Nursing Papers Market

Walden

Walden – NURS 6630 – Assessing and Treating Clients with Dementia

Week 10 discussion

Discussion: Influencing Social Change

Individuals with psychiatric mental health disorders are frequently stigmatized not only by society as a whole, but also by their friends, family, and sometimes healthcare providers. In your role, however, you have the opportunity to become a social change agent for these individuals. For this Discussion, consider how you might make a positive impact for your clients and advocate for social change within your own community.

Learning Objectives

Students will:

Apply strategies to become a social change agent for psychiatric mental health

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Angermeyer, M. C., Matschinger, H., & Schomerus, G. (2013). Attitudes towards psychiatric treatment and people with mental illness: Changes over two decades. The British Journal of Psychiatry, 203(2), 146–151. Retrieved from http://bjp.rcpsych.org/content/203/2/146.full

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

Dingfelder, S. F. (2009). Stigma: Alive and well. American Psychological Association, 40(6), 56. Retrieved from http://www.apa.org/monitor/2009/06/stigma.aspx

Jenkins, J. H. (2012). The anthropology of psychopharmacology: Commentary on contributions to the analysis of pharmaceutical self and imaginary. Culture, Medicine and Psychiatry, 36(1), 78–79. doi:10.1007/s11013-012-9248-0

Note: Retrieved from from the Walden Library databases.

Price, L. H. (2010). Violence in America: Is psychopharmacology the answer? Brown University Psychopharmacology Update, 21(5), 5. Retrieved from http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1556-7532

Note: Retrieved from from the Walden Library databases.

Optional Resources

Bennett, T. (2015). Changing the way society understands mental health. National Alliance on Mental Illness. Retrieved from http://www.nami.org/Blogs/NAMI-Blog/April-2015/Changing-The-Way-Society-Understands-Mental-Health

Mechanic, D. (2007). Mental health services then and now. Health Affairs, 26(6), 1548–1550. Retrieved from https://web.archive.org/web/20170605094514/http://content.healthaffairs.org/content/26/6/1548.full

Rothman, D. J. (1994). Shiny, happy people: The problem with “cosmetic psychopharmacology.” New Republic, 210(7), 34–38.

To prepare for this Discussion:

Reflect on how you might influence social change for psychiatric mental health.

Week 10 assignment

Assignment: Assessing and Treating Clients With Dementia

The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia.

Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 13, “Dementia and Its Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia
donepezil
galantamine
memantine
rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf

Required Media

Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

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

To prepare for this Assignment:

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

Walden NURS 6630 Week 10 Sample Paper

(Assessing and Treating Clients with Dementia)

Assessing and Treating Clients with Dementia

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Dementia

The treatment of brain degeneration illnesses such as Alzheimer’s will require the PMHNP to consider the benefits and side effects of such treatments. The PMHNP will recognize that though the brain degeneration caused by conditions such as Alzheimer’s is not reversible, it can be controlled when the right medication and dosage are administered to patients. This paper explores the pharmacokinetics and pharmacodynamics of the medications administered to control Alzheimer’s in a 76-year-old Iranian male.

Decision #1

For the first decision, I decided to administer Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID after two weeks. I made the decision to administer Exelon (rivastigmine) 1.5 mg to the patient and increase the dosage to 3 mg after two weeks as the drug is known to be effective in limiting the symptoms of degenerative brain disease as a cholinesterase inhibitor (Khoury, Rajamanickam, & Grossberg, 2018). I also made the decision, to begin with, a 1.5 mg dosage and increase to 3mg after two weeks as this would help to avoid severe side effects on the patients a such as the loss of appetite, nausea, and upset stomach (Khoury et al., 2018). The medication would benefit the patients and cause less harm.

The other two decisions, which would be to administer Aricept (donepezil) 5 mg orally or Razadyne (galantamine) 4 mg orally BID, would be less advantageous and would not be considered. The central reason for not administering Aricept (donepezil) 5 mg to the 76-year-old Iranian male would be because of the severe side effects associated with the drug. According to Agboton, Mahdavian, Singh, et al. (2014), Aricept has been shown to cause a slow and irregular heartbeat in some patients, which can result in fainting. On the other hand, the decision to administer Razadyne would be less advantageous as it can cause severe side effects such as fast, slow, and irregular breathing, which would be detrimental to the elderly patient’s health. Razadyne would also have a higher probability of contributing to severe side effects such as slow or irregular heartbeats in a patient and would not be considered (Nakagawa, Ohnishi, Kobayashi, et al., 2017).

By making the decision to administer Exelon (rivastigmine) 1.5 mg orally and increase to 3 mg orally BID in 2 weeks, I was hoping to help limit the symptoms of Alzheimer’s on the patient, including loss of interest in important activities, and increasing the patients Mini-Mental State Exam (MMSE) score. According to Kandiah, Pai, Senanarong, et al. (2017), Exelon will be effective in treating most symptoms of Alzheimer’s and will boost the brain’s activity of patients.

What I was hoping to achieve after administering Exelon 1.5 mg orally and increasing the dose to 3 mg orally after two weeks and the results of the decision were different because no improvements were noted in the patient’s MMSE score. The patient was also quite disinterested in important activities in their life, such as religious activities. From the results, it was evident that the medication had not yet been effective on the patient. According to Khoury et al. (2018), cholinesterase inhibitors will not be effective from the onset, with effects likely to be observed in the second month of administration.

