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Marty McFly is a a 30 year old Caucasian male with a chief complaint of a feeling of repetitious behavior and anxiety.
As a primary care NP I should be recommending my patient to a behavior health specialist in the first place. While SSRI treatment is considered the first line therapy, the patient truly needs behavioral therapy which introduces the stressor to the patient and reconditions them to be able to handle the stressor positively rather than with a compulsion (Rosenthal, L. & Burchum, J. 2021). One way for my to know if support is beyond me however, is if a compulsion becomes more frequent or if there is increased anxiety or fear about not performing a compulsion which may indicate a need for deep brain stimulation.
Balestra (2019) stresses that FNPs need to be aware of areas that fall outside of their scope of practice. Especially when it comes to treating complicated cases of mental illness.
While the affordable care act has allowed for broader care and better accessibility according to Robertson-Preidler et al. (2020) the access to mental health care both financially and non-financially remain.
Further according to Robertson-Preidler et al. (2020) thanks to the affordable care act the uninsured rate among those with mental health disorders has decreased by 39%.
The most cited disparity by Robertson-Preidler et al. (2020) is still cost driven and discusses lack of treatment due to lack of affordable care.
None of the factors listed above effect our following scenario.
The below facilities can be accessed for treatment prior to primary mental healthcare establishment.
Patient outreach centers (24 hour access):
Urgent/Emergent Assistance (24 hour access):
History of Present Illness: He started noticing that he was continually having to lock his windows and doors multiple times a day in a specific order, sometimes even leaving his job to ensure that the house was locked. He stated that he felt that if he didn't lock the house that someone would break into his home and attempt to set it on fire. Further, Mr. McFly stated that he understands that this idea is "crazy ." However, any time he does not perform the actions multiple times a day he begins to have trouble breathing, chest pains, nausea, and light headedness that all subside once the compulsion is performed. Mr. McFly is references a time when he was rushing home driving 88 mph just to ensure he reached his home before his lunch break was over to perform this compulsion.
Social History: No pertinent social history. No tobacco or smokeless tobacco use, nor alcohol or illicit drug use of any kind.
Family History: Father, deceased due to murder in 1973. Mother, history of alcohol and tobacco addiction. No other pertinent medical history.
Past Medical History: Hand injury due to street race.
Current Medications: Acetaminophen 500 PRN, Naproxine 440 mg PRN
Plan of Care: Fluoxetine 20 mg once a day for OCD behavior, Xanax 0.25 mg as needed no more than 3 times a day for panic/anxiety attack, referral to a behavior health specialist for cognitive behavior therapy.
Common Ground works with donations from the community along with the community health network and Easterseals to provide financial assistance to those who are not able to have affordable access. (Common Ground, 2022)
Ascension health also offers a financial assistance program for the uninsured and under insured. (Ascension, 2022)
According to a case in Michigan vs. Susan Lynn Drust RN NP (LARA. 2019) an NP treated patients with mental health conditions and failed to refer them to psychiatric help. Because of this she was guilty of negligence and to conform to minimum standards of a health profession.
While this was a civil complaint the NP was suspended from practice immediately for this and multiple other reasons (including distribution of controlled substances carelessly). (Lara. 2019)
Ethically we have a duty to act when treating patients with mental health disorders, while we are primary care this means that we know a little about a lot. We should be referring patients to the appropriate specialties as the need arises to allow for effective management of conditions.
Follow up should consist of once every 2-3 weeks post SSRI medications and every 4-6 weeks post anti-anxiety medications.
As a primary care provider we should be collaborating with mental health to optimize treatment for our patient to mitigate risks. We should further ensure that the patient has a sound plan and integrated support system available to them to avoid complications. Finally the primary care giver should be available for the patient to give the appropriate amount of time to the concern at hand.
It was also noted by Balestra (2019) that NPs should be aware of their scope of practice. Breaching ones scope could have civil liabilities and disciplinary actions such was the case with Susan Drust.
References
Kevin Green
NR-566
Chamberlain Univesrity
References Cont.
Michigan Legislature. (2022). Public Health Code Act 368 of 1978. Retrieved April 14, 2022, from https://www.legislature.mi.gov/(S(puxjiiq0qrmm3lrxvsajoav2))/mileg.aspx?page=GetObject&objectname=mcl-act-368-of-1978
Michigan Licensing and Regulatory Affairs (LARA). (2019). State Of Michigan Department of Licensing and Regulatory Affairs Bureau of Professional Licensing Board of Nursing Disciplinary Subcommitte. Retrieved April 14, 2022, from https://www.michigan.gov/lara/-/media/Project/Websites/lara/Folder1/Drust_Susan_L_RN_NP_-_47-18-000492_-_AC_and_OSS_signed.pdf?rev=eab5a5b54a99459fb3fba13c1e86fc0b&hash=9B1A9CE64EFB9BC02894624811B55F7B
Robertson-Preidler, J., Trachsel, M., Johnson, T., & Biller-Andorno, N. (2020). The Affordable Care Act and recent reforms: Policy implications for equitable mental health care delivery. Health Care Analysis, 28(3), 228–248. https://doi.org/10.1007/s10728-020-00391-0
Ascension. (2022). Financial assistance. Retrieved April 14, 2022, from https://healthcare.ascension.org/locations/michigan/midet/st-clair-shores-ascension-eastwood-behavioral-health-at-harper/financial-assistance
Balestra, M. L. (2019). Family nurse practitioner scope of practice issues when treating patients with mental health issues. The Journal for Nurse Practitioners, 15(7), 479–482. https://doi.org/10.1016/j.nurpra.2018.11.007
Common Ground. (2022, March 10). Additional resources. Retrieved April 14, 2022, from https://commongroundhelps.org/get-help/additional-resources/
Greene, J. (2021, August 16). Mental health code changes that ADD PAS, NPS to designated list of practitioners could ease stressed system. Crain's Detroit Business. Retrieved April 14, 2022, from https://www.crainsdetroit.com/special-report/mental-health-code-changes-add-pas-nps-designated-list-practitioners-could-ease?adobe_mc=MCMID%3D91121582255969701083555844623893653442%7CMCORGID%3D138FFF2554E6E7220A4C98C6%2540AdobeOrg%7CTS%3D1649910432&CSAuthResp=1%3A%3A611506%3A1745%3A24%3Asuccess%3A50C2992A45004EF1D072E11853822A36
Michigan Department of Health and Human Services (MDHHS). (2015). Use of Psychotropic Drugs. Retrieved from https://dhhs.michigan.gov/OLMWEB/EX/AP/Public/APF/153.pdf