Communication And Culture Asignment

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Communication And Culture Asignment

The assignment must have top, bottom, left, and right margins of one inch and be 1-2 pages in length.

Times New Roman font that is 12 points.

Double spaced.

Section headers (Student name documented in the header).

Each paragraph must have at least three sentences.

The reference article must be less than five years.  The selected article is relevant to course objectives; Communication in Nursing and how that can relate to the Culture of patients

Transforming Nursing And Healthcare Through Technology

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Transforming Nursing And Healthcare Through Technology

As a professional nurse, you are expected to apply your expertise to patient care. On occasion, you will also be expected to share that expertise.

With evolving technology and continuous changes to regulations designed to keep up these changes, there is usually a need to share information and expertise to inform colleagues, leadership, patients, and other stakeholders.

In this Assignment, you will study a recent nursing informatics-related healthcare policy, and you will share the relevant details via a fact sheet designed to inform and educate.

To Prepare:

The Assignment: (1 page not including the title and reference page)

Create a 1-page fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following:

  • Briefly and generally explain the policy or regulation you selected.
  • Address the impact of the policy or regulation you selected on system implementation.
  • Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow.
  • Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.
  • Use APA format and include a title page, in-text citations, and reference page.
  • Use the Safe Assign Drafts to check your match percentage before submitting your work.

Burn Victim Assessment

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Multidimensional Care IV

discuss the following:

  1. The staff are following the Parkland Formula for fluid resuscitation. The client arrived at 0200 and was admitted at 0400. She weighs 110 pounds. Calculate her fluid requirement, using the Parkland formula. Explain the time intervals and amounts for each.
  2. The client was sleeping when the fire started and managed to make her way out of the house through thick smoke. You are concerned about possible smoke inhalation. What assessment finding would corroborate this concern?
  3. The client is in severe pain. What is the drug of choice for pain relief and how should it be given?
  4. What nutritional requirements are necessary for the client’s burns to heal?
  5. What measures are taken with the client to prevent infection?

Module 06 Assignment

Multidimensional Care IV

 

Instructions

Submit your completed assignment by following the directions below. You must include 2-3 refences from scholarly sources and a reference list in APA format at the end of this document. Answers should be appropriately cited, in full sentences, and double-spaced per APA format. Please check the Course Calendar for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

Jstudent_exampleproblem_101504

 

Scenario

You are working the night shift on a medical-surgical unit. Your assignment includes a 19-year-old woman admitted early this morning. She has sustained burns over 30% of her body surface area, with partial-thickness burns on her legs and back.

 

 

 

Questions

Discuss the following:

  1. The staff are following the Parkland Formula for fluid resuscitation. The client arrived at 0200 and was admitted at 0400. She weighs 110 pounds. Calculate her fluid requirement, using the 4 ml Parkland formula. Explain the time intervals and amounts for each.
  1. Calculate Parkland formula amounts and rates:
Total fluid replacement for 1st 24 hours:
1st half of fluid replacement (1st 8 hours): Total volume:
Rate per hour:
2nd half of fluid replacement (next 16 hours): Total volume:
Rate per hour:
  1. Why is this time interval important for rescue of the burn victim?

 

  1. The client was sleeping when the fire started and managed to make her way out of the house through thick smoke. You are concerned about possible smoke inhalation. What assessment finding would corroborate this concern?

 

 

  1. The client is in severe pain. What is the drug of choice for pain relief and how should it be given? Are there any risks associated with these medications?

 

 

  1. What nutritional requirements are necessary for the client’s burns to heal? What is the goal of nutrition therapy in post-burn care?

 

  1. What measures are taken with the client suffering from burn injuries to prevent infection? What dressings may be used to prevent infection? Be sure to list and describe at least 3 types of dressings.

 

 

 

 

 

 

References

 

 

 

 

Rubric:

The rubric for the assignment can be viewed within Blackboard once you click the assignment. Under the “Points Possible” section next to the due date, there is a gray box with text “view rubric”.

 

 

 

 

GENITALIA ASSESSMENT

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GENITALIA ASSESSMENT

Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.

  • Based on the Episodic note case study:
    • Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
    • Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
    • Consider what history would be necessary to collect from the patient in the case study.
    • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
    • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Lab Assignment

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

  • Analyze the subjective portion of the note. List additional information that should be included in the documentation.
  • Analyze the objective portion of the note. List additional information that should be included in the documentation.
  • Is the assessment supported by the subjective and objective information? Why or why not?
  • Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
  • Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

 

GENITALIA ASSESSMENT (Review the requirements in this week’s course resources.  You can write this assignment in narrative format.