Decision #2

For the second decision, I choose to increase the dosage of Exelon to 4.5 mg orally. I selected this decision because the patient had not displayed any severe side effects with the administration of 3mg of Exelon in the past month. Increasing the dosage of Exelon to 4.5 mg was also needed to bring about the preferred results of limiting the symptom of Alzheimer’s on the patient. According to Kandiah et al. (2017), increasing the dosage of Exelon is recommended among patients who do not experience severe side effects so as to limit the symptoms of Alzheimer’s.

By making the decision to increase the dosage of Exelon to 4.5 mg, I was hoping to improve the patient’s brain functionality and interest in activities which they liked. What I expected to achieve in increasing the dosage of Exelon to 4.5 mg was similar to what I achieved in that after a month, the patients showed increased functionality by attending religious activities and showing interest. This showed the dosage was effective in limiting the symptoms of Alzheimer’s on the patient.

Decision #3

For the third decision, I choose to increase Exelon dosage to 6mg orally. According to Khoury et al. (2018), increasing the dosage of Exelon is recommended in cases where the patient does not show any severe side effects. The increased dosage will be more effective in limiting Alzheimer’s symptoms.

By making the decision to increase the Exelon dosage of the 76-year-old Iranian patient to 6mg, I was hoping to sustain the patient’s interests in activities which they liked and improve the brain functionality. Cholinesterase inhibitors help to stabilize the symptoms of Alzheimer’s and help patients to regain interest in activities they consider important while functioning better (Kandiah et al., 2017). What I was hoping to accomplish by increasing the dosage was similar to what I achieved in that the patient showed an increased interest in religious activities and general improvement in brain function. This showed that the increased dosage was effective in limiting Alzheimer’s symptoms in the patients.

Ethical Considerations

In treating the 76-year-old Iranian male, the ethical principles of confidentiality and beneficence would be followed. Only the medication that provides the benefits to the patients would be considered, with all the information related to the treatment being held in confidence by all involved parties.

References

Agboton, C Mahdavian, S., Singh, A., Ghazvini, P., Hill, A., & Sweet, R. (2014). Impact of

nighttime donepezil administration on sleep in the older adult population: A retrospective study. Mental Health Clinician 1; 4 (5): 257–259. doi: https://doi.org/10.9740/mhc.n222761.

Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current

therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic advances in drug safety, 9(3), 171–178. https://doi.org/10.1177/2042098617750555.

Kandiah N, Pai MC, Senanarong V, Looi I, Ampil E, Park KW, Karanam AK, & Christopher S.

(, 2017). Rivastigmine: the advantages of dual inhibition of acetylcholinesterase and butyrylcholinesterase and its role in subcortical vascular dementia and Parkinson’s disease dementia. Clin Interv Aging. 12:697-707 https://doi.org/10.2147/CIA.S129145.

Nakagawa, R., Ohnishi, T., Kobayashi, H., Yamaoka, T., Yajima, T., Tanimura, A., Kato, T., &

Yoshizawa, K. (2017). Long-term effect of galantamine on cognitive function in patients with Alzheimer’s disease versus a simulated disease trajectory: an observational study in the clinical setting. Neuropsychiatric disease and treatment, 13, 1115–1124. https://doi.org/10.2147/NDT.S133145.

The Assignment

Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact 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?

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

PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING PAPERS MARKET TODAY AND GET AN AMAZING DISCOUNT

Walden

Walden – NURS 6630 – Assessing and Treating Clients With ADHD

Week 9 discussion

Discussion: Presentations of ADHD

Although ADHD is often associated with children, this disorder is diagnosed in clients across the lifespan. While many individuals are properly diagnosed and treated during childhood, some individuals who have ADHD only present with subsyndromal evidence of the disorder. These individuals are often undiagnosed until they reach adulthood and struggle to cope with competing demands of running a household, caring for children, and maintaining employment. For this Discussion, you consider how you might assess and treat individuals presenting with ADHD.

Required Readings

Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Table B. KQ2: Long-term(>1 year) effectiveness of interventions for ADHD in people 6 years and older.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 12, “Attention Deficit Hyperactivity Disorder and Its Treatment”

Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the ADHD tab.

Chapter 4, “ADHD Treatments”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For ADHD
armodafinil
amphetamine (d)
amphetamine (d,l)
atomoxetine

Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty

Case 2: Volume 1, Case #14: The scatter-brained mother whose daughter has ADHD, like mother, like daughter

Case 3: Volume 2, Case #21: Hindsight is always 20/20, or attention deficit hyperactivity disorder

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

Week 9 assignment

Assignment: Assessing and Treating Clients With ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. They may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric mental health nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for clients across the lifespan. For this Assignment, you consider how you might assess and treat clients presenting with ADHD.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: Review all materials from the Discussion.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (2016d). Case study: A young Caucasian girl with ADHD [Interactive media file]. Baltimore, MD: Author

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

To prepare for this Assignment:

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

The Assignment

Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact 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?

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

Walden NURS 6630 Week 9 Sample Paper

(Assessing and Treating Clients With ADHD)

Assessing and Treating Clients with ADHD

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with ADHD

ADHD is a condition that makes it difficult for the individual affected to pay attention or control impulsive behavior. Patients suffering from ADHD might appear to be restless and continuously active. ADHD symptoms will begin in childhood among many patients and can continue as the child matures. Adults and children will show different ADHD presentations, while gender will also affect how ADHD progresses (Keilow, Holm, & Fallesen, 2018). In the treatment of ADHD patients, it will be important to consider the pharmacodynamics and pharmacokinetics of different medication therapies. PMHNPs need to perform careful evaluations and assessments to determine the risks and benefits of medication therapies they administer to ADHD patients. This paper reviews and supports the decisions that would be made in the treatment of a young girl with ADHD.

Decision #1

For the first decision, I selected administering Ritalin (methylphenidate) chewable tablets 10 mg to the patient. The patient was to take the medication orally every morning for a month until their next appointment. My decision to administer Ritalin was based on scholarly evidence that supported the effectiveness of the drug in treating ADHD among children while having less adverse side effects. According to Van der Schans, Çiçek, Vardar, et al. (2017). Ritalin will be effective in reducing ADHD among children. It will increase the production of chemicals in the brain that is responsible for increasing concentration, controlling behavior problems, and helping one pay attention.

The other decision of administering Intuniv or Wellbutrin would be less advantageous to the patient because of the adverse effects that the drugs are known to cause on children. According to Patel, Allen, Haque, et al. (2016), Wellbutrin may cause severe mood changes among patients that can drive them to want to hurt themselves. According to Martinez-Raga, Knecht, & de Alvaro (2015), Intuniv may cause severe dizziness and sluggishness in a patient, which may affect their productivity. Therefore, the decision to administer the two drugs would be avoided to avoid the adverse side effects.

By deciding to administer Ritalin to the young ADHD patients, I was hoping to help her improve her concentration in school while nursing the least side effects. What I was hoping to achieve with making the decision was different from the results in that the patient’s concentration in school increased only in the morning sessions. My expectations of side effects were similar to the results in that though the patients had an elevated heartbeat, it was within normal ranges, which was not dangerous for her health.

Decision #2

On the second decision, I choose to increase the dosage of the patient to Ritalin LA 20 mg orally taken daily in the morning. According to Storebø, Pedersen, Ramstad, et al. (2018), increasing the dosage of Ritalin can help a patient with ADHD to remain focused throughout the day if no adverse side effects had been observed previously. By making the decision to change the ADHD patient’s dosage to Ritalin LA 20 mg, I was hoping to improve the patient’s concentration throughout the day. I was also hoping that the patient would stop experiencing an elevated heartbeat. What I expected to achieve by increasing the dosage of Ritalin for the patient was similar to what I achieved in that the patient’s academic performance improved throughout the day while they stopped having an elevated heartbeat. According to Van der Schans et al. (2017), increasing the dosage of Ritalin among patients can help improve their concertation throughout the day. What I expected to achieve in making the decision to increase the dosage of Ritalin to the patient was similar to what I achieved.

Decision #3

For the third decision, I choose to maintain the dosage of Ritalin LA 20 mg to the young girl with ADHD and evaluate the patient’s performance after a month. According to Storebø et al. (2018), it is always advisable to maintain the lowest effective dose of a stimulant, especially among young patients. In making the decision, I was hoping that the concentration of the patient would be present throughout the day and that the patient would experience no side effects. What I expected to achieve in making the decision to maintain a dosage of Ritalin LA 20 mg to the patient was similar to what I achieved in that the patient’s concentration was maintained while they experienced no side effects.

Ethical Considerations

The two ethical considerations that would impact the treatment plans for the eight-year patient with ADHD would be the consideration of beneficence and informed consent (Howe, 2018). All the treatment plans would have to be approved by the patient’s parents as she is a minor, with parents being provided with necessary information relating to benefits and side effects to make the right decision. All the treatment decisions made would also be to benefit the patients.

References

Howe, E. (2018). Ethical considerations when treating patients with schizophrenia. Psychiatry

(Edgmont (Pa. : Township)), 5(4), 59–64.

Keilow, M., Holm, A., & Fallesen, P. (2018). Medical treatment of attention

Deficit/Hyperactivity Disorder (ADHD) and children’s academic performance. PloS one, 13(11), e0207905. https://doi.org/10.1371/journal.pone.0207905.

Martinez-Raga, J., Knecht, C., & de Alvaro, R. (2015). Profile of guanfacine extended release

and its potential in the treatment of attention-deficit hyperactivity disorder. Neuropsychiatric disease and treatment, 11, 1359–1370. https://doi.org/10.2147/NDT.S65735.

Patel, K., Allen, S., Haque, M. N., Angelescu, I., Baumeister, D., & Tracy, D. K. (2016).

Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Therapeutic advances in psychopharmacology, 6(2), 99–144. https://doi.org/10.1177/2045125316629071.

