NURS 6630 Assessing and Treating Patients With Bipolar Disorder

NURS 6630 Assessing and Treating Patients With Bipolar Disorder

NURS 6630 Assessing and Treating Patients With Bipolar Disorder

Bipolar Disorder

Bipolar is a mental health disorder characterized by extreme mood changes that alter the behavior and normal function of a patient. The mood fluctuation is on extreme ends and may take days to weeks before change, accompanied by difficulties in performing daily tasks and social interactions. The mood changes are mania or hypomania; mania is a happy or irritable mood, and hypomania is a sad mood or depression (Ashok, et al, 2017). These symptoms usually occur alternatively after weeks associated with a period of the normal state. There are types of bipolar which include bipolar 1, bipolar 2, and cyclothymic bipolar. Bipolar 1 has alternating episodes of mania, hypomania, and neutral mood. Bipolar two is associated with a major depressive mood disorder and hypomania state. Cyclothymic has frequent mood swings.

The signs and symptoms of the manic episode are diminished need for sleep, increased and faster speech, increased activity, increased risky behavior, distractibility, and uncontrollable racing thoughts. Hypomania presents with intense sadness or despair, loss of interest, fatigue, difficulties in concentration, frequent thoughts, and suicidal ideation. Common causes of bipolar are genetic predisposition, family history of bipolar, stressful environment, and substance abuse. The patient in the case study is a 26years old female with bipolar. According to the American psychiatric association, she meets the DSM-5 criteria through her symptoms of the diminished need to sleep, excessive talking, increased distractibility, she is in a happy mood, rapid or pressured speech, and increased energy. She scores 22 on the young scale mania. The interventions for bipolar are the use of antipsychotics and psychotherapy. Antipsychotics relieve the symptoms of the patient while psychotherapy enables the patient to change their thinking and behavior to improve cognitive functions and quality of life. The essay describes the three decisions made in treating the patient including the impact of ethical principles.

Decision One

Which decision did you select?

Begin Seroquel XR 300mg orally at HS

Why did you select this decision?

Seroquel is a second-generation antipsychotic with a high affinity for dopamine and serotonin receptors. Its mechanism of action is by antagonizing these receptors and binding them to the norepinephrine transporter (Hamed, et al, 2017). This helps in improving memory, mood, aggression, and the muscle movement that plays a vital role in the brain for pleasure. Seroquel is the best drug for the patient because it is FDA approved for acute manic episodes and bipolar. Moreover, the American psychiatric association proves it is efficient in treating bipolar in its studies.

Why did you not select the other two options provided in the exercise?

Risperdal is a second-generation antipsychotic for treating schizophrenia and maintenance treatment in bipolar. Its

NURS 6630 Assessing and Treating Patients With Bipolar Disorder
NURS 6630 Assessing and Treating Patients With Bipolar Disorder

mechanism of action is by decreasing the serotonin and dopamine activity in the brain thus reducing the mood symptoms, agitation, and symptoms of schizophrenia. it has 94% bioavailability and is protein-bound with an active metabolite (Schoretsanitis, et al, 2017). It has a plasma half-life of three to twenty hours. However, I did not select this drug for the patient because it has undesirable effects like drooling, nausea, weight gain, nausea, fatigue, and tiredness. Lithium is a commonly prescribed drug for prophylaxis and treatment of manic episodes. Its mechanism of action is by modulating the neurotransmitters and inhibiting the excitatory neurotransmitters like dopamine and glutamate. It has neuro-proliferative and neuroprotective effects on the brain that helps in regulating mood. It is FDA approved for mood disorders and bipolar. However, I did not select the drug because the patient has not been compliant due to its unpleasant effects.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6630 Assessing and Treating Patients With Bipolar Disorder

What were you hoping to achieve by making this decision?

The expectations of starting the patient on Seroquel XR 300mg are to relieve the symptoms and reduce the score of the young scale mania. The expected side effects are dry mouth, drowsiness, constipation, and weight gain.

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Communication is the exchange of information from the sender to the recipient to understand and interpret and eventually respond. Communicating with a patient with bipolar can be hectic because they talk fast and have racing thoughts. Therefore, the nurse incorporates the principle of justice when assessing the patient. Justice is providing equal and quality services to all despite their underlying issues. Justice enables the nurse to communicate effectively with the patient.

Decision Two

Which decision did you select?

Discontinue Seroquel and begin Geodon 40mg

Why did you select this decision?

Geodon is a second-generation antipsychotic that inhibits the reuptake of norepinephrine and serotonin, blocking the alpha and antihistaminic activities. These decrease hallucinations, improve clear and positive thinking, reduces agitation, and improve activities of daily living (Findling et al, 2022). It has 60% bioavailability and is 99% protein bound. The drug is initiated at a low dose and increased gradually within two weeks to reduce the side effects. I chose this drug because it is effective in treating bipolar and has no side effects on the patient.

