NURS 6630 Assessing and Treating Patients With Bipolar Disorder

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

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.

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.

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

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.

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

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.

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.
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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.

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 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

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NURS 6630 Assessing and Treating Patients With Bipolar Disorder Grading Criteria

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Week 5 Assignment

In the provided case study, the 8-year-old Caucasian female patient came to the clinic accompanied by her parents for psychiatric evaluation. The patient’s teacher suggested that the patient might be having attention deficit hyperactivity disorder (ADHD). Their family physician also suggested that the patient should see a psychiatrist for further evaluation of her mental disorder. The patient parents came with a completed Conner’s Teacher Rating Scale-Revised screening tool, which revealed that the patient is easily distracted at school, and with a short attention span. The patient also displayed poor arithmetic, spelling, and reading skills in addition to being inattentive and forgetful most of the time. Her teacher claims that the patient even failing to complete her homework will lack interest in school activities. She also fails to follow instructions at times. Despite the patient’s parents being in denial that their daughter has ADHD, mental status examination results proved otherwise together with the Conner’s Teacher Rating Scale-Revised screening tool completed by the teacher, supporting the diagnosis of attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation.

Developing a treatment plan for pediatric patients with mental disorders is quite challenging given the safety issues associated with this age group. However, appropriate prescriptive practice will involve considering patient-specific factors that might affect the pharmacokinetic and pharmacodynamic processes. Such factors which will affect the decision on which drugs to prescribe include the patient young age, Caucasian race, female gender, ADHD diagnosis, and presenting symptoms. The purpose of this discussion is thus to demonstrate the appropriate decision-making process in the selection of the most appropriate intervention in the treatment of the 8-year-old attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation.

Decision Point One

Selected Decision and Rationale

            From the listed options, initiating Ritalin (methylphenidate) 10mg chewable tablets taken every morning was decided on as the initial intervention. Ritalin is recommended by most clinical guidelines as the first-line medication for the management of ADHD among both children and adults (Rodrigues et al., 2021). Despite the psychostimulant not being approved by the FDA, it has displayed great effectiveness in the management of ADHD with a desirable safety profile in most children from ages 6 to 15 years (American Psychiatric Association, 2013; Castells et al., 2021)). It has demonstrated a substantial impact in managing ADHD symptoms such as inattention, forgetfulness, impulsivity, diminished interest, and hyperactivity among children (Hodgkins et al., 2012). The chewable formulation is considered the best option for children with sweeteners to mask the bitter taste of the drug (Breaux et al., 2022). Consequently, the drug has a short onset of action of between 1 to 2 hours with a long duration of action of between 7.5 to 10.5 hours after oral administration (Mechler et al., 2021). This helps in the management of the patient’s symptoms all day long (Coghill et al., 2021).

Bupropion is associated with increased risks of seizures among children below the age of 10 years, hence not an appropriate decision (Coghill et al., 2021). Intuniv on the other hand is associated with cardiovascular side effects, hence should only be considered in case there is no other safer and more effective drug for use in the pediatric population (Rodrigues et al., 2021).

Expected Outcome

The patient will experience improved symptoms of ADHD in the next four weeks (Coghill et al., 2021). She should be able to improve her spelling, arithmetic, and language skills, in addition to being more attentive and able to concentrate on school work (Hodgkins et al., 2012). Her school performance will improve significantly within this period.

Ethical Considerations

            The patient is 8 years of age, which gives the parents legal responsibility of making decisions concerning the health of their child (American Psychiatric Association, 2013). As such, the PMHNP must educate them adequately regarding the patient’s diagnosis and potential treatment options, to promote sound decision-making in promoting the health of their child (Rodrigues et al., 2021).

