{"id":9160,"date":"2021-10-21T06:11:35","date_gmt":"2021-10-21T06:11:35","guid":{"rendered":"https:\/\/nursingassignmentcrackers.com\/?p=9160"},"modified":"2024-02-15T06:00:11","modified_gmt":"2024-02-15T06:00:11","slug":"nurs-6630-case-study-53-year-old-puerto-rican-female-with-comorbid-addiction","status":"publish","type":"post","link":"https:\/\/nursingassignmentcrackers.com\/nurs-6630-case-study-53-year-old-puerto-rican-female-with-comorbid-addiction\/","title":{"rendered":"NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction"},"content":{"rendered":"<h2><strong>Sample Answer for NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction Included After Question<\/strong><\/h2>\n<p><em>NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction<\/em><\/p>\n<p>&nbsp;<\/p>\n<h3>BACKGROUND<\/h3>\n<p>Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather \u201cembarrassing problem.\u201d<\/p>\n<h3>SUBJECTIVE<\/h3>\n<p>Mrs. Perez admits that she has had \u201cproblems\u201d with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20\u2019s and has been involved with Alcoholics Anonymous \u201con and off\u201d for the past 25 years. She states that for the past 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new \u201cRising Sun\u201d casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its grand opening at which point she was \u201chooked.\u201d She states that she gets \u201csuch a high\u201d when she is gambling. While gambling, she \u201cenjoys a drink or two\u201d to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette <a href=\"https:\/\/nursingassignmentcrackers.com\/psy-350-week-5-dq-2-schizophrenia-and-smoking-latest\/\">smoking<\/a> has increased over the past 2 years and she is concerned about the negative effects of the cigarette smoking on her health.<\/p>\n<p>She states that she attempts to abstain from drinking but she gets such a \u201chigh\u201d from the act of gambling that she needs a few drinks to \u201ceven out.\u201d She also notices that when she drinks, she doesn\u2019t smoke \u201cas much,\u201d but she enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.<\/p>\n<p>Mrs. Perez is quite concerned today because she borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.<\/p>\n<figure id=\"attachment_107723\" aria-describedby=\"caption-attachment-107723\" style=\"width: 300px\" class=\"wp-caption alignright\"><img decoding=\"async\" class=\"size-medium wp-image-107723\" src=\"https:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2021\/10\/NURS-6630-Case-Study-53-year-old-Puerto-Rican-Female-with-Comorbid-Addiction-300x137.png\" alt=\"NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction\" width=\"300\" height=\"137\" srcset=\"https:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2021\/10\/NURS-6630-Case-Study-53-year-old-Puerto-Rican-Female-with-Comorbid-Addiction-300x137.png 300w, https:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2021\/10\/NURS-6630-Case-Study-53-year-old-Puerto-Rican-Female-with-Comorbid-Addiction-768x351.png 768w, https:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2021\/10\/NURS-6630-Case-Study-53-year-old-Puerto-Rican-Female-with-Comorbid-Addiction.png 960w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-107723\" class=\"wp-caption-text\">NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<h3>MENTAL STATUS EXAM<\/h3>\n<p>The client is a 53 year old Puerto Rican female who is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. When you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is \u201csad.\u201d Affect is appropriate to content of conversation and self-reported mood. She denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.<\/p>\n<h3><strong>Diagnosis: Gambling disorder, alcohol use disorder<\/strong><\/h3>\n<p>Decision Point One<\/p>\n<h4><strong>Select what you should do:<\/strong><\/h4>\n<p><a href=\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/DT\/week_08\/1.html\" target=\"_blank\" rel=\"noopener\">Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks <\/a><\/p>\n<p><a href=\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/DT\/week_08\/2.html\" target=\"_blank\" rel=\"noopener\">Antabuse (disulfiram) 250 mg orally daily <\/a><\/p>\n<p><a href=\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/DT\/week_08\/3.html\" target=\"_blank\" rel=\"noopener\">Campral (acamprosate) 666 mg orally three times\/day <\/a><\/p>\n<p>&nbsp;<\/p>\n<p>Decision Point