What is the difference between service-based and population-based applications for information systems in public health organizations? Present an example of each application and justify your rationale. .

ACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office 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 two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their 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 two 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 that 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 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 has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.

 

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert, 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. As 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 & self-reported mood. She visual or auditory hallucinations, 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

 Antabuse (Disulfiram) 250 mg orally every morning ON

 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

 E

·  Client returns to clinic in four weeks

·  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

·  Clientis She is also reporting that she is having “out of control” anxiety.. 

Decision Point Two

 

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 Decision Point Two

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

• 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 you to increase      the valium dose or frequency
• Although she reports that      her anxiety is gone, she still reports suicidal ideation, but states “with      that valium stuff, who cares?”;;;;;;;;
• Decision Point Three
• 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, the PMHNP needs      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.
• 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 stop to      complete the following:
• Decision #1
• Which decision did you select?
• Why did you select this      decision? Support your response with evidence and references to the      Learning Resources.
• What were you hoping to achieve      by making this decision? Support your response with evidence and      references to the Learning Resources.
• Explain any difference between      what you expected to achieve with Decision #1 and the results of the      decision. Why were they different?
• Decision #2
• Why did you select this      decision? Support your response with evidence and references to the      Learning Resources.
• What were you hoping to achieve      by making this decision? Support your response with evidence and      references to the Learning Resources.
• Explain any difference between      what you expected to achieve with Decision #2 and the results of the      decision. Why were they different?
• Decision #3
• Why did you select this      decision? Support your response with evidence and references to the      Learning Resources.
• What were you hoping to achieve      by making this decision? Support your response with evidence and      references to the Learning Resources.
• Explain any difference between      what you expected to achieve with Decision #3 and the results of the      decision. Why were they different?

 

edit this or redo other assignment.

 

Assessing and Treating Clients with Impulsivity, Compulsivity and Addiction 

Pharmacotherapy practice to treating substance use disorders is often referred to as medication assisted treatment (MAT) (Sharp et al., 2018). In this practice, specific medications approved by Federal Drug Administration (FDA) are used in combination with counseling and behavioral therapies in treatment of a substance use disorder (Sharp et al, 2018) Medications can reduce the cravings and other symptoms associated with withdrawal from a substance by occupying receptors in the brain associated with using that drug (agonists or partial agonists), block the rewarding sensation that comes with using a substance (antagonists), or induce negative feelings when a substance is taken ( SAMHSA, 2016). MAT has been primarily used for the treatment of opioid use disorder but is also used for alcohol use disorder and the treatment of some other substance use disorders. This paper focuses on pharmacotherapy approaches to treatment of alcohol use disorder, gambling disorder and smoking addiction in a 53 year- old female of Puerto origin.

Case Scenario

Decision Number One

Naltraxone (Vivitrol) injection, 380 mg intramuscularly in gluteal region every four weeks.

Rationale: Pharmacotherapy should be used in patients with alcohol use disorder who have current, heavy use and ongoing risk for consequences from use, motivated to reduce alcohol intake and do not have medical contraindications to the individual drug choice (SAMHSA, 2016). As the 53 year-old female has acknowledged that she has a drinking problem and has tried psychosocial approach with alcoholic anonymous(AA) without success, adding medication such as naltrexone would be warranted as next step. In random clinical trials (RCTs) naltrexone medication has been shown to reduce heavy drinking and enhance the likelihood of abstinence ( Garbutt et al.,  2014)

Naltraxone is mu opioid receptor antagonist, can be in form of oral ( Revia) and injection( Vivitrol) ( Stahl, 2017). Naltraxone is FDA approved to treat alcohol dependence, blockade of effects of exogenously administered opioids (oral) and prevention of relapse to opioid dependence (Stahl, 2017).  Naltrexone reduces alcohol consumption through modulation of opioid systems, thereby reducing the reinforcing effects of alcohol and opioids (cravings, rewarding effects). Moreover, naltrexone also modifies the hypothalamic-pituitary-adrenal axis to suppress ethanol consumption.

The recommended naltrexone injectable (vivitrol) suspension is 380mg and should be administered via intramuscular (IM)injection to the gluteal area using the provided 1.5 inch 20-gauge needle(Drugs.com, 2017).  Vivitrol is extensively metabolized in humans, and elimination half-life of naltrexone via injection is 5–10 days (Drugs. com, 2017) Common side effects of naltrexone are nausea, headache, and dizziness, joint or muscle pain which subside with continued use. Special considerations include that vivitrol should not be given to patients taking opioids, and if opioids are required to treat pain, naltrexone should be discontinued. Naltrexone is contraindicated in acute hepatitis or liver failure.

