Examine Case Study: Pakistani Woman with Delusional Thought Processes. \u00a0You will be asked to make three decisions concerning the medication to \u00a0prescribe to this client. Be sure to consider factors that might impact \u00a0the client\u2019s pharmacokinetic and pharmacodynamic processes.
\nAt each decision point stop to complete the following:<\/p>\n
Decision #1<\/p>\n
Which decision did you select?
\nWhy did you select this decision? Support your response with evidence and references to the Learning Resources.
\nWhat were you hoping to achieve by making this decision? Support \u00a0your response with evidence and references to the Learning Resources.
\nExplain any difference between what you expected to achieve with \u00a0Decision #1 and the results of the decision. Why were they different?<\/p>\n
Decision #2<\/p>\n
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
\nWhat were you hoping to achieve by making this decision? Support \u00a0your response with evidence and references to the Learning Resources.
\nExplain any difference between what you expected to achieve with \u00a0Decision #2 and the results of the decision. Why were they different?<\/p>\n
Decision #3<\/p>\n
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
\nWhat were you hoping to achieve by making this decision? Support \u00a0your response with evidence and references to the Learning Resources.
\nExplain any difference between what you expected to achieve with \u00a0Decision #3 and the results of the decision. Why were they different?<\/p>\n
Also include how ethical considerations might impact your treatment plan and communication with clients.
\nBACKGROUND
\nThe client is a 34-year-old Pakistani female who moved to the United \u00a0States in her late teens\/early 20s. She is currently in an \u201carranged\u201d \u00a0marriage (her husband was selected for her since she was 9 years old). \u00a0She presents to your office today following a 21 day hospitalization for \u00a0what was diagnosed as \u201cbrief psychotic disorder.\u201d She was given this \u00a0diagnosis as her symptoms have persisted for less than 1 month.\u00a0
\nPrior to admission, she was reporting visions of Allah, and over the \u00a0course of a week, she believed that she was the prophet Mohammad. She \u00a0believed that she would deliver the world from sin. Her husband became \u00a0concerned about her behavior to the point that he was afraid of leaving \u00a0their 4 children with her. One evening, she was \u201cout of control\u201d which \u00a0resulted in his calling the police and her subsequent admission to an \u00a0inpatient psych unit.
\nDuring today\u2019s assessment, she appears quite calm, and insists that \u00a0the entire incident was \u201cblown out of proportion.\u201d She denies that she \u00a0believed herself to be the prophet Mohammad and states that her husband \u00a0was just out to get her because he never loved her and wanted an \u00a0\u201cAmerican wife\u201d instead of her. She tells you that she knows this \u00a0because the television is telling her so. \u00a0
\nShe currently weighs 140 lbs, and is 5\u2019 5\u201d
\nSUBJECTIVE
\nClient reports that her mood is \u201cgood.\u201d She denies auditory\/visual \u00a0hallucinations, but believes that the television does talk to her. She \u00a0believes that Allah sends her messages through the TV. \u00a0At times \u00a0throughout the clinical interview, she becomes hostile towards the \u00a0PMHNP, but then calms down.
\nYou reviewed her hospital records and find that she has been \u00a0medically worked up by a physician who reported her to be in overall \u00a0good health. Lab studies were all within normal limits.\u00a0
\nClient admits that she stopped taking her Risperdal about a week \u00a0after she got out of the hospital because she thinks her husband is \u00a0going to poison her so that he can marry an American woman. \u00a0
\nMENTAL STATUS EXAM
\nThe client is alert, oriented to person, place, time, and event. She \u00a0is dressed appropriately for the weather and time of year. She \u00a0demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is \u00a0slow and at times, interrupted by periods of silence. Self-reported mood \u00a0is euthymic. Affect constricted. Although the client denies visual or \u00a0auditory hallucinations, she appears to be \u201clistening\u201d to something. \u00a0Delusional and paranoid thought processes as described, above. Insight \u00a0and judgment are impaired. She is currently denying suicidal or \u00a0homicidal ideation.
