Assessing and Treating Patients with Impulsivity,

Walden University Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630 assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630

Whether one passes or fails an academic assignment such as the Walden University Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630 depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630

The introduction for the Walden University Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630 is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

Struggling to Meet Your Deadline?

Get your assignment on Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630 done on time by medical experts. Don’t wait – ORDER NOW!

Meet my deadline

How to Write the Body for Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630

After the introduction, move into the main part of the Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630 assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

Stuck? Let Us Help You

Completing assignments can sometimes be overwhelming, especially with the multitude of academic and personal responsibilities you may have. If you find yourself stuck or unsure at any point in the process, don’t hesitate to reach out for professional assistance. Our assignment writing services are designed to help you achieve your academic goals with ease.

Our team of experienced writers is well-versed in academic writing and familiar with the specific requirements of the Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630 assignment. We can provide you with personalized support, ensuring your assignment is well-researched, properly formatted, and thoroughly edited. Get a feel of the quality we guarantee – ORDER NOW.

A Sample Answer For the Assignment: Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

The 53-year-old female appears with an alcohol use disorder that she was diagnosed with in her twenties. She maintains that her issues, which include alcoholism, cigarette smoking, and gambling, are embarrassing. The patient reports that a casino was established in the neighborhood around 2 years ago, which caused her to start drinking again after being sober for several years, as she enjoys consuming cigarettes and alcohol when gaming. This resulted in her gaining roughly 7 pounds. Her gambling has gotten worse since then, as she recalls borrowing $50,000 from her workplace pension and using the money to cover gambling bills. She is worried that her spouse will be furious when he finds out. The results of the mental state evaluation show that the patient is depressed, and her emotion regulation is also compromised. With really no psychiatric symptoms, the patient was initially diagnosed with gambling and alcohol use disorder (AUD)

Several factors will be taken into account when selecting the most effective and safest drug to prescribe in the treatment of the patient’s medical needs (Yang et al., 2022). For example, a patient’s history of persistent addiction to alcohol and gambling will influence the choice of the most beneficial drug. Her age and Puerto Rican race will also aid in medicine selection, as well as identifying the optimum dosage and frequency. Her recent weight increase will also have an impact on the prescription she chooses, as most psychiatric medications cause weight gain. The goal of this discussion is to choose the best treatments for this patient’s care, with an explanation of the predicted outcome and ethical issues at each decision point.

Decision #1

Selected Decision and Rationale

The initial intervention was a 380mg IM injection of naltrexone into the gluteal region. Naltrexone is the most effective and safest medicine for treating alcohol consumption disorder, according to the FDA and most clinical standards, including the National Institute for Health and Care Excellence (NICE) (Renner & Ward, 2016). Naltrexone has an antagonistic action on opioid receptors, inhibiting endogenous opioid binding (Pettorruso et al., 2023). According to studies, naltrexone may be useful in lowering the desire to gamble in patients with comorbid alcohol addiction and gambling (Yang et al., 2022). Naltrexone has been shown to primarily target the Asp40 allele, which is prevalent among Puerto Ricans, enhancing its efficacy in this community (Trick & Le Foll, 2020). Because it is administered once a month, the LA formulation was chosen because it is more pleasant for the patient (Taubin et al., 2022).

The prescribed disulfiram formulation is short-acting, which might affect the patient’s degree of compliance, in conjunction with the elevated risks of side effects like palpitations (Mistarz et al., 2021). Acamprosate is likewise short-acting, with a greater frequency of administering, which may make it difficult for the patient to adhere to the prescription (Antonelli et al., 2022).

Expected Outcome

The patient’s desire to consume alcohol or gamble should be greatly reduced after one month of using naltrexone (Renner & Ward, 2016). Her smoking habit is linked to gambling; thus, it is predicted to decrease during this period (Yang et al., 2022).

Ethical Consideration

Clinicians are recommended to be nonjudgmental and not discriminate against individuals with substance use disorders based on their gender, color, or any other criteria (Mistarz et al., 2021). In caring for this patient, the PMHNP followed the ethical ideal of justice (Pettorruso et al., 2023).

Background

Mrs. Maria Perez, a 53-year-old Puerto Rican woman, has presented with an issue that she finds “embarrassing.”

Subjective

Mrs. Perez has struggled with alcohol since her father’s death in her late teens. She has been in and out of Alcoholics Anonymous for the past 25 years. Recently, she has been finding it difficult to maintain her sobriety due to the opening of the “Rising Sun” casino near her home. During a visit to the casino’s grand opening, Mrs. Perez became hooked on gambling, which provides her with a sense of high.

She often drinks while gambling, which leads to reckless gambling and further drinking. She has also noticed an increase in cigarette smoking over the past two years, which worries her about its negative effects on her health. Mrs. Perez has attempted to stop drinking but finds it challenging to resist the high she experiences from gambling. She has gained seven pounds from drinking and weighs 122 lbs.

Mental Status Exam

During the clinical interview, Mrs. Perez demonstrated an alert and oriented state of mind. Her speech was clear, coherent, and goal-directed, and her eye contact was somewhat avoidant. She had no noteworthy mannerisms, gestures, or tics. Although her self-reported mood was “sad,” her affect was appropriate to the conversation and her mood. She reported no visual or auditory hallucinations, delusional or paranoid thought processes, and her insight and judgment were intact. However, her impulse control was impaired, and she denied any suicidal or homicidal ideation.

Diagnosis

Mrs. Perez has been diagnosed with gambling disorder and alcohol use disorder.

Introduction

Compulsivity and impulsivity can manifest in various ways and often coincide with other psychiatric disorders. Individuals who act without thinking may struggle to refuse certain things, such as spending money or using illegal drugs. Some people may engage in compulsive behavior that leads to adverse consequences.

In many cases, compulsivity and impulsivity contribute to addiction-related problems. To assess and treat clients effectively, a Psychiatric Mental Health Nurse Practitioner (PMHNP) must have a clear understanding of the differences between these disorders, their symptoms, and their impact on both clients and their families (Bandelow, Michaelis, & Wedekind, 2017).

Decision #1

I have selected to begin the Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks for the patient described in the case. My decision to choose Naltrexone was based on its effectiveness in reducing alcohol consumption, craving, and relapse rates in patients with alcohol use disorder.

Studies have demonstrated the efficacy of Naltrexone in reducing alcohol use in patients with alcohol use disorder, including those with comorbid psychiatric conditions. Additionally, Naltrexone has been shown to improve overall treatment outcomes and increase the likelihood of abstinence. In the context of the patient’s case, Naltrexone could help her maintain her sobriety by blocking the pleasurable effects of alcohol and reducing her craving for alcohol (Ray et al., 2019).

