NURS 6630 Week 10 Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Introduction

              The client, Mrs. Maria Perez, 53, is a Puerto Rican woman who presents today with an “embarrassing situation.” Mrs. Perez developed an alcohol problem after losing her father in her late teens. The client has had alcohol problems for probably 25 years now, with the situation getting worse in the past two years after the launch of Rising Sun Casino NURS 6630 Week 10 Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction. The influence of the casino came when she attended its grand opening, where she was hooked and started getting high while gambling. The client says she enjoys drinks that help her calm down when involved in high-stakes games. Mrs. Perez has also seen her cigarette smoking rate increase over the two years. However, she doesn’t smoke much while drinking,  Mrs. Perez enjoys smoking while playing with slot machines. The client is concerned with the $50,000 she has borrowed from her retirement account to settle her gambling debts and the fact that she has gained seven lb. of weight to 122lbs.

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The mental exam status shows that the client is oriented to time, place, person, event, and alert. She has dressed appropriately and has clear, coherent, and goal-directed speech. She, however, avoids eye direct eye contact. She exhibits no notable gestures, demeanors, or tics, and her self-described state of mind is “sad.” She rejects auditory or visual hallucinations and does not readily admit to delusory or paranoid mental processes. While insight and judgment appear to be intact, impulse control is weakened. She rejects homicidal or suicidal ideation at the moment.

Decision #1 Vivitrol (naltrexone) injection

The first medication step is injecting 380 mg of naltrexone (Vivitrol) intramuscularly in the gluteal area every four weeks. The use of orally and injection administrable naltrexone as an adjuvant treatment, notably in the decrease of heavy drinking, has been supported by increasing data. When used with alcohol, these medications increase the sedative effects and lessen alcohol cravings by blocking endorphin release. Extended-release injectable naltrexone reduces heavy drinking days by 25% and the likelihood of heavy drinking by 17% when taken daily in oral naltrexone 50-milligram tablets (Cardoza et al., 2018). The extended-release injection of naltrexone is designed to give a more consistent release and continuous bioavailability of the drug at a sufficiently low concentration to minimize side effects. When administered with Vivitrol, the client reports feeling wonderful and having dropped alcohol. However, the client still has issues with gambling and smoking and is experiencing anxiety which is a side effect of the medication.

Disulfiram was not selected because, when compared to naltrexone, it has high side effects. In a study to compare the two drugs in treating alcohol use disorders, Adhikari et al. (2020) found both medications lowered alcohol cravings and consumption. However, the naltrexone group had higher relapses. In another study to compare safety and efficacy, Kumar et al. (2020) found naltrexone to be more effective in decreasing alcohol craving and risk of relapse than acamprosate. Acamprosate was associated with the most dropouts in the study. Therefore, it was less tolerable than naltrexone. Naltrexone proves to be the better choice between the two. The main consideration while making the medication choice is the drug’s effectiveness and the patient’s safety. The main achievement intended is to prevent and minimize adverse reactions and injuries that could harm the patient’s health or even cause death by ensuring patient safety NURS 6630 Week 10 Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction. Good communication with the patient is essential to create rapport and convey the treatment’s benefits and risks to the individual. It aids in medication compliance and, as a result, therapeutic outcomes are improved.

Decision #2 Oral Valium (diazepam)

The second option is the introduction of orally administered Valium (5mg). Adding Valium addresses the patient’s experiences due to the initial treatment. Valium is among the most prevalent benzodiazepines used as anti-anxiety drug. The benzodiazepines improve the activity of the primary inhibitory neurotransmitter in the central nervous system. Petersen (2020) names benzodiazepines as an effective tool for the short-term management of acute anxiety. Another reason Valium was selected is its effectiveness in managing alcohol withdrawal symptoms. Benzodiazepines alleviate or avoid mild to severe alcohol intoxication symptoms, including hyperactivity of the autonomic nervous system, agitation, hallucinations, delirium, seizures, combativeness, and death. Lorazepam, oxazepam, chlordiazepoxide, and diazepam are the most often utilized benzodiazepines. Patel et al. (2022) named background benzodiazepines “the gold standard” in treating alcohol withdrawal symptoms.

When the Valium is administered, the client reports the drug treated her tremendously, and she felt like a new person. The feeling can be attributed to treating anxiety and easing withdrawal symptoms. Referral to a counselor was not selected because the client had anxiety which had to be addressed at this stage. Chantix was also not opted for due to the side effects associated with its use. The FDA amended its Drug Safety Communication in 2012 to include a warning about cardiovascular disorder events in patients treated with varenicline. A meta-analysis of 14 trials concluded that varenicline use was related to an increased risk of severe cardiovascular events (Burke et al., 2016). This is evident when the patient returns and reports that she ceased taking the drug due to agitation, abnormal dreams, nausea, and vomiting. In this step, the ethical guidance protects the patient’s well-being by administering the best medication. At this point, helping the patient with managing anxiety and withdrawal symptoms is the primary goal NURS 6630 Week 10 Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction. There is also the moral guidance not to cause harm to the patients through side effects by chosen methods. Effective communication with the patient is key to explaining the benefits of the chosen method, possible risks, and how they can be managed.

