Use the PMHNP Clinical Skills Self-Assessment Form to complete the following:   

• Rate yourself according to your confidence level performing the skills identified on the Clinical Skills Self-Assessment Form.  
• Based on your ratings, summarize your strengths and opportunities for improvement.   
• Based on your self-assessment and theory of nursing practice, develop 4 measurable goals and objectives for this practicum experience. Include them on the designated area of the form.   

Assignment Instructions: 

• Review the case study scenario below and the client’s family history and medical profile information from unit 1.  
• Next, write a 6-8  analysis of the client (including title and reference) according to the assignment specifications, outline, and grading rubric. 

Case Study 2 Scenario:

Client, William Collins, arrived to the emergency room for an exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The emergency department nurse enters the triage room to find Mr. Collins sitting at the side of the bed leaning forward with both arms on the bedside tray. He complains he is having shortness of breath that he is unable to control with his usual medications. His son is with him at the bedside because his wife is unable to come with him due to dialysis. 

Case Study Analysis Assignment Outline: 

The case study analysis should include the following sections with responses and rationales for all the prompts.

Introduction (3-5) 

Provide an overview of the pathophysiology of the disease exhibited by the client. Include: 

• What additional assessment findings would you look for? 
• What lab abnormalities would you expect to see? 
• What diagnostics would you anticipate the healthcare team ordering? 
• Provide a rationale for your answers. 

Implications for Self-Care (2 paragraphs) 

• Consider Maslow’s hierarchy of needs and describe where the client falls in that hierarchy and how this will impact care and healing.  
• How does this disease process impact the client’s and/or their care provider’s ability to care for themselves? 

Patient Education Strategy (2-3 paragraphs) 

• Identify 3-5 appropriate nursing interventions and teaching points for your client based on the pathophysiology and assessment findings. 
• Describe the educational strategies that should be incorporated when building a plan of care for your client.
• Support with rationale. 

Interdisciplinary Collaboration (2-3 paragraphs) 

• Identify 2-4 interdisciplinary team members who need to be included in the care of the client. Include rationale. 
• Consider the care the client will need while inpatient and upon discharge.  
• Consider nutrition, community services, and financial implications. 

Conclusion 

• Summarize the key concepts of this disease process and client case study scenario.  

References 

• A minimum of three references should be used.  
• References should be no more than five years old. Exceptions include seminal works, such as original publications by nurse theorists.  
• One reference must be your textbook, 
• One reference must be from a peer-reviewed journal,  
• One reference must be from an authoritative website such as the CDC, NIH or Healthy People 2030.

Assignment Specifications: 

• Name thewith a File Naming Protocol: When you save the, name it: LastName_NSG 3300_CaseStudyAnalysis_1.docx  reflects clinical and professional client/cases, and no references to personal or family issues.

APA Formatting 

• All should be written in APA formatting. This should include: 
• Formal components, such as a title, and APA formatting with an introductory and conclusion paragraph that summarizes the key concepts 
• APA-formatted level headings 
• APA margin, font, and paragraph spacing 
• Include page numbers 
• Appropriate in-text reference citations 
• A reference page, in correct APA format 

what is a good example of connecting health outcome to social determinant?

respond to the topic,(Pregnant women and bipolar depresion) say I agree with what you said for this and for this. and add information that deals with the same thing but is not mentioned in that work, the answers that have an argument…

at least 3 references

Pregnant Women and Bipolar Depression

     In this discussion post, I will explain pregnancy in women diagnosed with bipolar disorder (BD), classified as high-risk due to various clinical and pharmacotherapeutic factors.  When giving psychiatric drugs to a pregnant woman, it is very important to carefully weigh the possible effects of psychotropic drug exposure on the unborn fetus against the chance of a bipolar disorder relapse. If bipolar disorder is not treated, it can have detrimental effects on the health of both the mother and the unborn child in the case of a relapse. Access to comprehensive and up-to-date information regarding the safety of preventive medications for bipolar disorder is essential for making informed choices (Singh & Deep, 2022).

It is crucial for healthcare providers to have discussions with patients about psychiatric drugs, including their advantages and disadvantages, both before and during pregnancy, as well as postpartum; however, we will concentrate on pharmacological interventions during pregnancy in general. Even if the patient decides not to pursue pharmacotherapy, this choice is still considered a therapeutic option. Most mental health conditions, including postpartum depression, anxiety, bipolar disorder, and schizophrenia, require therapeutic drug management during pregnancy (Creeley & Denton, 2019).

