same path. You know, they’re just two little snobs. It’s a real shame. She… We’re not allowed to see them anymore though, so I guess, you know, like what’s the difference? She went to court and said we were unsuitable. Not suitable. You know, says it all real nice in court, and then not so nice over the phone, if you know what I mean? She’s a real bitch.

00:10:25UNKNOWN Any other drugs? Ecstasy? LSD?

00:10:30UNKNOWN All right. This is going to make me sound like I’m some 1970s hippy, druggo person. But I’ve tried ecstasy twice, just twice, and LSD once, last year. That was a bad trip. I am not doing that again.

00:10:55UNKNOWN Anything else?

00:10:55UNKNOWN Like what?

00:10:55UNKNOWN Stimulants?

00:11:00UNKNOWN Like power drinks if I need to stay up?

00:11:05UNKNOWN Sure.

00:11:05UNKNOWN Caffeine, I drink a lot of coffee. I don’t know if cigarettes, do they count as stimulants?

00:11:10UNKNOWN Yeah.

00:11:15UNKNOWN Yeah, I’m trying to cut back. Two packs a day.

00:11:15UNKNOWN Ritalin, Dexedrine?

00:11:20UNKNOWN Oh, like stimulants?

00:11:20UNKNOWN Right.

00:11:25UNKNOWN Oh, yeah. Not a lot. Like hardly ever. I mean, like if Zano and I are down for whatever reason, or sluggish like, from smoking pot, or just like if I need to get back up again. Yeah, like Adderall, just 20 helps.

00:11:40UNKNOWN Do you ever take prescription medications that are not prescribed for you?

00:11:45UNKNOWN Well, are you kidding me? Why would I do that? I told you I don’t like medications in the first place.

00:11:55UNKNOWN Klonopin, Ativan, Xanax?

00:11:55UNKNOWN Oh, those?

00:11:55UNKNOWN Yeah.

00:12:00UNKNOWN Yeah, I mean if, if my anxiety is acting up, if my meditation isn’t working? Yeah, a couple of Xana bars, you know, but not a lot.

00:12:15UNKNOWN How often would you estimate that is?

00:12:15UNKNOWN I don’t know. Two? I don’t know. I need like a freaking calendar to keep up with all your questions, Doc, God.

00:12:30UNKNOWN So in the past, who prescribed the oxycodone for you?

00:12:35UNKNOWN No one yet. Zano, he takes them because he’s got shoulder and back problems, and I tried one and, oh, man, it really works. To be honest it works fantastic.

00:12:50[sil.]

00:12:55END TRANSCRIPT

 

Rubric

NRNP_6635_Week8_Assignment_Rubric

NRNP_6635_Week8_Assignment_Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeCreate documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. In the Subjective section, provide: • Chief complaint• History of present illness (HPI)• Past psychiatric history• Medication trials and current medications• Psychotherapy or previous psychiatric diagnosis• Pertinent substance use, family psychiatric/substance use, social, and medical history• Allergies• ROS	20 to >17.0 pts Excellent The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. 17 to >15.0 pts Good The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. 15 to >13.0 pts Fair The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies. 13 to >0 pts Poor The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.	20 pts
This criterion is linked to a Learning OutcomeIn the Objective section, provide:• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.	20 to >17.0 pts Excellent The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented. 17 to >15.0 pts Good The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented. 15 to >13.0 pts Fair Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies. 13 to >0 pts Poor The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.	20 pts
This criterion is linked to a Learning OutcomeIn the Assessment section, provide:• Results of the mental status examination, presented in paragraph form.• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.	25 to >22.0 pts Excellent The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected. 22 to >19.0 pts Good The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected. 19 to >17.0 pts Fair The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy. 17 to >0 pts Poor The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.	25 pts
This criterion is linked to a Learning OutcomeReflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).	10 to >8.0 pts Excellent Reflections are thorough, thoughtful, and demonstrate critical thinking. 8 to >7.0 pts Good Reflections demonstrate critical thinking. 7 to >6.0 pts Fair Reflections are somewhat general or do not demonstrate critical thinking. 6 to >0 pts Poor Reflections are incomplete, inaccurate, or missing.	10 pts
This criterion is linked to a Learning OutcomeProvide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).	15 to >13.0 pts Excellent The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making. 13 to >11.0 pts Good The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study. 11 to >10.0 pts Fair Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification. 10 to >0 pts Poor Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.	15 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph development and organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 to >4.0 pts Excellent A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity. 4 to >3.5 pts Good Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. 3.5 to >3.0 pts Fair Purpose, introduction, and conclusion of the assignment is vague or off topic. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time. 3 to >0 pts Poor No purpose statement, introduction, or conclusion were provided. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation	5 to >4.0 pts Excellent Uses correct grammar, spelling, and punctuation with no errors 4 to >3.0 pts Good Contains a few (one or two) grammar, spelling, and punctuation errors 3 to >2.0 pts Fair Contains several (three or four) grammar, spelling, and punctuation errors 2 to >0 pts Poor Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding	5 pts
Total Points: 100