Write a brief Conclusion why you made these decisions and what will be the objective of obtaining an improvement in the condition of this patient .

Decision 1

The PMHNP will administer 10 mg of zyprexa orally at bed time and initiate 230mg of invega sustenna through intramuscular, in addition to 156 mg via the same route on day four. A similar dose will be administered within one months’ time. In addition the PMHNP will administer 10mg of Abfility orally at bed time. Expected outcome for this decision is a 25% decrease in the PANSS score (Stahl, 2013). This decision is also expected to alleviate the patient’s psychotic symptoms and achieve normalcy within one month. A slight weight gain is also expected as the drugs are known to increase weight in patients. Because I don’t select the other decisions, the patient is expected to have faster and noticeable changes in psychotic behavior within two weeks of treatment commencement. 

Decision 2

At this point the PMHNP will decide to continue with use of medications selected in decision 1 (Stahl, 2013). However the PMHNP will instruct the administering nurse to begin intramuscular injections of 300mg of Abfility and continue with 10 mg of the same drug in the morning. At this point, PANSS is expected to decrease by 50 % although the patient will also have noticeable weight gain due to use of invega sustenna (Stahl 2014). Because I don’t select other decisions, the patient is expected to have less cardiovascular drug toxicities and experience reduced risks for adverse drug reactions between Invega sustenna and Haldol Deaconoate. 

Decision 3

The decision at this point is to have the patient continue with Invega Sustenna and provide psychological counseling on the effects of the drugs associated with weight gain. It will be essential to explain to the patient that the weight gain from this drug is minimal in comparison with other drugs (Stahl, 2013). The PMHNP will set an appointment follow up date with the patient after one month duration and refer to the nutritionist and physical activity instructor. The difference between expected outcome in decision 3 and results of the decision is Abfility may not be efficacious for more than a period of 6 months given that it does not bind to D 2 receptors in a similar manner as Invega Sustenna. This will necessitate the PMHNP to change to Abfility Maintena because it is easily tolerated by patients on Abfility. 

Because I don’t select the other decisions, the patent will be able to utilize the same drug for the longest possible duration and optimize on their efficacy prior to switching to other types of medication (Stahl, 2013). Since the patient may not have the mental capacity to participate in the decision making process or make autonomous mental health decisions, it is essential to discuss treatment options with the spouse and explain the importance of adherence to treatment (Stein & Giordano, 2015). In addition, the mental health nurse is required to make those decisions which will benefit the patient and also outweigh the risk for adverse health outcomes. 

References

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stein, D. J., & Giordano, J. (2015). Global mental health and neuroethics. BMC Medicine, 13(1), 44.  

Schizophrenia Treatment

Decision 1

The PMHNP will administer 10 mg of zyprexa orally at bed time and initiate 230mg of invega sustenna through intramuscular, in addition to 156 mg via the same route on day four. A similar dose will be administered within one months’ time. In addition the PMHNP will administer 10mg of Abfility orally at bed time. Expected outcome for this decision is a 25% decrease in the PANSS score (Stahl, 2013). This decision is also expected to alleviate the patient’s psychotic symptoms and achieve normalcy within one month. A slight weight gain is also expected as the drugs are known to increase weight in patients. Because I don’t select the other decisions, the patient is expected to have faster and noticeable changes in psychotic behavior within two weeks of treatment commencement. 

Decision 2

At this point the PMHNP will decide to continue with use of medications selected in decision 1 (Stahl, 2013). However the PMHNP will instruct the administering nurse to begin intramuscular injections of 300mg of Abfility and continue with 10 mg of the same drug in the morning. At this point, PANSS is expected to decrease by 50 % although the patient will also have noticeable weight gain due to use of invega sustenna (Stahl 2014). Because I don’t select other decisions, the patient is expected to have less cardiovascular drug toxicities and experience reduced risks for adverse drug reactions between Invega sustenna and Haldol Deaconoate. 

Decision 3

The decision at this point is to have the patient continue with Invega Sustenna and provide psychological counseling on the effects of the drugs associated with weight gain. It will be essential to explain to the patient that the weight gain from this drug is minimal in comparison with other drugs (Stahl, 2013). The PMHNP will set an appointment follow up date with the patient after one month duration and refer to the nutritionist and physical activity instructor. The difference between expected outcome in decision 3 and results of the decision is Abfility may not be efficacious for more than a period of 6 months given that it does not bind to D 2 receptors in a similar manner as Invega Sustenna. This will necessitate the PMHNP to change to Abfility Maintena because it is easily tolerated by patients on Abfility. 

Because I don’t select the other decisions, the patent will be able to utilize the same drug for the longest possible duration and optimize on their efficacy prior to switching to other types of medication (Stahl, 2013). Since the patient may not have the mental capacity to participate in the decision making process or make autonomous mental health decisions, it is essential to discuss treatment options with the spouse and explain the importance of adherence to treatment (Stein & Giordano, 2015). In addition, the mental health nurse is required to make those decisions which will benefit the patient and also outweigh the risk for adverse health outcomes. 

