The Assignment: 5 pages Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this patient. Consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
Assessing and Treating Patients With Bipolar Disorder
Bipolar disorder is a prevalent psychiatric condition that affects many individuals. Approximately 1-2 % of the adult population suffers from this chronic and severe mental condition (World Health Organization, 2019). The signs and symptoms that the patient presents differ on whether the patient has mania or depression. During an episode of bipolar disorder, individuals act differently from their normal moods, their attitudes change, and their thinking and behavior are highly altered. Bipolar disorder affects people from all areas and does not discriminate against the millions of individuals it affects globally (WHO, 2019). It is not a respecter of the socioeconomic status. The onset of this condition is around 25 years, but it can also affect teenagers. The National Institute of Mental Health (2017) states that 2.6 % of the US population suffers from this condition. If not properly treated, it can be fatal. A nurse practitioner must thus be able to diagnose these patients and formulate a care plan correctly.
This essay will outline the decision tree in managing an Asian American female diagnosed with bipolar disorder. This woman is aged twenty-six years, and she presented to the clinic after twenty-one days of being hospitalized. The diagnosis by the nurse practitioner is bipolar I disorder. The nurse practitioner will consider the patient-specific patients throughout the decision tree. The nurse practitioner will evaluate the safety, cost, and efficacy of the medications they select during the decision tree. The clinician will also consider the legal and ethical issues that impact patient communication and management of bipolar disorders and other mental conditions. The nurse practitioner must thus have extensive clinical knowledge and use evidence-based guidelines when managing the patient in the case study.
Decision Point One
The first decision would be to initiate the client on Lithium 300mg orally twice every day. Lithium acts as a mood stabilizer, and it is the first-line drug in managing bipolar disorders (Wolz, 2020). The medical history of the patient indicated that she was previously on Lithium. The patient, however, stopped using the drug after being discharged from the hospital. Lithium was effective in managing her bipolar symptoms during her hospitalization. She, however, stopped using the medication after the relapse of the symptoms.
The nurse practitioner did not select Risperdal since the patient tested positive for the CYP2D6 allele. Because of the CYP2D6 allele, the client will slowly clear the drug from her body, leading to higher drug levels in her bloodstream. This will cause sedation (Seripa et al., 2018). This is why the nurse practitioner did genetic testing to confirm the presence of the allele. The nurse practitioner decided not to initiate the patient on Seroquel since it has the side effects of blurred vision, mouth dryness, stomach upset, and constipation (Seripa et al., 2018). This drug is an atypical antipsychotic that works by restoring the neurotransmitters’ balance in the brain. It increases patient concentration and lowers the hallucinations. It helps patients think positively about themselves (National Alliance on Mental Illness, 2021). It also reduces nervousness and enables individuals to participate in daily life activities actively. This medication can also enhance energy levels and moods while preventing severe mood swings.
By initiating the patient on Lithium, the nurse practitioner hoped to stabilize the client’s mood. It will bring the client to symptomatic recovery. The nurse practitioner was also hoping to prevent symptoms relapse, lower the subthreshold symptoms, and enhance the patient’s occupational and social functions (Wolz, 2020).
Decision Point Two
The client returned to the clinic four weeks later, informing the nurse practitioner that she did not consistently take the Lithium. She further stated that she only took the drug when she felt like she needed it. She presented with the same symptoms she had when she first came to the clinic four weeks ago. The nurse practitioner evaluated her reasons for non-compliance to determine why the patient did not consistently take the medication. The patient was then to be educated on drug pharmacology and the effects of medications. Non-compliance can result in severe consequences such as poor disease prognosis, reoccurrence, and relapse. The common reason bipolar patients are non-compliant is the stigma linked with bipolar disorder, substance abuse, and manic symptoms (Azadforouz et al., 2016).
The nurse practitioner did not increase the lithium dosage to 450mg since it would increase the side effects, such as lithium toxicity (Azadforouz et al., 2016). The client is not complying with medication