Nursing Assignment Acers

Assessing And Treating Clients With Psychosis And Schizophrenia

Assessing And Treating Clients With Psychosis And Schizophrenia

Assessing And Treating Clients With Psychosis And Schizophrenia

The Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes. 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.

BACKGROUND

The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.

Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.

During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so.

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She currently weighs 140 lbs, and is 5’ 5”

SUBJECTIVE

Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down.

You 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.

Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described, above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.

The PMHNP administers the PANSS which reveals the following scores:

    • -40 for the positive symptoms scale
    • -20 for the negative symptom scale
    • -60 for general psychopathology scale

Diagnosis: Schizophrenia, paranoid type

RESOURCES
  • Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.
  • Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems…
  • Paz, Z., Nalls, M. & Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal. 13. 625-629.

Decision Point One

Select what the PMHNP should do:
  1. Start Zyprexa 10 mg orally at BEDTIME
  2. Start Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter
  3. Start Abilify 10 mg orally at BEDTIME

At each decision point stop to complete the following:

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: 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.

For this week’s assignment, the case study consists of a woman which is 34 years old and belongs to Pakistan. She has been diagnosed with “brief psychotic disorder” and hospitalized for 21 days. She stated that, after taking the medications which were Risperdal recommended by the physician, she has stoppedto take it due to the misconceptions regarding her husband that he is going to give her poison. She further stated that she is getting the distrustful and misbelief thoughts (Laureate Education, 2016j). The client was diagnosed with schizophrenia which was paranoid type on the Positive and Negative Syndrome Scale (PANSS), the scores by the scale revealed the diagnosis (Laureate Education, 2016j). The complexity of positive and negative symptoms and also the overall psychology of schizophrenic people can be classified by the help of PANSS which is a consistent or scientific interview and rates the negative and positive symptoms schizophrenia (Depp, Loughran, Vahia, & Molinari, 2010). The main objective of this week’s assignment is to evaluate and manage the client who needs the antipsychotic therapy which depends upon the decisions regarding the drugs which have been recommended for a Pakistani woman who is 34 years old and diagnosed with schizophrenia, the impact of drugs pharmacokinetic and pharmacodynamics, and also consists of the ethical considerations which influence the strategy of the treatment and also the communication with the patient. Assessing And Treating Clients With Psychosis And Schizophrenia

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