Assessment of the abdomen and the gastrointestinal system
January 17, 2020
The Disaster, Man-Made or Natural
January 17, 2020

 Write a brief
Conclusion why you made these decisions and what will be the objective
of obtaining an improvement in the condition of this patient .

Decision 1

The PMHNP will administer 10 mg of zyprexa orally at bed time and
initiate 230mg of invega sustenna through intramuscular, in addition to
156 mg via the same route on day four. A similar dose will be
administered within one months’ time. In addition the PMHNP will
administer 10mg of Abfility orally at bed time. Expected outcome for
this decision is a 25% decrease in the PANSS score (Stahl, 2013). This
decision is also expected to alleviate the patient’s psychotic symptoms
and achieve normalcy within one month. A slight weight gain is also
expected as the drugs are known to increase weight in patients. Because I
don’t select the other decisions, the patient is expected to have
faster and noticeable changes in psychotic behavior within two weeks of
treatment commencement. 

Decision 2

At this point the PMHNP will decide to continue with use of
medications selected in decision 1 (Stahl, 2013). However the PMHNP will
instruct the administering nurse to begin intramuscular injections of
300mg of Abfility and continue with 10 mg of the same drug in the
morning. At this point, PANSS is expected to decrease by 50 % although
the patient will also have noticeable weight gain due to use of invega
sustenna (Stahl 2014). Because I don’t select other decisions, the
patient is expected to have less cardiovascular drug toxicities and
experience reduced risks for adverse drug reactions between Invega
sustenna and Haldol Deaconoate. 

Decision 3

The decision at this point is to have the patient continue with
Invega Sustenna and provide psychological counseling on the effects of
the drugs associated with weight gain. It will be essential to explain
to the patient that the weight gain from this drug is minimal in
comparison with other drugs (Stahl, 2013). The PMHNP will set an
appointment follow up date with the patient after one month duration and
refer to the nutritionist and physical activity instructor. The
difference between expected outcome in decision 3 and results of the
decision is Abfility may not be efficacious for more than a period of 6
months given that it does not bind to D 2 receptors in a similar manner
as Invega Sustenna. This will necessitate the PMHNP to change to
Abfility Maintena because it is easily tolerated by patients on
Abfility. 

Because I don’t select the other decisions, the patent will be able
to utilize the same drug for the longest possible duration and optimize
on their efficacy prior to switching to other types of medication
(Stahl, 2013). Since the patient may not have the mental capacity to
participate in the decision making process or make autonomous mental
health decisions, it is essential to discuss treatment options with the
spouse and explain the importance of adherence to treatment (Stein &
Giordano, 2015). In addition, the mental health nurse is required to
make those decisions which will benefit the patient and also outweigh
the risk for adverse health outcomes. 

References

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stein, D. J., & Giordano, J. (2015). Global mental health and neuroethics. BMC Medicine, 13(1), 44.  

Schizophrenia Treatment

Decision 1

The PMHNP will administer 10 mg of zyprexa orally at bed time and
initiate 230mg of invega sustenna through intramuscular, in addition to
156 mg via the same route on day four. A similar dose will be
administered within one months’ time. In addition the PMHNP will
administer 10mg of Abfility orally at bed time. Expected outcome for
this decision is a 25% decrease in the PANSS score (Stahl, 2013). This
decision is also expected to alleviate the patient’s psychotic symptoms
and achieve normalcy within one month. A slight weight gain is also
expected as the drugs are known to increase weight in patients. Because I
don’t select the other decisions, the patient is expected to have
faster and noticeable changes in psychotic behavior within two weeks of
treatment commencement. 

Decision 2

At this point the PMHNP will decide to continue with use of
medications selected in decision 1 (Stahl, 2013). However the PMHNP will
instruct the administering nurse to begin intramuscular injections of
300mg of Abfility and continue with 10 mg of the same drug in the
morning. At this point, PANSS is expected to decrease by 50 % although
the patient will also have noticeable weight gain due to use of invega
sustenna (Stahl 2014). Because I don’t select other decisions, the
patient is expected to have less cardiovascular drug toxicities and
experience reduced risks for adverse drug reactions between Invega
sustenna and Haldol Deaconoate. 

Decision 3

The decision at this point is to have the patient continue with
Invega Sustenna and provide psychological counseling on the effects of
the drugs associated with weight gain. It will be essential to explain
to the patient that the weight gain from this drug is minimal in
comparison with other drugs (Stahl, 2013). The PMHNP will set an
appointment follow up date with the patient after one month duration and
refer to the nutritionist and physical activity instructor. The
difference between expected outcome in decision 3 and results of the
decision is Abfility may not be efficacious for more than a period of 6
months given that it does not bind to D 2 receptors in a similar manner
as Invega Sustenna. This will necessitate the PMHNP to change to
Abfility Maintena because it is easily tolerated by patients on
Abfility. 

Because I don’t select the other decisions, the patent will be able
to utilize the same drug for the longest possible duration and optimize
on their efficacy prior to switching to other types of medication
(Stahl, 2013). Since the patient may not have the mental capacity to
participate in the decision making process or make autonomous mental
health decisions, it is essential to discuss treatment options with the
spouse and explain the importance of adherence to treatment (Stein &
Giordano, 2015). In addition, the mental health nurse is required to
make those decisions which will benefit the patient and also outweigh
the risk for adverse health outcomes. 

References

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stein, D. J., & Giordano, J. (2015). Global mental health and neuroethics. BMC Medicine, 13(1), 44.

  • Posted: 17 days ago
  • Due: 01/01/2020
  • Budget: $5

 

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