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NURS 6630 Assignment Assessing and Treating Patients With Psychosis and Schizophrenia

NURS 6630 Assignment Assessing and Treating Patients With Psychosis and Schizophrenia

Introduction

Schizophrenia is a serious mental health illness that affects a significant proportion of the world’s population. Schizophrenia patients present to the hospital with symptoms such as disorganized thought and changed perceptions of self and others. Schizophrenia has a major impact on patients’ functional and occupational performance. Schizophrenia patients require social, emotional, physical, and psychological assistance. Psychiatric mental health nurse practitioners (PMHNPs) ensure that affected patients receive effective pharmacological and non-pharmacological interventions that facilitate effective symptom management. The treatment selections made in practice are mostly determined by the patients’ symptoms and the safety concerns related with the medications used.

As such, this article will analyze a case study involving a 34-year-old Pakistani female who was admitted to the hospital with a history of psychotic condition. The patient was presented with a history of Allah’s visions, leading her to believe she was Prophet Mohammad and could save the world from sin. The client’s husband is concerned about the client’s health after the symptoms became out of hand. During the clinical visit, the woman was calm, denied believing she was Prophet Mohammad, and reported auditory hallucinations when the television informed her that her husband desired an American wife. The patient is currently 140 pounds and 5’5 inches tall. The patient stated that she has stopped taking Risperdal out of fear that her spouse may poison her in order to marry an American lady. The PANSS test revealed that the patient scored 40 on the positive symptom scale, 20 on the negative symptom scale, and 60 on the general psychopathology scale. As a result, the patient considerations and findings discussed above will inform the decisions taken in this case study. Assessing and Treating Patients Suffering From Psychosis and Schizophrenia 6630 NURS

Decision Point 1

            The decision that I will select for the patient is starting her on Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter.

Reason for the Decision

The use of Invega Sustenna has been shown in studies to be effective in the management of symptoms of schizophrenia. The drug also reduces the symptoms of patients as seen in the reduction of PANSS scores. The administration of Invega Sustenna intramuscularly on day four and on monthly basis for maintenance dosage is effective in preventing relapse of symptoms of schizophrenia (Correll et al., 2019). Therefore, the patient’s social and occupational functioning is expected with the use of the drug in managing schizophrenia.

NURS 6630 Assignment Assessing and Treating Patients With Psychosis and Schizophrenia

NURS 6630 Assignment Assessing and Treating Patients With Psychosis and Schizophrenia

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Why the Other Choices were not Selected

The decision to start Zyprexa 10 mg orally at bedtime was not selected for the patient in the case study because of the side effects that are associated with the medication. The use of Zyprexa is associated with side effects such as weight gain, memory loss, and changes in menstrual cycle, which might affect its adherence by the patient in the case study. The patient is already overweight and experiencing altered memory, hence, contraindicated in the patient. Similar reasons also informed the decision not to administer the patient Abilify 10 mg orally at bedtime (Ribeiro et al., 2018).

Expectations vs. Outcomes

The above decision was made with the aim of improving the symptoms of schizophrenia being experienced by the patient. The

decision was also made with the aim of reducing the PANSS score of the patient. The outcome at four weeks showed a decrease of PANSS score by 25%. The client tolerated the medication. There was however a 2 pound weight gain, which did not concern the patient and pain at the injection site. The outcomes aligned with the expected results in the adopted decision. However, the weight gain was not expected despite being the side effect of Invega Sustenna. The experience of pain at the injection site was expected because it is a common side effect associated with the medication (Patel et al., 2020). The ethical consideration that guided the adoption of the above decision is the promotion of benevolence and non-maleficence. The decision was made with the aim of using a medication that was associated with minimal side effects and optimum benefits to the patient. The PMHNP weighed the benefits versus risks of the given alternatives prior to making a decision. Assignment Assessing and Treating Patients With Psychosis and Schizophrenia NURS 6630

Decision Point 2

The selected decision is continue same decision made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward.

Reason for the Decision

The administration of Invega Sustenna in the first decision has led to the improvement in symptoms of schizophrenia. The improvements can be seen in the 25% reduction in PANSS score. The patient also developed mild side effects to the treatment. Maintaining the current dose is therefore recommended to minimize the side effects of Invega Sustenna. Maintaining the current dosage will also lead to the achievement of the desired therapeutic effect of Invega Sustenna (Fellner, 2017).

