Bipolar Therapy
Client of Korean Descent/Ancestry

BACKGROUND INFORMATION

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder. 

Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”

She weights 110 lbs. and is 5’ 5” 

SUBJECTIVE

Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.” 

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work. 

Genetic testing reveals that she is positive for CYP2D6*10 allele. 

Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago. 

MENTAL STATUS EXAM

The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.

The Young Mania Rating Scale (YMRS) score is 22

RESOURCES

§ Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

Decision Point One

Select what the PMHNP should do:

Begin Lithium 300 mg orally BID

Begin Risperdal 1 mg orally BID

Begin Seroquel XR 100 mg orally at HS

Examine Case Study: An Asian American Woman With Bipolar Disorder. 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.

Choice one: I choose to start Seroquel

Decision Point One

Begin Seroquel XR 100 mg orally at HS

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Client is reporting that she sleeps a bit more at bedtime
• Client states that she has gained about 2 or 3 pounds, which she does not like
• Client also reports that she has been constipated since starting this medication
• Client is also complaining of dry mouth which she does not like.
• Client’s score on the Young Mania Rating Scale has decreased from a 22 to an 18
• Client is reporting really good mood, but is asking for a different medication because of the weight gain

Decision Point Two

Select what the PMHNP should do next:

Increase Seroquel XR to 300 mg orally daily 

Discontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie meal 

Continue same dose of Seroquel and counsel client regarding ways to prevent constipation

I choose to discontinue Seroquel and start Geodon 40 mg orally BID. ADminister with 500 calorie meal

Discontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie meal 

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Client demonstrates a 50% decrease in score on the Young Mania Rating Scale (from 22 to 11)
• Client denies any additional weight gain and denies any additional side effects

Decision Point Three

Select what the PMHNP should do next:

Continue same dose and reassess in 4 weeks 

Increase Geodon to 60 mg orally BID with a 500 calorie meal 

Augment with Lithium sustained release 300 mg orally BID

I now choose to continue same dose and reassess in 4 weeks

Decision Point Three

Continue same dose and reassess in 4 weeks 

Guidance to Student
The PMHNP should provide counseling to the client about this side effect and encourage increased fluids and fiber in the diet to combat constipation. Hard candies or gum can be used to prevent dry mouth. This is another issue as the drug can cause dental problems as a result of dry mouth.

Changing to Geodon clearly helped with symptoms and arrested weight gain in this client. The PMHNP could wait 4 weeks and see if any changes in Young Mania Rating Scale are noted, or increasing to 60 mg orally BID in an attempt to hasten symptom improvement. Increasing dose may be associated with side effects.

Augmentation with Lithium may be appropriate if the goal of therapy is to discontinue antipsychotic therapy and treat with Lithium monotherapy. Lithium was problematic for this client but changing formulation to the extended release may overcome the difficulties she was experiencing with side effects. The PMHNP would need to educate client regarding side effects of medication and need to maintain compliance. 

You are admitting a 19-year old female college student to the hospital for fevers.  Using the patient information provided, choose a culture unfamiliar to you and describe what would be important to remember while you interview this patient. Discuss the health care support systems available in your community for someone of this culture. If no support systems are available in your community, identify a national resource.

how this aligns with Haught’s in Prophetic Religions; how Islamic spirituality described here aligns/diverges Models of Spiritual Care & Feminist Spirituality

CAHIIM Competencies Assessed: 

Subdomain VI.D. Human Resources Management

1. Create and implement staff orientation and training programs (Blooms 6)

Instructions:  You are an HIM Supervisor at a hospital and you have been asked to create a new staff training on data compliance rules.  Assume that the new staff has a wide variety of background, with some new staff knowing nothing about data compliance at all.  The training should be basic and introductory.

Create an outline for your training.

Requirements:

1. Include an introduction and summary within your outline
2. Length of outline should be 3-4 pages
3. It should be an annotated outline.  This means that it should include citations within the outline and a reference page.
4. Your training should include the topics of HIPAA and The Joint Commission and other data compliance topics that affect hospital staff

1. 200 words– Elaborate on the mental illness of schizophrenia. State how this disease related to the book and The Hate You Give and the assigned character Starr. 

2. 150 words– What is the epidemiology of this disease? Speak on the population distribution, health determinants, risk factors, and specific population that is impacted. 

3. 150 words–What is the prevalence rate of the disease within the US? 

4. 150 words–What is the etiology of the disease? 

5. 200 words–What pharmacological treatments are available for this disease? Provide specific instructions for the patient and provider for this medication. Is there a risk associated with each medication? 

6. 150 words– What adverse effects are associated with each individual medication? 

7. 150 words– What nonpharmacological treatment options are available? 

8. 150 words– What primary secondary and tertiary prevention are available for patients who diagnosed with schizophrenia? 

9. 200 words– Locate a research article pertaining to bipolar disorder as it pertains to public and community health nursing summarize this article in 200 words or more. 

10. 200 words—Locate a research article pertaining to schizophrenia disorder as it pertains to the medias perception of this disease, what role do community and public health nurses play in minimizing the negative stigma surrounding this mental illness, provide examples? 

Please respond to the questions in APA 7th format. The attached textbook MUST be used to formulate a response. In addition to the textbook please include 5 scholarly articles. Each section Must have subheadings. 

Attention Wizard Kim. 

