Assessing and Treating Clients With Complex Regional Pain Disorder

Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder

Complex Regional Pain Disorder
White Male With Hip Pain

BACKGROUND
This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical interview, the client reports that his family doctor sent him for psychiatric assessment because the doctor felt that the pain was “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.” Assessing and Treating Clients With Complex Regional Pain Disorder

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SUBJECTIVE
The client reports that his pain began about 7 years ago when he sustained a fall at work. He states that he landed on his right hip. Over the years, he has had numerous diagnostic tests done (x-rays, CT scans, and MRIs). He reports that about 4 years ago, it was discovered that the cartilage surrounding his right hip joint was 75% torn (from the 3 o’clock to 12 o’clock position). He reports that none of the surgeons he saw would operate because they felt him too young for a total hip replacement and believed that the tissue would repair with the passage of time. Since then, he reported development of a strange constellation of symptoms including cooling of the extremity (measured by electromyogram). He also reports that he experiences severe cramping of the extremity. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). However, the neurologist referred him back to his family doctor for treatment of this condition. He reports that his family doctor said “there is no such thing as RSD, it comes from depression” and this was what prompted the referral to psychiatry. He reports that one specialist he saw a few years ago suggested that he use a wheelchair, to which the client states “I said ‘no,’ there is no need for a wheelchair, I can beat this!”
The client reports that he used to be a machinist where he made “pretty good money.” He was engaged to be married, but his fiancé got “sick and tired of putting up with me and my pain, she thought I was just turning into a junkie.”Assessing and Treating Clients With Complex Regional Pain Disorder
He reports that he does get “down in the dumps” from time to time when he sees how his life has turned out, but emphatically denies depression. He states “you can’t let yourself get depressed… you can drive yourself crazy if you do. I’m not really sure what’s wrong with me, but I know I can beat it.”
During the client interview, the client states “oh! It’s happening, let me show you!” this prompts him to stand with the assistance of the corner of your desk, he pulls off his shoe and shows you his right leg. His leg is turning purple from the knee down, and his foot is clearly in a visible cramp as the toes are curled inward and his foot looks like it is folding in on itself. “It will last about a minute or two, then it will let up” he reports. Sure enough, after about two minutes, the color begins to return and the cramping in the foot/toes appears to be releasing. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder. The client states “if there is anything you can do to help me with this pain, I would really appreciate it.” He does report that his family doctor has been giving him hydrocodone, but he states that he uses is “sparingly” because he does not like the side effects of feeling “sleepy” and constipation. He also reports that the medication makes him “loopy” and doesn’t really do anything for the pain.

MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is dressed appropriately for the weather and time of year. He makes good eye contact. Speech is clear, coherent, goal directed, and spontaneous. His self-reported mood is euthymic. Affect consistent to self-reported mood and content of conversation. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes appreciated. Judgment, insight, and reality contact are all intact. He denies suicidal/homicidal ideation, and is future oriented. Assessing and Treating Clients With Complex Regional Pain Disorder.
Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy)
Decision Point One
Select what the PMHNP should do:

Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by
Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter

50 mg BID thereafter

Amitriptyline 25 mg po QHS and titrate upward weekly by 25
Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day

mg to a max dose of 200 mg per day

Neurontin 300 mg po BEDTIME with weekly increases of 300
Neurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg if needed

mg per day to a max of 2400 mg if needed

The Assignment
Examine Case Study: A Caucasian Man With Hip Pain. 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. Assessing and Treating Clients With Complex Regional Pain Disorder.
At each decision point stop to complete the following:
• Decision #1
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Assessing and Treating Clients With Complex Regional Pain Disorder.
• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o 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.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Below is a simple paper for reference, the needs an introduction and a conclusion.

