ASSESSING AND TREATING PATIENTS WITH IMPILSIVITY, COMPLULSIVITY AND ADDICTION NURS 6630

Sample Answer for ASSESSING AND TREATING PATIENTS WITH IMPILSIVITY, COMPLULSIVITY AND ADDICTION NURS 6630 Included After Question

ASSESSING AND TREATING PATIENTS WITH IMPILSIVITY, COMPLULSIVITY AND ADDICTION NURS 6630

ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION NURS 6630 

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/ 

Resources 

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.  

WEEKLY RESOURCES 

Learning Resources 

Required Readings 

  • 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. 
  • Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders: Treatment improvement protocol series  

  Links to an external site., no. 32. http://www.ncbi.nlm.nih.gov/books/NBK64350/ 

  • Chapter 1, “Substance Use Among Adolescents” 
  • Chapter 2, “Tailoring Treatment to the Adolescent’s Problem” 
  • Chapter 7, “Youths with Distinctive Treatment Needs” 

  University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control. Journal of Psychosocial Nursing & Mental Health Services  

  Links to an external site., 54(4), 15.  

  Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology  

  Links to an external site., 77(2), 375–381. https://doi.org/10.1111/j.1365-2125.2012.04457.x  

  Hulvershorn, L. A., Schroeder, K. M., Wink, L. K., Erickson, C. A., & McDougle, C. J. (2015). Psychopharmacologic treatment of children prenatally exposed to drugs of abuse. Human Psychopharmacology  

  Links to an external site., 30(3), 164–172. https://doi.org/10.1002/hup.2467  

  Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing  

  Links to an external site., 42(4), 10–15. https://doi.org/10.3928/00989134-20160314-04  

  Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis  

  Links to an external site., 8(1), 74–84. https://doi.org/10.1080/15504263.2012.648439  

  Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., Olvera, R., Swann, A. C., & Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry  

Medication Resources 

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 

Required Media 

Note: This case study will serve as the foundation for this week’s Assignment. 

Optional Resources 

  • Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., Cinose, E., Di Iorio, G., Di Nicola, M., & Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014  

Links to an external site.. https://doi.org/10.1155/2014/537306 

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. 

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting  

Links to an external site.. 

By Day 7 

Submit your Assignment.  

submission information 

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.  

  1. To submit your completed assignment, save your Assignment as WK10Assgn1_LastName_Firstinitial  
  1. Then, click on Start Assignment near the top of the page. 
  1. Next, click on Upload File and select Submit Assignment for review. 

 

Rubric 

NURS_6630_Week10_Assignment1_Rubric  

NURS_6630_Week10_Assignment1_Rubric  
Criteria  Ratings  Pts  
This criterion is linked to a Learning Outcome 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.  
10 to >8.0 pts  

Excellent Point range: 90–100 

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. 

8 to >7.0 pts  

Good Point range: 80–89 

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. 

7 to >6.0 pts  

Fair Point range: 70–79 

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. 

6 to >0 pts  

Poor Point range: 0–69 

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. 

 

10 pts 
This criterion is linked to a Learning Outcome 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.  
20 to >17.0 pts  

Excellent Point range: 90–100 

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. 

17 to >15.0 pts  

Good Point range: 80–89 

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. 

15 to >13.0 pts  

Fair Point range: 70–79 

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. 

13 to >0 pts  

Poor Point range: 0–69 

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. 

 

20 pts 
This criterion is linked to a Learning Outcome 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.  
20 to >17.0 pts  

Excellent Point range: 90–100 

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. 

17 to >15.0 pts  

Good Point range: 80–89 

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. 

15 to >13.0 pts  

Fair Point range: 70–79 

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. 

13 to >0 pts  

Poor Point range: 0–69 

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. 

 

20 pts 
This criterion is linked to a Learning Outcome 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.  
20 to >17.0 pts  

Excellent Point range: 90–100 

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. 

17 to >15.0 pts  

Good Point range: 80–89 

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. 

15 to >13.0 pts  

Fair Point range: 70–79 

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. 

13 to >0 pts  

Poor Point range: 0–69 

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. 

 

20 pts 
This criterion is linked to a Learning Outcome 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.  
15 to >13.0 pts  

Excellent Point range: 90–100 

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. 

13 to >11.0 pts  

Good Point range: 80–89 

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. 

11 to >10.0 pts  

Fair Point range: 70–79 

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. 

10 to >0 pts  

Poor Point range: 0–69 

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. 

 

15 pts 
This criterion is linked to a Learning Outcome 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.  
5 to >4.0 pts  

Excellent Point range: 90–100 

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. 

4 to >3.5 pts  

Good Point range: 80–89 

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. 

3.5 to >3.0 pts  

Fair Point range: 70–79 

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. 

3 to >0 pts  

Poor Point range: 0–69 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided. 

