Assignent Solutionnurs

Examine Case Study: Pakistani Woman With Delusional Thought Processes. 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. 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. 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. BACKGROUND The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month. Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control,” which resulted in his calling the police and her subsequent admission to an inpatient psych unit. During today’s assessment, she appears quite calm and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She says she knows this because the television is telling her so. She currently weighs 140 lbs., and she is 5’ 5. SUBJECTIVE Client reports that her mood is “good.” She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down. A review of her hospital records shows that she received a medical workup from a physician, who reported her to be in overall good health. Lab studies were all within normal limits. Client admits that she was tolerating her Risperdal well but stopped taking about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman. MENTAL STATUS EXAM The client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation. You administer the PANSS which reveals the following scores: -40 for the positive symptoms scale -20 for the negative symptom scale -60 for general psychopathology scale Diagnosis: Schizophrenia, paranoid type Decision Point One Select what you should do: Start Zyprexa (olanzapine) 10 mg orally at BEDTIME Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter Start Abilify (aripiprazole) 10 mg orally at BEDTIME Decision Point One Start Zyprexa (olanzapine) 10 mg orally at BEDTIME RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Her PANSS decreases to a partial response (decrease in positive symptoms by 25%) She comes in today with a reported weight gain of 5 pounds. When questioned further on this point, she states that she can never seem to get full from her meals, so she is snacking constantly throughout the day Decision Point Two Decrease Zyprexa to mg orally at BEDTIME RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Result of next decision (what happened): Client worsens (her positive symtpoms scale increased by 25% and her negative symptom scale score decreased by 10% indicating improved negative symptoms), but her weight becomes stabilized and excessive hunger abates Husband explains that she is becoming less manageable at home, and he has to take time off from work because he is fearful of leaving her alone Decision Point One Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks A decrease in the PANSS score of 25% (in positive symtpoms) is noted at this visit Client seems to be tolerating medication Her husband has made sure she makes her appointments for injections (one thus far) She has noted a 2-pound weight gain, but it does not seem to be an important point for her She does, however, complain of injection-site pain, telling you that she has trouble sitting for a few hours after the injections and doesn’t like having to walk around for such a long period of time Decision Point Two Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Her PANNS has been reduced by a total of 50% (in positive symptoms) from the initiation of Invega Sustenna When questioned about injection-site pain, she states it is much better in the arm Her weight has increased by an additional pounds (total of pounds in a 2-month period). She is somewhat bothered by the weight gain and is afraid that her husband does not like it. He is not present at this visit as she brought herself She likes how she feels on the Invega Sustenna but is wondering if there is another drug like it that would not cause the weight gain Decision Point One Start Abilify (aripiprazole) 10 mg orally at BEDTIME RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Client returns and looks disheveled. Upon questioning, her husband states that she has not been sleeping at night. He states she is up and down all night. It has been disrupting his sleep too The client is unable to participate in the PANSS rating tool because she is continually nodding off (sleeping) during the appointment The appointment is not productive for assessing how she is responding to the Abilify started 4 weeks ago Decision Point Two Change Abilify administration time to AM dosing RESULTS OF DECISION POINT TWO Client arrives at office appearing to have slept better. Her husband tells you that she is still up and down at night, but it is much less frequently He notices that it is better when she takes her medication as soon as she awakens, but some days she forgets and takes it when she remembers (in the afternoon) Her PANNS has decreased by 5% since her initial visit