Assessing and Treating Clients with Anxiety Disorder
Introduction
Anxiety disorders refer to a syndrome of mental disorders typified by substantial feelings of fear and anxiety. The anxiety and fears may cause physical symptoms like shakiness and rapid heart rate. Various forms of anxiety disorders include panic disorder, social anxiety disorder, agoraphobia, generalized anxiety disorder, among other disorders (Locke et al, 2015). The focus of this assignment is on a 46-year-old male who presented with symptoms of anxiety disorder that included shortness of breath, chest tightness as well as a feeling of impending doom. Lab results and EKG in the ER were normal which ruled out myocardial infarction. (HAM-A) scale yielded a score of 26 and a diagnosis of generalized anxiety disorder (GAD) was made. Following the diagnosis, three decisions will be made about the treatment regimen for the client. After making each decision, a rationale supported by clinical evidence and patient data will be provided. Moreover, after making each decision, factors likely to impact the pharmacokinetic and pharmacodynamic processes for the client will be considered when making decisions. Finally, ethical considerations likely to impact the client’s treatment plan will be discussed. Assessing and Treating Clients With Complex Regional Pain Disorder.
Decision # 1
The first decision for this client would be to start Zoloft 50 mg orally daily. This decision was made because Zoloft is selective serotonin reuptake inhibitors (SSRIs) and SSRIs are the recommended first-line treatments for anxiety disorders. SSRIs work by increasing the amount of serotonin within the brain; serotonin is a brain chemical that is very important for mood regulation (Locher et al, 2017). Accordingly, SSRIs such as Zoloft work by hindering serotonin reuptake in the brain and therefore increases the level of serotonin in the brain; availability of serotonin thus helps in regulating moods and hence improves anxiety symptoms. In addition, evidence shows that Zoloft is effective in improving anxiety symptoms manifest in GAD; this is because anxiety depletes serotonin in the brain and this is addressed by an SSRI such as Zoloft which replaces the depleted serotonin in the brain (Patel et al, 2018).
Imipramine (Tofranil) at 25 mg BID and Buspirone (Buspar) 10 mg orally twice daily choices were not selected because evidence shows that SSRIs as the first-line medications in the treatment of anxiety disorders. Both Imipramine and Buspirone takes about 2 – 4 weeks before making any improvement on the symptoms. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder. Moreover, these two medications are not well tolerated as Zoloft and also have numerous side effects when compared to Zoloft.
By selecting the decision to begin Zoloft 50 mg orally daily, it was expected that symptoms of generalized anxiety disorder manifested by the client would gradually clear away. It was also expected that the HAM-A score for the client would significantly reduce indicating an improvement of the anxiety symptoms. This is because evidence shows that Zoloft as an SSRI is effective in the treatment of GAD symptoms (Patel et al, 2018). In addition, it was hoped that the client would have minimal side effects and tolerate the medication because evidence shows that SSRIs have minimal side effects are well tolerated (Clevenger et al, 2018)
There was no significant difference between the actual outcome of the decision and the expected results because when the client came for review the anxiety symptoms had significantly reduced and manifested by the client not having symptoms such as shortness of breath or chest tightness. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder. Moreover, the client reported that he had stopped worrying about his job and also the HAM-A score dropped from 28 to 18 which shows that the client was responding to treatment, although partially Assessing and Treating Clients With Complex Regional Pain Disorder.
Decision # 2
The chosen second decision is to increase the client’s Zoloft dose to 75 mg orally daily. This decision was selected because the client’s HAM-A score dropped from 28 to 18 which indicated a partial response to treatment which shows that the client is responding to the treatment. Therefore, the increase of the dose from 50 mg to 75mg will further increase the availability of serotonin within the brain and thus further improve the anxiety symptoms for the client. Evidence supports the gradual increase of the SSRIs dosage if the clients are not satisfactorily responsive to the treatment (Jakubovski et al, 2016). This decision was also based on the fact that the client seems to be tolerating Zoloft medication well and without any side effect.
The option to increase Zoloft to 100mg was not chosen because dosage increase and titration are supposed to be gradual to ensure the client continues to tolerate the medication well with minimal side effects. On the other hand, the option to have the client continue with the same dose and have him reassessed after four weeks was not selected because the client’s response is partial and therefore it is essential to increase the dosage to ensure complete response to the medication (Jakubovski et al, 2016).
By choosing this decision, the expectation was that the anxiety symptoms would continue reducing and this would be indicated by a significantly reduced HAM-A score. There was no noticeable difference between the actual decision and the expected decision because on coming to the clinic the client’s anxiety symptoms had further reduced as indicated by the further reduction of the HAM-A score. Assessing and Treating Clients With Complex Regional Pain Disorder.
Decision # 3
For the third decision, the decision will be to maintain the client on the current dose of Zoloft 75 mg orally daily. This decision was made because with the current regime the client is showing improvement of the anxiety symptoms as such as tightness in the chest, difficulty breathing or the feeling that something terrible is about to happen and also the HAM-A score indicated significant reduction with the current dose. This means that the client is responding to the current medication and dose adequately. In addition, with the current dose, the client is not experiencing any side effects and he is tolerating the medication very well. Evidence and clinical guidelines recommend titration of medications according to the response of the client; in this case, the client is responding very well and hence there is no need to titrate medication any further (Jakobsen et al, 2017).
The option to either augment the current treatment with Buspar or the option of increasing the current dose of Zoloft to 100mg was not chosen since the client is showing a satisfactory response to the current dose of Zoloft 75 mg.
By selecting this decision, the expectation is that the client will show a complete response to the treatment where the client will report complete clearance of the symptoms and the HAM-A score will significantly reduce.
Impact of Ethical Considerations on the Treatment Plan
For this client, the ethical considerations will encompass informed consent, confidentiality, and autonomy. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder. First, it is essential to seek informed consent from the client to ensure that the client has full information about the recommended treatment before he consents to the treatment (Millum, 2013). Secondly, the confidentiality of the client should be respected. This means that any information and the client’s treatment regimen should not be disclosed to any other party without the consent of the client. Lastly, the client’s autonomy should be respected where the client should not be forced or coerced to have any treatment; he should decide to accept or refuse the treatment. Any decision the client makes about the treatment should be respected (Millum, 2013) Assessing and Treating Clients With Complex Regional Pain Disorder.

Conclusion
The selected first decision is to begin Zoloft 50 mg orally daily. The rationale for selecting this decision is because SSRIs such as Zoloft are the first treatment choice for anxiety disorders and evidence shows that the medication is effective in treating anxiety symptoms. There was significant improvement with this decision. The second decision was to increase the dose to the Zoloft dose to 75 mg orally daily. This decision was made because the client was showing partial response as indicated by the HAM-A score and hence increasing the dose would facilitate a satisfactory response. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder. The third decision is to maintain the current dose because the client is showing a satisfactory response to the treatment as indicated by the reduced HAM-A score and reduced symptoms as per the subjective data. Finally, the ethical considerations that should be considered include autonomy, confidentiality, and informed consent Assessing and Treating Clients With Complex Regional Pain Disorder.

References
Clevenger S, Devvrat M, Dang J, Vanle B & William I. (2018). The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder. Ther Adv Psychopharmacology. 8(1): 49–58.
Jakubovski E, Anjali V, Freemantle N, Taylr M & Bloch M. (2016). Systematic Review and Meta-Analysis: Dose-Response Relationship of Selective-Serotonin Reuptake Inhibitors in Major Depressive Disorder. Am J Psychiatry. 173(2): 174–183.
Jakobsen J, Kumar K, Timm A, Gluud C, Ebert E et al. (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry. 17(58).
Locke A, Faafp M, Krist N & Shultz C. (2015). Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults. Am Fam Physician. 1;91(9),617-624. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder.
Locher, C., Koechlin, H., Zion, S. R., Werner, C., Pine, D. S., Kirsch, I. & Kossowsky, J. (2017).
Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Psychiatry. 74(10), 1011–1020.
Millum J. (2013). Introduction: Case Studies in the Ethics of Mental Health Research. J Nerv Ment Dis. 200(3), 230–235.
Patel D, Feucht C, Brown K & Ramsay J. (2018). Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners. Transl Pediatr. 7(1): 23–35. Assessing and Treating Clients With Complex Regional Pain Disorder.

