Assessing and Diagnosing Substance-Related Disorders: A Case Study, Study Guides, Projects, Research of Nursing

Download Assessing and Diagnosing Substance-Related Disorders: A Case Study and more Study Guides, Projects, Research Nursing in PDF only on Docsity!

Week 4 Assignment Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders College of Nursing-PMHNP, Walden University PRAC 6675: PMHNP Care Across the Lifespan II Dr. Nataliya Ishkova December 20, 2023 Objectives for the presentation.

Evaluation Template

 The audience will be able to identify and explain some interventions for alcohol intoxification, stimulant use disorder.  Integrate the DSM IV diagnostic codes in diagnosing patients with substance abuse and addictive disorders.  Explaine the neurobehavioral effects of cocaine. Patient info: Initials: S.S Age: 26 Sex: Female Race: A.A Subjective: CC (chief complaint): “ I feel scared and horrible.” HPI : S, S is a 26 y/o AA female who presents in the office today with complaints of feeling scared and horrible. Her symptoms started 2 weeks ago. She reports smoking cracked cocaine in a party 4 months ago. She has used crack cocaine repeatedly since then. She has been getting depressed moods and fatigue especially when she has not smoked. She has these intense cravings to use or obtain crack over and over again. She feels that she can’t get enough of it. She has been eating a lot lately and her appetite has increased. The patient is currently nauseous after drinking too much alcohol last night. She also reports occasional headaches that are not relieved by Tylenol. However, her symptoms get relieved with crack. Her headache is sometimes relieved by

Evaluation Template

caffeine. She is currently unable to attend her classes since her symptoms are progressively worsening despite using crack to relieve them. Substance Current Use: Positive for crack cocaine. She reports that It makes her feel good and also relieves her symptoms. She also reports smoking marijuana 2-4 times a week. She drinks alcohol especially during weekends. Her boyfriend makes her drink too much. However, she doesn’t like consuming too much alcohol since it makes her vomit and trouble staying conscious. She reports recent intoxification, happened last night. She also likes drinking coffee 3-4 cups in a day. She also smokes a pack of cigarette per day since the age of 17, started back in high school. Medical History:  Current Medications : She tried Tylenol to relieve headaches. No prescription drugs or any supplements.  Allergies : positive for sting allergies.  Reproductive Hx : She is sexually active with her boyfriend. She is currently on her DMPA shot. Her periods are irregular due to the contraceptives. Denies any history of STIs. ROS :  GENERAL: Reports increased appetite and extreme fatigue. No fever, chills, weight gain or difficulty sleeping reported. She reports sleeping 5-6 hours in a night which is okay for her.

Evaluation Template

 HEENT: Reports occasional headaches sometimes relieved by caffeine. Denies blurry vision, itchy eyes, hearing problems, sinus pressure, rhinorrhea, or sore throat.  SKIN: No dry skin, itchy skin or rash.  CARDIOVASCULAR: Positive for irregular heartbeats. No chest pain, swelling or blue skin reported  RESPIRATORY: No breathing problems, cough, sneezing or wheezing reported  GASTROINTESTINAL: Reports nausea and vomiting when she consumes too much alcohol. No complaints of GERD, constipation or diarrhea reported.  GENITOURINARY: No dysuria, nocturia, urinary urgency or burning when urinating  NEUROLOGICAL: reports dizziness, trouble staying conscious when she takes too much alcohol. No history of syncope reported.  MUSCULOSKELETAL: No muscle problems, morning stiffness, joint pain or swelling reported.  HEMATOLOGIC: No bleeding problems, anemia or bleeding gums reported.  LYMPHATICS: Negative for enlarged glands  ENDOCRINOLOGIC: No problems with thirst, sweating, heat or cold intolerance Objective:

Evaluation Template

Vitals signs: Blood pressure: 119/74 normotensive, Heart rate: 84, Respiratory rate: 16 bpm, regular and unlabored. General: pt. appears to be healthy with no signs of acute distress. She is well groomed, interactive, maintains good eye contact and provide answers to questions asked. No signs of acute distress noted. HEENT: pt. has normocephalic and atraumatic head. Scalp hair is well distributed, symmetric facial features, no skull deformities noted. Her conjunctiva is pink, no sclera icterus, normal reactive pupils, no ptosis or nystagmus were noted. Pearly gray TM, no erythema, no discharge noted. Hearing is intact bilaterally. Pink nasal mucosa, no polyps, no discharge noted. Oropharynx is okay, pink in color and cobble stoning, intact gag reflex. Cardiovascular: Normotensive blood pressure, capillary refill <3 secs. The patient has no thrills, no bruits were noted. PMI is intact, in mid-clavicular bone. S1 and S2 sounds audible, no extra gallops or murmurs. Respiratory: Regular and unlabored respiration. Symmetric chest walls, bilateral chest expansion noted. Negative bronchophony. Lungs clear on auscultation. Abdomen: Flat and symmetric abdomen, no visible abnormal findings. It is soft and non-tender on palpation. No abnormal masses were noted. Neurological: The patient is alert, 4 x oriented. She has a steady gait and posture. Intact cranial nerves. Patient is able to maintain balance. No signs of pain noted. Grossly intact sensation in all the extremities.

