NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example
NRNP 6635 Week 8: Substance-Related and Addictive Disorders Assignment
NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Assignment Brief
Assignment Instructions Overview
This assignment involves assessing and diagnosing a patient with substance-related or addictive disorders using a video case study. Advanced practice nurses are tasked with evaluating a patient’s symptoms and background while remaining attentive to cultural, socioeconomic, and personal factors that may influence diagnosis and treatment. Each student’s goal is to apply clinical knowledge, critical thinking, and culturally sensitive approaches to determine an accurate diagnosis.
Understanding Assignment Objectives
The objective is to practice the clinical skills needed to accurately assess and diagnose substance-related disorders while incorporating patient history, mental status examination, and differential diagnoses. An essential focus is on integrating the patient’s cultural and social context into clinical judgments, which enhances the depth of assessment and ensures a patient-centered approach to diagnosis and treatment.
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The Student’s Role
In this assignment, students act as psychiatric-mental health nurse practitioners (PMHNPs) conducting a comprehensive psychiatric evaluation. Students should gather patient history, assess mental status, and consider cultural perspectives that shape each patient’s experiences and behaviors. Through this role, students apply their understanding of DSM-5 criteria, craft differential diagnoses, and hone their skills in adapting clinical approaches to individual patient backgrounds.
Competencies Measured
This assignment evaluates several core competencies, including:
- Clinical assessment and diagnostic skills: Through structured psychiatric evaluations, students will demonstrate their ability to accurately identify and differentiate among possible substance-related and addictive disorders.
- Cultural competency and sensitivity: Students will demonstrate their ability to integrate cultural understanding and insights into diagnostic processes, considering how cultural values and personal experiences influence symptom presentation.
- Ethical and professional responsibility: Students are expected to consider legal and ethical aspects, such as confidentiality, informed consent, and culturally appropriate care practices.
- Critical thinking and diagnostic reasoning: By formulating and prioritizing differential diagnoses based on DSM-5 criteria, students will exhibit their critical thinking process, which guides clinical decision-making.
You can also read other assignment examples for the NRNP 6635 – Psychopathology and Diagnostic Reasoning Course below:
NRNP 6635 Week 1: Competencies of Advanced Nursing Practice Paper Example
NRNP 6635 Week 1 Assignment 2: Clinical Skills Self-Assessment Paper Example
NRNP 6635 Week 2: Practicum Experience Plan (PEP) Paper Example
NRNP 6635 week 3 Assignment: Assessing and Diagnosing Patients With Mood Disorders Paper Example
NRNP 6635 Week 5: Comprehensive Psychiatric Evaluation and Patient Case Presentation Example
NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example
Subjective
Chief Complaint and Symptomology
The patient, a 35-year-old male, presents with concerns about increased alcohol consumption and difficulty controlling his drinking. He reports consuming six to eight drinks daily for the past year, leading to multiple consequences, including conflicts at work and in his personal relationships. The patient acknowledges that he has tried to reduce his drinking but has repeatedly failed. Symptoms include cravings, increased tolerance, and occasional withdrawal symptoms, such as shakiness and irritability when abstaining.
History of Present Illness (HPI)
The patient describes his drinking patterns as progressively worsening over the past few years, especially following a stressful family event. He first began drinking socially in his late teens, but his usage increased over time. He reports a history of alcohol use in his family, specifically in his father, who struggled with alcoholism. The patient denies illicit drug use but occasionally uses nicotine. He has not previously sought treatment or counseling for substance use.
Past Psychiatric History
The patient denies any previous psychiatric diagnoses or treatments. He reports experiencing stress and mild depressive symptoms but has not received formal mental health care. He occasionally experiences sleep disturbances and low mood.
Family History
The patient reports a family history of alcohol use disorder in his father and maternal uncle. No family history of other mental illnesses is noted.
Social and Occupational History
The patient is employed full-time and lives with his partner. He describes his work environment as high-stress, contributing to his increased alcohol use as a coping mechanism. He maintains some social support through friends and family but mentions that alcohol often features prominently in his social gatherings.
Cultural Background
The patient identifies as part of a cultural group in which alcohol use is socially normalized, and abstinence is sometimes stigmatized. This may have contributed to his reluctance to seek treatment or reduce his consumption independently.
Interview Questions
- How does alcohol fit into your social and family life?
- Have you experienced any physical or mental symptoms when you have tried to reduce or stop drinking?
- Do you feel that alcohol has impacted your work or relationships?
- What challenges do you foresee if you were to pursue treatment or reduction in drinking?
