Nursing essay
BACKGROUND INFORMATION The shopper is a 26-year-old lady of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was recognized with bipolar I dysfunction. Upon arrival in your workplace, she is sort of “busy,” enjoying with issues in your desk and shifting back and forth in her chair. She informs you that “they mentioned I used to be bipolar, I don’t imagine that, do you? I identical to to speak, and dance, and sing. Did I inform you that I appreciated to cook dinner?” She weights 110 lbs. and is 5’ 5” SUBJECTIVE Affected person stories “unbelievable” temper. Studies that she sleeps about 5 hours/evening to which she provides “I hate sleep, it’s no enjoyable.” You reviewed her hospital data and discover that she has been medically labored up by a doctor who reported her to be in total good well being. Lab research had been all inside regular limits. You discover that the affected person had genetic testing within the hospital (particularly GeneSight testing) as not one of the drugs that they had been treating her with appeared to work. Genetic testing reveals that she is optimistic for CYP2D6*10 allele. Affected person confesses that she stopped taking her lithium (which was prescribed within the hospital) since she was discharged two weeks in the past. MENTAL STATUS EXAM The affected person is alert, oriented to individual, place, time, and occasion. She is dressed fairly oddly- sporting what seems to be a night robe to her appointment. Speech is speedy, pressured, tangential. Self-reported temper is euthymic. Have an effect on broad. Affected person denies visible or auditory hallucinations, no overt delusional or paranoid thought processes readily obvious. Judgment is grossly intact, however perception is clearly impaired. She is at the moment denying suicidal or homicidal ideation. The Younger Mania Ranking Scale (YMRS) rating is 22 RESOURCES § Chen, R., Wang, H., Shi, J., Shen, Ok., & Hu, P. (2015). Cytochrome P450 2D6 genotype impacts the pharmacokinetics of controlled-release paroxetine in wholesome Chinese language topics: comparability of conventional phenotype and exercise rating techniques. European Journal of Scientific Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6 Resolution Level One Choose what you must do: Start Lithium 300 mg orally BID Start Risperdal 1 mg orally BID Start Seroquel XR 100 mg orally at HS Resolution Level One Start lithium 300mg orally BID Start Lithium 300 mg orally BID in Lithium 300 mg orally BID RESULTS OF DECISION POINT ONE · Shopper returns to clinic in 4 weeks · Shopper informs you that she has been taking her drug “on and off” solely when she “appears like she wants it” · At present’s presentation is much like the primary day you met her Resolution Level Two Choose what you must do subsequent: Improve Lithium to 450 mg orally BID Assess rationale for non-compliance to elicit motive for non-compliance and educate shopper re: drug results, and pharmacology Swap to Depakote ER 500 mg orally at HS Resolution Level Two Assess rationale for non-compliance to elicit motive for non-compliance and educate shopper re: drug results, and pharmacology RESULTS OF DECISION POINT TWO · Shopper returns to clinic in 4 weeks · Shopper states that the drug makes her nauseated and provides her diarrhea · Shopper states that she stops taking it till these signs abate, at which level she re-starts solely to expertise the signs once more Resolution Level Three Choose what you must do subsequent: Change to Depakote ER 500 mg at HS Change Lithium to sustained launch preparation at identical dose and frequency Change to trileptal 300 mg orally BID Resolution Level Three Change Lithium to sustained launch preparation at identical dose and frequency Steerage to Pupil On this case, the shopper is having nausea and diarrhea, traditional unintended effects of lithium remedy. Altering the shopper to an prolonged launch formulation can typically stop these signs whereas on the identical time affording the shopper the good thing about lithium’s temper stabilizing properties. Additionally, lithium is an efficient selection for management of mania and has additionally been proven to lower danger of suicide, which provides to its total advantages. Depakote could also be an choice if altering to sustained launch lithium doesn't alleviate the unintended effects. Oxcarbazpine (Trileptal) is an choice, however is a second line remedy and isn't acceptable at this stage because the shopper has not had an enough trial of first line brokers. -research paper writing service