Question

You have a 38 y/o male patient with a history of the symptoms below. He is married and has children. He also has a military background and served in a combat unit which saw a great deal of action. He was active-duty from ages 21 to 31 when he retired from the military d/t PTSD and possibly other undiagnosed mental illnesses. Since his retirement from the military, he has had trouble sleeping, aggressive outburst, he has withdrawn from his family and friends, often misses work and stays in bed or watches TV all day, he no longer enjoys wood-working in his workshop which is something he has done for years; and he has expressed frustration with his low libido. He has started drinking heavily, approx 12 pack nightly, and sometimes 1/5 of vodka straight. He has also stared smoking cannabis daily for the past 3 months. He has 2 young children and has been married since he was 28 years old.

1) What other diagnosis might you add to his PTSD diagnosis (choose 2)? Using your text, what criteria do you think he has that would justify the other diagnosis you give him?

2) What medications (give names and drug class) would you put his pt on. Keep in mind he is worried about low libido. Give explanations as to why you chose the medication you chose.  

3) Based on the known diagnosis of PTSD; write 5 questions that you must ask when assessing for and verifying his PTSD diagnosis.

4) Based on your other proposed or ruling out diagnosis, write 5 specific assessment questions you would ask to determine if he should be diagnosed with the new mental illnesses. (5 total for all r/o or comorbid diagnosis). Use your DSM-5 criteria to ensure your questions are specific enough.

5) Write nursing interventions for this patient if he was admitted for an in-patient hospitalization due to verbalizing suicide plan to shoot himself in the chest one his wife goes to work and the kids are at school.

6) What is your discharge goal for this patient if he were admitted for a suicide plan as above? (write a complete answer)

7) If he was suffering severe anxiety what medication would you send him home on? Write name and class of drug and why you chose it.

8) Due to his heavy alcohol and drug use, what psychiatric diagnosis (not nursing) do you think he would receive related to those? How did this knowledge affect your medication choice?

9) Choose one of the diagnosis you chose to r/o or that could be a co-morbidity, and list all of the behaviors and s/sx that are similar to PTSD. How will you differentiate to r/o or diagnose it as a co-morbid diagnosis?

Answer 1

Ans) 1) To diagnose post-traumatic stress disorder, your doctor will likely: Perform a physical exam to check for medical problems that may be causing your symptoms. Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them.

2) Medications that help PTSD sufferers include serotonergic antidepressants (SSRIs), like fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), and medicines that help decrease the physical symptoms associated with illness, like prazosin (Minipress), clonidine (Catapres), guanfacine (Tenex), and propranolol.

3) Questions: for PTSD

• Repeated, disturbing, and unwanted memories of the stressful experience?

• Repeated, disturbing dreams of the stressful experience?

• Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?

• Feeling very upset when something reminded you of the stressful experience

• Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?