Assessing and Treating Patients With Bipolar Disorder NURS 6630

Sample Answer for Assessing and Treating Patients With Bipolar Disorder NURS 6630 Included After Question

Assessing and Treating Patients With Bipolar Disorder NURS 6630

Assessing and Treating Patients With Bipolar Disorder  

Bipolar 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. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder. 

Resources 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.  

Assessing and Treating Patients With Bipolar Disorder NURS 6630
Assessing and Treating Patients With Bipolar Disorder NURS 6630

WEEKLY RESOURCES 

To prepare for this Assignment: 

  • Review this week’s Learning Resources, including the Medication Resources indicated for this week. 
  • Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring bipolar therapy. 

The Assignment: 5 pages 

For this assignment, you will write a 5–6-page paper on the topic of bipolar and bipolar and related disorders. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources. 

In your paper, you will choose one of the following diagnoses: Bipolar I, Bipolar II, Cyclothymic Disorder, Substance/Medication-Induced Bipolar and Related Disorder, Bipolar and Related Disorder Due to Another Medical Condition. Your paper will include discussion for your chosen diagnosis of bipolar and related disorder on the following: 

  • Prevalence and Neurobiology of your chosen disorder 
  • Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria 
  • Discuss special populations and considerations (children, adolescents, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder; demonstrating critical thinking beyond basics of HIPPA and informed consent with discussion of at least one for EACH category:  legal considerations, ethical considerations, cultural considerations, social determinants of health 
  • Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder 
  • Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings.  What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring 
  • Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.  

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. 

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center  

Links to an external site. provides an example of those required elements (available at  https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting. 

By Day 7 

Submit your Assignment.  

submission information 

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  1. To submit your completed assignment, save your Assignment as WK5Assgn_LastName_Firstinitial  
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  1. Next, click on Upload File and select Submit Assignment for review. 

 

Rubric 

NURS_6630_Week5_Assignment_Rubric  

NURS_6630_Week5_Assignment_Rubric  
Criteria  Ratings  Pts  
This criterion is linked to a Learning Outcome Write a 5–6-page paper on the topic of bipolar and bipolar related disorders: • Prevalence • Neurobiology  
20 to >17.0 pts  

Excellent Point range: 90–100 

Discussion includes Prevalence and Neurobiology of chosen bipolar and related disorder. 

17 to >15.0 pts  

Good Point range: 80–89 

Discussion is vague regarding Prevalence and Neurobiology of chosen bipolar and related disorder. 

15 to >13.0 pts  

Fair Point range: 70–79 

Discussion is missing one section for Prevalence and Neurobiology of chosen bipolar and related disorder. 

13 to >0 pts  

Poor Point range: 0–69 

Discussion is inaccurate or missing more than one section for Prevalence and Neurobiology of chosen bipolar and related disorder. 

 

20 pts 
This criterion is linked to a Learning Outcome • Discuss the differences between your chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria.  
20 to >17.0 pts  

Excellent Point range: 90–100 

Discussion includes the differences between chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria. 

17 to >15.0 pts  

Good Point range: 80–89 

Discussion includes the differences between chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM version older than DSM 5 TR criteria. 

15 to >13.0 pts  

Fair Point range: 70–79 

Discussion is vague in differences between chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria and/or missing discussion presentation of symptoms according to DSM 5 TR criteria or older version of DSM. 

13 to >0 pts  

Poor Point range: 0–69 

Discussion is inaccurate or does not include the differences between chosen disorder and one other bipolar and related disorders in relation to the diagnostic criteria including presentation of symptoms according to DSM 5 TR criteria or older version of DSM. 

 

20 pts 
This criterion is linked to a Learning Outcome • Discuss special populations and considerations (children, adolescent, pregnancy/post-partum, older adult, emergency care) for your chosen bipolar and related disorder-be specific, not general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health.  
20 to >17.0 pts  

Excellent Point range: 90–100 

Special Populations and Considerations are discussed and specific, not general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. 

17 to >15.0 pts  

Good Point range: 80–89 

Special Populations and Considerations are discussed not specific, but general and address at least one for EACH category demonstrating critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. 

15 to >13.0 pts  

Fair Point range: 70–79 

Special Populations Considerations are discussed not specific, but general and missing 1-2 of EACH category and does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. 

13 to >0 pts  

Poor Point range: 0–69 

Special Populations Considerations are vaguley or not discussed, not specific, is inaccurate and/or general and missing 3+ or more of or none of EACH category, inaccurate discussion and/or does not demonstrate critical thinking beyond basics of HIPPA and informed consent: legal considerations, ethical considerations, cultural considerations, social determinants of health. 