Introduction

Complex regional pain syndrome is a debilitating condition that affects the limbs and is likely to be induced by trauma or surgery.  Apart from complicating the entire recovery process, it tends to impair the psychosocial and functional well-being of an individual. It’s characterized by vasomotor abnormalities, hyperalgesia, , and allodynia. The pain that a patient experiences is often disproportionate to the degree of tissue injury that occurs and may persist beyond the anticipated period required for tissue healing (Stanton-Hicks, 2018). Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder. The major goals of therapy are: to ensure pain relief, to restore functioning and psychologically stabilize a patient.

Many drugs are often used in pain management to improve functional status. However, mental health practitioners should ensure that the choice of drugs promotes compliance and have fewer side effects. This paper discusses the management of a 43-year-old who presented with complex regional pain disorder. In his management, three decisions are to be made regarding the most effective medications, expected outcomes, , and actual outcomes. A description of the ethical issues when engaging clients with complex regional pain disorder and their families will also be provided Assessing and Treating Clients With Complex Regional Pain Disorder.

Decision #1

Decision Selected

Start Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter

Reasons for Selecting This Decision

            Patients with regional pain disorder have a low pain threshold which may be caused by changes in the central nervous system. These changes cause a patient to be more sensitive to pain due to wrong neurotransmitter levels in the brain. As selective norepinephrine and serotonin reuptake inhibitor (SNRI) that has an equal effect on both neurotransmitters, Savella is an NMDA antagonist that works on nerve endings to produce analgesic effects (Stanton-Hicks, 2018).  It promotes the reuptake of the neurotransmitters in the brain thus easing the pain, reducing fatigue and promoting memory. Assessing and Treating Clients With Complex Regional Pain Disorder.

Amitriptyline, a tricyclic antidepressant that has proven to be effective in the management of neuropathic pain off label could also be a good option (Benzon, Liu & Buvanendran, 2016).  However, it has a side effect of drowsiness and dizziness that the client initially stated clearly that he didn’t like. Therefore, prescribing this medication for a start might only trigger non-compliance.

Neurontin, also referred to as gabapentin, is an anti-epileptic / anticonvulsant, is used in for nerve pain relief. Therefore, it could also be a good option for the management of this patient. However, it also has the side effects of drowsiness and in high doses, results in extreme somnolence and drowsiness (Finnerup, et al., 2015).  Since the patient expressed his dislike for the side effect of feeling sleepy from the start, prescribing it would only lead to non-compliance. Assessing and Treating Clients With Complex Regional Pain Disorder.

Expected Outcome

By starting the patient on Savella, it was expected that his pain will significantly reduce to 3 on a scale of 1-10 and be able to walk without support. It was also expected that he would resume to a normal work routine and be able to perform activities of daily life will very minimal or no assistance (Stanton-Hicks, 2018).  His mood would be happy or joyous and he would have a stable effect.

Difference between Expected outcome and Actual Outcome

            The client returned to the clinic after four weeks walking without crutches but minimally limping.  He reported that the main was more manageable and he was able to walk around with no assistance. However, he noted that the pain was worse during the morning hours and got better as the day progressed.  On a scale of 1-10, his pain was reportedly 4 but admitted that he could be able to live and tolerate a level of 3. The client also noted that he occasionally experienced bouts of sweating that he couldn’t explain with some sleep disturbance. An assessment revealed that he had a blood pressure of 147/92mmhg and a pulse of 110 beats/ min. He was still future-oriented and denied homicidal/suicidal ideation. One of the major side effects of Savella is heart palpitations (Finnerup, et al., 2015).  It is for this reason that the patient experienced bouts of sweating, sleep disturbance and had a high blood pressure. Reducing the dosage can help to minimize this side effect.

Decision #2

Decision Selected

Continue With the Current medication but reduce the dosage to 25 mg twice daily

Reasons for Selecting This Decision

During the first visit, the client reported that he experienced unexplained symptoms of bouts of sweats, sleep disturbance and he had a high blood pressure. These symptoms were the resultant side effects of Savella. According to Stanton-Hicks (2018), by reducing the dosage of Savella, its side effects are also minimized resulting in more improved health outcomes. Assessing and Treating Clients With Complex Regional Pain Disorder.

Expected Outcome

By reducing the dosage of Savella, it was expected that the patient’spatient’s pain level will also be minimized, he will still be able to perform most activities of daily life with very minimal support and that his social, professional and physical functioning will also improve (Benzon, Liu & Buvanendran, 2016). Above all, the dosage reduction aimed to ensure that the side effects weren’t adverse and that he would live a near normal life.

Difference between Expected outcome and Actual Outcome

            After four weeks, the patient returned to the clinic walking with crutches. He stated that the pain was 7 out of 10 and admitted that he didn’t feel good as compared to the previous month. He frequently woke up at night due to pain on his right leg and foot. He, however,, however, denied homicidal and suicidal ideation. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder. His blood pressure was 124/85 and pulse rate was 87 beats/ min. He looked sad and discouraged by the slip in the management of his pain. The decision to lower the dosage of Savella in managing the client’s initial side effects to the dug inspired this difference at the cost of uncontrolled pain (Murnion, 2018) Assessing and Treating Clients With Complex Regional Pain Disorder.

