How to Assess and Treat clients with Bipolar Disorder?

Topic:nnAssessing and Treating clients with Bipolar Disorder.nnSubjectnnNursingnnDescriptionnnBipolar TherapynClient of Korean Descent/AncestrynAsian girlnnnBACKGROUND INFORMATIONnnThe client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.nnUpon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”nnShe weights 110 lbs. and is 5’ 5”nnnSUBJECTIVEnnPatient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”nnYou 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. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.nnGenetic testing reveals that she is positive for CYP2D6*10 allele.nnPatient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.nnnMENTAL STATUS EXAMnnThe patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.nnThe Young Mania Rating Scale (YMRS) score is 22nnnRESOURCESnnnDecision Point OnenSelect what the PMHNP should do:nnBegin Lithium 300 mg orally BIDnBegin Risperdal 1 mg orally BIDnBegin Seroquel XR 100 mg orally at HSnnStahl, S. M. (2013). Stahl’s essential psychopharmacology:nnThe AssignmentnnExamine Case Study: An Asian American Woman With Bipolar Disorder. 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.nnAt each decision point stop to complete the following:nnDecision #1nWhich 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 your response with evidence and references to the Learning Resources.nExplain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?nDecision #2nWhy 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 your response with evidence and references to the Learning Resources.nExplain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?nDecision #3nWhy 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 your response with evidence and references to the Learning Resources.nExplain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?nAlso include how ethical considerations might impact your treatment plan and communication with clients.nnNote: 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.