Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.

Answer these 2 questions.

1. What other therapy approaches can be easily applied to this patient? (different therapy than the one she developed here)

2. How can we help the patient stick to the treatment plan?( based on what it says here, how I can help the patient.)

At least 2 references

Complex Case Study Presentation

CC (chief complaint): “I need medication. I don't feel good.”

HPI: C is a 15-year-old African American female who came for a psychiatric evaluation with her case manager. She states, ” I need medication. I don't feel good.” The client noted that the other day, she had a breakdown where she was crying and laughing. Also, she mentioned that she started thinking about bad things. Most of the time she feels sad, that is why she feels “better when I’m with my friends.” She also noted that she can be agitated very easily. Her concentration is poor, and she said “everything” stresses her out. The client denies any symptoms of suicidal ideations, but she said, “I don't want to kill anybody, but when I'm upset, I make threats to kill people.” She said she suddenly has difficulty meeting new people, has problems with crowds in the grocery store or big box stores, and feels judged when out in person. The client reports verbal, physical, and sexual abuse that started in childhood. She experiences painful flashbacks and nightmares in the past. She reports abuse and misuse of ADHD medications and no complaints with medications. Also, she mentioned to be on probation, and she would like to be out of prison.

Diagnostic Impression:

Major depressive disorder

Approximately 12.8% of people between 12-17 years have been diagnosed with Major depression in the United States. (Mullen, 2018) The client presents most of the diagnosis criteria for this disease. She is showing a depressed mood irritation that is typical for adolescents. She has a poor interest in activities, low energy, and poor appetite. Also, she mentioned that she has trouble falling asleep and staying asleep. These symptoms caused social impairment, evidenced by the frequent fights. It is essential to mention that her family is dysfunctional, and her mom and brother are diagnosed with major depression.

Generalized anxiety disorder F41.1

Generalized anxiety disorder is a common mental health disorder affecting more females. Anxiety leads to restlessness, feeling keyed up or on edge, fear, and difficulty concentrating. (APA,2022 ) The client presents excessive anxiety and difficulty controlling worry and concern that something will happen. She has problems being around crowds, feels anxious, and feels judged. Also, she is always irritable, losing her temper, involving her in multiple fights. This client's diagnosis criteria are restlessness, difficulty concentrating, irritability, sleep disturbance, and muscle tension.

Post-Traumatic Stress Disorder F43.10

This disorder results from exposure to one or more traumatic events. Usually, the symptoms start showing up within three months of the traumatic events. The symptoms interfere with the daily tasks. The client reports verbal, physical, and sexual abuse that started in childhood, and she experiences painful flashbacks and nightmares from the event. This situation met the first criterion for this diagnosis because she was exposed to a traumatic event. Also, she mentioned recurrent and intrusive thoughts about something terrible that would happen. She avoids speaking about the incident and has persistent negative feelings. The client said to be hypervigilance.

Reflection:

The client comes for the first-time evaluation, saying she needs medications because she doesn't feel good. This client is presenting almost all the symptoms of major depression. She lacks energy, and most of the time, she is irritated, evidenced by getting involved in many fights. Also, she stated being sad almost every day and having breakdowns. She was sexually, mentally, and physically abused, which is most likely why she presents all those symptoms. Women victims of child sexual assault are twice as likely to have more depression and anxiety than no female victims. Also, major depressive episodes among those with PTSD have a higher risk of suicide than those with PTSD. (Alix,2020) She mentioned the sexual abuse and said that she was thinking about crazy stuff. We suspect she was thinking about suicide, which is why the primary diagnosis is Major depression. Alix (2020) states that self-blame is an internal attribution, a cognitive process by which some individuals with traumas can attribute the event of an unfavorable event to themselves. She also said that she feels guilty about what happened to her.

The second diagnosis is Generalized anxiety disorder because the client finds it difficult to control her concern about something wrong will happen. She stated feeling restless, having problems concentrating, muscle tension, and sleep disturbance. Also, she is presenting poor concentration. This affects her daily tasks even though she mentioned that she couldn't be around people anymore. De Beru (2020) states that the only two disorders significantly associated with suicide ideation were MDD and GAD. For this reason, this will be my secondary diagnosis and the one I will pay more attention to.