 

5 pts 
This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation  
5 to >4.0 pts  

Excellent Point range: 90–100 

Uses correct grammar, spelling, and punctuation with no errors. 

4 to >3.5 pts  

Good Point range: 80–89 

Contains a few (1 or 2) grammar, spelling, and punctuation errors. 

3.5 to >3.0 pts  

Fair Point range: 70–79 

Contains several (3 or 4) grammar, spelling, and punctuation errors. 

3 to >0 pts  

Poor Point range: 0–69 

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. 

 

5 pts 
This criterion is linked to a Learning Outcome 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.  
5 to >4.0 pts  

Excellent Point range: 90–100 

Uses correct APA format with no errors. 

4 to >3.5 pts  

Good Point range: 80–89 

Contains a few (1 or 2) APA format errors. 

3.5 to >3.0 pts  

Fair Point range: 70–79 

Contains several (3 or 4) APA format errors. 

3 to >0 pts  

Poor Point range: 0–69 

Contains many (≥ 5) APA format errors. 

 

5 pts 
Total Points: 100  

 

A Sample Answer For the Assignment: ASSESSING AND TREATING PATIENTS WITH IMPILSIVITY, COMPLULSIVITY AND ADDICTION NURS 6630

Title: ASSESSING AND TREATING PATIENTS WITH IMPILSIVITY, COMPLULSIVITY AND ADDICTION NURS 6630

 

Impulsivity disorders are characterized by the inability to resist the sudden, powerful desire to do something and difficulties controlling emotions or behaviors. On the other hand, addiction is a complex mental condition characterized by compulsive substance use regardless of detrimental consequences. The purpose of this paper is to describe a patient with an addiction disorder and the treatment interventions.

Introduction to the Case

The case scenario depicts Mrs. Perez, a 53-year-old Puerto Rican woman with alcohol drinking problems since her late teenage years. Perez has been a part of Alcoholics Anonymous from time to time for the last 25 years. The patient also reports that she has been finding it more difficult to remain sober in the past two years since a casino was opened in her neighborhood. Perez mentions that she gets high when gambling since she takes some drinks when playing high-stake gambling games. However, this leads to increased alcohol consumption and irresponsible gambling. In addition, the client states she has increasingly been smoking in the past two years and is worried about the adverse health impacts.

Mrs. Perez reports that she has tried refraining from alcohol consumption, but gambling makes her high, making her take a few drinks to even up. She has also realized that when she consumes alcohol, she smokes minimally, but she enjoys smoking when gambling. The patient has experienced weight gain from excessive drinking, and her current weight is 122 lbs, having gained 7 lbs. The patient is worried since she borrowed more than $50,000 from her retirement account to pay gambling debts. Noteworthy MSE findings include avoiding eye contact, sad mood, and impaired impulse control. Mrs. Perez is diagnosed with Gambling disorder and alcohol use disorder. The patient factors that may affect decision-making with regard to treatment include age, overall health status, comorbid mental health illnesses, the patient’s previous experience with medication, the patient’s beliefs and opinions on useful therapies, history of treatment compliance, and the patient’s motivation for abstinence.

Decision #1

Vivitrol (naltrexone) injection, 380 mg IM in the gluteal region four-weekly.

Reason for this Decision

Naltrexone was the ideal treatment because it is an FDA-indicated drug for treating alcohol use disorder (AUD). Joshi et al. (2021) explain that naltrexone alleviates alcohol cravings, decreases alcohol consumption, and the monthly injectable formulation helps in compliance. Kranzler and Soyka (2018) explain that naltrexone decreases mesolimbic opioidergic activity, thus controlling the dopamine-mediated rewarding effects of alcohol, resulting in decreased alcohol consumption.

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ASSESSING AND TREATING PATIENTS WITH IMPILSIVITY, COMPLULSIVITY AND ADDICTION NURS 6630
ASSESSING AND TREATING PATIENTS WITH IMPILSIVITY, COMPLULSIVITY AND ADDICTION NURS 6630

Why Other Decisions Were Not Selected

Disulfiram was not ideal because the physical reaction of alcohol and disulfiram causes dizziness, tachycardia, nausea, flushing, chest pain, and BP changes, which can harm patients, making it less recommended (Joshi et al., 2021). Acamprosate was not selected because it is approved by the FDA to promote abstinence in patients who are abstinent when starting treatment (Kranzler & Soyka, 2018). Mrs. Perez was not abstinent and thus not a suitable candidate for acamprosate therapy.

What I Was Hoping To Achieve By Making This Decision

The PMHNP hoped that naltrexone would reduce the patient’s alcohol cravings and excessive consumption (Witkiewitz et al., 2019). Kranzler and Soyka (2018) found that naltrexone effectively reduces the risk of relapse into alcohol and relapse to binge drinking.

