Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction Essay

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction Essay

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

Gambling and alcohol abuse disorders are mental health problems with adverse effects on the patients’ mental health status and quality of life. This paper examines Maria Perez’s case, a 53-year-old Puerto Rican female that has come to the office today for assistance with an embarrassing problem. Perez reports that she had had alcohol problems since her father’s death. She has been unsuccessfully involved in Alcohol Anonymous for the last 25 years. She also reports having a gambling problem since the Rising Sun casino was opened near her home. She notes that she gets high when gambling and enjoys drinking alcohol to help calm her during high-stakes games. In such situations, she gives way to more drinking and reckless gambling. She also reports increased cigarette smoking over the last two years, which has been her concern.

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Perez has unsuccessfully tried to abstain from drinking and gambling. She is also concerned about her current weight, as she weighs 122 lbs, 7 lb weight from her usual 115 lb weight. Recently, Perez borrowed $50000 from her retirement account to pay off her gambling debts. The mental assessment was within the normal range with impaired impulse control. As a result, she had been diagnosed with gambling disorder, alcohol use disorder. Consequently, the patient factors that will influence the treatment decisions include her age, alcohol consumption habits, weight gain, and gambling behaviors.

Decision 1

Selected Decision

Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

Reason for Selection

I selected the administration of naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every four weeks as the patient’s first line of treatment. Evidence supports naltrexone use in the treatment of substance abuse disorders. It reduces alcohol use and cravings through its opioid receptor antagonist actions. Naltrexone also reduces heavy alcohol use days; the number of alcoholic drinks and extends the rates of alcohol abstinence(Estes, 2019). The priority client’s problem in the case study is alcohol abuse and smoking. Therefore, targeted treatment to address alcohol abuse is important to facilitate Perez’s minimal engagement in gambling behaviors, hence, the selected decision.

Why the Other Two Were Not Selected

I did not select the decision to begin the client with Antabuse (Disulfiram) 250 mg orally daily because it is the recommended drug of use in patients that have stopped alcohol intake or abuse. It is not the first-line drug for initiating treatment for alcohol use disorder. Its use in current alcohol abusers may increase the client’s risk of developing tachycardia, thereby lowering treatment outcomes and adherence(Meier et al., 2021). I did not select the decision to initiate the client on Campral (Acamprosate) 666 mg orally three times a day, as its efficacy in heavy drinking days is lower compared to naltrexone. Its efficacy does not improve despite combining it with other medications such as naltrexone or psychosocial treatments(Avanceña et al., 2021).

What I Was Hoping To Achieve

Naltrexone reduces alcohol cravings, the number of drinks per day, and heavy alcohol intake. Therefore, I was hoping to achieve a reduction in the client’s binge alcohol consumption. I was also hoping to see a reduction in the client’s gambling behaviors, as they directly correlate with alcohol abuse (Farhadian et al., 2020).

Ethical Considerations

Psychiatric mental health nurses aim at optimizing treatment outcomes in their practice. The adopted treatments should minimize the risk of patient harm. Initiating the patient on naltrexone was an appropriate decision due to its optimum benefits and minimizing harm. Vivitrol is likely to predispose the client to adverse outcomes while Campral may not produce any improvement in symptoms (Estes, 2019). Consequently, weighing the benefits and risks of treatment is important for safety and quality outcomes.

Decision 2

Selected Decision

Refer the client to a counselor to address gambling issues

Reason for Selection

The administration of naltrexone led to a significant reduction in alcohol intake for the past four weeks. However, she raises concerns related to her gambling behaviors. As a result, the best decision at the moment is to refer her to a counselor to be assisted with her gambling problem. Gambling disorders do not have recommended pharmacological treatments. Instead, non-pharmacological treatments such as psychotherapy and counseling are recommended, as they help clients to develop effective skills for coping with gambling impulses (Ede et al., 2020).

Why the Other Two Were Not Selected

I did not select the decision to add valium (diazepam) 5 mg orally TID/PRN/anxiety because of safety concerns and its lack of indication to the current problems. Valium increases the risk of sedation and drowsiness, which may affect the client’s productivity. Valium is also not indicated for use in gambling disorders. Chantix (varenicline) 1 mg orally BID was also not chosen because naltrexone led to significant symptom improvement (Farhadian et al., 2020). As a result, there are no indications for augmenting the treatment.

