NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment
NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment
Case
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_08/index.html
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)NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment
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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)NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment.
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)NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment.
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.
Introduction
Stress is a major contributing factor to addictive and compulsive behaviors. Trait impulsivity is also associated with risk for the addictive and compulsive disorder. Impulsivity is the proneness to act without thinking, despite the consequences of inappropriate actions (Albertella et al., 2021)NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment. Studies have shown that increased trait impulsivity results in increased problematic addictive and compulsive behaviors, including alcohol use, gambling, pornography, binge eating, and internet use. A second factor associated with addictive and compulsive behavior is the likelihood of repetitively engaging in habitual behaviors that become difficult to control or interfere with daily activities (Albertella et al., 2021). Increased compulsivity traits have also been associated with problematic alcohol use, gambling, binge eating, and obsessive-compulsive behaviors. Further, studies suggest that the interaction of impulsivity and compulsivity has the most significant risk for complex impulsive-compulsive behaviors.
Compulsivity and impulsivity might comprise opposite ends of spectrums, but both have been associated with co-occurring symptoms; hence it has been suggested that the two have a standard neurobiological process. Impulsive behavior symptoms are listed in the DSM-5 criterion, similar to those for attention-deficit hyperactivity disorder. The prevalence of impulsive behavior is approximately 7% for children and 2.5% for adults (Chamberlain et al., 2017). Compulsivity symptoms are well-listed for obsessive-compulsive disorder, and the majority is estimated at 1-8% of the population. Additionally, compulsivity is a core feature of gambling or substance use disorder, with a prevalence rate of 3.1% and 8.5%, respectively (Chamberlain et al., 2017)NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment. Therefore, early detection of the impulsive-compulsive condition is essential to enable early access to intervention, thus decreasing adverse health outcomes.
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Summary of the Case Study
Mrs. Maria Perez, a 53-year-old Puerto Rican Female, presents to the clinic with alcohol problems since her father’s demise in her late teen. She reports struggling with alcoholism for the past 25 years; the condition has worsened in the last two years. A new casino near her home has contributed to her difficulty maintaining sobriety. She reports visiting the Casino with her friends during its grand opening. She says she gets ‘such a high’ when gambling and takes a drink or two to keep her calm during high-stakes games. She admits to giving way to more drinking and reckless gambling.
Further, she reports having an increased urge to smoke cigarettes for the past two years and is worried about its effect on her health. She says that her efforts to stop drinking are worsened when she gets ‘high’ while gambling, as she needs a drink or two to even out. She enjoys smoking while playing at the slot machine. Mrs. Perez reported gaining weight from her standard 115.4lb to 122 lbs. She is worried as she borrowed $150,000 from her retirement account to pay off a gambling debt, and her husband is unaware. NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment
The patient is a 53-year-old Puerto Rican female alert and oriented to place, time, and event. She is well-groomed and appropriately dressed. Her speech is clear and coherent. She avoids eye contact and looks away or down in attempting to have eye contact. She shows no significant gestures or mannerisms. Her self-reported mood is sad, and her affect is appropriate. She denied visual or auditory hallucinations but has impaired impulse control. She denies any homicidal or suicidal ideations. After the assessment, the correct diagnosis for Mrs. Perez is gambling disorder and alcohol use disorder.
Decision Point One
Administer Vivitrol (naltrexone) injection, 380mg intramuscularly, in the gluteal region every four weeks. Naltrexone is an opioid antagonist proven effective in reducing cravings and heavy alcohol use. The medication works by blocking the endorphin receptors in the brain, thus indirectly inhibiting dopamine release after alcohol consumption (Guglielmo et al., 2021). For gambling disorders, naltrexone effectively reduces craving by binding to the same opioid receptors in the brain. This consequently blocks the euphoric and sedative impacts of opioid drugs, which eases and prevents opioid cravings.
The decision to administer Antabuse (disulfiram) was not considered because studies have shown its association with adverse side effects, including headaches, dyspnea, palpitation, seizure, coma, or death. Further, the drug can cause high toxicity, resulting in detrimental health outcomes. Acamprosate was not also considered, as studies have shown that its efficacy is optimal when combined with other psychological and social treatments (Guglielmo et al., 2021)NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment.
The decision to start naltrexone dosage was to gradually reduce alcohol cravings and consumption and Mrs. Perez’s gambling urge. Studies have shown that the medication effectively reduces alcohol use disorder and gambling disorder. Further, the drug is associated with less-adverse side effects like anxiety which the patient reported.