The advantage usage is that naltrexone can be initiated while the individual is still drinking (Canidate et al., 2017) This allows treatment for alcohol use disorder to be provided in community-based practice at the point of maximum crisis without the need for enforced abstinence or detoxification, thus beneficial for the client. Additionally, depot preparations of naltrexone may improve adherence by reducing the frequency of medication administration from daily to monthly and by achieving a steady therapeutic level of medication, thus avoiding peak effects that can exacerbate adverse events.

The reason I did not select disulfiram (Antabuse) which by intent leads to adverse effects ( nausea, vomiting, metallic taste, tachycardia) when combined with alcohol intake, was that it  should only be used by abstinent patients in the context of treatment intended to maintain abstinence. In regards of Acamprosate, I did not select the medication because research indicates that Acamprosate should be used once abstinence is achieved (Yahn, Witterson, & Olive, 2013).

The main goal of prescribing medication for treatment for alcohol use disorder is abstinence, which remains a primary treatment focus. However, decrease of heavy drinking can be accepted as an alternative treatment goal, especially if unwanted risks (health, social and financial) are reduced.

The client returns four weeks after the injections, she has been sober since receiving injection, she denies any side effects from medications. The main chief complaint is gambling, but client is also concerned about her smoking and anxiety.

Decision Two

Refer to a Counselor for Gambling Issues 

Rationale:  Several different types of therapy are used to treat gambling disorder, including cognitive behavior therapy, psychodynamic therapy, group therapy and family therapy (American Psychiatric Association, 2016) As recent, there is no FDA approved pharmacotherapy for gambling disorder. But, pharmacotherapy approaches for problem gambling can be effective when directed toward the patient’s comorbid psychiatric condition such as bipolar disorder, obsessive compulsive disorder(OCD), and substance abuse.

The client was concerned about her smoking and appeared to be motivated to stop smoking, hence adding medication to assist her to quit would have been a reasonable approach to avoid health complications (e.g cardiovascular, pulmonary) associated with smoking. However, I did not select the answer as the starting dosage (Varenicline 1mg PO BID) was slightly higher than recommended starting dose. Initial 0.5 mg/day; after 3 days increase to 1 mg/day in two divided doses; after 4 days can increase to 2 mg/day in two divided dose(Stahl, 2017) . Starting at a higher would have increased the possibilities of adverse effects such nausea, vomiting and even agitation.

Adding Diazepam (Valium) would not be a good option, as Valium is an addictive benzodiazepine with longer-lasting effects than other drugs in its class. In the light of the client’s history substance use disorder and addiction, adding another addictive substance such as valium would cause more harm.

The client returns in four weeks, reports that anxiety has gone. Client reports not liking the therapist, but she has joined gambling anonymous group.

Decision Number Three

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

Rationale: Despite that Mrs. Lopez did not have a good relationship with the counselor, but she remained committed to fighting her addiction by joining Gamblers Anonymous group. Still, counseling remains the main approach in gambling addiction treatment, hence exploring the issues that Mrs. Lopez had with counselor would help to guide the next step in treatment. Also, smoking cessation needs to be explored at this time. Assessing the client’s willingness to quit is the first step as smokers differ in their readiness to change their tobacco use (Niaura, 2017). Understanding the smokers’ perspectives is essential to providing useful assistance.

MENTAL STATUS EXAMEthical and Legal Implications in Prescribing Medications to Treat Substance Use Disorders.

In order to optimize care of clients with substance use disorder, health professionals are encouraged to learn  and appropriately use routine screening techniques, clinical laboratory tests, brief interventions, and treatment referrals ( Garbutt, 2014). Using screening tools such as CAGE Questionnaire for alcohol use dependence, would be ideal in guiding treatment approach. Additionally, client’s autonomy and confidentiality must be maintained before prescribing medications to treat an addiction. When a legal or medical obligation exists for  a health professional to test clients for substance use disorder, there is an ethical responsibility to notify clients of this testing and make a reasonable effort to obtain informed consent ( Garbutt, 2014)

References

American Psychiatric Association. (2016). What Is Gambling Disorder? Retrieved from https://www.psychiatry.org/patients-families/gambling-disorder/what-is-gambling-disorder

Canidate, S. S., Carnaby, G. D., Cook, C. L., & Cook, R. L. (2017). A Systematic Review of Naltrexone for Attenuating Alcohol Consumption in Women with Alcohol Use Disorders. Alcoholism: Clinical and Experimental Research, 41(3), 466-472. Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=14&sid=183cffb8-9da8-48b2-a1b7-66c14f735856%40sessionmgr101