What I Was Hoping To Achieve

Psychosocial interventions such as counseling increase the client’s awareness about triggers of alcohol abuse and interventions to manage them. Therefore, I was hoping that referring the client to a counselor would help her identify and manage triggers of gambling behaviors (Ginley et al., 2019). Consequently, her gambling behaviors would significantly reduce.

Ethical Considerations

Patient empowerment to self-manage conditions is important in psychiatric practice. By referring the patient to a counselor, the patient will be empowered to develop effective coping skills against gambling impulses. Counseling will also help the client make informed decisions about her behaviors, hence, the promotion of her autonomous role in the self-management process (Ginley et al., 2019).

Decision 3

Selected Decision

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

Reason for Selection

Referring the client to a counselor led to a significant improvement in her anxiety and gambling problems. She also reports that she began attending Gambling Anonymous group where she feels supported. Therefore, a focus should be on ensuring that she continues with the Gamblers Anonymous group to help her develop effective skills for managing her gambling impulses. A positive patient-counselor relationship is important for the realization of optimum treatment outcomes(Ede et al., 2020). As a result, finding out the issues that Perez has with her counselor is important, as it will contribute to the development of effective interventions to address the identified problems.

Why the Other Two Were Not Selected

I did not select the decision to encourage seeing her current counselor and continue with the Gamblers Anonymous group because it may affect the treatment outcomes. A negative patient-provider relationship affects treatment outcomes, including patients’ engagement in the treatment process and their empowerment to own the treatment interventions. I did not select the decision to discontinue Vivitrol, encourage Mrs. Perez to continue seeing her counselor, and continue participating in the Gamblers Anonymous group because she of safety issues (Estes, 2019). Discontinuing Vivitrol may lead to symptom relapse, hence, treatment ineffectiveness.

What I Was Hoping To Achieve

I was hoping to identify issues between the patient and counselor and interventions to address them for optimum treatment outcomes. I was also hoping that the client’s continued participation in the Gamblers Anonymous group would help him develop effective coping strategies and successfully cease gambling (Ginley et al., 2019).

Ethical Considerations

The client’s right to autonomy and informed decision-making should be considered in psychiatric practice. The psychiatric mental health nurse practitioner will have to respect the client’s right to have her counselor changed should it happen after investigating the issues contributing to their negative relationships(Ginley et al., 2019). Through it, Perez’s autonomy will be protected.

Conclusion

The adopted treatment interventions in this case study were evidence-based and effective. In the first decision, Naltrexone was adopted to treat alcohol use disorder. Evidence-based data recommend its use as the first-line treatment in alcohol use disorder. It helps reduce alcohol cravings, use, and prolongs the period of alcohol intake cessation. The other options were not considered since they are used in patients who have ceased alcohol use (Estes, 2019). The decision aimed to help the patient overcome alcohol addiction problems.

The second decision focused on helping the client overcome the gambling problem. Pharmacological interventions are not recommended for use in gambling disorders. Instead, psychosocial interventions such as cognitive-behavioral therapy and counseling are effective. They help clients develop effective strategies for managing impulsive behaviors that contribute to gambling(Ede et al., 2020). This step aimed to help Perez to overcome her gambling problems.

The third step focused on stabilizing the adopted treatments and strengthening a patient-counselor relationship. As a result, it was important for the psychiatric mental health nurse practitioner to determine the issues between the patient and counselor and encourage her participation in the Gamblers Anonymous group(Ginley et al., 2019). The decision to stop the treatments was not considered since it could increase the risk of symptom relapse.

Ethics informed the decisions made in treating Perez. The PMHNP weighed the benefits and risks of the given treatments in the first decision. The focus was on adopting a treatment with optimum benefits and minimal harm, hence, the selection of naltrexone. The second step entailed empowering the patient to adopt effective skills for managing gambling disorder, hence, her autonomy in the treatment process. The last step ensured a positive patient-provider relationship for care outcomes that include safety, quality, and efficiency(Ginley et al., 2019).