Objective
Observations During Psychiatric Assessment
The patient appears well-groomed and maintains good eye contact. He is alert and oriented to person, place, and time. His speech is coherent and at a normal rate, though he appears tense when discussing his alcohol use. He demonstrates mild hand tremors and is somewhat fidgety, which may be related to mild withdrawal symptoms.
Mental Status Examination (MSE)
- Appearance: Well-groomed, casually dressed.
- Behavior: Cooperative but slightly anxious when discussing his drinking habits.
- Speech: Normal rate and tone.
- Mood/Affect: Reports feeling anxious and guilty about his drinking; affect is congruent with mood.
- Thought Process: Logical and coherent.
- Thought Content: No delusions, hallucinations, or suicidal ideation noted.
- Cognitive Functioning: Intact, alert, and oriented.
- Insight and Judgment: Limited insight into the need for professional help; judgment impaired related to alcohol use.
Assessment
Differential Diagnoses
- Alcohol Use Disorder (AUD) (Primary Diagnosis): According to DSM-5, AUD is characterized by problematic alcohol use leading to significant impairment or distress. The patient meets several criteria for AUD, including increased tolerance, unsuccessful attempts to cut down, cravings, and persistent use despite interpersonal problems (American Psychiatric Association, 2013). These criteria strongly support AUD as the primary diagnosis.
- Adjustment Disorder with Depressed Mood: Adjustment disorder could be considered due to the patient’s reported stress and mild depressive symptoms following a significant life event. However, these symptoms appear to be secondary to the patient’s alcohol use, as they exacerbate with drinking patterns rather than standalone depressive symptoms. DSM-5 criteria for adjustment disorder do not fully align with the patient’s experience, ruling this out as the primary condition (First, 2013).
- Generalized Anxiety Disorder (GAD): The patient exhibits some anxiety symptoms, possibly related to withdrawal or as a consequence of stress from his substance use. GAD could be considered if symptoms were persistent and independent of alcohol use. However, anxiety symptoms seem situational and secondary to AUD, which is not consistent with a primary GAD diagnosis (First, 2013).
Primary Diagnosis Justification
The patient’s symptoms, including increased tolerance, cravings, and functional impairment, align with the DSM-5 criteria for Alcohol Use Disorder. The critical-thinking process prioritized AUD over other differentials, as it fully explains his symptoms, while other conditions are secondary and do not independently fulfill DSM-5 criteria (American Psychiatric Association, 2013).
Reflection Notes
Session Reflection
If this session were conducted again, additional culturally sensitive questions could improve the rapport, exploring how the patient’s cultural background influences his perspectives on drinking and treatment. Additionally, using motivational interviewing could encourage the patient to consider change without feeling judged.
Legal and Ethical Considerations
Confidentiality is paramount, but as a PMHNP, there is also a duty to address potential risks, such as workplace safety if drinking is impairing his job performance. The stigma within his cultural background around abstinence and treatment could present a barrier, which the PMHNP should approach empathetically and non-judgmentally.
Health Promotion and Disease Prevention
Emphasizing harm-reduction techniques, such as reducing alcohol consumption gradually or substituting with non-alcoholic beverages, could help manage cravings and withdrawal symptoms. Encouraging lifestyle changes, such as regular exercise and stress management techniques, could reduce the patient’s reliance on alcohol for stress relief. Socioeconomic and cultural factors should also be addressed to ensure access to support networks and resources that align with his values and norms.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
First, M. B. (2013). DSM-5 and paraphilic disorders. Journal of the American Academy of Psychiatry and the Law Online, 41(2), 191-202.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford press.
Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38-48.
Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice. John Wiley & Sons.
Detailed Assessment Instructions for the NRNP 6635 Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders Example
Assignment: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders
An important consideration when working with patients is their cultural background. Understanding an individual’s culture and personal experiences provides insight into who the person is and where he or she may progress in the future. Culture helps to establish a sense of identity, as well as to set values, behaviors, and purpose for individuals within a society. Culture may also contribute to a divide between specific interpretations of cultural behavior and societal norms. What one culture may deem as appropriate another culture may find inappropriate. As a result, it is important for advanced practice nurses to remain aware of cultural considerations and interpretations of behavior for diagnosis, especially with reference to substance-related disorders. At the same time, PMHNPs must balance their professional and legal responsibilities for assessment and diagnosis with such cultural considerations and interpretations.
For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background.
To Prepare:
- Review this week’s Learning Resources and consider the insights they provide.
- Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
- By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
- Consider what history would be necessary to collect from this patient.
- Consider what interview questions you would need to ask this patient.
- Identify at least three possible differential diagnoses for the patient.
By Day 7 of Week 8
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
- Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
- Objective: What observations did you make during the psychiatric assessment?
- Assessment:Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
- Reflection notes:What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
- Minimums 5 references
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