Based on this nursing situation, what would you identify as:? Abby’s diagnosis?? Does she meet the full criteria for your diagnosis?
Pageof 2ZOOMAbby was in her early 30’s, single, and has 3 young children, age 9months, 3, and 4. Abby, arrived in the US from Guatemala, 20 years,but has no green card for work. She works for a family caring for theirhome and 2 children. Her grandmother, 80 y/o, and mother lives with her and helps care forher children. Recently, Abby had been complaining to her mother thatshe thought she had an odor and felt “things” crawling in her vagina. Her grandmother told her she was crazy, but Abby continued toexperience these thoughts and sensations. Eventually, she was afraidher odor was so strong, she would lose her job and went to the localclinic open at night. Chief Complaint: “I don’t know what is wrong, but I think I have bugsdown here (pointing to her vagina). I can feel them crawling all around.I scrub and scrub but I can’t get rid of the smell. I think I need to justcut them out and maybe then the smell would go away.” Abby denies any medication or illicit drugs. Her appearance issomewhat unkempt, hair was uncombed, no make-up, and was dressedin sweat pants and top. Her clothes seemed too small. Her BMI is 30.Family History: Grandmother and mother both believe evil spirits causebad things, and her mother was hospitalized once in a psychiatrichospital, but she is unsure as to why. She thought her father put herthere as a punishment. He father no longer lives in the country. Abbyhas no siblings in the country and expressed feeling lonely most of thetime.Abby was seen by the FNP and had a gynecological exam, no overtabnormalities were noted. A pap smear was obtained, but resultswould not be available until next week. No vaginal odor was noted inthe chart. Abby was referred to the PMHNP for further consultation.Abby was unsure why she was seeing the PMHNP, and questioned ifthe FNP did not believe her about the “bugs”. “I know I have them,they are all up inside of me.” I’ve been putting bleach up there to killthem, but I still feel them.” When questioned how long she had thesethoughts, she said it had been going on for a while, maybe 2 months orso. She tried to treat them herself, but finally sought professional help. Abby denied hearing any voices, but reported she sometimes thinkspeople on the bus are talking about her. She is very afraid of losing herjob and needs to have a job to care for her family. The PMHNPrecognized the many stressors Abby was experiencing, and asked her toreturn weekly to talk with her. She assured Abby she would like to helpher and once the pap smear report was back, she would discuss withher options for her care. Based on this nursing situation, what would you identify as:? Abby’s diagnosis?? Does she meet the full criteria for your diagnosis? ? What specifiers might you use with your diagnosis?? What differential diagnoses might you be thinking? ? What other assessment tools would you recommend for use withthis client?? What would you determine to be the essence of caring in thissituation? ? Incorporate a scholarly article to support your diagnosis and/ordifferential diagnoses, and potential treatment plan.
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