NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders

NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders – Step-by-Step Guide

The first step before starting to write the NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

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It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders Instructions

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-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.).

Scenario

Name: Lisa Tremblay
Gender: female
Age: 33 years old
T- 100.0 P- 108 R 20 180/110 Ht 5’6 Wt 146lbs
Background: Lisa is in a Naples, FL detox facility thinking about long term rehab. She is
considering treatment for her Hep C+ but needs to get clean first. She has been abusing opiates,
approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”),
and 1/2 gallon of vodka daily. She has past drug paraphernalia possession arrest.

Her admission labs. abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS positive for opiates, THC. Positive for alcohol or other drugs. BAL .308; other labs within
normal ranges.

She reports sexual abuse as child ages 6-9 perpetrator being her father who went
to prison for the abuse and drug charges. She is estranged from him. Mother lives in Maine, hx
of agoraphobia and benzodiazepine abuse. Older brother has not contact with family in last 10
years, hx of opioid use. Sleeps 5-6 hrs., appetite decreased, prefers to get high instead of eating.
Allergies: azithromycin

NRNP 6635 Week 8 Assignment: Assessing And Diagnosing Patients With Substance-Related And Addictive Disorders Example

Patient Information:

Name: Lisa Tremblay

Gender: Female

Age: 33 years old

Subjective:

CC (chief complaint): “I’m scared. Well, I don’t want to be. I don’t want to be what people say I am because if I say it I’m not going to say it because I am not going to change. I can’t.”

HPI: L.T. is a 33-year-old female of Caucasian ethnicity who has been referred for evaluation and treatment from a detox facility in Naples, FL, where she has been considering long-term rehabilitation. She is seeking a psychiatric evaluation for her anxiety and substance use issues. Currently, L.T. is not taking any psychotropic medications. L.T. expresses fear and resistance towards going to rehab, indicating her emotional distress.

The anxiety symptoms experienced by L.T. have been present since she discovered her boyfriend’s infidelity and substance use, which has led to her fear of being labeled as an addict. L.T. engages in daily substance use, including opiates, cannabis, and alcohol, which significantly impacts her daily functioning.

L.T.’s emotional distress is severe, resulting in impaired judgment, decreased appetite, disrupted sleep, and a preference for substance use over essential activities. L.T. experiences disturbances in sleep duration, sleeping for 5-6 hours. L.T. reports a decreased appetite and a preference for substance use over her eating, indicating the impact of her substance use on her nutritional intake.

Past Psychiatric History:

• General Statement: her first mental health problems started at age 26
• Caregivers (if applicable): none
• Hospitalizations: Lisa’s hospitalization occurred at the age of 26 and was specifically related to detoxification from alcohol abuse. No history of suicidal or homicidal behaviors was reported. No history of self-harm behaviors
• Medication trials: no previous psychotropic medication treatment
• Psychotherapy or Previous Psychiatric Diagnosis: no history of previous psychotherapy. She was diagnosed with alcohol use disorder at age 26.

Substance Current Use and History: Lisa regularly uses opiates daily, incurring an estimated cost of $100. She also discloses her cannabis usage occurring at a frequency of 1-2 times per week. Lisa reveals her consumption of half a gallon of vodka each day over 7 years.

Family Psychiatric/Substance Use History: Lisa Tremblay’s father tragically passed away as a result of suicide (X). Additionally, he was responsible for perpetrating childhood sexual abuse, which ultimately led to his imprisonment. Lisa’s mother suffers from agoraphobia and has a troubling past of benzodiazepine abuse. Within the family dynamic, Lisa has an older brother who is currently estranged from the rest of the family. Another older brother has struggled with opioid use and has had no communication with the family for the past decade.