The third differential diagnosis will be post-traumatic stress disorder. As mentioned above, this client came from a household where she suffered a lot of violence, including physical, sexual, and emotional damage. She has problems falling asleep due to the trauma and avoided discussing the incident by changing the topic. The US Department of Veteran Affairs (2018) states that survivors of child sexual abuse show symptoms of PTSD that include agitated behavior, and they may exhibit anxiety. Also, another behavior that they may exhibit is inappropriate sexual behavior or seductiveness. The school sent her to a psychiatry evaluation in the 6th grade because of her aggressiveness and promiscuity. That was one of the indicators that she was suffering from sexual abuse. Also, she mentioned recurrent and intrusive thoughts about something terrible that would happen.

I agree with the PMHNP treatment plan, where she will start working with the depression symptoms. Since the client reports feeling sad, having low energy, and thinking about “crazy stuff,” we will prioritize those symptoms and treat them to avoid future serious problems like Suicide Ideations.

Case Formulation and Treatment Plan

C is a 15-year-old African American female client being seen for a first-time psychiatric evaluation. She is alert and oriented in person, place, time, and situation. She is restless, acting out, and looks irritable but cooperative. She mentioned being referred to a psychiatry evaluation in 6th grade, and since then, she has been in and out of treatment. The client presents depression symptoms like sadness, low energy, decreased activities that cause joy, irritability, poor concentration, and sleep disturbance. Also, she mentioned the difficulty in controlling her concern about something terrible will happen. She verbalizes a history of sexual, physical, and emotional abuse. The client avoids talking about the abuse. However, she will follow recommendations and continue with a treatment plan.

Most adolescents with major depression symptoms reported severe impairment in home life, school/work, family relationships, and social life. Studies have revealed that neurologic changes happen in the brain structure of those who have suffered sexual abuse during their childhood, and, therefore, they become more predisposed to suffer depression, anxiety, substance use, and other mental and behavioral problems. (Gokten, 2021) It is essential to start working with the adolescent since symptoms are notable, like in this client's case. The PMHNP chose Lexapro 5 mg PO daily; this medication is one of the two approved by the FDA. Lexapro has been approved for use in adolescents aged 12 years and older. (FDA, Nd) Jiang (2017) mentioned in his research that Lexapro helps to decrease depression and anxiety levels and significantly improve the quality of life, helping with the enjoyment and satisfaction of patients taking this medication. Besides the depression, she suffers from anxiety, which is why this medication is the first line of treatment since it helps to improve the two primary diagnoses for her. Anvari (2020) also recommends using Lexapro as a first-line antidepressant treatment for children and adolescents, optimally in conjunction with cognitive behavior therapy. He stated the conjunction of this therapy should optimize school, peer, and family communication, given a patient's sense of connectedness.

The second medication that the PMHNP prescribed is Lamotrigine 25 mg PO daily. Lamotrigine is an anticonvulsant medication that can be used as adjunctive treatment as a mood stabilizer. Prabhavalkar (2015) found Lamotrigine to be outstandingly effective in preventing bipolar depression in patients experiencing episodes of major depression. Lamotrigine can be a mood stabilizer that calms mood swings by lifting the depression symptoms. Also, he found that in 64.5% of the adjunctive treatment using lamotrigine, the symptoms of depression improved during the initial treatment and maintained for about one year.

Psychotherapy will be crucial to the treatment plan; changing the behavior and developing coping skills can benefit her treatment goal. Cognitive behavioral therapy is showing efficacy in GAD and MDD symptom reduction. In his research, Oud (2019) found that 63% of the child/adolescent has less risk of having a depressive disorder at follow-up and a 36% more chance of recovery. Also, CBT can be used to treat clients with PTSD. For that reason, this will be the therapy of choice.

Also, as part of the plan, the PMHNP ordered blood work CBC, BMP, Vit D, lipid panel, and thyroid function test. EKG will be ordered as well.

