ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630
A Sample Answer For the Assignment: ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630
Background
Mrs. Maria Perez, a 53-year-old Puerto Rican woman, has presented with an issue that she finds “embarrassing.”
Subjective
Mrs. Perez has struggled with alcohol since her father’s death in her late teens. She has been in and out of Alcoholics Anonymous for the past 25 years. Recently, she has been finding it difficult to maintain her sobriety due to the opening of the “Rising Sun” casino near her home. During a visit to the casino’s grand opening, Mrs. Perez became hooked on gambling, which provides her with a sense of high.
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She often drinks while gambling, which leads to reckless gambling and further drinking. She has also noticed an increase in cigarette smoking over the past two years, which worries her about its negative effects on her health. Mrs. Perez has attempted to stop drinking but finds it challenging to resist the high she experiences from gambling. She has gained seven pounds from drinking and weighs 122 lbs.
Mental Status Exam
During the clinical interview, Mrs. Perez demonstrated an alert and oriented state of mind. Her speech was clear, coherent, and goal-directed, and her eye contact was somewhat avoidant. She had no noteworthy mannerisms, gestures, or tics. Although her self-reported mood was “sad,” her affect was appropriate to the conversation and her mood. She reported no visual or auditory hallucinations, delusional or paranoid thought processes, and her insight and judgment were intact. However, her impulse control was impaired, and she denied any suicidal or homicidal ideation.
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Diagnosis
Mrs. Perez has been diagnosed with gambling disorder and alcohol use disorder.
Introduction
Compulsivity and impulsivity can manifest in various ways and often coincide with other psychiatric disorders. Individuals who act without thinking may struggle to refuse certain things, such as spending money or using illegal drugs. Some people may engage in compulsive behavior that leads to adverse consequences. In many cases, compulsivity and impulsivity contribute to addiction-related problems.
To assess and treat clients effectively, a Psychiatric Mental Health Nurse Practitioner (PMHNP) must have a clear understanding of the differences between these disorders, their symptoms, and their impact on both clients and their families (Bandelow, Michaelis, & Wedekind, 2017).
Decision #1
I have selected to begin the Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks for the patient described in the case. My decision to choose Naltrexone was based on its effectiveness in reducing alcohol consumption, craving, and relapse rates in patients with alcohol use disorder.
Studies have demonstrated the efficacy of Naltrexone in reducing alcohol use in patients with alcohol use disorder, including those with comorbid psychiatric conditions. Additionally, Naltrexone has been shown to improve overall treatment outcomes and increase the likelihood of abstinence. In the context of the patient’s case, Naltrexone could help her maintain her sobriety by blocking the pleasurable effects of alcohol and reducing her craving for alcohol (Ray et al., 2019).
I did not select Campral (Acamprosate) or Antabuse (Disulfiram) for the patient because they have different mechanisms of action and may not be as effective as Naltrexone in this particular case. Campral works by reducing cravings and withdrawal symptoms in patients who have already stopped drinking.
While it is generally well-tolerated, it has not been shown to be effective in reducing heavy drinking or promoting abstinence in patients with alcohol use disorder (Akbar et al., 2018). Antabuse, on the other hand, works by causing a psychologically unpleasant reaction if the patient drinks alcohol, which can serve as a deterrent. However, it has limited efficacy and is associated with low patient adherence due to its side effects (De Souza, 2019).
By choosing Naltrexone, I hoped to achieve a reduction in the patient’s alcohol consumption, craving, and risk of relapse. I also hoped to improve her overall treatment outcomes and increase her likelihood of abstinence. Studies such as Ray et al. (2019) have shown Naltrexone to be effective in reducing alcohol use in patients with alcohol use disorder, and I hoped to have similar results replicated in this case.
Ethical considerations play a significant role in the treatment plan and communication with patients. It is important to obtain informed consent from the patient before initiating any treatment, ensuring that they understand the risks and benefits associated with the treatment. In the case of Naltrexone, it is important to inform the patient of the potential side effects, including nausea, headache, and fatigue, and monitor them for any adverse reactions.