Storebø, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B.,

Moreira-Maia, C. R., Magnusson, F. L., Holmskov, M., Gerner, T., Skoog, M., Rosendal, S., Groth, C., Gillies, D., Buch Rasmussen, K., Gauci, D., Zwi, M., Kirubakaran, R., Håkonsen, S. J., Aagaard, L., … Gluud, C. (2018). Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of adverse events in non-randomised studies. The Cochrane database of systematic reviews, 5(5), CD012069. https://doi.org/10.1002/14651858.CD012069.pub2.

Van der Schans, J., Çiçek, R., Vardar, S. et al. (2017). Methylphenidate use and school

performance among primary school children: a descriptive study. BMC Psychiatry 17, 116 https://doi.org/10.1186/s12888-017-1279-1.

PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING PAPERS MARKET TODAY AND GET AN AMAZING DISCOUNT

Walden

Walden – NURS 6630 – Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction

Week 8 assignment

Assignment: Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction

Impulsivity, compulsivity, and addiction are challenging disorders for clients across the lifespan. These disorders often manifest as negative behaviors, resulting in adverse outcomes for clients. In your role as the psychiatric mental health nurse practitioner, you have the opportunity to help clients address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 14, “Impulsivity, Compulsivity, and Addiction”

Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the Substance Use and Impulsive Disorders tab.

Chapter 10, “Disorders of Impulsivity and Compulsivity”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia
For obsessive-compulsive disorder
Citalopram
clomipramine
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
venlafaxine
vilazodone
For alcohol withdrawal
chlordiazepoxide
clonidine
clorazepate
diazepam
lorazepam
oxazepam
For bulimia nervosa and binge eating
fluoxetine
topiramate
zonisamide
For alcohol abstinence
acamprosate
disulfiram
For alcohol dependence
nalmefene
naltrexone
For opioid dependence
buprenorphine
naltrexone
For nicotine addiction
bupropion
varenicline

Book Excerpt: S.ubstance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders. Treatment Improvement Protocol Series, No. 32. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64350/

Chapter 1, “Substance Use Among Adolescents”

Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”

Chapter 7, “Youths with Distinctive Treatment Needs”

University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control in adulthood, study finds. Retrieved from https://www.sciencedaily.com/releases/2016/01/160120201324.htm

Note: Retrieved from Walden Library databases.

Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. doi:10.1111/j.1365-2125.2012.04457.x

Note: Retrieved from Walden Library databases.

Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10–15. doi:10.3928/00989134-20160314-04

Note: Retrieved from Walden Library databases.

Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis, 8(1), 74–84. doi:10.1080/15504263.2012.648439

Note: Retrieved from Walden Library databases.

Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., & … Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry, 55(6), 1337–1341. doi:10.1016/j.comppsych.2014.04.018

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (2016c). Case study: A Puerto Rican woman with comorbid addiction [Interactive media file]. Baltimore, MD: Author

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

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat adolescent clients requiring therapy for impulsivity, compulsivity, and addiction.

The Assignment

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact 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?

Walden NURS 6630 Week 8 Sample Paper

(Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction)

Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

In the treatment of alcohol use disorder, gambling, and other addiction disorders, a PMHNP must take time to consider the effects of the chosen treatment and its effectiveness. This will be essential in ensuring that only the right medication is administered to avoid adverse effects on the patients and the chances of picking another addiction. The evaluation of pharmacokinetics and pharmacodynamics of different preferred drugs and their effects on patients is critical in making decisions of the most appropriate prescription for addiction patients. This paper explores the decisions that will be made in treating a 53-year-old Puertorican female with gambling and alcohol use disorder.

Decision #1

For the first decision, I choose to administer Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every four weeks to the patient. I selected the decision to administer Naltrexone to the patient as the drug would be effective in alleviating the alcoholism problems in the patient, which was their main challenge that fueled their gambling problems. According to Swiatek, Bosso, & Hughes (2018), Naltrexone (Vivitrol) injection is effective in treating alcoholism as it reduces the urge to drink. This helps patients to drink less or to stop drinking altogether.

I opted against the other two decisions, including administering Antabuse (Disulfiram) 250 mg orally every morning and administering Campral (acamprosate) 666 mg orally TID due to the adverse side effects that both the drugs would have on the patient and the less efficacy in resolving the patient’s alcohol abuse disorder. According to Skinner, Lahmek, Pham, & Aubin (2014), Antabuse (Disulfiram) may cause psychotic reactions among patients when it is administered in large doses. The administration of 250mg on the patient would be expected to have adverse side effects on the patients and thus was not chosen. According to Maisel, Blodgett, Wilbourne, et al. (2015), Campral (acamprosate) may have adverse side effects on patients, including fear, severe depression, and an extreme feeling of emptiness and sadness when administered in larger dosages. I ruled against the administration of Campral 666 mg orally was due to the anticipated adverse effects.

By administering Naltrexone (Vivitrol) injection, 380 mg intramuscularly, I was hoping to address the patient’s alcohol abuse disorder by reducing the amount of alcohol she took. Naltrexone (Vivitrol) injection is effective in treating alcoholism as it reduces the urge to drink among patients (Swiatek et al., 2018).

What I was hoping to achieve by administering Naltrexone (Vivitrol) injection was similar to what I achieved in that after a month, the client reported to the clinician and highlighted she had not taken alcohol in the past month and that she felt great. This showed that the naltrexone (Vivitrol) injection had worked as expected in stopping the patient from abusing alcohol.

