NU 665 WEEK 3 Assignment

Complicated Pregnancy Case Study

1. How will you navigate the dynamics between Jamie and her husband during this visit?

To navigate the dynamics between Jamie and her partner, a psychiatrist must establish a setting that encourages honest talk and teamwork. This encompasses encouraging open communication by asking questions like, “How do you feel your role could best support Jamie during this time?” this is critical in ensuring collaboration without undermining Jamie’s autonomy. In addition, active listening and validating Jamie’s emotions are crucial. This can be achieved by directly addressing her fears about childbirth by saying, “I understand your concerns about managing pain during this pregnancy. Let us work together to alleviate these fears.” According to Attard et al. (2022), the equitable participation method helps reduce conflicts while creating a friendly space that benefits patients’ health. A psychiatrist should allow patients to speak their minds by asking questions about their preferences and allowing everyone to talk.

2. How would you efficiently ensure you did not miss any potential symptoms of Jamie’s?

A comprehensive and structured approach is necessary to ensure no symptoms are overlooked. This involves:

1. PHQ-9 (Patient Health Questionnaire): Use an evidence-based tool like PHQ-9 to measure how severely someone is depressed and for how long they have had these symptoms.
2. GAD-7 (Generalized Anxiety Disorder Scale): Make good use of this tool to determine specific anxiety symptoms that impact the patient’s daily life.
3. PCL-5 (Posttraumatic Stress Disorder Checklist): It can be used to look for symptoms that relate to prior trauma, especially her initial birth process.
4. Clinical Interview: Can play a significant role in looking beyond Jamie’s physical signs to discover if she experiences sleep problems, mood swings, or loss of hope.

Before making recommendations, you must read Jamie’s medical documents to determine if her treatments could hurt her. Looking at her physical signs will show what health problems might be there. Showing active empathy during conversations helps Jamie feel safe to discuss her medical history and situations openly. In a nutshell, this method integrates her clinical context with screening results for a holistic assessment.

3. List 3-5 differential diagnoses for Jamie, including diagnostic codes.
4. Posttraumatic Stress Disorder (PTSD) – F43.10: Following her traumatic birth, Jamie experiences distressing thoughts combined with severe anxiety. Her symptoms fulfil PTSD criteria because they started right after her traumatic birth experience (Darwin et al., 2021). PTSD therapy will decrease Jamie’s unreasonably high delivery fears.
5. Generalized Anxiety Disorder (GAD) – F41.1: A Generalized Anxiety Disorder diagnosis is appropriate because Jamie experiences ongoing concerns about pain relief and her baby’s health. Jamie’s increased stress during pregnancy, combined with her continued fears related to pregnancy, effectively demonstrates Generalized Anxiety Disorder.
6. Major Depressive Disorder (MDD), Recurrent, Moderate – F33.1: The symptoms of moderate depression include crying spells during pregnancy, plus the patient’s lack of pleasure and absolute despair (Darwin et al., 2021). This diagnosis shows that treating Jamie’s condition needs to look at both her earlier life events and current stressors.
7. Substance Use Disorder (in remission) – F11.21: Jamie’s history of opioid misuse and ongoing treatment with buprenorphine/naloxone point to a substance use disorder in remission. Her long-term wellness depends on ongoing medical check-ups and helps her stay on her path to recovery.
8. Adjustment Disorder with Anxiety – F43.22: Jamie’s emotional problems during her pregnancy and fears surrounding childbirth match the symptoms of an adjustment disorder. Her emotional diagnosis focuses on the temporary issues she faces during this period.
9. Of your differentials, which diagnoses would you, the PMHNP, choose as a primary diagnosis to work on for today’s session? Provide rationale (1-2 paragraphs)

Primary Diagnosis: Posttraumatic Stress Disorder (PTSD) – F43.10

Rationale: The symptoms Jamie exhibits most strongly indicate manifestations of PTSD. These include repetitive mental intrusions coupled with purposeful avoidance patterns. Additionally, heightened physiological states are triggered by her distressing childbirth experience. Addressing PTSD as the primary diagnosis is critical, as it exacerbates comorbid conditions like anxiety and depression, further affecting Jamie’s emotional well-being during pregnancy. The combination of trauma-focused treatment through EMDR and properly prescribed medications allows Jamie to experience symptom relief in PTSD. This treatment path both alleviates childbirth anxiety and enhances maternal-fetal attachment, which leads to better pregnancy outcomes combined with emotional stability.

