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

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.

 

 

Need To Be More Active In Organizations

Need To Be More Active In Organizations

You have identified great organizations. You mentioned you are a member of the organizations but are you active with them? Are you part of a committee or participate in other organizational activities? Doing so can help build networking and help with participating in advocacy at a higher level.

Instructions:

Use an APA 7 style and a minimum of 250 words. Provide support from a minimum of at least three (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 years), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. Include the Doi or URL link.

• Textbooks are not considered scholarly sources. 

• Wikipedia, Wikis, .com website or blogs should not be used

Assessment And Management Of Patients With Diabetes

Case Study, Chapter 51, Assessment and Management of Patients With Diabetes

1.Sallie Smith, 42 years of age, is newly diagnosed with type 2 diabetes. During the patient education, the patient asks the nurse, “What should I do if I am sick and can’t eat; should I still take my medicine for the diabetes?” (Learning Objective 10)

1.What management strategies should the nurse provide the patient to deal with “sick days?”

2.Jerry Thomas is a 26-year-old type 1 diabetic. He was originally diagnosed at the age of 14, and currently manages his disease with an intensive regimen of insulin injections. Jerry is employed as a schoolteacher and soccer coach. He presents today with a 2-day history of vomiting and diarrhea. He has been closely monitoring his blood glucoses, and is using regular insulin for high blood glucose levels. He has only been able to tolerate liquids such as Gatorade, but today he is unable to even tolerate that, and comes to the clinic for evaluation of possible diabetic ketoacidosis (DKA). (Learning Objective 9)

1.Describe the pathophysiology of DKA and why it occurs in patients with type 1 diabetes.

2.Based on the diagnosis of DKA, what assessment findings does the nurse correlate to this disorder?

The physician orders a complete metabolic panel, and Jerry’s blood glucose is 425. Other lab values include a serum sodium of 152, serum potassium of 3.0, and BUN of 64. What is your assessment of these results?

1.Explain why it is important for Jerry to continue to take his insulin even though his oral intake is decreased.

 

 

DEVELOPING SELF AWARENESS LLM

DEVELOPING SELF AWARENESS LLM

. In what ways did LLM increase your knowledge about self-awareness?

2. List 2 interpersonal skills (Lessons learned) gain from reviewing the LLM(attached file) on identifying beliefs and enhancing self-awareness?

Answer each question and post your reflection to the discussion board IN 250 WORDS.

DEVELOPING SELF AWARENESS

We find ourselves in situations where we feel something is right or wrong in an instant. Perhaps you’ve seen a colleague  treated unfairly and you feel the situation is completely unjust or maybe you’ve been asked to complete a project at work and you immediately know the best course of action .At one point or other we all feel that we just know something to be true .Despite not having all the facts about the situation, this feeling of truth ,knowing the right way to do something is based on beliefs, your beliefs or your trust ,faith or confidence in someone or something .They have an acceptance that something is true .Your beliefs are so strong ,that often cause you to react to situations quickly almost like a reflex .What’s surprising is we don’t always know how to identify our beliefs and we don’t always take the time to dig below the surface and find out what’s going on .

Why is it so important we understand our beliefs?

Because the first step in building your self-awareness is understanding and identifying your beliefs. Enhancing yourself awareness will enable you to make accurate self-assessments ,manage your emotions and understand how you come across to others .

What’s building your self-confidence?

your beliefs will impact how you behave and interact with others. your beliefs also direct your emotions. if you believe somethings to be right or wrong that will cause an emotional response for you .if you want to build your self-awareness you need to make a conscious effort so identify and understand the strong beliefs that you have .you can do this by reflecting and using the ABC model which is a simple coaching psychology tool that I use with clients .I’d like you to think of a time when you had a negative experience lately.

ABC MODEL

A=Activating factors

Firstly, what was the activating event? the situation that you found yourself in that lead to you reacting negatively.

write down as much as you can about the event but trying to be objective with no emotional attachment to the scenario or people involved. If the activating event was someone putting out in front of you in the car on the way to work this would be what she would note here .at this stage don’t tell him to how you feel about the event or how you reacted .

B= Belief

next, identify your beliefs what did he believes to be true about the situation .in this example. you’ll believe maybe the other persons behavior is inconsiderate, dangerous and wrong .you may have even stronger believes .I think the person driving the other car is an idiot or shouldn’t be an out to drive a vehicle.