Psychosocial History: Lisa is the last born in a family of three.She has two older brothers, one estranged and the other struggling with opioid use. Lisa’s dropped out of school in grade 11. Lisa has an interest in entrepreneurship and digital media. She runs a business related to commercials and website development. She is currently self-employed. Her work history revolves around her business with her boyfriend, Jeremy. Lisa has a past arrest for drug possession. Lisa has experienced childhood sexual abuse by her father, but no further details are provided about additional traumatic experiences.

Medical History: She currently has hepatitis C, for which she is yet to seek care.

• Current Medications: none
• Allergies:azithromycin
• Reproductive Hx:She is para 0+0, whose LNMP was last month on the 28^th. No late menarche, painful menstruation, painful coitus, or use of contraceptives reported.

ROS:

• GENERAL: No weakness, night sweats, fever, or weight loss
• HEENT: No headache, hearing problems, or blurry vision
• SKIN: no skin ulcers, chronic wounds, or itchiness
• CARDIOVASCULAR: No left-sided chest pain, no fatigue, or leg swelling
• RESPIRATORY: No shortness of breath, no cough, or chest tightness
• GASTROINTESTINAL: No abdominal pain, diarrhea, no bloating, or constipation. Reports reduced appetite, no vomiting or nausea
• GENITOURINARY: No genital itchiness, discharge, or swelling. No reported change in urine color or output.
• NEUROLOGICAL: No unilateral weakness, no numbness, no tingling, no paralysis
• MUSCULOSKELETAL: No swelling, stiffness, or the joints or muscles
• HEMATOLOGIC: No bleeding or fainting episodes
• LYMPHATICS: No swelling of the extremities
• ENDOCRINOLOGIC: No neck swelling or discomfort in hot or cold weather

Objective:

Physical exam: if applicable

Temp – 100.0⁰F

Pulse – 108 beats per minute

RESP rate 20

BP180/110

Height 5’6

Weight 146lbs

BMI is 23.56 (Normal)

General: The patient has a tinge of scleral jaundice but no pallor, no edema, and no lymphadenopathy.

Abdomen: no hepatomegaly, no splenomegaly, no tenderness, normal bowel sounds

Diagnostic results: Her blood alcohol level (BAL) was reported at a remarkably high value of .308. Her urinary drug screen revealed positive results for both opiates and THC (cannabis). Hepatitis C screening test returned positive. The ALT and AST levels are elevated at 168 and 200, respectively. ALK and GGT levels are also elevated at 250 and 59. The bilirubin level is elevated at 2.5. The albumin level is decreased at 3.0.

Assessment:

Mental Status Examination: Lisa is a 33-year-old Caucasian female who looks her stated age. She is dressed appropriately but not well-kempt. She keeps scratching her forearms and appears restless. No fidgeting or tremors were witnessed. Her speech rhythm, volume, and articulation are normal. Her subjective mood is scared. Objectively, she appears anxious. Her affect is reactive and mood congruent.

She demonstrates a profound apprehension towards being labeled as an addict. She also demonstrates intrusive thoughts associated with her partner’s betrayal yet encounters difficulties in clearly expressing the specific details linked to her anxieties. Her thought showed no preoccupations, no overvalued ideas, no delusions, no suicidal/homicidal thoughts, or delusional perceptions. Her thought form was coherent with no flight of ideas, paucity, or tangentially.

No visual or auditory hallucinations, no evidence of depersonalization or tactile hallucinations. She is oriented in all spheres. Her remote, recent, and short-term memories are intact. Her concentration is alert and she keeps eye contact. Her judgment and abstract thinking are intact. Her understanding of her present circumstances is constrained, as she possesses limited insight. She exhibits reluctance towards the concept of rehabilitation, as she holds the belief that it will adversely impact her prospects for future employment.