It is also important to involve the patient in the decision-making process and respect their autonomy by considering their preferences and values. Additionally, confidentiality and privacy must be maintained throughout the treatment process, and the patient’s dignity and respect must be upheld (Adams & Volkow, 2020).
Decision #2
I selected to refer the client to a counselor to address her gambling issues. This decision was based on the client’s primary concern being gambling disorder and the potential benefits of concurrent counseling with her current medication regimen. Research has shown that counseling and therapy are effective in treating gambling disorder, including cognitive-behavioral therapy (CBT) and motivational interviewing (MI) (Hodgins et al., 2019).
Counseling can help the client identify and address the underlying reasons for their gambling behavior, develop coping skills, and improve their self-efficacy and motivation to change. Furthermore, counseling can provide ongoing support for maintaining sobriety and reducing the risk of relapse.
I did not select the other two options provided. Adding on Chantix (varenicline) may be effective in reducing nicotine dependence, but it does not address the client’s primary concern of gambling disorder. Additionally, the client’s smoking may be a secondary issue that can be addressed through counseling or other means.
Adding on Valium (diazepam) also presents a risk for the client due to her history of alcohol and drug abuse. Valium is a benzodiazepine meaning it has potential for being abused. Mixing alcohol with Valium is also associated with side effects such as slowed breathing which can be life threatening (Powers, 2022).
By referring the client to a counselor to address gambling issues, I hope to achieve additional support for the client’s primary concern of gambling disorder. The counselor can work with the client to identify triggers and develop coping strategies to prevent relapse. Additionally, the counselor can help the client address any underlying psychological or emotional issues that may be contributing to their gambling behavior (Knaebe et al., 2019).
Ethical considerations play a significant role in the treatment plan and communication with patients. It is essential to obtain informed consent from the patient and respect their autonomy in making decisions about their treatment. The patient must understand the benefits and risks associated with counseling and be able to provide informed consent.
Confidentiality must also be maintained, and the patient’s privacy and dignity must be upheld. Additionally, the counselor must be appropriately trained and qualified to address the client’s specific needs and concerns (Adams & Volkow, 2020).
Referring the client to a counselor to address gambling issues was the appropriate decision based on the patient’s primary concern and the potential benefits of concurrent counseling with her current medication regimen. Counseling can help the client identify underlying issues and develop coping strategies to prevent relapse. Ethical considerations must be considered throughout the treatment plan to ensure the patient’s autonomy and privacy are upheld (Knaebe et al., 2019).
Decision #3
I selected to explore the issue that Mrs. Perez is having with her counselor and encourage her to continue attending the Gamblers Anonymous meetings for decision #3. This decision was based on the client’s report that she did not really like her counselor and the potential benefits of addressing this issue and continuing with Gamblers Anonymous.
Research has shown that a positive therapeutic alliance between the patient and therapist is critical for successful treatment outcomes (Knaebe et al., 2019). Patients who have a positive relationship with their therapist are more likely to engage in therapy, feel supported, and make progress towards their treatment goals. Therefore, addressing the issue that Mrs. Perez is having with her counselor is crucial for maintaining her engagement in counseling and improving her treatment outcomes.
I did not select the other two options provided in the exercise. Encouraging Mrs. Perez to continue seeing her current counselor may not be effective if she does not have a positive therapeutic alliance with her therapist. Discontinuing Vivitrol is not recommended as it has been shown to be effective in reducing alcohol consumption and preventing relapse in patients with alcohol use disorder (Ray et al., 2019).
By exploring the issue that Mrs. Perez is having with her counselor and encouraging her to continue attending the Gamblers Anonymous meetings, I hope to improve her engagement in counseling and increase her chances of successful treatment outcomes. By addressing the issue with her counselor, we can work to improve the therapeutic alliance and ensure that Mrs. Perez is receiving effective treatment. Additionally, continuing with Gamblers Anonymous provides her with additional support and resources for maintaining sobriety and preventing relapse.
