NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis

NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis – Step-by-Step Guide

The first step before starting to write the NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis is to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the paper’s audience and purpose, as this will help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, review its use, including writing citations and referencing the resources used. You should also review the formatting requirements for the title page and headings in the paper, as outlined by Chamberlain University.

How to Research and Prepare for NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify a list of keywords related to your topic using various combinations. The first step is to visit the Chamberlain University library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from the Chamberlain University Library, PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last 5 years and go through each to check for credibility. Ensure that you obtain the references in the required format, such as APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next, create a detailed outline of the paper to help you develop headings and subheadings for the content. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis

The introduction of the paper is the most crucial part, as it helps provide the context of your work and determines whether the reader will be interested in reading through to the end. Begin with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence collected from the research, and ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance, as well as how it relates to the thesis statement. You should maintain a logical flow between paragraphs by using transition words and a flow of ideas.

How to Write the In-text Citations for NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis

In-text citations help readers give credit to the authors of the references they have used in their work. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

“The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Morelli et al. (2024), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Alawiye (2024) highlights that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.”

How to Write the Conclusion for NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis

When writing the conclusion of the paper, start by restating your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper by restating them. Discuss the implications of your findings and your arguments. Conclude with a call to action that leaves a lasting impression on the reader or offers recommendations.

How to Format the Reference List for NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically, and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Morelli, S., Daniele, C., D’Avenio, G., Grigioni, M., & Giansanti, D. (2024). Optimizing telehealth: Leveraging Key Performance Indicators for enhanced telehealth and digital healthcare outcomes (Telemechron Study). Healthcare, 12(13), 1319. https://doi.org/10.3390/healthcare12131319

Alawiye, T. (2024). The impact of digital technology on healthcare delivery and patient outcomes. E-Health Telecommunication Systems and Networks, 13, 13-22. 10.4236/etsn.2024.132002.

NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis Instructions

Part 1:

Bipolar II Disorder

Application of Course Knowledge: Use the mental health disorder Bipolar II Disorder and create a case study for a primary care client. You may use a client seen in practicum as the basis for the case study or you may create a case after researching your assigned disorder. In your initial post, address each of the following components using your own words:

Subjective data: chief complaint, history of present illness, demographic data, risk factors, previous medical, surgical, and psychiatric history

Objective data: Physical exam findings and mental status exam

Recommended diagnostic tests.

Based on the initial case presentation, list your top three differential diagnoses.

Choose the most likely diagnosis.

Support your decision with scholarly sources that represent a logical link between the case study and article information.

Present the actual diagnosis for your case study. Provide appropriate management options for the diagnosis.

Use the most current clinical practice guidelines to support your management plan.

Part 2:

Include the Following Sections:

1. Management Plan: Write a final management plan for the client you presented in the above Mental Health Case Study Discussion. Include the following components in the management plan:
   1. Primary diagnosis
   2. Recommended diagnostic testing based on clinical practice guidelines
   3. Medications
   4. Nonpharmacologic interventions
   5. Recommended follow-up schedule and referrals with rationale
2. Analysis: Complete an analysis of the case and management plan:
   1. Pathophysiology: Write a summary of the underlying pathophysiology of the diagnosis.
   2. Pharmacology: Write a summary of how the pharmacological agent chosen acts to reverse or control disease pathology.
   3. Additional analysis: Describe how clinical practice guidelines were used to make a diagnosis and management plan. If the case is based on a client you have seen in practicum, discuss how the client’s care compared to the recommended treatment guidelines.
   4. Follow-up and referrals: Describe what actions should be taken at the time of follow-up. If applicable, describe the client’s symptoms and response to the plan of care at the follow-up visit.
   5. Quality: Discuss any information you learned in the weekly discussion that impacted your approach to the creation of the client’s management plan or would inform your care of a future client with a similar disorder.
   6. Coding and billing: Identify all appropriate ICD-10 codes for the client.
3. Evidence-Based Resources
   1. Support the management plan and analysis with evidence from appropriate sources published within the last five years and the most recent clinical practice guidelines.
   2. Select articles and guidelines that represent a logical link to the management plan.
   3. Provide in-text citations and complete APA references for all selected scholarly resources.