5. Imagine Jamie wants to hear more about pharmacologic treatment options. In the table below, fill out your top three to four medication choices.

 

Medication	Risks	Benefits	Side effects	Risk association to trimester
Sertraline	Potential fetal risks (Category C, weigh risk/benefit)	Effective for PTSD, anxiety, and depression	Nausea, insomnia, dizziness	Low risk in the second trimester
Buprenorphine/Naloxone	Risk of neonatal abstinence syndrome	Maintains opioid dependence remission	Sedation, constipation	Continued use based on current trimester
Hydroxyzine	Mild sedation risks	Effective for anxiety and insomnia	Sedation, dry mouth	Safe in all trimesters
Acetaminophen for pain	Minimal fetal risks	Safe for pain Management	Nausea, dizziness	Safe in all trimesters

6. What non-pharmacologic treatment options would you suggest for Jamie?

Cognitive Behavioral Therapy (CBT):  Through proven methods of cognitive behavioral therapy, Jamie can learn to recognize and overcome automatic thoughts that result from her traumatic childbirth. Reprogramming her mind will lower her stress levels while giving her effective methods to handle hard times. As Gobin et al. (2022) show, cognitive behavioral therapy both reduces PTSD problems and gives Jamie tools to manage her feelings better.

Trauma-Focused Therapy: The treatment focuses exclusively on healing Jamie’s trauma from her initial childbirth experience. Through methods such as prolonged exposure or eye movement desensitization and reprocessing (EMDR), Jamie can treat and diminish the emotional impact of her past traumatic childbirth. Through trauma-focused therapy, Jamie can address her PTSD caused by her current pregnancy with less fear and anxiety.

Prenatal Yoga or Mindfulness Practices: Research from Zhang et al. in 2023 shows that prenatal yoga and meditation help patients calm down and manage stress better, creating better overall health. Mother’s feelings about pregnancy and childbirth decrease when they practice focused mindfulness activities and yoga. Practicing mindfulness can, therefore, help Jamie develop strong bonds with her baby and feel more peaceful throughout her pregnancy.

Group Therapy for Expectant Mothers: Through support group participation, Jamie can meet other expectant mothers who share similar experiences and challenges. This sense of community provides emotional support, reduces feelings of isolation, and allows the patient to exchange coping strategies (Molloy et al., 2020). Through group therapy, Jamie gains a better understanding of her pregnancy needs, which builds her self-assurance.

7. As a PMHNP, what education would you provide Jamie about buprenorphine/naloxone use in pregnancy?

Healthcare providers view buprenorphine/naloxone as safe for treating opioid dependence during pregnancy because it helps control both mother’s and baby’s health. By shielding Jamie from withdrawal symptoms and decreasing her chance of falling back into drug use, the medication improves both mother and baby’s health (Molloy et al., 2020). Under the doctor’s guidance, regular use of this medication brings more advantages than possible risks.

After birth, the baby might show signs of withdrawal under neonatal abstinence syndrome, which is a risk factor (NAS). Neonatal abstinence syndrome can be controlled appropriately when professionals develop timely strategies to track its progression (Molloy et al., 2020). Jamie’s healthcare team will design a comprehensive delivery plan that includes neonatal care to ensure the best outcomes for both mother and baby. The patient’s treatment success depends on ongoing open communication and routine prenatal care.

8. What will be your safety plan and follow-up plan for Jamie?

Safety Plan: Keeping Jamie safe demands taking specific actions ahead of time. Ensure Jamie gets emergency help numbers for crisis support from a hotline and clinic after-hours service. Work together with Jamie to recognize what causes relapses and make special plans to prevent these situations. It is also essential to set up clear steps for the patient’s support system and treatment follow-up, plus teach her how to spot relapse patterns (Gough & Giannouli, 2021).

Follow-Up Plan: Periodic check-ups in the first trimester enable Jamie’s healthcare team to track her progress while staying ahead of possible health issues. Increase your appointment frequency when Jamie’s health issues get worse. Coordinate care with her obstetrician to ensure an integrated approach that considers both her mental and physical health. Check the results of her treatment plan with recognized tools each week and make changes to keep her well-being high throughout pregnancy (Gough & Giannouli, 2021).

