Change JourneysPersonal and Professional Adaptations
Order ID | 53563633773 |
Type | Essay |
Writer Level | Masters |
Style | APA |
Sources/References | 4 |
The perfect number of Pages to Order | 5-10 Pages |
Change JourneysPersonal and Professional Adaptations
BELOW IS THE CASE STUDY THAT’S BEING TALKED ABOUT:
HISTORY OF PRESENT ILLNESS:
A 35-year-old male presents to the psychiatric emergency department for psychiatric evaluation. The client was sent directly from his PCP’s office. That morning, the client and his wife presented to the PCP’s office without an appointment, with a chief complaint of “being overwhelmingly depressed.” The client has developed a plan to die by suicide, which included taking a bottle of Tylenol and drinking “as much vodka as it takes.” The internist performed a thorough evaluation, drew labs, and called 911 to bring the client to the Emergency Department.
When the PMHNP encounters the client, the client is visibly upset and clinging to his wife. The couple explains that they separated a month ago because the client “just couldn’t be a husband anymore.” Over the past four weeks, he has become isolated and has complained of decreased energy, concentration, appetite, and sleep. He lost his job as a house painter four months earlier. The client no longer enjoys taking care of the couple’s two children, ages 4 and 6—a drastic change from the role he has previously enjoyed as a father.
The PMHNP asked the client when he first began feeling down. He states, “When my mother died one and a half years ago.” He says that he has been feeling guilty over the circumstances of her death and wishing he had been closer to her in the years preceding her death. The wife notes with concern: “That was just about the time you started drinking so heavily, as well.” As you question further, you determine that the client has been drinking daily since his mother’s death. He estimates that he drinks six beers a day. He admits that drinking is a problem, and he tried to stop drinking two weeks before this visit. The client says: “My wife kicked me out of the house, I missed my kids, I didn’t have a job…I knew something was wrong.” He notes that in the days after he stopped drinking, he experienced some shakiness and felt “like there were bugs under my skin.” He added that having a beer made these symptoms subside. Last night he became distraught after calling his wife to check on the children and finding they were not home. He sat in his hotel room and thought, “I can’t go on living like this.” He called his wife at 6 a.m. the next day and said he thought he might kill himself. She immediately brought him to the internist’s office.
PAST PSYCHIATRIC HISTORY:
The client has never seen a psychiatric provider or been hospitalized for a psychiatric diagnosis. He recalls having been depressed only once earlier in his life, during his 20s, but he did not seek treatment at that time. Although the client is currently suicidal, he denies any past suicidal thinking and has never made previous suicide attempts.
PAST MEDICAL HISTORY:
Hypertension, Hypercholesteremia.
MEDICATIONS: Hydrochlorothiazide 25 mg po daily
FAMILY HISTORY:
The client’s father has a history of alcohol dependence, and his mother had hypertension and coronary artery disease before dying of myocardial infarction at age 60. The client denies any Hx of psychiatric illness in his family.
SUBSTANCE ABUSE HX:
The client has been drinking six beers/day for the past year and a half; before that, he was not drinking daily. He has a remote history of similar drinking in his 20s during his first divorce, but he was able to quit “cold turkey” and has never been to any detox facility. He experienced symptoms of withdrawal when he quit, no history of withdrawal seizures. He denies using marijuana, heroin, cocaine, or other substances. He smokes ½ pk per day of cigarettes.
SOCIAL HISTORY:
The client describes his childhood as “chaotic.” Reports his father was “unpredictable” because of his drinking. The client graduated from high school and then went to vocational school. He became a house painter and worked sporadically. He was married in his early 20s and has a 17 y/o daughter who is being raised by her mother, his first wife. He married his current wife 8 yrs. ago; the marriage was functioning well until recently.
MENTAL STATUS EXAM:
The client is a white male who appears exhausted and mildly disheveled in a sweatshirt, baseball cap, and jeans. He frequently becomes teary throughout the evaluation and has poor eye contact, although he is cooperative during the interview. His stature is slumped, even seated in the chair, and he often leans forward and hides his face in his hands. His speech is notable for increased latency and paucity of words. His affect is dysphoric, congruent with the context of the discussion, and does not brighten throughout the interview. His thought process is linear and logical, and his thought content is preoccupied with his mother’s death. The client has no overt delusions; he denies ideas of reference and paranoid ideation. He also denies hallucinations. He is experiencing suicidal ideation with intent and plan but denied homicidal ideations.
His insight and judgment are fair at this moment in that he knows he needs treatment. The cognitive exam is grossly intact.
LABS:
Alcohol level= 130; AST = 68 IU/L; ALT = 45 IU/L; GGT= 35U/L; other liver function tests are WNL.
Hemoglobin =13.4; hematocrit = 41; MCV =95; triglycerides = 200 mg/dl.