NR603 Week 2 Assignment: Bipolar II Disorder Management Plan and Analysis Example

Part I: Bipolar II Disorder

Demographic Data

Initials: BA

Age: 22 years

Sex: Female

Residence: Virginia state

Occupation: Student

Subjective History

Admission: Involuntary

Informant: The patient and her mother

Chief Allegations

1. Persistently low mood for 3 weeks
2. Irritability and verbal aggression for 5 days
3. Excessive talkativeness for 4 days
4. Substance use

History of Presenting Illness

A 22-year-old female student from Virginia presents at the mental health unit with her mother, expressing concerns about her persistent low mood over the last three weeks. In addition to this, she has shown signs of irritability and verbal aggression for the past five days, as well as increased talkativeness over the last four days. Her mother observes a recent shift in behavior; previously, she would return home from college, participate in household chores, and tutor her younger sister. However, during the past three weeks, she has been secluded in her room upon returning home and avoids social interaction except during meals.

The mother’s inquiry uncovers that her daughter recently ended a romantic relationship with her boyfriend of 6 months. Additionally, she found two packets of cocaine in her possession. BA has displayed heightened irritability, aggression, and isolation, resulting in clashes with family and friends. She has also been absent from school due to a disagreement with her professor over disputed missing marks. Despite these symptoms, she partakes in unrestricted, lengthy conversations on diverse subjects and experiences disrupted sleep patterns by staying up until early hours watching movies and only sleeping for three hours before waking up.

When questioned, the patient refuses to acknowledge the necessity for treatment, claiming that she does not perceive herself as being unwell.

Previous Medical and Surgical History

She has a previous medical history of pneumonia but no past surgical history.

Psychiatric History

She denies any previous psychiatric diagnoses or treatments, making this her first encounter with mental health services.

Risk Factors

Recent stressor: Separation from her boyfriend

Substance abuse (cocaine)

Objective Data

She is in a fair general condition. She is not in any obvious respiratory distress. She has no jaundice, pallor, cyanosis, finger clubbing, edema, lymphadenopathy, or dehydration.

Her vital signs are stable, as demonstrated

Blood Pressure: 124/71 mmHg

Respiratory Rate: 22 breaths/minute

Pulse Rate: 77 beats/minute

Temperature: 98.4 F

SPO2: 100% in room air

Systemic Exam

No abnormal findings were revealed upon systemic examination.

Mental State Exam

She appears well-groomed and oriented to time, place, and person. Throughout the assessment, she seems restless and exhibits pressured speech with a flight of ideas, rapidly switching from one topic to another. Her mood is irritable, with a congruent affect. She holds grandiose delusions, convinced that her professor dislikes her the most in their class because she is the highest achiever; however, there is no evidence supporting this belief in her performance. While she demonstrates intact memory and good judgment skills, as well as abstract reasoning abilities, she lacks insight into her illness and does not recognize the necessity for treatment.

Recommended Diagnostic Tests

Laboratory tests, such as a full blood count, thyroid function assessments, and substance screening, may be requested to exclude physical ailments or mood disruptions triggered by substances. Further tests, such as a comprehensive metabolic panel and HIV screening, would be crucial for excluding other physiological explanations for the patient’s symptoms. Neuroimaging studies, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), are not typically standard diagnostic procedures for bipolar disorder but might be necessary if there are suspicions of underlying neurological disorders. The diagnosis of Bipolar II disorder ultimately depends on clinical assessment and the synthesis of various sources of data to make an accurate diagnosis and create a customized treatment plan suited to the patient’s requirements.

Differential Diagnoses and Rationale

Bipolar II Disorder (Main Diagnosis)

Rationale

Bipolar II disorder is identified by the presence of at least one hypomanic episode and at least one major depressive episode in an individual who has not experienced a full manic episode. The occurrence of these episodes cannot be attributed to other conditions such as schizoaffective disorder, schizophrenia, schizophreniform disorders, or delusional disorders (American Psychiatric Association, 2013; Severus & Bauer, 2020). The patient exhibits hypomanic characteristics, such as an abnormally and persistently irritable mood lasting for 5 days, disrupted sleep pattern, excessive talkativeness, racing thoughts during the mental state exam, and grandiose delusions. These symptoms have a significant impact on her academics and lead to truancy from school.

