Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example

Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example

CC (chief complaint): “My fiancé suggested, well, demanded that I make an appointment.”

HPI: Stg. P.F. is a 27-year-old American Caucasian male who checks in for psychiatric evaluation. The client’s fiancé is concerned with his recent behaviors and recommended that he makes an appointment with a mental health practitioner. Three nights ago, while making merry, the client took off running, scared, and trying to find cover after fireworks went off without warning and the sky filled up with explosions. In the aftermath, the police took him down and tried to cuff him, suspecting he might have robbed someone. The client reported that the fireworks sounded like combat fire, making him shake. The explosive sound of the fireworks took the client back into the middle of the enemy fire. A week before the psychiatric exam, the client had jumped behind a magazine rack after a can backfired. The client reports that even the sound of a circular saw cutting into wood takes him back into the enemy fire.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Moreover, the smell of diesel fuel or choppers smell sent him off to the enemy fire. He reports an incident a week before the psychiatric exam when his neighbor was grilling and scorched hair on the arm. The resultant smell was bad that he had to leave the party. The incident reminded him of how his two buddies smelled who got burned when their Humvee was blown. The client describes these memories as too strong. The client reports dreaming about these events daily, making him want to crawl into bed and close his eyes.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Stg. P.F. reports that he cannot stand heavy traffic or traffic light stop. He starts sweating, shaking, or having difficulty breathing whenever he is stuck in traffic or stops at a traffic light. He gets worried about people in front, behind, and beside him. Specifically, he fears that someone can roll an IED under the car while he is trapped inside. Such situations remind the client of an incident in which four of his buddies were blown to hell, and two other vehicles were blown up. The client perceives her fiancé’s arguments with her mother as negative and feels like crawling into and hole and hiding. He feels like a wimp and a freaking coward and does not want to go anywhere and stay in his room all day. He is afraid of sleeping and generally regards his situation as dire. Sometimes, he experiences tight stomach muscles and nausea and feels everything will never end. He sometimes feels crazy, stops thinking, becomes numb, and loses track of time. He does not want to be a whiner and would like to be in control of himself.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Past Psychiatric History: No previous psychiatric history.

General Statement:   This is the first time the client is entering treatment.

Hospitalizations: No previous hospitalization, residential treatments, detox, self-harming behaviors, suicidal or homicidal behaviors.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Medication trials: No previous psychotropic medication.  

Psychotherapy or Previous Psychiatric Diagnosis: No previous psychotherapy or psychiatric diagnosis.

Substance Use History: Denies substance use or abuse.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Family Psychiatric/Substance Use History: The father is an alcoholic. The paternal grandfather is a veteran and was diagnosed with depression.

Psychosocial History: The client was born and raised by both parents. The father is an alcoholic. The father has diabetes mellitus and hypertension. The mother is alive and well. The client has a younger sister and an older sister. The paternal grandfather is a live veteran and suffers from depression. After graduating from high school, the client joined the military and served for eight years. The client presently lives with the fiancé and works as a furniture salesman.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Medical History: The client has seasonal allergies and service-connected asthma.

Current Medications: No current medication.

Allergies:NKFDA

Reproductive Hx:Sexually active.

ROS:

GENERAL: The client is alert and oriented x 4, well groomed, dressed appropriately for the weather and occasion, and appears in no acute distress.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

HEENT: Denies head injury. No visual or hearing loss. No nasal congestion, changes in smell, or difficulty swallowing. 

SKIN: No skin discoloration. No scars, soreness, rashes, or abnormalities.

CARDIOVASCULAR: No chest pain, oedema, syncope, or palpitations.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

RESPIRATORY: Experiences difficulty breathing when exposed to traumatic triggers and flashbacks of traumatic events. Normal breath sounds or shortness of breath without triggers. No cough or wheezing.

GASTROINTESTINAL: Reports nausea when anxious or memorizing flashbacks.

GENITOURINARY: No pain on urination. No urination inconsistency.

NEUROLOGICAL: The client reports feeling numb when anxious or memorizing flashbacks and traumatic experiences in the military.

MUSCULOSKELETAL: No muscle or joint pain. Denies arthritis.

HEMATOLOGIC: No anemia or ease of bruising/bleeding. Denies blood-related disorders.

LYMPHATICS: No painful or swollen nodes.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

ENDOCRINOLOGIC: No polydipsia or polyphagia. Denies diabetes diagnosis and heat or cold intolerance.

Objective:

Physical exam: N.A.

Vital signs: T97.4, P84, R18, B/P134/88, Ht5’8”, Wt167 lbs, BMI – 25.4 (overweight)

Diagnostic results: Administering the CAPS-5 would be appropriate for assessing the client’s PTSD symptoms. The CAPS-5 is a clinician-administered psychiatric interview based on the DSM-5 criteria for PTSD symptoms. The tool is effective for screening for PTSD and diagnosis of PTSD (Weathers et al., 2018). The PCL-5 is considered the gold standard for PTSD diagnosis(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Assessment

Mental Status Examination: The client is a 27-year-old Caucasian American male who looks his stated age. He is well-dressed for the occasion. He is calm, conversant, and cooperative. He does not make direct eye contact. His mood is sad and congruent with the constricted affect. No psychomotor abnormality was noted during the exam. The client shivered at the mention of combat fire during the exam, breathed heavily, and became tearful as he recounted traumatizing incidences that he keeps memorizing. The speech is coherent. However, form and content are goal-oriented and optimistic. Memory is intact and recent. The client is alert and oriented in all spheres. No difficulty with attention and concentration. Judgment and insight are fair. Denies suicide or homicide ideation. The client is not at risk of harm to himself or others.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Differential Diagnoses

