NURS 6630 Week 4 Assessing and Treating Clients with Bipolar Disorder
NURS 6630 Week 4 Assessing and Treating Clients with Bipolar Disorder Free Sample Paper
Topic: Assessing and Treating Clients with Bipolar Disorder
BACKGROUND INFORMATION
NURS 6630 Week 4 Assessing and Treating Clients with Bipolar Disorder
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 confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.
MENTAL STATUS EXAM
The 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, 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 22
RESOURCES
- Chen, 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/s00228-015-1855-6
Decision Point One
Begin Risperdal 1 mg orally BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client is accompanied today by her mother who must help the client into your office, the client looks very sedated and lethargic
Client’s mother explains that “she has been like this since about a week after the last office visit”
Decision Point Two
Decrease Risperdal to 1 mg at HS
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client is less sedate, less lethargic and shows symptom improvement
Young Mania Rating Scale has decreased from 22 to 16 (a bit more than a 25% decrease in symptoms)
Decision Point Three
Select what the PMHNP should do next:
Decision Point Three
Continue at same dose of Risperdal and reassess in 4 weeks
Guidance to Student
At this point, the PMHNP may be wise to allow the client to remain at the same dose and reassess in 4 weeks. Recall that the client is of Korean descent and is positive for CYP2D6*10 allele. As a result, she may have slower clearance of Risperdal from her system, which may have resulted in higher than normal levels of Risperdal in the blood, which in turn resulted in sedation. Therefore, if we were to increase back to 1 mg orally BID, she may have the same side effects. Latuda is FDA approved for bipolar I depression, which is not the presentation we are attempting to treat. Additionally, it is quite expensive and many insurance companies will not pay for it until other agents have been attempted and failed.
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The Assignment
Examine Case Study: An Asian American Woman With Bipolar Disorder. 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 stops 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? NURS 6630 Week 4 Assessing and Treating Clients with Bipolar Disorder assignment help.
Also include how ethical considerations might impact your treatment plan and communication with clients.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
- Chapter 6, “Mood Disorders”
- Chapter 8, “Mood Stabilizers”
Stahl, S. M., & Ball, S. (2009b). Stahl’s illustrated mood stabilizers. New York, NY: Cambridge University Press.
To access the following chapters, click on the Illustrated Guides tab and then the Mood Stabilizers tab.
- Chapter 4, “Lithium and Various Anticonvulsants as Mood Stabilizers for Bipolar Disorder”
- Chapter 5, “Atypical Antipsychotics as Mood Stabilizers for Bipolar Disorder”
Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. doi:10.1007/s40263-013-0060-3
Note: Retrieved from Walden Library databases.
Chen, 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/s00228-015-1855-6
Required Media
Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author
Optional Resource
Mostafavi, A., Solhi, M., Mohammadi, M., Hamedi, M., Keshavarzi, M., & Akhondzadeh, S. (2014). Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial. Acta Medica Iranica, 52(10), 734-739.
Retrieved from http://acta.tums.ac.ir/index.php/acta
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See below NURS 6630 Week 4 Assessing and Treating Clients with Bipolar Disorder Free Sample Paper
Paper type: Research Paper
Course Level: Master
Subject Area: Nursing
# Pages: 6
Introduction
The prevalence of bipolar disorder is common among adults and adolescents. The illness has significant health problems for the caregivers and affected persons. According to Shah, Grover, and Rao (2017), bipolar disorder causes psychosocial dysfunction, work-related problems, educational challenges among school-going youths, and marriage-related problems. It is the responsibility of the advanced practice nurse to implement the correct therapeutic intervention to help the affected patients to regain normal functioning. One of the treatment approaches for bipolar disorder is the use of pharmacological agents. In order to achieve the best results with various medications, the attending healthcare professional must be adequately informed of the factors that may have an impact on the pharmacokinetic and pharmacodynamic processes in the client (Stahl, 2013). In this paper, the author has provided a comprehensive assessment of a 26-year-old Korean woman who has been diagnosed with bipolar disorder. Additionally, the writer has explained the reasons for selecting various treatment options for the client in every step of the therapeutic relationship.
Decision Point One
Selected Decision
Begin Risperdal 1 mg orally BID
Reason for Selection
The primary reason why Risperdal has been selected as the first treatment option for the client is due to its ability to create a balance in the secretion of serotonin and dopamine neurotransmitters. As Vitiello (2013) explains, bipolar disorder is a mental problem that occurs due to an imbalance in the production of dopamine and serotonin. The researcher further asserts that Risperdal is highly effective in rebalancing the discharge of the substances under discussion from their respective cells. Therefore, the pharmacological agent is the best option for improving the behavioral, thinking, and mood problems in the client (Fountoulakis, 2015). The other medications available such as lithium 300 mg and Seroquel XR are not appropriate choices in this case because the latter drug is associated with unpleasant side effects such as abnormal weight gain and that the client may not comply with the regimen for lithium.
Expected Results
The results that the clinician expects to achieve by orally administering 1 mg of Risperdal are directly related to the specific problems that he or she wants the drug to correct. The subjective data of the client reveals that she is experiencing sleep disturbance at night and that she has “fantastic” mood. It is anticipated that she should have an improvement in mood and be able to sleep normally at night after using Risperdal for four weeks (Shah, Grover, & Rao, 2017). Since the drug has the capacity to rebalance the production of dopamine and serotonin, its use of the named period of time should restore the client’s sleep pattern, behaviors, reactions, and thoughts (Stahl & Ball, 2009b).
