Maria case study

 

Case Study:

 

Maria is a 26-year-old nurse and Navy veteran. She presents to the PMHNP and discloses a hx of military sexual trauma. She says that she was raped by her commanding officer and when she attempted to report the incident up the chain of command, no one believed her and she experienced significant repercussions in terms of harassment from others. She attempted suicide via slitting her wrists while serving abroad and was treated at a hospital in Germany and then brought stateside. She received a medical discharge and says she has been really struggling with mental health symptoms since coming home. Specifically, she describes difficulty falling asleep, restless sleep, having nightmares of the sexual assault, and feeling depressed or “numb” all of the time. She becomes panicky when she leaves her house, especially in crowded places or when she is stuck in traffic in her car. At night, she “checks” every room and closet in her house repeatedly because she feels paranoid and unsafe, worried that she will be assaulted again. Further, she has been unable to work as a nurse. She tried to work as a floor nurse on a med surg unit for a couple of months, but felt that the work was “not as important as battlefield nursing” and she had trouble connecting with her coworkers. She also noticed that the alarms on the med surg unit triggered her startle reflex multiple times per shift. She informs the PMHNP today that she took “Plan B” about two weeks ago after a “one night stand” with a man at a local bar, but that she is otherwise in generally good physical health.

 

Questions:

 

1.    What else would you ask Maria in order to obtain a more complete evaluation for her?

2.    What is your differential diagnosis?  Describe the most likely diagnosis in terms of which criteria Maria presently meets and discuss any criteria that are unclear or unknown in this case.

3.    What is your initial treatment plan?  Include pharmacological and non-pharmacologic interventions.  Be specific in terms of each intervention, including for medications:

a.    Which medication or medications would you select?

b.    How and when would you start each one and at what dose and how/when would you titrate (if you plan to)?

c.     Describe how you would explain the medications to Maria – put in quotation marks exactly what you would say when counseling her regarding the potential risks, benefits, and side effects and any education tailored to Maria.

d.    Cite the evidence and references you used to develop this plan.

4.    For any non-pharmacologic interventions:

a.    List which treatments you would recommend and who would provide these treatments

b.    Cite the evidence and references that support your non-pharm plan