One<\/p>\n<p>&nbsp;<\/p>\n<p>Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks<\/p>\n<h3>RESULTS OF DECISION POINT ONE<\/h3>\n<ul>\n<li>Client returns to clinic in four weeks<\/li>\n<li>Mrs. Perez says she feels \u201cwonderful\u201d as she has not \u201ctouched a drop\u201d of alcohol since receiving the injection<\/li>\n<li>Client reports that she has not been going to the casino, as frequently, but when she does go she \u201cdrops a bundle\u201d (meaning, spends a lot of money gambling)<\/li>\n<li>Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned<\/li>\n<\/ul>\n<p>Decision Point Two<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/DT\/week_08\/1.html#option1\" target=\"_blank\" rel=\"noopener\">Add on Valium (diazepam) 5 mg orally TID\/PRN\/anxiety <\/a><\/p>\n<p>&nbsp;<\/p>\n<h3>RESULTS OF DECISION POINT TWO<\/h3>\n<ul>\n<li>Client returns to clinic in four weeks<\/li>\n<li>Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states \u201cI was like a new person. This is a miracle drug!\u201d However, she reports that she has trouble \u201cwaiting\u201d between drug administration times and sometimes takes her Valium early<\/li>\n<li>She is asking today for an increase the Valium dose or frequency<\/li>\n<\/ul>\n<p>Decision Point Three<\/p>\n<h3 style=\"text-align: center;\"><em><a href=\"https:\/\/nursingassignmentcrackers.com\/place-order\/\"><strong><span style=\"color: #ff0000;\">Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction<\/span> <\/strong><\/a><\/em><\/h3>\n<h3 style=\"text-align: center;\"><\/h3>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/DT\/week_08\/1.html#option1a\" target=\"_blank\" rel=\"noopener\">Continue current dose of Vivitrol, increase Valium to 10 mg orally TID\/PRN\/anxiety. Refer to counseling for her ongoing gambling issue <\/a><\/p>\n<p>&nbsp;<\/p>\n<h3><strong>Guidance to Student<\/strong><\/h3>\n<p>&nbsp;<\/p>\n<h2><strong>A Sample Answer For the Assignment: NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction<\/strong><\/h2>\n<h2><strong>Title: NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction<\/strong><\/h2>\n<p>Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez\u2019s case.<\/p>\n<p>The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At that point, you would need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists.<\/p>\n<p>Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder.<\/p>\n<p>Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of \u201cactivation\u201d associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures).<\/p>\n<p>Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous.<\/p>\n<p>You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.<\/p>\n<p>Decision Point One<\/p>\n<p>&nbsp;<\/p>\n<p>Antabuse (disulfiram) 250 mg orally every morning<\/p>\n<h3>RESULTS OF DECISION POINT ONE<\/h3>\n<ul>\n<li>Client returns to clinic in four weeks<\/li>\n<li>Mrs. Perez reports to the office complaining of sedation, fatigue, and a \u201cmetallic taste\u201d in her mouth, which \u201cseems to be going away.\u201d She also reports that she had just one drink about 5 days after starting the drug and thought that she would \u201cdie.\u201d She reports that her face was red, and she felt that her heart would \u201cpound right out of my chest.\u201d<\/li>\n<li>Mrs. Perez also reports that she continues to visit the casino but has not been spending as much money there. She has noticed that her cigarette smoking is increasing<\/li>\n<\/ul>\n<p>Decision Point Two<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/DT\/week_08\/2.html#option1\" target=\"_blank\" rel=\"noopener\">Continue current dose of Antabuse and begin Campral (acamprosate) 666 mg orally BID <\/a><\/p>\n<p>&nbsp;<\/p>\n<h3>RESULTS OF DECISION POINT TWO<\/h3>\n<ul>\n<li>Client returns to clinic in four weeks<\/li>\n<li>Mrs. Perez reports that the metallic taste is \u201cstill there\u201d but that it doesn\u2019t bother her anymore<\/li>\n<li>She reports that she has managed to avoid alcohol as she is afraid of the side effects of the medications when she does drink<\/li>\n<li>She reports that over the course of the past 2 weeks, her cigarette consumption is \u201calmost double\u2014I\u2019m up to almost 2 packs a day!