Differences Between Expected Results and Actual Results
There is a large difference between the actual results and the anticipated ones. On returning to the clinic after four weeks, the client appears lethargic and sedated. This time around, she under the company of her mother who narrates that she has been in her present condition for the past three weeks. The observed symptoms are contrary to the expected ones because they indicate that the client’s condition has worsened instead of improving. These manifestations have occurred as a result of the side effects of Risperdal. According to Stahl (2013), sedation and lethargy are some of the side effects of the drug under discussion. These problems are more severe in the current client because she has tested positive for CYP2D6*10 allele, which prevents effective elimination of Risperdal from blood (Chen et al., 2015).
Decision Point Two
Selected Decision
Decrease Risperdal to 1 mg at HS
Reason for Selection
The primary reason why a decrease in Risperdal dosage to 1 mg at HS has been selected is that it will reduce over-accumulation of the substance in the client’s blood thereby reducing lethargy and sedation. At this point, the motive of the clinician is to eliminate the side effects of the drug. Reducing the dosage is the most appropriate way to manage the side effects as opposed to discontinuing Risperdal (Stahl & Ball, 2009b). Notably, administering 2 mg of Risperdal at HS will still increase the concentration of the drug in blood and this will not solve the problem at hand. Moreover, using lithium may result in even more severe side effects. Since the presence of CYP2D6*10 allele will still prevent effective clearance of the drug from blood, it is clear that the best decision is to reduce the dosage of Risperdal from 1 mg BID to 1 mg HS (Chen et al., 2015).
Expected Results
The expected result following an oral administration of 1 mg of Risperdal at HS is a reduction in sedation and lethargic symptoms. When the dosage of the drug is reduced in a patient with CYP2D6*10 allele, it is anticipated that the problem of drug over-accumulation will not occur. Eventually, the client will experience an improvement in sedation and lethargy. The reason for the anticipation is that it is the overconcentration of Risperdal in blood that is causing the symptoms observed in the client during her second visit. Therefore, reducing the dose will reduce that concentration thereby solving the existing problem (Chen et al., 2015). Moreover, the healthcare professional expects the client to have improved symptoms of bipolar disorder. According to Vitiello (2013), Risperdal acts by balancing the secretion of dopamine and serotonin neurotransmitters. Therefore, by administering Risperdal dosage to 1 mg at HS, the client should have an improvement in behavior, mood, thought process, and ability to sleep normally after using the drug for four weeks (Stahl, 2013).
Differences Between Expected Results and Actual Results
The actual results perfectly match the expected results. The clinician predicted that the client should have an improvement in sedation and lethargic symptoms. After returning to the clinic in four weeks, it has been found that she is less lethargic, less sedate and reports significant improvements in symptoms of bipolar disorder. Additionally, when the client is rated on a Young Mania Rating Scale, it has been discovered that his clinical manifestations of mania have dropped from a score of 22 to 16. This value indicates a decrease in symptoms of about 25%. These results indicate that Risperdal a highly effective medication for reducing symptoms of bipolar disorder (Weiss & Connery, 2014).
Decision Point Three
Selected Decision
Continue at the same dose of Risperdal and reassess in four weeks
Reason for Selection
The primary reason for deciding to continue Risperdal 1 mg at HS is due to its effectiveness in improving several symptoms of bipolar disorder including sedation, lethargy, sleep disturbance, negative thoughts, ‘fantastic’ mood, and problem behaviors. Up to this extent, the client is responding well to the drug. However, there she might develop additional complications that will call for a change in drug dosage or replacement in medication (Weiss & Connery, 2014). Therefore, it is very crucial that the clinician performs a reassessment in four weeks to evaluate her progress. Essentially, the healthcare professional cannot administer Risperdal 1 mg orally BID because it had initially failed in correcting disease symptoms. Besides, he or she cannot replace the current regimen with Latuda due to the uniqueness in disease symptoms and as a result of its high costs which may limit its affordability (Stahl, 2013). Therefore, the most appropriate option is to continue administering Risperdal 1mg at the moment before the need to make a change arises.
Expected Results
The clinician expects to achieve even more positive results by …………………….. (Weiss & Connery, 2014).
Differences Between Expected Results and Actual Results
The overall goal of administering Risperdal was to …….by Vitiello (2013), the researcher has confirmed the ………. (Stahl, 2013).
Ethical Considerations
The attending clinician must understand the ethical considerations in the treatment plan as he or she attempts to help her manage symptoms of bipolar disorder. ……. (Laureate Education, 2016f).
Conclusion
To sum everything up, the ability of a patient to recover from symptoms of bipolar disorder depends on the ………………………….
References: NURS 6630 Week 4 Assessing and Treating Clients with Bipolar Disorder Free Sample Paper
Chen, 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/s00228-015-1855-6
Fountoulakis, K. N. (2015). Bipolar disorder: An evidence-based guide to manic depression. Springer, ISBN, 3642372171.
Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author
Mostafavi, A., Solhi, M., Mohammadi, M., Hamedi, M., Keshavarzi, M., & Akhondzadeh, S. (2014). Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial. Acta Medica Iranica, 52(10), 734-739.
Stahl, S. M., & Ball, S. (2009b). Stahl’s illustrated mood stabilizers. New York, NY: Cambridge University Press.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Shah, N., Grover, S., & Rao, P. S. (2017). Clinical practice guidelines for management of bipolar disorder. Indian Journal of Psychiatry, 59(1), S51-S66. doi:10.4103/0019-5545.196974
Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. doi:10.1007/s40263-013-0060-3
Weiss, R. D., & Connery, H. S. (2014). Integrated group therapy for bipolar disorder and substance abuse. New York: The Guilford Press.