The risks, benefits, side effects, and dosage schedules of medication were explained to the client. Otherwise, the benefits of continuing psychotherapy were explained for managing and controlling her emotions. We will recommend daily exercise, good hygiene, and a balanced diet. She was educated and encouraged about abstinence from drugs and alcohol. The potential risks, long-term consequences of Tardive Dyskinesia, and treatment alternatives were discussed with and understood by the client. The client has emergency numbers: Emergency Services 911, Suicide & Crisis Lifeline 988, and National Suicide Prevention Lifeline 1800-273-8255

  

In a 5-6 page Microsoft Word document, compare and contrast Britain’s and the United States health history and current structure, including: Different philosophical approaches to the provision of care Organization Financing Delivery of health services and public health systems Utilize your textbook and other scholarly sources for this assignment help to assist with your research. You may also find the following websites helpful: The Future of Public Health: A History of the Public Health System Overview of Healthcare in the UK

MAP-IT framework is a tool for organizing and gauging societal public health endeavors. Experienced and inexperienced public health workers may use MAP-IT processes to build ans develop a community that is healthy (McKnight, Kretzmann 1996). The MAP-IT approach takes time, effort, and a series of stages to ‘map out’ the journey towards a community’s desired change. Remember that there is no one solution that fit all when it comes to this, therefore, some procedures are needed repetitively. A coalition can use MAP-IT to develop a chronological, organized plan aimed towards a given community’s requirements.

Mobilize

Nursing intervention is developed to establish and enforce park exercise activities in zip code 33127. After looking at the data collected from the community at zip code 33127, it was rather evident that residents, especially on the north side of the zip code, are not even trying to participate in the community’s public parks.

Following the underlying investigation, the nurse intervention determines that a different strategy is required, and it brings together important stakeholders in the postal district 33127 to help nurture an agreement. The Nursing Intervention Task Force will comprise representatives from environmental health, education, and the community public health practitioners. The task force’s mission is to develop and maintain a healthy community in the postal district.

Assess

The task force holds a strategic planning meeting; furthermore, the task force holds data mining on healthy living from exercise. During the assessment, the task force discovered that the rate of chronic diseases reported in the postal district 33127 is alarming, especially among young people in the community. It has been discovered that the lack of physical exercise majorly triggers chronic disease.

Currently, the staffing, skills and information on the importance of healthy living are at our disposal, but where do we go from there? From further deliberation, it is concluded that we would need funding to conduct public awareness campaigns, initiate the building fitness park, and install outdoor exercise equipment.

Plan

During the afternoon of the strategic planning meeting, the task force agreed that installing at least four outdoor fitness equipment in the postal district 33127 should be the priority in addressing the rising chronic illness rate.

Our head decided to contact a community-based organization (CBO) with a long history of dealing with public workout equipment installation and ask them to assist in developing a project plan. If money is approved, the CBO signs a letter of understanding to participate in the project. In addition, the director collaborates with other members of the postal district’s health department and government to draft a plan.

We suggest a pilot program in which exercise equipment is installed in public parks. Some unemployed locals would be trained to assist in the procedures as part of the pilot program. We also decided to keep an eye on the rate of chronic illnesses to determine if it is decreasing. The federal government funds the project due to supporting data being the primary cause.

Implement

The CBO is enthusiastic about the project and is in charge of communicating with locals about the installations and reacting to emerging issues. In addition, the CBO is responsible for overseeing and performing the project’s training and employment aspects.

Our project manager manages the whole project and collaborates with contractors to ensure proper completion. In the parks, equipment such as sit-up benches, dip and leg raise stations, vertical ladders, and rope climbs is erected. In addition, two parks dedicated to workouts are being built. All of this takes place over the course of one and a half years.

Track

The task force keeps track of the project’s development and gathers official and informal data to assess its impact. Since the parks have been improved, the number of cases of chronic illnesses has decreased. Residents say they feel healthier now than they did before the adoption, and there are fewer incidents of heart attacks. Consequently, the inhabitants are pleased with the workout equipment in the parks. The task group understands that they must remain focused and engaged for the program to continue.

Conclusion at https://onlyassignmenthelp.com/custom-writing-service/write-my-assignment-for-me/get-information-technology-assignment-help-from-expert-writers/ 

In the execution of a solution, evaluation and tracking are critical activities. These tasks, which are carried out in phases, offer practitioners various information (McEwan & Bigelow, 1997). For example, the preliminary evaluation aids in the identification of barriers and risks. It is feasible to take early strategies that focus on this knowledge to optimize the advantages of the solution while avoiding the danger of failure (StudyCorgi, 2021). The post-evaluation of results aids in determining the plan’s overall efficiency. The information may be utilized to improve the existing educational program and help design new, more complex ones.

REFERENCES

StudyCorgi. (2021) MAP-IT Model: Evaluation of Plan Effectiveness. Retrieved 21 June 2022, from https://studycorgi.com/map-it-model-evaluation-of-plan-effectiveness/

McEwan, K., & Bigelow, A. (1997). Using a logic model to focus health services on population health goals. Canadian Journal of Program Evaluation 12(1): 167-174.

McKnight, J. L., & Kretzmann, J. P. (1996) Mapping Community Capacity. Onlyassignmenthelp.com The Asset-Based Community Development Institute, Institute for Policy Research, Northwestern University.

Unit 7 Discussion Case Study —2 Peer Response 600w. Due 10-20-23

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.

Unit 7: Initial Discussion-Case Study RM

· A 70-year-old woman has scheduled an initial evaluation with you. Her medical diagnoses include hypertension, hyperglycemia, mild obesity, and hyperlipidemia. Her psychiatric diagnoses include anxiety and depression. Her current medications are atorvastatin 20 mg daily for seven years, Ozempic 1 mg injection weekly for three years, lisinopril 10 mg daily for 10 years, and Abilify 5 mg daily for six years. 

· Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37. Her height is 5’2” and her weight is 176 pounds. Her blood pressure was 146/83 upon arrival at the office.  

· During your interview, she explains she became depressed following the death of her husband seven years ago. She became anxious about performing everyday tasks without him present.  After starting Abilify, she gained 25 pounds and required an increased dose of atorvastatin and Ozempic. She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates.  Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise. 

Subjective: 

CC: initial evaluation 

HPI: A 70-year-old female presents to the clinic for initial evaluation. She is a new patient in the practice. She reports a current history of hypertension, hyperglycemia, mild obesity, and hyperlipidemia. She also reports currently being diagnosed with anxiety and depression. She reports taking atorvastatin 20 mg daily for 7 years for hyperlipidemia, Ozempic 1 mg injection weekly for three years for hyperglycemia, lisinopril 10 mg daily for 10 years for hypertension, and ability 5 mg daily for 6 years for depression. 

PMH: Hypertension, hyperlipidemia, hyperglycemia, mild obesity, anxiety, and depression.  

Allergies: none reported 

Medications: atorvastatin 20 mg daily for 7 years for hyperlipidemia, Ozempic 1 mg injection weekly for three years for hyperglycemia, lisinopril 10 mg daily for 10 years for hypertension, and Abilify 5 mg daily for 6 years for depression. 

SH: Patient lost her husband seven years ago and became depressed. The patient reports her anxiety increased to perform everyday tasks without her husband. The patient states, that after starting Abilify she gained 25 pounds and required an increased dose of atorvastatin and Ozempic.  She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates.  Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise. 

FH: N/A 

Health promotion and maintenance: N/A 

ROS:  

Constitutional	reports weight gain of 25 lbs.
Head	N/A
Eyes	N/A
Ears, Nose, Mouth, Throat	N/A
Neck	N/A
Cardiovascular/Peripheral Vascular	N/A
Respiratory	N/A
Breast	N/A

Gastrointestinal	Reports increased cravings for carbohydrates.
Genitourinary	N/A
Musculoskeletal	N/A
Integumentary	N/A
Neurological	Alert and oriented x 3.
Psychiatric (screening tools: Ex: PHQ-9, MMSE, GAD-7)	Reports anxiety to go out of her house alone and depression slightly improved
Endocrine	Reports persistent elevated glucose and carbohydrate cravings.
Hematologic/Lymphatic	N/A
Allergic/Immunologic	N/A
Other

Objective:   

Her height is 5’2” and her weight is 176 pounds. Her blood pressure was 146/83 upon arrival at the office.  Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37. 

·
What advice or modifications to his treatment regimen would you recommend for your new patient? (Discuss a minimum of two). Please support your answer with research-based evidence.  

This 70-year-old female patient presents with diabetes as evidenced by a FBS of 115 

and a HgbA1C of 6.9. A HgbA1C level equal to 6.5% or greater indicates a diagnosis of diabetes mellitus 

(Centers for Disease Control and Prevention, 2023). The patient is currently at considerable risk for cardiovascular disease due to her borderline total cholesterol level of 200, LDL of 100, and HDL 37. The patient’s height is 5’2″ and weight is 176 lbs, BMI is 32.2 as per CDC (Centers for Disease Control) guidelines patient is obese which also contributes to cardiovascular disease (Centers for Disease Control and Prevention, 2022). The normal weight for the height of this patient is between 101lbs-136lbs (Centers for Disease Control and Prevention, 2022). According to Healthline, total cholesterol levels should be less than 200, LDL less than 100, HDL greater than 60, and triglycerides less than 149 for adult patients (2021). The patient has also been experiencing high blood pressure, BP 146/83 upon arrival. The patient has currently been taking lisinopril 10 mg daily for hypertension, atorvastatin 20 mg daily for 7 years for hyperlipidemia and Ozempic 1 mg injection weekly for three years for hyperglycemia. 

The patient has also been taking Abilify 5 mg daily for 6 years for depression. During this time, the patient gained twenty-five pounds and required an increased dose of Ozempic and atorvastatin. The patient has been unable to lose the weight she gained and reports closely monitoring dietary intake due to persistently increased glucose levels and carbohydrate cravings. The patient’s states depression slightly improved, however, anxiety has not improved and now the patient is having trouble leaving the house alone.  

According to the patient’s assessment, my treatment plan would be to continue Ozempic 1 mg injections weekly for diabetes management and add metformin IR 500mg PO BID with meals (Corcoran & Jacobs, 2023). Patient to check finger stick blood glucose levels 1-2 times daily on an empty stomach. Recommend the patient to a diabetes education program. To manage her cholesterol levels, I would titrate her atorvastatin from 20 mg to 40 mg PO daily. Re-check patient's lipid levels in 2-4 weeks (Drugs, 2023). To manage her high blood pressure, I would increase her lisinopril to 10 mg PO BID as a study shows that prescribing lisinopril twice daily vs once daily shows more improvements in SBP. Mean adjusted SBP reduction was 10.2 mm Hg greater in the twice‐daily cohort compared with the once‐daily cohort (Tsai et al., 2017). The patient will be coming back for follow-up in 2-4 weeks for further treatment outcome and if necessary, treatment plan adjustment.  

The patient has chronic depression that has improved slightly; however, she does voice increased anxiety and new symptoms of fear of going out alone since her husband died seven years ago. The patient is now restricting herself from going out for walks and exercise. She is starting to exhibit symptoms of agoraphobia. The patient is currently taking Abilify 5 mg PO daily for 6 years. Typically, second-generation antipsychotics are not the first line of treatment for depression, they are used once they have tried many antidepressants with no effect. I suggest treatment augmentation with an antidepressant. Zoloft is an SSRI that does not counteract Abilify, start Zoloft at 25 mg PO daily and increase the dose weekly as needed. Zoloft is used for depression and social anxiety disorder (Psych Central, 2021). The patient will also benefit from psychopharmacology, psychotherapy, cognitive behavioral therapy. 

Lastly, lifestyle change recommendations include diet and exercise modification. Work your way up to 150 minutes of moderate-intensity aerobic activity each week. This could be brisk walking 30 minutes a day, 5 days a week. Or you could do 75 minutes of vigorous-intensity aerobic activity each week, such as swimming laps. Regular physical activity provides immediate and long-term 

health benefits.Links to an external site.
 Physical activity and weight loss will Improve sleep quality, reduce high blood pressure, and reduce risk for type 2 diabetes, heart attack, stroke, and 

several forms of cancerLinks to an external site.
. It can help reduce arthritis pain and associated disability, reduce the risk for osteoporosis and falls, and reduce symptoms of depression and anxiety (Centers for Disease Control and Prevention, 2023). 

·
If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended?  

 Yes, as a practicing PMHNP for the state of Pennsylvania, prescribe drugs, devices, and Schedule II-V controlled substances if there is a written collaboration agreement with a physician (Pennsylvania Coalition of Nurse Practitioners, n.d.).  

References: 

Balaram, K., & Marwaha, R. (2023). Agoraphobia.
 NIH. 

https://www.ncbi.nlm.nih.gov/books/NBK554387/Links to an external site.
 

Centers for Disease Control and Prevention. (2022). Adult BMI calculator. CDC. 

https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.htmlLinks to an external site.
 

Centers for Disease Control and Prevention. (2023). Diabetes tests. 
CDC. 

  

https://www.cdc.gov/diabetes/basics/getting-tested.htmlLinks to an external site.
 

Centers for Disease Control and Prevention. (2023). Physical activity for a healthy weight. 
CDC. 

https://www.cdc.gov/healthyweight/physical_activity/index.htmlLinks to an external site.
 

Corcoran, C., & Jacobs, T.F. (2023). Metformin. 
NIH. 

https://www.ncbi.nlm.nih.gov/books/NBK518983/Links to an external site.
 

Drugs. (2023). Atorvastatin dosage. 

https://www.drugs.com/dosage/atorvastatin.html#Usual_Adult_Dose_for_HypertriglyceridemiaLinks to an external site.
 

Pennsylvania Coalition of Nurse Practitioners. (n.d.). Scope of Practice. PACNP. 

https://www.pacnp.org/page/ScopeofPractice#:~:text=In%20Pennsylvania%2C%20an%20NP%20may,collaboration%20agreement%20with%20a%20physicianLinks to an external site.
. 

Psych Central. (2021). Zoloft: What you want to know? 

https://psychcentral.com/drugs/zoloft#basicsLinks to an external site.
 

Tsai, T., Kroehl, M. E., Smith, S. M., Thompson, A. M., Dai, I. Y., & Trinkley, K. E. (2017). Efficacy and 

safety of twice- vs once-daily dosing of lisinopril for hypertension. 
Journal of clinical hypertension (Greenwich, Conn.), 
19(9), 868–873. https://doi.org/10.1111/jch.13011 

Unit 7 Discussion Case Study MV

What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Support your answer with research-based evidence.

In managing this patient's weight concern, a comprehensive approach that addresses both behavioral and pharmacological aspects would be necessary. First and foremost it's crucial to evaluate if the patient is prepared to make changes and how motivated she is to lose weight. We can use motivational interviewing techniques to delve into her reasons, for wanting to shed pounds and uncover any obstacles or difficulties she might encounter (Bischof et al., 2021). To address her worries, about how her weight might affect her ability to care for her child it could be advantageous to involve a team of professionals that includes a registered dietitian, an exercise specialist and a psychologist or therapist. The dietitian can work with the patient to develop a personalized meal plan that takes into consideration her busy schedule and frequent eating out habits. Emphasizing portion control, incorporating healthier food choices, and encouraging mindful eating practices have been shown to be effective in managing obesity (Foster et al., 2018). In terms of physical activity, an exercise specialist can help the patient create an individualized exercise routine that is feasible given her current responsibilities as a stay-at-home mother. Promoting regular physical activity has been found to aid in weight loss so finding activities that she enjoys and can incorporate into her daily routine will enhance adherence maintenance (Posadzki et al., 2020).

What would be our approach to the sexual side effects she is experiencing?

Regarding the sexual side effects experienced by the patient, it is crucial to address these concerns openly and compassionately. It's important to determine whether the issues are primarily caused by medication use or if they're influenced by factors, like stress or relationship dynamics. It might be beneficial to educate the patient about how fluoxetine and olanzapine can affect sexual functioning. If it is determined that the medication is causing these problems switching from fluoxetine to another antidepressant that has a less impact on sexual function could be considered. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine have been linked to sexual dysfunction (Yuan et al., 2021). Bupropion, which is an atypical antidepressant, with a lower likelihood of causing sexual side effects could be an alternative option worth exploring (Montejo et al., 2019).

If you suggest additional medication, look up your state’s prescribing laws. Are PMHNPs able to prescribe the medication you recommend?

Before suggesting any additional medication options such as Bupropion, it is essential to review prescribing laws specific to Illinois. As a PMHNP prescribing additional medication for the above concerns would depend on state laws. According to the Illinois Nurse Practice Act (2017), advanced practice registered nurses (APRNs) including PMHNPs have prescriptive authority. However, there are specific conditions and restrictions outlined in the Act (AANP, 2022). Therefore, it is necessary to review the current regulations and guidelines set forth by the Illinois Department of Financial and Professional Regulation (IDFPR) to ensure compliance with prescribing laws when considering Bupropion as a treatment option for this patient (Kleinpell et al., 2023). Psychiatric Mental Health Nurse Practitioners (PMHNPs) in Illinois have prescriptive authority to reduce practice. Illinois state law requires a career-long regulated collaborative agreement with a psychiatrist in order for the NP to prescribe medication. The nurse practitioner-psychiatrist collaborative practice agreement outlines their working relationship. It describes the categories of care, treatment, and procedures the nurse practitioner expects to perform (AANP, 2022). In Illinois, psychiatrists are not required to be physically present with the PMHNP. The psychiatrist must be available for consultation whether in person or by phone. A collaborating psychiatrist and PMHNP are required to meet at least once a month (AANP, 2022).

Include the subjective and objective information in this post.

Subjective information:

The patient reports concerns about her weight and its impact on her ability to care for her disabled child after her husband's death. She has tried numerous 'fad diets' without long-term success, losing only 15 pounds at most and maintaining it for three months. The patient expresses feelings of shame related to sexual dysfunction, specifically difficulty achieving orgasm during intimate moments with her husband.

Objective information:

The patient's objective data include being morbidly obese at 340 pounds with a height of 5'5″. She also has type II diabetes, hypertension, and hyperlipidemia. Additionally, she eats out frequently due to her children's busy schedules and leads a sedentary lifestyle with no regular physical activity.

References

American Association of Nurse Practitioners (2022). State practice by type. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment/66-legislation-regulation/state-practice-environment/1380-state-practice-by-typeLinks to an external site.

Bischof, G., Bischof, A., & Rumpf, H.-J. (2021). Motivational interviewing: An evidence-based approach for use in medical practice. Deutsches Ärzteblatt international. https://doi.org/10.3238/arztebl.m2021.0014Links to an external site.

Foster, D., Sanchez-Collins, S., & Cheskin, L. J. (2018). Multidisciplinary team–based obesity treatment in patients with diabetes: Current practices and the state of the science. Diabetes Spectrum, 30(4), 244–249. https://doi.org/10.2337/ds17-0045Links to an external site.

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to aprn practice: Policy and regulatory implications during covid-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9Links to an external site.

Montejo, A., Prieto, N., de Alarcón, R., Casado-Espada, N., de la Iglesia, J., & Montejo, L. (2019). Management strategies for antidepressant-related sexual dysfunction: A clinical approach. Journal of Clinical Medicine, 8(10), 1640. https://doi.org/10.3390/jcm8101640Links to an external site.

Posadzki, P., Pieper, D., Bajpai, R., Makaruk, H., Könsgen, N., Neuhaus, A., & Semwal, M. (2020). Exercise/physical activity and health outcomes: An overview of cochrane systematic reviews. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09855-3Links to an external site.

Yuan, S., & Deban, C. E. (2021). Ssri-induced hypersexuality. American Journal of Psychiatry Residents' Journal, 16(3), 9–12. https://doi.org/10.1176/appi.ajp-rj.2021.160305Links to an external site.