Advanced Psychopharmacology and Health Promotion

Unit 7 Discussion Case Study 600W. APA. 4 references due 10-17-23.

Case Study:

· Your patient is a 36-year-old woman with bipolar disorder and anxiety. She has been stable on a combination of fluoxetine and olanzapine for two years.  She is morbidly obese at 340 pounds at 5’5” in height, has type II diabetes, hypertension, and hyperlipidemia.  She has concerns about her weight and has tried numerous ‘fad diets’ to no avail.  She explains she has lost, at most, 15 pounds and has been able to keep it off for three months. 

· She has three children, one of which is severely disabled, and a husband who has a terminal diagnosis. She expresses worry that her weight will impact her ability to care for her disabled child when her husband dies.  She reports she eats out frequently due to her children’s busy schedules.  She is a stay-at-home mother but gets little exercise and performs no regular physical activity. 

· She reports feelings of shame that she can no longer orgasm on the rare occasions her husband has the energy and desire to be intimate.

  
Questions: 

· What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

· What would be our approach to the sexual side effects she is experiencing? 

· If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended? 

· Please include the subjective and objective information in this post.

All responses must by supported by correct APA 7th edition formatted citations and references.

1. What would be your approach to managing this patient's weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

1. Non-pharmacological Approach

2. Pharmacological Approach

2. What would be our approach to the sexual side effects she is experiencing?

· Lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support. 

3. If you suggested additional medication, look up your state's prescribing laws. Are PMHNPs able to prescribe the medication you recommended?

· Additional medication is Flibanserin, the PMHNP can prescribe this without the supervision of a psychiatrist since PMHNP is Psychiatric-Mental Health Nurse Practitioner which is Board Certified. And/or hormonal therapy which is usually prescribed by a gynecological physician.

Please see the explanation below. 

Step-by-step explanation

Approach to solving the question:

· Identification of clinical problems that a bipolar patient attained, classification of nonpharmacological and pharmacological treatment of a patient, planning for therapies essential in treating the patient, and evaluation of the process for positive outcomes.

1. What would be your approach to managing this patient's weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

1.
Non-pharmacological Approach

·
Detailed explanation: this is an approach that is essential in managing a patient's weight concern without the involvement of drugs to treat the weight problem. This aim is to provide alternative prevention in treating weight gain without any chemical side effects on the body. 
(Focus (American Psychiatric Publishing). 2021)

·
Examples: (1) Physical activity such as aerobic exercises, can help the patient maintain her within the normal range which will enhance her conditions of type II diabetes, hypertension, and hyperlipidemia and help in improving her sexual desire, (2) Healthy food intake such as fruits, vegetables, whole grains, nonsalty and fatty foods, can reduce the risk of weight gain, and increase blood pressure and cholesterol which can improve her well being, and (3) Peer support which is very helpful in getting motivation from those people who are experiencing the same situation with the patient which increase the chance of preventing to expose her self to stress and anxiety. 

2.
Pharmacological Approach  

·
Detailed explanation: this is an approach that is essential in managing a patient's weight concern with the involvement of drugs to treat the weight problem. This aim is to provide drug prevention to avoid the progression of the presenting clinical manifestation and development of complications. 
(Focus (American Psychiatric Publishing). 2021)

·
Examples: (1) Phentermine-topiramate which is helpful in cutting the cravings, and lessens the appetite during stress and anxiety. This is helpful to increase the chance of weight gain especially when the patient attempted to expose herself to overeating.

2. What would be our approach to the sexual side effects she is experiencing?

· The approach
 to the sexual side effects the patient is experiencing are lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support. Sexual side effects based on the scenario are linked to the stress, anxiety, and weight gain of the patient. It is important that as a healthcare provider, you must assess the related factors to the presenting problem. For a patient with bipolar disorder, it is important to have a care plan to follow so that the patient will be encouraged to do. Lifestyle changes such as physical activity and eating healthy food are the most important since the patient tends to eat out frequently due to her children's busy schedules, gets little exercise, and performs no regular physical activity. If the patient is healthy, their sexual desire will improve and help her to have orgasms since her hormones are healthy. Avoidance of stress and anxiety is helpful in sexual desire because a patient who is stressed can affect the sympathetic nervous system limiting the blood flow to the genitals to achieve genital arousal. Also, therapies are helpful in correcting abnormal hormones in the body system. 
(Lancet Public Health. 2021)

3. If you suggested additional medication, look up your state's prescribing laws. Are PMHNPs able to prescribe the medication you recommended?

· Since the patient is already taking combinations of olanzapine which is useful in treating schizophrenic episodes and fluoxetine which is an antidepressant used in bipolar disorder and linked to weight loss, the additional medication that I may recommend is Flibanserin which is an antidepressant helpful in correcting the imbalance of the neurotransmitters in the brain increasing the chance to sexual desire. The PMHNP can prescribe this medication in all states because Flibanserin should be prescribed by a psychiatrist physician and certified nurse practitioners. Another additional medication that I would like to conclude is hormonal therapy like estrogen therapy because the abnormal level of hormones in the body affects the body in sexual desires and can lead to stress and anxiety. 
(Psychiatr Serv. 2018)

REFERENCES:

· Vancampfort D, Firth J, Correll CU, et al.. The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials. 
Focus (American Psychiatric Publishing).2021;19:116-28. 

· Mitchell K.R., Lewis R., O'Sullivan L.F., Fortenberry J.D. What Is Sexual Wellbeing and Why Does It Matter for Public Health? 
Lancet Public Health. 2021;6:e608-e613. doi: 10.1016/S2468-2667(21)00099-2.  

· Blackmore M.A., Carleton K.E., Ricketts S.M. Comparison of collaborative care and colocation treatment for patients with clinically significant depression symptoms in primary care. 
Psychiatr Serv. 2018;69(11):1184-1187. doi: 10.1176/appi.ps.201700569.

Write 2-3 pages applicable to your capstone project. Identify the stakeholders (use fictitious names for stakeholders) that will play a major part with your study and integrate with your project.

Topics to include:

1. Roles of stakeholders
2. Identify your stakeholders – are they supportive to your project?
3. List of stakeholders who will be interested in the results of your project
4. Promoting stakeholder participation
5. Possible concerns/barriers from stakeholders
6. Strategies that you will use to gain support and assistance from your stakeholders

Expectations

• US sources and topic is (nurse retention).
• Length: 2-3  pages
• Format: APA 7th ed.
• Research: At least one peer reviewed reference within the last 5 years

Rasmussen University – Mental Health Care Plan
A. Patient identifiers: Age: Gender: Ht: Wt. Code Status: Isolation:	Development Stage (Erikson): Give the stage and rationale for your evaluation
Health Status
Date of admission: Activity level: Diet: Fall risk (indicate reason) Client’s description of health status Allergies: (include type of reaction)	Reason for admission: Past medical history that relates to admission:
Socio-cultural Orientation
Cultural and Ethnic Background with current practices: Socialization: Family system: (Support system) Spiritual: Occupation: (across the lifespan) Patterns of living: (define past and current)
Barriers to independent living:

Healthcare systems elements (continued) ALLERGIES:
Medications: List all medications, dosages, classifications and the rational for the medications prescribed for this patient include major considerations for administration and the possible negative outcomes associated with this medication. DEFINE 1: What the medications Mechanism of Action AND 2: Why the patient is taking the medication? Medication Classification Dosage Rationale Possible negative outcomes

Psychiatric Diagnosis and DSM 5 Diagnostic Criteria	History of Present Psychiatric Illness (Presenting signs & symptoms/ Previous Psychiatric Admission / Outpatient Mental Health Services)

CON
CEPT MAP

Pathophysiology – (to the cellular level)

Medical Diagnosis

Clinical Manifestations (all data subjective and objective: labs, radiology, all diagnostic studies) (What symptoms does your client present with?)

Complications

Treatment (Medical, medications, intervention and supportive)

Risk Factors (chemical, environmental, psychological, physiological and genetic)

Nursing Diagnosis

Problem statement: (NANDA)

Related to: (What is happening in the body to cause the issue?)