References

Attard, R., Iles, J., Bristow, F., & Satherley, R. (2022). An interpretative phenomenological analysis of the experience of couples’ recovery from the psychological symptoms of trauma following traumatic childbirth. BMC Pregnancy and Childbirth, 22(1). https://doi.org/10.1186/s12884-022-05091-2

Darwin, Z., Domoney, J., Iles, J., Bristow, F., Siew, J., & Sethna, V. (2021). Assessing the mental health of fathers, other co-parents, and partners in the perinatal period: mixed methods evidence synthesis. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.585479

Gobin, K. C., Boyd, J. E., & Green, S. M. (2022). Cognitive Processing Therapy for Childbirth-Related Posttraumatic Stress Disorder: A Case report. Cognitive and Behavioral Practice, 30(1), 133–145. https://doi.org/10.1016/j.cbpra.2021.12.004

Gough, E., & Giannouli, V. (2021). A qualitative study exploring the experience of psychotherapists working with birth trauma. Health Psychology Research, 8(3). https://doi.org/10.4081/hpr.2020.9178

Molloy, E., Biggerstaff, D., & Sidebotham, P. (2020). A phenomenological exploration of parenting after birth trauma: Mothers perceptions of the first year. Women and Birth, 34(3), 278–287. https://doi.org/10.1016/j.wombi.2020.03.004

Zhang, D., Tsang, K. W. K., Duncan, L. G., Yip, B. H. K., Chan, D. C. C., Lee, E. K. P., Gao, T. T., Tam, W. H., Lam, K. Y., Tong, W. H., Bardacke, N., & Wong, S. Y. S. (2023). Effects of the Mindfulness-Based Childbirth and Parenting (MBCP) Program among pregnant women: a randomized controlled trial. Mindfulness, 14(1), 50–65. https://doi.org/10.1007/s12671-022-02046-8

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NU 665 WEEK 3 Assignment

Name: 

Date:

Please use this document for the Week 3 complicated pregnancy assignment. Questions can be answered below and do not need converted to a paper.

You will need a minimum of two scholarly references to support your work, one of which should be from a nursing journal. Scholarly references should have been published within the last five years.

Complicated Pregnancy Case Study

Jamie enters your office today as a new patient seeking a psychiatric evaluation and possible medication management. Jamie is a 37-year-old white, cis-gendered, married woman who is currently 8 weeks pregnant. Her husband, a pharmacist, is present for the session today as well. As you work through the psychiatric interview, you learn that Jamie is currently prescribed a prenatal vitamin and buprenorphine/naloxone 8mg/2mg once daily.

You learn that Jamie experienced a pelvic fracture during her first delivery which caused excruciating pain. She was prescribed opioid pain medication following the fracture, but she found that she needed the medication for longer than her physicians felt appropriate. She found it increasingly difficult to taper and/or stop taking the opioid medications, so she started purchasing opioid medications illicitly. You learn that after about 3-6 months of illicitly using opioids, her husband learned about her medication misuse and encouraged her to enter treatment. Following a discussion with her husband, who has remained supportive throughout, she went to an outpatient substance use disorder clinic and was placed on the buprenorphine/naloxone.

Jamie becomes tearful as she describes her fears surrounding giving birth again. She is plagued by the memories of the first birth. She reports she has noticed increased anxiety since learning she is pregnant. Although she states she is genuinely happy to have a second baby, she feels she cannot enjoy her pregnancy due to her worries that her pain will not be controlled during and after delivery and that her baby will be born addicted to opioids. She often finds herself ruminating on the events from the first delivery.

Case Study Questions

 

1. How will you navigate the dynamics between Jamie and her husband during this visit?

 

2. How would you efficiently ensure you did not miss any potential symptoms of Jamie’s?

 

 

3. List 3-5 differential diagnoses for Jamie, including diagnostic codes.

 

4. Of your differentials, which diagnoses would you, the PMHNP, choose as a primary diagnosis to work on for today’s session? Provide rationale (1-2 paragraphs)

 

5. Imagine Jamie wants to hear more about pharmacologic treatment options. Fill out your top three to four medication choices in the table below.

 

Medication	Risks	Benefits	Side effects	Risk association to trimester

6. What non-pharmacologic treatment options would you suggest for Jamie?

 

7. As a PMHNP, what education would you provide Jamie about buprenorphine/naloxone use in pregnancy?

 

8. What will be your safety plan and follow up plan for Jamie?

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