In addition, the patient has been experiencing depressive symptoms, including a persistent low mood, over the past three weeks. She has low energy, or rather, has lost energy (anergia), and now isolates herself in her room to avoid house chores and interacting with others. Additionally, she no longer finds pleasure in activities that were previously enjoyable, like doing household chores or tutoring her younger sister.

The patient’s symptoms, which involve cycling between depressive and hypomanic episodes, correspond with the diagnostic criteria for Bipolar II disorder as per the DSM-5.

Major Depressive Disorder (Differential Diagnosis)

Rationale

One or more significant depressive episodes identify Major Depressive Disorder without a background of manic or hypomanic episodes. The patient displays depressive symptoms such as persistent low mood, anhedonia, lack of energy, irritability, social withdrawal and disturbed sleep. However, the presence of hypomanic symptoms like increased talkativeness, racing thoughts, and delusions of grandeur indicates a mood disorder. The cycling between depressive and hypomanic episodes aligns more with Bipolar II disorder than MDD.

Schizoaffective Disorder (Differential Diagnosis)

Rationale

Schizoaffective Disorder is characterized by a combination of mood disorder (depressive or manic) and psychotic symptoms resembling schizophrenia. Delusions are a common characteristic of the psychotic symptoms displayed by the patient. However, the presence of clear mood episodes, including both depressive and hypomanic states, indicates that a mood disorder may be the primary diagnosis rather than Schizoaffective Disorder, in which psychotic symptoms occur independently from mood episodes.

Appropriate Management Options for the Patient

The management of the patient involves a combination of both pharmacological and non-pharmacological approaches. Initially, injectable antipsychotic medications may be administered to stabilize acute hypomanic episodes effectively. Available and cost-effective options include chlorpromazine, Fluphenazine (Modecate), or Clopixol Acuphase/Depot (Goes, 2023). Once stabilized, mood stabilizers are usually prescribed. While lithium is the preferred option, its narrow therapeutic index and potential for toxicity restrict its use. Therefore, alternatives like carbamazepine, sodium valproate, lamotrigine, as well as second-generation antipsychotics such as quetiapine and olanzapine are commonly employed.

Given the depressive nature of Bipolar II disorder, medications like sertraline (a selective serotonin reuptake inhibitor) or combinations of olanzapine and fluoxetine could be prescribed to address depressive episodes. Additionally, psychotherapeutic approaches such as psychoeducation, cognitive behavioral therapy, and interpersonal and social rhythm therapy may be utilized. Lifestyle changes such as regular exercise, a healthy diet, and stress management techniques are crucial for alleviating symptoms of depression linked to this condition.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425596

Goes, F. S. (2023). Diagnosis and management of bipolar disorders. BMJ (Clinical Research Ed.), e073591. https://doi.org/10.1136/bmj-2022-073591

Severus, E., & Bauer, M. (2020). Diagnosing bipolar disorders: ICD-11 and beyond. International Journal of Bipolar Disorders, 8(1). https://doi.org/10.1186/s40345-019-0177-5

Part II: Management Plan

Primary Diagnosis

The patient, BA, has been diagnosed with Bipolar II Disorder. This diagnosis is based on the presence of hypomanic and depressive symptoms such as persistent low mood, irritability, increased talkativeness, disrupted sleep patterns, and delusions of grandeur. These symptoms have had a significant impact on her academic and social well-being and are in line with the diagnostic criteria for Bipolar II Disorder described in the DSM-5.

Recommended Diagnostic Testing

Based on established clinical guidelines, the recommended diagnostic assessments for BA would encompass laboratory tests such as a complete blood count (CBC), thyroid function tests, and screening for substance use to rule out medical conditions or mood disturbances resulting from substance use. Since BA was discovered to be in possession of cocaine, it is essential to conduct a urine toxicology screen to rule out cocaine-induced mood dysregulation.