Drugs.com. (2017). Vivitrol Dosage Guide – Drugs.com. Retrieved from https://www.drugs.com/dosage/vivitrol.html

Garbutt, J. C., Greenblatt, A. M., West, S. L., Morgan, L. C., Kampov-Polevoy, A., Jordan, H. S., & Bobashev, G. V. (2014). Clinical and biological moderators of response to naltrexone in alcohol dependence: a systematic review of the evidence. Addiction, 109(8), 1274-1284. Retrieved from https://web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=8&sid=41ca863e-175d-45ae-ba36-43317c3c58e5%40sessionmgr4008

Niaura, R. (2017). Learning From Our Failures in Smoking Cessation Research | Nicotine & Tobacco Research | Oxford Academic. Retrieved from https://academic.oup.com/ntr/article/19/8/889/3888613

SAMHSA. (2016). Treatments for Substance Use Disorders | SAMHSA – Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/treatment/substance-use-disorders

Sharp, A., Jones, A., Sherwood, J., Kutsa, O., Honermann, B., & Millett, G. (2018). Impact of Medicaid Expansion on Access to Opioid Analgesic Medications and Medication-Assisted Treatment. American Journal of Public Health, 108(5), 642-648. Retrieved from https://web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=5&sid=21e9426c-0afa-475e-9a9a-e1872d98830d%40sess

Stahl, S. M. (2017). Essential psychopharmacology: The prescriber’s guide : antipsychotics and mood stabilizers. Cambridge: Cambridge University Press.

Yahn, S. L., Watterson, L. R., & Olive, M. F. (2013). Safety and Efficacy of Acamprosate for the Treatment of Alcohol Dependence. Substance Abuse: Research and Treatment, 7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3565569/

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QUESTION 1

When will you lose access to your completed courses (excluding this Student Readiness Orientation)?

a. Never

b. 30 days after the course end date

c. 60 days after the course end date

d. 120 days after the course end date

1 points Save Answer

QUESTION 2

When you submit an assignment, when should you have the assignment complete by on the day assigned?

a. 11:59 p.m. Mountain Time (MT)—which is 1:59 a.m. Eastern Time (ET) the next day; the time stamp in the classroom will reflect Eastern Time (ET), regardless of your time zone

b. 11:59 p.m. Central Time (CT)—which is 10:59 p.m. Mountain Time (MT); the time stamp in the classroom will reflect Mountain Time (MT), regardless of your time zone

c. 11:59 p.m. Eastern Time (ET)—which is 8:59 p.m. Pacific Time (PT); the time stamp in the classroom will reflect Pacific Time (PT), regardless of your time zone

d. 10:59 p.m. Mountain Time (MT)—which is 12:59 a.m. Eastern Time (ET) the next day; the time stamp in the classroom will reflect Eastern Time (ET), regardless of your time zone

1 points Save Answer

QUESTION 3

Where in your online course will you find the contact information for your Instructor?

a. Syllabus

b. Student Support

c. Contact the Instructor

1 points Save Answer

QUESTION 4

If you are having trouble accessing your online classroom, what should you do first?

a. Clean your browser’s cookies and cache

b. Check firewall settings

c. Deactivate pop-up blockers

1 points Save Answer

QUESTION 5

In an online course, students can participate in the online classroom and submit assignments whenever it is convenient for them to do so.

True

False

1 points Save Answer

QUESTION 6

In which area will you retrieve written assignments with comments from your instructor?

a. Discussion

b. My Grades area

c. Assignment Link

1 points Save Answer

QUESTION 7

If you have a question about which courses you should register for next term, who should you contact?

a. Student Support Team

b. One of your current instructors

c. Your Academic Advisor

1 points Save Answer

QUESTION 8

As long as you save your work to your home computer’s hard drive, you are safe.

True

False

1 points Save Answer

QUESTION 9

When sending and e-mail to your Instructor or any Walden staff, your e-mail should:

a. Include color stationary as a background

b. USE ALL CAPITAL LETTERS SO THEY KNOW YOUR EMAIL IS IMPORTANT

c. Include your full legal name, your program or course, and your Walden ID Number

1 points Save Answer

QUESTION 10

The online classroom area where you can post an assignment and have your classmates and instructor respond to your ideas is called:

a. My Grades area

b. Discussion

c. Assignment Link

1 points Save Answer

QUESTION 11

Students can always edit their posting in Discussion.

True

False

1 points Save Answer

QUESTION 12

Who should you contact with questions about online classroom technical concerns?

a. Your Instructor

b. Walden Academic Advisor

c. Student Support

d. Program Director

1 points Save Answer

QUESTION 13

Since your online classroom could unexpectedly time out on occasion, what should you do before submitting a long Discussion posting?

a. Type and save the assignment as a word-processed document first.

b. Tell your instructor you are going to submit an assignment.

c. Create a new topic.

d. Call the Student Support Team for help.

