Substance-related and Addictive Disorders Essay Paper
Substance-related and Addictive Disorders Essay Paper
Chief Complaint: “I am feeling scared”
History of Presenting Illness: Lisa Pittman is a 29years old American female who states that she is scared of going to the rehabilitation center because she is not willing to change. Moreover, she is scared of what people will think and talk about her. She seems to feel about people saying that she is an addict. She takes alcohol with her friends but is in control. She states that her boyfriend introduced her to smoking crack cocaine daily and cannabis at least twice a week. She says that cocaine makes her feel good and fast and she cannot get enough of it. She sleeps 4-5hours in a day and has a reduced appetite. She prefers getting high to eating. Substance-related and Addictive Disorders Essay Paper
Past Psychiatric History: the patient denies substance addition. However, she smokes cocaine, and cannabis, and drinks alcohol.
Caregivers (If Applicable): she is cohabiting with her boyfriend. She is independent
Medication Trials: none
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Psychotherapy Or Previous Psychiatric Diagnosis: none
Substance Current Use And History: she smokes crank cocaine daily, smokes cannabis 1-2times in a week, and drinks alcohol 2-3weekly
Family Psychiatric/Substance Use History: her father went to prison due to rape, abuse, and drug charges. Her mother has a history of anxiety and benzodiazepine use. Her brother has no contact with the family and has a history of opioid use.
Psychosocial History: the patient is single. She cohabits with her boyfriend and they work together. They have had a strained relationship due to financial misuse and infidelity. She has a business of her own for creating websites for clients. She has a child from another relationship who stays at her friend’s house. She enjoys smoking cocaine in the company of her friends and boyfriend. She takes alcohol 2-3times a week. She smokes cannabis 1-2times a week. She leads a sedentary lifestyle. She has a history of drug possession and theft convictions, currently on two-year probation with a randomized drug screen. Substance-related and Addictive Disorders Essay Paper
Medical History: the patient has a recent diagnosis of hepatitis C+. However, she denies hospitalization, blood transfusion, and surgical procedures.
Current Medications: none
Allergies: the patient is allergic to amoxicillin. She develops angioedema and relives by taking prednisone.
Reproductive Hx: her menarche was at the age of 15years. She has a regular 28days cycle with a moderate 3days flow. She denies premenstrual syndrome and dysmenorrhea. The patient has one child. She has no history of pregnancy-related complications. She is heterosexual with one partner. However, she has no history of cervical cancer and sexually transmitted infection screening.
Review of systems
General: The patient denies headache, fatigue, fever, and weight changes.
HEENT: she denies headache, visual disturbance, loss of hearing, throat pain, and running nose.
Skin: the patient has a smooth skin with no acne, wrinkles, and scars
Cardiovascular: she reports an increased heartbeat. She denies orthopnea, syncope, and paroxysmal nocturnal dyspnea.
Respiratory: she denies coughing, chest pain, wheezing, and sputum production.
Gastrointestinal: the patient has reduced appetite. She denies abdominal pain, nausea, vomiting, and heartburn.
Genitourinary: she denies urinary urgency, frequency, incontinence, vaginal discharge, dyspareunia, and hematuria.
Neurological: the patient reports numbness of the extremities. However, she denies facial droop, burning sensation, diminished tendon reflexes, and weakness. Substance-related and Addictive Disorders Essay Paper
Musculoskeletal: she denies joint pain, stiffness, muscle spasms, and fracture.
Hematological system: the patient denies easy bruising, frequent infections, fever, and bleeding tendencies.
Lymphatic system: the patient denies lower limb edema, recurring infections, skin fibrosis, and lymph nodes.
Endocrine: patient denies weight fluctuation, weakness, fatigue, heat and cold intolerance, and mood swings.
Physical Exam: The patient is alert and oriented. She has no pallor, jaundice, or cyanosis.
Vitals: temperature is 99F, P 101, BP 178/94mmHg, RR 20beats per minute, weight 140Ibs, and height 5’6inches.
- UDS is positive for cocaine
- THC is negative for alcohol
- ALT is 168
- AST is 200
- ALK is 250
- Bilirubin is 2.5
- Albumin is 3.0
- GGT is 59
The patient is scared of going to the rehabilitation center because of its environment. She sleeps for a few hours a day, has decreased appetite, and prefers smoking cannabis to eat. She takes alcohol, smokes cocaine, and tobacco. She has a history of drug possession and theft convictions, currently on two-year probation with a randomized drug screen. She has a positive family history of psychiatric diseases and substance abuse. Therefore, the patient’s differential diagnosis is substance-related addiction, substance use disorder, and alcohol use disorder.