\nThe PMHNP administers the PANSS which reveals the following scores:
\n-40 for the positive symptoms scale
\n-20 for the negative symptom scale
\n-60 for general psychopathology scale
\nDiagnosis: Schizophrenia, paranoid type
\n\u00a0Decision Point One <\/p>\n
Start Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter \u00a0\u00a0
\nRESULTS OF DECISION POINT ONE<\/p>\n
Client returns to clinic in four weeks
\nA decrease in PANSS score of 25% is noted at this visit \u00a0
\nClient seems to be tolerating medication
\nClient’s husband has made sure she makes her appointments for injections (one thus far)\u00a0
\nClient has noted a 2 pound weight gain but it does not seem to be an important point for her
\nClient complains of injection site pain telling the PMHNP that she \u00a0has trouble siting for a few hours after the injections and doesn\u2019t like \u00a0having to walk around for such a long period of time\u00a0<\/p>\n
Decision Point Two <\/p>\n
\u00a0Continue \u00a0same decision made but instruct administering nurse to begin injections \u00a0into the deltoid at this visit and moving forward \u00a0\u00a0\u00a0\u00a0
\nRESULTS OF DECISION POINT TWO<\/p>\n
Client returns to clinic in four weeks
\nClient’s PANNS has reduced by a total of 50% from the initiation of Invega sustenna
\nWhen questioned about injection site pain, client states it is much better in the arm\u00a0
\nClient’s weight has increased by an \u00a0additional 2.5 pounds (total of 4.5 pounds in a 2 month period). She is \u00a0somewhat bothered by the weight gain and is afraid that her husband does \u00a0not like it. He is not present at this visit as she brought herself\u00a0
\nClient likes how she feels on the \u00a0Invega Sustenna but is wondering if there is another drug like it that \u00a0would not cause the weight gain\u00a0<\/p>\n
Decision Point Three <\/p>\n
\u00a0Continue \u00a0with the Invega Sustenna. Counsel client on the fact that weight gain \u00a0from Invega Sustenna is not as much as what other drugs with similar \u00a0efficacy can cause. Make appointment with a dietician and an exercise \u00a0physiologist. Follow up in one month \u00a0\u00a0\u00a0\u00a0
\nGuidance to Student
\n \u00a0Weight gain can occur with Invega \u00a0Sustenna. It is modest in nature and can be controlled with proper \u00a0nutrition and exercise. It is always a good idea to try and control a \u00a0client\u2019s weight through consultation with a dietician and exercise \u00a0physiologist (life coach) before switching to another agent when a \u00a0product is showing efficacy for at least 6 months. \u00a0
\nAbilify Maintena is a good option for someone who has good \u00a0response to abilify oral. Remember that Abilify does not bind to the D2 \u00a0receptor for a great period of time (such as Invega) and can be less \u00a0affective in certain individuals. Also, remember that akathisia \u00a0can be a \u00a0possible side effect. Once an IM long acting medication is given, the \u00a0effects of the drug (both efficacious and untoward effects) can be \u00a0maintained for a long duration (up to a month or longer). Tolerability \u00a0and efficacy should be established with oral medication first before \u00a0administering the first injection. Also a disadvantage to Abilify \u00a0Maintena is a 2-week overlap of oral therapy is required due to \u00a0effective blood levels lagging behind the induction dose. \u00a0
\nQsymia is a weight loss medication that is a combination of \u00a0Phenteramine and Topiramate. It is only indicated to treat obesity. This \u00a0client\u2019s BMI (28.9 kg\/M2) does not fit the definition of obesity (BMI \u00a0>30 Kg\/M2- Following from CDC website: Class 1: BMI of 30 to < 35, \u00a0Class 2: BMI of 35 to < 40, Class 3: BMI of 40 or higher. Class 3 \u00a0obesity is sometimes categorized as \u201cextreme\u201d or \u201csevere\u201d obesity). \u00a0\u00a0There are two things wrong with this therapy option. First, there are \u00a0only a few occasions where add-on therapy to treat a side effect is \u00a0acceptable and weight gain is not one of those scenarios. Secondly, \u00a0Phenteramine has a lot of cardiovascular toxicities (such as elevated \u00a0BP, HR, increased workload on the heart).
\n\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"
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