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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.
case study;Use this case; Mr J.V
HISTORY OF PRESENT ILLNESS: This is a case of a 26 year old Caucasian single male who comes to the clinic today to establish care with this program today. pt. states he was referred to Iconichealth by a friend. pt. reports he has been to other places with no success. pt. reports he struggles with depression for the past 15 years. pt. reports it is getting worse for the past 5 years. pt. describes his mood today as “oK’, neutral, states past few days hard for him, stuck in the house, car is broken. pt. denies SI/HI, denies A/V/H. pt. reports he does not sleep but sleeps during the day sometimes. sleeps at 4:30am, states he wakes up 3pm. appetite is low, eats one a day.
pt. states his future goal is to focus on his depression, start going back to the Gym and be able to work his therapy dog. pt. states he does not just have energy to do things. strength is having a strong will, does not give up on things. weaknesses is repeating himself.
pt. attends methadone clinic. take 110 mg po daily of methadone. pt. reports 90% he is down and 10% hyper and anxiety.
pt. reports he has tried many medications in the past, Seroquel, gabapentin, Suboxone.
pt. is alert and oriented x3, presents with a good judgement. pt. calm and cooperative, denies and discomfort or pain.
ALLERGIES: NKDA. CURRENT PSYCH MEDICATIONS: CURRENT NON-PSYCH MEDICATIONS: PAST PSYCHIATRIC HISTORY: pt. reports he started having problems at elementary school. he states he was diagnosed of ADHD at younger age, addicted to video game. as he got older, he started having problems with drugs and other substances. pt. reports he was treated by his primary doctor, did not work out well. pt. denies past psychiatric hospitalization. pt. reports he was at the detox several times, like 13 times for alcohol and Opioid. last time was over a year ago. pt. denies past suicide attempts. pt. reports being in car accidents 3 to 4 times, reports head injury and loss of consciousness once due to collision. pt. reports emotional abuse in the past, denies physical or sexual.
•O/P Psychiatrist/therapists: yes •Previous diagnosis: ADHD, depression •Previous admissions: 0 •Previous suicide attempts: 0 •Past Medication History: had left kidney surgery as a baby. SUBSTANCE ABUSE HISTORY: •Tobacco: pt. smokes a pack of cigarettes daily. pt. started smoking at age 15, last smoked today. •ETOH: pt. reports he drinks twice weekly, beer, liquors. pt. last had a drink last night. pt. started drinking at age 16. •Illicit Drugs: pt. reports he used weed, alcohol, heroin, cocaine. last used weed a few months ago, cocaine 6 months and heroin two weeks ago. pt. started using substances at age 16. pt. reports being overdosed once at age 19. •Rehab Programs: 3 to 4 times SOCIAL HISTORY: pt. was born and raised Springfield, NJ. pt.’s both parents still alive, divorced. pt. has one older sister. pt. is single, in a relationship at present. states he is attracted to females. pt. has no children. •Living Situation: lives with his mother and step father in a single family home. •Marital History: single •Children: 0 •Occupation: pt. has no job. does not work. •Education: has GED. •Parents: both alive, divorced •Siblings: one older sister •Sexual Orientation: heterosexual. •History of Abuse: reports emotional abuse •Legal: pt. denies FAMILY PSYCHIATRIC HISTORY: pt. reports grandmother has depression. father has addiction to gambling. pt. denies family history of substance use. PAST MEDICAL HISTORY:
Axis I: MDD, mild; Anxiety D/O NOS, smoker.
Opiod use disorder.
Diagnoses attached to this encounter:
• Major depression [ICD-10: F32.9], [ICD-9: 296.20], [SNOMED: 370143000]
• Opioid use [ICD-10: F11.90],
• Medications as detailed below:.
• 1. Zoloft 25 mg po daily
• 2. Wellbutrin XL 150 mg po daily
• 3. Follow-up Appointment: in 4 weeks.
• 4. Psychoeducation: Reviewed the symptoms with patient and compared with symptoms of other psychiatric disorders..
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.).
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