NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

 

Impulsivity, compulsivity, and addiction are challenging disorders for patients across the life span. Impulsivity is the inclination to act upon sudden urges or desires without considering potential consequences; patients often describe impulsivity as living in the present moment without regard to the future (MentalHelp.net, n.d.). Thus, these disorders often manifest as negative behaviors, resulting in adverse outcomes for patients. For example, compulsivity represents a behavior that an individual feels driven to perform to relieve anxiety (MentalHelp.net, n.d.). The presence of these behaviors often results in addiction, which represents the process of the transition from impulsive to compulsive behavior.

In your role as the psychiatric nurse practitioner (PNP), you have the opportunity to help patients address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction.

_{Reference: MentalHelp.net. (n.d.). Impaired decision-making, impulsivity, and compulsivity: Addictions’ effect on the cerebral cortex. https://www.mentalhelp.net/addiction/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex/}

To prepare for this Assignment:

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for impulsivity, compulsivity, and addiction.

The Assignment: 5 pages

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

By Day 7

Submit your Assignment. 

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK10Assgn1+last name+first initial.(extension)” as the name.
• Click the Week 10 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 10 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

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Week 10 Assignment 1 Rubric

 

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Submit your Week 10 Assignment 1 draft and review the originality report.

 

Submit Your Assignment by Day 7 of Week 10

To participate in this Assignment:

Week 10 Assignment 1

 

Module 3: Disorders With Behavioral Components

Mental health and substance abuse disorders can affect individuals across the life span. While these illnesses are common, recurrent, and serious, they are often treatable and many people do recover (SAMHSA, 2020). Mental disorders involve changes in thinking, mood, and/or behavior such that these changes can and do affect how individuals relate to others and how they make choices.

Behavioral disorders that give rise to impulsivity and substance abuse represent one area of expertise for which a psychiatric nurse practitioner (PNP) may prescribe pharmacologic treatments. Furthermore, understanding the underlying mechanisms that result in these behavioral disorders will be an important component of any treatment plan. Not surprisingly, PNPs may observe the coexistence of both a mental health and a substance use disorder (SAMHSA, 2020). Such co-occurring disorders or comorbidities present additional challenges for PNPs in assessing, treating, and providing care to their patients.

As you engage with the content for this module, reflect on how you might assess, treat, and provide care for patients presenting with behavioral disorders. While some disorders may have a direct treatment plan, others may require additional assessment considerations and pharmacologic interventions.

_{Reference:
Substance Abuse and Mental Health Services Administration. (2020). Mental health and substance use disorders. https://www.samhsa.gov/find-help/disorders}

What’s Happening This Module?

Module 3, Disorders With Behavioral Components, is a 2-week module. During Week 10, you will continue to apply your assessment and therapy skills as you assess and treat patients suffering from impulsivity, compulsivity, and addiction. In Week 11, you will review treatment plans and concepts related to the treatment of patients with dementia/Alzheimer’s and comorbid states. You will also complete your Final Exam for the course.

What do I have to do?	When do I have to do it?
Review your Learning Resources.	Days 1–7, Weeks 10–11
Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction	Submit your Assignment 1 by Day 7 of Week 10.
Assignment 2: Practicum Application Assignment	Submit your Assignment 2 by Day 7 of Week 10.
Final Exam	Complete Final Exam by Day 7 of Week 11.

Go to the Weekly Content

 Week 10: Therapy for Patients With Impulsive/Substance Use Disorders (SUD)

Impulsivity and compulsivity have a wide range of clinical presentations and often overlap with many other psychiatric disorders. Some individuals act without forethought and have difficulty saying “no” to certain things, such as using illicit drugs or spending money, whereas other individuals engage in compulsive behaviors with undesirable consequences. In some cases, these impulsive and compulsive behaviors also fuel issues with addiction. To effectively assess and treat patients, you must understand how these disorders differ as well as how their symptoms impact patients and their families.

This week, as you examine therapies for individuals with impulsivity, compulsivity, and addiction, you explore the assessment and treatment of patients with these disorders. You also consider ethical and legal implications of these therapies.