Decision #3

Decision Selected

Change Savella to 25 mg orally in the morning and 50 mg orally at bedtime

Reasons for Selecting This Decision

            During the client’s first visit to the clinic, he clearly stated that the medication Savella was effective for his pain management but the pain worsened early morning and improved as the day progressed. As supported by Finnerup, et al., (2015), starting with dose reductions during parts of the day when pain is mostly under control is a good idea that can still contribute to the achievement of therapeutic goals.

Expected Outcome

It was expected that the patient’s pain will effectively be managed to a level of 3 on a scale of 1-10. He will also be able to walk and perform most of his activities of daily life with minimal or no support. As supported by Stanton-Hicks (2018), the patient would no longer experience sleep disturbance and that his affect and mood will gradually be stable. With regards to the drugs side effects, it was expected that the patient’s blood pressure and pulse rate will gradually normalize and that he will no longer experience palpitations or unexplained bouts of sweating Assessing and Treating Clients With Complex Regional Pain Disorder.

Difference between Expected outcome and Actual Outcome

The client returned to the clinic after four weeks walking without crutches. He reported his pain level to be 4 on a scale of 1-10 and expressed how he was grateful but would love it to reduce to 3 since it’s the best level that he could easily manage. His blood pressure was 120/84mmhg and pulse rate 86beats/min. He denied suicidal/homicidal ideation and was still future-oriented. At this point, it will be necessary to explain to the client that he has a neuropathic pain syndrome which probably may never respond to pain medications. Therefore, it would be practical to collaboratively set realistic expectations and make the patient understand that he will frequently experience some pain level daily (Benzon, Liu & Buvanendran, 2016). What matters most is to manage it in such a manner that permits him to effectively perform activities of daily life.  The patient should also be educated that medications are not a final solution but a part of a complex regimen of chiropractic care, physical therapy, massage and heat therapy (Murnion, 2018).

How Ethical Considerations Might Impact Treatment plan and Communication With Clients

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The most significant ethical consideration for this client is that of informed consent, autonomy, beneficence, and non-maleficence. Before changing any treatments, it is important to seek informed consent just to ensure that he is fully aware of what he is consenting to, possible dangers and outcomes involved (Millum, 2013).  Secondly, any treatment options considered should only be for the patient’s best interest/benefit and have fewer side effects. This will guarantee that all treatment options cause no harm. Lastly, the client’s autonomy should also be respected such that, he shouldn’t be forced or coerced to agree to a treatment modality that his conscience is against (Millum, 2013). Assessing and Treating Clients With Complex Regional Pain Disorder.

Conclusion

The management of regional pain disorder in adults requires a careful and thorough assessment of a patients needs which will help to decide the best medications to use as part of a broader regimen of heat and massage therapy, chiropractic care and physical therapy. Savella, an SNRI was the best medication choice for the management of this patient’s pain. It has minimal side effects with the major side effect being heart palpitations which can be managed with dosage reduction. Although in patients with regional pain disorder dose reduction comes with the cost of uncontrolled pain, string reductions during the parts of a day when pain is mostly under control helphelp to achieve the desired therapeutic goals as it was in this case.

References

Benzon, H. T., Liu, S. S., & Buvanendran, A. (2016). Evolving definitions and pharmacologic management of complex regional pain syndrome Assessing and Treating Clients With Complex Regional Pain Disorder.

Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H., .& Kamerman, P. R. (2015). Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology, 14(2), 162-173. Assessing and Treating Clients With Pain Essay – Complex Regional Pain Disorder.

Millum J. (2013). Introduction: Case Studies in the Ethics of Mental Health Research. J Nerv Ment Dis. 200(3), 230–235.

Murnion, B. P. (2018). Neuropathic pain: current definition and review of drug treatment. Australian Prescriber, 41(3), 60.

Stanton-Hicks, M. (2018). Complex regional pain syndrome. In Fundamentals of Pain Medicine (pp. 211-220). Springer, Cham. Assessing and Treating Clients With Complex Regional Pain Disorder

Psychopharmalogical Approach

Central nervous system

1. In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous system, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples.
2. Answer the following (listing is acceptable for these questions):
   

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   • What are the major components that make up the subcortical structures?
   • Which component plays a role in learning, memory, and addiction?
   • What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?
3. In 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples.
4. The synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.
5. In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples.

NURS 3375 Health Policy And Legal Aspect (Assignment)

Overview: Peer Review

In the Module 3 Reflection Assignment, you will reflect upon what you have learned about Peer Review Committee processes and Texas Board of Nursing rules as you consider the actions of fictitious nurses and committee members in scenarios. REMEMBER, YOU ARE USING THE TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. Please use the link provided in the assignment for the Texas BON Rule 217.16. NURS 3375 Health Policy And Legal Aspect (Assignment)

ALSO, THERE ARE 2 PARTS TO THIS ASSIGNMENT. PLEASE MAKE SURE YOU COMPLETE BOTH PARTS.

Refer to your course readings and lectures as you complete the assignment.

Performance Objectives:

· Apply the Minor Incident Rule to specific incidents.

· Describe the due process protections for a nurse who is peer-reviewed.

Rubric

Use this rubric to guide your work on the assignment, “Peer Review.”

Task

Accomplished

Proficient

Needs Improvement

Part 1 (a)

Applying Rule 217.16

(Total 50 points)

Lists all the correct 5 criteria, accurately explains application of   criteria clearly. (25 points)

Lists 3 or 4 of the   correct criteria, accurately explains application of these criteria

(15 points)

Lists 2 applications of criteria.

10 points)

Incorrectly lists criteria (0   point)

Part   1 (b)

Reflects upon applications

of Rule 217.16

(Total 25 points)

Correctly states if nurse should be reported or not reported with 3 substantial sentences. (25 points)

Correctly states if nurse should be reported or not reported with 2 sentences.