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630

I did not select Campral (Acamprosate) or Antabuse (Disulfiram) for the patient because they have different mechanisms of action and may not be as effective as Naltrexone in this particular case. Campral works by reducing cravings and withdrawal symptoms in patients who have already stopped drinking.

While it is generally well-tolerated, it has not been shown to be effective in reducing heavy drinking or promoting abstinence in patients with alcohol use disorder (Akbar et al., 2018). Antabuse, on the other hand, works by causing a psychologically unpleasant reaction if the patient drinks alcohol, which can serve as a deterrent. However, it has limited efficacy and is associated with low patient adherence due to its side effects (De Souza, 2019).

By choosing Naltrexone, I hoped to achieve a reduction in the patient’s alcohol consumption, craving, and risk of relapse. I also hoped to improve her overall treatment outcomes and increase her likelihood of abstinence. Studies such as Ray et al. (2019) have shown Naltrexone to be effective in reducing alcohol use in patients with alcohol use disorder, and I hoped to have similar results replicated in this case.

Ethical considerations play a significant role in the treatment plan and communication with patients. It is important to obtain informed consent from the patient before initiating any treatment, ensuring that they understand the risks and benefits associated with the treatment. In the case of Naltrexone, it is important to inform the patient of the potential side effects, including nausea, headache, and fatigue, and monitor them for any adverse reactions.

It is also important to involve the patient in the decision-making process and respect their autonomy by considering their preferences and values. Additionally, confidentiality and privacy must be maintained throughout the treatment process, and the patient’s dignity and respect must be upheld (Adams & Volkow, 2020).

Decision #2

I selected to refer the client to a counselor to address her gambling issues. This decision was based on the client’s primary concern being gambling disorder and the potential benefits of concurrent counseling with her current medication regimen. Research has shown that counseling and therapy are effective in treating gambling disorder, including cognitive-behavioral therapy (CBT) and motivational interviewing (MI) (Hodgins et al., 2019).

Counseling can help the client identify and address the underlying reasons for their gambling behavior, develop coping skills, and improve their self-efficacy and motivation to change. Furthermore, counseling can provide ongoing support for maintaining sobriety and reducing the risk of relapse.

I did not select the other two options provided. Adding on Chantix (varenicline) may be effective in reducing nicotine dependence, but it does not address the client’s primary concern of gambling disorder. Additionally, the client’s smoking may be a secondary issue that can be addressed through counseling or other means.

Adding on Valium (diazepam) also presents a risk for the client due to her history of alcohol and drug abuse. Valium is a benzodiazepine meaning it has potential for being abused. Mixing alcohol with Valium is also associated with side effects such as slowed breathing which can be life threatening (Powers, 2022).

By referring the client to a counselor to address gambling issues, I hope to achieve additional support for the client’s primary concern of gambling disorder. The counselor can work with the client to identify triggers and develop coping strategies to prevent relapse. Additionally, the counselor can help the client address any underlying psychological or emotional issues that may be contributing to their gambling behavior (Knaebe et al., 2019).

Ethical considerations play a significant role in the treatment plan and communication with patients. It is essential to obtain informed consent from the patient and respect their autonomy in making decisions about their treatment. The patient must understand the benefits and risks associated with counseling and be able to provide informed consent. Confidentiality must also be maintained, and the patient’s privacy and dignity must be upheld. Additionally, the counselor must be appropriately trained and qualified to address the client’s specific needs and concerns (Adams & Volkow, 2020).

Referring the client to a counselor to address gambling issues was the appropriate decision based on the patient’s primary concern and the potential benefits of concurrent counseling with her current medication regimen. Counseling can help the client identify underlying issues and develop coping strategies to prevent relapse. Ethical considerations must be considered throughout the treatment plan to ensure the patient’s autonomy and privacy are upheld (Knaebe et al., 2019).

Decision #3

I selected to explore the issue that Mrs. Perez is having with her counselor and encourage her to continue attending the Gamblers Anonymous meetings for decision #3. This decision was based on the client’s report that she did not really like her counselor and the potential benefits of addressing this issue and continuing with Gamblers Anonymous.

Research has shown that a positive therapeutic alliance between the patient and therapist is critical for successful treatment outcomes (Knaebe et al., 2019). Patients who have a positive relationship with their therapist are more likely to engage in therapy, feel supported, and make progress towards their treatment goals. Therefore, addressing the issue that Mrs. Perez is having with her counselor is crucial for maintaining her engagement in counseling and improving her treatment outcomes.

I did not select the other two options provided in the exercise. Encouraging Mrs. Perez to continue seeing her current counselor may not be effective if she does not have a positive therapeutic alliance with her therapist. Discontinuing Vivitrol is not recommended as it has been shown to be effective in reducing alcohol consumption and preventing relapse in patients with alcohol use disorder (Ray et al., 2019).

By exploring the issue that Mrs. Perez is having with her counselor and encouraging her to continue attending the Gamblers Anonymous meetings, I hope to improve her engagement in counseling and increase her chances of successful treatment outcomes. By addressing the issue with her counselor, we can work to improve the therapeutic alliance and ensure that Mrs. Perez is receiving effective treatment. Additionally, continuing with Gamblers Anonymous provides her with additional support and resources for maintaining sobriety and preventing relapse.

Ethical considerations must be considered throughout the treatment plan and communication with patients. It is essential to respect the patient’s autonomy and preferences in their treatment. Mrs. Perez must be informed of the potential benefits and risks associated with continuing with her current counselor and encouraged to express any concerns or issues she may have. Confidentiality must also be maintained, and any communication with her counselor must be conducted with her informed consent. The goal is to provide Mrs. Perez with the best possible care while respecting her autonomy and privacy (Adams & Volkow, 2020).

Conclusion

In summary, my recommendations for the treatment of Mrs. Perez’s alcohol and gambling disorders involved a combination of pharmacological and psychosocial interventions. Treating addiction, compulsivity, and impulsivity disorders presents significant challenges to healthcare providers.

These disorders are often associated with negative behaviors that can have adverse consequences for patients. It is crucial for Psychiatric Mental Health Nurse Practitioners (PMHNPs) to actively listen to clients with these disorders, evaluate their circumstances, and create a comprehensive treatment plan.

The decision to administer Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks. Was based on the effectiveness of Naltrexone in reducing alcohol cravings and preventing relapse in patients with alcohol use disorder (Ray et al., 2021). The client responded well to this medication, with reduced alcohol consumption and improved sobriety. In Mrs. Perez’s case, there are inadequate FDA-approved medications for gambling addiction.

However, counseling has been shown to be an effective treatment option for this disorder. For the gambling disorder, I referred her to a counselor to address her gambling issues and encouraged her to participate in Gamblers Anonymous meetings. This decision was based on research that supports the effectiveness of counseling and support groups combined with pharmacological intervention in treating comorbid alcohol abuse and gambling disorder (Kraus, Etuk, & Potenza, 2020).