1. Posttraumatic Stress Disorder (PTSD), 309.81 (F43.10). The diagnostic criteria for PTSD in adults include exposure to threatened or actual injury, death, or sexual violence, presence of one or more intrusion symptoms, persistent stimuli avoidance, altered cognitions/mood associated with the traumatic event, and altered arousal or reactivity associated with the traumatic event (American Psychiatric Association [APA], 2019). These symptoms include intrusive distressing and recurrent dreams or memories of traumatic events, dissociative reactions or flashbacks, prolonged psychological reactions or distress cures that resemble the traumatic event, and avoidance of distressing memories or reminders that arouse recollections of traumatic events. Individuals also experience altered mood and cognition associated with traumatic events, which cause distorted cognition of the events, negative emotional state, detachment, and inability to experience positive emotions (APA, 2019). This is the primary diagnosis.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)
2. Generalized anxiety disorder (GAD), 300.02 (F41.1). GAD is determined by excessive worry/anxiety, difficulty controlling worry, and presenting three or more worry/anxiety-related symptoms (APA, 2019). These symptoms include restlessness, fatigue, irritability, difficulty concentrating, sleep disturbance, and muscle tension. These symptoms cause significant clinical distress, impair essential areas of functioning, and have been present for the past six months.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)
3. Acute stress disorder (ASD), 308.3 (F43.0). The diagnostic criteria for ASD include exposure to threatened or actual injury, death, or sexual abuse and experiencing symptoms for at least nine related to dissociative signs, arousal intrusion, negative mood, and avoidance symptoms between three days and one month. These symptoms include intrusive and recurrent distressing dreams, memories, and reactions of a traumatic event, lack of positive emotions, altered sense of reality and aspects of the traumatic event, hypervigilance, avoidance of the distressing memories and reminders, sleep disturbance, irritability, startle response, and altered concentration. This is a secondary diagnosis.   (Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Case Formulation and Treatment Plan

Psychotherapy: Start the client on prolonged exposure therapy (P.E.). P.E. is effective in managing PTSD symptoms. Clients are taught how to progressively approach traumatic situations, feelings, and memories (Watkins et al., 2018). This would allow the client to go through the painful memories and gradually begin participating in activities previously avoided.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Pharmacotherapy: Two selective serotonin reuptake inhibitors, i.e., Zoloft and Paxil, are primarily recommended by the FDA. For this client, Zoloft 50mg P.O. Q.D. Zoloft effectively reduces PTSD symptoms (Kaysen et al., 2019).(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Education: The client should be given theVeterans Crisis Line: 1-800-273-8255, press 1, and a guide to coping with combat stress. Inform the client of the importance of pharmacological and psychological therapies.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Reflections

PTSD is the primary diagnosis. The client’s symptoms meet the full diagnostic criteria for PTSD diagnosis. The client experienced traumatic events while serving in the army and associates his present encounters with these events through dressing memories and flashbacks. For instance, the client associated loud noises and firework explosions to enemy fire and downtown traffic to IED experiences during the war. Moreover, the client practices avoidance of these reminded as shown by running away from notice or disagreements. These are flashbacks of enemy fire, and running to find the cover is an attempt to avoid the stimuli. Thu, the client shows altered cognition and mood towards loud noises.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Studies have shown that PTSD is common among service members. The condition is associated with direct involvement in combat and exposure to horrible and life-threatening experiences. Armenta et al. (2018) established that combat experiences and intensity, sexual assault, illness/injury, and death predispose individuals to develop PTSD. When dealing with military-related PTSD, the mental health practitioner must uphold the ethical and legal tenets of beneficence and nonmaleficence (Yang et al., 2017). In this case, maintaining nonmaleficence and beneficence would allow a mental health practitioner to establish therapeutic alliances with the client, adopt a client-centered approach, and engage the client, incorporating the client’s interest. In this case, the practitioner should encourage the client and advise him of the importance of medication. (Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

References

American Psychiatric Association. (2019). Diagnostic and statistical manual of mental disorders  (7^th ed.). American Psychiatric Publishing, Inc.   (Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)

Armenta, R. F., Rush, T., LeardMann, C. A., Millegan, J., Cooper, A., & Hoge, C. W. (2018). Factors associated with persistent posttraumatic stress disorder among U.S. military service members and veterans. BMC Psychiatry, 18(1), 1-11. (Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example)https://doi.org/10.1186/s12888-018-1590-5

Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian Journal of Psychological Medicine, 41(2), 108-112. https://doi.org/10.4103%2FIJPSYM.IJPSYM_59_19

Kaysen, D. L., Bedard-Gilligan, M. A., & Saxon, A. J. (2019). Use of prolonged exposure and sertraline in the treatment of posttraumatic stress disorder for veterans. JAMA Psychiatry, 76(2), 109-110.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example) https://doi.org/10.1001/jamapsychiatry.2018.3410

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example). https://doi.org/10.3389%2Ffnbeh.2018.00258

Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., … & Marx, B. P. (2018). The Clinician-Administered PTSD Scale for DSM–5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychological Assessment, 30(3), 383(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example). https://doi.org/10.1037%2Fpas0000486

Yang, S., Schneider, B., Wynn, G. H., & Howe III, E. (2017). Ethical considerations in the treatment of PTSD in military populations. Focus, 15(4), 435-440.(Assessing and Diagnosing Patients with PTSD and OCD Comprehensive Solved Nursing Paper Example) https://doi.org/10.1176%2Fappi.focus.20170035