\u201d<\/li>\n<\/ul>\n<p>Decision Point Three<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/DT\/week_08\/2.html#option1a\" target=\"_blank\" rel=\"noopener\">Continue current doses of medications and discuss smoking cessation options <\/a><\/p>\n<p>&nbsp;<\/p>\n<h3><strong>Guidance to Student<\/strong><\/h3>\n<p>Sedation\/fatigue is a common complaint of people who take Antabuse. The best approach would be to change the administration time to the evening. The \u201cmetallic\u201d taste in Mrs. Perez\u2019s mouth is also another side effect that should lessen and may fully go away with the passage of time. When a person taking Antabuse ingests alcohol, they will most likely experience \u201cflushing,\u201d tachycardia, nausea, and vomiting.<\/p>\n<p>There is no reason to add Campral to her current medication regimen. Although the two drugs do not interact, it is simply a waste of money and increases the pill burden on the patient. There is no reason to discontinue both medications\u2014only one should be discontinued to help support sobriety. The remaining medication could be stopped in several weeks after the client as demonstrated a pattern of abstinence<\/p>\n<p>At this point, you should maintain the Antabuse, discontinue Campral, and discuss smoking cessation options with the client in order to address the totality of addictions and to enhance her overall health.<\/p>\n<p>Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling.<\/p>\n<p>Decision Point One<\/p>\n<p>&nbsp;<\/p>\n<p>Campral (acamprosate) 666 mg orally TID<\/p>\n<h3>RESULTS OF DECISION POINT ONE<\/h3>\n<ul>\n<li>Client returns to clinic in four weeks<\/li>\n<li>Upon return Mrs. Perez states that she has noticed that she has been having suicidal ideation over the past week, and it seems to be getting worse<\/li>\n<li>She is also reporting that she is having \u201cout of control\u201d anxiety<\/li>\n<\/ul>\n<p>Decision Point Two<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/DT\/week_08\/3.html#option1\" target=\"_blank\" rel=\"noopener\">Educate Mrs. Perez on the side effects of Campral and add Valium (diazepam) 5 mg orally TID to address anxiety symptoms <\/a><\/p>\n<p>&nbsp;<\/p>\n<h3>RESULTS OF DECISION POINT TWO<\/h3>\n<ul>\n<li>Client returns to clinic in four weeks<\/li>\n<li>Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states, \u201cI was like a new person. This is a miracle drug!\u201d However, she reports that she has trouble \u201cwaiting\u201d between drug administration times and sometimes takes her Valium early. She is asking today for an increase in the Valium dose or frequency<\/li>\n<li>Although she reports that her anxiety is gone. She still reports suicidal ideation, but she states, \u201cWith that Valium stuff, who cares?\u201d<\/li>\n<\/ul>\n<p>Decision Point Three<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/DT\/week_08\/3.html#option1a\" target=\"_blank\" rel=\"noopener\">Continue current dose of Campral, and increase Valium to 10 mg orally TID\/PRN\/anxiety. Refer to counseling for her ongoing gambling issue <\/a><\/p>\n<p>&nbsp;<\/p>\n<h3><strong>Guidance to Student<\/strong><\/h3>\n<p>Given her weight (less than 60 kg), Campral should have been started at 666 mg orally BID. Her side effects were most likely related to the high starting dose.<\/p>\n<p>Although the anxiety is a problematic side effect, it is not as serious as her suicidal ideation. The suicidal ideation is a side effect that should have signaled the need to discontinue the drug and consider a different agent such as Antabuse.<\/p>\n<p>Medication should never be added to treat the side effect of another medication unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of \u201cactivation\u201d associated with initiation of SSRI, or SNRI therapy). However, in a patient with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures). Additionally, benzodiazepines are not to be used long term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what is being seen in Mrs. Perez\u2019s case.<\/p>\n<p>Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of Gamblers Anonymous.<\/p>\n<p>You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions and to enhance her overall health.<\/p>\n<h3><strong>Learning Resources<\/strong><\/h3>\n<p><strong><a href=\"https:\/\/class.content.laureate.net\/21a7a90db655419e20fee1deb890f877.html#section_container_1716881496-accordion-53\" target=\"_blank\" rel=\"noopener\">Required Readings (click to expand\/reduce) <\/a><\/strong><\/p>\n<p>&nbsp;<\/p>\n<p>Kelly, J. E., &amp; Renner, J. A. (2016). Alcohol-Related disorders. In T. A. Stern, M. Favo, T. E. Wilens, &amp; J. F. Rosenbaum. (Eds.), <em>Massachusetts General Hospital psychopharmacology and neurotherapeutics<\/em>\u00a0(pp. 163\u2013182). Elsevier.