1. Psych NP Didactic Assignment 2 Essay.
Psych NP Didactic Assignment 2 Essay. Didactic Discussion 2 Post, Respond, Provide
Evidence: Didactic Discussion 2 Post to the cases below, using the questions provided for
each case (due Week 1). Developing comprehensive treatment plans is one of the
advantages of private practice. Generate letter(s) of denial of payment, as if you were the
insurer, to at least one of your peers based on their initial posts (due Week 2).Psych NP
Didactic Assignment 2 Essay. Ask your peer for additional information, and to justify the
rationale for treatment approach selected, etc. Letters of denial of payment are one of the
challenges of private practice.ORDER A PLAGIARISM-FREE PAPER HEREProvide well-
reasoned rationale to refute the denial of payment letter from your peer, including current,
peer-reviewed references (minimum of 2), due Week 3. Cases: Hepatitis C &
Methamphetamine addiction- A twenty-six-year-old incarcerated lesbian female from South
America. She reports that she began as a child using the coca leaf, but eventually graduated
to cocaine, and finally methamphetamine. She reports that she has been ostracized and
rejected by her family secondary to her sexual orientation. She reports that she had been
“speed balling” on a few occasions, and it was through sharing needles, that she contracted
hepatitis C. At present, she does not have any insurance, and cannot afford consultation
with the gastroenterologist to have her hepatitis C treatment. HIV & Anxiety disorder as
well as Panic Disorder- A thirty-eight-year-old Vietnamese male who contracted HIV from
an unknown source. He lives with his older sister who is very concerned for him. He reports
that he is currently taking the BIKTARVY regimen, and currently has an undetectable viral
load. He states that one day he would like to be in a relationship but fears that people will
reject him once they learn of his HIV status. He is also reported multiple panic attacks, in
which he feels as if he is going to die. Metabolic syndrome & Schizophrenia- A thirty-two-
year-old Puerto Rican male who was diagnosed with schizophrenia age 19. He is currently
homeless after being evicted from a low-income apartment complex for setting fires and
waste paper baskets. Currently weighing 230 pounds. His current medication regimen
includes Metformin, Zyprexa, and lisinopril. Psych NP Didactic Assignment 2 Essay.His
primary care provider has informed him during his last visit that he also has dyslipidemia,
is considering starting him on an HMG Co-A reductase inhibitor. Questions to address in
your main posting: Discuss the process of diagnostic differentiation (be specific about what
your assessment would include specific to the diagnoses provided) - how would you
determine symptoms belonging to each condition and how would you work with symptom
overlap? Describe how the current setting in which the child lives would impact your
2. care/treatment plan. Discuss physical assessments you would make with the client- include
a description of any referrals you would consider (and what is the rationale for those
referrals?). List laboratory testing and rationale for selected tests. Discuss concerns with
existing pharmacotherapeutic approaches and discuss any changes you would consider-
include rationale for any changes you may suggest. Tell us about the psychotherapeutic
approaches you would use with this client. Specifically, what psychotherapy will you use,
and why? Will you make referrals for any type of specialized psychological testing? Will you
refer the individual to group psychotherapy? Again, all responses should be evidence-based.
