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Substance-Related And Addictive Disorders Discussion

Substance-Related And Addictive Disorders Discussion

Subjective:

CC: The patient presents with a complaint of the fear of attending rehabilitation for her drug addiction.

HPI: The client is a 29-year-old White female who is afraid of going to treatment to get free from her drug addiction. She denies having had this anxiety in the past, but admits that she requires assistance. This worry began after she reconnected with her lover, Jeremy, who also smokes crack cocaine and drinks. The fear is constant and lingers in her mind as it should. It is exacerbated by the prospect of going to rehab and comforted by the knowledge that there are clean rehabilitation clinics that are not as filthy as the ones she is familiar with. She notices the worry whenever the topic of rehabilitation is brought up, and she ranks its severity as 6/10. Substance-Related And Addictive Disorders Discussion

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Past Psychiatric History: She has a drug addiction past, specifically consuming crack cocaine and cannabis.

  • General Statement: She is a resident of West Palm Beach, Florida. She is currently on probation and detox, and the facility is exploring long-term rehabilitation for her.
  • Caretakers: She does not require caregivers because she is capable of meeting her own needs.
  • Hospitalizations: She had previously been hospitalized for both a heroin overdose and pneumonia.
  • Medication trials: She has previously been on psychiatric drugs.
  • Psychotherapy or Previous Psychiatric Diagnosis: She has a history of substance abuse disorder, for which she is currently receiving detox and rehabilitation. Substance-Related And Addictive Disorders Discussion

Substance Current Use and History: She has a long history of drug abuse. She admits to consuming crack cocaine on a daily basis. She also smokes marijuana once or twice a week and consumes alcohol once a week. She is currently detoxing and on probation.

Family Psychiatric/Substance Use History: Her mother, who lives in Alabama, has a history of addiction and anxiety. The older brother also suffers from opioid use disorder, and the father has a history of pedophilia. She was sexually molested by her father when she was 5-7 years old. The father was a drug addict as well, and he is presently serving jail time for defilement and drug related crimes.

Psychosocial History: She presently lives with her partner, and they both take crack cocaine. She is concerned that her partner is encouraging her to continue doing drugs. She claims to have a daughter who is staying with friends.

Medical History:

  • Current Medications: Modafinil 200 mg OD
  • Allergies: She is allergic to penicillin.
  • Reproductive Hx: She is heterosexual and in a relationship.

ROS:

  • GENERAL: Negative for weariness, malaise, chills, or fever.
  • HEENT: Negative for diplopia, photophobia, tinnitus, otorrhea, rhinorrhea, sneezing, sore throat, or dysphagia.
  • SKIN: Negative for itching or rashes.
  • CARDIOVASCULAR: Negative for chest pain or edema.
  • RESPIRATORY: Negative for dyspnea, wheezing, or coughing.
  • GASTROINTESTINAL: Negative for nausea, vomiting, diarrhea, or bowel control problems. Regular bowel movements are reported.
  • GENITOURINARY: Negative for frequency, hesitancy, dysuria, or incontinence.
  • NEUROLOGICAL: Negative for loss of bowel and bladder control, numbness, dizziness, paresis, or loss of sensation.
  • MUSCULOSKELETAL: Denies myalgia, joint pains, and arthralgia.
  • HEMATOLOGIC: Negative for a history of blood or clotting disorders.
  • LYMPHATICS: Denies lymphadenopathy and splenectomy.
  • ENDOCRINOLOGIC: Negative for a history of hormonal replacement therapy, excessive diaphoresis, heat or cold intolerance, excessive thirst, or excessive drinking of water. Substance-Related And Addictive Disorders Discussion

Objective:

Vital signs: T 98.7; P 82; BP 150/90; BMI 23.5 kg/m2 (normal weight for height).

Physical exam: She is properly dressed, albeit her hair appears unkempt. She is aware of people, places, times, and events. Her discourse is coherent, albeit hesitating at times, and goal-oriented.

Diagnostic results: ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS positive for cocaine, THC. She is negative for alcohol or other drugs in blood.

Assessment:

MSE

The client is a 29-year-old White female who is aware and aware of her surroundings, including place, person, time, and event. Her attire is suited for the time of day and season. Her communication is hesitant, but it is also coherent, goal-oriented, and unambiguous. She keeps her gaze fixed on you and appears to be yawning. There were no other movements or tics observed. Her self-reported mood is “anxious,” however she has euthymic affect. As a result, there is no correspondence between the mood and the affect. She denies having auditory hallucinations, having delusions, or having paranoid thoughts. She denies having homicidal or suicidal thoughts, and her insight and judgment are sound. Diagnosis is Stimulant Use Disorder – Cocaine (APA, 2013; Sadock et al., 2015)Substance-Related And Addictive Disorders Discussion.

