Tricyclic Antidepressant Toxicity in Geriatric Patient Presentation

Tricyclic Antidepressant Toxicity in Geriatric Patient Presentation Tricyclic Antidepressant Toxicity in Geriatric Patient Presentation Peer review is an important process in graduate education where we offer constructive criticism of the work of our peers. For this discussion, post a draft of your Case Study Presentation. It does not need to be a video and can be the visual presentation only. After you have posted your initial posting (your rough draft) by the third day of the module, respond substantively to at least two peers with suggestions for improvement by the end of the module. Post your initial assignment then respond to 3 peer for a total of 4 post. __a_autism__evelyn.pptx b__kelly_casestudy_16presentation.pptx c_stacey_schizophrenia_ppt.pptx ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Autism Spectrum Disorder Case study 7-Ashley 17 yo with ASD and ID diagonsis since early childhood. Recent dx of Kleefstra syndrome Reevaluation; Not independent with ADLS Able to read and spell at 2nd grade level with decreased understanding of material Presenting to office for second opinion and assess genetic risk in the future children of her 2 older sisters. Changes in scheduled caused irritability with self-injurious behaviors and aggressive towards others when upset. Histories Family hx : Dyslexia Epilepsy Asperger’s Syndrom Non-verbal IQ of 39 and Verbal IQ of 32 Formal Testing Full scale IQ of 31 Adaptive score of 42 (Average is a score of 100). Strong Memory Skills Diagnosis Autism Spectrum Disorder Statistics Causes: Genetic Link: Kleefstra Syndrome DSM -5 Diagnostic Criteria Diagnostic Tools Some studies have shown that the use of Quantitative Electroencephalography (QEEG), can be an effective tool to diagnose Autism Spectrum Disorder (Abdulhay, et., al. 2020). Treatment Evidence Based Strategies Intensive Interaction Applied Behavioral Analysis Conclusion References ? CC: Psychotic Behavior ? HPI: This 63-year-old businessman, was “found down” in the road by police and brought to the emergency room with complaint of psychotic behavior. There’s no reported past psychiatric history. Psychiatry service was consulted for management. The patient’s family reported that the patient had exhibited approximately 2-week history of “strange behavior.” According to his sister, the patient had been running around the kitchen with knives, sending paranoid emails about the justice system to his friends, showing his guns to the neighbors, seeing people in the walls, having paranoid thoughts that his wife was having an affair, and not sleeping. The patient’s wife had reported him missing 3 days prior to admission. Notably, as per the PD report his car was found a few blocks away with a large box in its trunk containing numerous medications and the patient’s extensive gun collection. ? Constitutional: denies any change in weight, weakness, fatigue or fever. ? Eyes: patient does not wear glasses or contact lenses denies any visual loss, pain, redness, excessive tearing or excessive dry eyes. ? Ears, nose, mouth, throat: denies nasal congestion reports nosebleed, denies sore throat, denies tooth pain, denies change in sense of smell, denies tongue swelling. ? Cardiovascular: denies chest pain, denies palpitations, denies shortness of breath, denies edema ? Respiratory: denies cough, wheezing, hemoptysis, denies history of TB exposure, denies night sweats ? GI: denies trouble swallowing, denies nausea vomiting or diarrhea, denies dysuria, denies bowel incontinence ? GU: reports urinary retention, denies dysuria, denies hematuria, denies foul smelling urine, denies testicular pain ? Musculoskeletal: reports chronic back pain, denies gout or history fractures ? Skin: denies rashes, denies puritis, denies dry patchy skin ? Neurological: denies syncopal episodes, denies seizures, denies paralysis, denies vertigo, denies tingling, denies tremors ? Psychiatric: paranoid behavior, denies suicidal ideation, denies homicidal ideation, denies depression or anxiety, denies auditory or visual hallucinations Sanders, 2020 ? PMH: CAD, Chronic Back pain ? PSH: CABG 5 years ago, Multiple back surgeries NUR 3846 UTRGV Tricyclic Antidepressant Toxicity in Geriatric Patient Presentation ? Home Medication: metoprolol, cyclobenzaprine, and MS-Contin ? Constitutional: VS: WNL, HT: & WT. WNL, afebrile ? Eyes: pupillary dilation, PERRLA, EOMI ? Ears, nose, mouth, throat: blood noted in bilateral nares, moist mucus membranes, normal tympanic membrane, normal dentation ? Cardiovascular: normal cardiac rate and rhythm, normal heart sounds, no murmurs, rubs or clicks. ? Respiratory: respiratory rate and rhythm normal, normal breath sounds, no wheezes, rails or rhonchi. ? GI: hypoactive bowel sounds ? GU: full bladder noted on palpation ? Musculoskeletal: tenderness noted lumbar spine region, upper and lower extremities are symmetrical no clubbing or edema noted pulses are bilaterally equal and palpable ? Skin: no rashes, skin is intact dry, normal turgor ? Neurological: slurred speech, psychomotor retardation, depressed bilateral Reflexes ? Psychiatric: Heavy sedation, waxing and waning alertness, unkempt appearance, lack of cooperation, affect alternated between subdued/somnolent and restless/agitated, thought process is tangential, insight is impaired ? Score of 16 of 30. ? He lost 7 of 10 points for orientation ? 3 for attention and calculation ? 2 for recall ? 1 each for sentence writing and copying design (Yurto?lu, 2018) (Godman, 2016) ? ECG WNL, (CT) scan of the head was negative, CT of the cervical spine showed degeneration ? Blood alcohol screen was negative ? complete blood count and comprehensive metabolic panel results were within normal limits ? cerebrospinal fluid from a lumbar puncture with in normal limits ? UDS positive for benzodiazepines and tricyclics, negative for opioids ? Working Diagnosis: Anticholinergic Delirium Delirium as described in the DSM-5 (2017) • Acute onset, Fluctuating course of symptoms, inattention, impaired level of consciousness, disturbance of cognitive indicating disorganization of thought such as disorientation, memory impairment, or alterations in language (Oh, Fong, Hshieh, & Inouye, 2017). • Alterations in sleep wake cycle, perceptual disturbances such as hallucinations or miss perceptions such as paranoia, delusions, inappropriate or unsafe behavior and emotional lability. Talking points: ? Surgical History-Greaves et al. (2019), Report that cognitive impairment and delirium in postoperative CABG patients, although the impairment is higher at six months to one year postoperatively there is only a 7% risk at 5 to 7 years post-surgery. ? Other medical condition-This patient is suffering from urinary retention as per his history. Infections, to include urinary tract infections, followed by drugs, and hydroelectric disorders seem to be the most prevalent precipitating factors for delirium (Magny et al., 2018). ? Opioid use-A registered-based study found that opioid use for pain is problematic in that it causes sedation as well as possible cognitive impairment (Jensen-Dahm, Zakarias, Gasse, & Waldemar, 2019). Nonpharmacologic: Environmental and behavioral modifications • Safe and cognitively nondemanding surroundings • Re-orient, redirect, and reassure ? For acute delirium, haloperidol plus ? Anticholinergic delirium can be lorazepam has a safe response for treated with a cholinesterase treatment and prevention of delirium inhibitor such as Physostigmine. in a meta-analysis by Wu et al. Physostigmine is an effective and (2019). relatively safe medication to use in an anticholinergic delirium (Dawson (Admin, 2019) & Buckley, 2015). Reference: Admin. (2019, July 22). What the “Rx” on Prescription Drugs Means. Retrieved August 06, 2020, from Dawson, A. H., & Buckley, N. A. (2015). Pharmacological management of anticholinergic delirium – theory, evidence and practice. British Journal of Clinical Pharmacology, 81(3), 516-524. doi:10.1111/bcp.12839 Diagnostic and statistical manual of mental disorders: DSM-5. (2017). Arlington, VA: American Psychiatric Association. Greaves, D., Psaltis, P. J., Ross, T. J., Davis, D., Smith, A. E., Boord, M. S., & Keage, H. A. (2019). Cognitive outcomes following coronary artery bypass grafting: A systematic review and meta-analysis of 91,829 patients. International Journal of Cardiology, 289, 43-49. doi:10.1016/j.ijcard.2019.04.065 Godman, H.NUR 3846 UTRGV Tricyclic Antidepressant Toxicity in Geriatric Patient Presentation (2016, June 6). What to do when blood test results are not quite “normal” [Web log post]. Retrieved August 06, 2020, from Jensen-Dahm, C., Zakarias, J. K., Gasse, C., & Waldemar, G. (2019). Geographical Variation in Opioid Use in Elderly Patients with Dementia: A Nationwide Study. Journal of Alzheimer’s Disease, 70(4), 1209-1216. doi:10.3233/jad-190413 Louhija, U., Saarela, T., Juva, K., & Appelberg, B. (2017). Brain atrophy is a frequent finding in elderly patients with first episode psychosis. International Psychogeriatrics, 29(11), 1925-1929. doi:10.1017/s1041610217000953 Magny, E., Petitcorps, H. L., Pociumban, M., Bouksani-Kacher, Z., Pautas, É, Belmin, J., . . . Lafuente-Lafuente, C. (2018). Predisposing and precipitating factors for delirium in community-dwelling older adults admitted to hospital with this condition: A prospective case series. Plos One, 13(2). doi:10.1371/journal.pone.0193034 Refernce: Oh, E. S., Fong, T. G., Hshieh, T. T., & Inouye, S. K. (2017). Delirium in Older Persons. Jama, 318(12), 1161. doi:10.1001/jama.2017.12067 Schwartz, A. C., Fisher, T. J., Greenspan, H. N., & Heinrich, T. W. (2016). Pharmacologic and nonpharmacologic approaches to the prevention and management of delirium. The International Journal of Psychiatry in Medicine,51(2), 160-170. doi:10.1177/0091217416636578 Tsoi, K. K., Chan, J. Y., Hirai, H. W., Wong, S. Y., & Kwok, T. C. (2015). Cognitive Tests to Detect Dementia. JAMA Internal Medicine, 175(9), 1450. doi:10.1001/jamainternmed.2015.2152 Wu, Y., Tseng, P., Tu, Y., Hsu, C., Liang, C., Yeh, T., . . . Su, K. (2019). Association of Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium. JAMA Psychiatry, 76(5), 526. doi:10.1001/jamapsychiatry.2018.4365 Yurto?lu, N. (2018). Mini mental state examination (MMSE). History Studies International Journal of History, 10(7), 241-264. doi:10.9737/hist.2018.658 SCHIZOPHRENIA Stacey Ervin, ARNP NURS 6261.92L University of Texas Rio Grande Valley Dr. Anna Tabet Description ? Schizophrenia is a mental and psychiatric disorder that causes individuals to interpret reality abnormally (Nuño et al., 2019). ? Often manifests through an amalgam of delusions, hallucinations, and extremely disordered behavior and thinking. ? These manifestations invariably diminish the daily functioning of the individuals suffering from the condition (Rasool, ZeeshanZafar, Ali & Erum, 2018). ? Some patients end up totally disabled. Such individuals usually require lifelong psychiatric treatment. ? Early treatment may allow the symptoms to be contained to avoid the development of serious complications, thus improving long-term outlook. Manifestations ? In adults, schizophrenia is characterized by a wide range of signs and symptoms, including cognitive, emotional, and behavioral problems (Rasool, ZeeshanZafar, Ali & Erum, 2018). ? The signs and symptoms vary but usually experience disorganized speech (thinking), delusions, hallucinations, extremely disordered or abnormal motor behavior, and negative symptoms. ? Delusions refer to false beliefs that conflict with or not founded. ? May issue answers that are either wholly or partly unrelated to questions asked, and their speech may include meaningless and unintelligible words. ? The individual may exhibit childlike silliness, unpredictable agitation, resistance to instructions, bizarre posture, and useless movements. ? Also one may neglect of personal hygiene and loss of interest in everyday activities. Manifestations in Teens ? symptoms of the disease are like those of the adults. ? more challenging to diagnose in teenagers than in adults. ? the symptoms of the condition in teenagers are common with the developmental features during the teen years. ? Examples include a decline in school performance, trouble sleeping, lack of motivation, withdrawal from family and friends, and depressed mood. NUR 3846 UTRGV Tricyclic Antidepressant Toxicity in Geriatric Patient Presentation ? The use of recreational substances such as marijuana and methamphetamines could also lead to similar signs and symptoms. ? Unlike in adults, teenagers may not exhibit symptoms of delusions and are highly likely to experience hallucinations. Causes ? Unknown, but researchers generally believe that combined factors such as brain chemistry, genetics, and the environment are the key contributors to the development of the condition (U Khan, Martin-Montañez & Chris Muly, 2013). ? psychiatric science suggests that conflicts with some of the naturally existing brain chemicals, for instance, neurotransmitters known as glutamate and dopamine, could contribute to the disorder. ? Neuroimaging studies reveal that the central nervous system and brain structure of individuals with schizophrenia are different from those without the disease. Risk Factors ? Evidence suggests that several factors heighten the risk of triggering or developing schizophrenia (Janoutová et al., 2016). One of the elements is belonging to a family with a history of schizophrenia. ? Other risk factors include pregnancy and birth complications (such as exposure to viruses/toxins and malnutrition that could compromise a child’s brain development) ? use of psychoactive and psychotropic drugs, especially during the teenage years and early adulthood. Complications ? Schizophrenia could lead to severe complications if left unattended. Some of the common complications associated with the disease include depression, social isolation, medical and health problems, abuse of psychoactive and psychotropic drugs, obsessive-compulsive disorder (OCD), anxiety disorder, being suicidal, homelessness, financial difficulties, and homelessness, inability to attend school or work, being victimized, development an aggressive behavior even this is rare (Kheir, Kheir, Tan, Ackerman, Rondon & Chen, 2018). Treatment Pharmacology is first in the line of schizophrenia treatment (National Institute for Health and Clinical Excellence, 2010). Antipsychotic medications administered to patients with these conditions often act on the neurotransmitters present in the brain. the drugs help ameliorate experiences such as delusions, hallucinations, and thought disorders. antipsychotic medications tend to be more effective in managing the disease’s positive effects than its adverse effects (Bevan, Gulliford, Steadman, Taskila, Thomas & Moise, 2013). ? most individuals report significant improvements after administration to them. ? many have reported a reduction of relapse of psychosis, at least in the short-term. ? those that adhere less to the medications tend to register higher symptom severity, substance abuse, and treatment with mood stabilizers. ? patients who receive injectable medication have reported significant cognitive function improvements, such as attention, memory, and verbal learning. Pharmacologists should thus Treatment Cont ? psychologists who often administer psychological therapy and psychosocial interventions usually work closely with pharmacologists to treat and manage patients with schizophrenia. ? Though the administration of psychological therapy and psychosocial interventions were less previously practiced concerning the management of schizophrenia, recent studies have seen it gain traction in application (Bevan, Gulliford, Steadman, Taskila, Thomas & Moise, 2013). ? Today, more psychologists rely on this intervention to manage and treat patients ailing from the disease. ? research and knowledge on the nexus between schizophrenia and cognitive behavioral therapy and family interventions, have seen the latter applied by psychologists in managing and improving the coping strategies Practice Change ? Schizophrenia is one of the psychiatric and mental conditions that affect the wellness of a significant number of persons. ?NUR 3846 UTRGV Tricyclic Antidepressant Toxicity in Geriatric Patient Presentation The condition thus falls within the ambit of my psychiatric practice. ? Combined pharmacological and therapeutic interventions are necessary ? Compliance can be an issue References ? Bevan, S., Gulliford, J., Steadman, K., Taskila, T., Thomas, R., & Moise, A. (2013). Working with schizophrenia: Pathways to employment, recovery & inclusion. The Work Foundation. ? Buckley, P. F., & Foster, A. (2008). Schizophrenia: current concepts and approaches to patient care. American health & drug benefits, 1(4), 13. ? Dewan, M. J. (2016). The psychology of schizophrenia: Implications for biological and psychotherapeutic treatments. The Journal of nervous and mental disease, 204(8), 564-569. ? Janoutová, J., Janá?ková, P., Šerý, O., Zeman, T., Ambroz, P., Kovalová, M., & Janout, V. (2016). Epidemiology and risk factors of schizophrenia. Neuroendocrinology Letters, 37(1), 1-8. ? Kheir, M. M., Kheir, Y. N. P., Tan, T. L., Ackerman, C. T., Rondon, A. J., & Chen, A. F. (2018). Increased complications for schizophrenia and bipolar disorder patients undergoing total joint arthroplasty. The Journal of arthroplasty, 33(5), 1462-1466. ? National Institute for Health and Clinical Excellence. (2010). Schizophrenia: the nice guideline on core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. National Clinical Guideline. London: National Institute for Health and Clinical Excellence. References ? Nuño, L., Guilera, G., Coenen, M., Rojo, E., Gómez-Benito, J., & Barrios, M. (2019). Functioning in schizophrenia from the perspective of psychologists: A worldwide study. PloS one, 14(6), e0217936. ? Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. Pharmacy and Therapeutics, 39(9), 638. ? Rasool, S., ZeeshanZafar, M., Ali, Z., & Erum, A. (2018). Schizophrenia: An overview. Clinical Practice, 15(5), 847-851. ? Sie, M. (2011). Clinical features and diagnosis. Clinical Pharmacist. ? U Khan, Z., Martin-Montañez, E., & Chris Muly, E. (2013). Schizophrenia: causes and treatments. Current pharmaceutical design, 19(36), 6451-6461. … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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