Scenario you are referencing below.
| Subjective | Objective |
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Patient’s Chief Complaints: “ I am hearing voices ” History of Present Illness MM states she believes her boyfriend is cheating on her, which her boyfriend denies. She states she can hear two women talking about her boyfriend and her, how they have sex with her boyfriend and how KB isn’t good enough for him. This has been occurring for a few weeks now and the voices mock her daily. Her boyfriend has been caught cheating in the past and she is now wondering if the women she hears talking about her boyfriend are real or not. She has not asked anyone else if they can hear the women talking because what they have to say is so negative. She hears these women talking mostly at home with her boyfriend, especially at night, but sometimes she hears them when she is out too, especially when she is out in public with her boyfriend. Past psychiatric history: None Past Medical History: Occasional headaches, treated with OTC pain relievers. Family History · Father is alive, has hypertension. · Mother is alive, has history of depression · One brother, healthy · one son age 4, alive and well Social History · Lives with fiancé and their 4-year-old son · does not have any friends · unemployed since her son was born · High school graduate · Nonsmoker · Drinks socially, 1-2 times a week · Several gasses of coke or sweet tea during the day · vapes CBD occasionally, 1-2 times a week. · no formal exercise · no hobbies
Review of Systems · occasional headache, relieved with acetaminophen · appetite poor, weight stable · sleeps 4-5 hours at night Allergies: NKDA
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Physical Examination: General
Alert, appropriately dressed Caucasian female in no apparent distress. She appears older than her stated age. Vital Signs: BP-120/80, T-98.6F, P-88, RR-20, SpO2: 98% Wt 110 lbs, Ht 5’6” |
| · | Mental status exam:
•Cranial nerves II-VIII intact •Gait steady •Denies headache and dizziness Appearance: appropriate dress for age and situation, well nourished, eye contact poor, No apparent distress Alertness and Orientation: fully oriented to person‚ place‚ time‚ and situation, Alert Behavior: cooperative Speech: soft, flat Mood: euthymic Affect: constricted, congruent Thought Process: logical‚ linear Thought content: No thoughts of suicide‚ self-harm‚ or passive death wish Perceptions: No evidence of psychosis, no response to internal stimuli noted during interview, reports auditory hallucinations. Memory: Recent and remote WNL Judgement/Insight: Insight is fair, Judgement is poor Attention and observed intellectual functioning: Attention intact for purpose of assessment. Fund of knowledge: Good general fund of knowledge and vocabulary Musculoskeletal: normal gait and station |
Diagnosis: F20.9 Schizophrenia, unspecified
READ AND REPLY TO THE CASE STUDY RESPONSE BELOW-
Aripiprazole, known as Abilify, is prescribed to treat both the positive symptoms of schizophrenia, such as hallucinations and delusions, as well as the negative symptoms, such as social isolation (lack of friends) and constricted affect (Stahl, 2020; Stahl, 2021).
2. List medication class and mechanism of action for the chosen medication.
Aripiprazole is categorized as an atypical third-generation antipsychotic and is sometimes considered a second-generation antipsychotic. It functions as a dopamine serotonin receptor partial agonist and serves as a mood (Stahl, 2020; Stahl, 2021). This medication operates by acting as a partial agonist at dopamine 2 receptors, enhancing positive symptoms of psychosis. Additionally, it boosts dopamine output to address cognitive, negative, and mood symptoms. Aripiprazole interacts with various neurotransmitter receptors, including dopamine 3 receptors, potentially contributing to its efficacy (Stahl, 2020). Its partial agonism at 5HT1A receptors may be clinically relevant, and its blockade of serotonin type 2C and 7 receptors plays a role in its antidepressant effects (Stahl, 2020). The drug’s blocking of serotonin 2A receptors results in increased dopamine release in specific brain regions, reducing motor side effects and potentially improving cognitive and affective symptoms (Stahl, 2020).
