Metamorphic Reflections Personal and Professional Evolution
Order ID | 53563633773 |
Type | Essay |
Writer Level | Masters |
Style | APA |
Sources/References | 4 |
The perfect number of Pages to Order | 5-10 Pages |
Metamorphic Reflections Personal and Professional Evolution
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 my response to the above case study:
Psychiatric Drug Selection: Methylphenidate
Medication Class: Stimulant
Mechanism of Action: Methylphenidate is a central nervous system (CNS) stimulant and a member of the psycho-stimulants (Mechler et al., 2021). It blocks their reuptake thus increasing the levels of dopamine and norepinephrine in the brain. Thus, by enhancing activity of these neurotransmitters, methylphenidate improves attention, focus, and impulse control.
Prescription Format:
Rx:
Provider-Rachel Smith
DEA# 951756
Prescription no.: 3216540
Today’s Date: December 13, 2023
Patient: Joe Smith
Age: 7
Allergies: No known Drug Allergies
Medication: Methylphenidate
Dosage: 10 mg immediate-release, once daily
QTY: 60 tablets
Route: Oral
Duration: 8 weeks, with regular follow-up for monitoring
Refills: 0
Provider Signature: Smith, Rachel
Methylphenidate Rationale:
The reason Methylphenidate was chosen is because its efficacy in treating ADHD symptoms is well-established especially in combined presentation case. It has been found to be helpful in improving attention, lessening impulsiveness, and getting better behavioral control in kids with ADHD (Stahl, 2021). The pharmacological activity of methylphenidate mainly involves elevation of dopamine and noradrenaline levels within the synaptic cleft thereby modulating the neural circuits responsible for attention and behavioral control. This stimulant medication reduces inattention, hyperactivity and impulsivity thus enhancing academic and social functioning of the child.
Side Effects
Methylphenidate has the side effects of reducing appetite, insomnia, abdominal pain, headaches and sometimes affects the growth rate and weight among others. Most of these side effects are common; however, worst case scenarios may involve hallucinations, increased heartbeats and psychiatric symptoms like restlessness or hostility (Bieś et al., 2023). It is very important to pay close attention to these signs. However, it is important that users have a heightened awareness of methylphenidate’s potential adverse event profile in cases of severe behavioral or cardiac changes. The best way to maintain the most effective and safest treatment for ADHD by minimizing side effects is through regular communication with healthcare providers during medication use.
Required Diagnostic Testing
Starting methylphenidate, one should check blood pressure, heart rate, and weight for the baseline. It becomes important to continuously monitor these measures especially when there are changes in dosage or signs of heart disease (Omidi et al., 2021). However, a stimulant like methylphenidate may require an ECG if there is evidence of possible cardiac pathology in order to assess cardiac function and detect arrhythmias. A normal ECG reading usually has a pulse rate between 60 and 100 beats per minute with no major abnormality seen on the rhythm strip. This cautious approach allows for the early diagnosis of cardiovascular changes that might be caused by medication. Regular follow-ups and evaluations not only reduce the risks associated with heart complications but also give a comprehensive picture of the drug’s effect on the major physiological parameters which increases safety and efficiency in ADHD treatment over time.
Medication-Related Teaching Points
Understanding Methylphenidate:
In general, methylphenidate improves focus and reduces impulsiveness in managing ADHD symptoms. In other words, this drug helps to improve the neurochemical balance in the brain that enables it to operate more effectively. In this case, it is necessary to explain to children and parent how this medicine can help them at school and in their daily lives.
Dosage, Frequency, and Consistency:
Highlighting the amount of medicine prescribed, when and how often it should be taken, as well as the importance of being consistent about taking it will ensure its optimal effectiveness. However, one should stress following a provider’s advice precisely as a critical requirement to make medication work better.
Monitoring, Side Effects and Reporting:
As a provider we must also inform patients about potential side effects like altered appetite or sleep patterns and remind them about regular check-ups. Parents should instruct their children on informing an adult should they have any questions concerning methylphenidate prescriptions or related usage. Finally, such an approach helps nip any issues in the bud without dragging down the benefits of a medication while keeping its potential risks at bay.
You are to read MY response and answer the following questions below based on the case study of using Methyphenidate
Respond to this “The IR have a short duration of action and are using prescribed BID. What have you read this week about the advantages of the extended release dosing option?”
· 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.
Stahl, S.M. (2020). Stahl’s essential psychopharmacology: Prescribers guide (7th ed.). Cambridge University Press.
Metamorphic Reflections Personal and Professional Evolution
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