BACKGROUNDMrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”SUBJECTIVEMrs. 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 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its 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 2 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 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 she 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 borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.MENTAL STATUS EXAMThe client is a 53 year old Puerto Rican female who is alert and 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. When 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 and self-reported mood. She denies visual or auditory hallucinations, and 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 disorderMY DECISION:DECISION 1:Decision Point OneVivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeksRESULTS OF DECISION POINT ONEClient returns to clinic in four weeksMrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injectionClient 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 has her concerneOTHER DECISIONS NOTCHOSEN:Antabuse (disulfiram) 250 mg orally every morningRESULTS OF DECISION POINT ONEClient returns toclinic in four weeksMrs. Perez reports to the office complaining of sedation, fatigue, and a “metallic taste” in her mouth, which “seems to be going away.” She also reports that she had just one drink about 5 days after starting the drug and thought that she would “die.” She reports that her face was red, and she felt that her heart would “pound right out of my chest.”Mrs. Perez also reports that she continues to visit the casino but has not been spending as much money there. She has noticed that her cigarette smoking is increasingAND:Campral (acamprosate) 666 mg orally TIDRESULTS OF DECISION POINT ONEClient returns to clinic in four weeksUpon return Mrs. Perez states that she has noticed that she has been having suicidal ideation over the past week, andit seems to be getting worseShe is also reporting that she is having “out of control” anxietyMY DECISION 2:ecision Point TwoAdd on Chantix (varenicline) 1 mg orally BIDRESULTS OF DECISION POINT TWOClient returns to clinic in four weeksClient reports that she had to stop taking Chantix secondary to abnormal dreams and agitationShe also reports that she felt nauseous and vomited several times after she began taking the drugMY DECISION 3:Decision Point ThreeDiscontinue Chantix and start Wellbutrin (bupropion) XL 150 mg orally dailyGuidance to StudentMrs. Perez was experiencing normal side effects associated with Chantix. She should be counseled regarding the potential side effects associated with Chantix and reassured that they will most likely abate. It should be noted that the problem Mrs. Perez is experiencing from the Chantix is most likely related to the starting dose. Recall that this drug should be initiated at 0.5 mg/day; after 3 days, increase to 1 mg/day in two divided doses; after 4 days, the dose can be increased to 2 mg/day in two divided doses. Side effects would most likely have been minimized or completely avoided had she been started at the appropriate starting dose. Therefore, it may be prudent to restart this drug at 0.5 mg orally daily and uptitrate consistent with the manufacturer’s suggested titration schedule. It would not be appropriate to restart Mrs. Perez at 1 mg orally BID, as it would most likely result in a return of the unpleasant symptoms she experienced.If Mrs. Perez is adverse to the idea of restarting Chantix, you could begin Wellbutrin XL, 150 mg orally daily.Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatmentof gambling disorder and should also be encouraged to establish herself with a local chapter of GamblersAnonymous.RUBRIC:RUBRIC: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-specificresources, including theprimary 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-specificresources, 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 LearningResources (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.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.
Why Choose Us
Top Writers4me provides the best top-grade academic writing services in compliance with our customers’ instructions. Have your paper written by a certified professional online college homework help writer to produce only high-quality essays with zero plagiarism.
Professional Academic Writers
You can now choose from a pool of online college homework help writers. Choose your writer and have them write the best content for you.Top Writers4me has, over the years, secured a team of the most reliable, experienced, and qualified writers. You can, therefore, trust that your assignment is in good hands.
We know that students have very limited budgets. And for that, we always strive to provide only the best, most affordable online college homework help services to our customers. Our goal is to provide top-quality assignment help services to all customers at the lowest, most affordable prices.
At Topwriters4me.com, we pay strict attention to deadlines. We recommend you to check out clients’ reviews for assurance that we will complete your assignments within the set deadlines. You can, therefore, trust that your paper will be done within and before the set deadline. Until now, we have not missed a single deadline.
Our Topwriters4me.com homework helper experts write only 100% original and plagiarism-free content for all of our clients. We also have a Quality Assurance Department team that goes through all work submitted by our writers multiple times. You can, therefore, rest assured that any signs of plagiarized or unoriginal content will be rejected before it reaches your portal.
Customer Support 24/7
Topwriters4me.com expert writers are always available 24/7 for customers who need assistance with using our website. You don’t have to check your watch the next time you want to have your assignment written. Our customer support is always available round the clock and ready to listen to your queries. Feel free to contact us via the Chat window or support email: email@example.com.
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
For years now, Topwriters4me.com has stood as a leader in providing its customers with the best online college homework help service in the industry. And all you have to do is provide us with the details of your order. Leave everything else to us. We’ve always got you covered.
Since we launched, Topwriters4me.com deserved the best online “college homework help status” thanks to our essay ordering, writing, and delivery process. We deliver nothing but excellence in our results. Our essay writing services include impeccable grammar, zero-plagiarism, proper structure, and conformance to guidelines.
Admission and Business Papers
Our top-quality online college homework help services guarantee that you will be accepted into your desired university. You just need to fill out your admission and business papers, and our team of online homework help workers will handle the rest. We will help you achieve and secure the best positions in your admissions forms.
Editing and Proofreading
At Topwriters4me.com, we have a skilled writing and editing team that’s dedicated to creating, editing, and restructuring for all types of papers. Our online college homework help editing and proofreading team will check, paraphrase, and correct any grammar mistakes on your paper before submitting the final document to you.
At Topwriters4me.com, we pride ourselves in having writers in almost all fields, even the most technical ones. You never have to worry about your paper being too technical for our certified online college homework help writers to handle. Mycoursewriter's team of writers can handle even the most complex writers. We will match your paper to the most competent writer that we believe will handle your paper the best way possible.