Week 6 ion channel —2 Peer Response 600w. due 10-12-23

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

· Compare and contrast your initial posting with those of your peers.  

· How are they similar or how are they different?

· What information can you add that would help support the responses of your peers?

· Ask your peers a question for clarification about their post.

· What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

IA

This is a very interesting case since Sam is only 19 years old and has a history of major depressive disorder (MDD) and also generalized anxiety disorder (GAD). At a glance, I noticed that his behavior has highs and lows since he has gone from being violent by throwing a chair at a store window to having a “resounding moment” where everything makes sense. Among many other clues, this leads me to believe Sam can be newly diagnosed with bipolar disorder with manic episodes.

After consulting our DSM-5-TR book on page 140, I also realized Sam presents multiple symptoms that represent the diagnosis of bipolar disorder. To start Sam preceded a “psychotic breakdown” along with a history of MDD. He has also presented physiologic changes like diminished sleep, and other signs, and symptoms of a manic episode (Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR 2022). It also appears he is more talkative than usual by engaging his colleagues for long hours in conversation. Adding on to his symptoms it also appears he has engaged in high-risk behaviors such as drinking and sexual relations which was not his norm before. He has thought of himself as being better than the professors which match the ideas of grandiosity.

At first, I wasn’t sure which medication to prescribe, but it seems he would benefit from lithium since lithium is an antimanic medication primarily used to treat bipolar disorder(Lithium, 2022). Sources such as MedlinePlus indicate lithium is a mood stabilizer and works by releasing dopamine and serotonin in the brain (Lithium: MedlinePlus Drug Information 2023). Just like this case, I have seen many but now I see things differently since I know more in-depth the signs and symptoms as well as researching the proper medication.

References:

Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th ed.). (2022). . American Psychiatric Association Publishing.

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: The Prescriber’s Guide (7th ed.). Cambridge University Press.

Townsend., K. I. M., Mary C. (2020). Essentials of Psychiatric Mental Health Nursing, 8th edition. F.A. Davis.

MAM

Week 6, Medication for Bipolar Disorders

What diagnosis do you believe may apply to this individual?

The patient is a young boy presenting with a 'psychotic break,' characterized by reckless behaviors, sudden and unconventional decision-making (such as changing his major in university), distractibility, reduced need for sleep, a heightened sense of knowledge and grandiosity (believing he can teach courses in the university), and unusual beliefs regarding the nature of reality and his newfound appreciation for life. He is also engaging in high-risk behaviors, including excessive drinking, sexual activity, violence, increased spending, and initiating numerous projects without completing any. These symptoms are indicative of a manic episode (if they present more than a week).

Considering the patient's history of Major Depressive Disorder (MDD) and anxiety disorder, the diagnosis of Bipolar I Disorder (BPD) has been established. It is crucial to first rule out any medical problems, brain trauma, substance abuse, and other mental disorders that may be included in the differential diagnosis of BPD. The primary distinction between bipolar I and II lies in the nature of the manic or hypomanic episodes. In bipolar I disorder, individuals experience full manic episodes that typically last for at least one week. On the other hand, bipolar II disorder is characterized by hypomanic episodes, which are milder in intensity and shorter in duration, lasting no more than four days (Stahl, 2021).

Beyond this key difference, there are also variations in the clinical course and family history associated with these two subtypes. Individuals with bipolar II disorder tend to receive their diagnosis later in life, and their first experience of hypomania occurs at an older age compared to those with bipolar I disorder. These distinctions in age of onset and diagnostic patterns contribute to the differentiation between bipolar I and II disorders (Brancati et al., 2023).

Manic often presents with the feeling of being extremely important and having a very high opinion of oneself, sometimes to the point of having false beliefs about one's capabilities (Howse et al., 2023). In this case, the patient believes he is capable of teaching at the university. An experienced Psychiatric Mental Health Nurse Practitioner (PMHNP) can conduct a thorough history assessment to determine whether the psychosis is linked to brain traumas, substance use, schizoaffective disorders, or BPD.

What classifications of medications can be used to treat this disorder? Which medication do you recommend and why?

When the patient is diagnosed with Bipolar disorder, it indicates the need for mood stabilizers. Various mood stabilizers are available, including Lithium, Lamotrigine, Valproic Acid, and Carbamazepine. According to Stahl (2021), Lithium is considered the foundational and standard treatment for bipolar disorder and acute mania. However, this medication comes with several potential side effects, such as tremors, nephrotoxicity (Diabetes Insipidus), hypothyroidism, dyspepsia, nausea, vomiting, diarrhea, weight gain, hair loss, acne, sedation, decreased cognition, and incoordination. It can also lead to EB Stain anomalies in the fetus if taken during pregnancy.

