Nursing CASE STUDY

Case study: Kim Remirez, a 20-year-old Native American woman with no past medical history, comes to the mental health clinic for medication management.

The patient is a poor historian, and information is obtained from her significant other of the past 2 years. She reports that Kim has been sleeping for about 1 hour and then is up for the rest of the day, and that she seems to have endless energy and is “excessively cheery.” The significant other states that there have been some episodes like this before that lasted a day or two, but this is the longest (7 days) that she has ever seen Kim act like this. Sometimes, Kim does not make sense when she talks, and it seems like her thoughts are not connecting in her head. Kim has run up a large amount of credit card debt in the past 2 days, buying things that the couple did not need or want. Kim sometimes talks so much, her partner says, that “I can’t get a word in, and she hasn’t gone to work all week because she can’t function.” She reports that usually Kim “crashes” after episodes like this, will not get out of bed for several days, and is “depressed.”

Kim herself denies suicidal or homicidal ideation in the clinic, but she does say that when she gets really down, she thinks about “ending it.”

Kim’s partner states that neither of them drinks nor smokes.

Kim is clean but untidy, and she paces the room, making poor eye contact. When she does speak, her sentences appear forced and do not always align with the conversation.

Allergies/adverse drug reactions: NKDA

Current medication list: None

Diagnosis: Bipolar Disorder Answer the following questions in APA 7th edition writing formart:

1. Medication regimen: Based on evidence-based clinical guidelines, choose and prioritize the first-line, second-line (using brand and generic names), and any other common medications for the identified psychiatric mental health condition or diagnosis, including:

• • • Mechanism of action and neurotransmitters involved (pathophysiology)
    • Indications/contraindications
    • Drug/food/other interactions
    • Ongoing monitoring parameters (for safety and efficacy)
    • Common formulations/doses available, including routes
    • Prescreening labs or treatment requirements
    • Discontinuation, including tapering of medication if applicable or preparation for a change of therapy/new medication
    • Patient teaching/education (common side-effects, self-monitoring, time to efficacy, etc.)
    • Considerations related to scheduled/controlled substances, if applicable

2. CAM (complementary/alternative medicine): Identify 1–2 possible complementary/alternative medications for the identified psychiatric mental health condition or diagnosis, including:

• • • Mechanism of action and neurotransmitter involved (pathophysiology)
    • Indications/contraindications
    • Drug/food/other interactions
    • Expected and unexpected side effects and/or warnings
    • Ongoing monitoring parameters
    • Common formulations/doses available, including routes
    • Patient teaching/education (common side-effects, self-monitoring, time to efficacy, etc.)

3. Response: Promote safety and continuous quality improvement by identifying expected and possible unexpected patient responses, and describe how the plan may need to be modified, with documentation thereof (what would you do, based on the patient’s response?).

4. Lab monitoring: Identify any labs utilized for safety and efficacy (drug levels, complete metabolic profile (CMP), etc.) specific to the medications you chose.

5. RX: Based on your recommendations for therapy, write out your full prescription (just like you would on a prescription pad) for one of the medications you picked. Ensure that you meet the minimum requirements for prescribing as set forth by the Texas Board of Nursing for APRNs.

6. Population considerations: What dose adjustments or other considerations would you make, based on the following populations:

• • • Elderly
    • Pediatric
    • Pregnant
    • Complex medical comorbidities (Case Study grading Rubric):
      Proficient Addresses all aspects of the case study by providing original and critical analysis. Suggests actions appropriate for the clinical setting and best practices. Prescription follows standards of practice and includes all components of a valid prescription as directed. Case study content is supported with more than two professional, evidence-based sources. Follows correct APA format; is free of grammatical or spelling errors; uses an articulate, scholarly tone, with well-organized ideas; follows the format provided. Suggested Textbooks: · Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences clinical psychology (11^th ed.). Wolters Kluwer. ISBN 9781609139711 · Stahl, S.M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (4th ed). Cambridge. ISBN: 9781107025981 · American Psychological Association. (2020). Publication manual of the American Psychological Association (7^th ed.). Author. ISBN: 978-1-4338-3216-1