Case Study 

Delusional Disorders

Pakistani Female With Delusional Thought Processes

Hispanic male

BACKGROUND

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.

SUBJECTIVE

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 EXAM

The 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 scalDiagnosis: Schizophrenia, paranoid type

RESOURCES

PANSS Scale. Available at: http://egret.psychol.cam.ac.uk/medicine/scales/PANSS

§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. doi:10.1093/schbul/13.2.261

https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

§ Clozapine REMS Program. (n.d.). Clozapine REMS: A guide for healthcare providers. Retrieved September 7, 2016, from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf

§ Paz, Z., Nalls, M., and Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal, 13(10), 625–629. Retrieved from http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf

Decision Point One

Select what you should do:

Start Zyprexa (olanzapine) 10 mg orally at BEDTIME

Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter

Start Abilify (aripiprazole) 10 mg orally at BEDTIME

The Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1 

o Which decision did you select?

Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Decision Point Two

Select what the PMHNP should do next:

Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward

DC Invega Sustenna and start Haldol Decanoate (haloperidol decanoate ) 50 mg IM q2weeks with oral Haldol 5 mg BID for the next 3 months

Continue Invega Sustenna. Begin injections into the deltoid and add on Abilify Maintena 300 mg IM qmonthly with oral Abilify 10 mg in the MORNING for 2 weeks

Which decision did you select?

Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Decision Point Three

Select what you should do next:

Decision Point Three

Select what you should do next:

Continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one month

DC Invega Sustenna and start Abilify Maintena (aripiprazole ) 400 mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral Abilify 10 mg in the MORNING

Continue Invega Sustenna and add on Qsymia (phentermine and topiramate) for weight lossDC Invega Sustenna and start Abilify Maintena (aripiprazole ) 400 mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral Abilify 10 mg in the MORNING

Continue Invega Sustenna and add on Qsymia (phentermine and topiramate) for weight loss

Which decision did you select?

Continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one month

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement

Please follow  the instructions and answer the questions as it asking: 

In order to fully understand Hannah’s situation, please first answer the following:

• When are carbohydrates good for us?
• What are “good” versus “bad” carbohydrates?
• When are they not good for us or our bodies?
• What chemistry is involved in their breakdown, usage, and storage?

After you have discussed this, consider Hannah and Rose’s situations and think like a nurse!

Hannah is a 12-year-old who has had Type I diabetes for a few years. Her mother, Rose, is a strict vegetarian and believes this is also the best diet plan for her daughter. Hannah says, “I just want to eat like all my friends do!” As a result, she often cheats, and lately, there has been a steady increase in Hannah’s blood sugar.

What are the first steps you would take, as Hannah’s nurse, to assess her eating habits and understanding of diabetes mellitus?

What did Hannah and Rose tell you (subjective) and what did you see (objective)?

I only need a half-page. Citation and references from the book: Nutritional foundations and clinical application: a nursing approach. 

 Develop a scholarly paper that includes the following:

1. Choose one professional nursing organization of interest —-ANA (American Nurses Association)
2. Discuss the mission of the organization.
3. Select one nursing issue listed on the organization’s website.
4. Explain the issue you chose and how it supports the mission of the organization.
5. Discuss what impact the issue has on professional nursing practice.
6. The scholarly paper should be in third person, narrative format, 2 to 3 pages excluding the title and reference pages.
7. Include an introductory paragraph (not labeled Introduction) and a conclusion.
8. Include Level I headings to organize the paper (see below).
9. References must include, at a minimum, the textbook, the professional nursing organization’s website, and a minimum of one peer-reviewed scholarly journal article no greater than five (5) years old.
10. APA (7th) Student Paper format is required (title page, a reference page, and all citations). Also, attention to spelling, grammar, and style. Do not use quotations. 
11. Review your Turnitin Similarity Score and make any needed changes. If the score is greater than 20%, you must revise and resubmit the paper prior to the due date.

Title of Paper

(Note: Here you will write your introductory paragraph but do not label it as Introduction)

Mission of the Nursing Organization

Nursing Issue

Impact of Nursing Issue on Professional Nursing Practice

Conclusion

 Directions

• Social Media discussions are designed to promote dialogue between faculty and students, and students and their peers using a social media platform as inspiration. In the social media discussions, students:
  • Demonstrate understanding of concepts for the week
  • Integrate outside scholarly sources and social media postings
  • Engage in meaningful dialogue with classmates and/or instructor
  • Express opinions clearly and logically, in a professional manner
• Use the rubric on this page as you compose your answers.
• Best Practices include:
  • Participation early in the week is encouraged to stimulate meaningful discussion among classmates and instructor.
  • Enter the discussion often during the week to read and learn from posts.
  • Select different classmates for your reply each week.

Discussion Question

Problems that impact populations are vast and now more than ever social media is getting involved.

1. Choose one of the following population health problems to focus on:
   1. Substance use and/or abuse
   2. Environmental health (air, water, ground, energy, climate, etc.)
      1. https://www3.epa.gov/myem/envmap/find.html (Links to an external site.) has a wealth of information
   3. Violence
   4. Abuse
2. Research and share an overview of the current data on this population health problem specific to your community. You must use one (or more) of the resources from the Direct Care Project Part 1: Assessment and Diagnosis assignment. You may choose to find additional outside source(s).
3. Then take a moment to review the Twitter feed for compelling Tweets that may have an impact on or discuss the population health problem.
4. Give an overview of any agency, organization, person, or affiliation that is addressing the population health problem.
5. How could a community health nurse collaborate with the agency, organization, person, or affiliation address the population health problem?
6. Compose a 280-character or fewer Tweet that describes what you have shared with the class. Remember Twitter only allows 280 characters (this includes spaces, etc.) so you will need to be concise. It should include a hashtag. Include the URL to the reference or Tweet if applicable. Share this Tweet in the discussion.
7. Note: A Twitter account is not required nor is posting your Tweet on social media.
8. Your discussion post should look like:
   • Paragraph one: Overview of the current data on this population health problem specific to your community
   • Paragraph two: Overview of any agency, organization, person, or affiliation that is addressing the population health problem
   • Paragraph three: How could a community health nurse collaborate with the agency, organization, person, or affiliation to address the population health problem?
   • Tweet: 280-character or fewer Tweet with hashtag and reference if applicable.
   • Resources: Where did you find your data?
9. Example Tweet: Your zip code can have more of an impact on your health than your genetic code. Know your stats. #socialdeterminantsofhealth #SDoH #knowyourstats www3.epa.gov/myem/envmap/find.html