Included discussion of possible strengths and weaknesses of each client. Describe discharge
criteria-that is, what is it that the client must be able to successfully do, achieve, or
complete, for you to discharge them from your current patient load?Case Study 1The initial
evaluation of this patient will involve a thorough history taking that focuses on the risk
factors for acquisition of hepatitis C infection (history of injecting drug use, alcohol intake),
underlying medical comorbidities, a psychiatric history, a history of previous treatments
and clinical manifestations attributable to hepatitis C and methamphetamine addiction. A
physical assessment for methamphetamine addiction will include; cardiovascular for
tachycardia, and chest pain due to cardiac infarction and ischemia. Respiratory for
wheezing and barotrauma, CNS for headache due to cerebral edema, vasculitis, vasospasm,
or hemorrhage (Grebely et al., 2016). GIT for severe abdominal pain and the skin for
cellulitis or abscesses.Psych NP Didactic Assignment 2 Essay.The physical assessment of for
hepatitis C infection will include the hands for palmar erythema and clubbing, abdomen for
abdominal bruits, hepatosplenomegaly, a periumbilical hernia, ascites and caput-medusae,
musculoskeletal for ankle edema and integumentary for petechiae, jaundice, spider nevi and
excoriations due to pruritus.Laboratory testsComplete blood count-platelet count (to assess
for the patient’s electrolyte and renal function)Chest x-ray- to assess the pulmonary status
of patients with chest pain or pulmonary symptoms.TFT-to ascertain hepatitis C infection
extrahepatic manifestationMyoglobin levels- to rule out rhabdomyolysisLiver Function
Tests-to check for serum albumin, INR, direct bilirubin, and serum bilirubin concerning
liver dysfunction.HCV RNA- to determine the viral load, confirm a diagnosis and establish a
baseline for treatmentThe child’s current environment influences her negatively due to
stigmatization. Therefore, before initiating treatment, it will be necessary to educate her
and her loved ones/family on how stigmatization due to sexual orientation worsens
outcomes. She could also benefit from transfer to a treatment shelter/center. A major
pharmacotherapy issue in managing this patient would be the impact of substance use
(Methamphetamine addiction) on adherence and reinfection (Grebely et al., 2016). The best
psychotherapeutic approach for this patient is group CBT. When patients with addictions
comprehend why they act or feel in a specific manner and how the actions and feelings
result in substance use, they are well equipped to overcome addiction. The patient should
be able to discard all Methamphetamine related items and contacts, restore positive
relationships with her family members and friends (Grebely et al., 2016).Psych NP Didactic
Assignment 2 Essay.Case Study 2According to the American Psychological Association, most
patients with HIV are at risk of other disorders such as PTSD. In this case, anxiety may
present in several ways but the most distinguishing signs and symptoms from HIV are; a
3. racing heart, nausea, shortness of breath, tingling/numbness, and a choking sensation. A
thorough history to determine the symptoms of anxiety should assess for the frequency,
onset, and severity (Chaudhury, Bakhla & Saini, R. (2016). History will also include family
history, stressful life events, use of alcohol, and medications. It will also be essential to rule
out specific neuropsychiatric disorders, which are common in individuals diagnosed with
HIV such as delirium and HIV-associated dementia. Several HIV medications cause anxiety
as a potential side effect (interleukin-2, efavirenz, corticosteroids) thus, it will be necessary
to ascertain that the anxiety does not occur because of the current medications taken by the
patient (Chaudhury, Bakhla & Saini, R. (2016). The most significant tests during this visit
are; kidney and liver functioning tests to assess for the renal functioning since metabolism
and elimination of the patient’s current drug regimen occur in the liver and urine
respectively.Psych NP Didactic Assignment 2 Essay.Anxiety is an example of a grade 2
adverse reaction in patients taking BIKTARVY regimen. Evidence suggests that once
patients start to experience anxiety, it is important to discontinue BIKTARVY. The best
psychotherapeutic approach for this patient would be group CBT to prevent any emerging
concerns about potential interactions with drugs. Group CBT will encourage peer support
and social networking (Chaudhury, Bakhla & Saini, R. (2016). It will also promote the
training of coping skills and techniques for relaxation. The patient must report a significant
decrease in the intensity and frequency of panic attacks with full symptoms remission and
optimal return to a premorbid functioning level.Case Study 3Although there exists a
significant overlap of symptoms when diagnosing metabolic syndrome schizophrenic
patients, differentiating criteria is: abdominal obesity of (≥ 40 inches (males) and 35
(females), increased levels of triglycerides (150 mg/dL or greater), high blood pressure
(130 / 85 or greater) (Burghardt & Ellingrod, 2013). The patent’s current weight and
intake of antipsychotics impair the metabolism of glucose and increase the levels of
triglycerides and cholesterol, increasing the risk of arterial hypertension. Homelessness
worsens mental illness since it leads to behavioral and cognitive problems. For this patient,
it increases the difficulty to earn income to purchase medications or access care. Basing on
the patient’s current weight and drug regimen, Lisinopril increases the effect of metformin
and can potentially result in lower blood glucose levels (Burghardt & Ellingrod, 2013). The
suggestion to start her on HMG Co-A reductase inhibitor will improve systolic function but
will not prevent cardiac risks.Psych NP Didactic Assignment 2 Essay.