Learning Objectives

Students will:

• Assess patient factors and history to develop personalized therapy plans for patients with impulsivity, compulsivity, and addiction
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for impulsivity, compulsivity, and addiction
• Synthesize knowledge of providing care to patients presenting for impulsivity, compulsivity, and addiction
• Analyze ethical and legal implications related to prescribing therapy for patients with impulsivity, compulsivity, and addiction

Learning Resources

 

Kelly, J. E., & Renner, J. A. (2016). Alcohol-Related disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.

Renner, J. A., & Ward, N. (2016). Drug addiction. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.

 

 

 

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

naltrexone (revia/vivitrol) naloxone acamprosate disulfiram

 

 

 

 

Rubric Detail

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Content

Name: NURS_6630_Week10_Assignment1_Rubric

		Excellent Point range: 90–100	Good Point range: 80–89	Fair Point range: 70–79	Poor Point range: 0–69
Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.		Points Range: 9 (9%) – 10 (10%) The response accurately, clearly, and fully summarizes in detail the case for the Assignment. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.	Points Range: 8 (8%) – 8 (8%) The response accurately summarizes the case for the Assignment. The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.	Points Range: 7 (7%) – 7 (7%) The response inaccurately or vaguely summarizes the case for the Assignment. The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.	Points Range: 0 (0%) – 6 (6%) The response inaccurately and vaguely summarizes the case for the Assignment, or is missing. The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
Decision #1 (1–2 pages) • Which decision did you select? • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.		Points Range: 18 (18%) – 20 (20%) The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided.	Points Range: 16 (16%) – 17 (17%) The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided.	Points Range: 14 (14%) – 15 (15%) The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided.	Points Range: 0 (0%) – 13 (13%) The response inaccurately and vaguely explains the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing.
Decision #2 (1–2 pages) • Which decision did you select? • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.		Points Range: 18 (18%) – 20 (20%) The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided.	Points Range: 16 (16%) – 17 (17%) The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided.	Points Range: 14 (14%) – 15 (15%) The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided.	Points Range: 0 (0%) – 13 (13%) The response inaccurately and vaguely explains in detail the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing.
Decision #3 (1–2 pages) • Which decision did you select? • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.		Points Range: 18 (18%) – 20 (20%) The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided.	Points Range: 16 (16%) – 17 (17%) The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided.	Points Range: 14 (14%) – 15 (15%) The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided.	Points Range: 0 (0%) – 13 (13%) The response inaccurately and vaguely explains in detail the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing.
Conclusion (1 page) • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.		Points Range: 14 (14%) – 15 (15%) The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient. The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.	Points Range: 12 (12%) – 13 (13%) The response accurately summarizes the recommendations on the treatment options selected for this patient. The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided.	Points Range: 11 (11%) – 11 (11%) The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient. The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided.	Points Range: 0 (0%) – 10 (10%) The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing. The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.		Points Range: 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	Points Range: 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.	Points Range: 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation		Points Range: 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	Points Range: 4 (4%) – 4 (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors.	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (3 or 4) grammar, spelling, and punctuation errors.	Points Range: 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.		Points Range: 5 (5%) – 5 (5%) Uses correct APA format with no errors.	Points Range: 4 (4%) – 4 (4%) Contains a few (1 or 2) APA format errors.	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (3 or 4) APA format errors.	Points Range: 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors.
Total Points: 100

Name: NURS_6630_Week10_Assignment1_Rubric

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

The presented case demonstrates a 53-year-old Puerto Rican female with a history of alcohol use disorder ever since her 20s. She however presented to the clinic because of “embarrassing problems” of both alcohol addiction and gambling. She claims that a casino was opened next to her home 2 years ago, which has even made it harder for her to remain sober. She reports enjoying taking alcohol when gambling. She has also increased her cigarette smoking over this period. The patient has also gained weight by about 7 lbs. The patient claims that her gambling made her borrow over  $50,000 from her retirement account which she is afraid will bring problems when her husband finds out. Upon conducting the mental status examination, it was noticed that the patient displayed a sad mood with impaired impulse control. She was diagnosed with gambling disorder, and alcohol use disorder as she displayed no other psychiatric symptoms.

