Making a Medical Decision

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.

Calculate the price
Make an order in advance and get the best price
Pages (550 words)
$0.00
*Price with a welcome 15% discount applied.
Pro tip: If you want to save more money and pay the lowest price, you need to set a more extended deadline.
We know how difficult it is to be a student these days. That's why our prices are one of the most affordable on the market, and there are no hidden fees.

Instead, we offer bonuses, discounts, and free services to make your experience outstanding.
How it works
Receive a 100% original paper that will pass Turnitin from a top essay writing service
step 1
Upload your instructions
Fill out the order form and provide paper details. You can even attach screenshots or add additional instructions later. If something is not clear or missing, the writer will contact you for clarification.
Pro service tips
How to get the most out of your experience with Assignments ABC
One writer throughout the entire course
If you like the writer, you can hire them again. Just copy & paste their ID on the order form ("Preferred Writer's ID" field). This way, your vocabulary will be uniform, and the writer will be aware of your needs.
The same paper from different writers
You can order essay or any other work from two different writers to choose the best one or give another version to a friend. This can be done through the add-on "Same paper from another writer."
Copy of sources used by the writer
Our college essay writers work with ScienceDirect and other databases. They can send you articles or materials used in PDF or through screenshots. Just tick the "Copy of sources" field on the order form.
Testimonials
See why 10k+ students have chosen us as their sole writing assistance provider
Check out the latest reviews and opinions submitted by real customers worldwide and make an informed decision.
Classic English Literature
Great paper, thank you!
Customer 452591, May 5th, 2022
Microbiology
Thank you so much! I appreciate what you do and all of the great help you've given me!
Customer 452483, September 6th, 2021
English 101
This writer was very quick with the draft and even faster with the revision! Thank you!
Customer 452603, May 30th, 2022
Mathematics
PERFECT! Thanks a million, you're all awesome!!!!
Customer 452483, July 7th, 2021
Sociology
Thank you so much! Appreciate it!
Customer 452483, November 8th, 2021
Communications
You're awesome! Thank you so much!
Customer 452483, July 27th, 2021
Psychology
Thank you so much for all of your hard work, appreciate every bit of it!
Customer 452483, September 6th, 2021
Nursing
Excellent!!! Thank you.
Customer 452487, September 13th, 2021
Group Dynamics
Great job. I appreciate it.
Customer 452521, November 22nd, 2021
Communications
Thank you for your hard work; I enjoyed reading the essay and appreciate your writing.
Customer 452483, July 18th, 2021
Healthcare Writing & Communications
Excellent!! You’re awesome, thank you very much for all of your hard work & help!!
Customer 452483, October 24th, 2021
Healthcare Writing & Communications
You guys are awesome! Appreciate all of your hard work! Thank you.
Customer 452483, October 15th, 2021
1159
Customer reviews in total
96%
Current satisfaction rate
2 pages
Average paper length
47%
Customers referred by a friend
OUR GIFT TO YOU
15% OFF your first order
Use a coupon ABC15 and enjoy expert help with any task at the most affordable price.
Claim my 15% OFF Order in Chat
Open chat
Chat with us Live Here
Get in Touch with Our Live Chat Agents via WhatsApp on +1(346) 416-0954. Get Unlimited Access to Answers on Any Queries With Your Paper.