Lithium additionally has a very low therapeutic index, signifying that the lethal dose of this medication is very close to the therapeutic level in the blood. Therefore, monitoring of blood levels of this medication is crucial throughout the treatment process. Regular assessments of kidney function, thyroid hormone levels, and electrolytes are also necessary. Lithium effectively stabilizes mood and reduces the severity of manic episodes (Stahl, 2021). Alongside medication, psychotherapy, such as cognitive-behavioral therapy or family-focused therapy, plays an essential role in treatment. It is equally important to educate the patient's family members about the disease and the treatment process.

References

Brancati, G. E., Nunes, A., Scott, K., O’Donovan, C., Cervantes, P., Grof, P., & Alda, M. (2023). Differential characteristics of bipolar I and II disorders: a retrospective, cross-sectional evaluation of clinical features, illness course, and response to treatment. International Journal of Bipolar Disorders, 11(1), 25. https://doi.org/10.1186/s40345-023-00304-9

Howse, J., Kanter, J., Muhammad, Q. C., & Wojcik, K. D. (2023). Mood disorders with psychotic features: Diagnostic considerations and treatment challenges. Psychiatric Annals, 53(4), 160-165. https://doi.org/10.3928/00485713-20230313-01Links to an external site.

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).

Chapter 3 has a description of various leadership types. Below are the leadership types:

· Agile Leadership Theory

· Authentic Leadership Theory

· Emotional Quotient Leadership Theory

· Human Capital Leadership Theory

· Principal Agent Leadership Theory

· Quantum Leadership Theory

· Rebel Leadership Theory

· Servant Leadership Theory

· Social Capital Leadership Theory

· Thought Leadership Theory

Instructions:

1. Pick one (1) leadership type that you favor and explain the following:

a. Why does that type of leadership seems attractive to you?

b. Can you use that type of leadership in a real situation that you have encountered?

· Describe the situation.

c. Why the type you chose works well in that situation, and, finally

d. Does the type of leadership fits with one trait that you possess?

2. Your post should:

. Answer the questions as thoroughly and concisely as possible.

. Be sure to reference any works that you utilize in answering the questions

2. Be sure that references are in 
APALinks to an external site. format.

 The theoretical foundations of qualitative and quantitative methods are very different, but many researchers believe both methods should be used in the research study to increase validity and reliability. What advantages or disadvantages do you see in using both types of methods in a nursing study? Support your answer with current evidence-based literature. 

Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities, and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with APA format. Add questions to paper

CASE STUDY: 
Asthma

 

Patient Profile:

    Miss Winters, age 25, comes to the emergency department with severe wheezing, dyspnea, and anxiety. She was in the ED only 6 hours ago with an acute asthma attack, which resolved with nebulized albuteral treatments.

 

Subjective Data:

-Admits to use of albuterol inhaler several times weekly for the last few months 

-Asthma symptoms occasionally awaken her at night (about 3 times a week), and she has cancelled several outings with her family due to her symptoms

          -Can now only speak in one to three word sentences

          -Is allergic to cigarette smoke

-Began to experience increased shortness of breath and chest tightness when she returned home

-Used albuterol inhaler repeatedly at home without relief

-History of pruritic skin lesions that have come and gone since childhood.

 

Objective Data:

            Physical Examination:

                -Using accessory muscles to breath

             -Audible inspiratory and expiratory wheezing to auscultation with no air movement in lower lobes of l

                     lungs

             -HR = 126/min; Resp = 40/min

             -Areas of dry, scaling skin in antecubital areas bilaterally with evidence of scratching

            
Diagnostic Studies:

                        ABGs: PO2  = 80 mm Hg

                                    PCO2  = 35mm Hg

                                    HCO3  = 24 mEq/L

                                    pH = 7.48

                        PEFR: 150 L/min (Personal best: 400 L/min)

                        Continuous pulse oximetry: 82-85

 

CRITICAL THINKING QUESTIONS:

 

1. Why did Ms. W. return to the ED? Explain the pathophysiology of this second exacerbation of asthma.

 

2. Describe the progression of breath sounds auscultated from early in an asthma attack through very severe respiratory impairment. How do the sounds change as the patient improves?

 

3. What is the significance of her dry, scaling, pruritic skin lesions? What is your diagnosis (no nursing dx please)? How do these types of lesions relate to asthma? What is their physiologic cause ?

 

4. Analyze the ABG. What type of acid-base disorder is present? Why? Is there any compensation?

 

5. Discuss the four categories of asthma diagnosis advocated in the 
Guidelines for the Diagnosis and Management of Asthma from the National Heart, Lung, and Blood Institute of the National Institutes of Health. Which classification best describes Ms. W.'s asthma?

 

6. According to the asthma treatment guidelines from #5: the “Step up-Step down” approach, what is the recommended treatment strategy for a patient currently at Ms. W.’s classification level once this current exacerbation is controlled? When would it be appropriate to reevaluate the interventions and possibly adjust the medications?

 

7. She lost her Peak Flow meter during a recent house move. Why would you want to order a new one for her? How is it used and how can it help increase her ability to control her asthma? Explain the red, yellow, and green zones. What is the significance of her PEFR level on her return to the Emergency Room?