NURS 6670 Week 5 Bipolar Disorder Paper

NURS 6670 Week 5 Bipolar Disorder Paper

NURS 6670 Week 5 Bipolar Disorder Paper

Bipolar Disorder Sample

Chief complaint:  Sleeplessness at night and paces the room worrying about Covid-19.

Present illness: Ms. C is a 44-year-old female patient, married with 2 children, who presented with insomnia. She had a difficulty in falling asleep and would walk around her room for the majority of the night, overly stressed and anxious about the current Covid-19 pandemic. Patient reports being excessively restless at night and sleeping for about four hours every night. She also reports that she generally feels sad and has difficulty concentrating even on tasks that require her complete attention. The patient does not have any suicidal ideations and does not contemplate the idea of harming herself or those around her. She does not experience any visual or auditory hallucinations. NURS 6670 Week 5 Bipolar Disorder Paper

Ms. C is a known bipolar disorder patient having been diagnosed five years ago. She has been on Abilify 50 mg PO daily and Risperidone 10 mg PO daily for the past five years. There are no obvious side effects to the medication she is taking and she has not experienced any significant weight gain since her last appointment. The patient says that she has been taking a balanced diet and has been compliant to her medication. The patients also reports that she is seeing her therapist once per week and has been attending group therapy. NURS 6670 Week 5 Bipolar Disorder Paper

Treatment plans

The dose of risperidone is not effective and thus there is need for an increased dose. Patient is also experiencing anxiety and hence it is important to manage the anxiety symptoms. The plan of management is to increase the dose of risperidone taken to 15 mg PO daily, and to administer 10 mg of trazodone PO daily each night for one week. The patient is also encouraged to dim the lights and also reduce the noise around her bedroom or to read a book before she sleeps to enable her sleep better. The patient also requires an annual physical examination from her doctor. NURS 6670 Week 5 Bipolar Disorder Paper

Psychopharmacologic treatment.

The treatment plan includes increasing the dosage of risperidone to 15 mg PO for a duration of one week. The drug is to be administered at night. The average half life of risperidone ranges from 3 hours to 20 hours (Gründer et al., 2019 NURS 6670 Week 5 Bipolar Disorder Paper). In the patient, the initial dose recommended is 2 mg with increments of 1-2 mg with the target dose recommended ranging from 4-8 mg. The effective dose in patients is 4-16 mg. Administration of risperidone once a day reduces the occurrence of side effects that include extrapyramidal symptoms. NURS 6670 Week 5 Bipolar Disorder Paper

Trazodone used as an antidepressant in the treatment of insomnia and in the management of anxiety disorders has a half-life of approximately 5-9 hours. A starting dose of 150 mg is recommended for depression with a gradual increase of 50-70 mg per day every 3 days (Cuomo et al., 2019 NURS 6670 Week 5 Bipolar Disorder Paper). Caution is taken not to exceed 375 mg. In patients with insomnia, 50-100 mg once per day are recommended. For doses not exceeding 300 mg taken once per day, it is recommended that it be taken before bedtime since trazodone induces sleep and thus can aid with the sleep disturbance problem of Ms. C.

Psychotherapy.

Individual psychotherapy is very vital in the management of bipolar disorder. Behavioural therapy enables the individual to channel their efforts on behaviours that reduce stress. Cognitive therapy entails enabling the patient to recognize and change any thought patterns that may be associated with changes in mood (Leahy, 2017). Social rhythm therapy seeks to help the individual come up with and maintain a normal sleep pattern and a daily routine that is more predictable.

Family psychotherapy is also key as the family is the closest social bond that the patient has. Psychoeducation of family members and close friends is very important. It enables the family members and friends to gain a better understanding of the condition, share any issues and questions they may have and also educates them on how to best support and care for their loved ones with bipolar disorder (Grenyer et al., 2019 NURS 6670 Week 5 Bipolar Disorder Paper).

Group therapy is also vital as the patient receives encouragement, shares her concerns to the group and equips one with mechanisms to cope with the condition. This greatly reduces the feeling of isolation. Groups are also key as they provide a platform to share with others and help the patients cope better as isolation can interfere with the compliance to medication (Vigo et al., 2018 NURS 6670 Week 5 Bipolar Disorder Paper).

Medical management needs.

Proper education of the patient and the family about the condition is key in the management of bipolar disorder. Ensuring that the patient maintains a good and healthy dietary intake is also key in ensuring effectiveness of medication. Ensuring that there is a suitable caregiver to take care of the patient and also ensure that the patient is compliant to her medication is also vital in ensuring proper management of the condition (Dowding et al., 2020 NURS 6670 Week 5 Bipolar Disorder Paper). Finally, ensuring that her co-workers are aware of the condition is also key in managing the conditions as it can help reduce and eliminate stressors at the workplace, especially those associated with stigma.

Community support resources.

The Depression and Bipolar Support Alliance offers support to people living with depression and bipolar disorder. This is achieved through regular meetings, online resources such as videos and online support groups. It also provides information on how to help an individual living with bipolar mood disorder. The National Alliance on Mental Illness focuses on educating the public about various mental disorders with the aim of improving the quality of life of individuals who are diagnosed with mental illnesses (Maura & de Mamani, 2017 NURS 6670 Week 5 Bipolar Disorder Paper).

Follow up plan.

Patient should ensure that she eats a balanced diet and exercises regularly. Patient should avoid any alcohol or drug use and avoid stressors as they may trigger mood disorders and reduce effectiveness of treatment (Romeo et al., 2021). Compliance to the medication provided is also key. Regular check ups are also vital in managing the bipolar mood disorder. Collaboration with organizations that offer group therapy also vital in ensuring that the patient is not undermining treatment.

