Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction Paper
Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction
Case Scenario
Mrs. Perez is 53 years old female struggling with alcohol intake since her 20s. She has been experiencing difficulties in maintaining sobriety. She experiences a certain kind of ‘high’ when gambling. Her smoking cigarette rate has increased over the past two years. She enjoys smoking cigarettes, drinking alcohol, and gambling. Upon her mental state examination, she is well dressed and oriented. She is avoidant eye contact. She is in a sad mood with an appropriate effect for conversation. The diagnosis made by the PNP is gambling disorder and alcohol use disorder. This paper describes gambling disorder and alcohol use disorder, the treatment modalities, and the three decisions made during treatment. Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction
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Gambling disorder GD is a behavioral disorder characterized by an increased urge of gambling in a way that affects the person’s finances and relationships. Often, gambling is grouped with substance-related disorders and addiction. This constant desire to gamble with a huge amount of money leads to debts and financial distress. Clinical signs and symptoms of GD are difficulties in reducing or controlling the behavior, hiding the extent of gambling behavior, and seeking relief from financial situations brought on by gambling (Potenza, et al, 2019). Treatment modalities of GD are cognitive behavioral therapy, motivational interviewing, group therapy, antidepressants, naltrexone, and mood stabilizers. Alcohol use disorder is long-term exposure to alcohol with subsequent mental and physical dependence.it leads to academic, social, and functional impairment. Often, it is associated with anxiety disorder, insomnia, and depressive episodes. The presenting signs and symptoms are increased consumption of alcohol, reduced efforts in reducing consumption, and interference with personal and professional life.
Decision 1#
Decision Selected
Naltrexone (Vivitrol) injection, 380mg intramuscularly in the gluteal region every four weeks
Reason For Selecting The Decision
Naltrexone is an opioid antagonist FDA approved for treating opioid dependency, alcohol use disorder, and gambling disorder. It works by blocking the mu-opioid receptors that alter the effects of alcohol in inducing euphoria (Trivedi, et al, 2021). It also alters the intoxication of opioids and the psychological dependency of the users. Naltrexone is available in oral and injectable forms. Injectable naltrexone 380mg monthly is recommended for patients with compliance issues. The drug is well tolerated with few side effects such as gastrointestinal irritation, nervousness, insomnias, and muscle pain. Naltrexone is the best selection for this patient because it reduces the urge of taking alcohol and inhibits the euphoric effects of alcoholic patients. In addition, it reduces the alcoholic withdrawal symptoms.
Reason For Excluding Other Decisions
Disulfiram is a first-line FDA-approved drug in the treatment of alcohol abuse disorder. It is used by patients with both long-term and short-term dependency on alcohol. It works by inhibiting the active metabolite for alcohol in the liver, thus producing unpleasant effects that discourage the patients from taking alcohol (Bernier, et al, 2020). These symptoms include facial flushing, palpitations, tachycardia, hypotension, vertigo, and diaphoresis. However, the drug is not selected for this patient because of its adverse effects. Acamprosate is the third drug approved for treating alcohol use disorder. It helps in inducing and maintaining alcohol abstinence. It reduces the common symptoms of alcohol withdrawal such as insomnia, restlessness, and anxiety (Antonescu, et al, 2020). However, it is not a choice for this patient because of its severe effects such as suicidal ideation, itchiness, drowsiness, and severe persistent diarrhea. Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction
Expected Outcome
After initiating naltrexone 380mg IM, I am expecting the patient to cut the alcohol consumption rate and the urge to gamble. However, the expected side effects are injection site pain, fatigue, and dizziness.
Ethical Consideration
The ethical values a nurse considers when initiating treatment are beneficence and non-maleficence. The PNP practices beneficence by selecting the best drug to cure the patient’s symptoms. They protect the patient from harm by giving a drug with fewer side effects to ensure compliance. Conflicting ethical values are respected for autonomy and consent because the patient is cannot make informed choices.
Decision 2#
Decision Selected
Refer the patient to a counselor to address the gambling issues.
