Go to this website: https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_06/index.html
Follow these steps:
Decision Point One- Click \”Start Zyprexa 10mg\”
Decision Point Two- Click \” Change medication to Geodon40mg\”
Decision Point Three- Click \”Give client few doses of Risperdal 1mg\”.
Assignment Paper-
The Assignment: 5 pages
Examine Case Study: 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.
-Page 1: Introduction
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.
– Page 2: Decision #1
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.
-Page 3: Decision #2
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.
-Page 4: Decision #3
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.
-Page 5: Conclusion
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.
Treating Psychotic Disorders
Student’s Name
Institutional Affiliation
Course
Instructor’s Name
Date
Treating Psychotic Disorders
Introduction
The delusional disorder may make a person unable to differentiate when something is real or imagined. A person is diagnosed with delusional disorder when delusional thoughts occur for one month or longer. This type of mental disorder can cause detrimental effects on the health of the patient (Lähteenvuo et al., 2021). The delusional disorder was previously known as paranoid disorder and is usually marked by unshakable beliefs in things that are not true. Some of the symptoms of delusional disorder include the presence of non-bizarre delusions, which involve situations that could occur in real life, such as being followed, poisoned, deceived, conspired against, or loved from a distance (Lähteenvuo et al., 2021). These individuals may socialize and function normally, except for the untrue beliefs. People with delusional disorder often misinterpret situations, perceptions, or events.
In the case study, a 34-year-old Pakistani female who moved to the United in her early 20s is seeking medical attention due to symptoms of delusional disorder. The patient presents to the clinic following a 21-day hospitalization after she was diagnosed with what was described as a brief psychotic disorder. The diagnosis was made because the patient’s experiences had not lasted for one month or longer. The symptoms included visions of Allah, whom she believed was the Prophet, Mohammed. She also believed to be the savior that would redeem the world from its sinful nature. The husband has raised concerns and is afraid of leaving their 4 children with her. During the assessment, on return to the clinic, the patient stays calm and denied visions of Allah. However, she demonstrates non-noteworthy mannerisms and appears to be listening to something. Her speech is slow and at a times interrupted. Therefore, the purpose of this paper is to provide the best decisions to help improve the patient’s condition.
Decision Point One
The selected decision pint one is to start Zyprexa (olanzapine) 10 mg orally at BEDTIME. This decision was arrived at because Zyprexa (olanzapine) is widely used to treat mental disorders, that involve delusions, such as schizophrenia (Taylor, 2018). This medication is effective in decreasing or eliminating symptoms of hallucinations and delusions to help the patient think more positively, be less agitated, and to participate more in daily activities (González-Rodríguez et al., 2018). Furthermore, the drug belongs to the class called atypical antipsychotics, which works by rebalancing dopamine and serotonin to improve thinking, mood, and behavior.
The other two options were not selected for specific reasons. For example, Starting Abilify (aripiprazole) 10 mg orally at BEDTIME was not selected because the ability is commonly used in treating manic episodes in schizophrenia, however, Zyprexa (olanzapine) is best in the treatment of delusions (Taylor, 2018). On the other hand, starting Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter was not the best option because the medication is associated with injection site reactions or pain, insomnia, drowsiness, and others. Zyprexa (olanzapine) was deemed the safest option.
The therapist expected that the patient would return to the clinic in four weeks. The symptoms of delusional disorder are expected to improve by 50%. The patient will stop seeing visions of Allah. False beliefs about being the savior are expected to disappear (Lähteenvuo et al., 2021). The patient is expected to tolerate her medications, her speech will improve, her concentration is expected to improve, and the non-noteworthy mannerism should disappear. There was a difference between the expected results and the actual ones. The patient returned to the clinic in four weeks and her PANNS decreased to a partial response by 25%. However, she complains of a weight gain of 5 pounds. She says she cannot get full from her means, so she is snacking constantly throughout the day (Leach & Welfel, 2018). Some of the ethical considerations include beneficence, non-maleficence, and patient autonomy (Tamilarasi & Kanagavalli, 2018). The ethical concerns should be adhered to throughout the treatment period.
Decision Point Two
The selected decision point two is to change medication to Geodon (ziprasidone) 40 mg orally BID with meals. This decision was selected because Zyprexa (olanzapine) caused negative side effects (Taylor, 2018). The patient was gaining much weight and had developed a poor eating pattern. Continuing with Zyprexa (olanzapine) could have led to more detrimental health effects on the patient. Since she was not tolerating the drug well, it was good to change to Geodon.
Decreasing Zyprexa to 7.5 mg orally at BEDTIME was not selected because it would worsen the patient’s symptoms. The patient’s symptoms would decrease by 25 % and return to her original situation, putting her life at risk. Also, Zyprexa 7.5mg orally at bedtime is not the recommended starting dose (Taylor, 2018). The recommended starting dose is Zyprexa 10mg orally at bedtime. On the other hand, adding Wellbutrin (bupropion) XL 150 mg orally in the MORNING was not selected because it was not necessary. Wellbutrin add-on therapy is usually saved for clients who are on SSRI therapy for MDD (and possibly schizoaffective disorder with MDD present) to help manage sexual side effects (Lähteenvuo et al., 2021). The client does not seem to be a candidate for this therapy.
