Assignment: Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction

   The Assignment: Examine Predicament Study: A Puerto Rican Woman Delay Comorbid Addiction. You succeed be asked to produce three firmnesss relating the medication to indicate to this client. Be unquestioning to deliberate factors that influence impression the client’s pharmacokinetic and pharmacodynamic processes. At each firmness purpose seal to accomplished the following: · Firmness #1 ·   o Which firmness did you prime? o Why did you prime this firmness? Support your acceptance delay averment and references to the Learning Resources. o What were you hoping to complete by making this firmness? Support your acceptance delay averment and references to the Learning Resources. o Explain any discord betwixt what you expected to complete delay Firmness #1 and the results of the firmness. Why were they unanalogous? · Firmness #2 ·   o Why did you prime this firmness? Support your acceptance delay averment and references to the Learning Resources. o What were you hoping to complete by making this firmness? Support your acceptance delay averment and references to the Learning Resources. o Explain any discord betwixt what you expected to complete delay Firmness #2 and the results of the firmness. Why were they unanalogous? · Firmness #3 ·   o Why did you prime this firmness? Support your acceptance delay averment and references to the Learning Resources. o What were you hoping to complete by making this firmness? Support your acceptance delay averment and references to the Learning Resources. o Explain any discord betwixt what you expected to complete delay Firmness #3 and the results of the firmness. Why were they unanalogous? Note: Support your rationale delay a partiality of three academic instrument no further than five years old.  Co-morbid Addiction (ETOH and Gambling) 53-year-old Puerto Rican Female BACKGROUND Mrs. Maria Perez is a 53 year old Puerto Rican effeminate who presents to your duty today due to a rather “embarrassing bearing.”     SUBJECTIVE Mrs. Perez admits that she has had “problems” delay alcohol late her senior died in her advanced teens. She reports that she has struggled delay alcohol late her 20’s and has been compromised delay Alcoholics Unattested “on and off” for the late 25 years. She states that for the late two years, she has been having further and further inaptitude maintaining her soberness late they opened the new “Rising Sun” casino adjacent her home. Mrs. Perez states that she and a ally went to mark the new casino during their large gap at which purpose she was “hooked.” She states that she gets “such a high” when she is gambling. Opportunity gambling, she “enjoys a quaff or two” to succor pacify her during high-stakes games. She states that this repeatedly gives way to further quaffing and further incautious gambling. She so reports that her cigarette smoking has extensiond balance the late two years and she is uneasy encircling the indirect property of the cigarette smoking on her vigor. She states that she attempts to abstain from quaffing but that she gets such a “high” from the act of gambling that she deficiencys a few quaffs to “even out.” She so notices that when she quaffs, she doesn’t fume “as ample” but enjoys smoking when she is gratuitous at the slot machines. She so reports that she has fashioned gravity from quaffing so ample- she generally gravitys 122 lbs., which represents a 7 lb. gravity fashion from her habitual 115 lb. gravity. Mrs. Perez is altogether uneasy today owing she has assumed balance $50,000 from her seclusion recital to pay off her gambling debts. She is very uneasy owing her mate does not recognize that she has gone-by this ample capital.     MENTAL STATUS EXAM The client is a 53 year old Puerto Rican effeminate who is lively, oriented to idiosyncratic, fir, term, and occurrence. She is finished well-behaved-behaved for the sky and term of year. Her oration is open, compact, and intent directed. Her eye touch is partially avoidant during the clinical confabulation. As you produce eye touch delay her, she looks afar or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported vein is “sad.” Affect is delayhold to willing of talk & self-reported vein. She visual or auditory hallucinations, no delusional or paranoid view processes are readily appreciated. Insight and decision are grossly undented, peaceful, incentive repress is adulterated. She is generally privative suicidal or homicidal ideation. Diagnosis: Gambling conjecture, alcohol use conjecture Decision Purpose One: Select what the PMHNP should do: Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal district complete 4 weeks RESULTS OF DECISION POINT ONE Client income to clinic in impure weeks Mrs. Perez said that she felt “wonderful” as she has not “touched a drop” to quaff late receiving the injection Client reports that she has not been going to the casino, as regularly, but when she does go she “drops a bundle” (meaning, spends a lot of capital gambling) Client She is so peaceful smoking, which has her uneasy. She is so reporting some bearings delay misgiving, which so feel her uneasy Decision Purpose Two: Select what the PMHNP should do direct: Add on Valium(diazepam) 5 mg orally TID/PRN/anxiety RESULTS OF DECISION POINT TWO Client income to clinic in impure weeks Mrs. Perez reports that when she foremost accepted the valium, it succored her tremendously. She states “I was enjoy a new idiosyncratic- this is a amazement offal!” However, she reports that she has uneasiness “waiting” betwixt offal government terms and casually takes her valium early Client is scrutiny today for you to extension the valium dose or frequency Decision Purpose Three: Select what the PMHNP should do direct: Continue general dose of Vivitrol, extension Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue Guidance to Student Anxiety is a beggarly behalf goods of Vivitrol. Mrs. Perez reports that she is doing well-behaved-behaved delay this medication, and enjoy other behalf property, the misgiving associated delay this medication may be passing. The psychiatric hyperphysical vigor nurture practitioner should never inaugurate benzodiazepines in a client who already has issues delay alcohol, or other pith dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated delay long-term benzodiazepine use apprehend the deficiency to extension the dose in adjust to complete the selfselfsame therapeutic goods. This is what we are examination in Mrs. Perez’s predicament. The most delayhold passage of operation in this predicament would be to endure the general dose of Vivitrol, opportunity decreasing the Valium delay the intent of discontinuation of the offal delayin the direct two weeks. At this purpose, we deficiency to evaluate whether or not the behalf goods of misgiving associated delay Vivitrol persists. Increasing the dose of Valium would not be delayhold, neither would maintaining her on the general dose of Valium. Additionally, the client should be referred for counseling to succor delay her gambling addiction, as there are no FDA liked medications gambling conjecture. Medication should never be borrowed discourse behalf goods of another medication, cosmical that behalf goods is recognizen to be passing (for prompting, benzodiazepines are casually indicated to balancecome the judicious bearing of “activation” associated delay inception of SSRI, or SNRI therapy). However, in a client delay multiple addictive conjectures, benzodiazepines should never be used (cosmical they are solely nature used for a poor space of therapy such as intelligent alcohol detoxification to proccurrence seizures). Additionally, it should be noted that Mrs. Perez endures to promise in bearingatic gambling, at deliberateable idiosyncratical financial require. Mrs. Perez deficiencys to be referred to a counselor who specializes in the discoursement of gambling conjecture and should so be encouraged to fir herself delay a national provision of gamblers unattested. The PMHNP deficiencys to debate smoking suspension options delay Mrs. Perez in adjust to oration the representation of addictions, and to improve her balanceall vigor.