the client is a 34-year-old Pakistani female who moved to the...

Question Answered step-by-step the client is a 34-year-old Pakistani female who moved to the… 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.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 EXAMThe 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 scaleDiagnosis: Schizophrenia, paranoid typeWhich would you choose Decision Point OneSelect what you should do:Start Zyprexa (olanzapine) 10 mg orally at BEDTIMERESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Her PANSS decreases to a partial response (decrease in positive symptoms by 25%) She comes in today with a reported weight gain of 5 pounds. When questioned further on this point, she states that she can never seem to get full from her meals, so she is snacking constantly throughout the dayStart Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafterRESULTS OF DECISION POINT ONE Client returns to clinic in four weeks A decrease in the PANSS score of 25% (in positive symtpoms) is noted at this visit Client seems to be tolerating medication Her husband has made sure she makes her appointments for injections (one thus far) She has noted a 2-pound weight gain, but it does not seem to be an important point for her She does, however, complain of injection-site pain, telling you that she has trouble sitting for a few hours after the injections and doesn’t like having to walk around for such a long period of timeStart Abilify (aripiprazole) 10 mg orally at BEDTIMERESULTS OF DECISION POINT ONE 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 Assess client factors and history to develop personalized therapy plans for patients with insomniaAnalyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for insomniaAssess patient factors and history to develop personalized plans of antipsychotic therapy for patientsAnalyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring antipsychotic therapySynthesize knowledge of providing care to patients presenting for antipsychotic therapyAnalyze ethical and legal implications related to prescribing antipsychotic therapy to patients across the lifespan Health Science Science Nursing NURS 6630 Share QuestionEmailCopy link Comments (0)