Pakistani Woman with Delusional Thought Processes –


Assignment: Pakistani Woman with Delusional Thought Processes

Assignment: Pakistani Woman with Delusional Thought Processes

 

The domains of an individual’s life are directly impacted by various mental disorders. People suffering from schizophrenia and psychosis show challenges in academic performance, social skills, as well as impaired thinking. The complexity of such conditions makes it critical for one to conduct an accurate diagnosis. Tools such as the PANNS are fundamental in the diagnostic process. An accurate diagnosis of the conditions precedes the formulation of an effective pharmacotherapy by the psychiatric mental health nurse practitioner. In order to develop an effective pharmacotherapy, the present paper will examine the case of a Pakistani woman who demonstrated PANSS scores of 60, 40, and 20 for general psychology, positive symptoms, and negative symptoms. Given that the diagnosis of the patient according to the above scores is positive schizophrenia of the paranoid type, some ethical considerations will be critical in the creation of the therapy.

The therapy will start with Invega Sustenna 234 intramuscular X1, which therapy will be followed by the same drug at 156 mg on the fourth day and then monthly thereafter (Laureate Education, 2016j).

            Paliperidone is an atypical antipsychotic and has been approved by the FDA to be used in the management of schizophrenia. Invega Sustena is chosen since it has a long acting mechanisms that permits its slow release into the system making its API to be effective in the management of the symptomatology of psychoaffective disorders. Moreover, the active compound of the drug produces its mechanism of action by creating balance in the concentrations of both dopamine and serotonin in the brain. The balance is created when the active compound of paliperidone inhibits the D2 and 5HT 2A receptors (Carpiniello & Pinna, 2016). Further, its long-acting mechanism makes it possible for compliance by the patient in comparison to oral medications. The drug’s limited metabolism though the liver makes it easier for the drug to avoid interactions regarding drug-drug and drug-diseases interactions.

Abilify and Zyprexa are similarly atypical antipsychotics; however, the PMNHP has overlooked them in the present scenario since the patient has delusion and confusion. The two drugs have not proven effective in the management of the same. The two drugs are also not safe due to their adverse effects while their tolerability profiles are low.

Anticipated Outcomes

            The intravenous injection has been chosen since the patient has previously demonstrated lack of compliance. Thus, the nurse anticipates lack of compliance issues with the drug. According to literature, schizophrenia’s psychotropic symptomatology can demonstrate improvement within a week of administration of the therapy (Held, Narang, & Lippmann, 2019). For this reason, the PMNHP will expect improvements in some of the symptoms such as delusion and paranoia by the time the Pakistani woman goes for the first assessment. Moreover, the affect, thinking and enhanced thinking are expected of the Pakistani woman.

Differences between Anticipated Results and Actual Results

            The patient showed an improvement when she came back for assessment as shown by her 25% improvement in her PANSS score. Moreover, the patient showed tolerance to the medication while her compliance was excellent. Nevertheless, weight gain also manifested yet it had not been expected when the PMNHP was creating the therapy. Further, the client complained of the presence of localized pain that forces her to walk for extended duration.

Second Point Decision

            The status quo will remain with the nurse using the deltoid mode of administration moving forward.

Reason for Selecting the Above Decision

The initial pharmacotherapy has proven effective in the management of the schizophrenia as the PANSS score had improved by 25%. Thus, altering the antipsychotic medication to a different module would not be logical. Changing the site of injection would address the pain that was demonstrated at the local site as well as the compliance issues (Macaluso, Oliver, & Sohail, 2017). The usage of the haloperidol decanoate could not be countenanced as akathisia side-effects are manifested. Moreover, Haldol produces tardive dyskinesia (TD) as side-effects making it disqualified from consideration. Introducing Abilify IM will also not be considered as the patient did not show tolerance to its tablet form.