C= Consequences

finally what were the consequences of your beliefs .what happens in the situation because of your beliefs how did you behave what was the impact of your behavior and example of the driver ,maybe you fell anger start to rise and you couldn’t stop thinking about the injustice of the situation .I hope you found yourself in a bad mood after the event snapping at colleague or ranting about your experience which affected your productivity at work .

this exercise has two purposes, firstly you’ll delve into identifying key beliefs. secondly you can clearly see the effects of your beliefs and not the activating event have on your behavior. It’s often not the event itself react well that the beliefs we have about the situation complete this exercise reflecting on a positive event also as this will help you identify positive and negative beliefs .

when you find yourself in changing situation take some time to complete this task after the event reflected in openings and the impact, they had on the situation is your self-awareness over the long term

prevent the spread of COVID-19 among nurses

prevent the spread of COVID-19 among nurses

My evidence-based project is based on determining the knowledge, attitude, and practice regarding using personal protective equipment (PPE) among nurses to prevent the spread of COVID-19 among nurses working at the accident and emergency department. To evaluate the outcomes of the EBP, collection of both dependent and independent variables is essential (Engels et al., 2020). one of the dependent variables that I would collect in the evidence-based projects is the health outcomes of nurses who correctly and consistently correctly and consistently use personal protective equipment. The variable is significant because it is determined by the correct use of personal equipment in the hospital care setting.

The health outcome includes the number of health care professional nurses working at accident and emergency departments who contract COVID-19 due to not using or incorrect use of personal protective equipment. The empirical evidence indicates that the number of nurses working in the out-patient department who contract the COVID -19 increases with the incorrect use of protective equipment such as face masks (Liu et al., 2020). With more health workers becoming infected, there is a decreased health workforce, resulting in pressure on the health care system. Evaluating the prevalence and incidence of the diverse outcomes among nurses would help assess the implementation success of change in the hospital.

According to Reggiani & Schiaffino (2020), the independent variable needed to evaluate an evidence-based project is the correct use of personal protective equipment within the healthcare setting. PPE among nurses determines the prevalence of COVID-19 and the resulting health complications. Uptake of correct and consistent use of PPEs also entails applying knowledge with attitude change and practice among the nursing staff in the healthcare setting. Correct use of PPE while in practice helps determine the COVID-19 cases among the healthcare professionals.

Based on how you will evaluate your EBP project, which independent and dependent variables do you need to collect? Why?

Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years. There should be a mix between research and your reflections. Add critical thinking in the posts along with research. Apply the material in a substantial way

aging affect nutrition in the older adult

aging affect nutrition in the older adult

Please do all questions and answer them in its entirety: Please cite your references

1. How can aging affect nutrition in the older adult?

2.What are some factors that are utilized to determine caloric intake of older adults.?

3. What are some basic life -sustaining needs of the What do you see as similarities and differences between the research process, the Evidence-Based Practice process, and nursing process? Include rationale to support your responseolder adult?

4.What are some health challenges related needs of the older (aging) adult.?

5.What are some laws governing Gerontological Nursing Practice?

6. What are some legal risks in Gerontological Nursing

7.Why are there increased Risk of Adverse Reaction as it relates to Medication Usages in the older Adult.

8.What are some intervention necessary to address  threat to safety, life and well-being in the older clients.

9. What are some Impact of Aging on Environment Safety and Function.

10. What are some possible Mental Health issues which Amy affect the older adult?

Please do all questions and answer them in its entirety: Please cite your references

1. How can

Please do all questions and answer them in its entirety: Please cite your references

1. How can aging affect nutrition in the older adult?

2.What are some factors that are utilized to determine caloric intake of older adults.?

3. What are some basic life -sustaining needs of the older adult?

4.What are some health challenges related needs of the older (aging) adult.?

5.What are some laws governing Gerontological Nursing Practice?

6. What are some legal risks in Gerontological Nursing

7.Why are there increased Risk of Adverse Reaction as it relates to Medication Usages in the older Adult.

8.What are some intervention necessary to address  threat to safety, life and well-being in the older clients.

9. What are some Impact of Aging on Environment Safety and Function.

10. What are some possible Mental Health issues which Amy affect the older adult?

?

2.What are some factors that are utilized to determine caloric intake of older adults.?

3. What are some basic life -sustaining needs of the older adult?

4.What are some health challenges related needs of the older (aging) adult.?

5.What are some laws governing Gerontological Nursing Practice?

6. What are some legal risks in Gerontological Nursing

7.Why are there increased Risk of Adverse Reaction as it relates to Medication Usages in the older Adult.

8.What are some intervention necessary to address  threat to safety, life and well-being in the older clients.

9. What are some Impact of Aging on Environment Safety and Function.

10. What are some possible Mental Health issues which Amy affect the older adult?

Healthcare policies impact all populations

Healthcare policies impact all populations

Whatever you’re experiencing, remember that you’re not alone & help is always available. If you, a friend, or someone you know is having a hard time this week, or for those struggling with mental health or substance use, visit http://samhsa.gov/find-help #GetUpDay #NationalGetUpDay

Discussion Question

Healthcare policies impact all populations. Now, with the use of social media, policies involvement and awareness are rising.

