Pharmacokinetic and Pharmacodynamic Nursing Assignment Help

Current Approaches to Assessment and Treatment of Patients with Schizophrenia-related Psychoses.

To prepare for this Assignment:

  • Review this week’s Learning Resources, including the Medication Resources indicated for this week.
  • Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses.

The Assignment: 5 pages

Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

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At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

  • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

  • Which decision did you select?
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

  • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

BACKGROUND

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 when she was 9 years old).

She presents 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. 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 says she knows this because the television is telling her so.

She currently weighs 140 lbs., and she is 5’ 5.

SUBJECTIVE

Client reports that her mood is “good.” She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.

A review of her hospital records shows that she received a medical workup from 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.

MENTAL STATUS EXAM

The client is alert and 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 is 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.

You administer 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

PANSS Scale. Available at:  http://egret.psychol.cam.ac.uk/medicine/scales/PANSS

§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. doi:10.1093/schbul/13.2.261

https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

§ Clozapine REMS Program. (n.d.). Clozapine REMS: A guide for healthcare providers. Retrieved September 7, 2016, from  https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf

§ Paz, Z., Nalls, M., and Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal, 13(10), 625–629. Retrieved from  http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf

RESULTS OF DECISION POINT ONE

Start Abilify (aripiprazole) 10 mg orally at BEDTIME

  •  Client returns to clinic in four weeks
  •  Client returns and looks disheveled. Upon questioning, her husband states that she has not been sleeping at night. He states she is up and down all night. It has been disrupting his sleep too
  •  The client is unable to participate in the PANSS rating tool because she is continually nodding off (sleeping) during the appointment
  •  The appointment is not productive for assessing how she is responding to the Abilify started 4 weeks ago

RESULTS OF DECISION POINT TWO

Change abilify administrations time to AM dosing

  •  Client arrives at office appearing to have slept better. Her husband tells you that she is still up and down at night, but it is much less frequently
  •  He notices that it is better when she takes her medication as soon as she awakens, but some days she forgets and takes it when she remembers (in the afternoon)
  •  Her PANNS has decreased by 5% since her initial visit

Decision Point Three

DC Abilify. Start Invega oral tablets 6 mg daily and begin the conversation about long-acting injectable antipsychotics in preparation of starting Invega Sustenna at the client’s next appointment

Guidance to Student

This is week 8 since therapy was initiated. Although the client’s side effects seem to be better managed, her PNSS is not changing by much. An acceptable time frame for treatment is defined as 4–6 weeks at an acceptable dose.

Increasing Abilify to 20 mg in the morning certainly is an option, but she seems to be forgetful of taking this medication first thing in the morning on occasion and is still experiencing side effects when it is taken later in the day. It might be a good time to explore other options.

Latuda is a medication that behaves much like Geodon (ziprasidone). It offers a once-daily dosing option and weight gain is minimal. She would not be expected to experience the insomnia and akathisia that has been experienced on the Abilify.

Tolerability can be an issue as doses are escalated. Particularly, nausea, vomiting, and extrapyramidal side effects can be problematic and therefore good counseling points to clients.

Clients usually tolerate lower doses (40 mg) but significant GI distress and movement disorders can occur when doses are pushed upward toward the daily max of 160 mg.

Invega oral therapy is a good option as it has a once daily dosing option, and it has a greater effect at the D2 receptor than Abilify and may offer more efficacy and less insomnia and akathisia than seen in Abilify.

It has a long-acting option that can be given monthly (to start). With good efficacy maintained over a 4-month period, it can be changed to once every 3 months. This is a good option in someone where compliance can be problematic.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6630_Week7_Discussion_Rubric

