Assessing And Treating A Patient With Bipolar essay

Assessing And Treating A Patient With Bipolar essay

Case overview

The patient is 26 years old Korean woman on her first day of the appointment, after 21 days of hospitalization for acute onset of mania. The patient states that she is in a fantastic mood and hates sleep because it Is not fun. She likes to talk, dance, and sing. Her Genetic testing- GeneSight reveals that she is positive for the CYP2D6*10 allele. Her laboratory workups are normal. The patient was put on lithium but has not been taking it as prescribed.  On examination, she is overweight, quite busy playing with things on the desk, and shifting from the side of the chair. The patient is alert and oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, and tangential. The self-reported mood is euthymic. Affect broad. The patient denies visual or auditory hallucinations, and no overt delusional or paranoid thought processes are readily apparent. Judgment is grossly intact, but insight is impaired. She is currently denying suicidal or homicidal ideation. The Young Mania Rating Scale (YMRS) score is 22. Assessing And Treating A Patient With Bipolar essay

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Bipolar

Bipolar is a mood disorder characterized by episodes of mania and hypomania in alternate seasons. It is a psychiatric disorder common in patients with a genetic predisposition to bipolar and personality disorders. It has a manic episode which presents with grandiosity, loss of need for sleep, pressured speech, flight of ideas, racing thoughts, increased level of goal-focused activity, excessive pleasurable activities, and excessive talking (Carvalho, et al, 2020). This episode lasts for about one week and it is followed by a hypomanic episode. The clinical signs and symptoms of the manic episode are depressed mod, loss of interest and pleasure, hypersomnia, psychomotor agitation, worthlessness, fatigue, decreased concentration, and suicidal ideation. Bipolar is prevalent in 5% of the total population in the united states of America. The age of onset is from 15 years and over 50 years old, especially in females. Risk factors for bipolar are biochemical, neurophysiologic, psychodynamic, environmental, and pharmacological factors.

The biochemical factors are the use of drugs such as cocaine, which triggers serotonin and noradrenaline, causing manic episodes. Neurophysiologic factors involve defects in the structural cortical-cognitive brain network that may cause activation of emotions and emotional responses. Psychodynamic factors are associated with depressive mood and low self-esteem. Environmental factors cause stress and external pressures cause emotional responses. Pharmacological factors, for example, the use of antidepressants triggers manic episodes. The patient has a bipolar manic phase because she is in a happy mood and doesn’t want to sleep. This essay describes the three decisions in treating the patient and the impact of ethical considerations during treatment.

Decision 1

Decision selected

Begin Seroquel XR 300 mg orally at HS

Reason for selecting this decision

Seroquel is a second-generation antipsychotic with a high affinity for the 5-HT2 receptors and mediates its effects through antagonist actions. It also has a high affinity for muscarinic, dopamine, muscarinic, and adrenergic receptors that improve mood, sleep, and concentration (Abdyrakhmanova, et al, 2021). It also relieves the positive symptoms of psychosis and schizophrenia. It is FDA approved for acute mania, psychosis, schizophrenia, and bipolar. Due to its antagonist mechanism, it causes dry mouth, weight gain, constipation, and dizziness. I chose this drug because it is given at an optimal dose to relieve a patient’s symptoms.

Reasons for excluding other decisions

Lithium is a mood stabilizer FDA-approved for bipolar and dysthymic disorders. It is the first-line treatment in treating bipolar and may be used as adjunctive therapy for mania (Rybakowski, J. K. 2018). Lithium alters the metabolism of other neurotransmitters to alter their genomic expression in them, hence reducing the grandiose symptoms. I did not select lithium because the patient has not been compliant. Moreover, it has unpleasant effects like confusion, tremors, delirium, and seizures. Risperdal is an atypical antipsychotic FDA approved for bipolar and schizophrenia. It has antagonism at the D2 receptors to treat the negative and positive symptom (Wilcox, et al, 2019) . I did not select the drug because it has extrapyramidal effects like dystonia, akathisia, parkinsonism, tremors, and shaffling gait. Assessing And Treating A Patient With Bipolar essay

What are your expectations for making the decisions?

The expectation of initiating this treatment was to relieve the symptoms of inability to sleep and grandiosity. To reduce the young mania scale to less than 22.

The impact of ethical consideration in treatment and communication

Ethics are the moral value that guides nursing practice in assessment and treatment. In this decision point, the nurse uses the principle of justice and beneficence. Justice Is a principle that allows nurses to treat all patients equally and in a righteous manner, especially during the assessment. Beneficence is the principle of doing good for the interest of the patient (McCradden, et al, 2020). The nurse initiates treatment for the patient to enable recovery.

Decision 2

Decision selected

Discontinue Seroquel  and start Geodon 40 mg orally BID with 500 calorie meal

Reason for selecting this decision

The patient complains of constipation and weight gain after initiating the treatment. She reports a slight improvement in the symptoms. Therefore, switching the patient to Geodon will improve the symptoms of bipolar, help in weight loss, and stop constipation. Geodon is an atypical antipsychotic that FDA approved for treating psychosis and bipolar. It has a higher affinity for dopaminergic and serotonin receptors that helps in reliving the positive symptoms. It is taken orally together with meals-high fat content to increase the drug bioavailability (Yeh, et al, 2018). I chose this drug because of its efficiency to treat patients’ symptoms and has fewer side effects.