Deciding on which medication to prescribe for this patient will depend on several factors affecting her pharmacokinetic and pharmacodynamic processes. For instance, her elderly age, Puerto Rican race, and female gender, in addition to her diagnosis of gambling disorder, and alcohol use disorder will determine the choice of drug to prescribe and the dosage. Her weight gain over the past five years will also help in selecting a drug whose side effects will not worsen the patient’s weight. Several ethical considerations will also be taken into account upon making every decision concerning the most appropriate intervention for the management of the patient’s gambling, cigarette smoking, and alcohol addiction. The purpose of this discussion is to illustrate the decisions made in developing the treatment plan for this patient, with the expected outcome and ethical considerations at each decision point.

 

Decision #1

Selected Decision and Rationale

            The initial intervention was to give naltrexone 380mg intramuscularly injected into the gluteal region every month. Naltrexone is recommended by most national guidelines and professional bodies such as the National Institute for Health and Care Excellence (NICE) as the first line in the management of opioid and alcohol use disorder (Cunningham et al., 2020; Renner & Ward, 2016). It is also approved by the US Food and Drug Administration (FDA) for the same indications given its effectiveness and safety profile displayed by clinical trials (Grant & Chamberlain, 2020; Kelly & Renner, 2016). It acts by purely antagonizing the opioid receptors hence blocking the binding of endogenous opioids. Since the patient has been struggling with the addiction for a long time, it was necessary to consider the long-acting preparation which is only administered once monthly convenient in promoting a high compliance level (Ward et al., 2018). Previous evidence also reports that naltrexone when used with a patient with comorbid alcohol use disorder and gambling, it reduces the urge to gamble by up to 20% (Brière et al., 2019). Consequently, studies show that individuals of Puerto Rican ancestry possess predominantly the genetic polymorphism of the Asp40 allele which is the primary target of naltrexone, hence promoting its effectiveness in managing alcohol addiction (Huggett et al., 2019).

Disulfiram was not appropriate for this patient given that it is short-acting which requires daily administration, in addition to increased incidences of unpleasant side effects such as palpitations and vertigo (Ward et al., 2018). Acamprosate on the other hand is also administered three times a day which is inconvenient for the patient (Brière et al., 2019).

 

 

Expected Outcome

            Over the following four weeks, the patient will experience a significantly reduced urge to drink alcohol or gamble (Grant & Chamberlain, 2020). She should be able to reduce her smoking habit consequently during this time. No serious adverse effect is expected (Cunningham et al., 2020).

Ethical Considerations

            Caring for patients with substance use disorder is always associated with ethical concerns associated with the patient’s judgment, values, and beliefs (Ward et al., 2018). The PMHNP had to consider and respect the patient’s ethnic and social beliefs and values, in addition to displaying great concern for the wellbeing of the patient in a nonjudgmental way (Brière et al., 2019).

Decision #2

Selected Decision and Rationale

            The second decision was to refer the patient to a counselor to help with her Gambling. The decision was made based on the reported great effectiveness of the medication in helping the patient stay sober. The patient also reported being anxious, which is a common self-limiting side effect of naltrexone that normally disappears with time (Huggett et al., 2019). However, since the patient’s gambling was still bad, studies show that incorporating psychotherapeutic approaches such as counseling among patients with comorbid substance use and gambling help promote the treatment outcome of both conditions (Grant & Chamberlain, 2020; Kelly & Renner, 2016). The patient also reported that she still smokes, which will be addressed by the specialist who is the counselor (Cunningham et al., 2020). The patient also reported that she still smokes, which is however associated with her gambling habit, hence the need to address gambling as the primary health concern at the moment (Brière et al., 2019; Renner & Ward, 2016).

Valium is addictive and hence discouraged among patients with a history of chronic substance use disorder just like the patient in the provided case study (Ward et al., 2018). Varenicline is also associated with adverse effects when administered as an adjunct to naltrexone such as agitation and nightmares (Huggett et al., 2019).

Expected Outcome

            With counseling for the next four weeks, the patient’s urge to gamble will reduce significantly (Brière et al., 2019). She is also expected not to smoke anymore as it was initially brought about by gambling (Grant & Chamberlain, 2020). The anxiety should also resolve within this time. The patient is also expected to continue staying sober.

