NU 643 Comprehensive Case Study: Week 4
NU 643 Comprehensive Case Study: Week 4
School of Nursing, Regis College
NUR643: Advanced Psychopharmacology
Month Day 27th, 202023
NU643 Comprehensive Case Study: Week 4
Introduction and Differential Diagnoses
Differential Diagnosis List
1. Insomnia Cod.780.52
2.PTSD.309.81
3 Generalized Anxiety disorder: F41.1
Rationale; Pertinent Positive, Negatives, DSM5 Criteria
Generalized anxiety (300.2 (F41.1): This is the condition where a person find it difficult to sleep. Due to some restlessness. (Ji et.al,2019) Most of the time due to lack of sleep, it could cause depression and other health problems such as irritability, restlessness, and lack of concentration which can lead to palpitation. Sleeplessness In appropriate excessive fear. This problem sometimes started when the person is young.
PTSD: It is characterized as over stress. This is in the same line with generalized anxiety disorder. Post traumatic stress symptoms including irritability, agitation, severe anxiety, social isolation, and emotional detachment. The patient has a history of PTSD, and we can confirm that he is suffering from PTSD.
AD: This is defined by excessive worry that has carried on occurring for more for more than half a year. (Godwin,2019) This problem is due to worry and anxiety disorder The patient displayed the signs of PTSD.
Narrative Mental Status Exam:
A patient is 19 years old years old Caucasian woman who left home to leave at the dorm for her study. She stated that she cannot sleep, cry often, heart race, SOB, sweating. Difficulty sleeping, dizziness, SOB, She stated that this symptoms are continuous every day. It worsens when she has classes, and this made her avoid going to some of her classes according to her. This made her to Isolate herself socially and avoid going to classes sometimes. She relieves her symptoms by drinking and smoking marijuana.
Variations from Normal and Monitoring Needs
The are variation based on the severity of the disorder. Though she denies Suicidal thoughts is common in individuals suffering from disorder which comes with social isolations. Patients are more susceptible to suicide and risk because they have an anxiety disorder. Suicide risk has in the people that are suffering from anxiety disorder and social isolation has more suicide risk than either alone (Wiebenga,2022) This patient is often upset, avoiding classes due to social phobia . My concern that needs to be monitored with is young patient is that of his coping mechanism during this episode. He uses alcohol and marijuana trying to cope with her anxiety of attending classes. This area needs to be monitored and help her to get out of such life style before it rule her future.
Assessment
The generalized disorder scale is the most important assessment tool for anxiety. The general anxiety disorder screens are to examine the severity in a patient level of individual with 7 items. As long the patient is feeling restlessness, insomnia, and irritability social isolation, which makes diagnosis of anxiety disorder substantial. According to the case study her problem did just started . She has problem living home, which could be separation anxiety
Primary Diagnosis and Coding
Coding of the GAD is (F41.1 ) It involves the symptoms for six months. Pt don’t sleep well, restlessness, feeling irritable, social isolation, crying, and anxious of attending her classes, drinking alcohol and marijuana for her coping mechanism.
Plan of Treatment and Rx
Through the symptoms the patient is displaying if left untreated it could result in something serious. In this case, the patient will benefit most in cognitive behavioral therapy and some medications. A combination of it will help this patient get her life together.
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Pharmacological Intervention and Rx
Alprazolam, which is the class of benzodiazepine.
Nonpharmacologic Interventions
Mindfulness therapy, and relaxation techniques which is Cognitive based therapy.to tolerate the disease of anxiety.
Patient Education
It is recommended that to try home relaxation techniques, if persist seek profession help to include the CBT therapy
Safety Plan:
The patient should be offered 988 suicide and class lifeline for suicide related inquiries. Coping mechanism.
Follow-up and Outcomes:
To come to the clinic 5 weeks post intervention to examine progress after the CBT therapy. Close monitoring with anxiety disorders every 102 weeks.
Billing Code for visit:
90792-WITHIN 45 MINS TO AN HOUR.
Approach to Care and Clinical Guidelines
The clinical guideline explain the provision of relief for psychological symptoms and reduce the disease process. Support through CBT therapy, pharmaceutical intervention and to include the important helpful process to her treatment plans.
References
Godwin Hywind’s & Hirsh (2019) GAD worry attention to treat, A systemic review. Clinical psychological review,54,107-122.
Ji Bastianich, Hale,I.& Grandner (2019) Disassembling insomnia symptoms and their association with depressive symptoms. Sleep health 376-381
Price M Legrand’s A.C. Brier Z.M. & Heberr -Dufresne 2019) the symptoms of the center. Journal of psychiatric research,109,52-58.https: dpi.org/10.1016j-jpsychires.2019-016.