(15 point)

Writes 1 sentence.

(10 points)

Incorrectly judges whether violations occurred (0 point)

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Part   2

Violation of IBPR Rule 217.19 (Total   25 points)

Correctly listed the 4 violations and provides correct explanations (25 points)

Correctly lists 2-3 violations and explanations (15 points)

Lists 1 violation and explanation (10 points)

Incorrectly lists criteria (0 point)

All 5 questions correct (25 points)

4 questions correct (20 points)

3 questions correct (15 points)

2 questions correct (10 points)

1 question correct (5 points)

0 questions correct (0 point)

Part 1: (a) Applying Rule 217.16(h) Minor Incidents

Read the following scenario and then answer the questions that follow:

You are on your hospital’s Peer Review Committee (PRC). You are reviewing Nurse A’s practice. She works on the pediatric unit. In the past, Nurse A has practiced safely without incidents. However, four months ago, Nurse A gave immunizations to five pediatric patients (3 months, 9 months, 2 years, 4 years, and 5 years of age). She used a vial of Hepatitis B vaccine that had been expired for 30 days but still was being stored in the unit refrigerator. She gave the five immunizations within a few minutes of each other, and she got the vial from the refrigerator only once (i.e., She did not take it out and replace it five times). She took responsibility for the errors when she was informed by her unit manager.

Should Nurse A be reported to the BON?

Let’s review what deems a minor vs. a reportable (NOT minor) incident-

A minor incident is- 217.16(a)-  as defined under the Texas Nursing Practice Act, Texas Occupations Code §301.401(2), means conduct by a nurse that may be a violation of the Texas Nursing Practice Act or a Board rule but does not indicate the nurse’s continued practice poses a risk of harm to a patient or another person.

A reportable incident is- 217.16(h)- conduct that falls outside of the definition of a minor incident and must be reported to a PRC or BON. NURS 3375 Health Policy And Legal Aspect (Assignment)

Apply the Minor Incident Rule to reach and support your decision. This Rule 217.16 can be found at http://www.bon.texas.gov/rr_current/217-16.asp

Use this specific link only- it is the official updated Texas Board of Nursing information. Click on the link and scroll down to the bottom to find the letter (h), where criteria are listed that describes actions that must be reported to the Peer Review Committee or BON.

Criteria. In the first column of the table, list the 5 criteria as it appears in the rule that are essential in determining if an incident is a reportable action. All 5 must be listed for full credit. Then, in the second column, record your explanation as to why or why not the nurse’s actions deem it reportable and therefore harmful to a patient.

Criteria that determine an incident is reportable

Rule 217.16(h)

Explanation of whether or not Nurse A’s actions are minor vs. reportable

Criteria :

1.

2.

3.

4.

5.

Part 1: (b) Report vs. Not Report

Based on the Rule 217.16(h) criteria you listed above, would you report Nurse A to the Board? Please explain why or why not. At least 3 substantial sentences are needed for full credit.:       (Explain below)

Part 2: Applying Rule 217.19 Incident-Based Peer Review

Read the following scenario and then reflect upon the actions it portrays.:

Last month, the chairperson of your hospital’s Peer Review Committee (PRC) passed you in the hallway and said, “I’m glad I ran into you. You’re going to be peer-reviewed.” The chairperson continued, saying, “Your manager found out that you called the Texas Department of State Health Services two months ago and reported that LVNs were being allowed to do the complete initial assessment on patients. Also, you made some medication errors over the past couple of months. I’ll let you know when the meeting is to occur.”

You heard nothing more about the PRC meeting. Today, the chairperson came to you and told you that you had been reported to the Texas Board of Nursing. She said, “It was just felt by the work group that you are a troublemaker and lack the skills to practice due to your med errors. I’m also giving you a ‘heads up’ that you are going to be put on suspension for at least three days by your unit manager.”

Applying Rule 217.19, what violations of the rule occurred in the above scenario?

First, review your learning about incident-based peer review. In the first column of the table, list any 4 criteria from Rule 217.19 that were violated (there are more than 4 to choose from).

1-

2-

3-

4-

In the second column, explain how each criterion was violated. All 4 boxes must be completed for full credit. Please use the link provided at http://www.bon.texas.gov/rr_current/217-19.asp

Which part of the rule was violated?

(Subsection number and letter OR descriptive phrase)

(Rule 217.19)

Explanation of violation ( from the 4 criteria above): NURS 3375 Health Policy And Legal Aspect (Assignment)

Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay

Delusional Disorders
Pakistani Female With Delusional Thought Processes

BACKGROUND
The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.
Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit. Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay.

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During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so.
She currently weighs 140 lbs, and is 5’ 5”

SUBJECTIVE
Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down.
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 Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay. Lab studies were all within normal limits.
Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.

MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described, above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation. Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay.
The PMHNP administers the PANSS which reveals the following scores:
-40 for the positive symptoms scale
-20 for the negative symptom scale
-60 for general psychopathology scale
Diagnosis: Schizophrenia, paranoid type

RESOURCES
§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.
§ Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf
§ Paz, Z., Nalls, M. & Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal. 13. 625-629.

Decision Point One
Select what the PMHNP should do:

Start Zyprexa 10 mg orally at BEDTIME

Start Zyprexa 10 mg orally at BEDTIME

Start Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter

Start Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter

Start Abilify 10 mg orally at BEDTIME

Start Abilify 10 mg orally at BEDTIME

Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay. 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
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay.
• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o 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.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Below is a simple paper for reference.

