NURS 6630 CCON Treating Clients with Bipolar Disorder Discussion

NURS 6630 CCON Treating Clients with Bipolar Disorder Discussion

NURS 6630 CCON Treating Clients with Bipolar Disorder Discussion

Week 4 Case Study

Assignment: Assessing and Treating Clients with With Bipolar Disorder

The Assignment

Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be required to make three judgments on the medicine to be prescribed to this customer. Take into account any circumstances that may have an influence on the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop 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 CCON Treating Clients with Bipolar Disorder Discussion

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

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. NURS 6630 CCON Treating Clients with Bipolar Disorder Discussion

Retrieved from http://acta.tums.ac.ir/index.php/acta

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy.

BACKGROUND INFORMATION

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. NURS 6630 CCON Treating Clients with Bipolar Disorder Discussion

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?” NURS 6630 CCON Treating Clients with Bipolar Disorder Discussion

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. NURS 6630 CCON Treating Clients with Bipolar Disorder Discussion

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 Seroquel XR 100 mg orally at HS

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Client is reporting that she sleeps a bit more at bedtime
  • Client states that she has gained about 2 or 3 pounds, which she does not like
  • Client also reports that she has been constipated since starting this medication
  • Client is also complaining of dry mouth which she does not like.
  • Client’s score on the Young Mania Rating Scale has decreased from a 22 to an 18
  • Client is reporting really good mood, but is asking for a different medication because of the weight gain

Decision Point Two

Discontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie meal

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client demonstrates a 50% decrease in score on the Young Mania Rating Scale (from 22 to 11)
  • Client denies any additional weight gain and denies any additional side effects

Decision Point Three

Continue same dose and reassess in 4 weeks

Guidance to Student

The PMHNP should provide counseling to the client about this side effect and encourage increased fluids and fiber in the diet to combat constipation. Hard candies or gum can be used to prevent dry mouth. This is another issue as the drug can cause dental problems as a result of dry mouth. NURS 6630 CCON Treating Clients with Bipolar Disorder Discussion

Changing to Geodon clearly helped with symptoms and arrested weight gain in this client. The PMHNP could wait 4 weeks and see if any changes in Young Mania Rating Scale are noted, or increasing to 60 mg orally BID in an attempt to hasten symptom improvement. Increasing dose may be associated with side effects.

Augmentation with Lithium may be appropriate if the goal of therapy is to discontinue antipsychotic therapy and treat with Lithium monotherapy. Lithium was problematic for this client but changing formulation to the extended release may overcome the difficulties she was experiencing with side effects. The PMHNP would need to educate client regarding side effects of medication and need to maintain compliance. NURS 6630 CCON Treating Clients with Bipolar Disorder Discussion