NRNP 6635 Week 4 Anxiety Disorders, PTSD, and OCD Paper

NRNP 6635 Week 4 Anxiety Disorders, PTSD, and OCD Paper

Subjective:

Biodata: Ms. Zahara Williams, 23-year-old female. She is an associate of arts degree and works for amazon warehouse. She is currently single.

CC (chief complaint): feelings of shame, embarrassment and feelings of loss of control.

HPI: Z.W. is a 23-year-old female patient who presents herself for an evaluation. The patient provides some very vital information during her assessment. According to the mental health checklist, the patient checks both boxes for feelings of shame, embarrassment and feelings of loss of control. The patient reports that she has had these feelings for the past 6-7 years and that these feelings are strong. These feelings started around the same time she started pulling her hair.

NRNP 6635 Week 4 Anxiety Disorders, PTSD, and OCD Paper

She reports that the hair pulling was mostly due to feelings of nervousness. The patient reports that this was something she did subconsciously and it was only after her coworkers informed her that she noticed this habit. She began plucking the hair of the right eye first before she proceeded to pluck hair from the left eyebrow. After she was done with the eyebrows is when she started plucking hair from the scalp. She says that she started this as if she was playing, and was shocked when her coworkers noticed areas of baldness on the scalp. The patient says that this has greatly affected her as she is now embarrassed of her bald head. This has led her to wear a wig as she does not want to be seen with a bald head.

The patient also reports that she has certain rituals. She always switches on the lights on and off 11 times. She also does this whenever she has to unplug her drier or mixer. She says that this is something she has to do and she factors it into her time. She patient also adds that she is preoccupied with thoughts of cats and how they carry diseases.

Past Psychiatric History:

  • General Statement: The patient has no known past psychiatric
  • Caregivers (if applicable): N/A
  • Hospitalizations: No history of hospitalization due to mental health problem
  • Medication trials: N/A
  • Psychotherapy or Previous Psychiatric Diagnosis: No history of past mental health diagnosis

Substance Current Use and History: She is currently not taking any substances.

Family Psychiatric/Substance Use History: Mother has a history of anxiety. Brother uses cannabis.

Psychosocial History: She has no legal history and has not been arrested before. She was born and raised in Jacksonville. She is an associate of arts degree and works for amazon warehouse. She recalls having a difficult relationship with her mother.  She is not in a relationship.

Medical History: Diabetic ever since she was five years old

  • Current Medications: None
  • Allergies: She has no known drug, environmental and food allergies.
  • Reproductive Hx: Patient reports that she is a lesbian

ROS:

  • GENERAL: The patient is generally in good health. Denies fatigue, fever, chills or night sweats. No body weakness reported. No recent history of changes in weight.
  • HEENT:

Head: Atraumatic, normocephalic. No lumps, bumps or bruises observed.

Eyes: No visual problems. No blurred vision or double vision recorded. Sclerae is white.

Ears, Nose and Throat: No ear pain, hearing loss, ringing earsreported. No sneezing, congestion or runny nose reported. No sore throat, dysphagia or hoarseness reported.

  • SKIN: No rash or itching reported.
  • CARDIOVASCULAR: Patient reports no chest pain or discomfort. The patient denies palpitation or history or heart murmurs. No arrythmias and edema in lower extremities.
  • RESPIRATORY: Denies cough, no sputum production. Denies shortness of breath. Reports no difficulty in breathing with exertion.
  • GASTROINTESTINAL: No history of anorexia, vomiting, nausea or diarrhea. No abdominal pain.
  • GENITOURINARY: No burning sensation when urinating. Menarche at 12 years. Last Menstrual period was 2 weeks ago.
  • NEUROLOGICAL: Cear memory, reports no recent changes in cognitive abilities.
  • MUSCULOSKELETAL: No history of muscle pain, back pain, joint pain or stiffness.
  • HEMATOLOGIC: No history of anemia. Denies bleeding or bruising easily.
  • LYMPHATICS: Denies history of spelenectomy. No lymphadenopathy.
  • ENDOCRINOLOGIC: No reports of heat or cold intolerance. No current or past history of polyuria or polydipsia.

Objective:

Physical exam:

Vital Signs: The patient weighed 130 lbs. and her height was 5’2”. Her pulse rate was 86 beats per minute, her blood pressure was 112/64 mmHg while her temperature was recorded to be 97.5.

General: A&O x3. Well dressed. Calm and cooperative.

Lungs: Lung sounds CTA. Bilaterally equal rise and fall of the chest.

Heart/Peripheral vascular: No galops, murmurs or rubs. S1, S2 present. No S3. Edema in lower extremities. 2+ bilateral radial pulses. 1+ bilateral pedal pulses.

Diagnostic results:

  1. Blood sugar – 190 ml/dl
  2. Fasting blood sugar – to be determined
  3. Oral glucose tolerance test – to be conducted

Assessment:

Mental Status Examination: On examination, the patient is neat and well kempt, conscious, is attentive, normal motor functions and speech. The mood and affect are congruent. She has poor insight into her condition. The patient is well oriented in time, place and person. Her level of concentration is normal. Her immediate, short-term and long-term memory are intact. The patient’s intelligence level is okay as she is able to correctly answer a few general knowledge questions posed by the psychiatrist. Her judgement is also not affected.

Differential Diagnoses:

  1. Obsessive Compulsive Disorder – Treatment of OCD is usually challenging due to the fact that clinicians fail to make a diagnosis early enough. Whenever a clinical is assessing a patient with anxiety or mood disorders, it is always important to include OCD as one of the differential diagnosis (Brock & Hany, 2020). Other compulsive disorders should also be considered. Example are trichotillomania and neurodermatitis.
  2. Trichotillomania, a chronic impulse disorder characterized by the irresistible urge to pull out one’s own hair. This results in noticeable hair loss. The pulling of hair usually occurs in any area where hair grows. The areas that are most commonly affected are the eyelashes, the eyebrows and the scalp. This disorder is classified under obsessive compulsive and related disorders in the American Psychiatric Association’s DSM-5 (2013). The criteria includes recurrent pulling out of hair that results in hair loss, physical distress and impairment of social functioning as a result of hair pulling, failure to attribute this hair pulling or loss to another medical condition, and failure to explain the hair pulling by the symptoms of another mental disorder (APA,2013). It is believed that this can trichotillomania can be a result of it being a coping mechanism for stress.
  3. Non suicidal self injurious behavior (NSSIB). This is evidence by the patient plucking off her hair.
  4. Major Depressive Disoder – The third differential diagnosis draws from the fact that patients with OCD are usually at risk of committing suicide, hence warranting assessment for major depressive disorder (MDD). MDD is also a frequent comorbid disorder encountered in patients with OCD. The DSM-5 criteria for diagnosing major depression includes depressed mood, reduced interest and pleasure in almost all activities, altered eating habits leading to either weight gain or weight loss, sleep disturbances, reduced energy levels, diminished concentration levels and psychomotor agitation (Zangani et al., 2021)

NRNP 6635 Week 4 Anxiety Disorders, PTSD, and OCD Paper Plan

  1. Tranquilizer – Administer Valium (Diazepam) 2 mg for the NSSIB. Start the patient on cognitive behavioral therapy to help manage her negative thoughts and behaviors.
  2. Uncontrolled Diabetes – Initiate the patient on metformin 500mg twice a day. Monitor the patient for metabolic acidosis. Foot care to prevent diabetic ulcers. Monthly monitor for serum blood sugar level. Consider adjunct therapy should metformin fail. Monitor the patient’s blood pressure regularly. Monthly Comprehensive Mentabolic Profile to determine the risks for cardiovascular events.

Reflections: If I were to conduct the session all over again, I would like to engage an informant, such as the patient’s mother, to give me further insight into the patient’s condition. I would further inquire about any traumatizing incidences that the patient has witnessed or experienced in the past that has led her to be so preoccupied with the thought of cats. Asking about recent drug use is also key to help in ruling out substance induced anxiety disorder.

Legal/ Ethical Considerations.

Some of the key ethical/ legal considerations to consider while assessing a psychiatric patient other than autonomy, confidentiality and consent include conflict of interest, therapeutic misconceptions, placebo related considerations, vulnerability, exploitation, operational challenges among other considerations (Bennett et al., 2017). It is important to seek informed consent from the patient before commencing on any form of treatment. Conflict of interest is demonstrated in an instance where a health care professional has an inappropriate relationship with his or her patient or shares a patient’s personal information with another professional without consent to do so.

Vulnerability expounds on the professional offering the best services to his or her patient without exploiting them, understanding that their patient is vulnerable as a result of his mental health status. Respect is another key ethical consideration. Providing the highest quality care to all patients without favor or discrimination of social class, race, political or religious affiliation is something that every health professional must strive to do.

Health Promotion and Disease Prevention.

In assessing health promotion and disease prevention factors, it is important to take into consideration the patient’s age, ethnic group and other predisposing factors. Health promotion measures that raise awareness concerning mental health issues, improving mental health literacy, reducing stigma associated with mental health and maximizing individuals and collective mental health and well-being.

These can be achieved by providing the necessary information and education about mental health, engaging in activities that aid in the promotion of mental health, carrying out initiatives that raise the awareness of mental health among the community and working towards reducing both discrimination and stigma towards people with mental health challenges (Ramchand et al., 2017). These initiatives and programs can be carried out by the government, non-profit organizations and campuses to raise awareness about the importance of mental health. Engaging young people in activities such as hikes and seminars can go a long way in promoting mental health awareness while also providing a platform to share their challenges and ways to overcome them.

Conclusion

The mental health status of an individual is particularly important as it affects their overall well-being. The recent surge in mental health related issues has led to a demand in the need to raise awareness concerning the issue. Obsessive-compulsive disorders and other major mental health issues are some of the many challenges plaguing a majority of individuals today, and especially the young population. Every one of us has a major part to play in raising the awareness of mental health issues. In the presented case of 23-year-old Ms. Zahara Williams, she is likely suffering from Obsessive-Compulsive Disorder, a type of psychiatric illness that is associated with recurrent persistent thoughts that can be intrusive and repetitive behaviors in connection to the thoughts. Assessment and management of the condition in a timely manner can help relieve the symptoms.

NRNP 6635 Week 4 Anxiety Disorders, PTSD, and OCD Paper References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Washington, DC: Author
  • Bennett, B., McDonald, F., Beattie, E., Carney, T., Freckelton, I., White, B., & Willmott, L. (2017). Assistive technologies for people with dementia: ethical considerations. Bulletin of the World Health Organization, 95(11), 749–755. https://doi.org/10.2471/BLT.16.187484
  • Brock, H., & Hany, M. (2020). Obsessive-Compulsive Disorder. In StatPearls. StatPearls Publishing.
  • Fawcett, E. J., Power, H., & Fawcett, J. M. (2020). Women Are at Greater Risk of OCD Than Men: A Meta-Analytic Review of OCD Prevalence Worldwide. The Journal of Clinical Psychiatry, 81(4), 0-0. https://doi.org/10.4088/jcp.19r13085
  • Ramchand, R., Ahluwalia, S. C., Xenakis, L., Apaydin, E., Raaen, L., & Grimm, G. (2017). A systematic review of peer-supported interventions for health promotion and disease prevention. Preventive Medicine, 101, 156-170. https://doi.org/10.1016/j.ypmed.2017.06.008.
  • Zangani, C., Giordano, B., Stein, H. C., Bonora, S., D’Agostino, A., & Ostinelli, E. G. (2021). Efficacy of amisulpride for depressive symptoms in individuals with mental disorders: A systematic review and meta‐analysis. Human Psychopathology: Clinical and Experimental, e2801. https://doi.org/10.1002/hup.2801