Ethical considerations must be considered throughout the treatment plan and communication with patients. It is essential to respect the patient’s autonomy and preferences in their treatment. Mrs. Perez must be informed of the potential benefits and risks associated with continuing with her current counselor and encouraged to express any concerns or issues she may have.
Confidentiality must also be maintained, and any communication with her counselor must be conducted with her informed consent. The goal is to provide Mrs. Perez with the best possible care while respecting her autonomy and privacy (Adams & Volkow, 2020).
Conclusion
In summary, my recommendations for the treatment of Mrs. Perez’s alcohol and gambling disorders involved a combination of pharmacological and psychosocial interventions. Treating addiction, compulsivity, and impulsivity disorders presents significant challenges to healthcare providers.
These disorders are often associated with negative behaviors that can have adverse consequences for patients. It is crucial for Psychiatric Mental Health Nurse Practitioners (PMHNPs) to actively listen to clients with these disorders, evaluate their circumstances, and create a comprehensive treatment plan.
The decision to administer Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks. Was based on the effectiveness of Naltrexone in reducing alcohol cravings and preventing relapse in patients with alcohol use disorder (Ray et al., 2021). The client responded well to this medication, with reduced alcohol consumption and improved sobriety. In Mrs. Perez’s case, there are inadequate FDA-approved medications for gambling addiction.
However, counseling has been shown to be an effective treatment option for this disorder. For the gambling disorder, I referred her to a counselor to address her gambling issues and encouraged her to participate in Gamblers Anonymous meetings. This decision was based on research that supports the effectiveness of counseling and support groups combined with pharmacological intervention in treating comorbid alcohol abuse and gambling disorder (Kraus, Etuk, & Potenza, 2020).
The client reported feeling supported and engaged in the Gamblers Anonymous group, and her anxiety and gambling behaviors improved. For the third decision point, I recommended exploring the issue that Mrs. Perez was having with her counselor and encouraging her to continue attending Gamblers Anonymous meetings. This decision was based on the importance of a positive therapeutic alliance in successful treatment outcomes (Knaebe et al., 2019) and the potential benefits of addressing any concerns with the counselor and continuing with the support provided by Gamblers Anonymous.
Overall, the combination of pharmacological and psychosocial interventions was effective in treating Mrs. Perez’s alcohol and gambling disorders. Ethical considerations were also taken into account throughout the treatment plan to ensure the patient’s autonomy and privacy were respected.
It is important to note that every patient is unique, and treatment plans must be tailored to their specific needs and concerns. Clinicians must consider the patient’s individual history, comorbidities, preferences, and potential risks and benefits of treatment options. Therefore, ongoing assessment and modification of the treatment plan are necessary for successful outcomes.
References
Adams, V. J. M., & Volkow, N. D. (2020). Ethical imperatives to overcome stigma against people with substance use disorders. AMA Journal of Ethics, 22(8), 702-708. Doi: 10.1001/amajethics.2020.702.