The ethical consideration that could impact the treatment plan is informed consent. It is essential to communicate to the patient why and how the decision was reached. It is also necessary to share the possible side effects of the medication. And with such information, the patient can decide whether or not to implement the treatment plan.
Decision Point Two
The second decision chosen was administering Valium (diazepam) 5mg orally. The decision point was based on the side effect of anxiety caused by naltrexone. According to Dhaliwal, Rosani & Saadabad, (2022)NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment, Valium influences unbalanced chemicals in the brain that trigger the onset of anxiety symptoms. Further, it affects and increases the GABA receptors’ action and slows the central nervous system, thus producing a calming effect.
The option to request the patient to attend counseling was not implemented because it would not have effectively reduced the anxiety symptoms caused by naltrexone. The client reported having improved on the craving for gambling which informs that naltrexone is effective and continuation of the drug was a viable option. The option to implement Chantix was also not chosen because the drug is associated with adverse side effects, including suicidal ideation and cardiovascular conditions.
Choosing to start Valium was recommended to reduce the anxiety symptoms from naltrexone intake (Dhaliwal, Rosani & Saadabad, 2022). Secondly, Valium is not associated with dependency on patients, and its efficacy in treating anxiety has been proven.
The ethical consideration that may affect the treatment plan is informed consent. It is essential to communicate to the patient the possible side effects of the medication. Further, the provider must highlight other treatment options that can be implemented for the patient to make an informed decision on whether or not to continue the treatment plan.
Decision Point Three
Decision point three was to continue with Vivitrol as the patient reports reduced cravings for gambling and alcohol use and taper valium with the aim of discontinuation as the patient in the last visit reported that she would want an increased dosage which showed dependence. The patient should also go for counseling to address the gambling issue. The decision to taper on Valium for two weeks was based on evidence that benzodiazepines like Valium must only be taken for less than four weeks. The decision to have counseling was recommended as its efficacy in reducing gambling symptoms has been proven (Menchon et al., 2018)NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment.
The option to continue with Vivitrol and maintain or increase the valium dose was not chosen because the patient showed dependence on the benzodiapine by requesting an increased dosage. Further, its withdrawal must be gradual rather than immediate discontinuation.
The decision to continue with the Vivitrol medication is because the patient reported reduced craving for alcohol consumption and gambling. The decision to taper on Valium was to gradually discontinue the medication as the patient showed dependence on the drug. With the counseling, the aim was to help the patient reduce gambling by taking more control over her behavior.
The ethical considerations affecting the treatment plan were confidentiality and informed consent. Providers must ensure that they protect patient information. Further, the patient must be informed of the possible side effects of the medication for them to give consent
Conclusion
In conclusion, studies have shown that Vivitrol (naltrexone) has effectively treated gambling disorder comorbid with alcohol use disorder. A survey conducted by Guglielmo et al. (2021) showed that patients in groups where naltrexone was used to treat alcohol abuse disorder had improved symptoms compared to those in groups where acamprosate was used in treating the same. Studies have shown the efficacy of Valium in treating anxiety. Thus, the three decisions were appropriate for reducing the patients’ gambling and alcohol abuse symptoms. NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment
References
Albertella, L., Rotaru, K., Christensen, E., Lowe, A., Brierley, M.-E., Richardson, K., Chamberlain, S. R., Lee, R. S., Kayayan, E., Grant, J. E., Schluter-Hughes, S., Ince, C., Fontenelle, L. F., Segrave, R., & Yücel, M. (2021). The influence of trait compulsivity and impulsivity on addictive and compulsive behaviors during COVID-19. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.634583
Chamberlain, S. R., Stochl, J., Redden, S. A., & Grant, J. E. (2017). Latent traits of impulsivity and compulsivity: Toward dimensional psychiatry. Psychological Medicine, 48(5), 810–821. https://doi.org/10.1017/s0033291717002185
Dhaliwal JS, Rosani A, Saadabadi A. Diazepam. [Updated 2022 Sep 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537022/
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Guglielmo, R., Kobylinska, L., & de Filippis, R. (2021). Topiramate, naltrexone, and Acamprosate in the treatment of Alcohol Use Disorders. NeuroPsychopharmacotherapy, 1–16. https://doi.org/10.1007/978-3-319-56015-1_430-1
Menchon, J. M., Mestre-Bach, G., Steward, T., Fernández-Aranda, F., & Jiménez-Murcia, S. (2018). An overview of gambling disorder: From treatment approaches to risk factors. F1000Research, 7, 434. https://doi.org/10.12688/f1000research.12784.1 NURS 6630 Assessing and Treating Patients With Comorbid Addiction Assignment