Decision #2

For the second decision, I choose to refer the client to the counselor to address her gambling issues. According to Choi, Shin, & Kim, et al. (2017), psychotherapy is the most effective method of treating pathological gambling, such as in the case of Mrs. Perez. Referring the client to the counselor would therefore put her up to receive evidence-based therapies, including cognitive-behavioral therapy, Gambler’s Anonymous, psychodynamic therapy, behavioral therapy, and family therapy (Choi et al. 2017). These therapies would be effective in treating the client’s gambling disorders.

By making the decision to refer the client to a counselor to address her gambling issues, I was hoping to help the clients deal with her gambling addictions. I was also hoping that the anxiety side effects that the client experienced after the first month of treatment with naltrexone (Vivitrol) injection would subside with no need for treatment.

What I was hoping to achieve in making decision #2 was similar to what I achieved in that though the patient stated that she did not like her counselor, she started some session and enrolled in gamblers anonymous, where she felt supported. The patient’s anxiety also dissipated with no need for treatment, which was expected.

Decision #3

For the third decision, I choose to explore the issues Mrs. Perez was having with her counselors and encouraged her to keep attending her gamblers anonymous meetings where she was receiving a lot of support. According to Menchon, Mestre-Bach, Steward, et al. (2018), there will be no FDA approved pharmacological treatments for gambling, with counseling being the only effective option for treatment.

In making the decision to explore the issues between Mrs. Perez and her counselor and encourage her to keep attending the gamblers anonymous session, I was therefore hoping to help her kick her gambling habit through evidence-based psychotherapeutic measures. According to Ngepa Menchon et al. (2018), psychotherapeutic measures are effective in treating pathological gambling.

What is expected to achieve in encouraging Mrs. Perez to keep seeing her counselor and attending gambler anonymous decisions were similar to what I achieved in that the client reduced her gambling habit after a month of attending the sessions with a clear indication that the client would be able to quit completely after a time.

Ethical Considerations

Confidentiality and beneficence will include the two ethical considerations that would need to be included in the care of the patient. All the treatment decisions taken would, therefore, be for the benefit of the patients. The decisions would also be kept confidential and never revealed to any third parties (Stein & van Niekerk, 2015).

References

Choi, S., Shin, Y., & Kim, D. et al. (2017). Treatment modalities for patients with gambling

disorder. Ann Gen Psychiatry 16, 23. https://doi.org/10.1186/s12991-017-0146-2.

Maisel, N. C., Blodgett, J. C., Wilbourne, P. L., Humphreys, K., & Finney, J. W. (2015). Meta-

analysis of Naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?. Addiction (Abingdon, England), 108(2), 275–293. https://doi.org/10.1111/j.1360-0443.2012.04054.x.

Menchon, J. M., Mestre-Bach, G., Steward, T., Fernández-Aranda, F., & Jiménez-Murcia, S.

(, 2018). An overview of gambling disorder: from treatment approaches to risk factors. F1000Research, 7, 434. https://doi.org/10.12688/f1000research.12784.1.

Stein, D. J., & van Niekerk, A. A. (2015). Ethics of psychopharmacology. International

perspectives in philosophy and psychiatry. The Oxford handbook of psychiatric ethics (p. 1175–1190). Oxford University Press.

Swiatek, D., Bosso, N.A., & Hughes, L.P (2018). Naltrexone for the Treatment of Alcohol Use

Disorder in the Primary Care Setting. US Pharm. 2018; 43(8)26-33.

Skinner, M. D., Lahmek, P., Pham, H., & Aubin, H. J. (2014). Disulfiram efficacy in the

treatment of alcohol dependence: a meta-analysis. PloS one, 9(2), e87366. https://doi.org/10.1371/journal.pone.0087366.

PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING PAPERS MARKET TODAY AND GET AN AMAZING DISCOUNT

Walden

Walden – NURS 6630 – Assessing and Treating Clients With Pain

Week 7 discussion

Discussion: Sleep/Wake Disorders

It is not uncommon to experience a night or two of disrupted sleep when there is something major going on in your life. However, sleep/wake disorders are much more than an occasional night of disrupted sleep. A recent report from the Centers for Disease Control and Prevention estimated that between 50 and 70 million American have problems with sleep/wake disorders (CDC, 2015). Although the vast majority of Americans will visit their primary care provider for treatment of these disorders, many providers will refer patients for further evaluation. For this Discussion, you consider how you might assess and treat the individuals based on the provided client factors.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia
alprazolam
amitriptyline
amoxapine
clomipramine

Case 1: Volume 2, Case #16: The woman who liked late-night TV

Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady

Case 3: Volume 1, Case #5: The sleepy woman with anxiety

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

Week 7 assignment

Assignment: Assessing and Treating Clients With Pain

Pain can greatly influence an individual’s quality of life, as uncontrolled pain negatively impacts mood, concentration, and the overall physical and mental well-being of clients. Although pain can often be controlled with medications, the process of assessing and treating clients can be challenging because pain is such a subjective experience. Only the person experiencing the pain truly knows the intensity of the pain and whether there is a need for medication therapies. Sometimes, beliefs about pain and treatments for pain can have an adverse effect on the provider-client relationship. For this Assignment, as you examine the interactive case study consider how you might assess and treat clients presenting with pain.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 10, “Chronic Pain and Its Treatment”

Stahl, S. M., & Ball, S. (2009a). Stahl’s illustrated chronic pain and fibromyalgia. New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the Chronic Pain and Fibromyalgia tab.