Expected Results

The reason for changing the route of administration is to handle the localized pain that was caused by the previous mode of administration. Moreover, the schizophrenic symptoms are also expected to improve. Further, the weight gain as caused by paliperidone is expected to persist since studies have shown that it is one of the medication’s side-effect (Kern et al., 2019). For the above reason, reductions in hallucinations, delusions, as well as mood are expected.

Variations between Anticipated Outcomes and Actual Outcomes

The symptoms of the Pakistani woman’s schizophrenia had improved by a further 25% when the patient visited the clinic again, which implied a reduction of the symptoms. Moreover, the localized pain that the patient had complained about had also vanished since the route of administration was altered. These results aligned to the expectations of the PMNHP. Nevertheless, the patient’s weight had further increased bothering the patient. All these are consistent with the expectation of the PMNHP.

Decision Point Three

            The PMNHP will maintain the same drug regimen while counseling the client concerning the fact that weight gain manifested in the Invena Sustenna is less in comparison to other drugs belonging to the same class. Moreover, dieting will be introduced to the therapy and a follow-up after a month planned.

Reasons for Electing the Above Decision

            The pharmacological agent is already showing excellent efficacy and tolerance profile. Moreover, the use of non-pharmacological interventions such as dieting is crucial as it will manage the weight gain issue presented by paliperidone. Thus, it would be logical to maintain the initial therapy. Literature reveals that the resolution of the symptomatology of the drug occurs within 16-20 weeks (Deslandes, Ward, Norris, & Sewell, 2018). This implies that it would be advisable to maintain the drug in the pharmacotherapy. The adoption of Abilify Maintena is disqualified since the patient showed compliance issues with the oral mode of the drug while Qysmia is disqualified due to the fact that the patient is not diabetic.

Expected Results

The expectations of the previous decision points are expected to be maintained since Invenna Sustenna is working at therapeutic level. Due to the same reason, resolution of the symptoms is expected (Kern et al., 2019). The PANSS score is expected to further reduce. Also, the nurse expects the combination therapy to manage the weight issue shown by the patient.

Differences between Anticipated Results and Actual Results

The decision to introduce the non-pharmacological intervention in the therapy aligns with the guidelines necessary for the management of the psychoaffective disorders using Invenna Sustenna and other similar medications. Using exercise and diet concomitantly will result in the reduction of the weight matter experienced by the patient. Moreover, the improvement of patient symptoms is anticipated from the formulated intervention.

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            The creation of the therapy has shown that the use of Invenna Sustenna produces undesirable impacts such as weight gain. As

Assignment Pakistani Woman with Delusional Thought Processes

Assignment Pakistani Woman with Delusional Thought Processes

such, it would be significant for the nurse practitioner to include the patient in the formulation of the therapy through sharing of information so as to ensure compliance (P. Chue & J. Chue, 2016). Further, the nurse practitioner should discuss the dangers of using the IV administration route. Also, the significance of integrating the non-pharmacological intervention to the therapy should be discussed by the nurse to ensure compliance.

Conclusion

            Schizophrenia negatively impacts several domains of a patient’s life. Nevertheless, for the effectiveness of the drugs to be noticed, one needs to ensure that an accurate diagnosis occurs. Further, atypical antipsychotics produce side-effects hence the need to involve non-pharmacological interventions.

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.

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.
I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. I do not need you to tell me the treatment options available to you – I am very familiar with the cases. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data).

 

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. Defend your choice like you are in the courtroom for a medical malpractice case!
Why were the other two decisions less advantageous? Support your response with evidence and references to the resource. Defend your choice like you are in the courtroom for a medical malpractice case!
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. Defend your choice like you are in the courtroom for a medical malpractice case!
Why were the other two decisions less advantageous? Support your response with evidence and references to the resource. Defend your choice like you are in the courtroom for a medical malpractice case!
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. Defend your choice like you are in the courtroom for a medical malpractice case!
Why were the other two decisions less advantageous? Support your response with evidence and references to the resource. Defend your choice like you are in the courtroom for a medical malpractice case!
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?
5 references are REQUIRED

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

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