References

Avanceña, A. L. V., Miller, N., Uttal, S. E., Hutton, D. W., &Mellinger, J. L. (2021). Cost-effectiveness of alcohol use treatments in patients with alcohol-related cirrhosis. Journal of Hepatology, 74(6), 1286–1294. https://doi.org/10.1016/j.jhep.2020.12.004

Ede, M. O., Omeje, J. C., Ncheke, D. C., Agah, J. J., Chinweuba, N. H., &Amoke, C. V. (2020). Assessment of the Effectiveness of Group Cognitive Behavioural Therapy in Reducing Pathological Gambling.Journal of Gambling Studies, 36(4), 1325–1339. https://doi.org/10.1007/s10899-020-09981-y

Estes, A. (2019). Recovery Success Through Combined Use of Vivitrol and Counseling versus Pharmacological Treatment Alone in Opiate-Addicted Patients. Doctoral Projects. https://digitalcommons.lmunet.edu/dnpprojects/1

Farhadian, N., Moradi, S., Zamanian, M. H., Farnia, V., Rezaeian, S., Farhadian, M., & Shahlaei, M. (2020). Effectiveness of naltrexone treatment for alcohol use disorders in HIV: A systematic review.Substance Abuse Treatment, Prevention, and Policy, 15(1), 24. https://doi.org/10.1186/s13011-020-00266-6

Ginley, M. K., Rash, C. J., &Petry, N. M. (2019).Psychological Interventions in Gambling Disorder. In A. Heinz, N. Romanczuk-Seiferth, & M. N. Potenza (Eds.), Gambling Disorder (pp. 181–194). Springer International Publishing. https://doi.org/10.1007/978-3-030-03060-5_9

Meier, S., Cantilena, S., NiklisonChirou, M. V., Anderson, J., Hargrave, D., Salomoni, P., de Boer, J., &Michod, D. (2021). Alcohol-abuse drug disulfiram targets pediatric glioma via MLL degradation. Cell Death & Disease, 12(8), 1–12. https://doi.org/10.1038/s41419-021-04078-9