<\/p>\n<p>Renner, J. A., &amp; Ward, N. (2016). Drug addiction. In T. A. Stern, M. Favo, T. E. Wilens, &amp; J. F. Rosenbaum. (Eds.), <em>Massachusetts General Hospital psychopharmacology and neurotherapeutics<\/em>\u00a0(pp. 163\u2013182). Elsevier.<\/p>\n<p><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK64350\/\" target=\"_blank\" rel=\"noopener\">Substance Abuse and Mental Health Services Administration. (1999). <em>Treatment of adolescents with substance use disorders: Treatment improvement protocol series, no. 32<\/em>. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK64350\/<\/a><\/p>\n<ul>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK64350\/\" target=\"_blank\" rel=\"noopener\">Chapter 1, \u201cSubstance Use Among Adolescents\u201d<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK64350\/\" target=\"_blank\" rel=\"noopener\">Chapter 2, \u201cTailoring Treatment to the Adolescent\u2019s Problem\u201d<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK64350\/\" target=\"_blank\" rel=\"noopener\">Chapter 7, \u201cYouths with Distinctive Treatment Needs\u201d<\/a><\/li>\n<\/ul>\n<p><a href=\"https:\/\/ezp.waldenulibrary.org\/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1782829190%3Faccountid%3D14872\" target=\"_blank\" rel=\"noopener\">University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control. <em>Journal of Psychosocial Nursing &amp; Mental Health Services, 54<\/em>(4), 15.<\/a><\/p>\n<p><a href=\"https:\/\/go.openathens.net\/redirector\/waldenu.edu?url=https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4014021\/\" target=\"_blank\" rel=\"noopener\">Grant, J. E., Odlaug, B. L., &amp; Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. <em>British Journal of Clinical Pharmacology, 77<\/em>(2), 375\u2013381. https:\/\/doi.org\/10.1111\/j.1365-2125.2012.04457.x<\/a><\/p>\n<p><a href=\"https:\/\/ezp.waldenulibrary.org\/login?url=https:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=a9h&amp;AN=103386397&amp;site=ehost-live&amp;scope=site\" target=\"_blank\" rel=\"noopener\">Hulvershorn, L. A., Schroeder, K. M., Wink, L. K., Erickson, C. A., &amp; McDougle, C. J. (2015). Psychopharmacologic treatment of children prenatally exposed to drugs of abuse. <em>Human Psychopharmacology, 30<\/em>(3), 164\u2013172. https:\/\/doi.org\/10.1002\/hup.2467<\/a><\/p>\n<p><a href=\"https:\/\/ezp.waldenulibrary.org\/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1810341157%3Faccountid%3D14872\" target=\"_blank\" rel=\"noopener\">Loreck, D., Brandt, N. J., &amp; DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. <em>Journal of Gerontological Nursing, 42<\/em>(4), 10\u201315. https:\/\/doi.org\/10.3928\/00989134-20160314-04<\/a><\/p>\n<p><a href=\"https:\/\/ezp.waldenulibrary.org\/login?url=https:\/\/search.ebscohost.com\/login.aspx?direct=true&amp;db=sih&amp;AN=71678483&amp;site=ehost-live&amp;scope=site\" target=\"_blank\" rel=\"noopener\">Salmon, J. M., &amp; Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. <em>Journal of Dual Diagnosis, 8<\/em>(1), 74\u201384. https:\/\/doi.org\/10.1080\/15504263.2012.648439<\/a><\/p>\n<p><a href=\"https:\/\/ezp.waldenulibrary.org\/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1545851982%3Faccountid%3D14872\" target=\"_blank\" rel=\"noopener\">Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., Olvera, R., Swann, A. C., &amp; Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. <em>Comprehensive Psychiatry, 55<\/em>(6), 1337\u20131341. https:\/\/doi.org\/10.1016\/j.comppsych.2014.04.018<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong><a href=\"https:\/\/class.content.laureate.net\/21a7a90db655419e20fee1deb890f877.html#section_container_1716881496-accordion_copy_copy_-64\" target=\"_blank\" rel=\"noopener\">Medication Resources (click to expand\/reduce) <\/a><\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/www.accessdata.fda.gov\/scripts\/cder\/daf\/index.cfm\" target=\"_blank\" rel=\"noopener\">U.S. Food &amp; Drug Administration. (n.d.). <em>Drugs@FDA: FDA-approved drugs<\/em>. https:\/\/www.accessdata.fda.gov\/scripts\/cder\/daf\/index.cfm<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Note:\u00a0<\/strong>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.