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.,Provide 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 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 1,The 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 tests,The childs 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 2,According 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 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 patients 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 3,Although 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 patents 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 patients 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.