Akbar, M., Egli, M., Cho, Y. E., Song, B. J., & Noronha, A. (2018). Medications for alcohol use disorders: An overview. Pharmacology & therapeutics, 185, 64-85. https://doi.org/10.1016/j.pharmthera.2017.11.007
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues
De Souza, A. (2019). Disulfiram in the Management of Alcohol Dependence. https://link.springer.com/chapter/10.1007/978-981-32-9876-7_3
in clinical neuroscience, 19(2), 93. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
Knaebe, B., Rodda, S. N., Hodgins, D. C., & Lubman, D. I. (2019). Behaviour change strategies endorsed by gamblers subtyped by psychological distress, risky alcohol use, and impulsivity. Journal of Gambling Studies, 35(1), 275-292. https://doi.org/10.1007/s10899- 018-9803-x
Kraus, S. W., Etuk, R., & Potenza, M. N. (2020). Current pharmacotherapy for gambling disorder: a systematic review. Expert Opinion on Pharmacotherapy, 21(3), 287-296. https://doi.org/10.1080/14656566.2019.1702969
Powers, H. (2022). The use of valium in alcohol withdrawal. https://scholarworks.utep.edu/cohort_10/5/
Ray, L. A., Green, R., Roche, D. J., Magill, M., & Bujarski, S. (2019). Naltrexone effects on subjective responses to alcohol in the human laboratory: A systematic review and meta‐ analysis. Addiction Biology, 24(6), 1138-1152. https://doi.org/10.1111/adb.12747
Gambling and alcohol abuse are some of the mental health problems that psychiatric mental health nurse practitioners (PMHNP) face in their practice. PMHNP ensures that patients suffering from gambling and alcohol abuse disorders are assisted to overcome their addition and live a normal life. Therefore, this paper examines a case study of a patient that has been diagnosed with gambling disorder and alcohol use disorder.
The patient is Maria Perez, a 53-year-old Puerto Rican female who came to the clinic with a complaint of an embarrassing problem. The client admitted having history of problems with alcohol since her father died during her teenage years. She has been struggling with alcohol since her 20’s and is involved with Alcohol Anonymous in on and off basis. The client reported to have difficulty in maintaining sobriety since the opening of a casino near her home.
Perez has been gambling in the casino with her friend and enjoys drinking alcohol to calm her during high stake games. Her drinking behavior has predisposed her to reckless gambling. The client also has history of smoking cigarette for the last two years and is getting worried about its effects on her health. The client also reported to have gained more than 7 pounds of weight from her usual 115-pound weight. Mental status examination was administered to the client.
The assessment showed the client to be oriented and alert, dressed appropriately for the occasion, has clear, goal directed and coherent speech and avoidance eye contact behaviors. The assessment also showed the client not to demonstrate any noteworthy mannerism, ticks or gestures. The mood of the client was sad with absence of hallucinations, delusions, paranoid, or suicidal and homicidal ideations.
Decision Point One
Selected Decision
Administer Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks.
Reason for Selection
Vivitrol was selected as the first line of treatment because it works as a competitive antagonist of alcohol receptors, making it suitable for addiction management. The inhibition of alcohol receptors minimizes craving for alcohol, hence, improvement in abuse behaviors (Stahl, 2013).
The inhibition of the alcohol receptors also reduces the perceived thirst for alcohol by the patient (Holt & Tobin, 2018). Patients who take alcohol but are in the process of overcoming their addiction problems may also use naltrexone. Naltrexone facilitates the systematic disuse of alcohol by the patients (Leighty & Ansara, 2019).
Why Other Options were not Selected
Antabuse (disulfiram) 250 mg orally daily and Campral (acamprosate) 666 mg orally three times a day were not selected because they are recommended for use in patients that have stopped alcohol intake (Stahl, 2013).
The medications were also likely to predispose the patients to side effects such as nausea and tachycardia with the administration of disulfiram (Shirley et al., 2021). Since the patient has not abstained from alcohol abuse, the above options were not selected to ensure safety and quality in the care given.
Expectations
The above decision was made with the expectation of ensuring the reducing in symptoms of alcohol addiction being experienced by the client. The decision also aimed at promoting the systematic desensitization of alcohol desires that the patient was experiencing (Stern et al., 2015). It was anticipated that the administration of naltrexone would result in improved tolerability and abstinence of the patient from alcohol abuse (Wightman et al., 2018).
Impact of Ethical Considerations on Treatment Plan and Communication with the Client
Ethical considerations such as benevolence and non-maleficence informed the treatment plan. The PMHNP aimed at ensuring that the use of naltrexone would result in minimal harm and side effects to the client (Loreck David et al., 2016). The ethical aspect of informed consent would also influence the care given to the patient (Ellis, 2017).