The client reported feeling supported and engaged in the Gamblers Anonymous group, and her anxiety and gambling behaviors improved. For the third decision point, I recommended exploring the issue that Mrs. Perez was having with her counselor and encouraging her to continue attending Gamblers Anonymous meetings.

This decision was based on the importance of a positive therapeutic alliance in successful treatment outcomes (Knaebe et al., 2019) and the potential benefits of addressing any concerns with the counselor and continuing with the support provided by Gamblers Anonymous.

Overall, the combination of pharmacological and psychosocial interventions was effective in treating Mrs. Perez’s alcohol and gambling disorders. Ethical considerations were also taken into account throughout the treatment plan to ensure the patient’s autonomy and privacy were respected.

It is important to note that every patient is unique, and treatment plans must be tailored to their specific needs and concerns. Clinicians must consider the patient’s individual history, comorbidities, preferences, and potential risks and benefits of treatment options. Therefore, ongoing assessment and modification of the treatment plan are necessary for successful outcomes.

References

Adams, V. J. M., & Volkow, N. D. (2020). Ethical imperatives to overcome stigma against people with substance use disorders. AMA Journal of Ethics, 22(8), 702-708. Doi: 10.1001/amajethics.2020.702.

Akbar, M., Egli, M., Cho, Y. E., Song, B. J., & Noronha, A. (2018). Medications for alcohol use disorders: An overview. Pharmacology & therapeutics, 185, 64-85. https://doi.org/10.1016/j.pharmthera.2017.11.007

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues

De Souza, A. (2019). Disulfiram in the Management of Alcohol Dependence. https://link.springer.com/chapter/10.1007/978-981-32-9876-7_3

in clinical neuroscience, 19(2), 93. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow

Knaebe, B., Rodda, S. N., Hodgins, D. C., & Lubman, D. I. (2019). Behaviour change strategies endorsed by gamblers subtyped by psychological distress, risky alcohol use, and impulsivity. Journal of Gambling Studies, 35(1), 275-292. https://doi.org/10.1007/s10899- 018-9803-x

Kraus, S. W., Etuk, R., & Potenza, M. N. (2020). Current pharmacotherapy for gambling disorder: a systematic review. Expert Opinion on Pharmacotherapy, 21(3), 287-296. https://doi.org/10.1080/14656566.2019.1702969

Powers, H. (2022). The use of valium in alcohol withdrawal. https://scholarworks.utep.edu/cohort_10/5/

Ray, L. A., Green, R., Roche, D. J., Magill, M., & Bujarski, S. (2019). Naltrexone effects on subjective responses to alcohol in the human laboratory: A systematic review and meta‐ analysis. Addiction Biology, 24(6), 1138-1152. https://doi.org/10.1111/adb.12747

The 53-year-old Puerto Rican female presents with alcohol use disorder which was diagnosed when she was in her 20s. She claims that her problems are embarrassing comprising of alcohol addiction, cigarette smoking, and gambling. About 2 years back, the patient claims that a casino was opened in the neighborhood, which made her start drinking a gain after several years of sober, as she enjoys taking alcohol and smoking when gambling.

This also led to her gaining about 7lbs. Her gambling has been getting worse ever since, as she reports that she borrowed about $50,000 from her retirement account and used the money to pay gambling debts. She is afraid that when her husband finds out, he will be furious. Mental status examination results reveal that the patient is sad, and her impulse control is also impaired. The patient displayed no psychiatric symptoms, hence diagnosed with alcohol use disorder (AUD) and gambling.

In the management of the patient’s health needs, several factors will be taken into account when choosing the most effective and safest medication to prescribe. For instance, the patient history of chronic alcohol use disorder and gambling will promote the selection of the most effective medication. Her age and race will also help in selecting the medication in addition to determining the appropriate dosage and frequency.

Her recent weight gain will also influence the decision on which drug to select as most psychotropic agents usually lead to weight gain. The purpose of this discussion is to select the most appropriate interventions in the management of this patient, with an illustration of the expected outcome and ethical considerations at each decision point.

Decision Point One

Selected Decision and Rationale

Administering naltrexone 380mg IM injection on the gluteal area was selected as the initial intervention. Naltrexone has been approved by the FDA and recommended by most clinical guidelines including National Institute for Health and Care Excellence (NICE) as the most effective and safest medication for treating alcohol use disorder (Martinac et al., 2019). Naltrexone had an antagonistic effect on the opioid receptors which inhibits the binding of endogenous opioids (Pakri Mohamed et al., 2018).

Studies show that naltrexone also has potential effectiveness in reducing the urge of gambling among patients with comorbid gambling and alcohol addiction (Blanco-Gandía & Rodríguez-Arias, 2018). Naltrexone has been reported to mainly target the Asp40 allele with is predominant among Puerto Ricans hence promoting its effectiveness among this population (Wieczorek & Dąbrowska, 2020). The long-acting formulation was selected as it is more convenient for the patient due to its administration once a month (Renner & Ward, 2016).

The disulfiram preparation provided is short-acting, which might affect the patient’s compliance level, in addition to its increased risks of adverse events like palpitations (Pakri Mohamed et al., 2018). Acamprosate is also short-acting, with an even higher frequency of administration, which might make it hard for the patient to remain compliant with the medication (Kelly & Renner, 2016).

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction NURS 6630:

Expected Outcome

With the use of naltrexone for the following month, the patient’s urge to drink or gamble should reduce significantly (Grant & Chamberlain, 2020). His smoking habit is associated with gambling, hence also expected to reduce within this time (Wieczorek & Dąbrowska, 2020).

Ethical Consideration

In taking care of patients with substance use disorder, clinicians are advised to be non-judgment and not to discriminate against the patient based on their gender or race, or any other factors (Martinac et al., 2019). The PMHNP observed the ethical principle of justice in taking care of this patient (Blanco-Gandía & Rodríguez-Arias, 2018).

Decision Point Two

Selected Decision and Rationale

Referring the patient to a counselor to help with the patient’s gambling habits was selected as the second decision. The patient displayed great effectiveness with naltrexone based on the reported outcome as she claims to have never used alcohol ever since the day she received the first injection (Kelly & Renner, 2016). The only side effect that was reported was anxiety, which is common among patients on naltrexone but disappears with time itself (Grant & Chamberlain, 2020).

The patient urge of gambling was also reduced but she was still concerned about the few times that she gambles as she wastes a lot of money hence the need for a specialist (Pakri Mohamed et al., 2018; Renner & Ward, 2016). Evidence demonstrates that there is no specific medication for gambling, but most patients have reported positive outcomes with the use of cognitive behavioral therapy (Wieczorek & Dąbrowska, 2020). The counselor is expected to address the patient’s gambling, which will in turn help her stop smoking.

Administering diazepam as an adjunct to naltrexone was inappropriate as the drug is addictive (Pakri Mohamed et al., 2018). Chantix is effective in smoking cessation but can only be used together with naltrexone in low doses once daily for a short period (Kelly & Renner, 2016).

Expected Outcome

With appropriate intervention implemented by the counselor and continuous use of naltrexone, the patient will continue being sober, with a reduced urge to gamble (Wieczorek & Dąbrowska, 2020). She will also be able to stop smoking (Grant & Chamberlain, 2020). The previously reported anxiety symptoms are also expected to resolve completely within this time.

Ethical Consideration

Ethically, nurses are required to treat every patient equally with no discrimination. Promoting patient-centered care is also crucial, with more focus on satisfying the needs of the patient (Martinac et al., 2019). For instance, in this decision, the patient was mainly concerned about her gambling, which can be adequately addressed by a counselor (Blanco-Gandía & Rodríguez-Arias, 2018). The PMHNP observed the ethical principle of nonmaleficence in making this decision.

Decision Point Three

Selected Decision and Rationale

Exploring the issues that the patient was having with her counselor and advising her to continue attending gamblers’ anonymous meetings was selected as the last decision. The decision was based on the reported outcome as the patient claimed to dislike her counselor (Pakri Mohamed et al., 2018). A healthy therapeutic relationship between the patient and the counselor is needed to promote positive outcomes (Wieczorek & Dąbrowska, 2020).

Consequently, studies show that a patient with a negative attitude toward their psychiatrist is more likely to stop going to therapy (Grant & Chamberlain, 2020). Attending alcohol anonymous meetings is also beneficial in promoting further sobriety from alcohol (Blanco-Gandía & Rodríguez-Arias, 2018). Previous evidence also demonstrates that naltrexone can take between 8 to 12 weeks for the most patient to attain full control over not taking alcohol (Kelly & Renner, 2016).

Encouraging the patient to continue seeing the counselor and ignoring their difference will make her stop attending the therapy sessions (Martinac et al., 2019). Discontinuing the use of naltrexone is also not appropriate as the drug is more effective for long-term use, especially among patients with chronic substance use disorder (Pakri Mohamed et al., 2018).

Expected Outcome

With the resolved conflict between the patient and her counselor, she is expected to stop gambling and continue abstaining from taking alcohol (Grant & Chamberlain, 2020). She should also be able to work on her smoking habits with her counselor (Blanco-Gandía & Rodríguez-Arias, 2018).

Ethical Considerations

Psychiatrists are encouraged to invest in developing a good therapeutic relationship with their patients to promote positive outcomes (Martinac et al., 2019). When resolving differences between the patient and her counselor, it is necessary to be neutral and help the patient understand the need of working on this relationship. Ethical principles such as respect for patient autonomy and non-maleficence were also considered in making this decision (Wieczorek & Dąbrowska, 2020).

Conclusion

The 53-year-old patient reported to the clinic with a chief complaint of embarrassing problems of alcohol use disorder and gambling. Several factors were considered in deciding on the most appropriate intervention for the management of the patient’s condition, such as her age, gender, and race. From the provided options, the initial intervention was to administer naltrexone, which is FDA approved and recommended by most clinical guidelines including NICE as the first line for the management of substance use disorder (Pakri Mohamed et al., 2018).

Disulfiram and Campral are short-acting, with elevated risks of adverse events hence not appropriate for the patient (Kelly & Renner, 2016). After 4 weeks, the patient reported that she has never taken alcohol ever since she received the first injection, but was still gambling and smoking (Martinac et al., 2019).

It was thus necessary to refer the patient to a counselor to help with her gambling. Adding diazepam to the patient’s treatment regimen or varenicline was not appropriate as the former is addictive and the latter is only used in small doses for smoking cessation (Blanco-Gandía & Rodríguez-Arias, 2018).

During the following visit, the patient reported improved symptoms but was mainly concerned about her dislike for her counselor. It was thus decided that the issues between the patient and her counselor be examined and encouraged the patient to continue attending gambling anonymous meetings as the final decision (Grant & Chamberlain, 2020).

Discontinuing the use of naltrexone and ignoring the patient’s dislike for her counselor were not appropriate decisions. The PMHNP encountered several ethical considerations at every decision point such as not discriminating against the patient and observing the right to autonomy (Wieczorek & Dąbrowska, 2020). Additional ethical principles encountered include justice and non-maleficence.

References

Blanco-Gandía, M. C., & Rodríguez-Arias, M. (2018). Pharmacological treatments for opiate and alcohol addiction: A historical perspective of the last 50 years. European journal of pharmacology, 836, 89-101. https://doi.org/10.1016/j.ejphar.2018.08.007

Grant, J. E., & Chamberlain, S. R. (2020). Gambling and substance use: Comorbidity and treatment implications. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 99, 109852. https://doi.org/10.1016/j.pnpbp.2019.109852

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.

Martinac, M., Karlović, D., & Babić, D. (2019). Alcohol and gambling addiction. In Neuroscience of alcohol (pp. 529-535). Academic Press. https://doi.org/10.1016/B978-0-12-813125-1.00054-4

Pakri Mohamed, R. M., Kumar, J., Ahmad, S. U., & Mohamed, I. N. (2018). Novel pharmacotherapeutic approaches in the treatment of alcohol addiction. Current drug targets, 19(12), 1378-1390. https://doi.org/10.2174/1389450119666180523092534

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.

Wieczorek, Ł., & Dąbrowska, K. (2020). Difficulties in treatment of people with comorbid gambling and substance use disorders. Journal of Substance Use, 25(4), 350-356. https://doi.org/10.1080/14659891.2019.1704078

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

Gambling and alcohol use disorder are common conditions that psychiatric mental health nurse practitioners encounter in their practice. The presence of symptoms such as impulsive and compulsive behaviors characterizes this disorder. The affected patients become increasingly involved in the intrusive behaviors irrespective of the associated impact on their mental, social, financial, and functional wellbeing.

Psychiatric mental health nurse practitioners utilize the existing best practice recommendations to implement interventions that optimize outcomes and promote recovery. Therefore, the purpose of this essay is to develop a treatment for a female client that has been diagnosed with gambling disorder and alcohol use disorder.

Introduction to the Case

The patient in the case study is Maria Perez. Perez is a 53-year-old Puerto Rican female that came to the hospital with an embarrassing problem. She reports having alcohol problems since her father died in her late teens. She has struggled with alcohol since her 20’s and has been involved with Alcohol Anonymous on and off for the last 25 years.

She also has gambling problem, which started with the opening of a casino near her home. She drinks while gambling and often gives way to it leading to more reckless gambling. She also smokes for the past 2 years and spends money recklessly due to gambling. Therefore, the patient factors that will influence treatment decisions include her experience with Alcohol Anonymous group, smoking, alcohol abuse, and weight.

