Scenario: Mr. Perez is a 76-year-old Mexican American who was recently diagnosed with a slow heartbeat requiring an implanted pacemaker. Mr. Perez has been married for 51 years and has 6 adult children (three daughters aged 50, 48, and 42; three sons aged 47, 45, and 36), 11 grandchildren; and 2 great grandchildren. The youngest boy lives three houses down from Mr. and Mrs. Perez. The other children, except the second-oldest daughter, live within 3 to 10 miles from their parents. The second-oldest daughter is a registered nurse and lives out of state. All members of the family except for Mr. Perez were born in the United States. He was born in Monterrey, Mexico, and immigrated to the United States at the age of 18 in order to work and send money back to the family in Mexico. Mr. Perez has returned to Mexico throughout the years to visit and has lived in Texas ever since. He is retired from work in a machine shop.

Mr. Perez has one living older brother who lives within 5 miles. All members of the family speak Spanish and English fluently. The Perez family is Catholic, as evidenced by the religious items hanging on the wall and prayer books and rosary on the coffee table. Statues of St. Jude and Our Lady of Guadalupe are on the living room table. Mr. and Mrs. Perez have made many mandas (bequests) to pray for the health of the family, including one to thank God for the healthy birth of all the children, especially after the doctor had discouraged them from having any more children after the complicated birth of their first child. The family attends Mass together every Sunday morning and then meets for breakfast chorizo at a local restaurant frequented by many of their church’s other parishioner families. Mr. Perez believes his health and the health of his family are in the hands of God.

 The Perez family lives in a modest four-bedroom ranch home that they bought 22 years ago. The home is in a predominantly Mexican American neighborhood located in the La Loma section of town. Mr. and Mrs. Perez are active in the church and neighborhood community. The Perez home is usually occupied by many people and has always been the gathering place for the family. During his years of employment, Mr. Perez was the sole provider for the family and now receives social security checks and a pension. Mrs. Perez is also retired and receives a small pension for a short work period as a teacher’s aide. Mr. and Mrs. Perez count on their nurse daughter to guide them and advise on their health care.

 Mr. Perez visits a curandero for medicinal folk remedies. Mrs. Perez is the provider of spiritual, physical, and emotional care for the family. In addition, their nurse daughter is always present during any major surgeries or procedures. Mrs. Perez and her daughter the nurse will be caring for Mr. Perez during his procedure for a pacemaker.

1. Explain the significance of family and kinship for the Perez family.
2. Describe the importance of religion and God for the Perez family.
3. Identify two stereotypes about Mexican Americans that were dispelled in this case with the Perez family.
4. What is the role of Mrs. Perez in this family?
5. Should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for patients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) patients often present as depressive or manic but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with bipolar disorder.

BACKGROUND INFORMATION

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder. 

Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”

She weights 110 lbs. and is 5’ 5” 

SUBJECTIVE

Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.” 

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work. 

Genetic testing reveals that she is positive for CYP2D6*10 allele. 

Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.