Assessing and Treating Clients Essay

Pain can greatly influence an individual’s quality of life, as uncontrolled pain negatively impacts mood, concentration, and the overall physical and mental well-being of clients. Although pain can often be controlled with medications, the process of assessing and treating clients can be challenging because pain is such a subjective experience. Only the person experiencing the pain truly knows the intensity of the pain and whether there is a need for medication therapies.  Assessing and Treating Clients Essay.Sometimes, beliefs about pain and treatments for pain can have an adverse effect on the provider-client relationship. For this Assignment, as you examine the interactive case study consider how you might assess and treat clients presenting with pain.

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Learning Objectives Students will: Assess client factors and history to develop personalized therapy plans for clients with pain Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for pain Evaluate efficacy of treatment plans for clients presenting for pain therapy Analyze ethical and legal implications related to prescribing therapy for clients with pain Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. Assessing and Treating Clients Essay. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. Chapter 10, “Chronic Pain and Its Treatment” Stahl, S. M., & Ball, S. (2009a). Stahl’s illustrated chronic pain and fibromyalgia. New York, NY: Cambridge University Press. To access the following chapter, click on the Illustrated Guides tab and then the Chronic Pain and Fibromyalgia tab. Chapter 5, “Pain Drugs” Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. lofepramine maprotiline memantine milnacipran nortriptyline pregabalin tiagabine topiramate trimipramine valproate (divalproex) zonisamide. Assessing and Treating Clients Essay.

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. Assessing and Treating Clients Essay. 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.
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. Assessing and Treating Clients Essay.

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/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

§ Paz, Z., Nalls, M. & Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal. 13. 625-629. Assessing and Treating Clients Essay.

Post

Discussion Tree Guide.
INTRODUCTION (Please Cover All These 3 Points in the Introduction)
1. Introduction regarding disease state
2. High-level summary of patient case
3. Purpose of the essay statement

NB: Provide an introduction to the disease state discussed in the case. I am looking for a high-level summary that briefly describes the key aspects of that disease state. I do not want several pages of information related to the diagnosis of the disease state. Provide a high-level summary of the important pieces of information from the case-study that is presented. I do not want the entire case study presented. The goal is that you would be able to give your essay to someone that does not know anything about the assignment and for that individual to be able to understand the purpose of your essay. Again….focus on the important pieces of information that will help you make your decision. You also want to mention the purpose of the assignment. This can be brief.

BODY
Paragraph 1

Decision 1
Here are the Options listed for this patient:
• Start Zyprexa 10mg orally at BEDTIME
• Start Invega Sustenna 234mg intramuscular X1 followed by 156mg intramuscular on day 4 and monthly thereafter.
• Start Abilify 10mg orally at BEDTIME

Decision #1

Which decision did you select?(Start Invega Sustenna 234mg intramuscular X1 followed by 156mg intramuscular on day 4 and monthly thereafter.
• Why did you select this decision? Support your response with evidence and references to the Learning Resources. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Why didn’t you select other option( please give a thorough explanation)
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Assessing and Treating Clients Essay.
• Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Outcomes for decision #1

Client returns to clinic in four weeks
A decrease in PANSS score of 25% is noted at this visit
Client seems to be tolerating medication
Client’s husband has made sure she makes her appointments for injections (one thus far)
Client has noted a 2 pound weight gain but it does not seem to be an important point for her
Client complains of injection site pain telling the PMHNP that she has trouble siting for a few hours after the injections and doesn’t like having to walk around for such a long period of time

Paragraph 2:

Here are the Options listed for this patient:
– Continue same decision made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward.
– Discontinue Invega Sustenna and start Haldol decanoate (haloperidol decanoate) 50mg IM Q 2 weeks with oral Haldol 5 mg BID for the next 3 months.
– Continue Invega Sustenna. Begin injections into the deltoid and add on Abilify Maintena 300mg intramuscular monthly with oral abilify 10 mg in the morning for 2 weeks.

Decision #2

Which decision did you select? (Continue same decision made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward)

• Why did you select this decision? Support your response with evidence and references to the Learning Resources. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Why didn’t you select other option( please give a thorough explanation) Assessing and Treating Clients Essay.
• 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?

Outcomes of Decision # 2

Client returns to clinic in four weeks
Client’s PANNS has reduced by a total of 50% from the initiation of Invega sustenna
When questioned about injection site pain, client states it is much better in the arm
Client’s weight has increased by an additional 2.5 pounds (total of 4.5 pounds in a 2 month period). She is somewhat bothered by the weight gain and is afraid that her husband does not like it. He is not present at this visit as she brought herself
Client likes how she feels on the Invega Sustenna but is wondering if there is another drug like it that would not cause the weight gain

Paragraph 3:

Decision 3
Here are the Options listed for this patient:
– Continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in 1 month.
– Discontinue Invega Sustenna and start Abilify Maintenna 400mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral abilify 10mg orally in the MORNING. Assessing and Treating Clients Essay.
– Continue Invega Sustenna and add-on Qsymia for weight loss.

Decision #3
Which decision did you select? (Continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in 1 month.)
Why did you select this decision?
• Support your response with evidence and references to the Learning Resources. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Why didn’t you select other option( please give a thorough explanation)
• 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?

Weight gain can occur with Invega Sustenna. It is modest in nature and can be controlled with proper nutrition and exercise. It is always a good idea to try and control a client’s weight through consultation with a dietician and exercise physiologist (life coach) before switching to another agent when a product is showing efficacy for at least 6 months. Assessing and Treating Clients Essay.

Abilify Maintena is a good option for someone who has good response to abilify oral. Remember that Abilify does not bind to the D2 receptor for a great period of time (such as Invega) and can be less affective in certain individuals. Also, remember that akathisia can be a possible side effect. Once an IM long acting medication is given, the effects of the drug (both efficacious and untoward effects) can be maintained for a long duration (up to a month or longer). Tolerability and efficacy should be established with oral medication first before administering the first injection. Also a disadvantage to Abilify Maintena is a 2-week overlap of oral therapy is required due to effective blood levels lagging behind the induction dose.

Qsymia is a weight loss medication that is a combination of Phenteramine and Topiramate. It is only indicated to treat obesity. This client’s BMI (28.9 kg/M2) does not fit the definition of obesity (BMI >30 Kg/M2- Following from CDC website: Class 1: BMI of 30 to < 35, Class 2: BMI of 35 to < 40, Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity). There are two things wrong with this therapy option. First, there are only a few occasions where add-on therapy to treat a side effect is acceptable and weight gain is not one of those scenarios. Secondly, Phenteramine has a lot of cardiovascular toxicities (such as elevated BP, HR, increased workload on the heart).

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Paragraph 4

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

IMPORTANT INFORMATION
In-text citations should match the references
Please use only Peer-Reviewed articles of not longer than 5 years old
Please Use Proper APA formatting in the discussion.
Please Use at least 3 References.
HERE ARE SOME RESOURCES TO USE FOR THE ASSIGNMENT

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659. doi:10.2165/00023210-200923080-00002

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/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124-134. doi:10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., &Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728-738. doi:10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., &Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107-121. doi:10.1007/s11126-014-9326-2