Assessing and Treating Patients with Bipolar Disorder
Introduction
The case involves an Asian American woman who has bipolar disorder. The condition leads to a shift in mood and energy, leading to mania and depression. Treatment of the condition is necessary to relieve the symptoms and enable the patients to participate in daily activities. The first decision is to prescribe Lithium 300mg orally. The drug has fewer side effects and is effective as compared to the other two drugs. The expected outcome is that the patient will experience better sleep, lessened hyperactivity, and mental status rating score. Observing ethical considerations is vital, including confidentiality, informed consent, do-no-harm ethical principle, and accountability. The purpose of the essay is to assess and treat an Asian American woman who has bipolar disorder.
Decision One
The first decision is to prescribe Lithium 300mg orally.
The Rationale for the Decision
The reason for prescribing Lithium is due to the drug’s popularity in treating bipolar disorder among adults and children 12 years and older (Rosenblat, 2019). Lithium has few side effects compared to other drugs used for the treatment of bipolar disorder. Lithium helps to reduce the severity and frequency of mania (Rosenblat, 2019). For example, studies show that Lithium reduces the risk of suicidal thoughts among patients with bipolar disorder.
The Other Two Options
The reason for not selecting Risperdal 1 mg orally BID or Seroquel XR 100 mg orally at HS is that the two drugs trigger more side effects than Lithium. For example, Risperdal has antihistaminic properties that may trigger a sedating effect and interfere with hormones that regulate blood flow and pressure (Rosenblat, 2019). Seroquel XR causes side effects such as difficulty swallowing, tremors, constipation, suicidal thoughts, and nausea. The two drugs are not the most preferable as the first line of treatment for bipolar disorder (Rosenblat, 2019). Risperdal 1 mg orally BID or Seroquel XR 100 mg orally are not the preferable first line of treatment for bipolar disorder. The drugs would be preferable only if the patient makes no progress after taking Lithium.
Expected Outcomes
The expected outcome is to improve the patient’s health condition by relieving the severity of the symptoms. For example, I expect that the patient’s sleeping schedule will improve. The patient should report improvements in sleep. Another expected outcome is to reduce the hyperactivity of the patient. Lithium improves the symptoms of bipolar disorder, such as hyperactivity (Malhi et al., 2017). For example, when she visits the office, she is not settled and is in denial that she is bipolar. Other areas of improvement include dressing code and speech. Another expected outcome is that the patient will adhere to the Lithium medication.
Decision Two
The second decision is to increase to Lithium 450mg orally.
Rationale
The reason for continuing the medication is since it generated positive results. After the four weeks, the client’s hyperactivity has lessened while their sleep has improved (Malhi et al., 2017). Continuing with the medication is essential since changing the drug after four weeks. Mental drugs are effective after a period of four to eight weeks. Changing the drug can increase the risk of health complications. The patient should continue taking the medication for another four weeks. Another reason to continue with the medication is minimal side effects (Tondo et al., 2017). The client did not report any adverse complications. Lithium is unlike Risperdal 1 mg orally BID or Seroquel XR 100 mg orally, which trigger severe side effects.
The Other Options
It is not preferable to select the other two options, including Risperdal 1 mg orally BID or Seroquel XR 100 mg orally. The reason is that changing psychiatric drugs within few weeks can trigger health complications (Tondo et al., 2017). Another reason is that polypharmacy is not an option in the treatment of mental disorders. The patient should continue with Lithium 300mg since it is already generating quality results. Evidence-based practice shows that practitioners should not introduce two drugs for the same purpose at the same time (Tondo et al., 2017). The introduction of two drugs will confuse the practitioners if patients have some reactions or side effects.
Expected Outcomes
The expected outcome is that the patient will continue to experience relief from the severe symptoms reported during the first day of reporting to the clinic. For example, the patient should have a better sleep experience. It is expected that the client will change the perspective of sleep. Another expected outcome is that the patient should experience low hyperactivity. For example, when she visits the office next time, she should be settled without any intention to play with the items on the table. Improvements in the patient should demonstrate that she is recovering (Baldessarini et al., 2021). The patient should have a better Young Mania Rating Scale (YMRS) scale score.
Decision Three
The third decision is to continue with Lithium 450mg orally.
Rationale
The rationale for increasing the drug is due to enhance the process of recovery. Evidence-based practice shows that increasing the dose will improve recovery if a drug is not triggering side effects (Baldessarini et al., 2021). Increasing the strength of the medication is crucial to ensure a quick recovery. Another reason for maintaining the drug is because the patient has not reported any adverse health outcomes, such as side effects (Baldessarini et al., 2021). Mild side effects do not affect the recovery process.
Expected Outcomes
The expected outcome is that the patient will experience minimal or no hyperactivity. In the 12th week of taking the medication, the patient should experience a full recovery. Another expected outcome is that she should enjoy quality and routine sleep. It is expected that the patient will have a better dress code to match events and days. The speech should improve to demonstrate the effectiveness of the medication (Baldessarini et al., 2021). The patient should have a better Young Mania Rating Scale (YMRS) scale score.
The Other Two Options
The other two options are not preferable in providing care since the current medication is already offering quality health outcomes (Baldessarini et al., 2021). The patient should continue with the current drug until complete recovery. It is justifiable to introduce a new drug if the current one is not generating the expected outcomes.
Ethical Considerations
Ethical and legal considerations are essential to ensure the quality of care. The first consideration is the patient’s informed consent (Voltelen et al., 2018). The client should have all the information about diagnosis and treatment and consent to the treatment. Another consideration is to respect the client’s autonomy. The client should participate in the decision-making process. The practitioner should observe the do-no-harm ethical principle of offering quality care to the patient without subjecting them to harmful medical procedures or medications. For example, a healthcare worker should review the patient’s medical history to evaluate allergic reactions to a specific medication. The patient should continue enjoying confidentiality as prescribed in the HIPPA principles (Ingham-Broomfiel, 2017). According to HIPPA principles, nurses should protect patient’s data from access by unauthorized third parties (Ingham-Broomfiel, 2017). The client’s health status should remain private unless there are compelling legal reasons to disclose the information.
Practitioners should use the best knowledge to provide quality care. Using the best knowledge will prevent adverse outcomes that can undermine patient recovery. A practitioner should be accountable for the healthcare decisions offered (Ingham-Broomfiel, 2017). The practitioner should observe veracity by remaining truthful to the patients. Beneficence is another ethical consideration that involves showing kindness and charity to the patient (Voltelen et al., 2018). Kindness and charity are required to promote a friendly healthcare environment. Observing ethical considerations in nursing is necessary to ensure the provision of quality and professional care.
Conclusion
Provision of care to patients with bipolar disorder is a complex encounter with many decisions to make. The decisions involve selecting the best medication for the patient and observing ethical considerations. In the current case study, the patient requires Lithium 300mg orally instead of Risperdal 1 mg orally BID or Seroquel XR 100 mg orally at HS. The other two drugs are not preferable since evidence-based practice shows they trigger adverse side effects. It is expected that the patient should report back to the clinic after four weeks. Improvements should include reduced hyperactivity, better sleep, and a better Young Mania Rating Scale (YMRS) scale score.
References
Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2021). Commentary: Lithium treatment for bipolar disorder. Bipolar Disorders, 23(1), 93-94.
Ingham-Broomfield, R. (2017). A nurses’ guide to ethical considerations and the process for ethical approval of nursing research. Australian Journal of Advanced Nursing, 35(1), 40-47.
Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of lithium for the treatment of bipolar disorder: recommendations from clinical practice guidelines. Journal of Affective Disorders, 217, 266-280.
Rosenblat, J. D. (2019). Targeting the immune system in the treatment of bipolar disorder. Psychopharmacology, 1-13.
Tondo, L., Abramowicz, M., Alda, M., Bauer, M., Bocchetta, A., Bolzani, L., … & Baldessarini, R. J. (2017). Long-term lithium treatment in bipolar disorder: effects on glomerular filtration rate and other metabolic parameters. International Journal of Bipolar Disorders, 5(1), 1-12.
Voltelen, B., Konradsen, H., & Ostergaard, B. (2018). Ethical considerations when conducting joint interviews with close relatives or family: an integrative review. Scandinavian Journal of Caring Sciences, 32(2), 515-526.