NURS_6630_Week10_Assignment1_Rubric

Criteria

Ratings

Pts

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.

10 to >8.0 pts

Excellent Point range: 90–100

The response accurately, clearly, and fully summarizes in detail the case for the Assignment…. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.

8 to >7.0 pts

Good Point range: 80–89

The response accurately summarizes the case for the Assignment…. The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.

7 to >6.0 pts

Fair Point range: 70–79

The response inaccurately or vaguely summarizes the case for the Assignment…. The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

6 to >0 pts

Poor Point range: 0–69

The response inaccurately and vaguely summarizes the case for the Assignment, or is missing…. The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

10 pts

Decision #1 (1–2 pages)• 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.

20 to >17.0 pts

Excellent Point range: 90–100

The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided.

17 to >15.0 pts

Good Point range: 80–89

The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided.

15 to >13.0 pts

Fair Point range: 70–79

The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided.

13 to >0 pts

Poor Point range: 0–69

The response inaccurately and vaguely explains the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing.

20 pts

Decision #2 (1–2 pages)• 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.

20 to >17.0 pts

Excellent Point range: 90–100

17 to >15.0 pts

Good Point range: 80–89

15 to >13.0 pts

Fair Point range: 70–79

13 to >0 pts

Poor Point range: 0–69

The response inaccurately and vaguely explains in detail the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing.

20 pts

Decision #3 (1–2 pages)• 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.

20 to >17.0 pts

Excellent Point range: 90–100

17 to >15.0 pts

Good Point range: 80–89

15 to >13.0 pts

Fair Point range: 70–79

13 to >0 pts

Poor Point range: 0–69

20 pts

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.

15 to >13.0 pts

Excellent Point range: 90–100

The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient…. The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.

13 to >11.0 pts

Good Point range: 80–89

The response accurately summarizes the recommendations on the treatment options selected for this patient…. The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided.

11 to >10.0 pts

Fair Point range: 70–79

The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient…. The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided.

10 to >0 pts

Poor Point range: 0–69

The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing…. The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.

15 pts

Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 to >4.0 pts

Excellent Point range: 90–100

Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.5 pts

Good Point range: 80–89

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time….Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5 to >3.0 pts

Fair Point range: 70–79

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment is vague or off topic.

3 to >0 pts

Poor Point range: 0–69

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.

5 pts

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.0 pts

Excellent Point range: 90–100

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.5 pts

Good Point range: 80–89

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.5 to >3.0 pts

Fair Point range: 70–79

Contains several (3 or 4) grammar, spelling, and punctuation errors.

3 to >0 pts

Poor Point range: 0–69

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 to >4.0 pts

Excellent Point range: 90–100

Uses correct APA format with no errors.

4 to >3.5 pts

Good Point range: 80–89

Contains a few (1 or 2) APA format errors.

3.5 to >3.0 pts

Fair Point range: 70–79

Contains several (3 or 4) APA format errors.

3 to >0 pts

Poor Point range: 0–69

Contains many (≥ 5) APA format errors.

5 pts

Total Points: 100

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.

_Reference:

_{MentalHelp.net. (n.d.). Impaired decision-making, impulsivity, and compulsivity: Addictions’ effect on the cerebral cortex. https://www.mentalhelp.net/addiction/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex/}

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare for this Assignment:

Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for 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.

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)

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. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting

Links to an external site..

By Day 7

Submit your Assignment.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

To submit your completed assignment, save your Assignment as WK10Assgn1_LastName_Firstinitial
Then, click on Start Assignment near the top of the page.
Next, click on Upload File and select Submit Assignment for review.

Gambling and alcohol abuse are some of the mental health problems that psychiatric mental health nurse practitioners (PMHNP) face in their practice. PMHNP ensures that patients suffering from gambling and alcohol abuse disorders are assisted to overcome their addition and live a normal life. Therefore, this paper examines a case study of a patient that has been diagnosed with gambling disorder and alcohol use disorder.

The patient is Maria Perez, a 53-year-old Puerto Rican female who came to the clinic with a complaint of an embarrassing problem. The client admitted having history of problems with alcohol since her father died during her teenage years. She has been struggling with alcohol since her 20’s and is involved with Alcohol Anonymous in on and off basis. The client reported to have difficulty in maintaining sobriety since the opening of a casino near her home.

Perez has been gambling in the casino with her friend and enjoys drinking alcohol to calm her during high stake games. Her drinking behavior has predisposed her to reckless gambling. The client also has history of smoking cigarette for the last two years and is getting worried about its effects on her health. The client also reported to have gained more than 7 pounds of weight from her usual 115-pound weight.

Mental status examination was administered to the client. The assessment showed the client to be oriented and alert, dressed appropriately for the occasion, has clear, goal directed and coherent speech and avoidance eye contact behaviors. The assessment also showed the client not to demonstrate any noteworthy mannerism, ticks or gestures. The mood of the client was sad with absence of hallucinations, delusions, paranoid, or suicidal and homicidal ideations.

Decision Point One

Selected Decision

Administer Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks.

Reason for Selection

Vivitrol was selected as the first line of treatment because it works as a competitive antagonist of alcohol receptors, making it suitable for addiction management. The inhibition of alcohol receptors minimizes craving for alcohol, hence, improvement in abuse behaviors (Stahl, 2013). The inhibition of the alcohol receptors also reduces the perceived thirst for alcohol by the patient (Holt & Tobin, 2018). Patients who take alcohol but are in the process of overcoming their addiction problems may also use naltrexone. Naltrexone facilitates the systematic disuse of alcohol by the patients (Leighty & Ansara, 2019).

Why Other Options were not Selected

Antabuse (disulfiram) 250 mg orally daily and Campral (acamprosate) 666 mg orally three times a day were not selected because they are recommended for use in patients that have stopped alcohol intake (Stahl, 2013). The medications were also likely to predispose the patients to side effects such as nausea and tachycardia with the administration of disulfiram (Shirley et al., 2021). Since the patient has not abstained from alcohol abuse, the above options were not selected to ensure safety and quality in the care given.

Expectations

The above decision was made with the expectation of ensuring the reducing in symptoms of alcohol addiction being experienced by the client. The decision also aimed at promoting the systematic desensitization of alcohol desires that the patient was experiencing (Stern et al., 2015). It was anticipated that the administration of naltrexone would result in improved tolerability and abstinence of the patient from alcohol abuse (Wightman et al., 2018).

Impact of Ethical Considerations on Treatment Plan and Communication with the Client

Ethical considerations such as benevolence and non-maleficence informed the treatment plan. The PMHNP aimed at ensuring that the use of naltrexone would result in minimal harm and side effects to the client (Loreck David et al., 2016). The ethical aspect of informed consent would also influence the care given to the patient (Ellis, 2017).