Week 6 Discussion: Practicum professional Development Objectives/ Progress Appraisal  3 pages. 

Rubrics 

I need 4 pages… 2 first ones on the provide template. 

 To Prepare:

• Review the agenda priorities of the current/sitting U.S. president and the two previous presidential administrations.
• Select an issue related to  healthcare that was addressed by each of the last three U.S. presidential      administrations.
• Reflect  on the focus of their respective agendas, including the allocation of financial resources for addressing the healthcare issue you selected.
• Consider how you would communicate the importance of a healthcare issue to a      legislator/policymaker or a member of their staff for inclusion on an      agenda.

Part 1: Agenda Comparison Grid – 1- to 2-page Comparison Grid

Use the Agenda Comparison Grid Template Attachment –  complete the Part 1: Agenda Comparison Grid based on the current/sitting U.S. president and the two previous presidential administrations and their agendas related to the public health concern you selected. Be sure to address the following:

• Identify and provide a brief description of the population health concern you selected and the factors that contribute to it.
• Describe the administrative agenda focus related to the issue you selected.
• Identify  the allocations of financial and other resources that the current and two previous presidents dedicated to this issue.
• Explain how each of the presidential administrations approached the issue.

Part 2: Agenda Comparison Grid Analysis – 1-Page Analysis

Using the information, you recorded in Part 1: Agenda Comparison Grid on the template, complete the Part 2: Agenda Comparison Grid Analysis portion of the template, by addressing the following:

• Which administrative agency would most likely be responsible for helping you address the healthcare issue you selected?
• How do  you think your selected healthcare issue might get on the agenda for the current and two previous presidents? How does it stay there?
• Who would you choose to be the entrepreneur/ champion/sponsor of the      healthcare issue you selected for the current and two previous presidents?
• At least 2 outside and 2-3 course resources are used.

Part 3: Narrative – 1-page Fact Sheet

Using the information recorded on the template in Parts 1 and 2, develop a 1-page narrative that you could use to communicate with a policymaker/legislator or a member of their staff for this healthcare issue. Be sure to address the following:

• Summarize why this healthcare issue is important and should be included in the  agenda for legislation.
• Justify the role of the nurse in agenda setting for healthcare issues.
• At least 3 resources are used.

You should write a two-page paper double spaced APA format about the affect  COVID-19 has on mental health/ patients with mental health disorders.  

This is due Friday 10/2 at Midnight. 

This is NOT a Research Project but a Quality Improvement Project 

TOPIC: Impact of Medication Administration Errors on 3-4-Year-old Leukemia Patients  

This week’s post will focus on Chapter Two. Address the areas below in your discussion post this week. Spelling and grammar will be reviewed and graded. Note: When you write the chapters, adhere to the Proposal Paper requirements.

Introduce Chapter Two: States the overall purpose of the project; lets reader knows what the literature review will address; describes how the chapter will be organized (including the specific sections and subsections); describes how the literature was surveyed, so the reader can evaluate the thoroughness of the review, provides a historical overview of the problem based on the gap or need defined in the literature and how it originated (this section must contain empirical citations; presents strong evidence for the intervention; and discusses how the problem has evolved historically into its current form.

Theoretical Framework: This section identifies the theories or models that provide the foundation for the project. This section should present the theories or models(s) and explain how the problem under investigation relates to the theory or model. The theories or models(s) guide the clinical questions and justify what is being measured (variables) as well as how those variables are related. Literature Review outlines your themes and subthemes and includes references. 

Characteristics of Food Pantry Clients are Changing (Theme 3rd level heading): Add all citations for this section listed:

Food Security. (Subtheme 4th level heading): Add all citations for this listed here.

Food pantry clients. (Subtheme 4th level heading): Add all citations for this listed here.

Summary of Theme (Second level heading)

Blood Pressure Control (Theme 3rd level heading): Add all citations for this section listed.

Behavior change (Subtheme 4th level heading): Add all citations for this listed here.

Community health interventions. (Subtheme 4th level heading): Add all citations for this listed here.

Diet and exercise. (Subtheme 4th level heading): Add all citations for this listed here.

Summary of Theme (2nd level heading): Continue in this fashion. Theme-sub theme, summary.

Significance of the Project: This section identifies and describes the significance of the project and the implications of the potential results based on the clinical questions and problem statement. It describes how the project fits within and will contribute to the current literature or the clinical site practice. It describes potential practical applications from the project.

Project Methodology: Providing the rationale for the selected project method (e.g. quantitative) and includes a discussion of why the selected method was chosen instead of another method.

Project Design: Providing the rationale for the selected project design and includes a discussion of why the selected design is the best one to collect the data needed.

Case Study: A 67-year-old man presents to the HCP with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks. The son also relates that his father needs help rising from his chair. Physical exam demonstrates tremors in the hands at rest and fingers exhibit “pill rolling” movement. The patient’s face is not mobile and exhibits a mask-like appearance. His gait is uneven, and he shuffles when he walks and his head/neck, hips, and knees are flexed forward. He exhibits jerky or cogwheeling movement. The patient states that he has episodes of extreme sweating and flushing not associated with activity. Laboratory data unremarkable and the HCP has diagnosed the patient with Parkinson’s Disease.

In your 2 page Case Study Analysis related to the scenario provided, explain the following:

• Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient.