Case 7- The Case Of Physician Do Not Heal Thyself

Want create site? With you can do it easy.

Case 7- The Case Of Physician Do Not Heal Thyself

Case #7 The Case of Physician Do Not Heal Thyself presents a case of a 60-year old patient who shows symptoms of complex mood disorder. Moreover, the patient is difficult to handle and uses his medical background to treat himself. Thus, in order to successfully diagnose and manage the condition, the section will examine certain important aspects in the management of such a unique case.

Struggling to find relevant content or pressed for time? – Don’t worry, we have a team of professionals to help you on
Case 7- The Case Of Physician Do Not Heal Thyself
Get a 15% Discount on this Paper
Order Now

Three Questions

Have you ever had a period in your life whereby you felt that you were different and consequently felt that you were irritable and shouted at other individuals or started fights and arguments?
Has a health professional ever said to you that you are suffering from a complex mood disorder or bipolar?
Has any of your relations ever suffered from any form of complex mood disorder e.g. bipolar?

The rationale for asking these questions involves getting a subjective perspective from the patient. As a starting point, the questions are important as they allow the present nurse practitioner to familiarize herself with the background of the patient before she can conduct a full analysis. In addition, question three may help the nurse identify the genetic makeup of the patient considering that he was not responsive to most of the antipsychotics that he had been given.

People in the Patient’s Life

According to the patient’s social history, he does not have a lot of people that could offer information regarding his status. The closest people that are mentioned are his three divorced wives. However, these are not in his life anymore. Thus, the only people that can be interviewed are his co-workers and friends. His colleagues will thus be asked: “What is his productivity and what does he say about it?” On the other hand, his friends will be requested to answer the question: “How can you describe the interpersonal relationship that he has with you?” These questions are pertinent since they seek to discover if the patient has demonstrated some of the symptoms of complex mood disorder to persons in his social life (Culpepper, 2014). Indeed, the two questions will help reveal the mood of the patient around the people that are in his life.

Case 7- The Case Of Physician Do Not Heal Thyself

Physical Examinations and Diagnostic Tests

A physical examination cannot confirm or discard the presence of complex mood disorder. However, such an examination may succeed in establishing the presence of a medical condition that may cause the existence of the condition’s symptoms. In the present case, the nurse may do a physical examination to establish the presence of either hyperthyroidism or hypothyroidism as they also cause the depressive symptoms that the patient has presented.

In addition to the physicals above, other diagnostic tests may be necessary. Whereas no laboratory test may be required to confirm the presence of the condition, they are important for excluding alternative etiologies for the symptoms shown by the patient (Mann. McGrath, & Roose, 2013). Important in this respect is a urine toxicology and a comprehensive blood count. The former will be utilized to confirm the usage of drugs by the patient whilst the latter test will exclude anemia or infection as the causes of the depressive episodes (Culpepper, 2014).  Moreover, an MRI will be important in excluding an organic etiology for the mood disorder.

Differential Diagnosis

The patient has shown numerous symptoms that make the diagnosis of the disease difficult. The symptoms of the patient indicate the presence of a complex mood disorder. A majority of the said symptoms are shared by other mood disorders. Personality disorders usually mimic or occur concomitantly with complex mood disorders (Culpepper, 2014). The client has demonstrated depressive symptoms that a patient with complex mood disorder is susceptible to having. Also, given the information from the family history in the case study, the patient should be examined for major depressive symptoms. However, the decision to go with complex mood disorder is informed by the presence of irritability and mania episodes that do not reach the thresholds of either hyper- or hypo-mania according to the DSM IV or even ICD 10 tools.

Pharmacologic Agents and their Dosing for the Patient

The patient has not displayed full manic episodes and has similarly not displayed hypomanic episodes. Given his treatment history, it becomes clear that most of the drugs prescribed to him do not work. However, that could be due to the patient’s intransigence as opposed to any scientific basis, with exception of cases wherein specific scientific reasons for discontinuation of an SSRI have been mentioned. Thus, according to the present nurse, the patient should be given either a sertraline (Zoloft) an SSRI or a methylphenidate (Ritalin), a monoamine oxidase inhibitor (Stahl, 2013), which seems to be working for the patient.  The Zoloft will be given in doses starting dose from 50 mg per day. Given the sensitivity of the patient to other SSRIs, this dosage will be increased to a therapeutic range of between 50-200 mg per day. On the other hand, Stahl (2014) states that Ritalin may be given in doses of 20 mg daily. The two agents are chosen for their faster absorption rates and equally fast metabolism once in the system.

Sertraline, which is an SSRI, works by inhibiting the selective reabsorption of serotonin in the brain. Consequently, the chemical elements in the brain responsible for the condition under consideration are balanced as a result. Nevertheless, methylphenidate acts by stimulating the central nervous system.  It does this by inhibiting the reuptake of catecholamines, essentially blocking the reuptake of dopamine and norepinephrine (Stahl, 2013). As a consequence, the concentration of norepinephrine at the synaptic left increases. Thus, from this point of view, the methylphenidate psychopharmacology will be more effective.

