Case Study: An Asian American Woman With Bipolar Disorder Assignment

You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. I do not need you to tell me the treatment options available to you – I am very familiar with the cases. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data).

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At each decision point stop to complete the following:

* Decision #1

o Which decision did you select?

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

* Decision #2

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

* Decision #3

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

**reminder that I require five references based on the grading rubric**

Week 4 assignment.

SUBJECTIVE DATA:

Chief Complaint (CC): Patient states that “I have dry, scaly patches on my skin”.

History of Present Illness (HPI): Patient a 46 year old African American female who presents with skin lesions as well dry skin on her lower extremities which usually last for more than 4 weeks . She reported that the “lesions seem to go away when her lower extremities get some sun but then come back after some time”. The lesions are red and dry they are also scaly. She has associated symptoms of itching. She has been putting over the counter hydrocortisone cream on the lesions, but it hasn’t really helped. She feels the severity of her symptom discomfort is getting worse which therefore she is today. Case Study: An Asian American Woman With Bipolar Disorder Assignment

Medications:

Celebrex 100 mg po twice a day.
Valtrex 1000 mg tab, 2 tabs every 12 hours for 24 hours as needed for oral herpes.
Ortho-Novum 777
Atenolol 12.5 Mg daily po

Allergies: penicillin.

Past Medical History (PMH):

Hypertension

Past Surgical History (PSH):

No past surgical history

Sexual/Reproductive History:

She is sexually active she also is not using any form of oral contraception at this time, though she does use preservative forms of contraception such as condoms, she is also living with her sixteen-year-old daughter as well as her boyfriend.

Personal/Social History:

She claims that she does not smoke or use illicit drugs, though she also does not drink.

Immunization History:

Immunizations are up to date.

Significant Family History:

Father diagnosed with melanoma at age 62.

Lifestyle:

She lives in Orlando Florida; were she works at the Disney amusement park working as a gift shop manager. In terms of her education she has a bachelor’s degree in business. She

rents an apartment with her boyfriend of 2 years as well as her sixteen-year-old daughter. She is active and eats a healthy diet. She has a good support system of family and friends.

Review of Systems:

General: No recent weight gains or losses of significance. Patient claims to not be experiencing any fatigue. She also claims to not be experiencing fevers or chills. She also is not dealing with any sleep disturbances or is having any difficulties falling asleep.

HEENT: Denies any change in vision, is not experiencing double vision, or eye pain. She wears glasses. Denies any changes in hearing or ear pain. Denies sinus infections and epistaxis. Her last dental exam was 2 weeks ago for a regular cleaning. Since this appointment she says that she has not experienced bleeding gums or toothache.

Neck: No injury or pain.

Breasts: Denies any breast changes. No history of masses, rashes, or lesions on breasts.

Respiratory: Denies cough or sputum production. No dyspnea on exertion.

Cardiovascular/Peripheral Vascular: No history of murmur. No chest discomfort or palpitations. No edema or claudication.

Gastrointestinal: + occasional abdominal pain in past, no nausea or vomiting, + irregular bowel pattern in past. Says that she does not have acid reflux. Case Study: An Asian American Woman With Bipolar Disorder Assignment

Genitourinary: Denies changes in urinary pattern. No incontinence, no history of STDs or HPV, patient is heterosexual.

Musculoskeletal: No limitation in range of motion. No history of trauma or fractures. Claims to not have arthritis.

Psychiatric: States that she does not have a history of suicide or homicide. No mental health history. No sleep disturbances, anxiety or depression. Though she does claim that she is experiencing some stress from dealing with her fathers’ recent diagnoses of Melanoma.

Neurological: No dizziness. Denies changes in memory or thinking patterns. No problems with coordination. Denies falls or seizures.

Skin: She has never had skin cancer, though her father does. She also has red scaly plaques on her lower extremities bilaterally. Along with occasional itchiness where the plaques are located. In order to treat the dryness of the plaques she uses Eucerin on plaques to decrease itching.

Hematologic: No bleeding disorders, clotting difficulties, or history of blood transfusion.

Endocrine: No endocrine symptoms.

Allergic/Immunologic: Denies environmental, food, or drug allergies. + Ulcerative colitis. No other known immune deficiencies.

OBJECTIVE DATA:

Physical Exam:

Vital signs: B/P 130/75; P 70 and regular; T 97.6; RR 16; Wt: 140 lbs.; Ht: 5’8”; BMI 19.

General: LD is a healthy appearing white female with no acute distress. A&O x3.

HEENT: PERRLA, oropharynx clear and mucosa moist. Healthy dentition present.

