Attachment # 00012365 - NR_566_Bipolar_Disorder.pptx
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Presented By Paula BoydNR 566 Bipolar Disorder Chamberlain College of Nursing Dr. Thompson April 14, 2022 Clinical Scenario for Bipolar DisorderPatient’s Name is Kara Flake, she has presented to my office with her husband. She is a 35 year old, black female. She has complaints of not sleeping or eating in several days.History of present illness: The patient states she hasn’t quite been herself for the last 2 weeks. She becomes very tearful and states that she has lost her job and feels worthless. The husband states that she has been up watching QVC every night and she has maxed out their credit cards and has used up their savings. Patient states, ”I don’t know why I did all of these things.” The patient denies any thoughts of any self-harm, suicidal ideations or homicidal ideations. Clinical Scenario for Bipolar DisorderSocial History: The patient is married with no children. The patient is recently unemployed. She currently smokes 3 cigarettes per day and occasionally smokes marijuana. She states she has been drinking to fall asleep every day.Family Medical History: Father is deceased. Father had a history of alcoholism. Mother is alive. Mother has a history of depression and anxiety.Past Medical History: Previously diagnosed with anxiety disorder at the age of 18.Medications: Clonazepam 0.5 mg po tablet every 8 hours as needed for anxiety. Current treatment plan: Given the evidence of patient’s current complaints and the history of the patient. The patient will be referred to a specialized clinician with possibility of inpatient hospitalization. The patient and husband are given education on the plan of care. Both patient and husband verbalized understanding and acceptance of the treatment plan. The patient will probably be given two mood stabilizers lithium and valproate which are the preferred drugs for the acute management of bipolar disorder. (Rosenthal & Burcham, 2021). Both drugs need to be given and monitored closely by psych-mental health NP.Baseline data should be obtained prior to drug therapy as in a CBC, CMP, LFT’s, cardiac and thyroid function tests. Clinical Scenario for Bipolar Disorder State and Federal RegulationsThe State of Intended practice is Florida.According to the Florida Board of Nursing all qualified APRN’s must restrict prescriptions of Schedule II controlled substances to a 7-day supply. However, restrictions do not apply to the prescription of controlled substances that are psychiatric medications prescribed by a psychiatric nurse.APRN’s who meet the definition of a credentialed psych-mental health NP may otherwise prescribe psychiatric mental health controlled substances to children younger than 18 years of age. ( The Florida Legislature, 2022) State and Federal RegulationsThe Affordable Care Act (ACA) has provided one of the largest expansions of mental health and substance use disorder coverage. (HHS.gov, 2019) This law requires most businesses to include coverage for mental health and substance use disorder services. This act greatly reduces financial burdens for those who are seeking mental health counseling/services.Given the scenario the ACA has relevant benefit to the patient. She is currently provided health insurance by her husband’s insurance per the small-group plan. This means that benefitys such as mental health and prescription drug coverage is mandated. Community ResourcesThe practitioner must evaluate the needs of the patient given in the patient scenario.Family support is important to monitor adherence to medication management and the treatment plan.Hospitalization should be ordered if there is any concern of self-harm, high-risk behaviors, such as grandeur or wildly unrealistic beliefs about one’s capabilities. (American Addiction Centers, 2021).Community Resources available in Miami-Dade County are free mental health services for residents. Community ResourcesThese particular services vary from acute stabilization of mental health illnesses, case management, social rehabilitation, medication management, supportive housing, and outpatient counseling.Care management also will coordinate and facilitate referral/coordination of an accepting primary mental health provider.In the patient scenario acute hospitalization may be warranted given the patients symptoms.Miami-Dade county health services aid in the promotion of mental health and wellbeing. Legal and Ethical ConsiderationsA potential legal issue the practitioner could face if not managed properly could be negligence.Negligence: Arises from carelessness that leads to the patient having unintended harm.This could result from the practitioner not recognizing self harm behaviors and not appropriately committing a person to a mental health facility for involuntary treatment.A potential ethical issue that could arise is the attempt to manage an illness beyond the practice capabilities of the NP.If the NP lacks the necessary skills to manage acute mental health illnesses they should highly consider referral • Legal and Ethical ConsiderationsThe practitioner must also consider prescription ability in the state of practice.As a primary care provider this is important to consider to mitigate potential risk with providing care for behavioral health concerns.To avoid legal fallback the NP should be attuned to their practice abilities.This is considered a moral imperative for NPs, as it represents a concern for the good of the patient as well as one’s professional credibility. (Kraus, 2017) Long-term psychiatric follow-up is needed for this patient. Legal and Ethical ConsiderationsAfter resolution of the acute episode (typically requires short-term hospitalization) long-term therapy will help to prevent recurrence of both mania and depression.In the patient scenario Lithium treatment maybe a recommendation.Plasma drug levels should be monitored routinely. Levels should be measured every 2 to 3 days at the beginning of treatment and every 3 to 6 months during maintenance therapy (Rosenthal & Burchum, 2021).Longitudinal monitoring for patients taking lithium should include electrolyte, urea, and creatinine levels every 3 to 6 months and calcium levels, thyroid-stimulating hormone levels, and weight every 6 to 12 months. (MacLeod-Glover, 2020). ReferencesAffordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans. (2019). ASPE.Chronic Lithium Toxicity.(2020). Canadian Family Physicians. 66(12). 882.3-882. https://dol.org/10.46747/cfp.6612882_2Kraus, E., & DuBois, J. M. (201). Knowing Your Limits: A Qualitative Study of Physician and Nurse Practitioner Perspectives on NP Independence in Primary Care. Journal of General Internal Medicine, 32(3), 284–290. https://doi.org/10.1007/s11606-016- 3896-7 Rosenthal, L.D., & Burchum, J.R. (2021). Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.) Elsevier. The Most Effective Treatment for Severe Bipolar Disorder & Addiction. (2021, October 27). American Addiction Centers. https://americanaddictioncenters.org/bipolar-and-addictio ReferencesStatutes & Constitution :View Statutes: Online Sunshine. (2022). The Florida Legislature. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0300-0399/0394/Sections/0394.455.html.The Most Effective Treatment for Severe Bipolar Disorder & Addiction. (2021, October 27). American Addiction Centers. https://americanaddictioncenters.org/bipolar-and-addictionMusic by 2Cellos playing perfect by Ed Sheeran
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