Reference no: EM133444095

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 husbandand 20-year-old granddaughter who have been concerned about increasingly odd behaviors. Lillianhas had previousdiagnoses of anxiety and obsessive-compulsive disorder.She says she first startedhand 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 smokingcigarettes. Lillian said that she has smokedover a pack a day for most of her life and had switchedto using nicotine patches and gum in her middle 50s.

Nicotine gum is a type of chewinggum that deliversnicotine to the body. It is used as an aid in nicotine replacement therapy (NRT), a process for smoking cessation. The nicotineis delivered to the bloodstream via absorption by the tissuesof the mouth. The piecesare usually available in individual package come in various flavors.Individuals are directedto 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-parkedin a new location. These steps are repeated until the gum is depletedof nicotine (about 30 minutes as the craving dissipates.)

Using NRT supported Lillian to stop smoking; however,she said that to this day she still feelsanxious about chewingthe gum and has oftenexpressed 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 chewingit and had woken up choking on the gum at night. Lillian also explained that she believedthat 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 becamevery anxious when speaking aboutthis. She explained that she thoughtnicotine could give her cancer.

Lillian's husband has been worriedabout her dose of antianxiety medication not beingsufficient 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-19and 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 recoveryfor 1 year. She has a grandsonwho she can'tsee because thereis a restraining order against her son and the rest of her family.

Questions

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.