Evaluation Template

Diagnostic results :  Toxicological screening. Positive for multiple drugs.  Complete blood count.  Urinalysis.  Alcohol blood test  HIV test. - Negative  Complete STD panel. -Negative GC/CT Assessment: Mental Status Examination: The patient is a 26 y/o female college student. She looks appropriate for the age. She is well nourished, well developed and dressed appropriately for the exam. She is cooperative, alert and well oriented to person, place, time and event. Her eye contact is good. Her speech is spontaneous and goal directed. She endorses feeling nervous and scared throughout the interview. She is aware she is becoming an addict making her to be more scared. Her judgement and thought process are intact. Denies any suicidal or homicidal ideation. She also denies visual, auditory hallucinations or any delusions. Diagnostic Impression: Cocaine Use Disorder (F14.10): This is a disorder that is well known due to its medical, psychological and behavioral consequences either due to long-term or short-term cocaine use. According to Kampman, (2019), the criteria for CUD is categorized in physiologic category

Evaluation Template

including craving, tolerance and withdrawal, loss of control, and cocaine preceding over responsibilities at home, work or school. The disorder progresses faster as compared to other substance use. Crack cocaine use is considered more addictive form or IV use as compared to intranasal route. In addition, the using it more frequently and in higher amounts increases the risks of CUD. It is estimated that about 45% of cocaine users may experience mood problems (Schwartz, et al, 2022). Cocaine basically works through activation of sympathetic nervous system. It increases the dopamine release in the brain mesolimbic reward systems. This is the underlying mechanism associated with addictive effects. Cocaine Withdrawal: Crack cocaine is an addictive substance. The cessation of cocaine uses and also reduced euphoria at a given dose often drives escalation. Withdrawal of cocaine use therefore drives it further use. The symptoms of cocaine withdrawal include fatigue, anxiety, increased appetite, intense cravings for cocaine use and sleep disturbance (Shwartz, et al, 2022). S,S reports similar symptoms and therefore this diagnosis should be considered. Alcohol Withdrawal (F10.230): This is a disorder that occurs after a heavy or prolonged alcohol consumption. It often develops several hours to a few days after cessation of alcohol, (Jesse, et al 2017). S,S reports alcohol use last night. She is currently feeling nauseas and was unable to attend her classes. Substance use Disorder (F19.10): This diagnosis should be considered since S,S reports use of cocaine, alcohol, coffee, marijuana and tobacco smoking. Reflections: Substance induced disorders are common reported. These disorders include substance intoxication, withdrawal and medication-induced disorders. This encounter is so beneficial to

Evaluation Template

me. It provided valuable insights on substance abuse disorders and the factors associated with addiction. It also helped me understand the neurobehavioral consequences of cocaine and other stimulants which may have similar effects. It is evident that patients tend to use more than one substance. It is therefore important to ask open ended questions and include the psychosocial history of the clients to identify the risk factors. I agree with my preceptor’s diagnosis and approach. This is because the patient meets DSM IV criteria, as evident in the information provided by the patient. If I meet patient with similar disorders, I would empathize with her, support her in some instances and utilize approaches like motivational interviewing. Sometimes patients may hide crucial information about their personal life. However, this depends with the interviewing strategies utilized. For instance, motivational interviewing an effective approach, well recommended in resolving issues with addiction. It allows empathy and also eliciting client’s reasons for and commitment to changing substance use and other behaviors (Tse, et al, 2022). Case Formulation and Treatment Plan:  Cognitive behavioral therapy: Group CBT. Two sessions per week. Educate clients on how to recognize situations that may provoke cravings, coping skills and positive thought substitution (Kampman, 2019)  Employ contingency management to promote abstinence among the selected group participants.  Educate the patient on side effects of the substances.

Evaluation Template

 Initiate dextroamphetamine 30 mg daily. Questions:

1. What strategies would you employ when interviewing patients with substance abuse disorders? 2) What interventions would you recommend for this patient? Give reasons.
2. Why do cocaine users develop addiction so fast? PRECEPTOR VERIFICATION: Preceptor signature: ________________________________________________________ Date: ________________________

Evaluation Template

References Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben-Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M., & Ludolph, A. (2016). Alcohol withdrawal syndrome: Mechanisms, manifestations, and management. Acta Neurologica Scandinavica , 135 (1), 4-16. https://doi.org/10.1111/ane. Kampman, K. M. (2019). The treatment of cocaine use disorder. Science Advances , 5 (10). https://doi.org/10.1126/sciadv.aax Schwartz, E. K., Wolkowicz, N. R., De Aquino, J. P., MacLean, R. R., & Sofuoglu, M. (2022). Cocaine use disorder (CUD): Current clinical perspectives. Substance Abuse and Rehabilitation , 13 , 25-46. https://doi.org/10.2147/sar.s Tse, N., Tse, S., & Wong, P. W. (2022). Collective motivational interviewing for individuals with drug use problems: A pre-post–follow-Up, uncontrolled pilot study. International

Evaluation Template

Journal of Environmental Research and Public Health , 19 (23),

16344. https://doi.org/10.3390/ijerph