Assignment: 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. Acid Base Blood Gas Case Study Essay Example
In your role as the psychiatric nurse practitioner (PNP), you have the opportunity to help patients 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.
Reference: MentalHelp.net. (n.d.). Impaired decision-making, impulsivity, and compulsivity: Addictions’ effect on the cerebral cortex. https://www.mentalhelp.net/addiction/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex/
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for impulsivity, compulsivity, and addiction.
The Assignment: 5 pages
Examine Case Study: A Puerto Rican Woman With Comorbid Addiction ( https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_08/index.html ). 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, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
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)
BUY A PLAGIARISM-FREE PAPER HERE
Which decision did you select?
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 (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-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.
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.
Introduction
In this paper, the author analyzes the blood chemistry, blood gas, and urinalysis findings of an 85-year-old who presented with a history of not breathing for two days, lethargy, and a decreased urine output. Blood gas analyses are a common diagnostic tool for evaluating the acid-base content and gas partial pressures in blood. Accurately interpreting the laboratory findings is key to understanding the pathophysiology, diagnosing, management planning, and monitoring patients with acid-base disorders.
Discussion
Identify each of the abnormal laboratory findings in the above results. Specify how they differ from a normal range and identify what condition each abnormality indicates.
All the laboratory findings for this patient are abnormal and point towards an underlying respiratory acidosis while the patient’s body attempts to equalize and compensate itself. The patient’s sodium levels are Na: 147 (normal range 135-145) indicating hypernatremia. The chloride levels are Cl: 110 (normal range 97-107 mEq/L) indicating hyperchloremia. Her carbon dioxide partial pressure (PCO2) is 48mmHg (normal range 35-45mmHg) indicating acidosis. Her urine specific gravity is 1.040 (normal range 1.002-1.030) indicating mild dehydration. McCance & Huether (2019) define respiratory acidosis as an acid-base disorder that occurs when the arterial partial pressure of carbon dioxide increase with a ventilation failure. Although the level of potassium is normal, the levels of chloride and sodium are elevated while that of HCO3 is on the higher side of the normal.
What specific electrolyte disturbance does the patient have?
The patient is gradually becoming dehydrated as evidenced by elevated levels of sodium and chloride which relates to an underlying respiratory acidosis. The patient presents with a lower pH due to a decreased ratio between arterial PCO2 and arterial bicarbonate. This occurs due to inadequate ventilation causing an elevation of pCO2 and a subsequent acid-base problem (Hamilton et al., 2017). Respiratory acidosis can also cause elevated calcium levels in the blood and a shift in potassium levels although the patient’s potassium levels are still within the normal range.
What clinical manifestations would the nurse expect to see with this electrolyte abnormality presented above?
Although the clinical manifestations to expect with this electrolyte abnormality are highly dependent on the primary duration and reason that caused the respiratory acidosis, the most likely clinical manifestations include; dyspnea, shortness of breath, wheezing, sleep disturbance, and in worst cases, cyanosis caused by hypoxemia. In cases where the electrolyte abnormality is severe, patients may also exhibit myoclonus, an altered mental state, and seizures.
If the patient had an increase in her potassium level, what clinical manifestations would the nurse monitor for?
If the patient had hyperkalemia, there would be cardiac arrhythmias and gradual renal compensation with increased resorption of ion of HCO3− and increased excretion of hydrogen ions (Hopkins & Sharma, 2019). Therefore, the most likely manifestations would include tachycardia, chest pain, fatigue, and frank muscle paralysis.
What blood gas abnormality is seen in this patient? Discuss the rationale for your answer.
A blood pH of 7.33 signifies acute uncompensated primary respiratory acidosis which usually occurs when the lungs are unable to remove CO2. Progressive accumulation decreases the pH of blood making it to be more acidic.
What are the three major mechanisms of pH regulation?
The three major mechanisms for regulating the pH of body fluids include the respiratory, buffers, and renal system (Hamilton et al., 2017). The buffer system involves proteins that can either donate or receive hydrogen ions for the pH to balance. The respiratory system involves the lungs releasing high amounts of carbon dioxide during exhalation when there is a low pH. In the renal regulation mechanism, the body attempts to correct the blood pH levels by excreting CO2 in the urine.
References
Hamilton, P. K., Morgan, N. A., Connolly, G. M., & Maxwell, A. P. (2017). Understanding Acid-Base Disorders. The Ulster medical journal, 86(3), 161–166.
Hopkins, E., & Sharma, S. (2019). Physiology, acid-base balance. In Stat Pearls [Internet]. Stat Pearls Publishing.
McCance, K. L., & Huether, S. L. (2019). Pathophysiology the biological basis for disease in adults and children. St. Louis, MO: Elsevier. Acid Base Blood Gas Case Study Essay Example