Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for impulsivity, compulsivity, and addiction

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Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for impulsivity, compulsivity, and addiction
Week 8: Therapy for Clients With Impulsivity, Compulsivity, and Addiction
Impulsivity and compulsivity have a wide range of clinical presentations and often overlap with many other psychiatric disorders. Some individuals act without forethought and have difficulty saying “no” to certain things such as using illicit drugs or spending money, whereas other individuals engage in compulsive behaviors with undesirable consequences. In some cases, these impulsive and compulsive behaviors also fuel issues with addiction. To effectively assess and treat clients, you must understand how these disorders differ, as well as how their symptoms impact clients and their families.
This week, as you examine therapies for individuals with impulsivity, compulsivity, and addiction, you explore the assessment and treatment of clients with these disorders. You also consider ethical and legal implications of these therapies.
Photo Credit: [Apolinar B. Fonseca]/[Moment]/Getty Images
Assignment: Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction
Impulsivity, compulsivity, and addiction are challenging disorders for clients across the lifespan. These disorders often manifest as negative behaviors, resulting in adverse outcomes for clients. In your role as the psychiatric mental health nurse practitioner, you have the opportunity to help clients 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.
Learning Objectives
Students will:
Assess client factors and history to develop personalized therapy plans for clients with impulsivity, compulsivity, and addiction
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for impulsivity, compulsivity, and addiction
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing therapy for clients with impulsivity, compulsivity, and addiction
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 14, “Impulsivity, Compulsivity, and Addiction”
Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press.
To access the following chapter, click on the Illustrated Guides tab and then the Substance Use and Impulsive Disorders tab.
Chapter 10, “Disorders of Impulsivity and Compulsivity”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
For insomnia
For obsessive-compulsive disorder
Citalopram
clomipramine
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
venlafaxine
vilazodone
For alcohol withdrawal
chlordiazepoxide
clonidine
clorazepate
diazepam
lorazepam
oxazepam
For bulimia nervosa and binge eating
fluoxetine
topiramate
zonisamide
For alcohol abstinence
acamprosate
disulfiram
For alcohol dependence
nalmefene
naltrexone
For opioid dependence
buprenorphine
naltrexone
For nicotine addiction
bupropion
varenicline
Book Excerpt: Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders. Treatment Improvement Protocol Series, No. 32. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64350/
Chapter 1, “Substance Use Among Adolescents”
Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”
Chapter 7, “Youths with Distinctive Treatment Needs”
University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control in adulthood, study finds. Retrieved from https://www.sciencedaily.com/releases/2016/01/160120201324.htm
Note: Retrieved from Walden Library databases.
Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. doi:10.1111/j.1365-2125.2012.04457.x
Note: Retrieved from Walden Library databases.
Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10–15. doi:10.3928/00989134-20160314-04
Note: Retrieved from Walden Library databases.
Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis, 8(1), 74–84. doi:10.1080/15504263.2012.648439
Note: Retrieved from Walden Library databases.
Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., & … Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry, 55(6), 1337–1341. doi:10.1016/j.comppsych.2014.04.018
Note: Retrieved from Walden Library databases.
Required Media
Laureate Education (2016c). Case study: A Puerto Rican woman with comorbid addiction [Interactive media file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this week’s Assignment.
To prepare for this Assignment:
Review this week’s Learning Resources. Consider how to assess and treat adolescent clients requiring therapy for impulsivity, compulsivity, and addiction.
The Assignment
Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.
Co-morbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female
BACKGROUND
Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.”
SUBJECTIVE
Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health.
She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.
Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.
MENTAL STATUS EXAM
The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.
Diagnosis: Gambling disorder, alcohol use disorder
Decision Point One
Select what the PMHNP should do:
Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks
Antabuse (Disulfiram) 250 mg orally daily
Campral (Acamprosate) 666 mg orally three times/day
Co-morbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female
Decision Point One
Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Mrs. Perez said that she felt “wonderful” as she has not “touched a drop” to drink since receiving the injection
Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)
Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also have her concerned
Decision Point Two
Refer to a counselor to address gambling issues
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client reports that the anxiety that she had been experiencing is gone
Client reports that she has met with the counselor, but did not really like her. She did start going to a local meeting gamblers anonymous. She stated that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group
Decision Point Three
Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings
Guidance to Student
Although controversy exists in the literature regarding how long to maintain a client on Vivitrol, four weeks is probably too soon to consider discontinuation. The psychiatric mental health nurse practitioner should explore the issues that Mrs. Perez is having with her counselor. As you will learn in future courses, ruptures and the therapeutic alliance can result in clients stopping therapy. Clearly, if the client does not continue with therapy, the likelihood of the gambling problem spontaneously remitting is lower (than had the client continued to receive therapy). Recall that there are no FDA approved treatments for gambling addiction, and the mainstay of treatment for this disorder is counseling. Since Mrs. Perez reports good perceived support from the gamblers anonymous meetings, she should be encouraged to continue her participation with this group.
The PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

Some nurses say that theory has no role in clinical practice. What are your thoughts?

