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For this assignment, put yourself in the role of a Nurse Case Manager (NCM. Generate a case report on a patient encountered at your current job or during your clinicals in nursing school, who experienced an acute exacerbation of an underling chronic physical illness. Use the same patient throughout the entire Assignment 1. Select a patient you cared for who required or would have benefited from having a NCM at both the patient and the system levels. The report will be narrated (written in paragraphs, following APA [7th ed.] guidelines for writing papers), not outlined or bulleted.
See grading rubric below.
• Patient profile: gender, age, ethnicity, socioeconomic status-including work status, financial sources, insurance coverage, living arrangements (needed for proper discharge planning), e.g., type of housing- one, two or more levels, any stairs etc.; marital status; social support.
• Acute and chronic illness description: medical diagnosis for the chronic illness, length of time with diagnoses, primary medical treatment (pharmacologic and non-pharmacologic);
NCM identified priority patient need/problem (at either the System or patient-level) affecting the pts health care; NCM identified priority intervention the NCM must implement to accomplish set goals, using NCM strategies (see below).
• Patient self-care and self-management capacity: summary of self-care capacity and specific self-management skills required for patient to adhere to recommended treatment and general statement about the patient’s functional status in terms of ADL and IADL, including patient’s ability to drive. If patient does not drive, who drives and are they willing to assist.
• Patient pattern of health care utilization: summary statement about the patient’s usual use of both primary and specialty care to manage chronic condition; include any acute care (urgentPage
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general statement about the patient's functional status in terms of ADL and lADL, including patient's ability to drive. If patient does not drive, who drives and are they willing to assist.
• Patient pattern of health care utilization: summary statement about the patient's usual use of both primary and specialty care to manage chronic condition; include any acute care (urgent care, ED, and hospital) accessed by the patient as well, and any supportive care (e.g., home health or any other system of care in the community).
When writing your case report paper, select from the following NCM strategies that would lead you to accomplish the goals/intervention set forth in the NCM plan to address the identified priority patient problem/need. You can use one or more NCM strategies if necessary. The system and patient level NCM strategies must be relevant for your patient. Provide justification for the selection of the NCM strategies (e.g. if you say you will use teaching disease and treatment strategy to educate your patient, then the justification would be that the patient lacks self-management skills or lacks an understanding of the disease or treatment).
Partnership:
Clinical:
* Empowering patients; Supporting transitions
Assessing health; Monitoring physiologic stability; Planning health care at patient level; Using specific nursing interventions
Education:
* Teaching disease and treatment, Coaching symptom self-management*, Coaching caregiving for family
Communication:
Managed Care:
Advocacy; Team communication, Therapeutic communication Risk Management (* risk stratification), Utilization Management.
Planning and coordinating, Resource Management, Cost management
*Key NCM Strategies

Technology and innovation can transform complex, ever-evolving healthcare environments and it is students who are often on the forefront with creative thoughts and ideas.The University of Cincinnati, College of Nursing is guided by the vision to lead and impact healthcare through the leveraging of technology and innovation.For this assignment, students will reflect on their clinical experiences in the outpatient environment and consider innovative thoughts and ideas which could positively impact the patient or provider.Thoughts and ideas are endless and can apply to the nurse practitioner role or the patient perspective.The students should consider what they have seen in the clinical setting that needs improved or revised?Is there an app that could help the patient or the provider?Perhaps, the student has an idea to redesign a piece of equipment or invent a tool for use in the clinical setting. This assignment encourages students to identify problems in the clinical setting and think of innovative solutions to solve the problem.The student should introduce their innovative thoughts and ideas through a Flipgrid video discussion and share with other students and indicate the following:
Why is this innovative idea needed and how will it benefit the healthcare industry as a whole?
How will this innovation impact the provider?
How will it impact the patient?
Consider the advantages and disadvantages to the student’s idea (i.e. consider cost, implementation, etc.)

he purpose of assignment is to provide experience and feedback with the development of a clinical question of interest to you using the PICO format along with designing and documenting the results of a search for scientific literature related to the clinical question. This assignment is intended to allow you to show evidence of achievement of:
CLO2: Develop evidenced-based practice questions using PICO format.
Requirements
This scholarly paper is due on day 7 of week 5. An APA template is provided which describes the expectations for each section of this scholarly paper. Graduate level writing is expected. The following rubric will be used to score this assignment.
Please use the attached APA Template as a guide for this assignment:

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.
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-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.
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
Chapter 13, “Impulsivity, Compulsivity, and Addiction” (pp. 538-578)
Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders: Treatment improvement protocol seriesLinks to an external site., no. 32. http://www.ncbi.nlm.nih.gov/books/NBK64350/
Chapter 1, “Substance Use Among Adolescents”
Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”
Chapter 7, “Youths with Distinctive Treatment Needs”
University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control. Journal of Psychosocial Nursing & Mental Health ServicesLinks to an external site., 54(4), 15.
Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical PharmacologyLinks to an external site., 77(2), 375–381. https://doi.org/10.1111/j.1365-2125.2012.04457.x
Hulvershorn, L. A., Schroeder, K. M., Wink, L. K., Erickson, C. A., & McDougle, C. J. (2015). Psychopharmacologic treatment of children prenatally exposed to drugs of abuse. Human PsychopharmacologyLinks to an external site., 30(3), 164–172. https://doi.org/10.1002/hup.2467
Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological NursingLinks to an external site., 42(4), 10–15. https://doi.org/10.3928/00989134-20160314-04
Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual DiagnosisLinks to an external site., 8(1), 74–84. https://doi.org/10.1080/15504263.2012.648439
Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., Olvera, R., Swann, A. C., & Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive PsychiatryLinks to an external site., 55(6), 1337–1341. https://doi.org/10.1016/j.comppsych.2014.04.018
naltrexone (revia/vivitrol)
naloxone
acamprosate
DisulfiramLupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., Cinose, E., Di Iorio, G., Di Nicola, M., & Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014Links to an external site.. https://doi.org/10.1155/2014/537306
Case Study: A Puerto Rican Woman with Comorbid AddictionLinks to an external site. Note: This case study will serve as the foundation for this week’s Assignment.
Decision Point One
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 Two
Continue current dose of Antabuse and begin Wellbutrin (bupropion) XL 150 mg orally daily RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Mrs. Perez reports that the side effects of the Antabuse are “gone” and that she is feeling much better
She reports that she is still smoking but that “it has dropped to only a couple of cigarettes a day.” She still reports that she is visiting the casino but is not spending “as much money” as she had been in the past
Decision Point Three
Maintain current doses of each medication and refer to counseling for her gambling Guidance to Student
Sedation/fatigue is a common complaint of people who take Antabuse, the best approach would be to change the administration time to the evening. The “metallic” taste in Mrs. Perez’s mouth is also another side effect that lessens and may fully go away with the passage of time. When a person taking disulfiram ingests alcohol, they will probably experience “flushing,” tachycardia, nausea, and vomiting.
At this point, you should maintain the current dose of each medication and refer the client to a counselor. Recall that there are no FDA-approved medications for the treatment of gambling addiction, and counseling is the mainstay of treatment for this particular disorder. Nothing indicates an increase the Wellbutrin. Recall that it could take as long as 12 weeks for this medication to exert its full therapeutic effect. Cognitive behavioral principles can also be employed to help Mrs. Perez stop smoking, in addition to the Wellbutrin.
Although controversy exists in the literature regarding how long to maintain a client on Antabuse, 8 weeks is probably too soon to consider discontinuation. Needs to include 5 APA references. Thank you!