For example, the PMHNP was expected to seek informed consent prior to implementing the care plan to minimize ethical and legal issues related to the care given to the patient. Seeking informed consent ensures the protection of the rights of the patient to informed care. It also promotes patient autonomy, as he has the decision to accept or decline the available treatment interventions (Stern et al., 2015).

Decision Point Two

Selected Decision

Refer the client to counselor to address gambling issues.

Reason for Selection

The administration of naltrexone was effective in causing moderate improvement in the management of alcohol addiction and abuse by the client. The client however reported to engaging in severe gambling when she visits the casino. An effective intervention at this stage would therefore be referring the patient to the counselor for assistance in managing gambling issues.

The FDA has not approved any drug for use in management of gambling issues (Grant et al., 2014). As a result, non-pharmacological interventions such as counseling are recommended. Counseling will enable the client to learn about the effective ways of overcoming gambling behaviors and coping up with her problem (Lee et al., 2021). The use of counseling interventions such as group therapy and cognitive behavioral therapy will equip the client with knowledge and skills needed in the management of anxiety.

Why Other Options were not Selected

The decisions to add valium (diazepam) 5 mg orally TID/PRN/anxiety and add Chantix (varenicline) 1 mg orally BID were not selected in the case study. The administration of valium was likely to increase the rise of side effects such as sedation, memory problems, tiredness, and drowsiness that were likely to affect the adherence to treatment (Sychla, Gründer, & Lammertz, 2017).

The decision to add Chantix was also not selected because the administration of naltrexone had led to moderate improvement in symptoms of addiction in the client (Echeburúa & Amor, 2021). Augmenting the treatment is therefore not recommended.

Expectations

The above decision was made with the expectation of facilitating the effective management of the gambling problem being experienced by the client. It was also expected that the client would be assisted to identify effective strategies for managing her gambling problem. The decision was also made with the aim of improving the effectiveness of the pharmacological interventions used in addiction management (Pickering et al., 2020).

Impact of Ethical Considerations on Treatment Plan and Communication with the Client

The ethical consideration of promoting privacy and confidentiality of patient data would influence the selection of treatment plans at this phase. PMHNP is expected to seek informed consent from the client prior to sharing her information with other healthcare providers (Ellis, 2017). PMHNP is also expected to promote patient’s right to autonomous care by educating her about the aims of the selected treatment interventions.

Decision Point Three

Selected Decision

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings.

Reason for Selection

The use of counseling services appears to have been effective for the client. For example, the client returned after 4 weeks reporting that the anxiety she had been experiencing was gone. She also reported that she has started attending Gamblers Anonymous group and has been participating in self-expression to seek the support that she needs. An effective intervention at this step would be to encourage the client to continue seeing her current counselor and continue with the Gamblers Anonymous group (Echeburúa & Amor, 2021).

There is the need for the PMHNP to obtain information from the client on the factors that contributed to her dissatisfaction with the care given by her counselor (Kelly & Renner, 2016). The information obtained from her will be used to implement effective interventions that would strengthen the relationship between her and the counselor (Lee et al., 2021). There is also the need to refer the client to the smoking cessation clinic to be assisted on the management of her health problem of smoking cigarette.

Why Other Options were not Selected

The decision to encourage Mrs. Perez to continue seeing her current counselor and continue with Gamblers Anonymous group was not selected because a strained relationship between her and the counselor could affect client’s participation and increase the risk of relapse (Heinz, Romanczuk-Seiferth, & Potenza, 2019). The decision to discontinue vivitrol and encourage Mrs. Perez to continue seeing her counselor and participating in the Gamblers Anonymous group was not selected because it would result in symptom relapse (Wightman et al., 2018).

Expectations

The above decision was made with the aim of adopting interventions to improve the relationship between the counselor and the client. The decision also aimed at ensuring continued improvement in the adoption of positive behaviors against gambling by the client. It was also expected that the client would adopt sustainable interventions to manage her addiction problems (Holt & Tobin, 2018).

Impact of Ethical Considerations on Treatment Plan and Communication with the Client

The ethical principle of informed consent influenced the selection of the above decision. The patient has a right to participate or not in a treatment program. Obtaining information about the factors affecting the relationship between her and the counselor would therefore improve the interventions used to facilitate recovery process. The other ethical consideration is privacy and confidentiality of data (Ellis, 2017). The PMHNP should ensure that the client’s data is protected from unauthorized access, hence, data integrity.

Conclusion

Gambling and alcohol abuse disorder affects a significant proportion of people globally. Gambling and alcohol abuse disorder affect the social and occupational functioning of a patient. The increased dependence on alcohol and engagement in addictive gambling behaviors hinders one’s ability to contribute optimally to self and community development. The administration of naltrexone to the patient was an effective decision in the case study (Stahl, 2013).

Naltrexone proved effective in managing the client’s alcohol addiction and abuse problem, leading to her improved social and occupational functioning. Naltrexone also facilitated the gradual cessation of alcohol abuse by the client (Holt & Tobin, 2018). Counseling was also found effective in managing the gambling problem being experienced by the client. Accordingly, counseling provided the client with knowledge and skills that are needed in coping up with addiction problems including gambling.

The client also participated in social support groups such as Gamblers Anonymous group to learn from others about the effective ways of overcoming gambling. The relationship between the client and the healthcare provider is important for optimal behavioral and lifestyle modification in case management. As a result, it was important to examine the factors that contribute to the poor relationship between the client and her counselor to inform improvement interventions in managing the client (Echeburúa & Amor, 2021). Based on the above analysis, I believe that I made ethical decisions in determining the treatment needs and options for the client in the case study.

References

Echeburúa, E., & Amor, P. J. (2021). Psychological Management of Gambling Disorder With or Without Other Psychiatric Comorbidities. In N. el-Guebaly, G. Carrà, M. Galanter, & A. M. Baldacchino (Eds.), Textbook of Addiction Treatment: International Perspectives (pp. 929–942). Springer International Publishing. https://doi.org/10.1007/978-3-030-36391-8_65

Ellis, P. (2017). Understanding Ethics for Nursing Students. Learning Matters.

Grant, J. E., Odlaug, B. L., & Schreiber, L. R. 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

Heinz, A., Romanczuk-Seiferth, N., & Potenza, M. N. (2019). Gambling disorder. Cham, Springer.