Reason for selecting the decision
Continuing with naltrexone is the best decision for the patient because she has not taken alcohol after the injection. Anxiety is a common side effect for patients on naltrexone. However, the symptoms disappear after a while. Smoking cessation takes a duration of 4 to 8 weeks. Naltrexone may or may not reduce the urge of gambling in helping the patient with alcohol abuse disorder. Therefore, opting for a counselor helps a patient overcome the strong emotions, triggers, and behavior toward gambling.
Reason For Excluding Other Decisions
Valium is a benzodiazepine approved for treating anxiety disorders, post-traumatic stress disorder, and insomnia. However, initiating valium 5mg on the patient has no therapeutic effect because the anxiety in this patient is a short-term side effect (Borchardt, 2021). In addition, adding valium increases the risk of dependence for the patient due to its sedative effects. Chantix helps in smoking abstinence among smokers by antagonizing the nicotinic receptors. Therefore, it lowers the desire to smoke and increases the smoke satisfaction, and the psychological reward. The recommended dose is 0.5mg then titrate by 0.5 on day four of drug initiation. Chantix 0.5mg orally would help the patient in smoke cessation. However, it will not have significant therapeutic effects because the patient is already on naltrexone. In addition, the drug has undesirable effects such as headaches, nightmares, insomnia, and nausea.
Expected outcome
After four weeks of counseling and continuation of naltrexone, the expected outcome includes complete cessation of taking alcohol and smoking, anxiety experiences, and gambling.
Ethical Consideration
The PNP should incorporate values such as confidentiality and integrity. The nurse should assure the patient’s information will be protected from the public. This enables the patient to open up about their experiences. The nurse practices integrity by being honest and giving complete information about a patient’s illness. This helps to facilitate the patient’s understanding.
Decision 3#
Decision Selected
Explore the issue Mrs. Perez is having with her counselor and encourage her to attend the gambler’s anonymous meeting.
Reason For Selecting The Decision
The patient did not like the counselor. This is expected of her because gambling affects relationships, especially with those that tend to advise against it. However, it is important to find the cause of their conflict to ensure the patient continues with therapy sessions. The sessions help motivate the patients to change their behavior. Gamblers’ anonymous meeting allows the gamblers to meet to share their experiences and help each other solve their common problem of gambling. This is a good decision for the patient because it will help her change her gambling habits.
Reason For Excluding Other Decisions
Encouraging Mrs. Perez to continue with her current counselor as well as the gambling anonymous meeting would not be of help because the patient is not comfortable. She might decline the counseling sessions and go back to gambling. Discontinuing naltrexone is not the best decision because there could be a relapse of the symptoms of alcohol withdrawal. In addition, the patient would be tempted to take alcohol.
Expected Outcome
The expectations from these decisions are a complete cessation of gambling, alcohol intake, and smoking. Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction
Ethical Consideration
The patient at this point can make decisions regarding their health. Therefore, the nurse should offer patient education regarding their illness, treatment methods, prognosis, and drug side effects. This will enable the patient to consent to treatment and make decisions. These are the principles of respect for autonomy and seeking consent.
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Conclusion
Gambling disorder GD is a behavioral disorder characterized by an increased urge of gambling in a way that affects the person’s finances and relationships. Alcohol use disorder is long-term exposure to alcohol with subsequent mental and physical dependence. The three decisions made for this patient are Naltrexone (Vivitrol) injection, 380mg intramuscularly in the gluteal region every four weeks, refer the patient to a counselor to address the gambling issues, and Explore the issue Mrs. Perez is having with her counselor and encourage her to attend the gamblers anonymous meeting. This decision helps in treating the gambling disorder and the alcohol use disorder. Cognitive-based therapy works well for GD compared to the use of antidepressants and naltrexone. Ethical principles are the moral values that guide nursing practice. These values help the nurses in prescribing drugs for psychiatric patients.
Link to case study- https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_08/index.html The Assignment: 5 pages Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’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 Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction 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. Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction
