Essay on Pathopharmacological Foundations for Advanced Nursing Practice

Published: 2021-07-05 19:13:36
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Harvey Mudd College
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Research paper
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In todays environment, there are many diseases one should be concerned with in the world. However, depression is the number one mental illness affecting the American society, according to National Institute of Mental Health (NIM). Depression affects more than 300 million people globally. Left untreated, individuals may turn to suicide, which would be worst case scenario.

Depression has multiple etiologies that affect individuals moods and behaviors. There are two specific depression diseases, major depressive disorder (MDD) and bipolar affective disorder (BD). The diseases are then categorized as mild, moderate, or severe, depending on the severity of signs and symptoms. At baseline, an individual may be experiencing symptoms that are continued daily. These symptoms can become exacerbated by an event or trigger, sending the person into a heightened state of depression. For this paper, bipolar disorder will be discussed.

There are one hundred billion neurons in the human brain that assist with affecting a persons mood, memory, and behavior. Neurons and Neurotransmitters are the communication system in the brain. The neurotransmitters fire impulses of electricity that connect the neurons together. There are a few important neurotransmitters that affect mood specifically; they are gamma-aminobutyric, serotonin, norepinephrine, and dopamine.

Bipolar is a mood disorder in which it is characterized by a combination of depression and manic behavior. Although there are many theories as of the pathology, the disease is idiopathic. There are things known to affect disease states, such as genetic predisposition, abnormal levels of serotonin and norepinephrine, and rapid or slow firing of neurons.

Because there is no cure for Bipolar Disorder, treatment is focused on maintenance of symptoms, compliance with a treatment plan, and disease education. Adherence to treatment plans is difficult due to patient compliance with follow-up treatment. Pathopharmacological treatments for manic episodes are lithium and an antipsychotic combination. Benzodiazepines may be warranted for short-term relief of anxiety. As mentioned by Voort 2016 most practice guidelines suggest that a combination of pharmacotherapy and psychotherapy is best. Voort also goes on to explain that despite this noted best practice, there is literature that supports, these guidelines are not always followed.

Psychiatric Management

The current clinical status, longitudinal, and context of the treatment decision should guide the bipolar disorder patient and the psychiatrist the best treatments and the setting of the treatments. Treatment decision should be based on knowledge of the possible adverse and beneficial effects of the available options together with data about the preferences of the patient. Moreover, decisions about treatment should be reassessed continuously as new information avails itself and the clinical status of the patient changes. It is important to involve the family members in making a decision about the treatment of a patient because of many victims of the disorder lack insight, and this limits their ability to make an informed decision. The treatment of the disease involves the following procedures to enable psychiatric to provide insight, assistance, and support to the client and family (Susman, 2010).

Perform a diagnostic assessment

The assessment for BD requires careful and comprehensive attention to the clinical history of the patients. People with BD, mostly show symptoms of depression but they may exhibit irritability, insomnia, impulsivity, agitation, and problems with relationships. Diagnosis of the patients with BD is a bit difficult because they rarely give information voluntarily about hypomanic or manic episodes. This means that physicians must probe the clients about mood dysregulation that are accompanied by maniac symptoms such as increased energy and reduced need for sleep. Sensitivity and efficiency in detecting BD can be improved by screening for it especially in clients with irritability, depression, and impulsivity.

Evaluate the safety of the client and determine a treatment setting

According to Hirschfeld et al. (2010), the rate of complete suicide among BD patients is high as 11-15% hence physicians should carefully assess the risk of the patient committing suicide. Most of the suicides attempts among BD patients are associated with depressive features and depressive episodes during mixed episodes. All patients must be questioned about suicidal ideation, preparation for suicide, and extent of these plans. In assessing suicide risk, it is crucial for the psychiatric to source information from the family members as they may provide other crucial information such as access to means of committing suicides such as firearms and medications. Family members should assist in determining the lethality of the available suicidal means. Care providers should assess other clinical factors that are likely to increase the risk of the client committing suicidal ideation. It is crucial to consider the nature of prior suicide attempts especially their potential for their lethality. Since the ability to predict violence and suicide is limited, clients who show violent or suicidal ideas should be closely monitored. Any time client shows violent or suicidal ideas; the information should be documented carefully to help in the decision-making process. Patients who pose a severe threat of harm to themselves or others should be considered for hospitalization. Even if family members refuse their patients to be hospitalized, they can be admitted involuntarily as long the condition of the client meets criteria of jurisdiction for involuntary admission. Additionally, patients who have not responded positively to outpatient treatment should be considered for hospitalization (Hirschfeld, 2010). Best outcomes can be achieved by reevaluating the ability of the patient to benefit from a various level of care throughout the treatment period. During manic episodes, patients should be provided with the calm and highly structured environment to avoid heightening manic thoughts and activities. During this period, family members should be informed that the patients might engage in reckless behaviors hence he/she should be limited to access items such as credits cards, cars, telephones, and bank accounts.