Holt, S. R., & Tobin, D. G. (2018). Pharmacotherapy for alcohol use disorder. Medical Clinics, 102(4), 653–666. https://doi.org/10.1016/j.mcna.2018.02.008

Lee, K., Kim, H., & Kim, Y. (2021). Gambling disorder symptoms, suicidal ideation, and suicide attempts. Psychiatry Investigation, 18(1), 88–93. https://doi.org/10.30773/pi.2020.0035

Leighty, A. E., & Ansara, E. D. (2019). Treatment outcomes of long-acting injectable naltrexone versus oral naltrexone in alcohol use disorder in veterans. Mental Health Clinician, 9(6), 392–396. https://doi.org/10.9740/mhc.2019.11.392

Loreck David, Brandt Nicole J., & DiPaula Bethany. (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

Pickering, D., Spoelma, M. J., Dawczyk, A., Gainsbury, S. M., & Blaszczynski, A. (2020). What does it mean to recover from a gambling disorder? Perspectives of gambling help service users. Addiction Research & Theory, 28(2), 132–143. https://doi.org/10.1080/16066359.2019.1601178

Shirley, D.-A., Sharma, I., Warren, C. A., & Moonah, S. (2021). Drug repurposing of the alcohol abuse medication disulfiram as an anti-parasitic agent. Frontiers in Cellular and Infection Microbiology, 11. https://doi.org/10.3389/fcimb.2021.633194

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.

Stern, T. A., Fava, M., Rosenbaum, J. F., & Wilens, T. E. (2015). Massachusetts General Hospital Psychopharmacology. Elsevier Science Health Science.

Sychla, H., Gründer, G., & Lammertz, S. E. (2017). Comparison of clomethiazole and diazepam in the treatment of alcohol withdrawal syndrome in clinical practice. European addiction research, 23(4), 211-218. https://doi.org/10.1159/000480380

Wightman, R. S., Nelson, L. S., Lee, J. D., Fox, L. M., & Smith, S. W. (2018). Severe opioid withdrawal precipitated by Vivitrol®. The American Journal of Emergency Medicine, 36(6), 1128.e1-1128.e2. https://doi.org/10.1016/j.ajem.2018.03.052

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

This resulted in her gaining roughly 7 pounds. Her gambling has gotten worse since then, as she recalls borrowing $50,000 from her workplace pension and using the money to cover gambling bills. She is worried that her spouse will be furious when he finds out. The results of the mental state evaluation show that the patient is depressed, and her emotion regulation is also compromised. With really no psychiatric symptoms, the patient was initially diagnosed with gambling and alcohol use disorder (AUD)

Her age and Puerto Rican race will also aid in medicine selection, as well as identifying the optimum dosage and frequency. Her recent weight increase will also have an impact on the prescription she chooses, as most psychiatric medications cause weight gain. The goal of this discussion is to choose the best treatments for this patient’s care, with an explanation of the predicted outcome and ethical issues at each decision point.

Decision #1

Selected Decision and Rationale

According to studies, naltrexone may be useful in lowering the desire to gamble in patients with comorbid alcohol addiction and gambling (Yang et al., 2022). Naltrexone has been shown to primarily target the Asp40 allele, which is prevalent among Puerto Ricans, enhancing its efficacy in this community (Trick & Le Foll, 2020). Because it is administered once a month, the LA formulation was chosen because it is more pleasant for the patient (Taubin et al., 2022).

Expected Outcome

Ethical Consideration

Decision #2

Selected Decision and Rationale

The second approach was to refer the patient to a psychotherapist for assistance with her gambling tendencies. From the reported outcome, the patient demonstrated outstanding efficacy with naltrexone, as she asserts to have never drunk alcohol after the initial injection (Taubin et al., 2022). The sole negative effect reported was anxiousness, which is frequent among naltrexone patients but fades with time (Mistarz et al., 2021).

The patient’s desire to gamble was also lessened, although she was still upset about the handful of times she gambled because she wasted a lot of money, necessitating the requirement of a specialist (Renner & Ward, 2016). Although there is no particular medication for gambling, most individuals have reported favorable outcomes when using cognitive behavioral treatment (Yang et al., 2022). The counselor is anticipated to resolve the client’s gambling, which will aid in her smoking cessation (Ray et al., 2020).

Because diazepam is addicting, using it as an adjuvant to naltrexone was improper (Mistarz et al., 2021). Chantix is an excellent smoking cessation medication, but it can only be used in conjunction with naltrexone in modest dosages once a day for a limited time (Pettorruso et al., 2023).

Expected Outcome

The patient will remain sober with a reduced desire to gamble if the counselor implements proper intervention and continues to utilize naltrexone (Antonelli et al., 2022). She will be able to quit smoking as well (Renner & Ward, 2016). The previously observed anxiety symptoms are also likely to entirely resolve over this time.

Ethical Consideration

Ethically, nurses must treat all patients equally and without discrimination. Promoting patient-centered treatment is also critical, with a greater emphasis on meeting the patient’s requirements (Trick & Le Foll, 2020). For example, in this judgment, the patient was primarily concerned regarding her gambling, which a counselor can effectively address (Pettorruso et al., 2023). In making its decision, the PMHNP followed the ethical concept of non-maleficence.

Decision #3

Selected Decision and Rationale

The patient’s challenges with her psychotherapist were discussed in the final decision, and she was advised to continue attending gamblers’ anonymous groups. Because the patient confessed to disliking her counselor, the decision was largely based on the stated outcome (Taubin et al., 2022). Positive counseling outcomes require a solid therapeutic relationship between the client and the counselor (Mistarz et al., 2021).

As a result, research suggests that patients who have a hostile perception toward their psychiatrist are more likely to discontinue therapy (Trick & Le Foll, 2020). Participating in alcohol anonymous meetings can also help to promote continued recovery from alcohol (Antonelli et al., 2022). Previous research indicates that naltrexone can take 8 to 12 weeks for the majority of patients to achieve complete control over not drinking alcohol (Ray et al., 2020).

Encouraging the patient to keep seeing the counselor while ignoring their differences will result in her discontinuing therapy sessions (Pettorruso et al., 2023). It is also not acceptable to discontinue naltrexone therapy because the medicine is more beneficial for long-term use, particularly in patients with chronic addiction to substances (Taubin et al., 2022).

Expected Outcome

With the client and her counselor’s disagreement addressed, she is expected to cease gambling and continue refraining from alcohol (Renner & Ward, 2016). She ought to be able to work with her counselor to improve her smoking behaviors (Ray et al., 2020).

Ethical Considerations

To enhance excellent outcomes, psychiatrists are recommended to invest in creating a healthy therapeutic interaction with their patients (Trick & Le Foll, 2020). When settling disagreements between the client and her psychiatrist, it is important to remain neutral and assist the patient in understanding the importance of concentrating on this connection (Ray et al., 2020). This decision was also guided by ethical concepts like respect for autonomy and non-maleficence.

Conclusion

The 53-year-old patient arrived at the clinic with the primary complaint of embarrassment due to alcohol addiction and gambling. Several characteristics, including the patient’s age, gender, and race, were examined when deciding on the best solution for her disease. The initial step was to provide naltrexone, which is FDA-authorized and recommended as the first line of treatment for substance use disorder by most clinical recommendations, including NICE (Renner & Ward, 2016).