Mental Status Examination: the patient is alert and oriented to time, place, and person. She is neat and appropriately dressed for the occasion. Initially, she seems to be uncooperative. She maintains eye contact and expresses anger. She is calm and attentive. Her speech has a normal tone, volume, and speed. Her mood is anxious and has a flat affect. Her thought process indicates a loose association with thought blocking. She has impaired judgment and insight. She has no hallucinations, paranoid behavior, and suicidal ideation.
A substance-related disorder is a psychiatric disorder characterized by craving and difficulties in controlling substance use. The patient may present with abrupt onset of withdrawal symptoms after cessation of substance use. The patient may have anxiety disorders, depression, and bipolar. Substance addiction disorder is common in alcohol, caffeine, opioids, sedatives, anxiolytics, cocaine, nicotine, and stimulants. The patient has an uncontrolled pattern of substance abuse that causes significant social and psychological impairment. Characteristics of addition are using a substance in large amounts than originally intended, intense desire to obtain it, and buying it (Rettie, et al, 2021). It leads to loss of interpersonal relationships, poor work performance, and risky habits. This patient is addicted to cocaine because she uses $100 daily to purchase. She says it makes her feel good and cannot get enough of it. She has lost interpersonal relationships. Moreover, she has hypertension, tachycardia, loss of appetite, and impaired judgment. Substance-related and Addictive Disorders Essay Paper
Substance use disorder is abuse, intoxication, and psychological dependence on the illicit drug due to excessive intake. Commonly abused drugs are alcohol, nicotine, inhalants, stimulants, hallucinogens, cocaine, and sedatives (Chye, et al, 2019). The effects of these substances are euphoria, profound sedation, and increased energy. The patient regularly takes alcohol and smokes cocaine and cannabis. She says it makes her feel good and cannot get enough of it. She prefers getting high to eating. However, it is not the actual diagnosis because the patient tends to take cocaine frequently compared to other substances.
Alcohol abuse disorder is the excessive intake of alcohol resulting in impaired cognitive function and interpersonal relationships. Often, patients with alcohol use disorders tend to hide or deny their addiction. They are annoyed and guilty about their drinking habits. The presenting symptoms are reduced appetite, insomnia, anxiety, agitation, tachycardia, delirium, temperature elevation, and hypertension (Wang, et al, 2019). The biomarkers of alcohol use disorder are elevated AST, ALT, GGT, and MCV. The patient presents with similar signs and symptoms. However, it is not the actual diagnosis because THC is negative for alcohol Substance-related and Addictive Disorders Essay Paper
Patients with substance-related addiction are sensitive to assessment due to mood fluctuations and difficulties in cooperating. I have learned to communicate effectively to create rapport with the patient. Understanding addiction behaviors will help me to have a judgment-free conversation with the patient. Privacy and confidentiality help the patient open up and prevent stigma.
Please Do Not Mess This Order Up I Need This Back Immediately 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? Substance-related and Addictive Disorders Essay Paper
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.). LISA Well I had to be here in this hospital if that answers your question. 00:00:25OFF CAMERA Yes, thank you. Can I get you a drink of water or something else to drink? Anything? 00:00:35LISA A drink isn’t going to convince me, right? You’re going to have to convince me. 00:00:40OFF CAMERA What is you want me to persuade you to do? 00:00:45LISA Going to rehab. 00:00:50OFF CAMERA What worries you about going to rehab? 00:00:55[sil.] 00:01:00LISA Everything. 00:01:00OFF CAMERA Okay. I tell you what let’s go back a little bit and tell me about how you’re feeling today. 00:01:10LISA Scared. 00:01:15OFF CAMERA Can you tell me more about that feeling of being scared? 00:01:20LISA Well, I don’t want to be. I don’t want to be what people say I am because if I say it and I’m not going to say it because I ain’t going to change. I can’t. 00:01:35OFF CAMERA What do people say you are? 00:01:40LISA And I’m not. 00:01:45OFF CAMERA What don’t you want to be? 00:01:45LISA An addict. 00:01:50OFF CAMERA Do you use drugs and alcohol? 00:01:50LISA Yeah sometimes I have a drink. You know with friends [inaudible] but it doesn’t matter. I’m in control. 00:02:00OFF CAMERA Do you feel in control now? 00:02:05LISA Maybe I could just get that drink [inaudible]. 00:02:10OFF CAMERA Sure. Sure. Here you go. 00:02:15LISA Thank you. 00:02:20[sil.] 00:02:30LISA You know what I just think I should leave. 