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The Assignment: 5 pages
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, 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.
The paper for your decision tree assignment will be written on the interactive case study entitled, A Puerto Rican Woman with Comorbid Addiction. . If your first draft is more than five pages, you should consolidate your writing. In my experience, papers greater than five pages in length are repetitive and/or contain extraneous information that is not part of the required content. Part of this exercise is to learn how to sift through the literature and extract the pertinent information. Failure to do so may result in point deductions for issues with clarity. The final draft that you submit must follow the format endorsed by the nursing program, and this paper must address the required content outlined in the grading rubric and instructions. The required format is illustrated in the writing template. The formal instructions and my notes on grading are shown below:
Formal Decision Tree Instructions
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.
Be aware that the writing template and grading rubric require your introduction to end with one sentence that is your thesis statement. See the writing template for format and the grading rubric for details on how you are graded on this statement.
Body of your document
The body of your document should contain three sections that are labeled as follows: decision #1, decision #2, and decision #3. Each section should address the topics below. In your writing, you should be concise, clear, and thorough. Pharmacokinetics, pharmacodynamics, and specific patient factors must be considered in your writing in order to get full credit.
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-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. *Ethical considerations must be clearly identified/labeled. You can identify them within the decision section (“My ethical considerations are…”), or you can identify them separately in a section labeled “Ethical Considerations.” Either option is acceptable.
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.
CASE STUDY
Comorbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female
BACKGROUND
Mrs. Maria Perez is a 53 year old Puerto Rican female who presents 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 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 EXAM
The 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 disorder
Decision Point One(1a
Select what you should do:
Vivitrol (naltrexone) 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 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
Decision Point One (1b)
Antabuse (disulfiram) 250 mg orally every morning
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Mrs. 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 increasing
Decision Point One (1c
Campral (acamprosate) 666 mg orally TID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Upon return Mrs. Perez states that she has noticed that she has been having suicidal ideation over the past week, and it seems to be getting worse
She is also reporting that she is having “out of control” anxiety
Decision Point Two (2a
Educate Mrs. Perez on the side effects of Campral and add Valium (diazepam) 5 mg orally TID to address anxiety symptoms
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states, “I was like a new person. This is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her Valium early. She is asking today for an increase in the Valium dose or frequency
Although she reports that her anxiety is gone. She still reports suicidal ideation, but she states, “With that Valium stuff, who cares?”
Decision Point Two (2b
Discontinue Campral and begin Antabuse (disulfiram) 250 mg orally daily
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Mrs. Perez states that the suicidal thoughts have abated but reports that she has been feeling tired for several hours after taking the drug
She reports that she has not been going to the casino because she is afraid that she may be tempted to drink, and she noticed that the last time she drank, she felt nauseous and began to vomit. She also reported that it felt like her heart would “pound right out” of her chest.” She does report that she is smoking more, however
Decision Point Two (2c
Decrease Campral to 666 mg orally BID
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Mrs. Perez reports that the suicidal ideation is “still there” but not as bad. She reports that she is still afraid to go to the casino for fear that she may drink, which may cause those “horrible” side effects to come back
Her anxiety has also decreased quite a bit since decreasing the dose to twice a day. She reports that she is still smoking cigarettes
Decision Point Three (3a
Discontinue Campral and begin Antabuse 250 mg orally daily
Guidance to Student
Given her weight (less than 60 kg), Campral should have been started at 666 mg orally BID. It is possible that the higher dose may be responsible for the severity of the symptoms that Mrs. Perez is experiencing.
Technically, the drug should have been stopped (not simply decreased) once Mrs. Perez reported suicidal ideation. Even with the decrease in dose, she is still having suicidal ideation, which indicates the need to discontinue the drug. Although controversy exists regarding how long to use pharmacologic approaches to treatment of alcohol dependence, 8 weeks is probably insufficient, therefore, the drug should not simply be discontinued without using a different agent in its place.
Mrs. Perez should be started on Antabuse at 250 mg orally daily and referred to psychotherapy to address her gambling issue.
In all cases, you need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions and to enhance her overall health. The decision to begin Wellbutrin XL 150 mg orally daily may help achieve this goal, but this choice does not address her abstinence from alcohol.
Additionally, it should be noted that although Mrs. Perez reports that she has been avoiding the casino secondary to her fear that she will drink, this “fear” has not actually treated her gambling addiction. This particular addiction has resulted in considerable personal financial cost to Ms. Perez. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and she should also be encouraged to establish herself with a local chapter of Gamblers Anonymous.
Decision Point Three (3b
Discontinue Campral and recommend psychotherapy for her gambling issue
Guidance to Student
Given her weight (less than 60 kg), Campral should have been started at 666 mg orally BID. It is possible that the higher dose may be responsible for the severity of the symptoms that Mrs. Perez is experiencing.
Technically, the drug should have been stopped (not simply decreased) once Mrs. Perez reported suicidal ideation. Even with the decrease in dose, she is still having suicidal ideation, which indicates the need to discontinue the drug. Although controversy exists regarding how long to use pharmacologic approaches to treatment of alcohol dependence, 8 weeks is probably insufficient, therefore, the drug should not simply be discontinued without using a different agent in its place.
Mrs. Perez should be started on Antabuse at 250 mg orally daily and referred to psychotherapy to address her gambling issue.
In all cases, you need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions and to enhance her overall health. The decision to begin Wellbutrin XL 150 mg orally daily may help achieve this goal, but this choice does not address her abstinence from alcohol.
Additionally, it should be noted that although Mrs. Perez reports that she has been avoiding the casino secondary to her fear that she will drink, this “fear” has not actually treated her gambling addiction. This particular addiction has resulted in considerable personal financial cost to Ms. Perez. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and she should also be encouraged to establish herself with a local chapter of Gamblers Anonymous.
Decision Point Three (3c
Add on Wellbutrin (bupropion) XL 150 mg orally daily
Guidance to Student
Given her weight (less than 60 kg), Campral should have been started at 666 mg orally BID. It is possible that the higher dose may be responsible for the severity of the symptoms that Mrs. Perez is experiencing.
Technically, the drug should have been stopped (not simply decreased) once Mrs. Perez reported suicidal ideation. Even with the decrease in dose, she is still having suicidal ideation, which indicates the need to discontinue the drug. Although controversy exists regarding how long to use pharmacologic approaches to treatment of alcohol dependence, 8 weeks is probably insufficient, therefore, the drug should not simply be discontinued without using a different agent in its place.
Mrs. Perez should be started on Antabuse at 250 mg orally daily and referred to psychotherapy to address her gambling issue.
In all cases, you need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions and to enhance her overall health. The decision to begin Wellbutrin XL 150 mg orally daily may help achieve this goal, but this choice does not address her abstinence from alcohol.
Additionally, it should be noted that although Mrs. Perez reports that she has been avoiding the casino secondary to her fear that she will drink, this “fear” has not actually treated her gambling addiction. This particular addiction has resulted in considerable personal financial cost to Ms. Perez. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and she should also be encouraged to establish herself with a local chapter of Gamblers Anonymous.

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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.
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.
The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.
Decision #1 (1–2 pages)
• 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Decision #2 (1–2 pages)
• 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
Examples provided fully support the decisions and responses provided
Decision #3 (1–2 pages)
• 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
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.
14 (14%) – 15 (15%). The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.
The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.
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.
5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%). Uses correct grammar, spelling, and punctuation with no errors.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%). Uses correct APA format with no errors.