675 Unit Unit 12 Assignment – Clinical: Journal Reflection

675 Unit Unit 12 Assignment – Clinical: Journal Reflection: You will create 7 entries for your Reflective Journal about a patient encounter. In the 7th entry, you will review the previous 6 entries and evaluate your progress in reflective practice over the course of the term…

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Unit 12 Assignment – Clinical: Journal Reflection

Instructions

You will create 7 entries for your Reflective Journal about a patient encounter. In the 7th entry, you will review the previous 6 entries and evaluate your progress in reflective practice over the course of the term? Each journal should be a minimum of 250 words.?

The purpose of this reflective journal is self-reflection regarding the role in the process of self-reflection as a PMHNP provider. Through reflective practice, the student will evaluate their own emotional health and recognize one’s own feelings as well as one’s ability to monitor and manage those feelings.

The point of the exercise is to learn yourself, your triggers, the types of cases you end up getting overly involved with, and those you’d rather refer to someone else. The idea is to be able to personally reflect on your behaviours/thoughts/decisions and how those impact you in the role of PMHNP. 

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Address the following items: 

  • For the following side effects, what are the options you can provide patients with?
    • Think about the risk/benefit of stopping, switching, or adding medication.
    • Explain the rationale for your decision:
    • Akathisia/Tremors
    • EPS/TD
    • Weight gain
    • Metabolic Syndrome
    • Sexual Dysfunction
    • Blunted affect
    • Agranulocytosis

Solution

Unit 12 Assignment-Clinical Reflection

Antipsychotic drugs used to treat mental health problems such as schizophrenia and bipolar normally have several side effects. Selective Serotonin Reuptake Inhibitors (SSRIs) induce Akathisia and tremor, causing movement problems. One medication I would prescribe to relieve these symptoms would be anticholinergics at lower doses. However, if the patient were already prescribed the medication, I would change the medication to benzodiazepines, beta-blockers, or trazodone (Kaar et al., 2020).

In the case of extrapyramidal side effects (EPS) or tardive dyskinesia (TD), I would prescribe anticholinergics, lipophilic beta-blockers, or benzodiazepines to reduce these symptoms. Also, I would change the medication to aripiprazole as third-generation antipsychotics have less impact on dopamine levels, carrying the lowest risk to EPS and TD (Smith et al., 2018).

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Additionally, for weight gain, I would prescribe metformin with an exercise or diet regimen to help reverse the weight gain from antipsychotics. However, if the patient were under antidepressants, I would change the medication to bupropion as it is considered as they have the least impact on weight gain (Kaar et al., 2020).

Nonetheless, atypical antipsychotics have an increased risk for metabolic syndrome. Therefore, if the patient has been using olanzapine or clozapine, I would change their medication to aripiprazole, lurasidone, brexpiprazole, or cariprazine have the best profiles on metabolic side effects (Xu & Zhuang, 2019).

Also, if a patient experiences antipsychotic-induced sexual dysfunction, changing the medication to olanzapine can help improve their sexual functioning. This medication is suitable for both men and women, while sildenafil is recommended for men who have schizophrenia (Allen et al., 2019).

For blunted affect, modifying the antipsychotics prescribed can help to improve the symptoms, making the patient more reactive and responsive to stimulations. Lastly, I would recommend the elimination of clozapine if the patient experiences agranulocytosis. Instead, I would prescribe pegfilgrastim, filgrastim, or lenograstim which may help to reduce the symptoms (Smith et al., 2018).

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References

  • Allen, K., Baban, A., Munjiza, J., & Pappa, S. (2019). Management of antipsychotic-related sexual dysfunction: Systematic review. The Journal of Sexual Medicine, 16(12), 1978-1987. https://doi.org/10.1016/j.jsxm.2019.08.022
  • Kaar, S. J., Natesan, S., McCutcheon, R., & Howes, O. D. (2020). Antipsychotics: Mechanisms underlying clinical response and side-effects and novel treatment approaches based on pathophysiology. Neuropharmacology, 172, 107704. https://doi.org/10.1016/j.neuropharm.2019.107704
  • Smith, R. C., Leucht, S., & Davis, J. M. (2018). Maximizing response to first-line antipsychotics in schizophrenia: A review focused on meta-analysis findings. Psychopharmacology, 236(2), 545-559. https://doi.org/10.1007/s00213-018-5133-z
  • Xu, H., & Zhuang, X. (2019). Atypical antipsychotics-induced metabolic syndrome and nonalcoholic fatty liver disease: A critical review. Neuropsychiatric Disease and Treatment, 15, 2087-2099. https://doi.org/10.2147/ndt.s208061

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