Why the Other Choices were not Selected

The decision to discontinue Invega Sustenna and start Haldol Decanoate (haloperidol decanoate) 50 mg IM q2weeks with oral Haldol 5 mg BID for the next 3 months was not selected because the administration of Invega Sustenna had yielded the desired improvement in symptoms. The decision to continue Invega Sustenna, begin injections into deltoid and add on Abilify was not selected because the desired therapeutic effect of Invega Sustenna had been achieved. As a result, there is no indication for augmenting the treatment (Ribeiro et al., 2018).

Expectations vs. Outcomes

The decision was made with the aim of improving the tolerability of Invega Sustenna by the patient. Changing the injection site to deltoid muscle would have also reduced the side effects experienced by the patient. The decision was also made with the aim of achieving further reduction in symptoms of schizophrenia as evidenced by low PANSS score. The client returned to the clinic after four weeks. The assessment findings showed that the client’s PANNS score had reduced by 50% from the initiation of Invega Sustenna. The patient also reported that he feels much better due to the changes in the injection sites. The client also reported that has had increased her body weight by additional 2.5 pounds implying 4.5 pounds in 2 months-period. The client was somewhat bothered by the weight gain and is afraid that her husband does not like it. The client expressed that she likes her feelings with Invega Sustenna and was wondering if there was another drug similar to it that does not cause weight gain. The expected outcomes of the decision in this step were therefore achieved (Pesa et al., 2017). The issue of weight gain was expected because it is a common side effect associated with Invega Sustenna. The ethical consideration that guided the selection of the above decision is the promotion of safety in care. The PMHNP ensured that the patient received high quality care that minimized pain and side effects with the medication used. The PMHNP also ensured that a drug with least side effects was administered to the patient.

Decision Point 3

The selected decision at this point is continuing with Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one month.

Reason for the Decision

The above decision was made due to the consideration of the safety needs of the client and efficacy of Invega Sustenna when compared to other drugs such as Zyprexia. Therefore, the client should be informed that the weight gain associated with Invega Sustenna is incomparable to that is associated with other drugs with similar efficacy. A dietician is needed to educate the patient on the importance of balanced diet and engaging in adequate physical activity. An exercise physiologist is required to guide the patient in the types of physical activity that the patient can engage to maintain healthy weight gain (Fellner, 2017).

Why the Other Choices were not Selected

The decision to discontinue Invega Sustenna and start abilify maintenna 400 mg IM monthly was not selected because the use of Invega Sustenna had produced the desired therapeutic effect in the patient. The decision to discontinue its use is therefore not indicated. The decision to continue Invega Sustenna and add Qsymia for weight loss was not considered because the use of lifestyle and behavioral interventions had not been explored. Qysmia is recommended in cases where the patient is unable to engage in physical activity or in obese patients (Ribeiro et al., 2018).

Expectations vs. Outcomes

The above decision was made with the aim of achieving further improvement in symptoms of the patient. The decision was also made with the aim of ensuring that the patient adopts healthy interventions for weight gain. The outcomes of the decision were not given. Therefore, patient education on medication adherence and maintenance of healthy lifestyle should be provided to the patient. The ethical consideration that guided the adoption of the above decision is promotion of patient autonomy (Fellner, 2017). The principle of respecting patient autonomy was taken into consideration by educating the patient about the benefits and risks of the available treatment interventions.

References

Correll, C. U., Sliwa, J. K., Najarian, D. M., & Saklad, S. R. (2019). Practical considerations for managing breakthrough psychosis and symptomatic worsening in patients with schizophrenia on long-acting injectable antipsychotics. CNS Spectrums, 24(4), 354–370. https://doi.org/10.1017/S1092852918001098

Fellner, C. (2017). New Schizophrenia Treatments Address Unmet Clinical Needs. Pharmacy and Therapeutics, 42(2), 130–134.