DIAGNOSIS:
Alcohol Use Disorder (F 10.20)
Major Depressive Disorder, single episode, severe without psychotic features (F32.2)
Below is the student response that you are agreeing with because we chose the same medications:
Comprehensive ADHD Management for 7-Year-Old Alex Johnson
ADHD can be very disruptive to children’s everyday lives, having negative consequences for learning, family relationships, peer relations, and general health. To deal with the specific requirements of Alex Johnson, aged seven, the initial intervention chosen would be methylphenidate, also called Ritalin. Evidence-based considerations of their effectiveness combined with individual attributes make this choice appropriate.
Select one drug
Alex’s ADHD symptoms lead to methylphenidate as the first-line medication. The presentation of his symptoms, involving inattention, hyperactivity, and impulsivity, conforms to the documented efficiency of methylphenidate as a medication for essential characteristics of ADHD.
Mechanism of action and medication class.
Methylphenidate belongs to the stimulant class and increases dopamine and norepinephrine activity in the brain. This mechanism helps in focusing, paying attention, and curbing impulsivity, hence improving what individuals with ADHD face.
Prescription Format
Patient Name: Alex Johnson
Age and DOB: 7, 05/12/2016
Patient Address: 123 Maple Street, Cityville
Allergies: NKA
Date: 03/20/2023
Rx: Methylphenidate 10 mg tablet
SIG: Take one tablet by mouth once a day
Dispense: 30 (thirty) tablets
Refills: 0 (zero) refills
Dr. Emily Thompson
NPI: 1234567890
DEA: A98765432
Evidence-Based Rationale
This decision to prescribe methylphenidate to Alex is backed by many years of studies on its effectiveness in eliminating the symptoms of ADHD in children (Kim et al., 2022). Methylphenidate is the current gold standard drug for treating children diagnosed with ADHD, as it has consistently been proven to enhance attention, behavior, and academics.
Side Effects or Adverse Effects
Although methylphenidate is usually tolerated well, it is essential to be aware of possible adverse reactions. Insomnia, poor appetite, and agitation are common but often temporary reactions. While rare, adverse effects, such as cardiac problems, can be experienced. It is important to parents as it helps in decision-making and monitoring Alex’s response to the drug.
Diagnostic Testing
Pre-administration baseline assessments of blood pressure and heart rate before using methylphenidate. Taking this action ensures that Alex’s systemic condition is sufficient to tolerate stimulant medication (Stahl, 2021). Ongoing safety is ensured through regular check-ups, which will allow timely action should any issues be observed in such checks.
Medication-Related Teaching Points
Consistent Administration:Parents should also give methylphenidate uniformly daily. For best symptom management, consistency is essential, and missing doses can lead to variable responses. Alex’s daily schedule may include an assigned duration during which he engages in giving these drugs (Stahl, 2021).
Monitoring Side Effects: The parents should be aware of the common side effects like disrupted appetite and sleep cycles. Open dialog about concerns related to persistent and troubling side effects should be fostered in healthcare providers to ensure timely attention (Sun et al., 2022). Involving the patient in side effect management helps promote a favorable treatment outcome. sentence
Behavioral Monitoring:This includes observing Alex’s behavior and noting any changes or reactions that might happen due to his parents’ medication use. The first few weeks of treatment can show signals about this drug and necessary changes (Stahl, 2021). Early reporting of significant change makes making necessary corrections and amendments easier within Alex’s treatment regime.
Conclusion
Hence, the methylphenidate prescription for Alex Johnson should be considered a pharmacological intervention and a complete care program element. Here, evidence-based practices, individualized features, and ongoing evaluation are considered to confirm the efficacy and safety of the selected therapy. The aim is to equip Alex, his parents, and a team of teachers in order to empower them to deal with ADHD symptoms through medicinal therapy coupled with tailored educational and behavioral strategies. This collaborative process seeks symptom relief and an encompassing environment for Alex’s growth and general wellness.
Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.
Liver function test (Baseline, 1 month after initiation, 3 months after initiation, 6 months after initiation and then annually)
Provide a minimum of three appropriate medication-related teaching points for the client and/or family.
Educate patient to seek help if feeling suicidal.
Monitor for signs of hepatitis such as fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice.
Educate on importance of adhering to medication regimen for full therapeutic potential and better patient outcomes.
You are to read the above case study response and provide a response agreeing with the use of Methyphenidate
· Please respond as a nurse practitioner student when responding to the above case study response. Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
· Reference Citation: Use current 7th edition APA format to format citations and references and is free of errors. Engage by asking questions, and offering new insights, applications, perspectives, information, or implications for practice. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
Please use 2 APA references within 5 yrs. With one of the references being
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.
Change JourneysPersonal and Professional Adaptations
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