Instructions: At each decision point stop to complete the following (decisions have already been made, results of decision are included)
Decision #1
Options: Begin Lithium 300mg orally BID, Risperdal 1mg oral BID, or Seroquel XR 100mg oral at HS
Which decision did you select?
Lithium 300mg oral BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client informs the PMHNP that she has been taking her drug “off and on” only when she “feels like she needs it”
Today’s presentation is similar to the first day you met her
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Options: Increase Lithium to 450mg oral BID, Assess rationale for non-compliance to elicit reason for non-complianceand educate client re: drug effects, and pharmacology, or Switch to Depakote ER 500mg oral at HS
Which did you select?
Assess rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client states that the drug makes her nauseated and gives her diarrhea
Client states that she stops taking it until these symptoms abate, at which point she re-starts only to experience the symptoms again
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Options: Change to Depakote ER500mg at HS, Change Lithium to sustained release preparation at same dose and frequency, or change to triplital 300mg oral BID
Which did you select?
Change Lithium to sustained release preparation at same dose and frequency
Results of decision 3:
In this case, the client is having nausea and diarrhea, classic side effects of lithium therapy. Changing the client to an extended release formulation can often prevent these symptoms while at the same time affording the client the benefit of lithium’s mood stabilizing properties. Also, lithium is a good choice for control of mania and has also been shown to decrease risk of suicide, which adds to its overall benefits. Depakote may be an option if changing to sustained release lithium does not alleviate the side effects. Oxcarbazpine (Trileptal) is an option, but is a second line therapy and is not appropriate at this stage as the client has not had an adequate trial of first line agents.
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.