  1. Take a moment to review the Twitter feed for compelling Tweets that are related to healthcare policy and are directly impacting your community or those you care for.
  2. Give an overview of a policy or potential policy. Include how it could impact your community or those you care for positively negatively.
  3. Next, discuss the importance that interdisciplinary collaboration would have related to the policy.
  4. Then, identify any ethical concerns it raises for you and why.
  5. Compose a 280-character or fewer Tweet that describes what you have shared with the class. Remember Twitter only allows 280 characters (this include spaces, etc.) so you will need to be concise. It should include a hashtag. Include a reference URL if applicable. Share this Tweet in the discussion. (Note: A Twitter account is not required).
  6. Your discussion post should look like:
    • Paragraph one: overview of the policy or potential policy. Include how it could impact your community or those you care for positively negatively.
    • Paragraph two: Discuss the importance that interdisciplinary collaboration would have related to the policy.
    • Paragraph three: Identify any ethical concerns it raises for you and why
    • Paragraph four: Compose a Tweet that describes what you have shared with the class.
    • Resources: Where did you find your data?
  7. Example Tweet: Medications should be affordable. #pharmaceuticaltransparency #nursesunit #advocate https://www.cms.gov/newsroom/press-releases/cms-takes-action-lower-prescription-drug-prices-and-increase-transparency

Annotated Bibliography includes 5 nursing theories.

Annotated Bibliography includes 5 nursing theories.

The Annotated Bibliography includes 5 nursing theories.

Please write in master level

Need nursing knowledge.

Annotated Bibliography is already formatted, and articles included. Please only use sources and articles provided.

Health Belief Model: Kocoglu‐Tanyer, Dengiz, K. S., & Sacikara, Z. (2020). Development and psychometric properties of the public attitude towards vaccination scale – Health belief model. Journal of Advanced Nursing76(6), 1458–1468. https://doi.org/10.1111/jan.14349

  • Summarize the article.
  • Describe how the article relates to the chosen theory/model.
  • Reflect on how the article could (or could not) be relevant to future Family Nurse Practitioner practice.

Social Cognitive Theory: Plotnikoff RC, Lubans DR, Penfold CM, Courneya KS. Testing the utility of three social‐cognitive models for predicting objective and self‐report physical activity in adults with type 2 diabetes. British Journal of Health Psychology. 2014 05;19(2):329-46.

  • Summarize the article.
  • Describe how the article relates to the chosen theory/model.
  • Reflect on how the article could (or could not) be relevant to future Family Nurse Practitioner practice.

Transtheoretical Model of Behavioral Change: Selçuk‐Tosun, & Zincir, H. (2019). The effect of a transtheoretical model–based motivational interview on self‐efficacy, metabolic control, and health behaviour in adults with type 2 diabetes mellitus: A randomized controlled trial. International Journal of Nursing Practice25(4), e12742–n/a. https://doi.org/10.1111/ijn.12742

  • Summarize the article.
  • Describe how the article relates to the chosen theory/model.
  • Reflect on how the article could (or could not) be relevant to future Family Nurse Practitioner practice.

Family Systems Theory: Pratt, K. J., & Skelton, J. A. (2018). Family Functioning and Childhood Obesity Treatment: A Family Systems Theory-Informed Approach. Academic Pediatrics18(6), 620–627. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.acap.2018.04.001

  • Summarize the article.
  • Describe how the article relates to the chosen theory/model.
  • Reflect on how the article could (or could not) be relevant to future Family Nurse Practitioner practice.

Family Assessment and Intervention Model: Aass, Skundberg-Kletthagen, H., Schrøder, A., & Moen, Ø. L. (2020). Young Adults and Their Families Living With Mental Illness: Evaluation of the Usefulness of Family-Centered Support Conversations in Community Mental Health care Settings. Journal of Family Nursing, 26(4), 302–314. https://doi.org/10.1177/1074840720964397

  • Summarize the article.
  • Describe how the article relates to the chosen theory/model.
  • Reflect on how the article could (or could not) be relevant to future Family Nurse Practitioner practice.

common cardiovascular disorders in the Adult and Geriatric patient

common cardiovascular disorders in the Adult and Geriatric patient

This week you have learned about common cardiovascular disorders in the Adult and Geriatric patient. For the purpose of this discussion select one of the following cardiovascular disorders and provide the following in your initial post:

• Common Signs and symptoms seen

Screening assessment tools

• Recommended diagnostic tests (if any)

• Treatment plans both pharmacologic and non-pharmacologic based on current clinical practice guidelines

Cardiovascular disorders:

• CHF

Provide apa references no longer then five years ago

Gerontology Questions

Gerontology Questions

Please do all questions and answer them in its entirety: Please cite your references

1. How can aging affect nutrition in the older adult?

2.What are some factors that are utilized to determine caloric intake of older adults.?

3. What are some basic life -sustaining needs of the older adult?

4.What are some health challenges related needs of the older (aging) adult.?

5.What are some laws governing Gerontological Nursing Practice?

6. What are some legal risks in Gerontological Nursing

7.Why are there increased Risk of Adverse Reaction as it relates to Medication Usages in the older Adult.

8.What are some intervention necessary to address  threat to safety, life and well-being in the older clients.

9. What are some Impact of Aging on Environment Safety and Function.

10. What are some possible Mental Health issues which Amy affect the older adult?