Ethical Considerations, Impact on Treatment Plan and Communication

Nonmaleficence impacted the treatment plan since the PMHNP had to select the intervention with the best outcomes and the least side effects. Consequently, naltrexone was chosen for its strong safety profile, and disulfiram was rejected. Respect for autonomy impacted communication with the clinician seeking patient consent to initiate treatment.

Decision #2

Refer the patient to a counselor to address gambling issues.

Reason for this Decision

The patient was referred to a counselor because she had persistent gambling issues that got her into financial problems. Menchon et al. (2018) explain that psychological therapies are the most effective approach for gambling disorders and are connected with marked improvements in the short and the long term. Counseling focuses on the patient, enabling them to search and solve uncertainties, and improving their willingness to change behavior (Ribeiro et al., 2021).

Why Other Decisions Were Not Selected

Adding diazepam to treat anxiety was not ideal because the patient’s anxiety is a likely side effect of naltrexone therapy and thus does not justify medication (Joshi et al., 2021). Chantix was also not added to promote smoking cessation because the smoking problem was linked to gambling, and thus it is important first to solve the gambling issue. Menchon et al. (2018) explain that cognitive behavioral therapy (CBT) facilitates an individual’s understanding of cognitive distortions connected to gambling behavior.

What I Was Hoping To Achieve By Making This Decision

The PMHNP hoped that psychological therapy would help the patient identify cognitive distortions connected with her gambling behavior. Counseling weakens the irrational beliefs, perseveration patterns, and magical thinking associated with the gambling disorder (Menchon et al., 2018). Ribeiro et al. (2021) explain that counseling primarily focuses on the patient’s behavior, cognition, and motivation, thus solving the psychological determinants of gambling.

Ethical Considerations Impact on Treatment Plan and Communication

Beneficence influenced the patient’s treatment since the PMHNP had to refer the patient for counseling to address the gambling issue and promote better health outcomes. Confidentiality impacted communication since the PMHNP had to ensure the patient’s health information was kept confidential and only shared after obtaining the patient’s consent.

Decision #3

Identify the patient’s problems with her counselor, and encourage her to continue attending GA meetings.

Reason for this Decision,

The PMHNP selected this decision because the client reported not liking her counselor, which could affect her adherence to counseling sessions and treatment outcomes. Bolsinger et al. (2020) explain that creating a good therapeutic relationship (TR) in counseling is crucial to improving clinical outcomes, quality of patient care, and patient satisfaction. Kleiven et al. (2020) explain that it is essential for the patient to open up to and connect with personal issues internally, despite this being highly uncomfortable.

Why Other Decisions Were Not Selected

It was not ideal to encourage the patient to continue counseling without addressing the concerns with the counselor because it would have further worsened the therapeutic relationship between Mrs. Perez and the counselor. Kleiven et al. (2020) explain that the TR in psychotherapy is crucial since it facilitates the clients’ ability to approach, acknowledge, and reflect upon challenging issues with sincerity and authenticity. Discontinuing naltrexone was not also ideal because it exhibited efficacy in alleviating alcohol consumption and cravings (Joshi et al., 2021).

What I Was Hoping To Achieve By Making This Decision

The PMHNP hoped that exploring Mrs. Perez’s issues with her counselor would enable her to open up and have an effective relationship with the counselor (Kleiven et al., 2020). Bolsinger et al. (2020) found that a positive TR is connected with better therapy outcomes with regard to clinical improvement, re-hospitalization, and patient satisfaction.

Ethical Considerations Impact on Treatment Plan and Communication

Beneficence affected the treatment plan since the PMHNP had to help the patient identify her issues with the counselor to create a positive TR, promoting better outcomes. Besides, the respect for autonomy affected communication with the client since the PMHNP had to engage the patient to identify the issues with the counselor and address them.

Conclusion

Mrs. Perez was diagnosed with alcohol use disorder and gambling disorder based on her history of excessive alcohol consumption and gambling, which got her in financial trouble. The patient was prescribed Naltrexone injection, 380 mg four weekly, since it reduces alcohol consumption and alcohol cravings (Joshi et al., 2021). Besides, naltrexone is well-tolerated and is not associated with dependence. Disulfiram was not selected because of its disulfiram-alcohol interaction, which causes BP changes, nausea, chest pain, flushing, dizziness, and tachycardia. Acamprosate was not also ideal because it is indicated for patients who have already achieved abstinence (Kranzler & Soyka, 2018).

The patient’s gambling disorder persisted, and the PMHNP referred her for counseling. A psychotherapy approach was the most ideal since it is considered the most treatment for gambling disorders and associated with marked improvements in the short and the long term (Menchon et al., 2018). However, she reported having issues with the counselor, although she participated in gambler anonymous groups. Consequently, the PMHNP sought to examine the client’s issues with her counselor and encouraged her to continue attending GA meetings. This was crucial to maintain a positive TR and ensure the client received the maximum from psychotherapy.