“Bipolar” refers to a mental condition characterized by a sudden shift in the energy and the moods of the patient. The condition may also result in the occurrence of manic phases along with slight depression. The condition is quite difficult to diagnose being that one may exhibit depression-like symptoms and/or manic phases. Symptoms associated with bipolar disorder are common, often symptoms of other disorders Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay. Cases of misdiagnosis for this condition is also common. This, in turn, results in wrong medication prescribed to the patient. Under such circumstance, the condition of the patient might become more complicated, and worst-case scenario, some might lose their lives (Stahl, 2013). It is therefore important to thoroughly assess the symptoms exhibited by a client before making a diagnosis. This is in a bid to eliminate any case of misdiagnosis. This paper will provide three medical decisions that can be taken in the treatment of a patient diagnosed with Bipolar disorder.
Background
The client that I assessed this week is a 26-year-old Korean female. The client has been hospitalized for 21 days as a result of manic phases that she experienced. During the assessment process, the client would fiddle with things. She weighed 110lbs while standing 5’5”. She explains how she only sleeps for five hours since “sleeping is not fun.” Her medical history indicated that she is of good health and the results from the lab evaluation indicated that her vital signs are within normal limits. A gene test of the client indicated that she is positive for CYP2D6*10 allele, which means any medication offered to her would not yield the desired results. She reports that she stopped taking the medications that she was prescribed within hospital (Laureate Education, 2016f). The client is alert and oriented to the events taking place around her. However, she is dressed inappropriately and her speaking rapidly. Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay. She reports her mood as unbothered and affects as broad. She denies any form of hallucination or paranoia Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay. Her judgment is intact while her insight is slightly affected. Nonetheless, she denies suicidal ideations.
Decision #1
Selected Decision
The first decision is to start Risperdal 1mg orally BID
Reason For Selecting This Decision
Risperdal, originally referred to as risperidone, is a typical antipsychotic that has proven to be highly effective in the management of bipolar disorders. It does so by trying to influence a rebalance in serotonin and dopamine thus resulting in good conduct. Since the patient was having bipolar confusion, Risperdal happens to be the best alternative also considering that it is readily accessible (Culpepper, 2014). In the past treatment therapy, the patient happened to default lithium. Therefore, it wouldn’t be a smart option to start lithium 300mg since the chances of the patient not adhering to treatment are high. Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay. Also, Lithium has a lot of side effects and the patient will be subjected to monitoring therapeutic range periodical to avoid toxic range, which means the patient have to go to a lab and have her blood drawn periodical. Similarly, Seroquel XR could be a good alternative, but it’s mostly used for acute Schizophrenia and Schizophrenia maintenance. However, its side effects of increase diabetes, dyslipidemia, constipation and weight addition might contribute to non-compliance thus not achieving the therapeutic goals (John & Antai-Otong, 2016). This leaves Risperdal as the best option in this case.
Expected Outcomes
Within four weeks on treatment, the patient is expected to show immense progress. The current manifestations of bipolar disorder that she experiences are also expected to diminish to an extent that the patient has a peaceful state of mind. The patient should be restful and be able to conduct her activities of daily life with little or no difficulty (John & Antai-Otong, 2016) Risperdal is the best choice to influence mental action and improve the patient’s capacity to be of rational sound mind in the way she addresses issues. It is also expected that the patient’s self-destructive practices and tension would diminish and will respond to her environment and social interactions positively (Fang, et al., 2017) Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay.

