15 Mar What is important to educate your patients on when prescribing SSRIs/SNRIs in regards to how long it takes to take full effect and the black box warnings?
For the discussion board this week please include answers to these questions:
If prescribing trazadone for sleep to a male patient what side effect should you include in your education? What about cardiac effects of trazadone with some other psychotropics? What test could you order for a baseline with this medication to monitor?
What is important to educate your patients on when prescribing SSRIs/SNRIs in regards to how long it takes to take full effect and the black box warnings?
What labs could help you identify an organic contributor to depressive symptoms?
What are some specifiers from the DSM 5 for depressive disorders?
Case Study Week One
Case study: Amanda – a 42-year-old with recurrence of a manic episode Amanda is a 42-year-old lady who has suffered from bipolar disorder since she was 22 years of age, and has had five acute episodes. Her bipolar disorder usually manifests itself as a manic episode although she did have one instance of severe depression during which time she attempted to take her own life.
Amanda was prescribed lithium as a mood stabilizer since her first episode which has helped her to be symptom free for several periods, and so function as a full-time mother to two small children and hold down a part-time job. Amanda, who had been taught to monitor her mood, noticed that it had started to become manic. Her family had also noticed marked pressure of speech and that she appeared to be spending a large amount of money on presents for the children, for her sister’s children and on goods for the house. As a consequence of this she accumulated considerable debt on her credit card. Acting on a prior agreement with Amanda, and her previously agreed authority with the credit card company, Amanda’s husband arranged for her credit card to be suspended and for some of the goods to be returned. Amanda herself recognized these as her usual symptoms of mania and contacted her community psychiatric nurse who referred her for psychiatric treatment. Amanda’s lithium dose was increased.
However, her mood continued to deteriorate and she became very manic and also to show signs of psychotic episodes. The multi-disciplinary community mental health team in consultation with Amanda and her family decided that Amanda would be better treated in hospital.
In the hospital, you are her PMHNP. Follow the directives for a treatment plan (in the assignment explanation). What would your primary diagnosis be? What medications would you change her to from the Lithium and why? Would you place an order for CBT or Behavioral therapy and why? Make your orders very clear, and use in-text citations, black box warnings for the meds, and what each med is being used for.
With this new course of treatment that you have ordered, and the inpatient stay in the psychiatric hospital, what outcomes do see being obtainable for Amanda? Do you need any blood test or medical tests? If yes, explain what they are and why.
List all 5 components of a suicide risk assessment, in addition to any other questions you may have for Amanda.
Use in-text citations, based your criterion off of the DSM-5, and use citations for the drugs you choose, and the non-pharm treatments as well.
For the case below complete the following areas for the case study presented:
Any differential diagnoses (Include a short line indicating why each one should be considered for the case)
Your diagnosis and reasoning
Any additional questions you would have asked
Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.
Any labs and why they may be indicated (including ruling out any organic causes of depression)
Screener scales or diagnostic tools that may be beneficial
Additional resources to give (Therapy modalities, support groups, activities, etc.) Make sure to include a hotline and support group in this section of your plan.
Discuss and answer questions related to the case presentations on the discussion board. You will need to utilize all of your nursing skills when evaluating the data.
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