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Some nurses say that theory has no role in clinical practice. What are your thoughts?
Must Be Plagiarism Free!!!
This answer must be at least 300 words, reference not included in word count. Needs at least 2 references that are peer reviewed articles within the last 5 years. Both articles need to be cited within the answer at least once.
Needs to be in correct APA format and this includes the references.
ANSWER MUST BE ORIGINAL, Below are the questions.
Connection Between Theory and Advanced Clinical Practice
-While the focus of this course is nursing theory, some nurses say that theory has no role in clinical practice.
-What are your thoughts?
-Does nursing theory have a role in clinical practice?
-How would you use nursing theory to improve or evaluate the quality of clinical practice?
-Be sure to include an example that demonstrates your thoughts

How can data provide information to evaluate quality patient outcomes? Give an example of data that can reflect poor quality in care.

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How can data provide information to evaluate quality patient outcomes? Give an example of data that can reflect poor quality in care.
How can data provide information to evaluate quality patient outcomes? Give an example of data that can reflect poor quality in care. How can quality improvement be a daily task in patient care? Why does continuous quality improvement need to be associated with change?
American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.
Read Safe Patient Handling and Mobility-Why and How of Nursing, pp. 22–33
Required Reading
Hughes, R. G. (Ed.). (2008). Patient safety and quality: An evidence-based handbook for nurses (AHRQ Publication No. 08-0043). Agency for Healthcare Research and Quality. Retrieved from https://archive.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/ (Links to an external site.)Links to an external site.
Section 1, Chapter 1: Defining Patient Safety and Quality Care

Write an executive report of 4–5 pages that analyzes the role of diversity in an underperforming community program and outline a plan for providing ongoing training on cultural awareness, inclusion, and sensitivity to current employees.