Chapter 5, “Pain Drugs”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia
amitriptyline
amoxapine
carbamazepine
clomipramine
clonidine (adjunct)
desipramine
dothiepin
doxepin
duloxetine
gabapentin
imipramine
lamotrigine
levetiracetam
lofepramine
maprotiline
memantine
milnacipran
nortriptyline
pregabalin
tiagabine
topiramate
trimipramine
valproate (divalproex)
zonisamide

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

National Institute of Neurological Disorders and Stroke. (2016). Pain: Hope through research. Retrieved from http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#3084_2

Required Media

Laureate Education (2016a). Case study: A Caucasian man with hip pain [Interactive media file]. Baltimore, MD: Author

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

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for pain and sleep/wake disorders.

The Assignment

Examine Case Study: A Caucasian Man With Hip Pain. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact 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?

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

Walden NURS 6630 Week 7 Sample Paper

(Assessing and Treating Clients With Pain)

Assessing and Treating Clients with Pain

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Pain

Mental disorders relating to pain can be quite challenging to treat as the PMHNP walks the tight rope to alleviate the patient’s pain and administer medications with the least severe side effects. Evaluating the pharmacodynamics and pharmacokinetics of a group of preferred drugs and their effects on patients can help make decisions of the most appropriate prescription. This paper explores the decisions that will be made in treating a White male with complex regional pain disorder.

Decision #1

I choose to administer Amitriptyline 25 mg PO QHS to the white male patient with hip pain for the first decision. I selected the decision to administer Amitriptyline 25 mg PO to the patient as he seemed to be experiencing pain due to depression. When administered in low doses such as 25 mg, Amitriptyline effectively alleviates depression and the disorders that it causes, such as complex regional pain disorders among patients. According to Lawson (2017), the daily recommend dose of Amitriptyline among outpatients is a maximum of 150 mg/day. Starting with a low dose and increasing the dosage as the treatment progresses is recommended to reduce the incidences of adverse effects caused by the drug. These negative side effects include agitation, anxiety, constipation, diarrhea, lethargy, sexual dysfunction, and weight gain, among others (Brueckle, Thomas, Seide, et al., 2020).

The other two decisions, which included administering Savella 12.5 mg to the patients or Neurontin (gabapentin) 300 mg, were less advantageous. The administration of Savella 12.5 mg was therefore ruled out because though the drug would effectively reduce the patient’s pain, it could cause adverse side effects that would be a huge health challenge to the patient. According to Derry, Phillips, Moore, & Wiffen (2015), the most adverse side effects of Savella include elevated blood pressure, nausea, insomnia, nausea, and sweating. The benefits of the drug to patients should be weighed against the side effects. In the case of the white male patient with hip pains, Savella’s adverse effects would exceed the benefits of the drug in reducing pain. The drug would thus be less beneficial. The administration of Neurontin (gabapentin) 300 mg would also be less beneficial to the patient. According to Peckham, Evoy et al. (2018), Neurontin (gabapentin) is mainly preferred as a form of antiepileptic drug and anticonvulsant. The patient did not seem to have any significant convulsing episodes that could warrant the use of Neurontin (gabapentin). The drug would also be less preferred due to its low effect on reducing pain and the adverse effect of drowsiness and feeling foggy, which could affect the patients’ quality of life.

In deciding to administer Amitriptyline 25 mg to the patient, I was hoping to reduce the patient’s pain levels to a level of about five out of teen on his scale and avoid any adverse effects. According to Brueckle et al. (2020), a low dosage of Amitriptyline is effective in alleviating pain among patients with complex regional pain disorder while not causing major side effects.

What I expected to achieve and what I achieved in deciding to administer Amitriptyline 25 mg to the patient was similar. After a month, the client reported that his pain level was six out of ten. Simultaneously, he also had no major adverse effects, with the only side effect being groggy in the morning.

Decision #2

For the second decision, I selected the option of increasing the administration of Amitriptyline from the current 25mg to 125mg before bed time. According to Lawson (2017), a maximum dosage of 150mg of Amitriptyline per day will be safe for outpatients. By increasing the dosage of Amitriptyline from 25mg per day to 125 mg taken before bedtime, I was hoping to reduce the patient’s pain levels to lower than 4 out of 10. I was also hoping to reduce the side effects of grogginess in the morning by asking the client to take the full dose before going to bed. My expectations in increasing the dosage of Amitriptyline from 25 mg to 125 mg on the client and the result of my decision were similar in that’s the patient reported having a pain level of four out of ten and not being groggy in the morning. His only complaint was a little weight gain.

Decision #3

I choose to continue administering Amitriptyline 125 mg daily dose to the patients during bed time for the third decision. I also chose to refer the patient to a life coach who would help him control his weight gain through healthy diets and effective exercise habits. According to Plodkowski, McGarvey, Reisinger-Kindle, et al. (2016), Qysmia should only be prescribed to morbidly obese patients with a BMI of more than 30kg/m2. Patients with a BMI of less than 30 should explore other options to manage their weight. By making this decision, I was hoping to achieve the client’s pain goals of three out of ten and help him control his weight gain. According to Lawson (2017), the appropriate dosage of Amitriptyline can play a significant role in treating patients with complex regional pain disorders.