 

20 pts 
This criterion is linked to a Learning Outcome • Discuss FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for your chosen bipolar and related disorder • Of the medication treatment options for your chosen disorder discuss side effects, FDA approvals and warnings. What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring.  
15 to >13.0 pts  

Excellent Point range: 90–100 

Discussion includes FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is discussion regarding side effects, FDA approvals and warnings. Paper includes what is important to monitor in terms of labs, comorbid medical issues with why important formonitoring. 

13 to >11.0 pts  

Good Point range: 80–89 

Discussion includes vague FDA and/or clinical practice guidelines approved pharmacological treatment options in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is vague discussion regarding side effects, FDA approvals and warnings. Paper includes vague discussion what is important to monitor in terms of labs, comorbid medical issues with why important for monitoring. 

11 to >9.0 pts  

Fair Point range: 70–79 

Discussion includes pharmacological treatment options but not aligned with FDA approved and/or clinical practice guidelines in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is missing elements for discussion regarding side effects, FDA approvals and warnings. Paper includes what is important to monitor in terms of labs, comorbid medical issues but does not discuss why important for monitoring. 

9 to >0 pts  

Poor Point range: 0–69 

Discussion inaccurate and/or missing pharmacological treatment options but not aligned with FDA approved and/or clinical practice guidelines in relation to acute and mixed episodes vs maintenance pharmacological treatment for chosen bipolar and related disorder; Of the medication treatment options chosen for the disorder there is inaccurate or no elements for discussion regarding side effects, FDA approvals and warnings. Paper does not include what is important to monitor in terms of labs, comorbid medical issues but does not discuss why important for monitoring. 

 

15 pts 
This criterion is linked to a Learning Outcome Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature.  
15 to >13.0 pts  

Excellent Point range: 90–100 

Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription contains date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature. 

13 to >11.0 pts  

Good Point range: 80–89 

Provides three examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 1-2 elements of the following; date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature. 

11 to >9.0 pts  

Fair Point range: 70–79 

Provides two examples of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 3 of the following: date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature. 

9 to >0 pts  

Poor Point range: 0–69 

Provides one example of how to write a proper prescription that would be provided to patient and/or transmitted to pharmacy. Prescription is missing 4+ or is inaccurately written for date, medication and strength, amount to be taken, route to be taken, frequency, indication, quantity, refills; providers signature. 

 

15 pts 
This criterion is linked to a Learning Outcome Written Expression and Formatting—Paragraph development and organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.  
5 to >4.0 pts  

Excellent Point range: 90–100 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 

4 to >3.5 pts  

Good Point range: 80–89 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time….Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 

3.5 to >3.0 pts  

Fair Point range: 70–79 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment is vague or off topic. 

3 to >0 pts  

Poor Point range: 0–69 

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided. 

 

5 pts 
This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources; Paper is 5-6 pages not counting title page and reference page.  
5 to >4.0 pts  

Excellent Point range: 90–100 

Uses correct grammar, spelling, and punctuation with no errors; Includes title page and reference page with a minimum of 3 scholarly supporting resources outside of course provided resources. Paper is 5-6 pages not counting title page and reference page. 

4 to >3.5 pts  

Good Point range: 80–89 

Contains a few (one or two) grammar, spelling, and punctuation errors; includes the following: title page and reference page. Only contains 2 scholarly supporting resources outside of course provided resources. Paper is 4 pages not counting title page and reference page. 

3.5 to >3.0 pts  

Fair Point range: 70–79 

Contains several (three or four) grammar, spelling, and punctuation errors; missing one of the following; title page or reference page; only contains 1 scholaraly supporting resources outside of course provided. Paper is 3 pages or exceeds to page 7 not counting title page and reference page. 

3 to >0 pts  

Poor Point range: 0–69 

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding; missing the following; title page and reference page; contains no scholaraly supporting resources outside of course provided resources. Paper is 2 pages or exceeds 8 pages not counting title page and reference page. 

 

5 pts 
Total Points: 100 

 

A Sample Answer For the Assignment: Assessing and Treating Patients With Bipolar Disorder NURS 6630

Title: Assessing and Treating Patients With Bipolar Disorder NURS 6630

Assignment: Assessing and Treating Patients with Bipolar Disorder 

A mental illness known as bipolar disorder is characterized by alternating episodes of mania and depression. However, mania or depression tend to have a greater impact on the majority of those who have this disorder. An intense stage of symptoms precedes the onset of the condition, which is subsequently followed by a cycle of remission and recurrence that occurs periodically (Carvalho et al., 2020). A period of time when a person’s mood is consistently expansive, high, or irritable as well as an apparent boost in energy is what is known as a manic episode. Hypomania is a milder form of mania that can occur in a patient and is characterized by a single episode lasting at least four days. Compared to experiences of mania or hypomania, episodes of depression often last longer (Carvalho et al., 2020). This essay’s goal is to describe a patient who has been diagnosed with bipolar disorder, her treatment strategy, and the ethical issues that may affect that strategy. 

Introduction to the Case 

A female client of Korean heritage, age 26, is seeing a doctor for the first time to get her bipolar I disease under control. The customer is 110 pounds and 5′ 5″ tall. She claims to be in a wonderful mood and finds sleep to be dull. Her medical records show she is in generally good condition, and her blood results fall within the expected ranges. Despite this, she has the CYP2D6*10 allele, according to genetic tests. Lithium was last taken by her two weeks ago. She receives a 22 on the Young Mania Rating Scale (YMRS), which is administered by the PMHNP. Patient characteristics that may affect prescribing choices include past and present drugs, previous treatment response, physical and mental comorbidities, side effects of prior medications, and the patient’s treatment preferences (Carvalho et al., 2020). The current mood (mania/depression) will also affect the drug that is prescribed. 

 

Decision 1 

Lithium 300 mg orally BID. 

Why is this decision appropriate? 

Because lithium is the preferred medication for people with classic mania, it was chosen. Lithium has been a cornerstone of BD treatment for decades and is still regarded as first-line therapy, claim Baldessarini et al. (2019). Lithium has a short-term effect for acute mania in adult bipolar patients and lengthens the interval between any mood episode relapses. 

Why not consider other two available options? 

Because it is not advised for patients who have the CYP2D6*10 allele, Risperdal was a poor choice. According to Cui et al. (2020), people with the CYP2D6*10 allele have a slower metabolism for the drug risperidone. Risperdal clearance is decreased by the decreased metabolic rate, which leads to higher serum levels of the medication, drowsiness, and eventually low drug compliance. Seroquel’s metabolic side effects, which result in elevated levels of total cholesterol and triglycerides as well as weight gain, make it less than optimal (Butler et al., 2018). Seroquel would make the patient’s elevated BMI worse. 

What is likely to be achieved when this decision is taken? 

In four weeks, I believed that lithium would reduce the manic symptoms and bring the YMRS score down to less than 12. According to Butler et al. (2018), lithium reduces acute mania in the short term while lengthening the duration between relapses in the long term. It efficiently controls manic or depressive acute episodes and works to stop relapses in both conditions. 

What are the Ethical Considerations when taking this decision? 

The PMHNP took the ethical principles of beneficence, which promotes the greater good, into account while choosing the drug associated with the best treatment outcomes. Additionally, nonmaleficence was upheld by evaluating the adverse effects of available medications and choosing one with minimal side effects in order to protect the patient (Ostacher, 2019). 

Decision 2 

To identify the reason for noncompliance, evaluate the patient’s justifications. Then, educate the patient on the pharmacology and side effects of the medication. 

Why is this decision appropriate? 

The choice was made because the patient changed how often she took her prescription. Treatment had stalled because of noncompliance. According to Jawad et al. (2018), a number of reasons, such as drug side effects, a lack of knowledge of the prescription, complex drug regimens, unfavorable patient attitudes about medication, and concurrent substance usage, contribute to medication non-adherence. The hoped-for therapeutic advantages and outcomes are hampered by these circumstances. 

Why not consider other two available options? 

The patient’s noncompliance with treatment would have lasted if the underlying causes had not been addressed before I did not increase the Lithium dose to 450 mg. Furthermore, I refrained from switching to Depakote because we had not yet demonstrated Lithium’s effectiveness in the management of mania. If, despite adequate medication compliance, the desired impact is not realized, switching from lithium should be done with caution. 

What is likely to be achieved when this decision is taken? 

I was really optimistic that identifying the cause of non-compliance would help us identify the issues causing the patient to take her medication sporadically so that we could deal with them as soon as feasible. Butt et al. (2018) contends that in order to enhance the effectiveness of therapy, non-compliance must be adequately recognized and appropriate measures must be taken to achieve therapeutic objectives. 

What are the Ethical Considerations when taking this decision? 

The PMHNP observed the patient’s autonomy when the patient took part in the process of determining the factors that contributed to non-compliance (Ostacher, 2019). The patient’s involvement in the variables’ determination and treatment will increase compliance, which will improve health outcomes and maintain beneficence. 

Decision 3 

Switch to a sustained-release version of lithium at the same dose and frequency. 

Why is this decision appropriate? 

I changed the patient to a sustained-release type of lithium after the patient reported experiencing nausea and diarrhea as a result of the initial drug preparation. Due to lithium’s ability to stabilize mood, its formulation with continuous release lowers the drug’s side effects while still producing the desired results. Changing the formulation of lithium from one that has an instant release to one that has a sustained release has no effect on the efficacy of the treatment, claim Pelacchi et al. (2022). 

Why not consider other two available options? 

Because lithium had not been shown to be unsuccessful in treating bipolar symptoms, switching to Depakote was not in the patient’s best interests. Additionally, it is connected to the negative effects of hepatic and hematological dysfunction, all of which may have detrimental effects on one’s health. The fact that Trileptal is a treatment for the second line of defense, which is utilized when the first line of defense fails, also made it a poor choice. 

What is likely to be achieved when this decision is taken? 

I was quite optimistic that changing to a therapy formulation with a sustained release would lessen the unpleasant side effects of the medication, notably nausea and diarrhea, enhancing patient compliance and the desired results of the medication. Benefits of sustained-release formulations include decreased local adverse effects in the GI and negative effects associated with peak blood levels. Furthermore, these types of drugs promote compliance (Pelacchi et al., 2022). 

What are the Ethical Considerations when taking this decision? 

By switching to a formulation that was linked to fewer side effects, increasing patient compliance, and improving the quality-of-care patients got, beneficence and nonmaleficence were strengthened. Autonomy would have an impact on the treatment plan if the patient requested a change in the event of persistent negative effects (Ostacher, 2019). 

Conclusion 

The patient’s preferred treatment options, current medications, prior treatment response, medical and mental comorbidities, side effects of prior medications, and other factors all affect the patient’s treatment strategy. The first stage of the patient’s treatment was to start giving him 300 mg BD of lithium. Lithium was selected as the therapy since it is advised as a first-line therapy (Baldessarini et al., 2019). Risperdal was not chosen because it would cause the patient to become sedated, which would diminish the rate of compliance (Cui et al., 2020). 

Seroquel was disqualified from consideration due to the addition of weight gain and an increase in total cholesterol and triglycerides brought on by the drug. The desired therapeutic effects of the treatment were not achieved because the patient repeatedly missed doses of the medication. As a result, it was decided to find the causes of the patient’s noncompliance with therapy and work on finding solutions. 

We chose to convert from an instant formulation of lithium to a prolonged preparation of the drug because the patient had mentioned experiencing side effects like nausea and diarrhea. Lithium sustained release is associated with fewer side effects as well as higher compliance (Pelacchi et al., 2022). Ethics principles including beneficence, nonmaleficence, and autonomy were taken into account when constructing the treatment. Based on best practices that were linked to outstanding treatment outcomes, the PMHNP made recommendations about therapy. 

References 

Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular psychiatry, 24(2), 198–217. https://doi.org/10.1038/s41380-018-0044-2 

Butler, M., Urosevic, S., Desai, P., Sponheim, S. R., Popp, J., Nelson, V. A., … & Sunderlin, B. (2018). Treatment for Bipolar Disorder in Adults: A Systematic Review. 

Butt, H., Muzaffar, Z., Rasool, F., & Mohsin, M. (2018). Assessment Of Patient Compliance, Its Associated Factors, And Predictable Interventions. Value in Health, 21, S1. https://doi.org/10.1016/j.jval.2018.07.009 

Carvalho, A. F., Firth, J., & Vieta, E. (2020). Bipolar Disorder. The New England journal of medicine, 383(1), 58–66. https://doi.org/10.1056/NEJMra1906193 

Cui, Y., Yan, H., Su, Y., Wang, L., Lu, T., Zhang, D., & Yue, W. (2020). CYP2D6 Genotype-Based Dose Recommendations for Risperidone in Asian People. Frontiers in pharmacology, 11, 936. https://doi.org/10.3389/fphar.2020.00936 

Ostacher, M. J. (2019). Ethical Issues in the Diagnosis and Treatment of Bipolar Disorders. FOCUS, A Journal of the American Psychiatric Association, 17(3), 265-268. https://doi.org/10.1176/appi.focus.20190010 

Pelacchi, F., Dell’Osso, L., Bondi, E., Amore, M., Fagiolini, A., Iazzetta, P., … & SALT Study Group. (2022). Clinical evaluation of switching from immediate‐release to prolonged‐release Lithium in bipolar patients, poorly tolerant to Lithium immediate‐release treatment: A randomized clinical trial. Brain and Behavior, e2485. https://doi.org/10.1002/brb3.2485