20 Feb Training Title 151: Daniela Petrov

Training Title 151
Name: Daniela Petrov
Gender: female
Age:47 years old
T- 98.8 P- 84 R 20 B/P 132/90 Ht 5’8 Wt 128lbs
Background: Moved to Everett, Washington from Russia with her parents when she was 16 years
old. Currently lives in Boise, Idaho. She has younger 1 brother, 3 older sisters. Denied family
mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx;
Menses regular. uses condoms for birth control Has fibromyalgia. She works part time cashier at
Save A Lot Grocery Store. Dropped out of high school in 10th grade. Sleeps 5-6 hours on
average, appetite good.
Symptom Media. (Producer). (2018). Training title 151 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-151

NRNP 6635 Case History Report – Week 8: Substance‑Related and Addictive Disorders
Training Title 151: Daniela Petrov
1. Introduction
Patient: Daniela Petrov, 47‑year‑old female.

Context: Case study from Symptom Media video (2018).

Clinical Focus: Substance‑related and addictive disorders in middle‑aged adults, psychosocial stressors, and comorbid medical conditions.

Importance: Highlights how chronic pain conditions (fibromyalgia), limited education, and occupational stress may intersect with risk for substance misuse.

2. Demographics and Background
Age: 47 years old.

Gender: Female.

Vitals: T 98.8, P 84, R 20, BP 132/90 (borderline hypertensive).

Height/Weight: 5’8”, 128 lbs (BMI ~19.5 → underweight/low‑normal).

Family: One younger brother, three older sisters. Parents immigrated with her from Russia to Everett, WA when she was 16.

Residence: Currently lives in Boise, Idaho.

Education/Occupation: Dropped out of high school in 10th grade; works part‑time as cashier at Save A Lot Grocery Store.

Medical History: Fibromyalgia.

Psychiatric/Substance History: Denies family mental health or substance use issues. No history of inpatient detox or rehab. Denies self‑harm.

Reproductive Health: Menses regular, uses condoms for birth control.

Lifestyle: Sleeps 5–6 hours nightly, appetite good.

3. Psychosocial Stressors
Immigration History: Transition from Russia to U.S. at age 16 may have influenced cultural identity and stress.

Educational Limitations: Dropped out of school, limited career opportunities.

Occupational Stress: Low‑wage, part‑time cashier job.

Medical Burden: Fibromyalgia → chronic pain, fatigue, risk of self‑medication.

Family Dynamics: Multiple siblings, but unclear support system.

Social Isolation: Lives alone, limited social support.

4. Clinical Presentation (Substance Use Disorder Features)
Reported Symptoms:

Denies inpatient detox or rehab history.

Denies self‑harm.

Appetite good, but sleep limited (5–6 hours).

Behavioral Indicators:

Chronic pain may predispose to opioid misuse.

Borderline hypertension may be exacerbated by stress or substance use.

Risk Factors:

Fibromyalgia (chronic pain).

Limited education and low socioeconomic status.

Sleep disturbance.

Family stressors.

5. Mental Status Examination (MSE)
Appearance: Thin, underweight, possibly fatigued.

Behavior: Cooperative, but guarded about substance history.

Speech: Normal rate/volume.

Mood: Neutral or anxious.

Affect: Constricted.

Thought Process: Logical, coherent.

Thought Content: Denies substance use, but risk factors present.

Cognition: Alert, oriented ×3.

Insight/Judgment: Fair, may minimize risk.

6. Differential Diagnosis
Alcohol Use Disorder: Must be considered despite denial.

Opioid Use Disorder: Risk due to fibromyalgia and chronic pain.

Sedative/Hypnotic Use Disorder: Possible if sleep disturbance leads to self‑medication.

Adjustment Disorder: Stress from occupational and family issues.

Depression/Anxiety Disorders: Sleep disturbance, chronic pain.

7. Diagnostic Considerations (DSM‑5)
Substance Use Disorder Criteria:

Impaired control.

Social impairment.

Risky use.

Pharmacological criteria (tolerance, withdrawal).

Daniela’s Case:

Denies use, but chronic pain and psychosocial stressors increase risk.

Sleep disturbance may be secondary to pain or substance use.

8. Assessment Tools
AUDIT: Alcohol use severity.

DAST‑10: Drug abuse screening.

CAGE Questionnaire: Alcohol dependence.

PHQ‑9: Depression screening.

GAD‑7: Anxiety screening.

Pain Scales: Fibromyalgia impact questionnaire.

9. Treatment Plan
Pharmacological:

Non‑opioid pain management for fibromyalgia (duloxetine, pregabalin).

SSRIs/SNRIs for comorbid depression/anxiety.

Avoid opioids unless strictly necessary.

Psychotherapy:

CBT for pain and coping.

Motivational interviewing if substance use suspected.

Stress management therapy.

Lifestyle Interventions:

Sleep hygiene.

Nutrition counseling.

Exercise and physical therapy for fibromyalgia.

Supportive Measures:

Family therapy.

Case management.

Community support services.

10. Monitoring and Follow‑Up
Regular psychiatric visits.

Pain management follow‑up.

Substance use screening.

Suicide risk reassessment.

Collaboration with family and healthcare team.

11. Challenges
Denial: Patient denies substance use despite risk factors.

Medical Burden: Fibromyalgia complicates treatment.

Family Stress: Limited support.

Occupational Stress: Low‑wage job, financial strain.

Stigma: Mental health and substance use stigma.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.

Consent: Informed consent for treatment.

Safety: Suicide and overdose risk management.

Cultural Sensitivity: Address immigrant background, respect autonomy.

13. Case Summary
Daniela Petrov: 47‑year‑old female with fibromyalgia, sleep disturbance, occupational stress, and risk factors for substance use disorder.

Likely Diagnosis: Possible substance use disorder, depression/anxiety, chronic pain syndrome.

Treatment: Non‑opioid pain management, psychotherapy, lifestyle interventions, supportive care.

Outcome Goal: Improve functioning, reduce risk, enhance quality of life.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Daniela’s age? a) 45 b) 47 c) 49 d) 51

Where does Daniela currently live? a) Everett, WA b) Boise, ID c) Portland, OR d) Seattle, WA

Where did Daniela immigrate from? a) Germany b) Russia c) Poland d) Ukraine

How many siblings does Daniela have? a) 2 b) 3 c) 4 d) 5

What medical condition does Daniela have? a) Diabetes b) Fibromyalgia c) Asthma d) Hypertension

What is Daniela’s occupation? a) Teacher b) Cashier c) Nurse d) Accountant

What level of education did Daniela complete? a) High school diploma b) Dropped out in 10th grade c) Bachelor’s degree d) Master’s degree

How many hours does Daniela sleep nightly? a) 3–4 b) 5–6 c) 7–8 d) 9–10

What is Daniela’s appetite status? a) Poor b) Good c) Decreased d) Variable

What contraceptive method does Daniela use? a) Birth control pills b) Condoms c) IUD d) None

What family history did Daniela deny? a) Mental health or substance use issues b) Diabetes c) Hypertension d) Cancer

What is Daniela’s allergy? a) Penicillin b) Azithromycin c) Latex d) Shellfish

What psychosocial stressor is relevant? a) Immigration history b) Divorce c) Custody battle d) Legal charges

What condition increases Daniela’s risk for substance misuse? a) Fibromyalgia b) Diabetes c) Asthma d) Hypertension

What is the primary outcome goal for Daniela? a) Improve functioning and quality of life b) Relocate to another city c) Gain custody of child d) Avoid medical treatment