Additionally, considering BA’s active sexual status, it is crucial to include a pregnancy test, as this could influence the choice of prescribed medications. Furthermore, it may be necessary to conduct a thorough metabolic panel and HIV screening to eliminate other possible physiological causes for her symptoms. Although imaging studies such as computed tomography (CT) scans or magnetic resonance imaging (MRI) could be taken into consideration if there are concerns about underlying neurological conditions, BA’s case does not present any typical signs warranting imaging.

Medications

For immediate stabilization, the patient will receive an intramuscular injection of 100 mg Clopixol Depot as a STAT dose. The frequency of administration may vary from every two to four weeks based on the individual’s needs, with adjustments made according to the patient’s condition. This medication is beneficial in stabilizing acute hypomanic episodes. Upon achieving stability, the maintenance therapy plan will involve prescribing carbamazepine at a dosage of 200 mg taken twice daily. Carbamazepine has been found effective in managing both hypomanic and depressive episodes associated with Bipolar II Disorder (Grunze et al., 2021).

Lithium is commonly prescribed for both the acute and maintenance phases of bipolar II disorder treatment. However, due to its narrow therapeutic index and potential for toxicity, it requires strict monitoring (Goes, 2023). In contrast, carbamazepine offers advantages as it does not require such intensive monitoring, justifying its use in BA’s case. Valproic acid also serves as an alternative option for maintenance therapy; however, its link to neural tube defects limits its use in women of childbearing age or those planning pregnancy. Lastly, considering her severe symptoms and disrupted sleep patterns, Olanzapine 10 mg administered orally at bedtime would be necessary.

Non-pharmacologic Interventions

Non-pharmacological treatments, including psychoeducation, cognitive-behavioral therapy, and insight-oriented therapy, will be used in combination with pharmacotherapy. The mental state examination indicates that BA lacks insight and would, therefore, benefit from insight-oriented therapy to assist her in gaining a better understanding of herself (Grover et al., 2020). This could lead to positive changes in her behavior and mindset. Additionally, these interventions can aid BA in enhancing her relationships with family and friends, developing coping mechanisms, and establishing healthy lifestyle habits.

Recommended Follow-Up and Referrals

BA will receive regular follow-up appointments with a psychiatrist to evaluate the progress of treatment, make changes to medications as necessary, and offer continuous support. Referrals for psychotherapy sessions with a psychologist or licensed therapist will be arranged to address the underlying psychological factors contributing to BA’s symptoms. In addition, BA may find it helpful to participate in support groups or access community resources tailored for individuals with bipolar disorder. Initially, follow-up appointments will take place every two weeks to assess the response to treatment and then transition to monthly visits or as recommended based on clinical assessment.

In-Depth Analysis of the Case and Management Plan

Pathophysiology

In bipolar II disorder, the pathophysiology includes dysregulation of different neurotransmitters and neural circuits. There is a notable increase in the activity of monoamines like noradrenaline, dopamine, GABA, and serotonin, which has a substantial impact. Specifically, there is heightened dopamine transmission from the substantia nigra to the neostriatum during manic episodes, leading to increased sensory stimuli and movement (Lee et al., 2022).

Likewise, elevated noradrenaline transmission from the caudate nuclei and locus coeruleus is also noted. Furthermore, reduced GABA activity in GABAergic pathways throughout the hypothalamus, hippocampus, cerebral cortex, and cerebellar cortex is associated with both depressive and manic episodes, underscoring the intricate nature of neural dysfunction in bipolar disorder (Lee et al., 2022). The medications given for managing bipolar II disorder work by modifying neurotransmitter function to impact the symptoms seen in the patient.

