Co-morbid Addiction (ETOH And Gambling) 2025

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 stop to complete the following: Decision #1 Which decision did you select? Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Decision #2 Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Decision #3 Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? case Study and the decisions BACKGROUND Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office 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 two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their 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 two 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 that 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 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 has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money. MENTAL STATUS EXAM The client is a 53 year old Puerto Rican female who is alert, 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. As 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 & self-reported mood. She visual or auditory hallucinations, 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. Decision Point One Select what the PMHNP should do: Naltrexone (Vivitrol) 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 Two Select what the PMHNP 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 Three Select what the PMHNP 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 BACKGROUND Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office 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 two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their 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 two 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 that 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 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 has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money. MENTAL STATUS EXAM The client is a 53 year old Puerto Rican female who is alert, 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. As 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 & self-reported mood. She visual or auditory hallucinations, 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. Decision Point One Select what the PMHNP should do: Naltrexone (Vivitrol) 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 Two Select what the PMHNP 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 Three Select what the PMHNP 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 My decisions DECISION POINT ONE Ø Naltrexone (Vivitrol) 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 said that she felt “wonderful” as she has not “touched a drop” to drink 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 have her concerned v DECISION POINT TWO Ø Refer to a counselor to address gambling issues RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Client reports that the anxiety that she had been experiencing is gone Client reports that she has met with the counselor, but did not really like her. She did start going to a local meeting gamblers anonymous. She stated that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group DECISION POINT THREE Ø 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, four 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 you will learn in future courses, ruptures and 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, and 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. The PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

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Chronic Illness 2025

Topic 2 There are several vulnerable populations who are susceptible to chronic illnesses (older; homeless; and lesbian, gay, bisexual, and transgender populations) and who face challenges when it comes to care. Choose one vulnerable population and identify chronic illnesses to which they might be susceptible Identify challenges they face related to one of the identified chronic illnesses Discuss what can be done to help alleviate these challenges.

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Need Apa Style Essay(nursing) 2025

Instructions: Now that you have completed Lesson 23 & 24 and have thought about the factors that affect the health of various communities, do the following: Identify prevalent issues or diseases that affect the health of your community (the specific populations you serve). Compare and contrast two (2) specific populations in your practice that are affected by the above issue(s) or disease(s) by listing their commonalities and their differences. Base on the information above, how can you change or refine your practice to meet each community’s specific needs? Your paper should: be typed doubled-space. a total of 5 paragraphs (not counting your list of commonalities and differences). Use factual information. be original work and will be checked for plagiarism. have required APA format if references are utilized – type references according to the APA Style Guide . book reference: Professional Nursing Practice Concepts and perspectives eidition 7

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Week 8 100 Work Positive Response Three References Due Tomorrow No Plagiarism 2025

Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale (Milstead & Short, 2019). When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation (Burke, 2016). There exist opportunities for RNs and APRNs to actively participate in policy-making . However, with the opportunities can come. To be influential, nurses – particularly RNs and APRNs – must see themselves as professionals with the responsibility and capacity to influence healthcare policies delivery systems (Burke, 2016). Nurses can lean towards the nature of nursing, which is a “science of caring” or operate from a framework that values all people in a holistic way to advance people’s health. RNs and APRNs can influence practice standards and processes to assure quality of care. How? Considered as advanced and specialized professionals, RNs and APRNs can sit on committees or panels panel that give expert advice to policy makers (Tummers & Bekkers, 2014). Secondly, RNs and APRNs can become part of or conduct research that provided evidenced based support in policy making. Writing white papers, newspaper editorials, position statements, and other informative correspondence that educates the public and policymakers about the needs can support improvement of healthcare outcomes and overall improved nursing care (Milstead & Short, 2019). With opportunities come challenges. Policymakers may be unwilling to listen to expert advice or evidence-based research on particular policies to further either their political or personal agenda. In such as case resilience and advocacy can help make the policymakers change their mind (Burke, 2016). Furthermore, sometimes some people (and/or policymakers) may question white papers, research, position statements, newspaper editorials or other correspondences that educate the public and policy makers (Burke, 2016). When that happens, you can seek the support of other stakeholders who support the evidence to help advance the policy agendas. Finally, as an RN/APRN you may be required to advocate for or communicate these opportunities to participate in policymaking. You can do that in many ways. Two of the ways include; Volunteering in policy-related activities including development meetings. Participating in activities that advance health-policy driven agendas. Seek appointments and serve on committees, boards, and leadership groups that have decision-making power. References Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 5, “Public Policy Design” (pp. 87–95 only) Tummers, L., & Bekkers, V. (2014). Policy implementation, street level bureaucracy, and the importance of discretion. Public Management Review, 16 (4), 527–547. doi:10.1080/14719037.2013.841978. Burke, S. A. (2016). Influence through policy: Nurses have a unique role | Reflections on Nursing Leadership. Retrieved from https://www.reflectionsonnursingleadership.org/commentary/more-commentary/Vol42_2_nurses-have-a-unique-role

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NUR 631-THOUGHT 2025

Minimum of 300 words with at least 2 peer review reference in 6th edition apa style. In what ways, as you begin to transition to the role of a provider, do you think you have grown? Are you able to see things or understand things you didn’t before? Do you feel like you have some appreciation for the depth of committment you need for the next 18 months of your program?

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