Decision Point Two

Selected Decision and Rationale

            The second decision was to change the treatment regimen to long-acting Ritalin 20mg administered orally in the morning. Based on the treatment outcome, Ritalin displayed potential effectiveness given that the patient’s ADHD symptoms improved evidenced by her improved school performance (Breaux et al., 2022). However, since the medication was not able to manage the patient’s symptoms throughout the entire day, it was necessary to introduce a long-acting formulation to prolong the duration of action of the drug (American Psychiatric Association, 2013). Studies show that long-acting Ritalin lasts for between 8 to 12 hours hence, helps in managing the patient’s symptoms throughout the day (Castells et al., 2021). It is also administered once daily which is more convenient and much easier. The patient also reported a side effect of elevated pulse, which is a common self-limiting side effect of Ritalin that is expected to diminish with time (Coghill et al., 2021).

Continuing with the same drug at the same dosage was inappropriate as the patient would still exhibit ADHD symptoms later in the day, once the drug wears off from the body system (Mechler et al., 2021). Replacing Ritalin with Adderall is also inappropriate as Adderall is associated with increased incidences of suicidal events when used among children (Hodgkins et al., 2012).

Expected Outcome

            The long-acting formulation is expected to manage the patient’s symptoms all day long within the following four weeks (Breaux et al., 2022). The patient’s school performance will improve even further. The side effect of elevated heart rate will resolve completely within this time (Coghill et al., 2021).

Ethical Considerations

            In making this decision, the PMHNP had to consider several ethical principles including justice, beneficence, nonmaleficence, and respect for the patient’s autonomy (Breaux et al., 2022). The patient was quite comfortable with how the drug was working, but only concerned with the side effect, and effectiveness of the medication later in the day (Rodrigues et al., 2021). As such, it was necessary to respect the patient and display clinical judgment in making decisions that will promote the patient’s mental health.

Decision Point Three

Selected Decision and Rationale

            Maintaining the patient on the current medication and reevaluating after four weeks, seemed to be the most appropriate decision for the third intervention. The patient reported great effectiveness and tolerance to the medication, with resolved side effects of an elevated pulse (Mechler et al., 2021). Previous evidence shows that once the optimal dose of Ritalin has been attained, it can take between 8 to 12 weeks to completely manage the patient’s symptoms of ADHD (American Psychiatric Association, 2013; Castells et al., 2021). Consequently, at safe doses, long-term use of the drug has been associated with limited possibilities of side effects, hence the need to reevaluate the patient within 4 weeks (Hodgkins et al., 2012). Studies also show that long-term use of Ritalin normally reduces the risks of side effects as the patient will display further tolerance to the drug, enhancing its safety profile (Breaux et al., 2022).

Increasing the dose of Ritalin to 30mg was not necessary at this point, as studies suggest that low effective doses are safer to use to promote positive outcomes, with reduced risks of side effects (Mechler et al., 2021). Consequently, obtaining EKG at this point was not necessary given that the patient’s pulse had already resolved back to normal for her age, with a recording of 92 during the current visit (Rodrigues et al., 2021).

Expected Outcome

            With great compliance to the treatment regimen, the patient will report even further management of the ADHD symptoms over the following two weeks (Breaux et al., 2022). Her academic performance is also expected to improve (American Psychiatric Association, 2013). No side effects are expected.

Ethical Considerations

            The nurse’s main objective is to promote the health of the patient and not harm. At this point, the patient was satisfied with the treatment outcome (Hodgkins et al., 2012). It was thus necessary to respect the patient’s autonomy and maintain the dose for further evaluation of the treatment outcome (Mechler et al., 2021).

NURS 6630 Assessing and Treating Patients With Bipolar Disorder Conclusion

The 8-year-old patient in the case study presented with symptoms of ADHD. Formulating a treatment plan for the patient involved consideration of certain patient-specific factors which affect her pharmacokinetic and pharmacodynamic processes (American Psychiatric Association, 2013). Such factors which will affect the decision on which drugs to prescribe include the patient young age, Caucasian race, female gender, ADHD diagnosis, and presenting symptoms. Based on these factors, the first decision was to initiate a 10mg Ritalin chewable table once daily as recommended by most clinical guidelines given its effectiveness in the management of ADHD and safety for pediatric use (Coghill et al., 2021). Intuniv and bupropion were neglected because of their increased risks of side effects among children as reported by most studies (Mechler et al., 2021). After 4 weeks, the patient came back to the clinic reporting improved symptoms but with side effects of increased pulse rate. The second decision was thus to change the treatment regimen to long-acting Ritalin 20mg once daily in the morning, to prolong the duration of action of the medication throughout the day (Castells et al., 2021). Maintaining the dose would still lead to ineffectiveness, while Adderall display increased risks of suicidality hence neglected (Breaux et al., 2022).

The patient reported further improvement in ADHD symptoms all day long, with resolved side effects of elevated pulse, which led to the final decision of maintaining the treatment regimen and reevaluating the patient after 4 weeks. Obtaining EKG and increasing the dose of Ritalin was not necessarily due to safety issues (Hodgkins et al., 2012). Finally, the PMHNP encountered several ethical considerations in each decision process with the observation of ethical principles such as justice, respect for patient autonomy, not harm, and beneficence (Rodrigues et al., 2021).

 

 

NURS 6630 Assessing and Treating Patients With Bipolar Disorder References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Breaux, R., Dunn, N. C., Swanson, C. S., Larkin, E., Waxmonsky, J., & Baweja, M. D. (2022). A Mini-Review of Pharmacological and Psychosocial Interventions for Reducing Irritability Among Youth With ADHD. Frontiers in Psychiatry, 151. https://doi.org/10.3389/fpsyt.2022.794044

Castells, X., Ramon, M., Cunill, R., Olivé, C., & Serrano, D. (2021). Relationship between treatment duration and efficacy of pharmacological treatment for ADHD: a meta-analysis and meta-regression of 87 randomized controlled clinical trials. Journal of attention disorders25(10), 1352-1361. https://doi.org/10.1177/1087054720903372

Coghill, D., Banaschewski, T., Cortese, S., Asherson, P., Brandeis, D., Buitelaar, J., … & Simonoff, E. (2021). The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG). European Child & Adolescent Psychiatry, 1-25. https://doi.org/10.1007/s00787-021-01871-x

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. https://doi.org/10.2165/11599630-000000000-00000

Mechler, K., Banaschewski, T., Hohmann, S., & Häge, A. (2021). Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & Therapeutics, 107940. https://doi.org/10.1016/j.pharmthera.2021.107940

Rodrigues, R., Lai, M. C., Beswick, A., Gorman, D. A., Anagnostou, E., Szatmari, P., … & Ameis, S. H. (2021). Practitioner Review: Pharmacological treatment of attention‐deficit/hyperactivity disorder symptoms in children and youth with autism spectrum disorder: a systematic review and meta‐analysis. Journal of Child Psychology and Psychiatry62(6), 680-700. https://doi.org/10.1111/jcpp.13305

NURS 6630 Assessing and Treating Patients With Bipolar Disorder Grading Rubric Guidelines DQ

Performance Category 10 9 8 4 0
Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic decisions.

  • Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions
  • Evaluates literature resources to develop a comprehensive analysis or synthesis.
  • Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion
  • Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions.
  • Evaluates information from source(s) to develop a coherent analysis or synthesis.
  • Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.
  • Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
  • Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.
  • Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion.
  • Demonstrates little or no understanding of the topic.
  • Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
  • Information is taken from source(s) without any interpretation/evaluation.
  • The posting uses information that is not valid, relevant, or reliable
  • No evidence of the use of scholarly inquiry to inform or change professional or academic decisions.
  • Information is not valid, relevant, or reliable
Performance Category  10 9 8 4 0
Application of Course Knowledge –

Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations

  • Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources;
  • Applies concepts to personal experience in the professional setting and or relevant application to real life.
  • Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources.
  • Applies concepts to personal experience in their professional setting and or relevant application to real life
  • Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content
  • Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson.
  • Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
  • Does not demonstrate a solid understanding of the principles and concepts presented in the lesson
  • Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post.
  • Posts are superficial and do not reflect an understanding of the lesson content
  • Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
  • Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored
  • No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category  5 4 3 2 0
Interactive Dialogue

Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days.

(5 points possible per graded thread)

  • Exceeds minimum post requirements
  • Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days.
  • Replies to a post posed by faculty and to a peer
  • Summarizes what was learned from the lesson, readings, and other student posts for the week.
  • Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days
  • Replies to a question posed by a peer

Summarizes what was learned from the lesson, readings, and other student posts for the week.

  • Meets expectations of 2 posts on 2 different days.
  • The main post is not made by the Wednesday deadline
  • Does not reply to a question posed by a peer or faculty
  • Has only one post for the week
  • Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments
  • Does not post to the thread
  • No connections are made to the topic
  Minus 1 Point Minus 2 Point Minus 3 Point Minus 4 Point Minus 5 Point
Grammar, Syntax, APA

Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted.

Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition

  • 2-3 errors in APA format.
  • Written responses have 2-3 grammatical, spelling, and punctuation errors.
  • Writing style is generally clear, focused, and facilitates communication.
  • 4-5 errors in APA format.
  • Writing responses have 4-5 grammatical, spelling and punctuation errors.
  • Writing style is somewhat focused.
  • 6-7 errors in APA format.
  • Writing responses have 6-7 grammatical, spelling and punctuation errors.
  • Writing style is slightly focused making discussion difficult to understand.
  • 8-10 errors in APA format.
  • Writing responses have 8-10 grammatical, spelling and punctuation errors.
  • Writing style is not focused, making discussion difficult to understand.
  • Post contains greater than 10 errors in APA format.
  • Written responses have more than 10 grammatical, spelling and punctuation errors.
  • Writing style does not facilitate communication.
  • The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
0 points lost       -5 points lost
Total Participation Requirements

per discussion thread

The student answers the threaded discussion question or topic on one day and posts a second response on another day. The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement

per discussion thread

The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week. The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

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

Title: NURS 6630 Assessing and Treating Patients With Bipolar Disorder

Assessing and Treating Patients With Bipolar Disorder  

Bipolar disorder is one of the most common mental illnesses characterized by drastic shifts in the patient’s mood, activity, and energy levels, affecting their ability to conduct daily tasks (Marzani, & Neff, 2021). Such drastic changes in the patient’s energy levels and mood are more severe, unlike the normal ups and downs experienced by most people. The National Institute of Mental Health (NIH) reported that approximately 2.8% of adults in the United States were diagnosed with bipolar disorder last year (Citrome, 2020). Bipolar disorders are associated with severe morbidity and mortality rates. However, through evidence-based practice, several treatment options have been proposed with proven effectiveness in the management of patients with bipolar disorder. In this discussion, the choices of medication used to manage a young Asian adult diagnosed with bipolar type 1 have been discussed in addition to the reasons behind the choice of psychotropic agent and the expected outcome and legal and ethical considerations encountered by the PMHNP. The choices of medications used are based on both pharmacodynamic and pharmacokinetic factors.  

The case study provided described a 26 years old Asian woman who presented to the clinic with a primary diagnosis of bipolar type 1. The patient was previously hospitalized for 21 days as a result of the onset of acute mania. The patient is in good health with a stable mood at the moment but claims to hate sleeping. She is however underweight with a BMI of 18.3. Genetic testing reveals that the patient is positive for the CYP2D6*10 allele. She has been taking lithium to manage her mental condition during the hospitalization period, which she stopped talking when she was discharged.  Mental examination results reveal that the patient is oddly groomed, but displays perfect orientation in person, time, and place. She is however rapid and pressured. Upon administration of the Young Mania Rating Scale (YMRS), the patient revealed a score of 22, which indicated mild mania. She however denies suicidal ideation and auditory or visual hallucination.  

Decision #1 

Begin Seroquel XR 100 mg orally at HS 

Reason Behind Decision 1:  

Seroquel (Quetiapine) is recommended by most study guidelines for the management of bipolar disorder as monotherapy. The mood-stabilizing effects of Seroquel are associated with its antagonistic effect at the 5-HT2A and D2 receptors (Citrome, 2020). Studies have revealed great effectiveness of the drug and long-term adherence among patients on extended-release (XR) quetiapine which is administered once daily. The drug also exhibits a desirable safety profile with mild side effects which can be managed non-pharmacologically such as changes in weight. The drug is metabolized in the liver by cytochrome P450 (CYP) 3A4, which is low among patients with CYP2D6*10 allele such as Asians. This promotes slow metabolism, hence prolonged duration of action. 

The use of lithium is not appropriate given that the patient stopped taking the drug immediately, which is discouraged as a result of increased risks of relapse and non-compliance. Lithium is also associated with undesirable side effects such as weight gain and GI disturbances especially when administered in higher doses like 300mg (Lin et al., 2020).  

Risperdal is also not a good alternative for the patient as monotherapy. The drug displays great effectiveness when administered in combination with lithium (Marzani, & Neff, 2021). Consequently, the recommended starting dose with Risperdal is 2 to 3mg once daily, which makes the 1mg dose undesirable.  

 

Expected Outcome 

Within the next 4 weeks, the patient is expected to exhibit at least 50% remission of manic symptoms (Citrome, 2020). Her compliance level is also expected to improve, with good sleeping patterns. Her agitation is also expected to reduce. Upon administration of the Young Mania Rating Scale (YMRS), the patient should record a score of less than 12.  

Ethical Considerations Impact on Treatment Plan 

According to the legal and ethical guidelines, the PMHNP must take into account the patient’s race and ethnicity in formulating the most effective treatment plan (Lin et al., 2020). Consequently, given that the patient is an adult, the nurse needs to involve the patient in making decisions concerning the medication choice to promote satisfaction.  

Decision 2: 

Discontinue using Seroquel and Start 40mg Geodon 40 mg orally BID. 

Reason Behind Decision 2: 

The initial intervention revealed minimal effectiveness in controlling the patient’s manic episodes. Consequently, undesired side effects were exhibited by the patient such as constipation, weight gain, and dry mouth which made the patient uncomfortable with the drug. As such it is necessary to discontinue the drug and initiate Geodon which is FDA approved for the management of manic episodes among patients diagnosed with bipolar 1 disorder (Marzani, & Neff, 2021). The drug exhibits a desirable safety profile, unlike Seroquel. Consequently, studies show that Geodon has great bioavailability, and hence must be administered with a 500 calorie intake. The patient also disliked the weight gain side effect associated with the initial drug which will not be the case with Geodon.  

Increasing the dose of Seroquel is not appropriate as this will only worsen the side effects already exhibited by the patient (Rhee et al., 2020). The patient also suggested the drug changes, and ignoring her request would only promote non-compliance and affects their therapeutic relationship with the nurse.   

Continuing the same dose of the medication is also against the patient’s will as this will lead to a further increase in the patient’s body weight (Lin et al., 2020). Consequently, the drug displayed minimal effectiveness which is below the desired therapeutic threshold in the management of bipolar.  

Expected Outcome 

The patient is expected to display at least 50% remission of symptoms within the next four weeks. Her sleeping pattern and agitation levels are expected to improve significantly (Rhee et al., 2020). Consequently, the initial side effects such as dry mouth, constipation, and weight gain are expected to resolve once Seroquel has been discontinued.  

Ethical Considerations Impact on Treatment Plan 

The legal and ethical requirements give the patient the right of making decisions concerning her health (Marzani, & Neff, 2021). As such, the PMHNP must respect the patient’s decision and make appropriate interventions as desired by the patient to promote satisfaction which intern builds on a positive therapeutic relationship with the patient.  

Decision 3: 

Continue the same dose and reassess in 4 weeks.  

Reason Behind Decision 1:  

The patient displayed great tolerance and adherence to the previous intervention with 50% remission of symptoms. Consequently, the undesired side effects were resolved within this time, promoting patient compliance. Studies show that despite the goal of attaining 100% remission of symptoms with psychotropic agents, a 50% management of symptoms is still desirable. Consequently, Geodon takes up to 8 to 12 weeks to completely managed maniac symptoms among patients with bipolar disorder (Mazza et al., 2020). As such, it is necessary to continue the same dose to promote further management of the patient’s symptoms, with no side effects. The treatment outcome must however be evaluated after four weeks, given that the treatment regimen was changed just after the first intervention failed. 

