The diagnosis of bipolar I disorder with acute manic phase is made for Ms. IC after rule out medical condition and substance abuse.
It is concerning that Ms. IC presents with little sleep for days, also might not consume food or fluids for days, poor judgment and behavior, plus her medical history of mania. Due to dehydration, faulty judgment and unable to meet her own physiologic need as well as to set limits on her own behavior, she is at risk for injury. In addition, her communication patterns (speaking readily and overly talkative), inappropriate dress and amusing behaviors show that she is decreasing defensive coping skills, therefore, she is not in a stable physical and mental status.
These signs and symptoms might escalate the manic state and then to cause possible exhaustion as well as cardiac collapse. The medical interventions, such as, medication regimens and/or admission are needed immediately. These interventions will help deescalate Ms. IC’s activity to minimize potential physical injury through the use of medication and provide a non-stimulating environment.
3. What changes might the NP make in the patient’s medications and why? (25pts)
Patients with bipolar one and manic episodes usually require psychiatric hospitalization to provide them a safe environment for treatments. A combination of mood stabilizer with a second generation antipsychotic (SGA) medication is recommended regimen to treat acute bipolar mania. The mood stabilizers for bipolar disorder include Lithium, Depakote, Tegretol, Trileptal and Lamictal. And the SGA use to treat bipolar disorder include Risperdal, Zyprexa, Seroquel, Geodon, Abilify, and Invega (McCarro...
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...iarrhea, vomiting polyuria, fatigue, acne, tremor diabetes insipidus, worsening psoriasis and ECG changes. She should be monitored lithium level five to seven days after each dose has been changed. She should also be checkup for her lithium level, TSH and metabolic panel each three months (McCarron, Xiong, & Bourgeois, 2009). Additional, the side effects of Olanzapine include extrapyramidal symptoms, metabolic abnormalities, orthostatic hypotension and sedation. Ms. IC should be closely monitored of her weigh, any signs and symptoms of extrapyramidal symptoms, vital signs, and prolactin level in the first four weeks (McCarron, Xiong, & Bourgeois, 2009). Besides, to notify patient the side effects of Depo-Provera include amenorrhea, weight changes, unscheduled bleeding, abdominal pain or discomfort, headache, dizziness, nervousness and asthenia (Lexicomp, 2015).
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