For example, the PMHNP was expected to seek informed consent prior to implementing the care plan to minimize ethical and legal issues related to the care given to the patient. Seeking informed consent ensures the protection of the rights of the patient to informed care. It also promotes patient autonomy, as he has the decision to accept or decline the available treatment interventions (Stern et al., 2015).
Decision Point Two
Selected Decision
Refer the client to counselor to address gambling issues.
Reason for Selection
The administration of naltrexone was effective in causing moderate improvement in the management of alcohol addiction and abuse by the client. The client however reported to engaging in severe gambling when she visits the casino. An effective intervention at this stage would therefore be referring the patient to the counselor for assistance in managing gambling issues.
The FDA has not approved any drug for use in management of gambling issues (Grant et al., 2014). As a result, non-pharmacological interventions such as counseling are recommended. Counseling will enable the client to learn about the effective ways of overcoming gambling behaviors and coping up with her problem (Lee et al., 2021). The use of counseling interventions such as group therapy and cognitive behavioral therapy will equip the client with knowledge and skills needed in the management of anxiety.
Why Other Options were not Selected
The decisions to add valium (diazepam) 5 mg orally TID/PRN/anxiety and add Chantix (varenicline) 1 mg orally BID were not selected in the case study. The administration of valium was likely to increase the rise of side effects such as sedation, memory problems, tiredness, and drowsiness that were likely to affect the adherence to treatment (Sychla, Gründer, & Lammertz, 2017).
The decision to add Chantix was also not selected because the administration of naltrexone had led to moderate improvement in symptoms of addiction in the client (Echeburúa & Amor, 2021). Augmenting the treatment is therefore not recommended.
Expectations
The above decision was made with the expectation of facilitating the effective management of the gambling problem being experienced by the client. It was also expected that the client would be assisted to identify effective strategies for managing her gambling problem. The decision was also made with the aim of improving the effectiveness of the pharmacological interventions used in addiction management (Pickering et al., 2020).
Impact of Ethical Considerations on Treatment Plan and Communication with the Client
The ethical consideration of promoting privacy and confidentiality of patient data would influence the selection of treatment plans at this phase. PMHNP is expected to seek informed consent from the client prior to sharing her information with other healthcare providers (Ellis, 2017). PMHNP is also expected to promote patient’s right to autonomous care by educating her about the aims of the selected treatment interventions.
Decision Point Three
Selected Decision
Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings.
Reason for Selection
The use of counseling services appears to have been effective for the client. For example, the client returned after 4 weeks reporting that the anxiety she had been experiencing was gone. She also reported that she has started attending Gamblers Anonymous group and has been participating in self-expression to seek the support that she needs. An effective intervention at this step would be to encourage the client to continue seeing her current counselor and continue with the Gamblers Anonymous group (Echeburúa & Amor, 2021).
There is the need for the PMHNP to obtain information from the client on the factors that contributed to her dissatisfaction with the care given by her counselor (Kelly & Renner, 2016). The information obtained from her will be used to implement effective interventions that would strengthen the relationship between her and the counselor (Lee et al., 2021). There is also the need to refer the client to the smoking cessation clinic to be assisted on the management of her health problem of smoking cigarette.
Why Other Options were not Selected
The decision to encourage Mrs. Perez to continue seeing her current counselor and continue with Gamblers Anonymous group was not selected because a strained relationship between her and the counselor could affect client’s participation and increase the risk of relapse (Heinz, Romanczuk-Seiferth, & Potenza, 2019). The decision to discontinue vivitrol and encourage Mrs. Perez to continue seeing her counselor and participating in the Gamblers Anonymous group was not selected because it would result in symptom relapse (Wightman et al., 2018).
Expectations
The above decision was made with the aim of adopting interventions to improve the relationship between the counselor and the client. The decision also aimed at ensuring continued improvement in the adoption of positive behaviors against gambling by the client. It was also expected that the client would adopt sustainable interventions to manage her addiction problems (Holt & Tobin, 2018).