The discontinuation of antipsychotic medication in patients is well documented to increase the likelihood of return of dipolar episodes. This is a significant problem, leading to a higher risk of inadequate peripartum care, suboptimal mother and fetal nutrition, difficulties throughout pregnancy, and postpartum depression. Furthermore, there is a hypothesis suggesting that the dysregulation of the hypothalamic-pituitary-adrenal system, which is linked to untreated depression, may have detrimental impacts on the fetus's health and the child's development (Creeley & Denton, 2019). Another significant concern is that no two expectant mothers with bipolar 1 depression are identical. For example, one patient has a documented record of multiple suicide attempts, while the other has been stable. The patient with a history of suicidal attempts would undoubtedly benefit from psychotropic medication at this juncture.

There is no documented approved FDA first-line drug therapy for pregnant women who are bipolar. However, atypical antipsychotics are used off-label, according to Betcher et al. (2019). Lurasidone is deemed a preferable option for antipsychotic treatment during pregnancy due to its categorization as a Category B medication in the previous pregnant drug classification system. This classification indicates that animal tests did not indicate birth defects.   Regrettably, there is a lack of empirical data regarding the safety or potential hazards of lurasidone in human subjects during pregnancy or lactation (Betcher et al., 2019). Several clinical investigations indicate that lurasidone is tolerable, demonstrating a favorable combination of effectiveness and safety. These antipsychotics are regarded as metabolically favorable. It does not affect weight gain, lipids, or glucose levels. Additionally, it is the only atypical antipsychotic proven not to induce Qtc prolongation and one of the few atypicals that do not have a Qtc warning (Stahl's, 2021).

One thing to keep in mind with pregnant and non-pregnant patients is the metabolic issues that arise from the use of antipsychotics. The physiologic changes that occur during pregnancy, like increased metabolism and a subsequent drop in antipsychotic serum levels, are both physiological effects of pregnancy. The amount of medicine in the body decreases during pregnancy because the uridine diphosphate glucuronosyltransferase (UGT) isoenzymes and the cytochrome P450 isoenzymes CYP3A4, CYP2D6, and CYP2C9 become more active. Gaining or losing weight, increasing or decreasing plasma volume, and altering renal clearance affect medication concentrations (Betcher et al., 2019).

The non-pharmacological treatment options for bipolar disorder (BD) in pregnant women include family-focused treatment (FFT), interpersonal and social rhythm therapy, and cognitive behavioral therapy (CBT). These intense psychotherapies have substantial evidence supporting their effectiveness in treating bipolar illness (Chiang & Miklowitz, 2023).  The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study and other psychotherapy studies highlight the significance of psychoeducation as a crucial element in treating bipolar depression. Group treatment that focuses on four clinical issues provides strong evidence for the effectiveness of psychoeducation. These issues include increasing awareness of the condition, promoting adherence to treatment, detecting prodromal symptoms and recurrence early, and encouraging a consistent lifestyle. After 5 years, individuals who underwent structured group psychoeducation experienced a reduction of 75% in the duration of their depressive episodes compared to those who participated in an unstructured support group (Chiang & Miklowitz, 2023).

The presence of bipolar disorder in pregnant and lactating women poses significant hazards to both the mother and the child, necessitating the need for comprehensive management (Graham et al., 2018).  Several guidelines emphasize the importance of carefully weighing the danger of bipolar relapse against the potential harms of psychotropic drugs to the newborn when making decisions about psychotropic therapy for women with bipolar disorder throughout this period.   Still, the study showed that there was not a lot of agreement among the guidelines about how dangerous these drugs might be. This made clinical recommendations and prescribing methods less effective (Graham et al., 2018).

Lastly, the risks and outcomes linked with untreated maternal disorder are as follows if a bipolar-depressive pregnant patient chooses not to use medications: Factors such as low birth weight, small size at birth, preterm birth, and an increased risk of cesarean birth can contribute to various health complications. These complications include small head circumference, hypoglycemia, and an increased risk for long-term neurocognitive, behavioral, and social deficits. Additionally, there is a high postpartum risk for first-onset and recurrent bipolar episodes, hospitalization due to substance use, poor prenatal care, and maternal suicide (Creeley & Denton, 2019). Some antipsychotic medications have harmful effects on pregnant women. For example, Clomipramine can lead to malformations in the fetal cardiovascular system; Valproates can cause birth defects; Carbamazepine can result in spina bifida; and Lithium can be teratogenic and increase the risk of miscarriage (Gruszczyńska-Sińczak et al., 2023).