NURS 6630 Comorbid Addiction 53-year-old Puerto Rican Female

Want create site? With Free visual composer you can do it easy.

NURS 6630 Comorbid Addiction 53-year-old Puerto Rican Female

NURS 6630 Comorbid Addiction 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

 

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

RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states “I was like a new person. This is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her Valium early
• She is asking today for an increase the Valium dose or frequency
Decision Point Three

 

Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue

Guidance to Student
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’s case.
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.
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.
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 “activation” 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).
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.
You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.
Decision Point One

Antabuse (disulfiram) 250 mg orally every morning
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Mrs. Perez reports to the office complaining of sedation, fatigue, and a “metallic taste” in her mouth, which “seems to be going away.” She also reports that she had just one drink about 5 days after starting the drug and thought that she would “die.” She reports that her face was red, and she felt that her heart would “pound right out of my chest.”
• Mrs. Perez also reports that she continues to visit the casino but has not been spending as much money there. She has noticed that her cigarette smoking is increasing
Decision Point Two

 

Continue current dose of Antabuse and begin Campral (acamprosate) 666 mg orally BID

RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Mrs. Perez reports that the metallic taste is “still there” but that it doesn’t bother her anymore
• She reports that she has managed to avoid alcohol as she is afraid of the side effects of the medications when she does drink
• She reports that over the course of the past 2 weeks, her cigarette consumption is “almost double—I’m up to almost 2 packs a day!”
Decision Point Three

 

Continue current doses of medications and discuss smoking cessation options

Guidance to Student
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 “metallic” taste in Mrs. Perez’s 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 “flushing,” tachycardia, nausea, and vomiting.
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—only 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
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.
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.
Decision Point One

Campral (acamprosate) 666 mg orally TID
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Upon return Mrs. Perez states that she has noticed that she has been having suicidal ideation over the past week, and it seems to be getting worse
• She is also reporting that she is having “out of control” anxiety
Decision Point Two

 

Educate Mrs. Perez on the side effects of Campral and add Valium (diazepam) 5 mg orally TID to address anxiety symptoms

RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states, “I was like a new person. This is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her Valium early. She is asking today for an increase in the Valium dose or frequency
• Although she reports that her anxiety is gone. She still reports suicidal ideation, but she states, “With that Valium stuff, who cares?”
Decision Point Three

 

Continue current dose of Campral, and increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue

Guidance to Student

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6630 Comorbid Addiction 53-year-old Puerto Rican Female

NURS 6630 Comorbid Addiction 53-year-old Puerto Rican Female

NURS 6630 Comorbid Addiction 53-year-old Puerto Rican Female

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.
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.
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 “activation” 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’s case.
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.
You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions and to enhance her overall health.
Learning Resources

Required Readings (click to expand/reduce)

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 (pp. 163–182). Elsevier.
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 (pp. 163–182). Elsevier.

Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders: Treatment improvement protocol series, no. 32. http://www.ncbi.nlm.nih.gov/books/NBK64350/
• Chapter 1, “Substance Use Among Adolescents”
• Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”
• Chapter 7, “Youths with Distinctive Treatment Needs”

University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control. Journal of Psychosocial Nursing & Mental Health Services, 54(4), 15.

Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. https://doi.org/10.1111/j.1365-2125.2012.04457.x

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(3), 164–172. https://doi.org/10.1002/hup.2467

Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10–15. https://doi.org/10.3928/00989134-20160314-04

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(1), 74–84. https://doi.org/10.1080/15504263.2012.648439

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(6), 1337–1341. https://doi.org/10.1016/j.comppsych.2014.04.018

Medication Resources (click to expand/reduce)

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Note: 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.
• naltrexone (revia/vivitrol)
• naloxone
• acamprosate
• disulfiram

Required Media (click to expand/reduce)

Case Study: A Puerto Rican Woman with Comorbid Addiction
Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources (click to expand/reduce)

Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., Cinose, E., Di Iorio, G., Di Nicola, M., & Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. https://doi.org/10.1155/2014/537306

 

 

Did you find apk for android? You can find new Free Android Games and apps.