Nursing homework help – Elite Custom Essays

Nursing homework help

Nursing homework help

Subjective

CC: “it works a little too well. It makes me sleepy.”

HPI: The patient is a White female who is 26 years old. She says that she was given medication that made her sleepy during her recent admission to an inpatient psychiatric facility. She says that she was struggling with sleep before she was treated at the facility. She also reports that she was diagnosed with bipolar disorder. She says that within one week, she has lost 14 pounds. She complains that she sleeps too much at night. She rates her happiness in life at an eight out of ten and denies suicide and homicide ideation. The patient reports that she has highs and lows in her moods. Nursing homework help

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Past Psychiatric History

General Statement: The patient has been previously diagnosed with bipolar disorder.

Caregivers: not reported.

Hospitalizations: Prior inpatient admission at a psychiatric facility.

Medication Trials: Lithium during last inpatient visit

Previous Psychiatric Diagnosis: Bipolar disorder

Substance Use History: The patient does not drink, abuse illicit drugs, and has never smoked.

Family History: Both her parents are alive, and her father has skin cancer that has metastases to the brain.

Psychosocial History: No reported psychosocial history.

Medical History:

Current Medications: Gabapentin 600mg in the morning and noon, and 1200mg at night. Abilify 5mg at night

Allergies: Lithium causes her to have diarrhea.

Reproductive Hx: No reported childern.

Past Medical History: Hyperlipidemia.

ROS:

GENERAL:  The patient is alert and well oriented to time, place, and person.

HEENT: The patient does not have any swellings on the head, audio and visual acuity is normal, no sinus infections, and no swollen lymph nodes in the throat.

SKIN: The skin does not have any breakages or rashes. It is also sufficiently moist with normal pigmentation.

CARDIOVASCULAR: The patient does not experience any discomfort in the chest.

RESPIRATORY: The patient has steady breathing and does not experience shortness of breath. The rising and falling of her chest are expected, with no dyspnea or respiratory issues.

GASTROINTESTINAL: The patient does not have any nausea, abdominal pains, running stomach, or vomiting episodes

GENITOURINARY: The patient can pass urine without experiencing any pain or discomfort.

MUSCULOSKELETAL: The patient has a full range of ambulatory movements with no pain in her joints. She moves freely with no constraints or pain.

HEMATOLOGIC: The patient does not have anemia.

LYMPHATICS: There is no splenectomy or swollen lymph nodes present.

ENDOCRINOLOGIC: There are no endocrinal conditions noted or any unusual hormonal changes.

Objective

Physical Examination: Vitals are as follows: Ht: 5’11” Wt: 169 lbs BMI: 23.57 Pain: 0/10

Diagnostic results: Blood and urine tests returned unremarkable results, and the MRI and CT scan also returned unremarkable results.

Assessment

Mental Status Examination

The patient is a 26-year-old White female who is well oriented to time, person, and place. She is cooperative during the examination with clear and coherent speech. She also articulates her thoughts clearly. She does not have any suicidal or homicidal ideations. The patient says that she has experienced hallucinations and delusions. Both her long-term and short-term concentration are good. The patient has experienced hypomania, mania, and depression.

Differential diagnosis

Bipolar I Disorder

Bipolar I disorder is a mental condition where the individual experiences manic or hypomanic episodes characterized by high increases in energy or irritability (McIntyre et al., 2020). Individuals also experience depressive episodes when they have low moods and isolate themselves from people. The diagnostic criteria for the condition involve the presence of manic and hypomanic episodes (McIntyre et al., 2020). The manic episode is characterized by grandiosity and inflated self-esteem, being talkative, flight of thought, and increased psychomotor activity. The depressive episodes are characterized by a persistent depressed mood, lack of interest in activities, considerable weight loss, hypersomnia or insomnia, and psychomotor retardation (McIntyre et al., 2020). The patient displays manic, hypomanic, and depressive episodes. They have also reported significant weight loss. These symptoms are consistent with bipolar I disorder, making it the primary diagnosis.

Schizoaffective Disorder

Schizoaffective disorder is a mental health condition characterized by schizophrenic symptoms, including delusions and hallucinations (Miller & Black, 2019). The state also presents with mood disorder symptoms which include mania and depression. There are two types of schizoaffective disorders, namely depressive type and bipolar type (Miller & Black, 2019). Individuals with the condition will present with delusive behavior such as having fixed and false beliefs that contradict apparent evidence. They will also have visual or auditory hallucinations and bizarre behavior (Miller & Black, 2019). The depressive symptoms will manifest as feelings of emptiness and sadness. The individual will also feel worthless. Individuals with schizoaffective disorder will often have suicide and homicidal ideation (Miller & Black, 2019). The main difference between bipolar I disorder and schizoaffective disorder is the presence of psychosis. The patient, in this case, does not exhibit symptoms of psychosis which rules out schizoaffective disorder.

Major Depressive Disorder

            Major depressive disorder is a mental health condition characterized by a relapsing and remitting cycle of depressive episodes (Hasin et al., 2018). The depressive episodes can manifest in a persistently low mood. During depressive moods, the individual will also experience a decrease in their self-attitude, which leads to low confidence and self-esteem. There will also be reduced physical and mental energy. The individual’s low mood may also manifest as hopelessness, self-deprecation, and self-blame (Hasin et al., 2018). Some of the common symptoms of the major depressive disorder include changes in the individual’s sleep patterns, either hypersomnia or insomnia (Hasin et al., 2018). The individual will also have suicidal and homicidal ideations. The presence of psychotic episodes is also another symptom where the individual will have delusions or hallucinations. While both major depressive disorder and bipolar I disorder have overlapping symptoms, the main distinction is that major depressive disorder is unipolar. It means that in major depressive disorder, there are no manic episodes, whereas in bipolar I disorder, there are manic episodes.

Reflections

The patient has been treated for bipolar I disorder in the past. She has been taking Gabapentin and Abilify, but she complains that she sleeps too much. She rates her happiness mood highly, meaning that she must be on a manic episode. Her pharmacological treatment plan will be Gabapentin, one tablet taken twice daily and 1.5 tablets taken at night. She will also be prescribed Aripiprazole 5 mg taken at night. Cognitive-behavioral therapy has been proven to be effective in treating bipolar I disorder (David et al., 2018). Therefore the psychotherapy plan will involve using cognitive-behavioral therapy to improve the patient’s symptoms by modifying her behavior and helping her manage both her manic and depressive episodes. The patient will also be subjected to alternative therapy, including joining support groups for individuals with the same condition. The patient will also be encouraged to adjust their diet and avoid diets rich in saturated fats, red meat, trans fats, and simple carbohydrates (Łojko et al., 2018). The patient should also be educated on how to adhere to their prescriptions, any potential side effects they should anticipate, and when to seek medical advice if the side effects worsen.

References

David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current

gold standard of psychotherapy. Frontiers in psychiatry, 9, 4.

Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018).

Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4), 336-346.

Łojko, D., Stelmach, M., & Suwalska, A. (2018). Is diet important in bipolar disorder?. Psychiatr.

Pol, 52(5), 783-795.

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., … &

Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856.

Miller, J. N., & Black, D. W. (2019). Schizoaffective disorder: A review. Annals of clinical

psychiatry: official journal of the American Academy of Clinical Psychiatrists, 31(1), 47-53.