References

Bolsinger, J., Jaeger, M., Hoff, P., & Theodoridou, A. (2020). Challenges and Opportunities in Building and Maintaining a Good Therapeutic Relationship in Acute Psychiatric Settings: A Narrative Review. Frontiers in psychiatry10, 965. https://doi.org/10.3389/fpsyt.2019.00965

Joshi, P., Duong, K. T., Trevisan, L. A., & Wilkins, K. M. (2021). Evaluation and Management of Alcohol Use Disorder among Older Adults. Current geriatrics reports10(3), 82–90. https://doi.org/10.1007/s13670-021-00359-5

Kleiven, G. S., Hjeltnes, A., Råbu, M., & Moltu, C. (2020). Opening Up: Clients’ Inner Struggles in the Initial Phase of Therapy. Frontiers in Psychology11, 591146. https://doi.org/10.3389/fpsyg.2020.591146

Kranzler, H. R., & Soyka, M. (2018). Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review. JAMA320(8), 815–824. https://doi.org/10.1001/jama.2018.11406

Menchon, J. M., Mestre-Bach, G., Steward, T., Fernández-Aranda, F., & Jiménez-Murcia, S. (2018). An overview of gambling disorder: from treatment approaches to risk factors. F1000Research7, 434. https://doi.org/10.12688/f1000research.12784.1

Ribeiro, E. O., Afonso, N. H., & Morgado, P. (2021). Non-pharmacological treatment of gambling disorder: a systematic review of randomized controlled trials. BMC Psychiatry21(1), 105. https://doi.org/10.1186/s12888-021-03097-2

Witkiewitz, K., Litten, R. Z., & Leggio, L. (2019). Advances in the science and treatment of alcohol use disorder. Science advances5(9), eaax4043. https://doi.org/10.1126/sciadv.aax4043

Grading Rubric

Performance Category 100% or highest level of performance

100%

16 points

Very good or high level of performance

88%

14 points

Acceptable level of performance

81%

13 points

Inadequate demonstration of expectations

68%

11 points

Deficient level of performance

56%

9 points

 

Failing level

of performance

55% or less

0 points

 Total Points Possible= 50           16 Points    14 Points 13 Points        11 Points           9 Points          0 Points
Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic topics.

Presentation of information was exceptional and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was minimally demonstrated in all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
 

Presentation of information is unsatisfactory in one of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
 

Presentation of information is unsatisfactory in two of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information is unsatisfactory in three or more of the following elements

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information
 16 Points  14 Points  13 Points 11 Points 9 Points  0 Points
Application of Course Knowledge

Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations

Presentation of information was exceptional and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was minimally demonstrated in the all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in one of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from and scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in two of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in three of the following elements

  • Applies principles, knowledge and information and scholarly resources to the required topic.
  • Applies facts, principles or concepts learned scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
   10 Points 9 Points  6 Points  0 Points
Interactive Dialogue

Initial post should be a minimum of 300 words (references do not count toward word count)

The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count)

Responses are substantive and relate to the topic.

Demonstrated all of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 3 of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 2 of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 1 or less of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
  8 Points 7 Points  6 Points         5 Points          4 Points  0 Points
Grammar, Syntax, APA

Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition

Error is defined to be a unique APA error. Same type of error is only counted as one error.

The following was present:

  • 0-3 errors in APA format

AND

  • Responses have 0-3 grammatical, spelling or punctuation errors

AND

  • Writing style is generally clear, focused on topic,and facilitates communication.
The following was present:

  • 4-6 errors in APA format.

AND/OR

  • Responses have 4-5 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is somewhat focused on topic.
The following was present:

  • 7-9 errors in APA format.

AND/OR

  • Responses have 6-7 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is slightly focused on topic making discussion difficult to understand.
 

The following was present:

  • 10- 12 errors in APA format

AND/OR

  • Responses have 8-9 grammatical, spelling and punctuation errors

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand.
 

The following was present:

  • 13 – 15 errors in APA format

AND/OR

  • Responses have 8-10 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand.

AND/OR

  • The student continues to make repeated mistakes in any of the above areas after written correction by the instructor.
The following was present:

  • 16 to greater errors in APA format.

AND/OR

  • Responses have more than 10 grammatical, spelling or punctuation errors.

AND/OR

  • Writing style does not facilitate communication
  0 Points Deducted 5 Points Lost
Participation

Requirements

Demonstrated the following:

  • Initial, peer, and faculty postings were made on 3 separate days
Failed to demonstrate the following:

  • Initial, peer, and faculty postings were made on 3 separate days
  0 Points Lost 5 Points Lost
Due Date Requirements Demonstrated all of the following:

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.

Demonstrates one or less of the following.

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.