Difference between Expected Outcomes and Actual Outcomes
After four weeks, the client returned to the clinic accompanied by her mother looking very lethargic and sedated. They, however, agreed that the patient\’s self-destructive practices had significantly diminished. The client’s mother explained that the client had been lethargic for about a week after the last visit. Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay. It should be noted that one of the side effects of Risperdal is sedation (John & Antai-Otong, 2016) Similarly, based on the fact that the client is reportedly positive for CYP2D6*10 allele, it is probable that she might be having a slow rate of clearance of Risperdal from her systems leading to higher levels than normal of Risperdal in blood (Chen et al., 2015).
Decision #2
Selected Decision
Based on the client\’s presentation and the initial decision, the second-best decision, in this case, would be reducing Risperdal to 1mg HS.
Reason for Selecting This Decision
Based on the patient\’s progress during the second visit, it was evident that Risperdal was effective in attaining therapeutic goals of treatment. However, the unwanted side effects were the major concerns. It is therefore wise to decrease the dosing to deal with the side effects rather than change to another drug. Decreasing the dosage to one mg HS would be the best alternative that will help to reduce the significant impact of the side effects (Culpepper, 2014). Changing the drug to lithium will possibly result in non-compliance since the client has already developed some demeanor towards it. Besides, the patient may turn out to generally have a negative attitude towards all medicines which may be prescribed by the mental health practitioner Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay. Giving the patient support to adapt to an alternate dosage of the same medication will also improve their dedication, trust, and understanding to collaborate in achieving the treatment goals (John & Antai-Otong, 2016).
Expected Outcomes
As earlier stated, Risperdal has proven to be effective in managing the symptoms of bipolar disorder by influencing a balance in serotonin and dopamine to help address a patient’s self-destructive behaviors. Based on the fact that the client is positive for CYP2D6*10 allele, the initial dosage could have resulted in an accumulation of Risperdal which is slowly being cleared (John & Antai-Otong, 2016). Reducing the dosage to one mg HS will definitely reduce the amount of Risperdal accumulated in the body and subsequent side effects of lethargy and sedation. By adjusting this dosage, it is expected that the patient will record some positive progress in terms of reduced self-destructive behaviors, ease in performing activities of daily life and thinking patterns (Fang, et al., 2017). It is also expected that the client will have minimal episodes of lethargy and sedation.
Difference between Expected Outcomes and Actual Outcomes
After four weeks, the client returned to the clinic accompanied by her mother. She was less sedated, less lethargic and showed a lot of improvement in symptoms. The young mania rating scale had also reduced from 22 to 16, an illustration that there was more than a 25% reduction in symptoms. These outcomes were actually foreseen and were the reason the dosage of Risperdal was reduced to one mg HS (John & Antai-Otong, 2016) Risperdal is a powerful choice for bipolar disorder; its side effects are easily manageable and help in the achievement of therapeutic goals for bipolar patients more easily.
Decision #3
Selected Decision
My third decision would be to continue at the same dosage of 1 mg HS.
Reason for Selecting This Decision
From the initial visit, it was evident that the client has good progress in terms of reducing self-destructive behaviors and management of the drugs side effects. Maintaining this dosage and reassessing the client after four weeks will contribute to the achievement of the treatment goals for both the client and the attending mental health practitioner. The initial dosage of 1 mg BID had turned out to be detrimental to the patient’s health (Fang, et al., 2017). Therefore, going back to it would prompt similar side effects. Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay. Besides, changing to Seroquel is not recommendable in this case since Seroquel is FDA approved for bipolar II depression and schizophrenia which differs from the patient\’s presentation that we are trying to manage.
Expected Outcomes
It is expected that, within four weeks, the patient will record immense progress by reducing self-destructive behaviors. Besides, she will report very minimal or no side effects from Risperdal. She will have a good state of mind, conduct, and good thinking patterns Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay. Risperdal is FDA approved for managing bipolar symptoms and has proven to be highly effective with manageable side effects (John & Antai-Otong, 2016)
Difference between Expected Outcomes and Actual Outcomes
As initially expected, the patient has some significant progress and very minimal side effects of lethargy and sedation. The reassessment proved that Risperdal had adequately helped to achieve the necessary treatment goals in the entire course of treatment. Given the pharmacodynamics and pharmacokinetics of Risperdal, these are certainly the outcomes that ought to be expected. Since the client is for positive for CYP2D6*10 allele, Risperdal could be clearing at a slower rate resulting to higher than normal levels in the blood (Fang, et al., 2017).
However, the effect, in this case, may not be significant as compared to the initial point.
How Ethical Considerations Might Impact the Treatment Plan and Communication with Clients
The major ethical considerations that ought to be considered in managing clients with bipolar disorder are beneficence, nonmaleficence, and autonomy. Despite the fact that clients need treatment to live near-normal lives, the risks of the choice of medications used should balance with the corresponding benefits. Alternatively, a mental healthcare provider should consider giving the patient some of the best available options for management to maximize the benefits of treatment (Ratheesh et al., 2017). The impairment or insight and judgment that is always characterized by mania and mood episodes may render a patient as not able to provide informed consent nor incapable of making rational decisions regarding their treatment. Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay. Besides, a number of clinical presentations such as delusional thinking and irritability could probably be a threat in damaging the therapeutic alliance that exists between a client and a mental healthcare provider. It should also be noted that, due to the relapsing-remitting nature of bipolar disorder, there are instances where a patient might feel well and question the need to continue with treatment (Ratheesh et al., 2017). This place the treatment goals laid by the mental healthcare provider is in conflict with the patient’s autonomy to make decisions.

Background Information

For this assignment, the patient was a 34-year old Pakistani female who relocated to the United States while in her early 20s. Currently, she was in an organized marriage with a husband who was selected for her since she was 9 years old.  Today, she presents at the clinic following hospitalization for 21 days for a ‘brief psychotic disorder’ since her symptoms had lasted for less than a month.

Prior admission, the client reported of visions of Allah and in an entire week, she strongly believed that she was Prophet Mohammad and would deliver the entire world from sin. Her husband became more concerned about her behavior to the extent that he was afraid of leaving their children with her. One evening, the client was described to be out of control. As a result, the husband called the police which was followed by a subsequent admission to an inpatient psychiatric unit. Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay.

In today’s assessment, the patient appeared to be calm and emphasizes that the whole incident was just blown out of proportion. She also denies having believed that she was Prophet Mohammad and stated that her husband was out to get her since he never loved her and wanted a wife who was American instead of her. She informs that she knows this since the television told her so. Currently, she was 140 lbs. and 5’5’’.

Based on this case study, this paper discusses three major decisions regarding the medication to be prescribed to this client suffering from Schizophrenia, paranoid type. A description of the expected outcomes and actual outcomes will be provided for every decision with an explanation for any differences likely to be witnessed. Major ethical considerations that are likely to impact the client’s treatment plan and communication with clients will also be provided Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay.

Decision Pont 1

Decision Selected

Start Zyprexa 10 mg orally at bedtime

Reason for Selecting this Decision

Zyprexa, also known as olanzapine is an antipsychotic drug which affects brain chemicals. It is approved to treat symptoms of mental health disorders such as bipolar disorder and schizophrenia in both children and adults who are 13 years or older. Zyprexa is an atypical antipsychotic, which functions by helping to restore the balance of neurotransmitters in the brain. In terms of dosing, it is administered once daily (Wei Xin, 2016). Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay. Zyprexa is used to treat dysfunctional behaviors, malfunctions, speeches and distorted interpretations of the issues and events surrounding them.

Abilify could be a good option but only for a patient who has a good response to oral abilify. It should also be remembered that, Abilify does not bind to D2 receptor for quite a long time. Therefore, it can be less effective for some patients. Another possible side effect of Abilify is akathisia which is an extrapyramidal side effect that may lead to medication non-adherence. On the other hand, Invega Sustenna could also be a good option. However, it increases the risk of  memory loss  and  its side effects of pain, redness, swelling at the site of injection increases the chances of the patient failing to turn up for appointments. Invega Sustenna also leads to muscle spasms, high cholesterol and weight gain, which may generally impair the client’s physical wellbeing based on her current weight.

Expected Outcomes

By administering Zyprexa, it was expected that the client will have no hallucinations or delusional thoughts and she would be able to think more positively and clearly about herself. It was also expected that she would feel less agitated and actively participate in activities of daily life (Drug, 2015) Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay.

