NURS 6670 Week 9 Case Study Assignment

NURS 6670 Week 9 Case Study Assignment

Week Nine Case Study Example Paper

This week’s case study is of a 63-year-old veteran Caucasian male who was diagnosed with schizophrenia and Post-Traumatic Stress Disorder (PTSD). The patient is jobless and homeless. He complains of auditory and visual hallucinations and paranoia. This paper describes the management and the history of presenting illness of the patient. NURS 6670 Week 9 Case Study Assignment

NURS 6670 Week 9 Case Study Assignment

History of Presenting Illness and Clinical Impression

The patient is a 63-year-old veteran Caucasian male who has visited the clinic for psychiatric review, evaluation, and treatment. He is was diagnosed with schizophrenia 1 month ago and was prescribed olanzapine 10 mg PO OD for schizophrenia. He has been hearing voices in the sleep at night yelling at him and ordering him to jump out through the window. When he wakes up, he sees shadows of people dancing on the wall. As a result, he does not sleep well at night and has to wake up and walk around. These symptoms have been present for 9 months after retiring from the army. He has no home and usually sleeps in his car. He has no close family members or friends but reports that his friends are still active in the US army. The patient has developed a fear for his life whenever he is near people for more than three months now. He develops palpitations and becomes paranoid. He, therefore, avoids people because they give him flashbacks of memories of his time during wars but cannot remember these events clearly. NURS 6670 Week 9 Case Study Assignment

This patient was diagnosed with schizophrenia (F20.9) using the DSM-5 criteria and MSE findings. He also has Post-Traumatic Stress Disorder (F43.10). He met the criteria for PTSD by showing symptoms of persistent avoidance, negative cognition, and alterations in arousals and sleep for more than three months (Dallel & Fakra, 2018 NURS 6670 Week 9 Case Study Assignment). His late-onset schizophrenia can be associated with psychotic PTSD (McIntosh & Story, 2021). However, the diagnosis of psychotic PTSD cannot be made at this point without full history and assessment of the events around the associated traumatic events

Psychopharmacologic Treatments for the Patient

Treatment goals for this patient include reduction in anxiety, psychosis, and panic episodes. Pharmacologic therapy will include an antipsychotic and anxiolytic. He is already on olanzapine 10 mg PO OD daily for schizophrenia. Additional buspirone 10 mg PO Od will be added to his psychopharmacotherapy. Buspirone is an anxiolytic medication that would alleviate the patient’s panic episodes from his PTSD. This therapy will take one month before evaluation for effectiveness. However, side effects may necessitate earlier dose adjustments or termination of the medications. Caution will be taken to avoid drug-drug interactions between buspirone and olanzapine. Olanzapine treatment will be long-term and regular reassessments will be done every two weeks to evaluate improvements and adverse effects that might warrant dose adjustments.

The therapeutic endpoints of this psychopharmacotherapy include improvement thought processes, reduction in hallucinations frequencies, and improvement in sleep patterns and durations. Prevention of his nighttime auditory and visual hallucination will improve his sleep. The absence of negative symptoms of schizophrenia is a good prognosticator. The overall treatment endpoint is to improve the quality of life of the patient. NURS 6670 Week 9 Case Study Assignment

Psychotherapy Choices

Cognitive Behavior Therapy (CBT) would be the best psychotherapy option for this patient. The gold standard for the management of PTSD is trauma-specific CBT (World Health Organization, 2019). In this therapy, the patient will be assessed properly to understand the traumatic experiences from the war encounters, their sequelae, and lifetime emotional traumatic experiences. This would determine the intensity and the impact of the trauma (Cornerstone of Recovery, 2019). The impacts of the trauma would be of more importance because the trauma severity, in most cases, is not related to the severity of the PTSD (Watkins et al., 2018). This therapy would be done on an individual basis. The second most appropriate psychotherapy option will be individual counseling. However, this can be done alongside the trauma-specific CBT sessions.

Medical Management Needs

The patient has no known chronic medical illnesses that would require attention. The most outstanding medical concern for this patient would be medication adherence and compliance. His prescription would, therefore, be designed in such a way that both medications be taken at the same time of the day. Screening for cardiovascular and metabolic diseases such as diabetes and hypertension would be indicated in this patient because of his living conditions, poor sleep patterns, and age.

Community Support Resources

The major community resource need for this is housing. The patient is homeless and sleeps in his car since retirement from the army. He also has socioeconomic needs since he is unemployed and would not afford the medications. He would therefore benefit from the services of veteran homes available in the state. The PTSD Foundation of America is an agency that would help the patent through the promotion of recovery and networking (Wright, 2020 NURS 6670 Week 9 Case Study Assignment). These resources would be essential in adjunction to pharmacotherapy and psychotherapy.

Follow-up Plan and Collaboration

The patient will be followed up and reassessed every two weeks alongside his psychotherapy sessions. Alongside the fortnight visit to the psychiatrist, the patient would be kept in daily communication with his care team. The care team will consist of a psychiatric nurse, a psychiatrist, and a psychologist. The collaboration between the nurse and the psychiatric team will be important for this follow-up and reassessments.

Conclusion

The patient is an elderly veteran Caucasian male who is homeless and has no close social relationships. He was diagnosed with schizophrenia about a month ago but has no negative symptoms. He also has PTSD that is associated with memories of traumatic experiences during the wars. Therefore, buspirone would be added to his olanzapine for the management of anxiety episodes. He has socioeconomic and housing needs that need to be addressed in his general management.

NURS 6670 Week 9 Case Study Assignment References

NURS 6670 Week 9 Case Study Assignment Instructions

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.” NURS 6670 Week 9 Case Study Assignment

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. NURS 6670 Week 9 Case Study Assignment
Clinical Impression: Based on the diagnostic criteria in APA (2013) Diagnosed: Schizoaffective disorder (ICD-10: F25.9), NURS 6670 Week 9 Case Study Assignment
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.

NURS 6670 Week 9 Case Study Assignment 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.
•
• 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.
•
• 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.
Comments / Note

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 9 Case Study Assignment

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?

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 9 Case Study Assignment

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 Week 9 Case Study Assignment

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.
    • 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. NURS 6670 Week 9 Case Study Assignment
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.

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