NURS 6670 Week 5 Bipolar Disorder Paper References

• Cuomo, A., Ballerini, A., Bruni, A. C., Decina, P., Di Sciascio, G., Fiorentini, A., Scaglione, F., Vampini, C., & Fagiolini, A. (2019). Clinical guidance for the use of trazodone in major depressive disorder and concomitant conditions: pharmacology and clinical practice. Rivista di Psichiatria, 54(4), 137-149. https://doi.org/10.1708/3202.31796
• Dowding, D., Russell, D., Trifilio, M., McDonald, M. V., & Shang, J. (2020). Home care nurses’ identification of patients at risk of infection and their risk mitigation strategies: a qualitative interview study. International Journal Of Nursing Studies, 107, 103617. https://doi.org/10.1016/j.ijnurstu.2020.103617
• Grenyer, B. F. S., Bailey, R. C., Lewis, K. L., Matthias, M., Garretty, T. & Bickerton, A. (2019). A randomized controlled trial of group psychoeducation for carers of with borderline personality disorder. Journal of Personality Disorders, 33(2). https://doi.org/10.1521/pedi_2018_32_340
• Gründer, P., Augustin, M., Paulzen, M., & Gründer, G. (2019). Influence of kidney function on serum risperidone concentrations in patients treated with risperidone. The Journal of clinical psychiatry, 80(6), 19m12890. https://doi.org/10.4088/jcp.19m12890
• Leahy, R. L. (2017). Cognitive therapy techniques: A practitioner’s guide. Guilford Publications.
• Romeo, B., Hermand, M., Petillion, A., Karila, L. & Benyamina, A. (2021). Clinical and biological predictors of psychedelic response in the treatment of psychiatric and addictive disorders: A systematic review. Journal of Psychiatric Research, 137(), 273-282. https://doi.org/10.1016/j.jpsychires.2021.03.002
• Maura, J. & de Mamani, A. W. (2017). Mental Health Disparities, Treatment Engagement, and Attrition Among Racial/Ethnic Minorities with Severe Mental Illness: A Review. Journal of Clinical Psychology in Medical Settings, 24(3-4), 187–210. doi:10.1007/s10880-017-9510-2. NURS 6670 Week 5 Bipolar Disorder Paper
• Vigo, D. V., Kestel, D., Pendakur, K., Thornicroft, G., & Atun, R. (2018). Disease burden and government spending on mental, neurological, and substance use disorders, and self-harm: cross-sectional, ecological study of health system response in the Americas. The Lancet Public Health, 4(2), e89-e96. doi:10.1016/S2468-2667(18)30203-2

NURS 6670 Week 5 Bipolar Disorder Paper Instructions

NUR 6670 Week 6 Captain of the Ship OCD Case

NURS 6670 Week 7 Case Study: A young woman with Depression

NURS 6670 Week 7 Case Study: A young woman with Depression

NOTE: Please includes introduction and conclusions

Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical, as well as mental factors that might impact the client’s diagnosis and treatment. NURS 6670 Week 5 Bipolar Disorder Paper

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?

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 Week 5 Bipolar Disorder Paper

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.

A young woman with Depression

SUBJECTIVE

Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night), but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she “crashes” and has a good night’s sleep. She states that sleep will be “alright” for a few days, even a few weeks, and then she will have a similar issue with sleep. NURS 6670 Week 5 Bipolar Disorder Paper

You learn throughout the assessment process that Stefanie has had this problem for years. She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. She also notices that she has periods where she will engage in increased amounts of goal-directed activity. She states that things will just “pile up” at work and she gets this burst of energy to “make everything right.” She states that these bursts will last most of the day. She states that these periods show up probably every 2 to 3 weeks.

Stefanie also confesses to problems with being “down in the dumps.” She states that when she has her episodes in which she endeavors to “make everything right,” she feels fantastic and on top of the world. However, when these periods of energy end, she reports that she feels “depressed”—but then states: “well, maybe not depressed, but I definitely feel sad and empty.” She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: “I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel!” NURS 6670 Week 5 Bipolar Disorder Paper

OBJECTIVE

Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable. Gross neurological assessment is within normal limits.

MENTAL STATUS EXAM

Stefanie is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is “sad.” Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented.

At this point, please discuss any additional diagnostic tests you would perform on Stefanie.

Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO STEFANIE?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

Bipolar I, current phase, depressed
Bipolar II, current phase, hypomanic
Cyclothymic disorder. NURS 6670 Week 5 Bipolar Disorder Paper

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. NURS 6670 Week 5 Bipolar Disorder Paper

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. NURS 6670 Week 5 Bipolar Disorder Paper

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 . NURS 6670 Week 5 Bipolar Disorder Paper
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 Week 5 Bipolar Disorder Paper
•
• 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. NURS 6670 Week 5 Bipolar Disorder Paper
•
• Identify medical management needs, including primary care needs, specific to this client.
•
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client. NURS 6670 Week 5 Bipolar Disorder Paper
•
•
• 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 Week 5 Bipolar Disorder Paper

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 Week 5 Bipolar Disorder Paper

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 Week 5 Bipolar Disorder Paper

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.

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 Week 5 Bipolar Disorder Paper
  • 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.

Explain the evidenced-based psychotherapy and psychopharmacologic treatment for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected. NURS 6670 Week 5 Bipolar Disorder Paper

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