The way it goes this week. They responded to my responses and I have to respond back.
You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.
Respond to KAD
RE: Discussion – Week 7
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Thank you, H, for your informative reply.
I agree that for a thorough assessment, I must assess general labs for CK for differential diagnosis purposes since bipolar disorder symptoms can resemble certain medical conditions. At this time, diagnosis of bipolar is based on symptoms rather than brain imaging or other diagnostic tests. (NIMH.com,(2021 )In my diagnostic section of CK SOAP, I mentioned the following: There were no laboratory tests specific to diagnose BD, however, the PMHNP will ask about current medical conditions that can affect the patient’s mood;
I will order a urine drug screen because of my patient’s strong family history of use of alcohol and drugs, I will order CBC, chemistry profile, thyroid function tests, and B12 level. These labs will help the PMHNP rule out metabolic causes or unidentified conditions. Johnson, Vanderhoef, & Johnson (2016). In my clinical rotations, I noticed that my preceptor continuously assesses our patients’ labs results, vital signs, and weight trends to ensure the safety and the well-being of our patients while they are being treated with psychotropic medications.
Bipolar Disorder. (2021). Retrieved July 15, 2021, from https://www.nimh.nih.gov/health/publications/bipolar-disorder/
Johnson, K., Vanderhoef, D., & Johnson, K. (2016). Psychiatric-mental health nurse practitioner
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Respond to Wand
Thank you for responding to my post. I agree with you that physical and psychological tests need to be
completed. I would also complete an EEG on the first episode of psychosis. Upon admission to the inpatient
unit, AM had labs completed which were all normal. When addressing an adolescent patient, the first episode
of psychosis one would need to rule out multiple etiologies including brain tumor or other brain
abnormalities, but this is not the first psychotic episode with this particular patient (Clancy et al., 2014) I would
think if its a an adolescent it may be just their imagination or non-compliant with medications. So unless this
is causing significant problems imaging would not be indicated.
This is a wonderful option that the patient lives in physical isolation in the home. Another option is that
AM go live with another family member who she feels safe and loved. When children struggle with their
behavior, it can have a negative impact on everyone in the family (Child Mind Institute, 2021). This will ensure
that everyone feel safe and she doesn’t have to go to a residential area to live with strangers. No matter
where she lives, she has tobe compliant with her medication or this cycle will continue.
Clancy, M. J., Clarke, M. C., Connor, D. J., Cannon, M., & Cotter, D. R. (2014, March 13). The prevalence of
psychosis in epilepsy; a systematic review and meta-analysis. BMC Psychiatry.
Maijer, K., Hayward, M., Fernyhough, C., Calkins, M. E., Debbané, M., Jardri, R., Kelleher, I., Raballo, A.,
Rammou, A., Scott, J. G., Shinn, A. K., Steenhuis, L. A., Wolf, D. H., & Bartels-Velthuis, A. A. (2019, February 1).
Hallucinations in Children and Adolescents: An Updated Review and Practical Recommendations for Clinicians.
Schizophrenia bulletin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357982/.
Parents Guide to Problem Behavior. Child Mind Institute. (2021, March 9). https://childmind.org/guide/parents-
Stevens, J. R., Prince, J. B., Prager, L. M., & Stern, T. A. (2014). Psychotic disorders in children and adolescents: a
primer on contemporary evaluation and management. The primary care companion for CNS disorders.
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