Create and maintain a therapeutic alliance

BD is a long-term condition, and it manifests itself in various ways in different individuals and at a different time during its course. It is critical for the psychiatric to establish and maintain a supportive relationship to properly understand and manage an individual patient. The knowledge gained throughout the patients illness is crucial to facilitate identification of new episodes as early as possible.

Monitor treatment response

The caregiver should be vigilant or any changes that may take place in psychiatric status. It is important for the psychiatrist to monitor BD patients because a small change in behavior or mood may signal the onset of a new episode mostly with devastating consequences. The knowledge about specific characteristics of the clients illness gained throughout the course of treatment with assisting the psychiatric while monitoring the patient.

Provide education to the client and the family

People with BD highly benefit from education and feedback about their illness and treatment. The ability of the client to accept and adapt the idea that they have a condition that needs long-term treatment varies greatly. This means it is important for the psychiatric to educate the patient about the disorder gradually and persistently. The gradual approach is intended to enable the client to collaborate in the process of treating his/her condition (Hirschfeld, 2010). The patient can be provided with printed material in a longitudinal and cross-sectional aspect of BD. The material on the internet can be helpful to assist the patient to know about the treatment of the disease.

Enhance treatment compliance

BD is a long-term illness that requires the patient to adhere to the treatment plan to improve his/her health status. However, many patients do not comply with medication and other treatment, and this is a fundamental cause of relapse. Ambivalence about the treatment being offered stems from various factors such as lack of insight. Some patients do not believe that they have a serious ailment and this highly contributes to the lack of adherence to the long-term treatment process. Furthermore, some patients are reluctant to give up the experience of mania or hypomania. This is because increased euphoria, energy, and heightened self-esteem can be very desirable and enjoyable. As a result, patients can resist taking medications that avert elevations in mood. It is crucial for the psychiatric to discuss the cost, side effects, and other demand of the treatment because they can be burdensome. Most of the side effect may be corrected by carefully paying attention to scheduling, dosing, and preparation.

Promote awareness of regular patterns and stressors of sleep and activity

Families and patients can benefit from knowing the role of psychosocial stressors in exacerbating or precipitating mood episodes. Psychosocial stressor increases consistently before both depressive and manic episodes. Patients with BD can benefit from regular daily activities such as eating, sleeping, physical activities, and depressive stimulations. Physicians have to assist the patient to understand how these factors affect their mood state and come up with a technique of monitoring and modulating these activities on a daily basis. In most cases, if the patient establishes regular sleeping patterns other crucial aspects will also fall regular patterns as well.

Assess and manage functional impairments

Episodes of depression and mania mostly leave the victim with social, emotional, occupational, family, and financial problems. For instance, during manic episodes patients can damage crucial relationships, lose jobs, squander their money, or commit sexual indiscretions. This means that such people require assistance in coping with psychosocial consequences of their previous actions. Moreover, individuals who have family and children might need help in assessing and addressing the needs of their kids. In most cases, kids of individuals with BD are at risk of developing one or more psychiatric disorder due to their genetic makeup hence they should be evaluated ascertain whether there are any signs of mood instability (Hirschfeld, 2010).

People who can undergo, the medication process may be able to go on with their career well, have a happy family life and be in a satisfying relationship. The person can interact with other individuals in the society well. The patient can gain back his sleeping patterns, appetite, memory, and self-esteem. A patient who has BD is likely to be affected by other chronic diseases such as diabetes, heart disease, and high blood pressure. These conditions are likely to short the life expectancy of the patient. The ailments can detect early enough in patients who go for a regular checkup and be able to receive early treatment thereby increasing their life expectancy (Susman, 2010).

Patients are affected by many factors in their attempt to acquire good care and manage their condition. First, depression is considered as a pre-existing condition by insurance companies, and it can affect chances of getting an insurance cover. However, an individual can still get a life insurance cover even he/she has the disorder. The companies giving an insurance cover have to assess depression history of the individual, at what age he was first diagnosed and the dur...

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