CASE:
The patient, Mrs. Maria Perez, is a 53-year-old Puerto Rican female who has presented for consultation regarding a personal issue she finds sensitive in
nature.
The client reports a history of alcohol use disorder dating back to her late teens and involvement with Alcoholics Anonymous over the past 25 years, with
increased difficulty maintaining sobriety since the opening of a nearby casino. She describes a high associated with gambling and an increased frequency of
drinking and cigarette smoking while gambling, as well as concerns about the health effects of the smoking. Despite attempts at abstinence, the client
reports feeling the need for alcohol during gambling activities. She has also experienced weight gain from excessive drinking. The client expresses concern
about having borrowed a substantial sum from her retirement account to pay off gambling debts without her husband's knowledge
The patient is a 53-year-old Puerto Rican female who is conscious and oriented to her surroundings. She is dressed appropriately for the weather and the
season. Her speech is clear and coherent, with a clear goal. Her eye contact during the clinical interview is somewhat limited, but her mannerisms, gestures,
and tics are not notable. She reports feeling "sad" and her affect is consistent with her reported mood. There is no evidence of hallucinations or delusional
thinking, and her insight and judgment appear to be intact. However, she has an impaired ability to control her impulses. There are no reported suicidal or
homicidal ideations at this time.
Diagnosis: Gambling Disorder, Alcohol Use Disorder.
- 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
After a thorough history and physical from the patient, the diagnosis is gambling disorder and alcohol use disorder. 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
My decision: Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region
every 4 weeks (BASE ANSWER ON THIS DECISION)
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks. Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol 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 has her concerned
• 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
Select what the PMHNP should do next:
• Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety
• Refer to a counselor to address gambling issues
• Add on Chantix (varenicline) 1 mg orally BID
My decision: Refer to a counselor to address gambling issues (BASE ANSWER ON THIS DECISION)
RESULTS OF DECISION POINT TWO
Mrs. Perez returns in 4 weeks and reports that the anxiety that she had been experiencing is gone. She reports that she has met with the counselor, but she
did not really like her. She also started going to a local meeting of Gamblers Anonymous. She states that last week, for the first time, she spoke during the
meeting. She reports feeling supported in this group.
• 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
Select what the PMHNP should do next:
• Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety
• Refer to a counselor to address gambling issues
• Add on Chantix (varenicline) 1 mg orally BID
My decision: Refer to a counselor to address gambling issues (BASE ANSWER ON THIS DECISION)
RESULTS OF DECISION POINT TWO
Mrs. Perez returns in 4 weeks and reports that the anxiety that she had been experiencing is gone. She reports that she has met with the counselor, but she
did not really like her. She also started going to a local meeting of Gamblers Anonymous. She states that last week, for the first time, she spoke during the
meeting. She reports feeling supported in this group.
• 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
Select what the PMHNP should do next:
• Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings
• Encourage Mrs. Perez to continue seeing her current counselor as well as continuing the Gamblers Anonymous group
• Discontinue Vivitrol. Encourage Mrs. Perez to continue seeing her counselor and to continue participating in the Gamblers Anonymous group
My decision: Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings
(BASE ANSWER ON THIS DECISION)
Sample Solution