NURS 6630 Treating Clients with Bipolar Disorder Discussion
NURS 6630 Treating Clients with Bipolar Disorder Discussion
Client of Korean Descent/Ancestry
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.
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 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 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. NURS 6630 Treating Clients with Bipolar Disorder Discussion
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. NURS 6630 Treating Clients with Bipolar Disorder Discussion
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. NURS 6630 Treating Clients with Bipolar Disorder Discussion
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 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. NURS 6630 Treating Clients with Bipolar Disorder Discussion
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 Treating Clients with Bipolar Disorder Discussion
The Assignment- NURS 6630 Treating Clients with Bipolar Disorder Discussion
Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sur e to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. NURS 6630 Treating Clients with Bipolar Disorder Discussion
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 Treating Clients with Bipolar Disorder Discussion
Also include how ethical considerations might impact your treatment plan and communication with clients.
Learning Resources- NURS 6630 Treating Clients with Bipolar Disorder Discussion
Required Readings (click to expand/reduce)
Ostacher, M. J., & Hsin, H. (2016). The use of antiepileptic drugs in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 93–98). Elsevier.
Perlis, R. H., & Ostacher, M. J. (2016a). Bipolar disorder. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 48–60). Elsevier.
Perlis, R. H., & Ostacher, M. J. (2016b). Lithium and its role in psychiatry. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 86–92). Elsevier.
Traeger, L., Brennan, M. M., & Herman, J. B. (2016). Treatment adherence. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 20–26). Elsevier.
Medication Resources (click to expand/reduce)
IBM Corporation. (2020). IBM Micromedex.
Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments. NURS 6630 Treating Clients with Bipolar Disorder Discussion
Review the following medications:
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Required Media (click to expand/reduce)