References

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stein, D. J., & Giordano, J. (2015). Global mental health and neuroethics. BMC Medicine, 13(1), 44.

 As individuals grow older, they experience biological changes, but how they experience these changes varies considerably. Senescence, or the process of aging, “affects different people, and various parts of the body, at different rates” (Zastrow & Kirst-Ashman, 2019, p. 644).

What factors affect the aging process? Why do some individuals appear to age faster than others? In this Discussion you address these questions and consider how, you, as a social worker, might apply your understanding of the aging process to your work with older clients.

To prepare for this Discussion, read “Working With the Aging: The Case of Francine” in Social Work Case Studies: Foundation Year.

Working With the Aging: The Case of Francine

Francine is a 70-year-old, Irish Catholic female. She worked for 40 years as a librarian in an institution of higher education and retired at age 65. Francine has lived alone for the past year, after her partner, Joan, died of cancer. Joan and Francine had been together for 30 years, and while Francine personally identifies as a lesbian, she never came out to her family or to her colleagues. When speaking to all but her closest confidantes, Francine referred to Joan as her “best friend” or her “roommate.” Francine’s bereavement was therefore complicated because she did not feel she could discuss the true nature of her partnership with Joan. She felt that there was little recognition from her family, and even some of her close associates, of the impact and meaning of Joan’s death to Francine. There is a history of alcohol abuse in Francine’s family, and Francine abused alcohol from late adolescence into her mid-30s. However, Francine has been in recovery for several decades. Francine has no known sexual abuse history and no criminal history.

Francine sought counseling with me for several reasons, including an ongoing depressed mood, a lack of pleasure or enjoyment in her life, and loneliness and isolation since Joan’s death. She also reported that she had begun to drink again and that while her drinking was not yet at the level it had been earlier in her life, she was concerned that she could return to a dependence upon alcohol. Francine came to counseling with several considerable strengths, including a capacity to form intimate relationships, a successful work history, a history of having maintained her sobriety in the past for many years, as well as insight into the factors that had contributed to her current difficulties.

During our initial meetings, Francine stated that her goals were to feel less depressed, to reduce or stop drinking, and to feel less isolated. In order to ensure that no medical issues were contributing to her depression symptoms, I referred Francine to her primary care physician for an evaluation. Francine’s physician did not find any medical cause of her symptoms, diagnosing Francine with moderate clinical depression and recommending that Francine begin a course of antidepressant medication. Francine was reluctant to take medication and first wanted to try a course of counseling.

In order to help Francine meet her goal of reducing her depression symptoms, I employed a technique called behavioral activation (BA), which is drawn from principles of cognitive behavioral therapy and helps to reengage people in pleasant physical, social, and recreational activities. We began with a small initial goal of having Francine dedicate at least 5 minutes of each day to an activity she found pleasant or rewarding. Over the following weeks, we increased the time. Francine’s treatment progress was monitored through weekly completion of the Patient Health Questionnaire (PHQ-9) in order to determine whether or not her depressive symptoms were improving.

I helped Francine address her drinking by reconnecting her with effective coping strategies she had used in the past to achieve and maintain her sobriety. These included identifying triggers for the urge to drink and exploring her motivations for both continuing to drink and for stopping her use of alcohol. Francine began attending regular meetings of Alcoholics Anonymous™ (AA) and found several meetings that were specifically for older women and for lesbians. In addition, Francine spoke regularly with a sponsor who helped her to remain abstinent during particularly stressful moments during her reengagement in sobriety.

Finally, in order to address Francine’s goal of feeling less lonely and isolated, we explored potential avenues to increase her social networks. In addition to spending time with her family, friends, and her AA sponsor, Francine began to visit the local lesbian, gay, bisexual, and transgender (LGBT), center for the first time in her life and attended a support group for women who had lost their partners. Francine also began spending time at her local senior center and went there at least three times a week for exercise classes, other recreational activities, and lunch. She also began to do volunteer work at her local library once a week.

Over several months of counseling, Francine stopped drinking; significantly increased her daily involvement in pleasant and rewarding activities, including social and recreational activities; and reported feeling less lonely, despite still missing her partner a great deal. Francine’s scores on the PHQ-9 gradually decreased over time, and after 16 weeks of counseling, Francine reported that she no longer felt she needed the session to move on with her life. In addition, Francine visited her primary care physician, who found upon evaluation that her depression had lifted considerably and that an antidepressant was no longer indicated. By the end of counseling, Francine’s focused work on identifying her depression symptoms and her triggers for drinking equipped her to better recognize when she might need support in the future and to whom she could reach out for help if she needed it.

By Day 3

Post a Discussion in which you:

• Apply your understanding of the aging process to Francine’s case. How might Francine’s environment have influenced her aging process? How might you, as Francine’s social worker, apply your knowledge of the aging process to her case?
• Identify an additional strategy you might use to apply your knowledge of the aging process to social work practice with older clients in general. Explain why you would use the strategy.