Differential Diagnoses

  1. Stimulant Use Disorder (Cocaine): 304.20 (F14.20)

A habit of cocaine use causing major clinically recognizable suffering is required by the DSM-5 diagnostic criteria for this disorder. This should be exhibited by at least two of a variety of symptoms within a year. These include getting the stimulant in greater quantities over a longer period of time than was originally assumed; actions to minimize use are ineffective; a lot of fruitful time is spent attempting to obtain the cocaine for use; there is extreme yearning for the cocaine; inability to fulfil vocational, household, and educational commitments; continued abuse notwithstanding experiencing issues linked to cocaine use; and ongoing use even in risky situations. Tolerance and withdrawal are also factors (APA, 2013)Substance-Related And Addictive Disorders Discussion.

  1. Primary Mental Disorders

Stimulant use disorder’s clinical signs may resemble those of other major psychiatric conditions such as major depression, bipolar disorder, or even generalized anxiety disorder or GAD (APA, 2013). Any of these symptoms could be mistaken for cocaine use disorder. These diagnoses can only be ruled out by obtaining a thorough history.

  • Phencyclidine Intoxication: F16.929

PCP is another name for phencyclidine. When used, it produces almost identical symptoms to cocaine abuse. It is one of the illicit chemicals known as synthetic or designer drugs. It can only be ruled out if urine or blood tests show that cocaine is present in the body (APA, 2013)Substance-Related And Addictive Disorders Discussion.  

Reflection

In this case, I learned how vital it is to take a thorough history when dealing with a suspected addiction diagnosis. I feel I did my best by following evidence-based standards for history taking and physical examination (Ball et al., 2019), and if given the opportunity again, I would do the same. Advised agreement was sought to ask questions, and the patient was informed that they were free to leave if they so desired, in accordance with ethical and legal issues. This complied with informed consent and autonomy (Haswell, 2019)Substance-Related And Addictive Disorders Discussion. Furthermore, by urging her to accept the offer of long-term rehabilitation, the bioethical norm of beneficence was upheld because this was what was best for her at the time. The client was urged to face her fears and pursue long-term therapy because it would benefit both her and her daughter in the long run. This patient has various risk factors that will be addressed through health education and promotion. Her drug abuse past and socioeconomic condition stand evident. She will need psychoeducation to be convinced that drug and substance usage is not normal.

References

American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.

Ball, J., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2019). Seidel’s guide to physical examination: An interprofessional approach, 9th ed. Elsevier.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer Substance-Related And Addictive Disorders Discussion.

Week 4: Substance-Related and Addictive Disorders Consider the experiences you have had thus far, either in the healthcare workplace or at your practicum site. As you likely know, a nurse’s job does not begin and end with one-to-one patient contact. It includes meetings, documentation, trainings, and collaboration. In particular, the nurse is a member of an interdisciplinary team and must use oral and written communication to inform others of a patient’s status. Substance-Related And Addictive Disorders Discussion

A central skill of advanced practice nursing, then, is the ability to present a patient’s history, symptoms, diagnosis, and treatment plan to relevant parties involved in treatment. This week, in addition to your Meditrek tracking, you will engage in collegial dialogue and clinical conference with your peers regarding patients you have interacted with in your clinical practicum. Learning Objectives Students will: Describe clinical hours and patient encounters Assess and diagnose patients in mental health settings* Develop plans of care for patients in mental health settings* Develop a case study presentation based on a clinical patient* Analyze cases involving advanced practice care of patients in mental health settings Advocate health promotion and patient education strategies across the lifespan Grand Rounds Discussion: Substance-Related And Addictive Disorders Discussion

Complex Case Study Presentation Photo Credit: [RGtimeline]/[iStock / Getty Images Plus]/Getty Images In Weeks 4, 7, and 9 of the course, you will participate in clinical discussions called grand rounds. In one of these three weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a Focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience. You should have received an assignment from your Instructor letting you know which week of the course you are assigned to present. To prepare: Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video. Select a child/adolescent or adult patient from your clinical experience that presents with a significant concern. Create a focused SOAP note for this patient using the template in the Resources. All SOAP notes must be signed, and each page must be initialed by your Preceptor. When you submit your SOAP note, you should include the complete SOAP note as a Word document and PDF/images of each page that is initialed and signed by your Preceptor. You must submit your SOAP Note using SafeAssign. Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Late Policies. Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice what you will say beforehand, and ensure that you have the appropriate lighting and equipment to record the presentation. Your presentation should include objectives for your audience, at least 3 possible discussion questions/prompts for your classmates to respond to, and at least 5 scholarly resources to support your diagnostic reasoning and treatment plan. Video assignment for this week’s presenters: Substance-Related And Addictive Disorders Discussion

Record yourself presenting the complex case study for your clinical patient. In your presentation: Dress professionally and present yourself in a professional manner. Display your photo ID at the start of the video when you introduce yourself. Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information). State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing. Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management. Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value. Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video. Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide. 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 their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and is supported by the patient’s symptoms. Plan: What was your plan for psychotherapy (include one health promotion activity and patient education)? Substance-Related And Addictive Disorders Discussion

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What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Reflection notes: What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow-up, discuss what your next intervention would be Substance-Related And Addictive Disorders Discussion