Differential Diagnoses:

1. 304.00 (F11.20) Opioid Use Disorder, Severe: she meets more than six criteria by DSM-V. Her excessive desire is manifested in her massive daily expenditure on opiates, reflecting her larger amounts of daily opioid intake. Her opiate use can be related to her recent relationship problems, lack of a stable job, and family issues. Despite her knowledge of the impact of her drug use, she still uses these substances. Therefore, she meets criteria A 1-6 per DSM-V diagnosis (American Psychiatric Association, 2022). However, she also uses other substances in larger amounts, making her symptomology more likely multifactorial. The presence of opiates in her UDS supports the opiate use history.   
2. 304 F12.20 Cannabis Use Disorder Severe: The patient has a longstanding cannabis use history and this has been evidenced in her positive UDS tests for THC. The relationship between her recurrent cannabis use and her cravings, poor social relationships, financial constraints, and use despite awareness of the hazardous use signify a problematic pattern that can explain a severe cannabis use disorder. However, this was not the only substance used in recurrent larger amounts by this patient (Hasin & Walsh, 2020).
3. F10.20 Alcohol use disorder, Severe: consuming half a gallon of vodka for a long period can also explain her recent tumultuous social and economic journey. She was also diagnosed with AUD before her admission to a detox facility, leading to this referral. Coexistence between AUD and cannabis use disorder has been prevalent in the US (Livne et al., 2023), and that makes AUD also more likely in this patient.
4. 292.8 (F19. 18)Substance or Medication-Induced Anxiety Disorder: this patient’s anxiety could be explained by substance use, including opioids, cannabis, and alcohol. She keeps worrying about her future job security as well as her social relationships and going to rehab (Bushnell et al., 2019). She displays no obsession or compulsions and this makes substance-induced anxiety more likely in this patient.

Reflections: The case of Lisa Tremblay exemplifies the intricate interplay between substance use, mental health, and social interpersonal relationships. It is evident from this case that addressing substance use requires navigating complex emotional dynamics and societal stigmas. The significance of trauma-informed care becomes apparent when considering Lisa’s history of childhood sexual abuse and her tumultuous relationships.

A more nuanced approach to evaluating the impact of these traumas on her mental health could be explored by integrating trauma-focused therapies into the treatment plan. Socioeconomic determinants evident in Lisa’s story include but are not limited to family and social relationships, absence of social support systems, lack of employment, limited educational attainment, lack of job security, traumatized early childhood development, and poor social integration.

Legal and ethical considerations arise due to Lisa’s resistance to rehab out of fear of potential job discrimination. This raises questions about the societal stigma associated with addiction and the necessity for advocacy to destigmatize seeking help. A comprehensive approach to health promotion and disease prevention is crucial, addressing social determinants of health such as the aforementioned socioeconomic factors and cultural background.

Recognizing these factors can inform tailored interventions to mitigate risks and enhance the overall well-being of the patient. If I were to redo the case a fresh, I would perform a comprehensive analysis of Lisa’s medical history, with a specific focus on the impact of substance use on her liver function and potential co-occurring health conditions, which would enhance the understanding of her overall health status such as the extent of her hepatitis C infection.

The case lacks information regarding Lisa’s social support network and the potential influence of these relationships on her recovery process. To address the legal and ethical considerations, it would be beneficial to engage in a detailed discussion about confidentiality, potential legal consequences associated with substance use, and the significance of seeking professional assistance for recovery.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, Fifth Edition, Text Revision. American Psychiatric Association Publishing.

Bushnell, G. A., Gaynes, B. N., Compton, S. N., Dusetzina, S. B., Olfson, M., & Stürmer, T. (2019). Incident substance use disorder following anxiety disorder in privately insured youth. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 65(4), 536–542. https://doi.org/10.1016/j.jadohealth.2019.05.007

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

Livne, O., Mannes, Z. L., McDowell, Y. E., Shmulewitz, D., Malte, C. A., Saxon, A. J., & Hasin, D. S. (2023). Mental and physical health conditions among U.S. veterans with cannabis use and cannabis use disorders. Current Addiction Reports, 10(3), 441–457. https://doi.org/10.1007/s40429-023-00490-7