Contraindications Based on Ethnicity

Methylphenidate acts by modulating the reabsorption of catecholamines in the brain. As such, the gene responsible for creating dopamine transporter (DART) plays a crucial role in the dosing response of the drug. A study by Froehlich et al. (2011) observed that individuals without copies of the 10 repeat (10R) alleles produced greater remission of the symptoms of the disease due to methylphenidate dose compared to those with the 10R alleles. Given that the 10R alleles are mostly present in Caucasians, Hispanics and African-Americans will experience contraindications from the drug due to its plasms level concentrations. As such, patients from those ethnicities may experience marked anxiety, agitation and tension when given methylphenidate in high doses.

Lessons Learned From This Case Study

The case study of “Physician do not heal thyself”’ has produced important lessons to the nurse. One is that healthcare professionals are in a spot of bother when their prospective client is a colleague in the industry. Such people often display a certain level of arrogance and intransigence when it comes to the prescription of drugs. As such, they need to be incorporated in the decision to formulate an intervention. Also, the case study has revealed that there are certain cases wherein SSRIs do not work but MAOs do. In this case, it becomes important to consider prescribing the MAOs but under very strict observations. Lastly, the case study has accentuated the process that one can use to differentially diagnose mood disorders coupled with personality disorders. The illumination becomes important for future practice as one will use the experience to handle such cases.

Moreover, the present nurse has gained fantastic insights into how to manage the so called difficult clients. According to the case study, the client did not respond to all the medications from his physicians, which compelled him to use his own prescription. Thus, the present nurse will consider listening to self-prescribed patients in future with a view of adopting their ideas in the management of various mental health issues.

Did you find apk for android? You can find new and apps.

Calculate the price
Make an order in advance and get the best price
Pages (550 words)
$0.00
*Price with a welcome 15% discount applied.
Pro tip: If you want to save more money and pay the lowest price, you need to set a more extended deadline.
We know how difficult it is to be a student these days. That's why our prices are one of the most affordable on the market, and there are no hidden fees.

Instead, we offer bonuses, discounts, and free services to make your experience outstanding.
How it works
Receive a 100% original paper that will pass Turnitin from a top essay writing service
step 1
Upload your instructions
Fill out the order form and provide paper details. You can even attach screenshots or add additional instructions later. If something is not clear or missing, the writer will contact you for clarification.
Pro service tips
How to get the most out of your experience with MyCoursebay
One writer throughout the entire course
If you like the writer, you can hire them again. Just copy & paste their ID on the order form ("Preferred Writer's ID" field). This way, your vocabulary will be uniform, and the writer will be aware of your needs.
The same paper from different writers
You can order essay or any other work from two different writers to choose the best one or give another version to a friend. This can be done through the add-on "Same paper from another writer."
Copy of sources used by the writer
Our college essay writers work with ScienceDirect and other databases. They can send you articles or materials used in PDF or through screenshots. Just tick the "Copy of sources" field on the order form.
Testimonials
See why 20k+ students have chosen us as their sole writing assistance provider
Check out the latest reviews and opinions submitted by real customers worldwide and make an informed decision.
Management
Comprehensively done. Thank you
Customer 452583, July 20th, 2021
Criminal Justice
Looks good! Thank you Jason
Customer 452711, January 25th, 2022
Social Work and Human Services
Excellent Work
Customer 452587, November 22nd, 2021
Criminal Justice
Impressive! Will be using the service again.
Customer 452485, December 5th, 2021
Nursing
Great work! Thank you so much.
Customer 452707, July 15th, 2022
Education
Thank you so much
Customer 452631, October 5th, 2021
Nursing
Thanks
Customer 452521, May 13th, 2021
Other
AWESOME
Customer 452813, June 30th, 2022
Other
Great Work!
Customer 452587, March 10th, 2022
Social Work and Human Services
Good Work!
Customer 452587, September 2nd, 2021
Nursing
Great writer (Proske). I highly recommend
Customer 452531, July 10th, 2021
Strategic Management
Thank you very much for the help, really appreciate it
Customer 452821, June 27th, 2022
11,595
Customer reviews in total
96%
Current satisfaction rate
3 pages
Average paper length
37%
Customers referred by a friend
OUR GIFT TO YOU
15% OFF your first order
Use a coupon FIRST15 and enjoy expert help with any task at the most affordable price.
Claim my 15% OFF Order in Chat

Get your perfect essay with a 15% discount. Use DC15

NEW

Thank you for choosing MyCoursebay. Your presence is a motivation to us. All papers are written from scratch. Plagiarism is not tolerated. Order now for a 15% discount

Order Now