Neck: Trachea midline. No masses, no bruit or JVD.

Chest/Lungs: Clear to auscultation bilaterally; no wheezes or crackles. Chest symmetric

Heart: Regular heart rate and rhythm; normal S1, S2; no murmurs, normal vascular sounds.

Peripheral Vascular: Pulses 2+ bilateral pedal and 2+ radial bilaterally.

Abdomen: Nontender. Murphy’s sign absent. Nondistended. Normal bowel sounds. No organomegaly noted.

Genital/Rectal: Adequate tone, no masses noted, eternal genitalia intact.

Musculoskeletal: Normal passive and active Range of Motion in upper and lower extremities. No focal joint inflammation or abnormalities were noted.

Neurological: CN ll-Xll grossly intact.

Skin: Lesions consisting of erythematous, silvery white scaly, sharply demarcated, indurated plaques, distributed symmetrically on the extensor surfaces of lower extremities and knees. No edema. Case Study: An Asian American Woman With Bipolar Disorder Assignment

ASSESSMENT:

Diagnostic test:

Dermoscopy

Auspitz sign –Positive for pinpoint bleeding when lesion surface is scraped.

Differential Diagnosis:

. Psoriasis

. Seborrheic dermatitis

. Tinea corporis.

There are multiple skin disorders that present with similar symptoms such as scaly dry skin, but they are also different and require a different method of treatment such as: Psoriasis, Tinea corporis, Seborrheic dermatitis. In the case of this patient, based on several factors this patient’s diagnosis is most likely psoriasis. Cardiovascular risk such as hypertension, hyperlipidemia additional to cigarette smoking, obesity, physical inactivity has been shown to increase ones risk of getting Psoriasis, along with high levels of stress. Psoriasis favors knees and elbows and the pruritus can be recurrent ( P.Gisondi, G, Tessari .2007). She has plaques on her knees and has experienced pruritus on and off since developing the lesions. The lesions are clearly demarcated which is a characteristic of psoriasis. Ely and Stone (2010) suggest that characteristics of a rash can narrow the differential diagnosis.

Tinea corporis has variable characteristics and commonly a clearing in the center of the lesion appearing ring like (Dains, Baumann, & Scheibel, 2016). Tinea corporis can affect any part of the body compared to psoriasis which favors knees, elbows, and extensor surfaces but does not usually involve the central face (Dains, Baumann, & Scheibel, 2016; Ely & Stone,2010).

Seborrheic dermatitis is a common skin condition that mainly affect your scalp, include chronic scaling, possible pruritus, erythema, and flaking which are similar to psoriasis. Seborrheic favors oily areas of the body such as the face, ears, eyebrows or chest (mayo clinc, 2018) which is not the area of eruption for this patient. Patches of seborrheic dermatitis are not sharply demarcated (Dains, Baumann, & Scheibel, 2016). After reviewing the family health history, the patient has been experiencing recent stress related to her father’s advancing Melanoma. Both psoriasis and seborrheic dermatitis can be aggravated by stress (Dains, Baumann, & Scheibel, 2016), but sun exposure effects psoriasis by slowing skin cell turnover reducing the inflammation and scaling (Søyland et al., 2011).

Based on the patient’s signs and symptoms include the family health history and the objective data gained from this assessment, psoriasis is the most likely diagnoses. Case Study: An Asian American Woman With Bipolar Disorder Assignment

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References,

Albornoz, M. D., Lopez, C. A., & Alfonzo, N. (1972). First case of tinea corporis due to Microsporum racemosum (Dante Borelli, 1965). Dermatologia Venezolana, 11(2), 310-18.

Borda, L. J., & Wikramanayake, T. C. (2015). Seborrheic dermatitis and dandruff: a comprehensive review. Journal of clinical and investigative dermatology, 3(2).

Gisondi, P., Tessari, G., Conti, A., Piaserico, S., Schianchi, S., Peserico, A., … & Girolomoni, G. (2007). Prevalence of metabolic syndrome in patients with psoriasis: a hospital?based case–control study. British Journal of Dermatology, 157(1), 68-73.

Stary, A., & Sarnow, E. (1998). Fluconazole in the treatment of tinea corporis and tinea cruris. Dermatology, 196(2), 237-241.

Due date: Monday by 02:00 EST

Good luck!!

Please do not wait until the last minute to complete assignments, discussions or quizzes as we all know technology can be quirky from time to time. This is a GRADUATE LEVEL program and you should be managing your time effectively by this point in your academic and professional career.

Case Study: An Asian American Woman With Bipolar Disorder Assignment