My expectations for taking the third decision to continue administering Amitriptyline 12mg to the patient were similar to the results. The patient’s pain goal of three was achieved with non-adverse side effects being witnessed.

Ethical Considerations

The three ethical considerations that would need to be considered in the patient’s treatment would include confidentiality and beneficence. All the decisions made to treat the patients would thus need to be made to benefit the patient. All the information relating to the patient’s identification and treatment details would also need to be kept in confidence (Stein & van Niekerk, 2015).

References

Brueckle, M., Thomas, E.T., Seide, S.E., et al. (2020). Adverse drug reactions associated with

Amitriptyline — protocol for a systematic multiple-indication review and meta-analysis. Syst Rev 9, 59 https://doi.org/10.1186/s13643-020-01296-8.

Derry, S., Phillips, T., Moore, R. A., & Wiffen, P. J. (2015). Milnacipran (Savella) for

neuropathic pain in adults. The Cochrane database of systematic reviews, 2015(7), CD011789. https://doi.org/10.1002/14651858.CD011789.

Lawson K. (2017). A Brief Review of the Pharmacology of Amitriptyline and Clinical Outcomes

in Treating Fibromyalgia. Biomedicines, 5(2), 24. https://doi.org/10.3390/biomedicines5020024.

Peckham, A. M., Evoy, K. E., Ochs, L., & Covvey, J. R. (2018). Gabapentin for Off-Label Use:

Evidence-Based or Cause for Concern?. Substance abuse : research and treatment, 12, 1178221818801311. https://doi.org/10.1177/1178221818801311.

Plodkowski, R. A., McGarvey, M. E., Reisinger-Kindle, K., Kramer, B., Nelson, E., Lee, J., &

Nguyen, Q. T. (2016). Obesity Management: Clinical Review and Update of the Pharmacologic Treatment Options. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 33(1), 6–16.

Stein, D. J., & van Niekerk, A. A. (2015). Ethics of psychopharmacology. International

perspectives in philosophy and psychiatry. The Oxford handbook of psychiatric ethics (p. 1175–1190). Oxford University Press.

PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING PAPERS MARKET TODAY AND GET AN AMAZING DISCOUNT

Walden

Walden – NURS 6630 – Assessing and Treating Clients With Psychosis and Schizophrenia

Week 6 midterm

Question 1

A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP).

Question 2

Which statement about neurotransmitters and medications is true?

Question 3

When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be:

Question 4

During gene expression, what must occur prior to a gene being expressed?

Question 5

While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?

Week 6 assignment

Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 4, “Psychosis and Schizophrenia”

Chapter 5, “Antipsychotic Agents”

Stahl, S. M. (2014b)

The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amisulpride
aripiprazole
asenapine
chlorpromazine
clozapine
flupenthixol
fluphenazine
haloperidol
iloperidone
loxapine
lurasidone
olanzapine
paliperidone
perphenazine
quetiapine
risperidone
sulpiride
thioridazine
thiothixene
trifluoperazine
ziprasidone

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659. doi:10.2165/00023210-200923080-00002

Note: Retrieved from Walden Library databases.

Document: Midterm Exam Study Guide (PDF)

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

Note: Retrieved from Walden Library databases.

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting

Required Media

Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author

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

Optional Resources

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124-134. doi:10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728-738. doi:10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107-121. doi:10.1007/s11126-014-9326-2

To prepare for this Assignment:

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

Walden NURS 6630 Week 6 Sample Paper

(Assessing and Treating Clients With Psychosis and Schizophrenia)

Assessing And Treating Clients With Psychosis And Schizophrenia Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Psychosis and Schizophrenia

In treating patients with mental disorders, it will be vital to evaluate the pharmacodynamics and the pharmacokinetics process of such drugs and their effects on the patients. This paper explores the decisions that will be made in treating a Pakistani woman with delusional thought processes.

Decision #1

For the first decision, I selected the Pakistani Woman to start by taking Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day four and monthly after that. The administration of this medication seemed to be effective. After the client returned to the clinic after four weeks, they displayed a decrease in PANSS score by about 25% and a good way of tolerating medications. I selected the decision to administer Invega Sustenna to the patients as numerous evidence-based scholarly studies have shown that the drug effectively treats schizoaffective disorders when administered as a monotherapy (Li, Turkoz, & Zhang, 2015). The drug is effective, acting as a mood stabilizer, which is an important element in treating the Pakistani Woman. In the first decision I did not choose administer Zyprexa 10 mg orally as the drug is known to cause a lot of adverse side effects including weight gain, headaches, changes in personality and problems with memory and speech. I also did not choose to administer Abilify 10 mg orally as the drug is also known to cause adverse side effects including insomnia, weight gain, drooling, headache and dizziness and anxiety and restlessness among many others (Wani, Dar, Chandel, et al., 2015).