00:02:30OFF CAMERA You keep saying you should leave. You said that earlier but do you really want to leave? 00:02:40LISA No. 00:02:45OFF CAMERA Okay. Tell me why you are here. 00:02:45LISA Because I’m scared. 00:02:50OFF CAMERA You said that earlier. You think if you could — then I could figure out together why you’re scared and maybe we can come up to a plan. Up with a plan and if we do that, then maybe your fears will disappear. 00:03:05LISA No not these fears [inaudible] because it’s over. 00:03:10OFF CAMERA What’s over? 00:03:10LISA Everything. The business. 00:03:15OFF CAMERA What do you mean? 00:03:20LISA Jeremy. 00:03:25OFF CAMERA Who is Jeremy? 00:03:25LISA He’s my boyfriend. I saw him naked with Alisa [assumed spelling] with the same fucking name as me. We now have the same fucking boyfriend. In my office, he was screwing that fucking cunk. 00:03:45OFF CAMERA So you’re the one who caught Jeremy cheating? 00:03:55LISA Yeah. Substance-related and Addictive Disorders Essay Paper
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Cheating? Yeah that’s a clever word shrinks use. 00:04:05OFF CAMERA So you and Jeremy share an office? 00:04:05LISA Yeah we do commercials for local businesses, you know, build websites, that kind of stuff. We started a business together. He moved in with me. 00:04:15OFF CAMERA How long ago was that? 00:04:20LISA Nine months. 00:04:20OFF CAMERA Do you have any children? 00:04:20LISA Not with that fucking asshole. 00:04:25[sil.] 00:04:30LISA I have a daughter, Sarah. Gosh, she’s beautiful. She stays with some friends. She’s not related to Jeremy, thank God. 00:04:45OFF CAMERA And where are you staying? 00:04:45LISA I’m renting a place far away from here. You know I ran down to the bank to empty both our bank accounts. 00:04:55OFF CAMERA Business accounts? 00:04:55LISA Yeah. And do you know that asshole has been draining them for 4 months? I swear. 00:05:05OFF CAMERA Taking money out of your account without your knowledge. 00:05:05LISA Yeah. For his buys. 00:05:10OFF CAMERA Buys? 00:05:10LISA Yeah, to payoff his debts with my money. 00:05:20OFF CAMERA Or crack cocaine? 00:05:25LISA Yeah for crack. 00:05:25OFF CAMERA How long have you know he’s been smoking crack? 00:05:30LISA Ever since I saw him with that — every since I saw with her naked. The both of them naked. 00:05:40OFF CAMERA What was that like seeing Jeremy and Alisa naked and smoking crack? 00:05:40LISA Well have you ever seen someone you love naked smoking crack? 00:05:45OFF CAMERA No. 00:05:50LISA Yeah no I didn’t think so. 00:05:50OFF CAMERA So what has that been like for you knowing Jeremy’s smoking crack? 00:05:55LISA Well, I’ve never seen him do drugs before. You know he drinks a lot, smokes weed, but crack cocaine. I mean God have mercy. 00:06:15OFF CAMERA What are you thinking about? 00:06:20LISA Everyone’s going to know. 00:06:25OFF CAMERA Know what? 00:06:30LISA That I was getting high to stay in this hospital and get cleaned up. 00:06:35OFF CAMERA You mean rather than go to rehab. 00:06:40LISA Rehab, man they’re fucking dirty places and I’m sick and tired of dirty places. 00:06:45OFF CAMERA No, no, no this rehab place is very clean. I’ve seen it. There are a lot of nice people there. People who feel like they get much better help than here in the hospital. In fact, I can call someone for you and let you talk with them. 00:06:55LISA No, no, no, no, no, no, no, no, don’t do that. 00:07:00OFF CAMERA You’re really fearful of going to rehab. 00:07:05LISA Well if everyone finds out that I’ve been to rehab, I won’t get a job. I won’t be hired anyway. 00:07:10OFF CAMERA Plus if people are fearful of the stigma and fearful of what people will think of them. 00:07:20LISA Yeah, but he says that I’m not addicted. It’s just — you know something wrong with my personality. 00:07:25OFF CAMERA Who says there’s something wrong with your personality? 00:07:30LISA Jeremy. 00:07:30OFF CAMERA When did he tell you that? 00:07:35LISA Lots of times. 00:07:35OFF CAMERA I thought you said you and Jeremy split up after you caught him cheating. 00:07:40LISA I — 00:07:45OFF CAMERA It’s okay. Substance-related and Addictive Disorders Essay Paper
Take your time. 00:07:50LISA Well yeah he moved back in. 00:07:50OFF CAMERA Into your new home? 00:07:55LISA Yeah. What changed that you two decided to get back together? 00:08:00OFF CAMERA Well he said he was sorry and he begged me. He’s done it before so I took him back. 00:08:10LISA And how has that been being back with Jeremy? 00:08:15OFF CAMERA Well I love Jeremy. I do and don’t want to go out and find another boyfriend. I mean we lost 80,000 dollars on that business. And he promised me that he would make it all back. 00:08:30LISA So is that why you took him back? Has Jeremy continued smoking crack? 00:08:45OFF CAMERA Yeah a little but he’s not addicted.