1 points

Save Answer

QUESTION 14

Students should avoid referencing Wikipedia as a scholarly resource in their assignments.

True

False

1 points Save Answer

QUESTION 15

Online students are expected to behave with academic integrity and honesty.

True

False

Comment 1

Diane Black is a register nurse who represents Tennessee in Congress. Mrs. Black was the first woman to chair the influential House Budget Committee. She serves on the House Ways and Means Committee and was quick to establish herself as a leader. She is focused on dismantling the president’s health care law and advancing true market-based, patient-centered reforms that will bring down the rising cost of care by increasing private sector competition and consumer choice.Her goal was to reform the U.S. tax code which has not been initiated in over twenty five years. She was selected to chair the Ways and Means Education and Family Benefits Tax Reform Working Group during the 113th Congress. During her career as a nurse, she saw a loophole in the Patient Protection and Affordable Act (PPACA)that allowed some higher paid middle class Americans to receive Medicaid benefits. She pointed out that the PPACA, unintentionally, would allow a couple who made close to $60,000 in income to qualify to receive Medicaid benefits. This loophole would allow for individuals whose incomes were up four hundred percent of the federal poverty level to also qualify to receive Medicaid benefits. The PPACA set a new income formula to calculate the income levels and make the determination for Medicaid eligibility. This formula did not include incomes received from all Social Security benefits including Supplemental Security Income, Supplemental Nutrition Assistance Program (food stamps), Temporary Assistance to Needy Families, and public housing. After her election to Tennessee representative, Mrs. Black started lobbying to change the bill H.R 2576. She made her claim that Medicaid should only be used for those who are in the most need and Medicaid needed to get back in line with all other public assistance. Mrs. Black made her claim to Congress that by passing her bill that America would save $13 billion dollars over ten years. She made it clear that they would be saving this money without taking away any benefits from anyone who currently has Medicaid. Mrs. Black’s bill was passed and signed into law. She was the first member of Congress to have legislation signed into law that repeals the health care provision in Obamacare.

Comment 2

Congresswoman Mrs. Deb Soholt is some of the current nurses who are currently serving in Congress. Mrs. Deb Soholt is an RN and also a senator in South Dakota (American Nurses Association, 2015). She is a Senate for South Dacota congressional District 14 before joining politics.
She had sponsored several bills that have influenced health care. For example, “the Senate Bill 61 is to update, revise, and repeal certain provisions relating to nurse practitioners and nurse midwives” (South Dakota Legislature, n.d.). The bill can help redefine the role and function of nurse practitioners and nurse midwives to change the health care delivery and resolve the health provider shortage. Health care can be more accessible and affordable.
The nurse role gives the legislators the ability to understand and recognize nursing and health care issues. Therefore, the legislators who are also nurses can use the political power to alter and guide the direction of health care delivery in an optimal way. Health policies at the state level impact the health and safety of the state’s residents, as well as lead the nursing and other health professions’ scope, practice, and performance through the state’s professional practice acts (Cherry & Jacob, 2016) “The federal government’s role in health care includes significant funding for health and disease prevention and research; supplemental funding for education for health professionals, including nurses and physicians; and paying for individual health care services “(Cherry & Jacob, 2016, pg. 400). Therefore, the legislators in the federal level will focus on these categories to shape health care delivery.
She firmly believes that there is a strong need for more healthcare professionals in Congress. After all, health care is at the forefront of many political debates. Since she was the nurse, she sees the importance of having lawmakers with the healthcare background, that way the issues could better be addressed. In 2011 she was the first to engage in the debate on the Affordable Care Act.

Comment 3

The legislator that I consider to answer the above question is Erin Murphy. Murphy has a long career advocating on legislation related to health care and childcare issues. As a nurse, Murphy serves as state representative in the Minnesota of Representatives. The new elected representative participated on the Health and Human Services Finance Committee.

In that capacity, she was instrumental and active to help craft reforms to “Minnesota’s health care system that aimed to expand access to affordable coverage and care” (Diane, S., 2017). The legislator has worked on various health care reforms such as women’s health, affordable childcare, and expanding access to health care for school employees.

One of the bills that Murphy sponsored and supported is the “Health Care Homes.” This specific bill is part of a “statewide health care reform initiative” (2017). The legislation embraces and endorses a health care strategy that focuses primarily on prevention, self-management, and community services. This health care model guarantees better outcomes and quality of life people with chronic and acute health conditions.