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Write an executive report of 4–5 pages that analyzes the role of diversity in an underperforming community program and outline a plan for providing ongoing training on cultural awareness, inclusion, and sensitivity to current employees.
Overview
Write an executive report of 4–5 pages that analyzes the role of diversity in an underperforming community program, unit, or department, and outline a plan for providing ongoing training on cultural awareness, inclusion, and sensitivity to current employees.
Be sure you read all of the requirements for this assessment and review the suggested resources to see if they may be useful in completing the assessment.
This assessment provides an opportunity to determine how you can help advance your professional field by developing a strategy for managing diversity that recognizes the synergy achieved by having a diverse and inclusive workforce.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
•Competency 1: Explain the concepts, principles, and characteristics of effective health care leadership. ◦Determine the influence of effective leadership on the development of a diverse and culturally competent workforce.
•Competency 3: Analyze standards of professional ethics and the principles of diversity and inclusion as applied by health care leaders in real-world situations. ◦Outline a plan to recruit, hire, and retain a diverse workforce.
◦Outline a plan for providing employee training on cultural awareness and sensitivity.
◦Explain the benefits of a diverse and culturally competent workforce to a health care organization and the community it serves.
•Competency 4: Determine the influence of the practitioner-scholar role on professional practice and leadership development. ◦Explain how the academic and research skills one develops as a practitioner-scholar can be of service in one’s role as a health care leader.
•Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards. ◦Write coherently to support a central idea, using correct grammar, mechanics, and APA formatting.
Context
The United States continues to reflect the diversity of the world, as the country seeks to maintain its tradition of being a safe haven of freedom and the world’s melting pot. As health care practitioners, leaders, and scholars, it is vital that we embrace, recognize, and celebrate the diversity of our workforces and population.
It is also important for health care organizations to represent the communities that they serve in as many ways as possible. This diversity is represented in gender, race, ethnicity, age, and ability. Wynne (2012) posits that this diversity makes organizations stronger, allows for more productivity, and leads to enhanced job satisfaction. When health care organizations make themselves as diverse and inclusive as possible, they are integrating the community into the organization and the organization into the community, creating a win-win scenario for both. The health care organization is now more in touch with the needs, desires, and fears of the community. At the same time, the community members feel that they have representation in health agencies.
Reference
Wynne, R. (2012). Defining diversity. BizEd, 11(1), 32–34.
Questions to Consider
As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, a family member, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
•How well does the workforce within your organization reflect the diversity of the community?
•Are the needs of the community well served by the organization?
•Have you ever observed or experienced situations of prejudice or bias by a coworker? How did you respond to the situation?
Required Resources
The following resources are required to complete the assessment.
•Executive Report Template [DOCX]- DOCUMENT ATTACHED
Suggested Resources
•Downey, S. N., van der Werff, L., Thomas, K. M., & Plaut, V. C. (2015). The role of diversity practices and inclusion in promoting trust and employee engagement. Journal of Applied Social Psychology, 45(1), 35–44. doi:10.1111/jasp.12273
•Flores, K., & Combs, G. (2013). Minority representation in healthcare: Increasing the number of professionals through focused recruitment. Hospital Topics, 91(2), 25–36.
•Jackson, C. S., & Gracia, J. N. (2014). Addressing health and health-care disparities: The role of a diverse workforce and the social determinants of health. Public Health Reports, 129(Suppl 2), 57–61.
•Thomas, B. (2014). College of health and health care disparities: The effect of social and environmental factors on individual and population health. International Journal of Environmental Research and Public Health, 11(7), 7492–7507.
These resources examine the impact of leadership diversity to improve quality health care delivery.
•Deas, D., Pisano, E. D., Mainous, A. G., Johnson, N. G., Singleton, M. H., Gordon, L., . . . Reves, J. G. (2012). Improving diversity through strategic planning: A 10 year (2002-2012) experience at the Medical University of South Carolina. Academic Medicine, 87(11), 1548–1555. doi: 10.1097/ACM.0b013e31826d63e0.
•Dotson, E., & Nuru-Jeter, A. (2012). Setting the stage for a business case for leadership diversity in healthcare: History, research, and leverage. Journal of Healthcare Management, 57(1), 35–44.
•Wesley, Y. (2015). Leadership competencies to reduce health disparities. Nursing Management, 46(2), 51–53.
Bookstore Resources
•Buchbinder, S. B., Shanks, N. H., & Buchbinder, D. (2014). Cases in health care management. Burlington, MA: Jones & Bartlett Learning. ◦This textbook contains some excellent case study scenarios. Interesting questions and useful resources are also included at the end of the each case.
•Green, J. L. (2015). Graduate savvy: Navigating the world of online higher education (3rd ed.). Warrenton, VA: Glocal Press. ◦Chapters 1, 2, 7, 8, 9, 10, and 11 provide offer useful information to help you succeed as a graduate-level learner in an online environment.
Assessment Instructions
Preparation
Use the following case study as the basis of this assessment.
Imagine you are the manager of a new health care facility satellite office or community outreach center located in a diverse neighborhood. The parent organization opened the facility to address the under-served health care needs of the culturally diverse residents who were not using the services offered at the main facility. The first month of operation saw a very high volume of patients, but since then, the numbers have dropped off drastically. Executive leadership wants to understand why this has happened and what you plan to do about it.
After careful examination of all aspects of the facility, and talking with some of the neighborhood residents, you have determined that the residents do not feel comfortable coming to the facility, because the staff does not represent the diversity of the neighborhood. Staff members were hired for their skill, but their diversity was not considered. Now, you must report to executive leadership what you have learned and how you intend to manage diversity.
Note: Remember, you can submit all, or a portion, of your draft to Smarthinking for feedback, before you submit the final version of your proposal for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.
Report Requirements
Write an executive report on the need for a diverse, culturally competent staff, including your plans to address that need.
Note: The requirements outlined below correspond to the grading criteria in the Managing Diversity scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance level descriptions for each criterion to see how your work will be assessed. You are provided an example report, to illustrate what proficient-level work for this assessment looks like.
Report Format and APA Style
•Use the Executive Report Template, linked in the Resources, to draft your report. You may also organize the content of your report in a format used in your organization. An abstract is not required.
•Your report should be 4–5 double-spaced pages in length, not including the title page and reference page.
•Apply correct APA formatting to all in-text citations and references.
•Use Times New Roman, 12-point font.
Writing
As you begin composing your report, consider the purpose of the report, the appropriate tone and style, and the expectations of the executive leaders who will be reading it.
•Be clear and concise in your reporting.
•Express your main points, arguments, and conclusions coherently.
•Use correct grammar and mechanics.
•Be sure to support your claims and arguments with credible evidence from 3–5 current, scholarly or professional sources.
•Proofread your writing.
Report Content
•Outline a plan to recruit, hire, and retain a more diverse workforce. Note: Your outline should be a high-level overview of a plan, not a detailed plan. Other courses in your program will go into human resource practices and diversity in depth. In drafting your plan, consider the following questions: ◦How does a leader develop a diverse workforce?
◦Where will you look for more diverse employees? Will you post job ads?
◦What will the interviewing and hiring process look like? Who will do the interviewing? Who will make the final decisions?
◦What kind of incentives will you offer diverse employees to retain them? What do you need to know about the culture and values of diverse employees before developing a retention plan?
◦How will you address issues related to diversity that result in conflict?
•Outline a plan for the ongoing training and professional development of existing staff in cultural awareness and sensitivity. Consider how your plan can: ◦Improve communications and interpersonal skills.
◦Help overcome bias and resistance to change.
•Explain the benefits, to both the organization and the community it serves, of having a diverse and culturally competent workforce. ◦Explain the relationship between health care organizations and communities.
◦Explain the role that diversity plays in providing culturally competent care and access for the under-served in a community.
•Determine the influence of effective leadership on the development of a diverse and culturally competent workforce. ◦Explain the importance of cultural competence for leaders in an organization.
•Explain how the academic and research skills you develop as a practitioner-scholar can serve you in your role as an effective health care leader. ◦Explain how those skills might contribute to your credibility and effectiveness as a leader.
◦Explain how those skills might prepare you to lead a diverse workforce.