  • Grid View
  • List View
 Excellent Point range: 90–100Good Point range: 80–89Fair Point range: 70–79Poor Point range: 0–69
Main Posting: Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.Points: Points Range: 40 (40%) – 44 (44%) Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. Feedback:Points: Points Range: 35 (35%) – 39 (39%) Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. Feedback:Points: Points Range: 31 (31%) – 34 (34%) Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with fewer than two credible references. Feedback:Points: Points Range: 0 (0%) – 30 (30%) Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. Feedback:
Main Posting: WritingPoints: Points Range: 6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. Feedback:Points: Points Range: 5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. Feedback:Points: Points Range: 4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors. Feedback:Points: Points Range: 0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Feedback:
Main Posting: Timely and full participationPoints: Points Range: 9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date. Feedback:Points: Points Range: 8 (8%) – 8 (8%) Posts main Discussion by due date. Meets requirements for full participation. Feedback:Points: Points Range: 7 (7%) – 7 (7%) Posts main Discussion by due date. Feedback:Points: Points Range: 0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main Discussion by due date. Feedback:
First Response: Post to colleague’s main post that is reflective and justified with credible sources.Points: Points Range: 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. Feedback:Points: Points Range: 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. Feedback:Points: Points Range: 7 (7%) – 7 (7%) Response is on topic, may have some depth. Feedback:Points: Points Range: 0 (0%) – 6 (6%) Response may not be on topic, lacks depth. Feedback:
First Response: WritingPoints: Points Range: 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in Standard, Edited English. Feedback:Points: Points Range: 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in Standard, Edited English. Feedback:Points: Points Range: 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. Feedback:Points: Points Range: 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. Feedback:
First Response: Timely and full participationPoints: Points Range: 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. Feedback:Points: Points Range: 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. Feedback:Points: Points Range: 3 (3%) – 3 (3%) Posts by due date. Feedback:Points: Points Range: 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Feedback:
Second Response: Post to colleague’s main post that is reflective and justified with credible sources.Points: Points Range: 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. Feedback:Points: Points Range: 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. Feedback:Points: Points Range: 7 (7%) – 7 (7%) Response is on topic, may have some depth. Feedback:Points: Points Range: 0 (0%) – 6 (6%) Response may not be on topic, lacks depth. Feedback:
Second Response: WritingPoints: Points Range: 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in Standard, Edited English. Feedback:Points: Points Range: 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in Standard, Edited English. Feedback:Points: Points Range: 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. Feedback:Points: Points Range: 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. Feedback:
Second Response: Timely and full participationPoints: Points Range: 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. Feedback:Points: Points Range: 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. Feedback:Points: Points Range: 3 (3%) – 3 (3%) Posts by due date. Feedback:Points: Points Range: 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Feedback:

Show Descriptions Show Feedback

Main Posting: Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.–

Levels of Achievement: Excellent Point range: 90–100 40 (40%) – 44 (44%) Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. Good Point range: 80–89 35 (35%) – 39 (39%) Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. Fair Point range: 70–79 31 (31%) – 34 (34%) Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with fewer than two credible references. Poor Point range: 0–69 0 (0%) – 30 (30%) Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. Feedback:

Main Posting: Writing–

Levels of Achievement: Excellent Point range: 90–100 6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. Good Point range: 80–89 5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. Fair Point range: 70–79 4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors. Poor Point range: 0–69 0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Feedback:

Main Posting: Timely and full participation–

Levels of Achievement: Excellent Point range: 90–100 9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date. Good Point range: 80–89 8 (8%) – 8 (8%) Posts main Discussion by due date. Meets requirements for full participation. Fair Point range: 70–79 7 (7%) – 7 (7%) Posts main Discussion by due date. Poor Point range: 0–69 0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main Discussion by due date. Feedback:

First Response: Post to colleague’s main post that is reflective and justified with credible sources.–

Levels of Achievement: Excellent Point range: 90–100 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. Good Point range: 80–89 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. Fair Point range: 70–79 7 (7%) – 7 (7%) Response is on topic, may have some depth. Poor Point range: 0–69 0 (0%) – 6 (6%) Response may not be on topic, lacks depth. Feedback:

First Response: Writing–

Levels of Achievement: Excellent Point range: 90–100 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in Standard, Edited English. Good Point range: 80–89 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in Standard, Edited English. Fair Point range: 70–79 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. Poor Point range: 0–69 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. Feedback:

First Response: Timely and full participation–

Levels of Achievement: Excellent Point range: 90–100 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. Good Point range: 80–89 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. Fair Point range: 70–79 3 (3%) – 3 (3%) Posts by due date. Poor Point range: 0–69 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Feedback:

Second Response: Post to colleague’s main post that is reflective and justified with credible sources.–

Levels of Achievement: Excellent Point range: 90–100 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. Good Point range: 80–89 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. Fair Point range: 70–79 7 (7%) – 7 (7%) Response is on topic, may have some depth. Poor Point range: 0–69 0 (0%) – 6 (6%) Response may not be on topic, lacks depth. Feedback:

Second Response: Writing–

Levels of Achievement: Excellent Point range: 90–100 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in Standard, Edited English. Good Point range: 80–89 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in Standard, Edited English. Fair Point range: 70–79 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. Poor Point range: 0–69 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. Feedback:

Second Response: Timely and full participation–

Levels of Achievement: Excellent Point range: 90–100 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. Good Point range: 80–89 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. Fair Point range: 70–79 3 (3%) – 3 (3%) Posts by due date. Poor Point range: 0–69 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Feedback:

Total Points: 100

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