NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction<\/em><\/p>\n <\/p>\n Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather \u201cembarrassing problem.\u201d<\/p>\n 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 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 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 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 <\/p>\n 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 Decision Point One<\/p>\n Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks <\/a><\/p>\n Antabuse (disulfiram) 250 mg orally daily <\/a><\/p>\n Campral (acamprosate) 666 mg orally three times\/day <\/a><\/p>\n <\/p>\n Decision Point One<\/p>\n <\/p>\n Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks<\/p>\n Decision Point Two<\/p>\n <\/p>\n Add on Valium (diazepam) 5 mg orally TID\/PRN\/anxiety <\/a><\/p>\n <\/p>\n Decision Point Three<\/p>\n <\/p>\n 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>\n <\/p>\n 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 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 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 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 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 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 Decision Point One<\/p>\n <\/p>\n Antabuse (disulfiram) 250 mg orally every morning<\/p>\n Decision Point Two<\/p>\n <\/p>\n Continue current dose of Antabuse and begin Campral (acamprosate) 666 mg orally BID <\/a><\/p>\n <\/p>\n Decision Point Three<\/p>\n <\/p>\n Continue current doses of medications and discuss smoking cessation options <\/a><\/p>\n <\/p>\n 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 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 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 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 Decision Point One<\/p>\n <\/p>\n Campral (acamprosate) 666 mg orally TID<\/p>\n Decision Point Two<\/p>\n <\/p>\n 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>\n Decision Point Three<\/p>\n <\/p>\n 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>\n 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 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 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 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 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 Required Readings (click to expand\/reduce) <\/a><\/strong><\/p>\n <\/p>\n 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<\/em>\u00a0(pp. 163\u2013182). Elsevier.<\/p>\n 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<\/em>\u00a0(pp. 163\u2013182). Elsevier.<\/p>\n Substance Abuse and Mental Health Services Administration. (1999). 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 University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control. Journal of Psychosocial Nursing & Mental Health Services, 54<\/em>(4), 15.<\/a><\/p>\n Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77<\/em>(2), 375\u2013381. https:\/\/doi.org\/10.1111\/j.1365-2125.2012.04457.x<\/a><\/p>\n 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, 30<\/em>(3), 164\u2013172. https:\/\/doi.org\/10.1002\/hup.2467<\/a><\/p>\n Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42<\/em>(4), 10\u201315. https:\/\/doi.org\/10.3928\/00989134-20160314-04<\/a><\/p>\n 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, 8<\/em>(1), 74\u201384. https:\/\/doi.org\/10.1080\/15504263.2012.648439<\/a><\/p>\n 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, 55<\/em>(6), 1337\u20131341. https:\/\/doi.org\/10.1016\/j.comppsych.2014.04.018<\/a><\/p>\n <\/p>\n Medication Resources (click to expand\/reduce) <\/a><\/strong><\/p>\n <\/p>\n U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs<\/em>. https:\/\/www.accessdata.fda.gov\/scripts\/cder\/daf\/index.cfm<\/a><\/p>\n <\/p>\n 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>\nBACKGROUND<\/h3>\n
SUBJECTIVE<\/h3>\n
![\"NURS](\"https:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2021\/10\/NURS-6630-Case-Study-53-year-old-Puerto-Rican-Female-with-Comorbid-Addiction-300x137.png\")
MENTAL STATUS EXAM<\/h3>\n
Diagnosis: Gambling disorder, alcohol use disorder<\/strong><\/h3>\n
Select what you should do:<\/strong><\/h4>\n
RESULTS OF DECISION POINT ONE<\/h3>\n
\n
RESULTS OF DECISION POINT TWO<\/h3>\n
\n
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>\n
Guidance to Student<\/strong><\/h3>\n
A Sample Answer For the Assignment: NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction<\/strong><\/h2>\n
Title: NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction<\/strong><\/h2>\n
RESULTS OF DECISION POINT ONE<\/h3>\n
\n
RESULTS OF DECISION POINT TWO<\/h3>\n
\n
Guidance to Student<\/strong><\/h3>\n
RESULTS OF DECISION POINT ONE<\/h3>\n
\n
RESULTS OF DECISION POINT TWO<\/h3>\n
\n
Guidance to Student<\/strong><\/h3>\n
Learning Resources<\/strong><\/h3>\n
\n