Pharmacology

The management of bipolar II disorder follows both an acute and a chronic course. Clopixol depot functions by blocking dopamine D2 receptors in the brain (Pantall et al., 2021), thereby reducing dopamine effects and alleviating symptoms such as delusions, as observed in the patient. Carbamazepine, selected for BA’s maintenance therapy, serves as a mood stabilizer by regulating voltage-gated sodium channels to stabilize neuronal membranes and decrease excessive excitability, thus managing the pathological mood fluctuations characteristic of bipolar II disorder (Grunze et al., 2021). In contrast to lithium, carbamazepine provides the advantage of not needing frequent monitoring because of its broader therapeutic range. Lastly, Olanzapine works by antagonizing dopamine D2 and serotonin 5-HT2A receptors in the brain, which produces antipsychotic effects through neurotransmission modulation.

Additional Analysis

Clinical practice guidelines were crucial in diagnosing BA and developing her treatment plan. They provided guidance for systematically assessing her symptoms and selecting appropriate medication, such as carbamazepine for maintenance therapy and olanzapine. In severe cases of bipolar disorder, the guidelines recommend the use of a combination therapy, such as Lithium or Valproic acid, alongside an antipsychotic.

However, in BA’s case, these options were not considered due to concerns about the narrow therapeutic range and potential toxicity of Lithium, as well as the risk of neural tube defects associated with Valproic acid (Goes et al., 2023), which is especially relevant considering BA’s reproductive age. As a result, carbamazepine was chosen as a safer alternative. Although there are clear and accessible management guidelines for mental illnesses, the clinician’s extensive knowledge and clinical judgment were essential in customizing treatment to meet BA’s individual requirements.

Follow-up and Referrals

During the follow-up, it is crucial to examine BA’s response to carbamazepine and Olanzapine by monitoring symptoms and conducting clinical evaluations. Modifications to the management strategy may be required depending on her clinical response. Referring her to therapy or support groups could further improve her long-term management.

Quality

Engaging in regular discussions highlighted the need to consider the individual requirements and preferences of each patient when developing treatment plans. This insight had a profound impact on my approach to designing BA’s management plan, ensuring that it was carefully customized to match her unique clinical profile and circumstances. By incorporating these observations, my goal was to enhance the efficiency and relevance of her care approach.

Coding and Billing

Bipolar II disorder: F31.81

Major depressive disorder: F32.9

Schizoaffective disorder (F25)

Conclusion

In summary, the BA case demonstrates the significance of individualized care in addressing bipolar II disorder. By following established clinical guidelines and considering specific patient variables like age and medication tolerance, BA’s treatment was customized to maximize effectiveness and safety. This distinctive case emphasizes the crucial involvement of clinician knowledge in navigating treatment choices and highlights the importance of continuous assessment and adjustment of management approaches. In the future, consistent follow-up visits and recommendations for therapy will be vital to support BA’s sustained health and stability while effectively managing her condition.

References

Goes, F. S. (2023). Diagnosis and management of bipolar disorders. BMJ (Clinical Research Ed.), e073591. https://doi.org/10.1136/bmj-2022-073591

Grover, S., Avasthi, A., & Jagiwala, M. (2020). Clinical practice guidelines for the practice of supportive psychotherapy. Indian Journal of Psychiatry, 62(8), 173. https://doi.org/10.4103/psychiatry.indianjpsychiatry_768_19

Grunze, A., Amann, B. L., & Grunze, H. (2021). Efficacy of carbamazepine and its derivatives in the treatment of bipolar disorder. Medicina (Kaunas, Lithuania), 57(5), 433. https://doi.org/10.3390/medicina57050433

Lee, J. G., Woo, Y. S., Park, S. W., Seog, D.-H., Seo, M. K., & Bahk, W.-M. (2022). Neuromolecular etiology of bipolar disorder: Possible therapeutic targets of mood stabilizers. Clinical Psychopharmacology and Neuroscience: The Official Scientific Journal of the Korean College of Neuropsychopharmacology, 20(2), 228–239. https://doi.org/10.9758/cpn.2022.20.2.228

Pantall, S.-A., Whitehouse, E., & Brownell, L. (2021). A description of the use of zuclopenthixol decanoate long-acting injection in a large mental health trust. BJPsych Open, 7(S1), S340–S340. https://doi.org/10.1192/bjo.2021.891