Why did you not select the other two options provided in the exercise?

Increasing the dose of Seroquel to 400mg to improve the patient’s symptoms is not a good option because she previously complained of weight gain and constipation. Increasing the dose worsens the drug’s side effects. The use of dietary measures to control weight gain and obesity is ineffective because the drug has the effect of muscarinic cholinergic antagonism that induces gastrointestinal hypomotility and hence constipation and weight gain. Decreasing the dosage will not have positive effects on the patient’s symptoms and will still exhibit unpleasant side effects.

What were you hoping to achieve by making this decision?

The expectation of switching the patient’s treatment to Geodon is to improve the symptoms, decrease the young scale mania, and relieve constipation and weight gain.

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

The nurse considers the principle of autonomy in this decision point. Autonomy is respect for a person’s decisions and preferences (Asl, et al, 2022). The patient is uncomfortable with Seroquel because it causes constipation despite the improvement of the symptoms. The nurse, therefore, changes the treatment to ensure patient satisfaction.

Decision Three

Which decision did you select?

Increase Geodon to 60 mg orally BID with a 500-calorie meal

Why did you select this decision?

Geodon was effective during the initial stage of treatment. Increasing from 40mg to 60mg is effective in improving the symptoms. Additionally, the recommended dose is 60mg to 80mg with a gradual increment every two weeks. I selected this choice because it will hasten the improvement of the symptoms.

Why did you not select the other two options provided in the exercise?

I did not continue with the same drug dosage because the American psychiatric association recommends 60mg to 80mg to relieve the symptoms. I did not augment with lithium because it has unpleasant side effects. Additionally, augmentation is recommendable in the incidence of depression and hypomania. There is a contraindication for lithium augmentation with antipsychotics like olanzapine, haloperidol, and Geodon.

What were you hoping to achieve by making this decision?

The expectation for increasing the dosage is to hasten the improvement of the symptoms.

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

The nurse uses the principle of beneficence and non-maleficence. Beneficence is doing what is right and non-maleficence is protecting the patient from harm. The nurse carefully analyzes the best treatment for the patient to improve the symptoms and prevent adverse effects.

Conclusion

Bipolar is a mood fluctuation disorder on the extreme ends and may take days to weeks before change, accompanied by difficulties in performing daily tasks and social interactions. The signs and symptoms of the manic episode are diminished need for sleep, increased and faster speech, increased activity, increased risky behavior, distractibility, and uncontrollable racing thoughts. Hypomania presents with intense sadness or despair, loss of interest, fatigue, difficulties in concentration, frequent thoughts, and suicidal ideation. Seroquel is a second-generation antipsychotic that antagonizes these receptors to improve memory, mood, aggression, and muscle movement that plays a vital role in the brain for pleasure. However, it causes weight gain and constipation. Geodon is an effective drug for treating bipolar because it is well tolerated. Ethical principles in nursing improve assessment and communication techniques. They are beneficence, autonomy, consent, justice, and non-maleficence.

References

Ashok, A., Marques, T., Jauhar, S. et al. The dopamine hypothesis of bipolar affective disorder: the state of the art and implications for treatment. Mol Psychiatry 22, 666–679 (2017). https://doi.org/10.1038/mp.2017.16

Asl, R. G., Taghinejad, R., Parizad, N., & Jasemi, M. (2022). The relationship between professional autonomy and job stress among intensive care unit nurses: A descriptive correlational study. Iranian Journal of Nursing and Midwifery Research27(2), 119. https://doi.org/10.4103%2Fijnmr.ijnmr_375_20

Findling, R. L., Atkinson, S., Bachinsky, M., Raiter, Y., Abreu, P., Ianos, C., & Chappell, P. (2022). Efficacy, Safety, and Tolerability of Flexibly Dosed Ziprasidone in Children and Adolescents with Mania in Bipolar I Disorder: A Randomized Placebo-Controlled Replication Study. Journal of Child and Adolescent Psychopharmacology32(3), 143-152. https://doi.org/10.1089/cap.2021.0121

Hamed, R., AlJanabi, R., Sunoqrot, S., & Abbas, A. (2017). The effect of pH, buffer capacity and ionic strength on quetiapine fumarate release from matrix tablets prepared using two different polymeric blends. Drug Development and Industrial Pharmacy43(8), 1330-1342. https://doi.org/10.1080/03639045.2017.1318897

Schoretsanitis, G., Spina, E., Hiemke, C., & de Leon, J. (2017). A systematic review and combined analysis of therapeutic drug monitoring studies for long-acting risperidone. Expert review of clinical pharmacology10(9), 965-981.

https://doi.org/10.1080/17512433.2017.1345623