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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 (CASE STUDY TRAINING TITLE 21) 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. – select a specific video case study (VIDEO TRAINING TITLE 82- THE LINK FOR THE TRANSCRIPT AND VIDEO SAMPLE IS BELOW) 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. THE LINK TO GET THE CASE STUDY VIDEO TRANSCRIPT *****Training Title 82. . (2017).[Video/DVD] Symptom Media. THE LINK TO THE VIDEO. YOU MIGHT BE ABLE TO SEE A SAMPLE OF THE VIDEO *****THE CASE HISTORY REPORT- ADDITIONAL INFORMATION ON THE CASE. -Training Title 82: Name: Lisa Pittman Gender: female 29yearsold P-101 R20 BP178/94 Ht5’6 Wt140lbs Background: Lisa is in a West Palm Beach, FL (Florida) 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 , albumin ; 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, the perpetrator being her father, who went to prison for the abuse and drug charges. She is estranged from him. Her mother lives in Alabama and has a history of anxiety and benzodiazepine use. Her older brother has not had contact with family in the last 10 years and has a history of opioid use. She Sleeps 4-5 hrs, her appetite has decreased, prefers to get high instead of eating. Allergies: amoxicillin. She is considering treatment for her Hepatitis C+ but needs to get clean first. -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. -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: (ATTACHED) ***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 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 (., socioeconomic, cultural background, etc.). Learning Resources NRNP 6635: Psychopathology and Diagnostic Reasoning American Psychiatric Association. (2013). Substance related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi: Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer. Chapter 20, Substance Use and Addictive Disorders Chapter , Adolescent Substance Abuse