In deciding to administer Invega Sustenna 234 mg to the Pakistani Woman, I was hoping that I would tone down her delusions, which have made it difficult for her to live with her husband and children. Therefore, I was hoping that the client would stop having delusions such as the TV talking to her and viewing herself as Prophet Muhamad. I was also hoping to decrease the patient’s PANSS score. What I was hoping to achieve by making the first decision was similar to what I achieved because by administering Invega Sustenna, I was able to decrease the patient’s PANSS score by nearly 25%. This showed an improvement in the patient’s condition and having fewer delusions. By administering Invega Sustenna, I expected some side effects on the patient, such as weight gain and pain in the injection area.

Decision #2

For the second decision, I choose to continue the administration of Invega Sustenna to the patient but asked the nurses to change the injection sites to the deltoid muscle for the subsequent visits. I selected this decision as Invega Sustenna was effective in reducing the patient’s delusional symptoms. According to Morris and Tarpada (2017), the dosage of Invega Sustenna should be continued if no major side effects were experienced in the patients. After the first month of the administration of Invega Sustenna to the Pakistani Woman, no major side effects expected weight gain and pain in the injection site were witnessed. According to Emsley and Kilian (2018), to deal with pain in the injection areas, the injection in the patients would have to be performed on the deltoid muscles with adequate alternation of the injection. By making the second decision to continue the administration of Invega Sustenna but on the patient’s alternating deltoid muscles, I was hoping to keep lowering the incidences of delusions on the Pakistani Woman and to reduce the complaints of pain in the injection area.

What I was hoping to achieve by electing to continue the administration of Invega Sustenna to the Pakistani Woman and what I achieved was similar. This is because the drug managed to reduce most of the patient’s delusional symptoms, with a PANNS score of the patient reducing by 50%. The patient also stated that they experienced less pain in the injection areas. However, in continuing the administration of Invega Sustenna to the patients, I was also hoping that the clients would gain some weight. According to Emsley & Kilian (2018), weight gain among patients is one of the common side effects of Invega Sustenna. The patient gaining only 4.5 pounds during a whole treatment period of two months was therefore not abnormal in any way.

Decision #3

For the third decision, I decided to continue the administration of Invega Sustenna to the Pakistani Woman. According to Savitz, Xu, Gopal, et al. (2016), if Invega Sustenna effectively alleviates delusional symptoms among patients and does not cause any significant negative side effects on the patients, it should be continued till the client completely recovers. I also choose to counsel the patient on her weight gain as the weight gain caused by Invega Sustenna was the least the patient could encounter than other drugs that had similar efficacy. I made the decisions to make appointments with the dieticians and exercise psychologists.

By deciding to continue the treatment of Invega Sustenna on the patients, I was hoping that all the client’s delusional symptoms would disappear, and the patient would return to their normal life. I was also hoping that the client could control her weight gain through a quality diet and exercise. What I expected to achieve in making the decision to continue Invega Sustenna administration in the patient and what I achieved were similar. This is because the patient’s delusions were alleviated so that they would perform daily living activities. The patient was also able to perform manage her weight by taking a healthy diet and exercising.

Ethical Considerations

The ethical consideration that would impact the patients’ treatment plan would include beneficence, non-maleficence, and confidentiality (Howe, 2018). All the decisions made relating to the patient would thus be made for their benefits with any intentional harm to patients being avoided. The treatment process of the patient would also be kept confidential.

References

Emsley, R., & Kilian, S. (2018). Efficacy and safety profile of paliperidone palmitate injections

in the management of patients with schizophrenia: an evidence-based review. Neuropsychiatric disease and treatment, 14, 205–223. https://doi.org/10.2147/NDT.S139633.

Howe E. (2018). Ethical considerations when treating patients with schizophrenia. Psychiatry

(Edgmont (Pa. : Township)), 5(4), 59–64.

Li, H., Turkoz, I., & Zhang, F. (2015). Efficacy and safety of once-monthly injection of

paliperidone palmitate in hospitalized Asian patients with acute exacerbated schizophrenia: an open-label, prospective, noncomparative study. Neuropsychiatric disease and treatment, 12, 15–24. https://doi.org/10.2147/NDT.S83651.

Morris, M. T., & Tarpada, S. P. (2017). Long-Acting Injectable Paliperidone Palmitate: A

Review of Efficacy and Safety. Psychopharmacology bulletin, 47(2), 42–52.

Savitz A ,J., Xu, H., Gopal, S, Nuamah, I., Ravenstijn, P., Janik, A., Schotte, A., Hough, D.,

Fleischhacker, W. (2016). Efficacy and Safety of Paliperidone Palmitate 3-Month Formulation for Patients with Schizophrenia: A Randomized, Multicenter, Double-Blind, Noninferiority Study, International Journal of Neuropsychopharmacology, Vol. 19, Iss. 7.

Wani, R. A., Dar, M. A., Chandel, R. K., Rather, Y. H., Haq, I., Hussain, A., & Malla, A. A.

(2015). Effects of switching from olanzapine to aripiprazole on the metabolic profiles of patients with schizophrenia and metabolic syndrome: a double-blind, randomized, open-label study. Neuropsychiatric disease and treatment, 11, 685–693. https://doi.org/10.2147/NDT.S80925

PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING PAPERS MARKET TODAY AND GET AN AMAZING DISCOUNT