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QUESTION
Create a presentation of your choice. Use PowToon, Kaltura, Prezi, infographic, or another medium aside from a written paper.
NOTE: If your recorded voice is part of the presentation, a transcript is required.
Videos should not exceed 10 minutes.
Include in-text citations, in current APA format, within the presentation itself.
Provide references, in current APA format, that match the in-text citations within the presentation.
References should be professional sources and no more than 5 years old.
Create a patient scenario for the behavioral health issue that corresponds with the first initial of your last name in the table below. This information was also provided in the Week 5 announcement made by faculty.
Behavioral Health Diagnosis : Bipolar Disorder
Include the following sections:
Patient chief complaint
History of present illness
Social history
Family medical history
Past medical history
Medications currently taken
Include specific drug names (not drug class), dose, frequency
Medications you will prescribe to address current situation.
If you are unable to prescribe anything for the current situation, explain why and what the plan will be to address the issue/symptoms.
State and Federal Regulations
Identify the state where you live.
Identify what your state laws say about prescribing behavioral health drugs without being certified and/or credentialed as a psych-mental health NP.
How does the Affordable Care Act affect behavioral health care?
How do these factors impact the patient in the scenario you provided?
Community Resources
Provide information on how you would know if the patient you create needs support beyond what you can provide as a primary care NP.
Identify community resources available in your area to refer patients in need of assistance before they can establish care with a primary mental health provider.
Identify the facilities in your area where you would send a patient in need of urgent assessment and intervention.
Identify resources in your area that are available to patients who may not be able to afford behavioral health care.
Legal & Ethical Considerations
Identify potential legal issues that could arise from how you do or do not choose to treat this patient.
Identify potential ethical issues that could arise from how you do or do not choose to treat this patient.
What follow-up is needed for your patient?
What do you need to do as a primary care provider to mitigate potential risks in providing care for behavioral health concerns?
ANSWER
Behavioral Health Diagnosis
Patient Situation
Primary concern of the patient
“I have been extremely energetic and joyful in recent weeks, but now it seems like I am losing my grip and can’t concentrate on anything. My sleep is disturbed, and I have been spending money with no regard for consequences. I also experience irritability and restlessness.
Present illness history
The patient, Ms. Brown, is a 35-year-old woman who comes with a background of bipolar disorder. She has been identified with bipolar disorder Type I for a decade and has experienced both manic and depressive episodes. She states that her current episode started roughly two weeks prior and has steadily deteriorated. She describes feeling elevated, reduced sleep, heightened energy, racing thoughts, and becoming easily sidetracked. Additionally, she mentions irritability, restlessness, and impulsive actions, such as excessive spending. Social background Ms. Brown is presently employed as an advertising manager and shares her living space with her partner. She has a past of alcohol misuse and used to smoke. She denies any recent alcohol or drug use.
Family health background
Her mother has experienced depression and anxiety. No family history of bipolar disorder or other psychological illnesses is present. Previous medical background Ms. Brown has a background of bipolar disorder, Type I, and has undergone treatment with mood stabilizers and antipsychotics in the past.
Current medications
Ms. Brown is currently using lithium carbonate 900mg, once daily, for mood stabilization. Medications suggested for the current situation As a primary care NP, I would recommend Ms. Brown take olanzapine 10mg, once daily, for acute mania, and lorazepam 1mg, as necessary for restlessness and anxiety. I would also raise her lithium carbonate dose to 1200mg, once daily, for mood stabilization (Kishi et al., 2021). State and Federal Regulations I reside in New York State. According to state law, nurse practitioners can prescribe behavioral health medications without certification or credentialing as a psych-mental health NP, as long as it falls within their practice scope (Buppert, 2020). The Affordable Care Act: The Affordable Care Act has broadened access to behavioral health care by mandating insurance providers to cover mental health services at the same rate as medical services. This has enhanced treatment accessibility for patients like Ms. Brown, who might have been unable to afford treatment previously (Howell et al., 2019). Community Assistance If Ms. Brown requires help beyond my capacity as a primary care NP, I would direct her to a mental health professional, such as a psychiatrist or a licensed clinical social worker. In my region, various community resources are available for patients needing support, including mental health centers, crisis helplines, and support groups. I would also refer her to the National Alliance on Mental Illness (NAMI) for further assistance.
Facilities for immediate evaluation and intervention
In my locality, several establishments offer immediate evaluation and intervention for patients encountering a psychiatric crisis, including the psychiatric emergency department at the nearby hospital and the Crisis Stabilization Unit at a neighboring mental health center. Resources for patients unable to afford behavioral health care Ms. Brown might qualify for financial aid for behavioral health care through Medicaid or a sliding fee scale program provided by a community mental health clinic. Legal and Ethical Factors Possible legal complications that could emerge from treating Ms. Brown include prescribing medications beyond the scope of practice, prescribing controlled substances without adequate monitoring, and not securing informed consent. Ethical dilemmas could involve balancing patient autonomy with treatment necessity and maintaining confidentiality while delivering appropriate care.
Essential follow-up
As a primary healthcare practitioner, I would arrange a subsequent consultation with Ms. Brown in a fortnight to evaluate her reaction to the prescribed medication and keep an eye on possible adverse effects. Moreover, I would set up routine appointments to maintain continuous oversight of her bipolar condition and modify her medication as needed.
Addressing potential hazards in managing behavioral health issues
As a primary healthcare practitioner, it is crucial to recognize possible dangers and implement measures to address them. This encompasses remaining current on best practices for handling behavioral health problems, securing informed consent for treatments, observing patients for potential side effects and drug interactions, and sustaining proper documentation. Furthermore, establishing a connection with mental health specialists and community resources for referral when required is essential.
To address potential hazards in managing behavioral health issues as a primary healthcare practitioner, I would undertake the following actions. Firstly, remain current on best practices for managing bipolar disorder: This entails staying informed on the most recent studies, recommendations, and treatment methods for bipolar disorder. Secondly, secure informed consent for treatments: This encompasses discussing the prospective advantages and risks of medications with the patient and acquiring their agreement to proceed with the therapy. Additionally, monitor patients for potential side effects and drug interactions: This includes overseeing the patient’s response to medications and routinely evaluating potential adverse effects or drug interactions. Preserve proper documentation: This entails maintaining precise and current records of the patient’s medical history, medication, and treatment strategy.
Finally, cultivate a network of mental health specialists and community resources, which would involve compiling a list of mental health professionals and community resources for patient referrals when needed. By implementing these measures, I can help ensure that my patients with bipolar disorder obtain secure and efficient care, while minimizing potential hazards and unfavorable outcomes.
References
Buppert, C. (2020). Nurse practitioner’s business practice and legal guide. Jones & Bartlett Learning. https://dl.uswr.ac.ir/bitstream/Hannan/32532/1/9781284117165.pdf
Howell, B. A., Wang, E. A., & Winkelman, T. N. (2019). Mental health treatment among individuals involved in the criminal justice system after implementation of the Affordable Care Act. Psychiatric Services, 70(9), 765-771. https://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201800559
Kishi, T., Ikuta, T., Matsuda, Y., Sakuma, K., Okuya, M., Mishima, K., & Iwata, N. (2021). Mood stabilizers and/or antipsychotics for bipolar disorder in the maintenance phase: a systematic review and network meta-analysis of randomized controlled trials. Molecular psychiatry, 26(8), 4146-4157 https://www.nature.com/articles/s41380-020-00946-6