Difference between Expected Outcomes and Actual Outcomes

After four weeks, the client returned to the clinic accompanied by her husband. The client’s PANSS had decreased to a partial response of 25%.  The client also reported a weight gain of 5 pounds. When questioned further, the client stated that she could never seem to get satisfied with her meals. Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay. As a result, she constantly snacked in an entire day. One of the major side effects of Zyprexa is increased appetite which influences an increase in the frequency of taking meals hence weight gain.  Among all atypical antipsychotics, Zyprexa causes the most significant weight gain. Zyprexa has also been associated with increasing the risk of hyperglycemia hence newly diagnosed diabetes mellitus in clients (Takeuchi et al., 2015) Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay.

Decision Point 2

Decision Selected

Reduce Zyprexa to 7.5 mg orally at bedtime

Reason for Selecting this Decision

Based on the client’s visit, it was evident that she was concerned about the weight gain and increased appetite which was caused by the medication Zyprexa at dosing of 10mg Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay. Therefore, reducing the dosage to 7.5mg orally at bedtime is an effort to purposely counter the side effect of weight gain and increased appetite while treating the psychotic symptoms of delusions, hallucinations, dysfunctional thoughts, mood and behaviors (Drug, 2015).

Expected Outcomes

            It was expected that, by reducing the dosage of Zyprexa from 10 mg orally at bedtime to 7.5mg orally at bedtime, the patient would not gain additional weight. Additionally, the currently revised dosage of 7.5mg orally at bedtime is within the patient’s weight. Apart from being advised to stop snacking an entire day, the client will be advised to observe normal meal schedules and actively engage in regular physical exercise to lose the excess weight that she had initially added(Wei Xin, 2016).

Difference between Expected Outcomes and Actual Outcomes

The client returned to the clinic after four weeks accompanied by her husband. She had worsened. Her PANNS had increased by 10%, an indicator that all her negative symptoms were gradually worsening. However, her weight had stabilized and excess hunger episodes had abated. According to the husband’s explanation, the client was gradually becoming less manageable at home, which forced him to take time off work as he was fearful to leave her alone. This was clear that the therapeutic goals were not being achieved with the current dosing of 7.5 mg of Zyprexa orally at bedtime (Takeuchi et al., 2015). Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay.

Decision Point 3

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Decision Selected

Increase the dosage of Zyprexa to 10mg orally at bedtime and

Reason for Selecting this Decision

            From the client’s previous visit, it was notable that the dosage of 7.5 mg failed to help achieve the desired therapeutic levels. Despite the fact that having no complaints of weight gain and a manageable appetite, the client was reportedly unmanageable which also inconvenienced the husband. This also means that 7.5mg was an under dosage for the patient hence was insufficient to achieve the desired therapeutic goals for treatment. However, by returning to a dosage of 10 mg orally at bedtime, the client will receive similar side effects as that of the initial point of weight gain and increased appetite. Assessing and Treating Clients With Psychosis and Schizophrenia Sample Essay. Besides, she will also be at risk of Diabetes mellitus (Drug, 2015). Therefore, Risperdal could be considered a perfect option. Nonetheless, since Risperdal is dosed twice daily, compliance for this patient could be a problem. Evidence exists to support the efficacy of administering Risperdal once which is a good option in case compliance for this patient becomes an issue. Despite the fact that weight gain is also a side effect of Risperdal, it is not as serious as Zyprexa (Takeuchi et al., 2015).

Expected Outcomes

With Risperdal as an alternative, it is expected that the client will be more manageable and display less severe psychotic symptoms. She will report little or no delusions, hallucinations and significantly improve in terms of being more manageable (Takeuchi et al., 2015). Besides, the client will be able to execute her activities of daily life with little or no assistance and associated symptoms will have very minimal effect/impact on her overall life. Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay.

Difference between Expected Outcomes and Actual Outcomes

            Although the patient reported minor on and off delusional symptoms, there was no significant difference between the expected outcome and the actual outcome. The client demonstrated to be alert and oriented with a stable mood and fluent affect. She also reported no side effects of increased appetite or weight gain, an indicator that therapeutic goals were gradually being achieved (Takeuchi et al., 2015).

How Ethical Considerations Might Impact the Treatment Plan and Communication with Clients

A major ethical consideration in counseling this client and making the treatment plan is that of informed consent. Patients with schizophrenia tend to have neurological deficits such that, they are not mentally/psychologically fit to make decisions for themselves regarding treatment. The same way, it is difficult to tell whether by consenting to a treatment plan, they fully understand what they are consenting to. As supported by Young, Taylor & Lawrie (2015), while attempting to get an informed and voluntary consent from the patient, caution should be taken to ensure that any decisions made do not harm the patient. This means that a mental health practitioner ought to strive to strike a balance between the principle of autonomy and non-maleficence. Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay.

References

The drug, A. A. (2015). 8 Olanzapine (Zyprexa). Top Drugs: Their History, Pharmacology, and Syntheses, 138.

Takeuchi, H., Fervaha, G., Lee, J., Agid, O., & Remington, G. (2015). The effectiveness of different dosing regimens of risperidone and olanzapine in schizophrenia. European Neuropsychopharmacology, 25(3), 295-302.

Wei Xin Chong, J., Hsien-Jie Tan, E., Chong, C. E., Ng, Y., & Wijesinghe, R. (2016). Atypical antipsychotics: A review on the prevalence, monitoring, and management of their metabolic and cardiovascular side effects. Mental Health Clinician, 6(4), 178-184.

Young, S. L., Taylor, M., & Lawrie, S. M. (2015). “First do no harm.” A systematic review of the prevalence and management of antipsychotic adverse effects. Journal of Psychopharmacology, 29(4), 353-362. Assessing and Treating Clients With Psychosis and Schizophrenia Example Essay