Patel, C., Emond, B., Lafeuille, M.-H., Côté-Sergent, A., Lefebvre, P., Tandon, N., & El Khoury, A. C. (2020). Real-World Analysis of Switching Patients with Schizophrenia from Oral Risperidone or Oral Paliperidone to Once-Monthly Paliperidone Palmitate. Drugs – Real World Outcomes, 7(1), 19–29. https://doi.org/10.1007/s40801-019-00172-9

Pesa, J. A., Doshi, D., Wang, L., Yuce, H., & Baser, O. (2017). Health care resource utilization and costs of California Medicaid patients with schizophrenia treated with paliperidone palmitate once monthly or atypical oral antipsychotic treatment. Current Medical Research and Opinion, 33(4), 723–731. https://doi.org/10.1080/03007995.2016.1278202

Ribeiro, E. L. A., de Mendonça Lima, T., Vieira, M. E. B., Storpirtis, S., & Aguiar, P. M. (2018). Efficacy and safety of aripiprazole for the treatment of schizophrenia: An overview of systematic reviews. European Journal of Clinical Pharmacology, 74(10), 1215–1233. https://doi.org/10.1007/s00228-018-2498-1. Assignment Assessing and Treating Patients With Psychosis and Schizophrenia NURS 6630

Name:  Assignment Rubric

  Excellent Good Fair Poor
Summarize your interpretation of the frequency data provided in the output for respondent’s age, highest school grade completed, and family income from prior month. 32 (32%) – 35 (35%)

The response accurately and clearly explains, in detail, a summary of the frequency distributions for the variables presented.

The response accurately and clearly explains, in detail, the number of times the value occurs in the data.

The response accurately and clearly explains, in detail, the appearance of the data, the range of data values, and an explanation of extreme values in describing intervals that sufficiently provides an analysis that fully supports the categorization of each variable value.

The response includes relevant, specific, and appropriate examples that fully support the explanations provided for each of the areas described.

28 (28%) – 31 (31%)

The response accurately summarizes the frequency distributions for the variables presented.

The response accurately explains the number of times the value occurs in the data.

The response accurately explains the appearance of the data, the range of data values, and explains extreme values in describing intervals that provides an analysis which supports the categorization of each variable value.

The response includes relevant, specific, and accurate examples that support the explanations provided for each of the areas described.

25 (25%) – 27 (27%)

The response inaccurately or vaguely summarizes the frequency distributions for the variables presented.

The response inaccurately or vaguely explains the number of times the value occurs in the data.

The response inaccurately or vaguely explains the appearance of the data, the range of data values, and inaccurately or vaguely explains extreme values.

An analysis that may support the categorization of each variable value is inaccurate or vague.

The response includes inaccurate and irrelevant examples that may support the explanations provided for each of the areas described.

0 (0%) – 24 (24%)

The response inaccurately and vaguely summarizes the frequency distributions for the variables presented, or it is missing.

The response inaccurately and vaguely explains the number of times the value occurs in the data, or it is missing.

The response inaccurately and vaguely explains the appearance of the data, the range of data values, and an explanation of extreme values, or it is missing.

An analysis that does not support the categorization of each variable values is provided, or it is missing.

The response includes inaccurate and vague examples that do not support the explanations provided for each of the areas described, or it is missing.

Summarize your interpretation of the descriptive statistics provided in the output for respondent’s age, highest school grade completed, race and ethnicity, currently employed, and family income from prior month. 45 (45%) – 50 (50%)

The response accurately and clearly summarizes in detail the interpretation of the descriptive statistics provided.

The response accurately and clearly evaluates in detail each of the variables presented, including an accurate and complete description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

40 (40%) – 44 (44%)

The response accurately summarizes the interpretation of the descriptive statistics provided.

The response accurately explains evaluates each of the variables presented, including an accurate description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

35 (35%) – 39 (39%)

The response inaccurately or vaguely summarizes the interpretation of the descriptive statistics provided.

The response inaccurately or vaguely evaluates each of the variables presented, including an inaccurate or vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data.

0 (0%) – 34 (34%)

The response inaccurately and vaguely summarizes the interpretation of the descriptive statistics provided, or it is missing.

The response inaccurately and vaguely evaluates each of the variables presented, including an inaccurate and vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data, or it is missing.

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 is provided which delineates all required criteria.
5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

3 (3%) – 3 (3%)

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.

0 (0%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was provided.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

4 (4%) – 4 (4%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3 (3%) – 3 (3%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 (0%) – 2 (2%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

3 (3%) – 3 (3%)

Contains several (3 or 4) APA format errors.

0 (0%) – 2 (2%)

Contains many (≥ 5) APA format errors.

Total Points: 100

Name:  Assignment Rubric

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