Reasons for excluding other decisions

Increasing the dosage of Seroquel from 300mg to 400mg has a mild impact on the patient’s symptoms but worsens the side effects of gaining weight and constipation (Abdyrakhmanova, et al, 2021). The patient is obese and gaining more weight makes them uncomfortable. Therefore, I did not make this decision to ensure the psychological well-being of the patient. Continuing with the same dose and offering a solution for constipation is not a good idea for this patient because the drug has the effect of gaining weight.

What are your expectations for making the decisions?

The expectations for changing to Geodon are to improve the manic symptoms, reduce weight, and stop constipation.

The impact of ethical consideration in treatment and communication

At this decision point, the nurse considers the principle of autonomy. Autonomy is the respect for a person’s decision or preference regarding their health (McCradden, et al, 2020). The patient requests the nurse to prescribe a drug that will ease her bowel movement and stop weight gain.

Decision 3

Decision selected

Increase Geodon to 60mg

Reason for selecting this decision

I increased the dosage of the drug to increase the effective therapeutic concentration of the drug. The recommended dose is a maximum of 80mg. therefore, increasing by 20mg and monitoring the side effects helps reach the maximum therapeutic goal.

Reasons for excluding other decisions

I did not augment the patient with lithium because of the drug’s adverse effects. Moreover, she is not compliant with the drug because of its unpleasant effects. I did not maintain Geodon at 40mg because the American psychiatric association guidelines recommend dose adjustment to 60mg to achieve the therapeutic goal.

What are your expectations for making the decisions?

The expectations of increasing the dosage to 60mg are to improve the symptoms with minimum side effects.

The impact of ethical consideration in treatment and communication

The nurse incorporates the principle of non-maleficence.  Non-maleficence is not doing harm intentionally or unintentionally (McCradden, et al, 2020). The nurse protects the patient from medical harm by prescribing treatment with fewer side effects on the patient. Assessing And Treating A Patient With Bipolar essay

Conclusion

Bipolar is a mood disorder characterized by episodes of mania and hypomania. Risk factors for bipolar are biochemical, neurophysiologic, psychodynamic, environmental, and pharmacological factors. The client has a CYP2D6*10 allele that predisposed her to bipolar. Treatment methods for bipolar are antipsychotics or antidepressants to relieve the symptoms. The recommendable drug should be effcective with no unpleasant effects on the body. The majority of antipsychotics slow down lipid metabolism resulting in hyperlipidemia and weight gain. Undesirable effects of drugs are dry mouth, constipation, drowsiness, confusion, tremors, ataxia, and convulsions. Ethical principles are the moral values that guide nursing practice. Examples are beneficence, justice, fairness, consent, respect for autonomy, confidentiality, and non-maleficence.

Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’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.

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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. Assessing And Treating A Patient With Bipolar essay

 

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.

 

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

 

BACKGROUND INFORMATION

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.

Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”

She weights 110 lbs. and is 5’ 5”

SUBJECTIVE

Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.

Genetic testing reveals that she is positive for CYP2D6*10 allele.

Patient did well enough on Lithium to be discharged from the hospital but admits she has not been taking it as prescribed. When further questioned on the subject, she provides no additional details.

 References

Abdyrakhmanova, A. K., Shnayder, N. A., Neznanov, N. G., & Nasyrova, R. F. (2021). Pharmacogenetics of quetiapine. Personalized Psychiatry and Neurology, 1(1), 73-83. https://doi.org/10.52667/2712-9179-2021-1-1-73-83

Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar disorder. New England Journal of Medicine, 383(1), 58-66. https://www.nejm.org/doi/full/10.1056/NEJMra1906193

McCradden, M. D., Joshi, S., Anderson, J. A., Mazwi, M., Goldenberg, A., & Zlotnik Shaul, R. (2020). Patient safety and quality improvement: Ethical principles for a regulatory approach to bias in healthcare machine learning. Journal of the American Medical Informatics Association, 27(12), 2024-2027. Assessing And Treating A Patient With Bipolar essay https://doi.org/10.1093/jamia/ocaa085

Rybakowski, J. K. (2018). Challenging the negative perception of lithium and optimizing its long-term administration. Frontiers in molecular neuroscience, 11, 349. https://doi.org/10.3389/fnmol.2018.00349

Wilcox, M.A., Coppola, D., Bailey, N. et al. Risperdal® CONSTA® Needle Detachment. Incidence Rates Before and After Kit Redesign: A Retrospective Study using Electronic Health Records and Natural Language Processing in the Department of Veterans Affairs. Neurol Ther 8, 95–108 (2019). https://doi.org/10.1007/s40120-019-0130-7

Yeh, Y. C., Yu, X., Zhang, C., Hao, W., Du, F., Liu, D., … & Gao, X. (2018). Literature review and economic evaluation of oral and intramuscular ziprasidone treatment among patients with schizophrenia in China. General Psychiatry, 31(3). https://doi.org/10.1136%2Fgpsych-2018-100016. Assessing And Treating A Patient With Bipolar essay

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