Disulfiram and Campral have a short half-life and a high risk of side effects, making them unsuitable for the patient (Mistarz et al., 2021). After four weeks, the patient indicated that she had not used alcohol since the first injection, although she still gambled and smoked (Yang et al., 2022). As a result, it was necessary to recommend the client to a psychotherapist for assistance with her gambling. Adding diazepam or varenicline to the patient’s therapy regimen was not acceptable because the former is addictive, whereas the latter is only recommended in low dosages for smoking cessation (Trick & Le Foll, 2020).

During the subsequent visit, the client reported enhanced symptoms but was mostly concerned with her contempt for her counselor (Pettorruso et al., 2023). As a result, it was determined that the conflicts between the client and her therapist be investigated and that the patient be motivated to keep participating in gambling anonymous sessions as the overall solution (Antonelli et al., 2022).

Discontinuing naltrexone and dismissing the patient’s distaste for her psychotherapist were not appropriate actions (Taubin et al., 2022). At each decision point, the PMHNP was confronted with various ethical considerations, such as not prejudice against the client and respecting the right to self – determination (Ray et al., 2020). Other ethical principles observed include fairness and non-maleficence.

References

Antonelli, M., Sestito, L., Tarli, C., & Addolorato, G. (2022). Perspectives on the pharmacological management of alcohol use disorder: Are the approved medications effective? European Journal of Internal Medicine, 103, 13–22. https://doi.org/10.1016/j.ejim.2022.05.016

Mistarz, N., Nielsen, A. S., Andersen, K., Goudriaan, A. E., Skøt, L., Mathiasen, K., Michel, T. M., & Mellentin, A. I. (2021). Brain+ AlcoRecover: A Randomized Controlled Pilot-Study and Feasibility Study of Multiple-Domain Cognitive Training Using a Serious Gaming App for Treating Alcohol Use Disorders. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.727001

Pettorruso, M., Di Carlo, F., Romeo, V. M., Jimenez-Murcia, S., Grant, J. E., Martinotti, G., & di Giannantonio, M. (2023). The pharmacological management of gambling disorder: if, when and how. Expert Opinion on Pharmacotherapy. https://doi.org/10.1080/14656566.2023.2172329

Ray, L. A., Meredith, L. R., Kiluk, B. D., Walthers, J., Carroll, K. M., & Magill, M. (2020). Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders. JAMA Network Open, 3(6), e208279. https://doi.org/10.1001/jamanetworkopen.2020.8279

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.

Taubin, D., Wilson, J. C., & Wilens, T. E. (2022). ADHD and Substance Use Disorders in Young People. Child and Adolescent Psychiatric Clinics of North America. https://doi.org/10.1016/j.chc.2022.01.005

Trick, L., & Le Foll, B. (2020). Pharmacological Treatment of Alcohol Use Disorder. Textbook of Addiction Treatment, 123–139. https://doi.org/10.1007/978-3-030-36391-8_10

Yang, W., Singla, R., Maheshwari, O., Fontaine, C. J., & Gil-Mohapel, J. (2022). Alcohol Use Disorder: Neurobiology and Therapeutics. Biomedicines, 10(5), 1192. https://doi.org/10.3390/biomedicines10051192

‌

Rubric

NURS_6630_Week10_Assignment1_Rubric

NURS_6630_Week10_Assignment1_Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning Outcome 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.	10 to >8.0 pts Excellent Point range: 90–100 The response accurately, clearly, and fully summarizes in detail the case for the Assignment…. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. 8 to >7.0 pts Good Point range: 80–89 The response accurately summarizes the case for the Assignment…. The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. 7 to >6.0 pts Fair Point range: 70–79 The response inaccurately or vaguely summarizes the case for the Assignment…. The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. 6 to >0 pts Poor Point range: 0–69 The response inaccurately and vaguely summarizes the case for the Assignment, or is missing…. The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.	10 pts
This criterion is linked to a Learning Outcome Decision #1 (1–2 pages)• 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.	20 to >17.0 pts Excellent Point range: 90–100 The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 17 to >15.0 pts Good Point range: 80–89 The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 15 to >13.0 pts Fair Point range: 70–79 The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 13 to >0 pts Poor Point range: 0–69 The response inaccurately and vaguely explains the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing.	20 pts
This criterion is linked to a Learning Outcome Decision #2 (1–2 pages)• 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.	20 to >17.0 pts Excellent Point range: 90–100 The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 17 to >15.0 pts Good Point range: 80–89 The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 15 to >13.0 pts Fair Point range: 70–79 The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 13 to >0 pts Poor Point range: 0–69 The response inaccurately and vaguely explains in detail the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing.	20 pts
This criterion is linked to a Learning Outcome Decision #3 (1–2 pages)• 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.	20 to >17.0 pts Excellent Point range: 90–100 The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 17 to >15.0 pts Good Point range: 80–89 The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 15 to >13.0 pts Fair Point range: 70–79 The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 13 to >0 pts Poor Point range: 0–69 The response inaccurately and vaguely explains in detail the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing.	20 pts
This criterion is linked to a Learning Outcome 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.	15 to >13.0 pts Excellent Point range: 90–100 The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient…. The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. 13 to >11.0 pts Good Point range: 80–89 The response accurately summarizes the recommendations on the treatment options selected for this patient…. The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. 11 to >10.0 pts Fair Point range: 70–79 The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient…. The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. 10 to >0 pts Poor Point range: 0–69 The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing…. The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.	15 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 to >4.0 pts Excellent Point range: 90–100 Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.5 pts Good Point range: 80–89 Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time….Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 3.5 to >3.0 pts Fair Point range: 70–79 Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment is vague or off topic. 3 to >0 pts Poor Point range: 0–69 Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.	5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 to >4.0 pts Excellent Point range: 90–100 Uses correct grammar, spelling, and punctuation with no errors. 4 to >3.5 pts Good Point range: 80–89 Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3.5 to >3.0 pts Fair Point range: 70–79 Contains several (3 or 4) grammar, spelling, and punctuation errors. 3 to >0 pts Poor Point range: 0–69 Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.	5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.	5 to >4.0 pts Excellent Point range: 90–100 Uses correct APA format with no errors. 4 to >3.5 pts Good Point range: 80–89 Contains a few (1 or 2) APA format errors. 3.5 to >3.0 pts Fair Point range: 70–79 Contains several (3 or 4) APA format errors. 3 to >0 pts Poor Point range: 0–69 Contains many (≥ 5) APA format errors.	5 pts
Total Points: 100

Submission

Submitted!

Feb 5 at 11:12am

Submission Details

Download NURS 6630 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction IRIKEFE.docx

Grade: 100 (100 pts possible)

Graded Anonymously: no

Comments: