NURS_6630 Assignment: Assessing and Treating Patients with Bipolar Disorder Essay

NURS_6630 Assignment: Assessing and Treating Patients with Bipolar Disorder Essay

NURS_6630 Assignment: Assessing and Treating Patients with Bipolar Disorder Essay

Bipolar disorder is a chronic mood disorder that presents with a combination of hypomanic, manic, and depressive episodes, with significant sub-syndromal features that often manifest between the major mood episodes. Bipolar is classified into Bipolar I characterized by hypomania and major depression, and Bipolar II, characterized by mania and major depression. The case study is about a 26-year-old female of Korean descent on her first appointment after being hospitalized with acute mania and diagnosed with Bipolar I disorder. The client states that she has a fantastic mood. She sleeps roughly 5 hours per night, but she hates sleeping. Her medical records and diagnostic results show that she is in good health. However, genetic testing shows that she has a positive CYP2D6*10 allele. The client’s symptoms improved with lithium, but she has not adhered to the medication as prescribed. The patient weighs 110 pounds and is 5′ 5.

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On MSE, the patient is dressed inappropriately for the event. She has a rapid, pressured, and tangential speech. In addition, she has a euthymic mood and a broad affect. Her insight is impaired, but she denies having suicidal or homicidal ideations. She scores 22 on the Young Mania Rating Scale (YMRS). Patient factors that may influence decisions when prescribing medication for this client include the patient’s mood state since the treatment modality differs for mania, hypomania, and depression. Other factors that will impact treatment include past or current medications, medical and psychiatric comorbidities, treatment response, side effects, and the client’s treatment preferences. The purpose of this paper is to describe the patient’s treatment plan and the ethical factors that may impact the treatment plan and communication with the client.

Decision #1

Initiate Lithium 300 mg orally BID.

Why Did I Select This Decision?

Lithium was selected because it is the gold standard for treating bipolar disorder and preventing recurrences of both types I and II bipolar disorder. The long-term use of lithium has shown a decrease in suicide risk, and 50%-70% of patients on lithium demonstrate a decrease in mania (Tondo et al., 2019). According to Volkmann et al. (2020), lithium is recommended by significant guidelines as a first-line medication for maintenance therapy.

Why Did I Not Select The Other Two Options Provided In The Exercise?

The Risperdal option was not selected because it is not approved for patients with a positive CYP2D6*10 allele. Cui et al. (2020) explain that individuals with a CYP2D6*10 allele have a reduced metabolism rate of risperidone. The reduced metabolism rate slows Risperdal clearance, causing sedation due to high serum drug levels. Risperdal would cause sedation in the patient, decreasing the compliance rate. In addition, Seroquel was not selected because of its associated metabolic side effects that cause elevated triglycerides and total cholesterol levels and eventually weight gain (Shah et al., 2017). The client is overweight, and prescribing Seroquel would worsen it, making it a less ideal medication.

What Was I Hoping To Achieve By Making This Decision?

            I hoped that lithium would alleviate the patient’s manic symptoms and reduce the YMRS score to at least 12. Tondo et al. (2019) explain that lithium has shown the benefit of preventing recurrences of mania and depression in bipolar disorder in multiple placebo-controlled, randomized trials.

Ethical Considerations

Ethical considerations that would affect the treatment plan include principles of beneficence and nonmaleficence. Beneficence requires that the provider promotes the best outcomes, while nonmaleficence is the moral duty to cause no harm (Ostacher, 2019). The two principles impacted the treatment plan since I had to select a drug associated with promoting the best outcomes in bipolar disorder with the least side effects.

Decision #2

Increase lithium to 450 mg orally BID.

Why Did I Select This Decision?

The decision to increase the Lithium dose was selected because the patient exhibited no changes in the manic symptoms. I continued treatment with lithium because patients should be continued on lithium for some months when treating an acute manic episode or bipolar depression (Tondo et al., 2019).

Why Did I Not Select The Other Two Options Provided In The Exercise?

I did not select the option of assessing the rationale for non-compliance because the patient did not report any side effects with the current drug that caused non-compliance to treatment. Besides, I did not change treatment to Depakote because lithium’s effect in treating mania had not been established. According to Volkmann et al. (2020), changing lithium to another drug requires caution and only after the desired treatment response is not attained despite the patient complying with treatment.

What Was I Hoping To Achieve By Making This Decision?

I hoped that increasing the Lithium dose would improve the patient’s manic symptoms and she would report seeing improvement in her mood. Tondo et al. (2019) assert that early long-term treatment and follow-up are recommended after a patient has developed a manic episode due to the adverse effect of bipolar disorder on a patient’s occupational, educational, and social functioning.

Ethical Considerations

Ethical considerations that affected the treatment plan include beneficence, which led to interventions to promote good (Ostacher, 2019). For instance, the Lithium dose was increased to promote better health outcomes for the patient and alleviate manic symptoms that impair her normal functioning.

Decision #3

Assess the rationale for non-compliance and educate the client.

Why Did I Select This Decision?

The above option was selected because the patient stated that she was not complying with her treatment. The incompliance had interfered with the recovery, as evidenced by the persistence of the patient’s manic symptoms. Jawad et al. (2018) state that factors that cause nonadherence include poor insight, complex medication regimens, adverse effects of medication, negative client attitudes to the drug, comorbid substance misuse, and an ineffective therapeutic alliance.

Why Did I Not Select The Other Two Options Provided In The Exercise?

The option of hospitalization was not considered because the patient did not have any symptoms necessitating admission, such as suicidal thoughts. Most Bipolar patients are treated and monitored as outpatients unless their medications require monitoring or daily adjustment (Shah et al., 2017). Furthermore, I did not change treatment to Abilify because it is recommended as an adjunct treatment to mood stabilizers in treating new-onset and recurrent mania.

What Was I Hoping To Achieve By Making This Decision?

I was hoping that examining the rationale for non-compliance would help identify the patient’s reasons and thus take interventions to address them. I also hoped that increasing adherence would ultimately improve the client’s manic symptoms. Providers should regularly ask about nonadherence in a non-judgmental way. Potential approaches to enhance compliance include simple, practical steps associated with prescribing, including psychoeducation focusing on adherence, shared decision-making, and improving therapeutic alliance (Jawad et al., 2018).

Ethical Considerations

The respect for autonomy influenced the treatment plan since the patient had to identify the reasons for treatment compliance. Involving the patient would help increase her compliance and enable her to appreciate the importance of medication in alleviating the manic symptoms (Ostacher, 2019).

Conclusion

The patient in the case study has Bipolar disorder with features of mania and a YMRS score of 22. The patient was started on Lithium 300 mg because it is the gold standard for treating bipolar disorder and preventing recurrences of both types I and II bipolar disorder (Tondo et al., 2019). It is indicated as the first-line therapy in maintenance therapy. Risperdal was not appropriate for this patient because it is not recommended for patients with a positive CYP2D6*10 allele, resulting in a reduced clearance rate. Risperdal would have led to sedation due to increased blood levels. Seroquel was not also appropriate due to the side effect of weight gain, which would have worsened the patient’s current overweight status.

In the second decision, the Lithium dose was increased to 450 mg because the patient showed no response to treatment. However, no positive response was seen after increasing the dose because of the patient’s incompliance with treatment. In the third step, the patient’s rationale for non-compliance was assessed, and she was educated on the importance of compliance (Jawad et al., 2018). The aim was to involve the patient and thus increase compliance and eventually reduce manic symptoms. Ethical considerations that impacted the treatment plan include beneficence, nonmaleficence, and autonomy (Ostacher, 2019). The selected treatment interventions were associated with the best outcomes and had the least adverse effects, which promoted these principles.

References

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

Jawad, I., Watson, S., Haddad, P. M., Talbot, P. S., & McAllister-Williams, R. H. (2018). Medication nonadherence in bipolar disorder: a narrative review. Therapeutic advances in psychopharmacology, 8(12), 349–363. https://doi.org/10.1177/2045125318804364

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

Shah, N., Grover, S., & Rao, G. P. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian journal of psychiatry, 59(Suppl 1), S51–S66. https://doi.org/10.4103/0019-5545.196974

Tondo, L., Alda, M., Bauer, M., Bergink, V., Grof, P., Hajek, T., Lewitka, U., Licht, R. W., Manchia, M., Müller-Oerlinghausen, B., Nielsen, R. E., Selo, M., Simhandl, C., Baldessarini, R. J., & International Group for Studies of Lithium (IGSLi) (2019). Clinical use of lithium salts: guide for users and prescribers. International journal of bipolar disorders, 7(1), 16. https://doi.org/10.1186/s40345-019-0151-2

Volkmann, C., Bschor, T., & Köhler, S. (2020). Lithium Treatment over the Lifespan in Bipolar Disorders. Frontiers in psychiatry, 11, 377. https://doi.org/10.3389/fpsyt.2020.00377

BUY A CUSTOM-PAPER HERE ON;NURS_6630 Assignment: Assessing and Treating Patients with Bipolar Disorder Essay

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.
The Decision Tree Assignments are based on interactive case studies that allow you to explore pharmaceutical options and make decisions centered on the client’s needs. You will be asked to make three decisions concerning the medication to prescribe to a client in the assigned scenarios. At each decision point, you must evaluate all options before clicking on your decision and moving through the rest of the exercise. The rationale for your decisions must be supported with a minimum of five academic resources from the primary and secondary literature. While you may use the course text to support your rationale, it will not count toward the resource requirement.
Submit a 5 page paper written on the interactive case study entitled, An Asian American Woman with Bipolar Disorder. This case can be found in the week 5 folder under the Resources tab. Click on Required Media to expand the case. If your first draft is more than 5 pages, you should consolidate your writing. In my experience, papers greater than 5 pages in length are repetitive and/or contain extraneous information that is not part of the required content. Part of this exercise is to learn how to sift through the literature and extract the pertinent information. Failure to do so may result in point deductions for issues with clarity. The final draft that you submit must follow the format endorsed by the nursing program, and this paper must address the required content outlined in the grading rubric and instructions. The required format is illustrated in the writing template. The writing template and grading rubric can all be found under the Assignment tab in the week 4 folder. The formal instructions and my notes on grading are shown below:
Formal Decision Tree Instructions
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.
Be aware that the writing template and grading rubric require your introduction to end with one sentence that is your thesis statement. See the writing template for format and the grading rubric for details on how you are graded on this statement.
Body of your document
The body of your document should contain three sections that are labeled as follows: decision #1, decision #2, and decision #3. Each section should address the topics below. In your writing, you should be concise, clear, and thorough. Pharmacokinetics, pharmacodynamics, and specific patient factors must be considered in your writing in order to get full credit.
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. *Ethical considerations must be clearly identified/labeled. You can identify them within the decision section (“My ethical considerations are…”), or you can identify them separately in a section labeled “Ethical Considerations.” Either option is acceptable.
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.
Grading
My goal is to provide you with a grade and meaningful feedback within 5 days after the due date. Please note that assignments turned in late will not be graded within this time frame and feedback will be minimal.
Rubric Detail

BUY A CUSTOM-PAPER HERE ON;NURS_6630 Assignment: Assessing and Treating Patients with Bipolar Disorder Essay

Name: NURS_6630_Week5_Assignment_Rubric
Grid View
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.
9 (9%) – 10 (10%)
Decision #1 (1–2 pages)
• 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
Decision #2 (1–2 pages)
• 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
Decision #3 (1–2 pages)
• 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
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.
14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.
The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.
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.
Total Points: 100