Subjective:

  • CC: dysuria and urinary frequency
  • HPI: RG is a 30 year old female with increase urinary frequency and dysuria that began 3 days ago. Pain is intermittent and described a burning only in urination, but c/o flank pain since last night. Reports intermittent chills and fever. Used Tylenol for pain with no relief. She rates her pain 6/10 on urination. Reports a similar episode 3 years ago.
  • PMH: UTI 3 years ago
  • PSHx: Hysterectomy at 25 years
  • Medication: Tylenol 1000 mg PO every 6 hours for pain
  • FHx: Mother breast cancer ( alive) Father hypertension (alive)
  • Social: Single, no tobacco , works as a bartender, positive for ETOH
  • Allergies: PCN and Sulfa
  • LMP: N/A

Review of Symptoms:

  • General: Denies weight change, positive for sleeping difficulty because e the flank pain. Feels warm.
  • Abdominal: Denies nausea and vomiting. No appetite

Objective:

Assessment:

  • UTI
  • STD

 

Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

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Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

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/

 

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.

PLEASE I HAVE ATTACHED THE CASE STUDY AND THE DECISIONS YOURS IS JUSTIFICATION.

DON’T FORGET TO INCLUDE REFERENCES

Postpartum

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Postpartum

Case Study 128 – Postpartum

Read the scenario and answer all questions

Scenario:

T.N. delivered a healthy male infant 2 hours ago. She had a midline episiotomy. This is her sixth pregnancy. Before this delivery, she was G6, T4, P0, A1, L4. She had an epidural block for her labor and delivery. She is now admitted to the postpartum unit.

  1. What is important to note in the initial assessment?
  2. You find a boggy fundus during your assessment. What corrective measures should be instituted?
  3. The patient complains of pain and discomfort in her perineal area. How will you respond?
  4. The nurse reviews the hospital security guidelines with T.N. The nurse points out that her baby has a special identification bracelet that matches a bracelet worn by T.N., and the nurse reviews other security procedures. Which statement by T.N. indicates a need for more teaching?
    1. “If I have a question about someone’s identity, I can ask my nurse about it.”
    2. “If someone comes to take my baby for an examination, that person will carry my baby to the examination room.”
    3. “Nurses on this unit all wear the same color uniform.”
    4. “Each staff member who takes my baby somewhere will have a picture identification badge.”
  5. An hour after admission, you recheck T.N.s perineal pad and find that there is a very small amount of lochia on the perineal pad. What will you do next? a. Ask T.N. to change her perineal pad
  6. Check her perineal pad again in 1 hour
c. Check the pad underneath T.N.’s buttocks
  1. Document the findings in T.N.’s medical record
  2. That evening, the nursing assistive personnel assesses T.N.’s vital signs. Which vital signs would be of concern at this time?

Vital Signs:

Temperature: 99.9°F
Blood pressure: 100/50
Pulse rate: 120 bpm

Respiratory rate:      16/min.

  1. What will you do next? Monitor VS, notify doctor is BP and pulse do not improve. Assess pt for bleeding or leaking. Assess for color, amount, consistency, and odor of the lochia. Check to see if blood has spread to other areas of the body. Check uterine fundus, if boggy, massage until firm.
  2. After your prompt intervention, you need to document what occurred. Write an example of a documentation entry describing this event.

Time: 1600  Pulse: 120 BP: 100/50

Large amount of lochia rubra noted with small clots underneath patients buttocks. Fundus was boggy until massaged firm. Patient encouraged to increase fluid intake. Patient voiding without difficulty. Assisted patient with perineal hygiene and provided a clean perineal pad which was placed under patient. Will continue to monitor.

  1. Two hours later, you perform another perineal pad check and observe a 2 in. stain on the pad. How would you document your findings in terms of the amount of lochia on the peripad? Light
  2. N.’s condition is stable, and you prepare to provide patient teaching. What patient teaching is vital after delivery?
  3. N. tells you she must go back to work in 6 weeks and is not sure she can continue breastfeeding. What options are available to her?

T.N. is discharged to home and plans to consult a lactation specialist before returning to work.

Powered by TCPDF (www.tcpdf.org)

 

 

Maternalchildclinical_conceptmap_careplanPostpartum Hemorrhage

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Maternalchildclinical_conceptmap_careplanPostpartum Hemorrhage

REMEMBER THAT THE EXPECTED OUTCOMES MUST BE MEASURABLE.  THE INTERVENTIONS ARE WHAT YOU DO TO ASSURE THE OUTCOME AND THE CLIENT’S RESPONSE IS SPECIFICALLY HER RESPONSE.

