PTSD: NRNP 6665: PMHNP Care Across the Lifespan I

NRNP 6665: PMHNP Care Across the Lifespan I

 

Subjective:

CC (chief complaint): flashbacks, involuntary memories, and nightmares

HPI: The patient who is 42 years old for the last 4 weeks has been experiencing intrusion feelings. He is a veteran who served in Afghanistan for 3 years. He has been experiencing flashbacks, involuntary memories, and nightmares, which have resulted in poor sleep and irritability.

Substance Current Use: 3 beers weekly and uses nicotine

Medical History:

 

  • Current Medications: Vitamin D supplements
  • Allergies: No known allergies
  • Reproductive Hx: No history of STIs

ROS:

  • GENERAL: No increase or reduction of weight, no fever or chills or fatigue
  • HEENT: No eye pain or redness, no vision changes, no sour taste in the mouth, no sore throat no congestion no sneezing
  • SKIN: Skin is warm to touch, no rash, no itching
  • CARDIOVASCULAR: denies chest pain, edema, or palpitations,
  • RESPIRATORY: No cough or sputum, no shortness of breath, no wheezing
  • GASTROINTESTINAL: No constipation, no diarrhea, no abdominal pain no anorexia
  • GENITOURINARY: No changes in urine pattern, no color, no incontinence
  • NEUROLOGICAL: Denies dizziness, tingling no headache no paralysis no tingling or weakness no confusion
  • MUSCULOSKELETAL: no joint pain, no stiffness no weakness of the joints
  • HEMATOLOGIC: no bleeding, no bruising, no history of anemia
  • LYMPHATICS: has no swollen nodes, has no history of splenectomy
  • PSYCHIATRIC: involuntary memories and flashbacks
  • ENDOCRINOLOGIC: no history of sweating, heat or cold intolerance, No polyuria or polydipsia

Objective:

Physical exam

Vitals: 95.2, pulse rate 70, Respiration 18, B/P 126/80

Psychiatric: Seems lost in thought, has flashbacks, and involuntary memories    

Diagnostic results:

Assessment:

DSM-5 criteria indicate that the patient has intrusion symptoms (involuntary memories, nightmares, and flashbacks) which are one of the four cluster symptoms in PTSD. The other cluster three symptoms include avoidance symptoms, arousal and reactive symptoms, and negative thoughts and feelings (Parekh & Ranna, 2017)

Mental Status Examination:

Mental Status Examination: He is a 42-year old Caucasian male. He cooperates during the session and seems attentive throughout out. He is unkempt with uncombed hair and shabbily dressed. He has normal motor activity during the interview. He does not use correct facial expressions and gestures. He sometimes seems lost in thought. He denies any suicidal thoughts

Diagnostic Impression: Post traumatic stress disorder

Post-traumatic stress disorder (PTSD) is the primary diagnosis. PTSD refers to a psychiatric disorder among individuals that have experienced atraumatic events in their life such as violence, war, personal assault, or rape. According to Ghaffarzadegan (2016) between 11 and 20 percent of US, the military deployed to Iraq and Afghanistan suffer from PTSD. The four cluster symptoms that patients must present with are avoidance symptoms, intrusion symptoms, arousal, and reactive symptoms as well as negative thoughts and feelings.

Differential Diagnoses

Acute stress disorder

Acute stress disorder refers to a condition that develops within a month of experiencing a traumatic event (Meiser-Stedman et al., 2017). The events might include death, a threat to death, and injury to self or others. The traumatic events case fear, helplessness, and horror

Adjustment disorder

Adjustment disorder refers to a mental health illness where individuals experience emotional or behavioral symptoms in response to identifiable stressors (O’Donnell et al., 2017). The stressors must have occurred three months before the beginning of the symptoms. The stressful episodes result in strained relationships at work, school, and home.

Generalized anxiety disorder

Generalized anxiety disorder refers to a disorder whose characteristics include excessive anxiety and worrying which are difficult to control (American Psychiatric Association, 2013). The disorder causes distress, which may last for more than six month

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