https://lmscontent.embanet.com/Media/RC/NU665C/NU665C-w10-m05/
Above is the link for the case study. Please follow the prompts as directed.
Please answer the questions below:
After viewing the patient interactive information, address the following:
1. What important information is missing from the case study?
2. Discuss normal developmental achievements and potential vulnerabilities.
3. What precipitating factors could be contributing to the current symptoms?
4. What is the differential diagnosis?
5. Describe the etiology of the primary diagnosis.
6. How should physiologic complications be monitored and assessed?
7. What are the usual nonpharmacologic therapies that would help?
8. What medications could help and why?
9. Identify safety risks and how they should be dealt with in the treatment plan.
Include current supportive evidence in your responses to the questions above using two required resources from this week’s materials and one new resource. National guidelines should also be considered with treatment plans.
See the transcript below. But there are still more information in the link so follow the link.
Transcript
Scenario:
Lillian is a 72-year-old, African American woman living in a rural farming county with her husband and two grandchildren. She comes today accompanied by her husband and 20-year-old granddaughter who have been concerned about increasingly odd behaviors. Lillian has had previous diagnoses of anxiety and obsessive-compulsive disorder. She says she first started hand washing behaviors and counting around the age of 8 years old. She has spent a great deal of her life in and out of psychiatric hospitals this is where she said she started smoking cigarettes. Lillian said that she has smoked over a pack a day for most of her life and had switched to using nicotine patches and gum in her middle 50s.
Nicotine gum is a type of chewing gum that delivers nicotine to the body. It is used as an aid in nicotine replacement therapy (NRT), a process for smoking cessation. The nicotine is delivered to the bloodstream via absorption by the tissues of the mouth. The pieces are usually available in individual package come in various flavors. Individuals are directed to chew the gum until it softens, and the gum is then “parked,†or tucked, in between the cheek and gums chewed again until taste returns and is then re-parked in a new location. These steps are repeated until the gum is depleted of nicotine (about 30 minutes as the craving dissipates.)
Using NRT supported Lillian to stop smoking; however, she said that to this day she still feels anxious about chewing the gum and has often expressed the desire to cease altogether. She has been counting how many times she chews and has little time for much else.
Lillian disclosed that she was chewing a significantly high amount of gum and was often going to bed chewing it and had woken up choking on the gum at night. Lillian also explained that she believed that the gum chewing over the past few years was problematic, and that she was expecting to be diagnosed with lung cancer at her PCP appointment next week. She has been counting how many times she has been coughing on gum and is alarmed. Lillian became very anxious when speaking about this. She explained that she thought nicotine could give her cancer.
Lillian’s husband has been worried about her dose of antianxiety medication not being sufficient or that she has not been taking it. He has found her way out in their soybean fields counting the rows. Recent stressors are the death of a close friend from COVID-19 and her granddaughter’s plans to move out next month to go to an out of state university. She has a family history of alcohol use disorder (father) and anxiety (mother). Son had treatment for opioid use disorder (OUD) but has been in recovery for 1 year. She has a grandson who she can’t see because there is a restraining order against her son and the rest of her family.
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