3. Write the prescription in prescription format.
Date: 11/15/2023
Patient name: MM
DOB: xx/xx/xx
℞: Abilify 10mg tab
Sig: take one tab (10mg) by mouth daily
Disp: #30 (thirty)
Refills: none
APRN, PMHNP-BC
NPI#: xxxxxxxxx
4. Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference.
Aripiprazole was selected for MM due to various factors. It has a low occurrence of motor side effects, is non-sedating, can lower prolactin levels instead of raising them, thereby avoiding weight gain. Additionally, it boasts a favorable tolerability profile, a prolonged half-life, and its absorption is unaffected by food, allowing for flexibility in administration with or without meals, potentially enhancing adherence (Stahl, 2020; Stahl, 2021).
According to the American Psychiatric Association recommendations, individuals diagnosed with schizophrenia should receive antipsychotic medication, with ongoing monitoring for both effectiveness and potential side effects. Furthermore, the guidelines suggest that patients whose symptoms have shown improvement through antipsychotic medication should continue with the same treatment for sustained benefits (Keepers et al., 2020).
5. List any side effects or adverse effects associated with the medication.
Side effects or adverse effects of aripiprazole includes dizziness, insomnia, akathisia, activation, nausea, vomiting, orthostatic hypotension, constipation, headache, asthenia, sedation, tardive dyskinesia, and there is also a chance of irreversible involuntary dyskinetic movements at higher doses (Stahl, 2020). A few rare but severe side effects are seizures, impulse control problems, and neuroleptic malignant syndrome, which is characterized by muscle rigidity, high fever, delirium, and renal failure (Stahl, 2020).
6. Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.
· Monitor weight and BMI (Normal range:18.5-24.9) before initiation and during treatment monthly for the first 3 months then every 3 months after that (Stahl, 2020).
· Baseline blood pressure- normal range for SBP is <120mmHg and for DBP is <80mmHg (American Heart Association, 2023).
· Fasting plasma glucose (normal range: 70-110 mg/dL), and fasting lipids should be obtained within the first 3 months and then annually going forward. These monitoring may need to be more frequent in patients who have diabetes or have gained greater than 5% of their initial weight (Stahl, 2020). Patients that are at higher risk for metabolic complications should have triglycerides checked monthly for several months (Stahl, 2020). According to Lee, Y. & Siddiqui, W. J. (2023), normal range for triglyceride level is less than 150 mg/dL, optimal LDL-C level is less than 100 mg/ dL; normal range for HDL level is 40-60 (Lee, Y. & Siddiqui, W. J., 2023).
7. Provide a minimum of three appropriate medication-related teaching points for the client and/or family.
1. Medications may reduce symptoms but won’t remove them completely (Stahl, 2020).
2. Improvement in symptoms may be evident within a week, but many weeks are necessary for stabilization (Stahl, 2020).
3. Adhere to the prescribed medication regimen; consult your provider before adjusting the dosage, either increasing or decreasing (Stahl, 2020).
4. Take the medication consistently around the same time each day, with or without food (Stahl, 2020).
5. Regularly assess symptoms and potential side effects; inform your provider if target symptoms persist or if side effects emerge (Stahl, 2020).
6. Reduce the consumption of sugary soft drinks, monitor for diabetes signs (polyuria, polydipsia, polyphagia, weight loss, nausea/vomiting, dehydration, confusion), and promptly report any occurrences to your provider (Stahl, 2020).
INSTRUCTIONS BELOW-
Reply to the above case study response and drug choice. Reply agreeing with Aripiprazole as the drug of choice. I chose Risperidone as my treatment drug, you could tie that in as to why I choice risperidone. Respond as a Nurse Practitioner/Nurse practitioner student.
Please provide 2 APA Scholarly references within 5 years. One of the references being
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.
Engage by asking questions, and offering new insights, applications, perspectives, information, or implications for practice. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice. Communicate with minimal errors in English grammar, spelling, syntax, and punctuation. current APA format to format citations and references and is free of errors. 1 paragraph needed with references.
5.23 CCK
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