Decision #3 Continue Vivitrol/ decrease valium and refer to counseling.

The third selected option is continuing current Vivitrol medication, decreasing Valium for discontinuation in the following two weeks, and referring to counseling for gambling. This is because she is still consistent with her gambling problem and needs to be addressed. The other reason is that the method discontinues the use of Valium, which should not be used for long periods. The other options are not selected because they encourage prolonged use and increment of valium dosage. Valium has side effects when used for long periods and must be discontinued after a short period. Petersen (2020) argues that benzodiazepine drugs can be difficult to discontinue. The difficulty of discontinuing is proved when the patient requests an increment of dosage or frequency since she finds it hard to wait between administrations, which forces times to take the drug earlier. Symptoms of withdrawal can include increased anxiety, tremors, and, in some circumstances, seizures. The drugs can be especially hazardous for senior citizens, and their use is related to crashes and cognitive impairments in seniors. Because benzodiazepines can impair the body’s breathing ability, overdosing can be fatal NURS 6630 Week 10 Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction. This is particularly true if they’re used with alcohol and opiates. Continuation of Vivitrol is important at this stage to help the patient sustain alcohol independence.

This stage aims to help the patient in alcohol withdrawal, address gambling, and successfully prevent harm that severe side effects of Valium can cause. Referring to a therapist is important in addressing her ongoing gambling. Effective communication is essential to pass information to the patient about side effects she might encounter from using Valium and how they should be addressed. Effective communication is also key in preparing the client mentally for discontinuation of Valium, as she is getting addicted up to a point, she requests increased dosage or frequency. It is ethical to discontinue Valium to prevent harm its continued use may cause to the patient and talk to her about smoking and how she can address it.

 Conclusion

This case involves a 53 year old woman who has encountered an alcohol problem after losing her father in her 20s. Two years ago, the opening of the “Rising Sun” casino near her homemade things worse for her after getting hooked. While gambling at the casino, she enjoys a couple of drinking and frequently smokes; smoking has, however, become more frequent in the recent two years when she enjoys drinking while playing with slot machines. Her attempt to abstain from drinking bears no fruit, and now she is concerned after borrowing $50,000 to pay her gambling bets. Her mental status exam reveals she’s sound in all aspects from speech, dressing, and gestures. However, her mood is sad, and she denies eye contact. She denies suicidal or homicidal thoughts, although her impulse control is impaired.

The first process of her treatment is Vivitrol injection, 380 mg every week, to help in alcohol abstinence. The client reports to have dropped alcohol, also goes to the casino, and is experiencing anxiety and still smoking. Valium is added to the dosage, and the client reports impatience with the drug. The last decision is to continue with Vivitrol dosage, discontinue Valium and refer the client to counseling on the gambling issues. Discontinuation of Valium is done due to the harsh side effects the drug exposes patients to. The effects can be severe to fatality when the patient cannot breathe.

 

 

References

Adhikari, S., Tulachan, P., Ojha, S. P., Chapagai, M., Dhungana, S., & Pant, S. B. (2020). Comparison of Disulfiram and Naltrexone in Cases of Alcohol Dependence Syndrome. Journal of Nepal Health Research Council, 18(1), 75-81.

Burke, M. V., Hays, J. T., & Ebbert, J. O. (2016). Varenicline for smoking cessation: a narrative review of efficacy, adverse effects, use in at-risk populations, and adherence. Patient preference and adherence, 10, 435.

Cardoza, K., Gunn, D., & Katsman, A. (2018). Diagnosis and Treatment of Alcohol Use Disorder. Proceedings of UCLA Health, 22.

Kumar, A., Sharma, A., Bansal, P. D., Bahetra, M., Gill, H. K., & Kumar, R. (2020). A comparative study on the safety and efficacy of naltrexone versus baclofen versus acamprosate in managing alcohol dependence. Indian Journal of Psychiatry, 62(6), 650.

Patel, L., Beddow, D., Kirven, J., Smith, C. S., Hanovich, S., Holaday, K., … & Hill, C. A. S. (2022). Outcomes of Minnesota Detoxification Scale (MINDS) Assessment With High-Dose Front Loading Diazepam Treatment for Alcohol Withdrawal in Hospitalized Patients. The American Journal of the Medical Sciences, 363(1), 42-47 NURS 6630 Week 10 Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction.

Petersen, A. (2020). More people are taking drugs for anxiety and insomnia, and doctors are worried. The Wall Street Journal.

 

Assignment 1: 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.

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