Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example

Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example

Assessing and diagnosing patients with substance-related and addictive disorders requires evaluating and assessing the patient’s stated symptoms and performing objective evaluation and diagnostics tests. It is standard to use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM5), published by the American Psychiatric Association (Dugosh & Cacciola, 2018). The paper presents a comprehensive evaluation and diagnosis of a perceived substance and addictive disorder involving a case patient.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Subjective:

CC (chief complaint): “I’m scared.”

HPI: Lisa is a 33-year-old female present in a Naples, FL, detox facility. She is conflicted about long-term rehab and detox before her Hep + treatment. She is scared about what people will say about her going to rehab because of the perceived stigma. She does not want to be an addict, yet, she wants to be convinced to go to rehab. She sometimes drinks with friends and reports that she is in control of her drinking. She is also scared about the commercial business she owns with her boyfriend. She reports witnessing her boyfriend cheating on her with another lady from her office. The boyfriend has drained the account they jointly own for four months to pay his debts and for his alcohol and cocaine addiction.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

His boyfriend drinks a lot, smokes weed, and takes cocaine. She fears everybody will know she has been getting high to be in the hospital and get cleaned up. She believes rehabs are dirty places and worries that if anyone finds out she has been to rehab; she will be stigmatized and may lose employment opportunities. She says that she is not addicted and that something is wrong with her personality. She loves her boyfriend and does not want to leave him, and although they lost over $80000 from the business, the boyfriend has convinced him that he will make it all back.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

She reports being introduced to cocaine by her boyfriend, and then it felt good fast, and she cannot get enough of it. She does not want to feel horrible again. She feels good smoking and worse when she does not smoke. She knows this is an addiction but does not want it to be. She says she does not need help since her boyfriend promised her everything would fall into place. She believes her boyfriend because she loves him.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Past Psychiatric History:

General Statement: This is the first time the patient has entered detox at age 33.

Hospitalizations: None reported.

Medication trials: None reported.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Psychotherapy or Previous Psychiatric Diagnosis: None.

Substance Use History: She abuses opiates ($60 daily) and vodka (half a gallon of vodka daily). Smokes cannabis one to two times weekly (Has medical marijuana card).

Family Psychiatric/Substance Use History: Father has a history of abuse and drug issues. Mother has a history of agoraphobia and benzodiazepine abuse. Brother has a history of opioid use.

Social History: The client lives in a rented house with her daughter and her boyfriend. She is estranged from his father. The mother lives in Maine. The older brother has not contacted the family for the last decade.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Educational Level: Not reported

Hobbies: Not reported

Work History: Does commercials for local businesses

Lifestyle: Sleeps 5-6 hrs. Her appetite has decreased, and she prefers to get high rather than eat.

Legal history: She has a past drug paraphernalia possession arrest.

Trauma history: She was sexually abused by her father between ages 6 and 9.

Violence Hx: None reported.

Medical History: 

Current Medications: None reported.

Allergies: Azithromycin

Reproductive Hx: LMP not reported. No sexual concerns were reported.

ROS:

GENERAL: No weakness or fatigue. No fever, chills, or weight loss.

HEENT: Eyes: No blurred/double vision or visual loss. Ears, Nose, Throat: No hearing loss, congestion, or sore throat.

SKIN: No skin rash or itches.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

CARDIOVASCULAR: No chest discomfort, pain, or pressure. No palpitations/ edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain. GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No tingling in the extremities, no numbness of paralysis, no headache, or dizziness.

MUSCULOSKELETAL: No muscle, back, or joint pain/stiffness.

HEMATOLOGIC: No anemia, ease of bruising, or bleeding.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No sweat, heat, or cold intolerance. No polydipsia or polyuria.

Objective

Vital Signs: T- 100.0, P- 108, R 20, BP 180/110, Ht 5’6 Wt., 146lbs, BMI = 23.6 kg/m²  (Normal weight).

Physical exam: Lucia is a 33-year-old female who looks the stated age. She is well-developed with a steady gait. Maintain a natural head position, symmetric scalp, and facial features.

Diagnostic results:

ALT: 168

AST: 200

ALK: 250 U/L

Bilirubin: 2.5mg/dL

Albumin 3.0g/L

GGT: 59 IU/L 

UDS: Positive for opiates, THC, and alcohol.

BAL: 308

Assessment

Mental Status Examination: 

The client is a 33-year-old Caucasian female who looks her stated age. She is appropriately dressed. She is calm and appears to be in no acute psychological distress. She is interactive and makes fair eye contact. She is depressed with expansive emotions. Her mood is congruent with affect. Her thought form and content are past-oriented and somber. She experiences some attentional difficulties during the examination. She has poor insight, her memory is grossly intact, and she experiences difficulty with abstract thought. Judgment is below average. No present or past suicide ideation or intent. The client has no risk of self-harm or harm to others.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Differential Diagnoses:

1. Alcohol Use Disorder (AUD), with acute intoxication.  The client presents changing energy levels, mood stability, and eating patterns commonly observed among individuals with alcohol use disorder (APA, 2019). These signs and symptoms are likely due to alcohol intoxication. The client’s urine test is positive for alcohol. The client reports consuming half a gallon of vodka daily but denies addictions and believes she is in control of her drinking. However, despite her dangerously high BAL of .308 (tolerance), she presents with a relatively clear sensorium, even with elevated LFTs and being Hepatitis C positive. According to the DSM-5, AUD is characterized by large alcohol consumption, a desire to cut down consumption, most time spent consuming or seeking means to obtain alcohol, and consequent impairment of significant areas of functioning occurring in 12 months (APA, 2019). Therefore, this is the primary diagnosis. (Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)
2. Moderate Stimulant (Cocaine) Use Disorder, with cocaine intoxication. The client reports that using crack cocaine feels good fast and cannot get enough of it. According to the DSM-D, stimulant use disorder is diagnosed with evidence of recent use, clinically significant/behavioral changes, and two or more other signs and symptoms, including bradycardia, pupil dilation, weight loss, psychomotor agitation, muscular weakness, confusion, and elevated blood pressure not attributed to other medical condition (APA, 2019). The patient presents signs of confusion by believing that she is not addicted and that something is wrong with her personality, as the boyfriend tells her. The patient shows signs of psychomotor agitation since she wants to be convinced about rehab, reports depression, and has elevated blood pressure. However, the client’s cocaine use is fairly recent. Therefore, this diagnosis is secondary. (Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)
3. Opioid Use Disorder, moderate. The client’s laboratory report is positive for opiates. She owns to abusing opiates, approximately worth $60 daily. The diagnostic criteria for opioid use disorder include prolonged and larger consumption of opiates characterized by persistent and ineffective desire to control the use and recurrent use leading to impairment of significant areas of functioning. Individuals diagnosed with opioid use disorder continue using opiates despite social, interpersonal, or physical issues due to the strong desire.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Reflections

The primary diagnosis, in this case, is Alcohol Use Disorder (AUD) with acute intoxication. The patient presents symptoms characteristic of AUD, such as alcohol consumption, desire to cut down consumption, most time spent consuming or seeking means to obtain alcohol, and consequent impairment of significant areas of functioning occurring in 12 months (APA, 2019). The client also presents symptoms of moderate stimulant (cocaine) use disorders, with intoxication and moderate opioid use disorder as secondary diagnoses. The client reports smoking crack cocaine and cannot get enough, which suggests addiction. Equally, the client reports daily opiate use, which shows continuous use. The USD test is positive for opiates. Although the test results are questionable for cocaine, further tests are necessary to ascertain the diagnosis.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Environmental factors are the primary risk and prognostic factors for substance abuse and addiction. Mainly, studies have shown that stress levels are a primary risk factor for the development of substance use addiction and a predictor of craving for drug abuse, including alcohol, cocaine, and opiates (Torres-Berrio et al., 2018). In this case, the patient reports a history of anxiety and depression occasioned dysfunctional family and sexual abuse as a child. Besides, the patient reports being cheated on by her boyfriend and losing over $80000 of their savings. These experiences are significant stressors that could have contributed to the client’s addiction. Women who abuse cocaine are addicted to the rewarding feeling associated with the drug and the need to soothe the adverse life experiences they are going through (Tractenberg et al., 2022). Besides, the client acknowledges that she does not want to return to feeling horrible again when she is not high.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Besides written and spoken informed consent, mental health practitioners should uphold the ethical principles of beneficence and nonmaleficence. Beneficence assumes that a mental health practitioner has the responsibility to enhance and improve the welfare of others (Ventura et al., 2021). (Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)However, this responsibility is affected by a patient lifestyle that would interfere with treatment. In this context, the practitioner should consider a client’s point of view and cultural context when determining what actions enhance the client’s welfare. On the other hand, nonmaleficence refers to the practitioners’ responsibility of not harming the client (Ventura et al., 2021). However, when dealing with drug and substance abuse clients, abstinence is believed to be a rigid philosophy and prohibits recovery since it does not give room for compassion or meet the addiction needs of the clients. Nevertheless, practitioners should account for the recovery process and be passionate about the clients.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

A practitioner must acknowledge the complexity of addiction disorders when handling such patients. Substance abuse and addiction disorders are associated with relapse and are influenced by environmental and social factors (APA, 2019). Therefore, psychiatric assessments must be made in a broader context supported by diagnostic tests, mainly UDS tests, to detect substance and drug abuse in the body. Furthermore, a practitioner should conduct more diagnostic tests to evaluate the impact of an underlying medical condition on a patient’s symptoms and behavior.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Conclusion

The client presents symptoms that meet the DSM-5 diagnostic crate for alcohol use disorder with comorbid intoxication. The client reports persistent alcohol consumption, and the diagnostics tests are positive for alcohol. Per the client’s HPI, the client presents symptoms for secondary diagnoses, including moderate cocaine and opiate use disorders. Significantly, these addictions are associated with the client’s environmental factors, mainly stress levels associated with family dysfunction, sexual abuse, and relationship stressors. When dealing with such patients, the practitioner should incorporate their views regarding treatment and involve them during the assessment to make a definitive diagnosis.(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders 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 Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Dugosh, K. L., & Cacciola, J. S. (2018). Clinical assessment of substance use disorders. UpToDate. Retrieved February. Available at: https://www.uptodate.com/contents/clinical-assessment-of-substance-use-disorders (Accessed 4 September 2022)(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)

Torres-Berrio, A., Cuesta, S., Lopez-Guzman, S., & Nava-Mesa, M. O. (2018). Interaction between stress and addiction: Contributions from Latin-American neuroscience. Frontiers in Psychology, 2639(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example). https://doi.org/10.3389/fpsyg.2018.02639

Tractenberg, S. G., Schneider, J. A., De Mattos, B. P., Bicca, C. H., Kluwe-Schiavon, B., de Castro, T. G., … & Grassi-Oliveira, R. (2022). The Perceptions of Women About Their High Experience of Using Crack Cocaine. Frontiers in Psychiatry, 13(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example)https://doi.org/10.3389/fpsyt.2022.898570 

Ventura, C. A. A., Austin, W., Carrara, B. S., & de Brito, E. S. (2021). Nursing care in mental health: Human rights and ethical issues. Nursing ethics, 28(4), 463-480(Assessing and Diagnosing Patients with Substance-Related and Addictive Disorders Comprehensive Solved Nursing Paper Example). https://doi.org/10.1177/0969733020952102