The patient is expected to return to the clinic in four weeks. The delusional symptoms are expected to reduce by 50% on the PANNS scale. The weight gain should stop and the weight reduced by 2 pounds. Additionally, her excessive hunger should have resolved in four weeks (González-Rodríguez et al., 2018). She should be tolerating the drug without further side effects. Most of the expected outcomes matched the actual results. The patient returned to the clinic in four weeks as expected. She experienced a significant reduction in symptoms of delusional disorder, with the PANNS score indicating a reduction of 40% in symptoms (González-Rodríguez et al., 2018). Her weight is slightly down by 2 pounds from the previous visit. Hunger has reduced, however, she complains of difficulty remembering the second dose and admits to missing afternoon doses on several occasions over the past month. Ethical concerns about this decision include patient education (Tamilarasi & Kanagavalli, 2018). The patient should be educated about the side effects of the drug. Also, the autonomy of the patient should not be despised to ensure she makes her preferred decisions.
Decision Point Three
The selected decision point three is to give the client a few test doses of Risperdal 1 mg orally BID for 3 days to see if she tolerates the medication. If tolerated, start Invega Sustenna at an appropriate starting and maintenance dose (Taylor, 2018). It is a good option for a client who has problems with compliance and who shows good effects from oral therapy. Clients should be switched from an entirely different medication to Invega Sustenna if tolerability can be shown through oral therapy.
Since the patient showed serious side effects, it is not appropriate to decide to change Geodon to 80 MG at bedtime daily. Increasing the Geodon doses would worsen the side effects, hence, changing to Risperdal oral therapy to test for side effects and then switching to Invega Sustenna would be a good option (Lähteenvuo et al., 2021). On the other hand, discontinuing Geodon and starting Latuda (lurasidone) 40 mg orally daily was not selected because it usually has compliance problems due to its once-daily dosing schedule. Tolerability can be an issue as doses are escalated. Furthermore, nausea, vomiting, and extrapyramidal side effects can be problematic (González-Rodríguez et al., 2018). Tolerability is often good at lower doses (40 mg) but significant GI distress and movement disorders can occur when doses are pushed upward toward the daily max of 160 mg. It is expected that the patient would return to be a clinic in four weeks and should have recovered completely from the symptoms. The delusional symptoms are expected to disappear. The PANNS score is expected to show more than 90% symptoms improvement. Ethical considerations include beneficence, non-maleficence, autonomy and informed consent, and justice (Leach & Welfel, 2018). All these ethical considerations must take effect to improve care delivery
Conclusion
Delusional disorder is associated with detrimental effects on the health of the patient. Delusional disorder is also known as psychosis. People with mental illness cannot differentiate between reality and imagination. types of delusional disorder include erotomanic, grandiose, jealous, persecutory, and somatic. The presented case study is about a 34 year of Pakistani female who moved to the United States in her late teens/early 20s. She reports to the clinic with symptoms of delusional disorder. Three appropriate decisions were made to help her improve her condition.
The selected decision pint one is to start Zyprexa (olanzapine) 10 mg orally at BEDTIME. This decision was arrived at because Zyprexa (olanzapine) is widely used to treat mental disorders, that involved delusions, such as schizophrenia. The selected decision point two is to change medication to Geodon (ziprasidone) 40 mg orally BID with meals. The selected decision point three is to give the client a few test doses of Risperdal 1 mg orally BID for 3 days to see if she tolerates the medication. If tolerated, start Invega Sustenna at an appropriate starting and maintenance dose. Throughout the treatment period, certain ethical considerations were made to improve care delivery. They included beneficence, non-maleficence, patient autonomy and consent, and the principle of justice.
References
González-Rodríguez, A., Estrada, F., Monreal, J. A., Palao, D., & Labad, J. (2018). A systematic review of the operational definitions for antipsychotic response in delusional disorder. International clinical psychopharmacology, 33(5), 261-267. https://doi.org/10.1097/YIC.0000000000000227
Leach, M. M., & In Welfel, E. R. (2018). The Cambridge handbook of applied psychological ethics. Cambridge University Press.
Lähteenvuo, M., Taipale, H., Tanskanen, A., Mittendorfer-Rutz, E., & Tiihonen, J. (2021). Effectiveness of pharmacotherapies for delusional disorder in a Swedish national cohort of 9076 patients. Schizophrenia Research, 228, 367-372.
Taylor, D. (2018). The Maudsley Prescribing Guidelines in Psychiatry. John Wiley & Sons.
Tamilarasi, B., & Kanagavalli, P. (2018). Knowledge regarding legal and ethical issues in nursing practice among final year B. Sc nursing students. TNNMC Journal of Nursing Education and Administration, 6(2), 7-10. https://www.indianjournals.com/ijor.aspx?target=ijor:tnnmcjnea&volume=6&issue=2&article=002