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Assessing and Treating Patients with Bipolar Disorder Essay Paper

Assessing and Treating Patients with Bipolar Disorder Essay PaperAssessing and Treating Patients with Bipolar Disorder Essay PaperBipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. Instructions – The Assignment: 5 pages 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.** Please address each bullet point for Decision # 1, 2 and 3**ORDER A PLAGIARISM-FREE PAPER HEREIntroduction 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.Assessing and Treating Patients with Bipolar Disorder Essay PaperAssessing and Treating Patients with Bipolar Disorder Essay PaperDecision #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.Assessing and Treating Patients with Bipolar Disorder Essay PaperDecision #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.Assessing and Treating Patients with Bipolar Disorder Essay PaperNote: Support your rationale with a minimum of five academic resources.Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.Bipolar TherapyBACKGROUND INFORMATIONThe 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 weighs 110 lbs. and is 5’ 5”SUBJECTIVEPatient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”Assessing and Treating Patients with Bipolar Disorder Essay PaperYou 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.MENTAL STATUS EXAMThe patient is alert, 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. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.The Young Mania Rating Scale (YMRS) score is 22RESOURCESChen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6Assessing and Treating Patients with Bipolar Disorder Essay Paper Decision Point OneSelect what the PMHNP should do:Begin Lithium 300 mg orally BIDBegin Risperdal 1 mg orally BIDBegin Seroquel XR 300 mg orally at HS Decision Point OneBegin Seroquel XR 300 mg orally at HSRESULTS OF DECISION POINT ONEClient returns to clinic in four weeksClient is reporting that she sleeps a bit more at bedtimeClient states that she has gained about 2 or 3 pounds, which she does not likeClient also reports that she has been constipated since starting this medicationClient is also complaining of dry mouth which she does not like.Client’s score on the Young Mania Rating Scale has decreased from a 22 to an 18Client is reporting really good mood, but is asking for a different medication because of the weight gainAssessing and Treating Patients with Bipolar Disorder Essay PaperDecision Point TwoSelect what the PMHNP should do:Increase Seroquel XR to 400 mg orally at HSDiscontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie mealContinue same dose of Seroquel and counsel client regarding ways to prevent constipation Decision Point TwoDiscontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie mealRESULTS OF DECISION POINT TWOAssessing and Treating Patients with Bipolar Disorder Essay PaperClient returns to clinic in four weeksClient demonstrates a 50% decrease in score on the Young Mania Rating Scale (from 22 to 11)Client denies any additional weight gain and denies any additional side effects Decision Point ThreeSelect what the PMHNP should do:Continue same dose and reassess in 4 weeksIncrease Geodon to 60 mg orally BID with a 500 calorie mealAugment with Lithium sustained release 300 mg orally BID Decision Point ThreeContinue same dose and reassess in 4 weeksGuidance to StudentAssessing and Treating Patients with Bipolar Disorder Essay PaperThe PMHNP should provide counseling to the client about this side effect and encourage increased fluids and fiber in the diet to combat constipation. Hard candies or gum can be used to prevent dry mouth. This is another issue as the drug can cause dental problems as a result of dry mouth.Assessing and Treating Patients with Bipolar Disorder Essay PaperChanging to Geodon clearly helped with symptoms and arrested weight gain in this client. The PMHNP could wait 4 weeks and see if any changes in Young Mania Rating Scale are noted, or increasing to 60 mg orally BID in an attempt to hasten symptom improvement. Increasing dose may be associated with side effects.Augmentation with Lithium may be appropriate if the goal of therapy is to discontinue antipsychotic therapy and treat with Lithium monotherapy. Lithium was problematic for this client but changing formulation to the extended release may overcome the difficulties she was experiencing with side effects. The PMHNP would need to educate client regarding side effects of medication and need to maintain complianceAssessing and Treating Patients with Bipolar Disorder Essay Paper

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