Ethical Considerations

Nurses are obliged to promote patient-centered care by focusing on their needs. At this point, the patient was concerned with her anxiety and gambling which promoted the need for a counselor (Ward et al., 2018). The PMHNP had to observe ethical principles such as justice, beneficence, and nonmaleficence (Huggett et al., 2019).

Decision #3

Selected Decision and Rationale

            The final decision was to explore the issues that the patient was having with her counselor and encourage her to continue taking part in gamblers’ anonymous meetings. The decision was mainly made based on the outcome of the previous intervention as the patient reported that the anxiety had disappeared and she has been active in gamblers anonymous with her main problem being her dislike for the counselor (Brière et al., 2019). Studies show that having a healthy therapeutic relationship between the patient and the counselor is key in promoting the optimal outcomes of psychotherapy (Grant & Chamberlain, 2020; Kelly & Renner, 2016). Challenges with the therapeutic alliance between the patient and the counselor can make her stop therapy (Cunningham et al., 2020; Renner & Ward, 2016). Given that the patient also reported positive outcomes with the Gamblers Anonymous meetings, continuing to participate actively will help manage her gambling even further (Huggett et al., 2019).

Ignoring the patient’s dislike for her counselor was not an appropriate decision as this would have made her stop therapy (Ward et al., 2018). Consequently, discontinuing the use of naltrexone at this point was also not appropriate as the evidence demonstrates the drugs take at least 12 weeks, to completely manage chronic alcoholism (Brière et al., 2019).

Expected Outcome

            With appropriate conflict resolution, the patient is expected to enjoy therapy with improved gambling addiction (Huggett et al., 2019). Taking an active role in the Gamblers Anonymous meetings, is also expected to shorten the recovery period (Grant & Chamberlain, 2020). she should be able to stop smoking within this time.

Ethical Considerations

            Maintaining a healthy therapeutic alliance between the counselor and the patient is key to promoting positive outcomes. The PMHNP must not discriminate against the patient in any way when addressing the issue, they have with her counselor (Ward et al., 2018). Consequently, respecting the patient’s autonomy is key hence the need to convince her of the importance of continuing with therapy for an optimal outcome (Brière et al., 2019).

Conclusion

The 53-year-old patient in the assigned case study presented with a history of alcohol use disorder and gambling. The patient also reported cigarette smoking which was associated with her gambling. With consideration of this diagnosis in addition to other factors such as her age and race, it was decided that the patient should take naltrexone 380mg intramuscularly injected into the gluteal region every month. Naltrexone is recommended by most clinical practice guidelines for the management of opioid and alcohol addiction due to its great effectiveness and desirable safety profile (Grant & Chamberlain, 2020). Disulfiram and Acamprosate were disregarded due to their increased risks of adverse effects (Ward et al., 2018). After four weeks, the patient reported a positive outcome with alcohol addiction but was concerned about anxiety and gambling (Renner & Ward, 2016). This led to the second decision where the patient was referred to a counselor (Kelly & Renner, 2016). Adding diazepam to the treatment regimen or varenicline was disregarded as it would only complicate the patient’s compliance with an increased incidence of adverse effects (Brière et al., 2019).

After four weeks, the patient reported that her anxiety had disappeared with great progress in Gamblers Anonymous. She, however, disliked her counselor which led to the final decision to examine and address the issues they had and encourages her to continue taking part in Gamblers Anonymous meetings (Huggett et al., 2019). Ignoring the issue, the patient had with her counselor or discontinuing naltrexone was not appropriate at this point. At every decision point, the PMHNP encountered several ethical considerations including respect for patient autonomy and not discriminating against the patient based on her gender, race, or age (Cunningham et al., 2020). Ethical principles such as justice, nonmaleficence, and beneficence were also observed.

 

 

References

‌Brière, M., Tocanier, L., Allain, P., Le Gal, D., Allet, G., Gorwood, P., & Gohier, B. (2019). Decision-Making Measured by the Iowa Gambling Task in Patients with Alcohol Use Disorders Choosing Harm Reduction versus Relapse Prevention Program. European Addiction Research, 25(4), 182–190. ‌

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