Abby was in her early 30’s, single, and has 3 young children, age 9 months, 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 their home and 2 children. Her grandmother, 80 y/o, and mother lives with her and helps care for her children. Recently, Abby had been complaining to her mother that she thought she had an odor and felt “things” crawling in her vagina. Her grandmother told her she was crazy, but Abby continued to experience these thoughts and sensations. Eventually, she was afraid her odor was so strong, she would lose her job and went to the local clinic open at night. Chief Complaint: “I don’t know what is wrong, but I think I have bugs down 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 just cut them out and maybe then the smell would go away.” Abby denies any medication or illicit drugs. Her appearance is somewhat unkempt, hair was uncombed, no make-up, and was dressed in sweat pants and top. Her clothes seemed too small. Her BMI is 30. Family History: Grandmother and mother both believe evil spirits cause bad things, and her mother was hospitalized once in a psychiatric hospital, but she is unsure as to why. She thought her father put her there as a punishment. He father no longer lives in the country. Abby has no siblings in the country and expressed feeling lonely most of the time. Abby was seen by the FNP and had a gynecological exam, no overt abnormalities were noted. A pap smear was obtained, but results would not be available until next week. No vaginal odor was noted in the chart. Abby was referred to the PMHNP for further consultation. Abby was unsure why she was seeing the PMHNP, and questioned if the 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 kill them, but I still feel them.” When questioned how long she had these thoughts, she said it had been going on for a while, maybe 2 months or so. She tried to treat them herself, but finally sought professional help. Abby denied hearing any voices, but reported she sometimes thinks people on the bus are talking about her. She is very afraid of losing her job and needs to have a job to care for her family. The PMHNP recognized the many stressors Abby was experiencing, and asked her to return weekly to talk with her. She assured Abby she would like to help her and once the pap smear report was back, she would discuss with her 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 with this client?What would you determine to be the essence of caring in this situation? Incorporate a scholarly article to support your diagnosis and/or differential diagnoses, and potential treatment plan.
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