Case study: Your patient is a 36-year-old woman with bipolar disorder and anxiety. She has been stable on a combination of fluoxetine and olanzapine for two years. She is morbidly obese at 340 pounds at 55 in height, has type II diabetes, hypertension, and hyperlipidemia. She has concerns about her weight and has tried numerous fad diets to no avail. She explains she has lost, at most, 15 pounds and has been able to keep it off for three months. · She has three children, one of which is severely disabled, and a husband who has a terminal diagnosis. She expresses worry that her weight will impact her ability to care for her disabled child when her husband dies. She reports she eats out frequently due to her childrens busy schedules. She is a stay-at-home mother but gets little exercise and performs no regular physical activity. · She reports feelings of shame that she can no longer orgasm on the rare occasions her husband has the energy and desire to be intimate.What would be your approach to managing this patients weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence.
Case Study:
· Your patient is a 36-year-old woman with bipolar disorder and anxiety. She has been stable on a combination of fluoxetine and olanzapine for two years. She is morbidly obese at 340 pounds at 55 in height, has type II diabetes, hypertension, and hyperlipidemia. She has concerns about her weight and has tried numerous fad diets to no avail. She explains she has lost, at most, 15 pounds and has been able to keep it off for three months.
· She has three children, one of which is severely disabled, and a husband who has a terminal diagnosis. She expresses worry that her weight will impact her ability to care for her disabled child when her husband dies. She reports she eats out frequently due to her childrens busy schedules. She is a stay-at-home mother but gets little exercise and performs no regular physical activity.
· She reports feelings of shame that she can no longer orgasm on the rare occasions her husband has the energy and desire to be intimate.What would be your approach to managing this patients weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence.
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Questions:
· What would be your approach to managing this patients weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence.
· What would be our approach to the sexual side effects she is experiencing?
· If you suggested additional medication, look up your states prescribing laws. Are PMHNPs able to prescribe the medication you recommended?
· Please include the subjective and objective information in this post.
1. What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence.
1. Non-pharmacological Approach
2. Pharmacological Approach
2. What would be our approach to the sexual side effects she is experiencing?
· Lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support.
3. If you suggested additional medication, look up your state’s prescribing laws. Are PMHNPs able to prescribe the medication you recommended?
· Additional medication is Flibanserin, the PMHNP can prescribe this without the supervision of a psychiatrist since PMHNP is Psychiatric-Mental Health Nurse Practitioner which is Board Certified. And/or hormonal therapy which is usually prescribed by a gynecological physician.
Please see the explanation below.
Step-by-step explanation
Approach to solving the question:
· Identification of clinical problems that a bipolar patient attained, classification of nonpharmacological and pharmacological treatment of a patient, planning for therapies essential in treating the patient, and evaluation of the process for positive outcomes.
1. What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence.
1.
Non-pharmacological Approach
·
Detailed explanation: this is an approach that is essential in managing a patient’s weight concern without the involvement of drugs to treat the weight problem. This aim is to provide alternative prevention in treating weight gain without any chemical side effects on the body.
(Focus (American Psychiatric Publishing). 2021)
·
Examples: (1) Physical activity such as aerobic exercises, can help the patient maintain her within the normal range which will enhance her conditions of type II diabetes, hypertension, and hyperlipidemia and help in improving her sexual desire, (2) Healthy food intake such as fruits, vegetables, whole grains, nonsalty and fatty foods, can reduce the risk of weight gain, and increase blood pressure and cholesterol which can improve her well being, and (3) Peer support which is very helpful in getting motivation from those people who are experiencing the same situation with the patient which increase the chance of preventing to expose her self to stress and anxiety.
2.
Pharmacological Approach
·
Detailed explanation: this is an approach that is essential in managing a patient’s weight concern with the involvement of drugs to treat the weight problem. This aim is to provide drug prevention to avoid the progression of the presenting clinical manifestation and development of complications.
(Focus (American Psychiatric Publishing). 2021)
·
Examples: (1) Phentermine-topiramate which is helpful in cutting the cravings, and lessens the appetite during stress and anxiety. This is helpful to increase the chance of weight gain especially when the patient attempted to expose herself to overeating.
2. What would be our approach to the sexual side effects she is experiencing?
· The approach
to the sexual side effects the patient is experiencing are lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support. Sexual side effects based on the scenario are linked to the stress, anxiety, and weight gain of the patient. It is important that as a healthcare provider, you must assess the related factors to the presenting problem. For a patient with bipolar disorder, it is important to have a care plan to follow so that the patient will be encouraged to do. Lifestyle changes such as physical activity and eating healthy food are the most important since the patient tends to eat out frequently due to her children’s busy schedules, gets little exercise, and performs no regular physical activity. If the patient is healthy, their sexual desire will improve and help her to have orgasms since her hormones are healthy. Avoidance of stress and anxiety is helpful in sexual desire because a patient who is stressed can affect the sympathetic nervous system limiting the blood flow to the genitals to achieve genital arousal. Also, therapies are helpful in correcting abnormal hormones in the body system.
(Lancet Public Health. 2021)
3. If you suggested additional medication, look up your state’s prescribing laws. Are PMHNPs able to prescribe the medication you recommended?
· Since the patient is already taking combinations of olanzapine which is useful in treating schizophrenic episodes and fluoxetine which is an antidepressant used in bipolar disorder and linked to weight loss, the additional medication that I may recommend is Flibanserin which is an antidepressant helpful in correcting the imbalance of the neurotransmitters in the brain increasing the chance to sexual desire. The PMHNP can prescribe this medication in all states because Flibanserin should be prescribed by a psychiatrist physician and certified nurse practitioners. Another additional medication that I would like to conclude is hormonal therapy like estrogen therapy because the abnormal level of hormones in the body affects the body in sexual desires and can lead to stress and anxiety.
(Psychiatr Serv. 2018)
REFERENCES:
· Vancampfort D, Firth J, Correll CU, et al.. The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials.
Focus (American Psychiatric Publishing).2021;19:116-28.
· Mitchell K.R., Lewis R., O’Sullivan L.F., Fortenberry J.D. What Is Sexual Wellbeing and Why Does It Matter for Public Health?
Lancet Public Health. 2021;6:e608-e613. doi: 10.1016/S2468-2667(21)00099-2.
· Blackmore M.A., Carleton K.E., Ricketts S.M. Comparison of collaborative care and colocation treatment for patients with clinically significant depression symptoms in primary care.
Psychiatr Serv. 2018;69(11):1184-1187. doi: 10.1176/appi.ps.201700569.