NURS 6670 6670 Week 8 Discussion

NURS 6670 6670 Week 8 Discussion

NURS 6670 6670 Week 8 Discussion

Delirium: Diagnostic Criteria Example Paper

DSM-5 diagnostic criteria for delirium describes it as altered consciousness which occurs with the reduced ability to focus, sustain or shift attention. There is also a change in cognition such as deficits in memory, language disturbance, which is not associated with preexisting dementia (American Psychiatric Association, 2013 NURS 6670 6670 Week 8 Discussion). Delirium is categorized into three forms: hyperactive, hypoactive, and mixed.

Hyperactive delirium manifests as restlessness and agitation. It is sometimes confused with psychosis (Soiza & Myint, 2019 NURS 6670 6670 Week 8 Discussion). Hypoactive delirium is characterized by psychomotor retardation, lethargy, and reduced level of responsiveness and is often mistaken for depression. Mixed delirium is a manifestation of both types. The diagnosis of delirium is purely clinical (National Institute for Health and Clinical Excellence, 2019). However, there are several challenges in the diagnosis of delirium such as the fluctuating course of symptoms, interviewing a patient during a delirious episode, and overlooking the hypoactive type.

Psychotherapeutic and Psychopharmacologic Treatment of Delirium

The goal of treatment is to determine the underlying cause and stop it. Delirium can be managed either by medication or supportive therapy. Delirium can arise from many causes such as sepsis.

Psychopharmacologic Approach

The goal of treatment is to find and stop or reverse the underlying cause of delirium.

Antipsychotics are the medications of choice in the treatment of psychotic manifestations of delirium. There are two classes of antipsychotics; typical and atypical antipsychotics. Typical antipsychotics such as haloperidol and chlorpromazine have been proven to have extrapyramidal effects which are less witnessed in the atypical antipsychotics such as risperidone.

Haloperidol is the most effective antipsychotic for delirium. Risperidone, a newer antipsychotic agent, with fewer extrapyramidal effects, binds to D2 receptors. Benzodiazepines are used to manage delirium resulting from seizures or withdrawal from alcohol. Vitamins, especially thiamine should be administered to patients with alcohol-induced delirium or delirium caused by malnutrition. Vitamin B-12 should also be administered in case of deficiency. Melatonin has been proven to be as effective as haloperidol in the treatment of delirium (Jaiswal et al., 2018; Choy et al., 2017 NURS 6670 6670 Week 8 Discussion). Exogenous melatonin is formulated and given to patients with delirium to combat sleep disturbances (Abbasi et al., Fall 2018). Its role has been implicated in the sleep-wake cycle.

The major risks of antipsychotic drugs especially the typical antipsychotics are the presence of extrapyramidal effects such as tremors, slurred speech, akathisia, dystonia, paranoia, anxiety, distress, and bradyphenia. These effects make drugs such as haloperidol undesirable. The benefits, as explained above may outweigh the risk of these drugs. Moreover, these effects can be treated by anticholinergic agents such as atropine.

Psychotherapeutic and Nonpharmacological approach

Psychotherapy is integral in limiting the morbidity and mortality of delirium and reduction in the risk of long-term cognitive impairment. Patient education about delirium should also involve family education. Fluid and nutritional support for these patients should be given as they may be unwilling or unable to do so themselves (Soiza & Myint, 2019 NURS 6670 6670 Week 8 Discussion). The goal of this treatment is to reduce anxiety which is a result of the symptoms of delirium (Grover & Avasthi, 2018). The patient should be made aware that the symptoms they are experiencing are temporary and reversible so they should remain calm. Educating the family of the patient is important. Family and friends should be advised to provide familiarity by bringing personal objects to the patient’s room.

Psychotherapeutic and Nonpharmacological approaches may delay the achievement of eradication of the cause. Even though they are safer, they may not be used in achieving therapeutic responses. The benefits of monotherapy with psychotherapy may not outweigh the risks as the quality of the patient’s life may not be improved rapidly (Grover & Avasthi, 2018 ). NURS 6670 6670 Week 8 DiscussionDelirium is an acute condition that may require immediate care. 

NURS 6670 6670 Week 8 Discussion References

• Abbasi, S., Farsaei, S., Ghasemi, D., & Mansourian, M. (Fall 2018). Potential role of exogenous melatonin supplement in delirium prevention in critically ill patients: A double-blind randomized pilot study. Iranian Journal of Pharmaceutical Research: IJPR, 17(4), 1571–1580. https://www.ncbi.nlm.nih.gov/pubmed/30568713
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing.
• Choy, S. W., Yeoh, A. C., Lee, Z. Z., Srikanth, V., & Moran, C. (2017). Melatonin and the prevention and management of delirium: A scoping study. Frontiers in Medicine, 4, 242. https://doi.org/10.3389/fmed.2017.00242
• Grover, S., & Avasthi, A. (2018). Clinical practice guidelines for the management of delirium in the elderly. Indian Journal of Psychiatry, 60(Suppl 3), S329–S340. https://doi.org/10.4103/0019-5545.224473
• Jaiswal, S. J., McCarthy, T. J., Wineinger, N. E., Kang, D. Y., Song, J., Garcia, S., van Niekerk, C. J., Lu, C. Y., Loeks, M., & Owens, R. L. (2018). Melatonin and sleep in preventing hospitalized delirium: A randomized clinical trial. The American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2018.04.009
• National Institute for Health and Clinical Excellence. (2019). Delirium: prevention, diagnosis, and management. Nice.Org. https://www.nice.org.uk/guidance/CG103
• Soiza, R. L., & Myint, P. K. (2019). The Scottish Intercollegiate Guidelines Network (SIGN) 157: Guidelines on risk reduction and management of delirium. Medicina (Kaunas, Lithuania), 55(8), 491. https://doi.org/10.3390/medicina55080491

NURS 6670 6670 Week 8 Discussion Instructions

NURS 6670 Week 8 Assignment

Explain the diagnostic criteria for delirium.
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned neurocognitive disorder thus deliriums\’.
Identify the risks of different types of therapy and explain how the benefits of the therapy that might be achieved might outweigh the risks.
Support your rationale with references to the Learning Resources or other academic resource.

NURS 6670 Week 9 Assignment

A 63 year-old male Caucasian, homeless ,with no jobs , retired from the military, has been diagnosed with Schizophrenia and PTSD.

CC: He states, “During the night, I hear voices in my head, constantly yelling and telling me to do things like jumping my window. I see shadows dancing across the wall and .
Lately whenever somebody comes near me, I fear for my life and my heart rate starts to increase and I start getting paranoid.”

The patient is experiencing the symptoms of hallucinations and voices from his Schizophrenia which is also causing his anxiety to occur and become paranoid around people.

Medication: Buspirone 10mg PO Daily for anxiety.
Olanzapine 10mg PO Daily for his Schizophrenia

Informed consent explained and signed by patient
Pt is alert and oriented x4,
Denies any street drug taken
Denies any alcohol use
Denies any allergy to medications or food
No side effects of any taken medications presently

Sleeps Pattern :Not sleeping well during the night or day, paces around in her room sometimes reading.
Food she stated she cannot eat well now Has gain 1 lb. after her last visit with her psychiatrist Is not pregnant Very compliance with taken medications taken
No suicidal ideations Hearing of voices or seeing any images Sees her regular therapist weekly Goes for individual therapy Family therapy SI/HI/AVH.
Clinical Impression: Based on the diagnostic criteria in APA (2013) Diagnosed: Schizoaffective disorder (ICD-10: F25.9),
Psychopharmacology of the patient’s symptoms cause a significant impairment in function or agitation, irritable treatment is based on patients’ signs and symptoms presented, client cannot sleep always on the edge ,easily irritated ,dissociate herself from friends and family and has decrease in her appetite.

Medication Management :Increase buspirone 15mg PO Daily continue to for month.
Olanzapine 15mg po for a month .
Decreases all active activities before bedtime ,getting her family involve especially.

Sees her regular therapist weekly Goes for individual therapy Family therapy monthly Family and client educated about her illness to watch for any suicidal ideations .
Advise given to husband not arguing with client. Read or dim lights or noise around her sleeping room Patient to see her PCP for regular checkup and labs Return for evaluation in a month time.

Questions

In 3–4 pages, write a treatment plan for your client in which you do the following:
• Describe the HPI and clinical impression for the client. NURS 6670 6670 Week 8 Discussion
•
• Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
•
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
•
• Identify medical management needs, including primary care needs, specific to this client.
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• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
•
•
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

NURS 6670 6670 Week 10 Schizophrenia Case

CASE

Charlie A 49 years-old male AA, is a homeless man had never been in a relationship, works at a local grocery store as a stocker, has been diagnosed with schizophrenia, complains of hearing voices even while at work which distracts her from what she needs to do, she also states that she feels hopeless in some situations which cause her to be anti-social. NURS 6670 6670 Week 8 Discussion

Medication:
Olanzapine-15mg PO Daily
Seroquel-200mg at night

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

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? NURS 6670 6670 Week 8 Discussion

Decision #2: Treatment Plan for Psychotherapy

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? NURS 6670 6670 Week 8 Discussion

Decision #3: Treatment Plan for Psychopharmacology

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 and their family. NURS 6670 6670 Week 8 Discussion

Week 10 Discussion – Sleep/Wake Disorders

topic :Insomnia

• Explain the diagnostic criteria for your assigned sleep/wake disorder.
  • Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder.
  • Describe at what point you would refer the client to their primary care physician for an additional referral to a neurologist, pulmonologist, or physician specializing in sleep disorders and explain why. NURS 6670 6670 Week 8 Discussion
  • Support your rationale with references to the Learning Resources or other academic resources.

NURS 6670 6670 Week 11

To prepare for this Discussion:

TOPIC IS GENDER DYSPHORIA

Select a gender dysphoria, that interests you.
Review the Learning Resources.
By Day 3
Post:

Explain the diagnostic criteria for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected. NURS 6670 6670 Week 8 Discussion

Explain the evidenced-based psychotherapy and psychopharmacologic treatment for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.

Support your rationale with references to the Learning Resources or other academic resource.