Increasing the dose of Geodon is not necessary given the great tolerance and effectiveness displayed by the patient (Mazza et al., 2020). Consequently, studies show that increased plasma concentrations of the drug are associated with severe side effects such as weight gain which resulted in to change of regimen in the first place. 

Augmenting Geodon with lithium is desirable, but at low doses to avoid side effects (Mazza et al., 2020). Consequently, this intervention could only be considered among patients who are not lithium defaulters as this will only compromise the patient’s compliance levels.  

Expected Outcome 

The patient is expected to display complete remission of symptoms within the next four weeks. She should be able to sleep well, with significantly reduced agitation levels (Rhee et al., 2020). Her scores upon administration of the Young Mania Rating Scale should also display a reading of less than 8.  

Ethical Considerations Impact on Treatment Plan 

According to the nursing code of ethics, it is the obligation of the PMHNP to promote the patient’s health and prevent harm. Consequently, holistic care requires the nurse to promote patient-centered care to attain positive treatment outcomes (Rhee et al., 2020). As such, listening to the patient and involving them in making decisions concerning which intervention is appropriate for their health is necessary.  

Conclusion 

Bipolar disorder is one of the most common mental illnesses across the world with increased morbidity and mortality rates. However, with early detection, studies show that patients can greatly benefit from the available treatment options with improved quality of life. Clinicians must also consider pharmacodynamic and pharmacokinetic factors when deciding on which medication to use for a given patient (Citrome, 2020). In the provided case study, the first intervention was to initiate the patient on Seroquel which is FDA approved for the management of bipolar among adults. However, the drug displayed undesired side effects such as weight gain, which made the patient uncomfortable with taking the medication (Lin et al., 2020). Consequently, the drug displayed minimal effectiveness, which led to changing the treatment regimen is the second decision. Geodon, is also FDA approved for the management of manic episodes among bipolar patients, hence considered as the best replacement for Seroquel (Mazza et al., 2020). The patient displayed great adherence and tolerance to this medication with 50% remission of symptoms. Consequently, the initial side effects were resolved. 

As a result, it was necessary to maintain the dose of this medication for the third intervention to avoid additional side effects and promote further remission of the patient’s symptoms. several legal and ethical considerations were encountered with the PMHNP in the management of this patient (Marzani, & Neff, 2021). For instance, the patient being an adult gives her the right of making decisions concerning her health. As such, the nurse needed to change the patient’s regimen when she was not comfortable with the weight to gain side effects as a result of Seroquel (Rhee et al., 2020). General, the nurse has the obligation of promoting the patient health and preventing harm.  

 

 

References 

Citrome, L. (2020). Food and Drug Administration–Approved Treatments for Acute Bipolar Depression: What We Have and What We Need. Journal of Clinical Psychopharmacology, 40(4), 334-338. DOI: 10.1097/JCP.0000000000001227 

Lin, Y., Mojtabai, R., Goes, F. S., & Zandi, P. P. (2020). Trends in prescriptions of lithium and other medications for patients with bipolar disorder in office-based practices in the United States: 1996–2015. Journal of Affective Disorders, 276, 883-889. https://doi.org/10.1016/j.jad.2020.07.063 

Marzani, G., & Neff, A. P. (2021). Bipolar Disorders: Evaluation and Treatment. American Family Physician, 103(4), 227-239. PMID: 33587568. 

Mazza, M., Marano, G., Giuseppin, G., & Janiri, L. (2020). Ziprasidone in treating bipolar child and adolescent patients: More research is warranted. Bipolar disorders, 22(3), 311-312. https://doi.org/10.1111/bdi.12911 

Rhee, T. G., Olfson, M., Nierenberg, A. A., & Wilkinson, S. T. (2020). 20-year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings. American Journal of Psychiatry, 177(8), 706-715. https://doi.org/10.1176/appi.ajp.2020.19091000 

 

 

 

 

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