He says that it calms him down. Me too. 00:09:05LISA You too? 00:09:05OFF CAMERA So do you smoke crack with Jeremy? 00:09:15LISA Yeah we — he made me try it. 00:09:25[sil.] 00:09:30[ Crying ] 00:09:40LISA And then he tried just once. We did it together. [Inaudible] I could. 00:09:55[ Crying ] 00:10:00LISA Hit me like a bullet. And it felt so good. I felt so good. And real fast. 00:10:20[sil.] 00:10:25LISA Have you ever felt like you were dancing with butterflies? 00:10:30OFF CAMERA Dancing with butterflies? No I have not. 00:10:40[sil.] 00:10:45LISA But he says it’s not addictive, Jeremy. 00:10:50OFF CAMERA What do you think? 00:10:55LISA Well I know I can’t get enough. 00:11:00[ Crying ] 00:11:10LISA And I know I don’t want to go back to feeling horrible again because when I don’t smoke it I get worse. And when I have it, I feel good. And then it’s gone. And then I know that I’m going to be needing another hit. 00:11:45OFF CAMERA That sounds a lot like addiction. 00:11:55LISA Yeah but I know I don’t want it to be. 00:12:00OFF CAMERA It sounds like you are very scared of getting help and yet at the same very time, it sounds like you know you need that help. 00:12:15LISA I know I don’t need help. I don’t need anything. Jeremy promised me that everything is going to be okay. And when you love someone like I do, you got to believe him. Right? 00:12:45[sil.] 00:12:45END TRANSCRIPT Name: Lisa Pittman Gender: female Age: 29 years old T- 99.8 P- 101 R 20 178/94 Ht 5’6 Wt 140lbs Background: Lisa is in a West Palm Beach, FL detox facility thinking about long term rehab. She has been smoking crack cocaine, approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”), and 2–3 alcohol drinks once weekly. She has past drug possession and theft convictions; currently on 2 yr probation with randomized drug screens. She tries to find the pattern for the calls in order not to test dirty urine. Her admission labs abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS positive for cocaine, THC. Negative for alcohol or other drugs. BAL 0; other labs within normal ranges. She reports sexual abuse as child ages 5–7, perpetrator being her father who went to prison for the abuse and drug charges. She is estranged from him. Mother lives in Alabama, hx of anxiety, benzodiazepine use. Older brother has not contact with family in last 10 years, hx of opioid use. Sleeps 4-5 hrs, appetite decreased, prefers to get high instead of eating. Allergies: amoxicillin She is considering treatment for her Hep C+ but needs to get clean first. Symptom Media. (Producer). (2017). Training title 82 [Video]. https://video-alexanderstreet com.ezp.waldenulibrary.org/watch/training-title-82 Week (enter week #): (Enter assignment title) Student Name College of Nursing-PMHNP, Walden University NRNP 6635: Psychopathology and Diagnostic Reasoning Faculty Name Assignment Due Date Subjective: CC (chief complaint): HPI: Past Psychiatric History: General Statement: Caregivers (if applicable): Hospitalizations: Medication trials: Psychotherapy or Previous Psychiatric Diagnosis: Substance Current Use and History: Family Psychiatric/Substance Use History: Psychosocial History: Medical History: Current Medications: Allergies: Reproductive Hx: ROS: GENERAL: HEENT: SKIN: CARDIOVASCULAR: RESPIRATORY: GASTROINTESTINAL: GENITOURINARY: NEUROLOGICAL: MUSCULOSKELETAL: HEMATOLOGIC: LYMPHATICS: ENDOCRINOLOGIC: Objective: Physical exam: if applicable Diagnostic results: Assessment: Mental Status Examination: Differential Diagnoses: Reflections: References Substance-related and Addictive Disorders Essay Paper