                                                    PLAN OF CARE:                                                                                             Use your top two priorities

NANDA NURSING DIAGNOSIS use NANDA definition Expected outcomes of care (Goals)          Interventions       Patient response        Goal evaluation
NRS DX:

Problem Statement: 

 

 

 

 

 

 

 

 

R/T: (What is the cause of the symptom)

 

 

 

 

 

 

 

 

Manifested by: (Specific symptoms)

 

 

 

 

 

 

 

 

 

 Short term goal:  Create a SMART goal that relates to hospital stay/shift/day.

 

 

 

 

 

 

 

 

 

 

 

 

Long term goal:  Create a SMART goal that is appropriate for discharge.

 

 This is specific to the patient that you are caring for. A list of planned actions that will assist the patient to achieve the desired goal. (i.e. obtain foods that the patient can eat/ likes)

 

Interventions for short-term goal:

1.

2.

3.

 

 

 

 

Interventions for long term goal:

1.

2.

3.

 

 

 Identify what the patients response or “outcome is to the goal or care that you have provided. i.e. patient ate 45% of lunch)

 

 

 

Reassess for short-term goal:

1.

2.

3.

 

 

 

 

 

Reassess for long-term goal:

1.

2.

3.

 

 Was it met or not met there is no partially met.

 

 

 

PART 2

 

Healthcare systems elements (continued)                      ALLERGIES:
Medications: List all medications, dosages, classifications and the rational for the medications prescribed for this patient include major considerations for administration and the possible negative outcomes associated with this medication.

                                 DEFINE 1:  What the medications does to the body to the cellular level AND 2: Why the patient is taking the medication?

Medication/dose              Classification          Indication/ Rationale        SE’s/Nursing Considerations                 Client Education                    Text Reference
 

Oxytocin
 

Carboprost (Methergine)
 

Hemabate
 

Misoprostol (Cytotec)
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 

 

 

Telephonic Nursing

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Telephonic Nursing

Discussion Question

developing a project scope

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developing a project scope

In 750-1,000 words, address the following:

  1. Identify the steps in developing a project scope.
  2. Evaluate the importance of the stakeholder’s understanding of in and out of project scope.
  3. Create the steps for how to identify high-level deliverables and key milestones.
  4. Identify the steps to create the completion criteria.
  5. Report the success criteria (completed within budget and on schedule).

Cite a minimum of three scholarly resources.  It must be published within the past 5 years and appropriate for health care and health informatics content.

Comorbid Addiction (ETOH and Gambling) 53-year-old Puerto Rican Female

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Comorbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female

Assignment 1: Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

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.

 

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.

 

** Please address each bullet point for Decision # 1, 2 and 3**

 

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.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

Comorbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female

 

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” 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 “Rising Sun” 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 “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” 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 has increased over the past 2 years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much,” 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.

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.

MENTAL STATUS EXAM

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 “sad.” 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.

Diagnosis: Gambling disorder, alcohol use disorder

 

 Decision Point One

Select what you should do:

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

Antabuse (disulfiram) 250 mg orally daily

Campral (acamprosate) 666 mg orally three times/day

 

Decision Point One

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE

  •  Client returns to clinic in four weeks
  •  Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection
  •  Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)
  •  Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned

 

Decision Point Two

Select what you should do next:

Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

Refer to a counselor to address gambling issues

Add on Chantix (varenicline) 1 mg orally BID

Decision Point Two

Refer to a counselor to address gambling issues

 

RESULTS OF DECISION POINT TWO

  •  Mrs. Perez returns in 4 weeks and reports that the anxiety that she had been experiencing is gone.
  •  She reports that she has met with the counselor, but she did not really like her.
  •  She also started going to a local meeting of Gamblers Anonymous. She states that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group.

 

Decision Point Three

Select what you should do next:

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

Encourage Mrs. Perez to continue seeing her current counselor as well as continuing with the Gamblers Anonymous group

Discontinue Vivitrol. Encourage Mrs. Perez to continue seeing her counselor and to continue participating in the Gamblers Anonymous group

Decision Point Three

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

 

Guidance to Student

Although controversy exists in the literature regarding how long to maintain a client on Vivitrol, 8 weeks is probably too soon to consider discontinuation. The psychiatric mental health nurse practitioner should explore the issues that Mrs. Perez is having with her counselor. As will be covered in more depth in future courses, ruptures in the therapeutic alliance can result in clients stopping therapy. Clearly, if the client does not continue with therapy, the likelihood of the gambling problem spontaneously remitting is lower (than had the client continued to receive therapy). Recall that there are no FDA-approved treatments for gambling addiction. The mainstay of treatment for this disorder is counseling. Since Mrs. Perez reports good perceived support from the Gamblers Anonymous meetings, she should be encouraged to continue her participation with this group.

You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.