Manifested by: (Specific symptoms)

	General Appearance
Presenting Appearance (nutritional status, physical deformities, hearing impaired, glasses, injuries, cane) Basic Grooming and Hygiene (clean, disheveled and whether it is appropriate attire for the weather)	Gait and Motor Coordination (awkward, staggering, shuffling, rigid, trembling with intentional movement or at rest), posture (slouched, erect), any noticeable mannerisms or gestures	Level of Participation in the Program/Activity (Group attendance and milieu participation, exercise)
	Manner and Approach
Interpersonal Characteristics and Approach to Evaluation (oppositional/resistant, submissive, defensive, open and friendly, candid and cooperative, showed subdued mistrust and hostility, excessive shyness)	Behavioral Approach (distant, indifferent, unconcerned, evasive, negative, irritable, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated, lethargic, needed minor/considerable reinforcement and soothing). Coping and stress tolerance.	Speech (normal rate and volume, pressured, slow, loud, quiet, impoverished) Expressive Language (no problems expressing self, circumstantial and tangential responses, difficulties finding words, echolalia, mumbling) Receptive Language (normal, able to comprehend questions,
	Orientation, Alertness, and Thought Process
Recall and Memory (recalls recent and past events in their personal history). Recalls three words (e.g., Cadillac, zebra, and purple) Orientation (person, place, time, presidents, your name)	Alertness (sleepy, alert, dull and uninterested, highly distractible) Coherence (responses were coherent and easy to understand, simplistic and concrete, lacking in necessary detail, overly detailed and difficult to follow)	Concentration and Attention (naming the days of the week or months of the year in reverse order, spelling the word “world”, their own last name, or the ABC's backwards)
Thought Processes (loose associations, confabulations, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, perseveration, delusions, reports of experiences of depersonalization). Values and belief system	Hallucinations and Delusions (presence, absence, denied visual but admitted olfactory and auditory, denied but showed signs of them during testing, denied except for times associated with the use of substances, denied while taking medications)	Judgment and Insight (based on explanations of what they did, what happened, and if they expected the outcome, good, poor, fair, strong)

	Mood and Affect
Mood or how they feel most days (happy, sad, despondent, melancholic, euphoric, elevated, depressed, irritable, anxious, angry). Affect or how they felt at a given moment (comments can include range of emotions such as broad, restricted, blunted, flat, inappropriate, labile, consistent with the content of the conversation.	Rapport (easy to establish, initially difficult but easier over time, difficult to establish, tenuous, easily upset) Facial and Emotional Expressions (relaxed, tense, smiled, laughed, became insulting, yelled, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious, tearful, pessimistic, optimistic)	Response to Failure on Test Items (unaware, frustrated, anxious, obsessed, unaffected) Impulsivity (poor, effected by substance use) Anxiety (note level of anxiety, any behaviors that indicated anxiety, ways they handled it)

Lab	Range	Value	Reason Obtained

Risk Assessment: Suicidal and Homicidal Ideation (ideation but no plan or intent, clear/unclear plan but no intent) Self-Injurious Behavior (cutting, burning) Hypersexual, Elopement, Non-adherence to treatment	Discharge Plans and Instruction: Placement, outpatient treatment, partial hospitalization, sober living, board and care, shelter, long term care facility, 12 step program

Teaching Assessment and Client / Family Education: (Disease process, medication, coping, relaxation, diet, exercise, hygiene) Include barriers to learning and preferred learning styles

NRS DX: Problem Statement: R/T: (What is the cause of the symptom?) Manifested by: (specific symptoms)

Short term goal: Create a SMART goal that relates to hospital stay. Long term goal: Create a SMART goal that is appropriate for discharge.

This is specific to the patient that you are caring for. A list of planned actions that will assist the patient to achieve the desired goal. (i.e. obtain foods that the patient can eat/ likes)

Identify what the patients response or “outcome is to the goal or care that you have provided. i.e. patient ate 45% of lunch)

Was it met or not met there is no partially met.

References:

Please see attached