<\/p>\n<table width=\"100%\">\n<thead>\n<tr>\n<td width=\"33\">\n<ul>\n<li>naltrexone (revia\/vivitrol)<\/li>\n<li>naloxone<\/li>\n<li>acamprosate<\/li>\n<li>disulfiram<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/thead>\n<\/table>\n<p><strong><a href=\"https:\/\/class.content.laureate.net\/21a7a90db655419e20fee1deb890f877.html#section_container_1716881496-accordion_copy-69\" target=\"_blank\" rel=\"noopener\">Required Media (click to expand\/reduce) <\/a><\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/DT\/week_08\/index.html\" target=\"_blank\" rel=\"noopener\">Case Study: A Puerto Rican Woman with Comorbid Addiction<br \/>\n<strong>Note:<\/strong>\u00a0This case study will serve as the foundation for this week\u2019s Assignment.<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong><a href=\"https:\/\/class.content.laureate.net\/21a7a90db655419e20fee1deb890f877.html#section_container_1716881496-accordion_copy_copy__1837603112-73\" target=\"_blank\" rel=\"noopener\">Optional Resources (click to expand\/reduce) <\/a><\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/doi.org\/10.1155\/2014\/537306\" target=\"_blank\" rel=\"noopener\">Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., Cinose, E., Di Iorio, G., Di Nicola, M., &amp; Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. <em>Biomed Research International<\/em>, <em>2014<\/em>. https:\/\/doi.org\/10.1155\/2014\/537306<\/a><\/p>\n<p>&nbsp;<\/p>\n<h3><strong>Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction<\/strong><\/h3>\n<p>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.<\/p>\n<p>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\u2019s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction.<\/p>\n<h3><sub>NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction Reference:\u00a0<\/sub><\/h3>\n<p><sub>MentalHelp.net. (n.d.). <em>Impaired decision-making, impulsivity, and compulsivity: Addictions\u2019 effect on the cerebral cortex<\/em>. <a href=\"https:\/\/www.mentalhelp.net\/addiction\/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.mentalhelp.net\/addiction\/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex\/<\/a><\/sub><\/p>\n<h3><strong>To prepare for this Assignment:<\/strong><\/h3>\n<ul>\n<li>Review this week\u2019s Learning Resources, including the Medication Resources indicated for this week.<\/li>\n<li>Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for impulsivity, compulsivity, and addiction.<\/li>\n<\/ul>\n<h3><strong>The Assignment: 5 pages<\/strong><\/h3>\n<p>Examine\u00a0<em>Case Study: A Puerto Rican Woman With Comorbid Addiction<\/em>. You will be asked to make three decisions concerning the medication to prescribe to this client.\u00a0Be sure to consider factors that might impact the client\u2019s\u00a0pharmacokinetic and pharmacodynamic processes.<\/p>\n<p>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.<\/p>\n<h3><strong>Introduction to the case (1 page)<\/strong><\/h3>\n<ul>\n<li>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.<\/li>\n<\/ul>\n<h3><strong>Decision #1 (1 page)<\/strong><\/h3>\n<ul>\n<li>Which decision did you select?<\/li>\n<li>Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.<\/li>\n<li>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.<\/li>\n<li>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).<\/li>\n<li>Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.<\/li>\n<\/ul>\n<h3><strong>Decision #2 (1 page)<\/strong><\/h3>\n<ul>\n<li>Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.<\/li>\n<li>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.<\/li>\n<li>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).<\/li>\n<li>Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.<\/li>\n<\/ul>\n<h3><strong>Decision #3 (1 page)<\/strong><\/h3>\n<ul>\n<li>Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.<\/li>\n<li>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.<\/li>\n<li>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).<\/li>\n<li>Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.<\/li>\n<\/ul>\n<h3><strong>Conclusion (1 page)<\/strong><\/h3>\n<ul>\n<li>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.<\/li>\n<\/ul>\n<p><strong><em>Note:<\/em><\/strong><em>\u00a0Support 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.<\/em><\/p>\n<p><strong><u><a href=\"https:\/\/academicguides.waldenu.edu\/writingcenter\/templates\/general#s-lg-box-20293632\" target=\"_blank\" rel=\"noopener\">ReminNURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction der : 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.<\/a><\/u><\/strong><\/p>\n<h3><strong>Lopes Write Policy<\/strong><\/h3>\n<p>For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a \u201cfinal submit\u201d to me.<\/p>\n<p>Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.<\/p>\n<p>Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else\u2019s thoughts more than your own?<\/p>\n<p>Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.<\/p>\n<h3><strong>Late Policy<\/strong><\/h3>\n<p>The university\u2019s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.<\/p>\n<p>Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.<\/p>\n<p>If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.<\/p>\n<p>I do not accept assignments that are two or more weeks late unless we have worked out an extension.<\/p>\n<p>As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.<\/p>\n<h3><strong>Communication<\/strong><\/h3>\n<p>Communication is so very important. There are multiple ways to communicate with me:<\/p>\n<p>Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.<\/p>\n<p>Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.<\/p>\n<h3><strong>Important information for writing discussion questions and participation<\/strong><\/h3>\n<h4><strong>Welcome to class<\/strong><\/h4>\n<p>Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the \u201cmessage\u201d icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to<\/p>\n<p>I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.<\/p>\n<p>Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.<\/p>\n<p>If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.<\/p>\n<p>Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.<\/p>\n<p>Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.<\/p>\n<p>I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God\u2019s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!<\/p>\n<p>Hi Class,<\/p>\n<p>Please read through the following information on writing a Discussion question response and participation posts.<\/p>\n<p>Contact me if you have any questions.<\/p>\n<h3><strong>Important information on Writing a Discussion Question<\/strong><\/h3>\n<ul>\n<li>Your response needs to be\u00a0a minimum\u00a0of 150 words (not including your list of references)<\/li>\n<li>There needs to be at least TWO references with ONE being a peer reviewed professional journal article.<\/li>\n<li>Include in-text citations in your response<\/li>\n<li>Do not include quotes\u2014instead summarize and paraphrase the information<\/li>\n<li>Follow APA-7th edition<\/li>\n<li>Points will be deducted if the above is not followed<\/li>\n<\/ul>\n<h3><strong>Participation \u2013replies to your classmates or instructor<\/strong><\/h3>\n<ul>\n<li>A minimum of 6 responses per week, on at least 3 days of the week.<\/li>\n<li>Each response needs at least ONE reference with citations\u2014best if it is a peer reviewed journal article<\/li>\n<li>Each response needs to be at least 75 words in length (does not include your list of references)<\/li>\n<li>Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of \u201cI agree\u201d or \u201cgreat post\u201d does not count for the word count.<\/li>\n<li>Follow APA 7th edition<\/li>\n<li>Points will be deducted if the above is not followed<\/li>\n<li>Remember to use and follow APA-7th\u00a0edition for all weekly assignments, discussion questions, and participation points.<\/li>\n<li>Here are some helpful links<\/li>\n<li><a href=\"https:\/\/apastyle.apa.org\/style-grammar-guidelines\/paper-format\/student-annotated.pdf\" target=\"_blank\" rel=\"noopener\">Student paper example<\/a><\/li>\n<li><a href=\"https:\/\/libguides.gcu.edu\/CitingSources\" target=\"_blank\" rel=\"noopener\">Citing Sources<\/a><\/li>\n<li>The\u00a0<a href=\"https:\/\/www.gcumedia.com\/lms-resources\/student-success-center\/v3.1\/\" target=\"_blank\" rel=\"noopener\">Writing Center\u00a0<\/a>is a great resource<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Sample Answer for NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction Included After Question NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction &nbsp; BACKGROUND Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather \u201cembarrassing problem.\u201d SUBJECTIVE Mrs. Perez admits that [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"rank_math_lock_modified_date":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9160","post","type-post","status-publish","format-standard","hentry","category-nursing-papers"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":6}},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction - Nursing 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