Decision #1
In the first decision, I, as the psychiatric-mental health nurse practitioner (PMHNP), may choose to begin with Zoloft 50 mg po daily. The main reason for the selection of Zoloft is due to the fact that it helps in reducing anxiety attacks within a very short period, thus, working towards ensuring that patients achieve the best possible health outcomes. Strawn, Wehry, DelBello, Rynn, & Strakowski (2012) indicate that the effectiveness of medication depends wholly on ability to deal with the health issues that a patient is facing within the shortest period possible. In this case, usage of Zoloft would offer such as a solution for the patient with the focus being towards building on overall effectiveness as part of the treatment process.
By making this decision, I was hoping that the client would experience a significant reduction in the tightness in his chest, as well as, shortness of breath resulting from issues associated with anxiety. Anxiety disorders create a situation where it becomes hard for patients to undertake their regular duties, as they affect the overall quality of their lives (Stahl, 2013). I was also hoping to reduce the HAM-A score to approximately 18 within a four-week period. An analysis of the expectation of the decision and the outcomes, it is clear that there is no visible difference, as the expectations are similar to the outcomes.
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Decision #2
In the second decision, I, being the PMHNP, choose to increase dose to 75 mg orally daily. The main reason defining this decision revolves around the fact that the patient is responding positively to the medication, which creates the need to increase his dose slightly. When make adjustment or changes to a patient’s dosage, it is important to consider the impacts of such changes on the patients themselves, as this would act as a key determinant of whether the change is effective (Stahl & Grady, 2010). In this case, the focus is on changing the client’s dosage slightly with the focus being towards building on positive outcomes.
Through the increase in dosage, I was hoping that the client would experience an even further reduction in his symptoms resulting from an anxiety disorder. As a PMHNP, the key focus is working towards creating an environment in which the patient would achieve the best possible health outcomes. In this case, the focus was on trying to reduce the patient’s symptoms through the increase in dosage for the medication (Lupi et al., 2014). On the other hand, I was hoping to decrease the patient’s HAM-A score to 10, which may translate to a 61% in reduction of the symptoms. The expectations and the outcomes do not show any major variations, as the client was able to achieve a HAM-A score of 11, which is somewhat close to the set out objective.
Decision #3
In the third decision, the focus is on maintaining the current dose for the client as a way of ensuring that patient works towards maintaining some form of positive response to the medication. When making decisions on whether to maintain, increase, or reduce dosage, it is important to reflect on the previous reactions that the client has had within different dose levels (Newman, Castonguay, Borkovec, Fisher, & Nordberg, 2008). In this case, the current dose has been critical towards reducing his symptoms by over 50% while minimizing the risk of side effects. Thus, this means that although increase in dosage may be viewed as a critical option, it also creates the risk for having to increase the possibility of side effects. From that view, it is important to maintain the current dose level as it is, as this would be of great value towards promoting effective treatment for the patient.
Ethical considerations might impact the treatment plan, as has been presented in the decisions, by ensuring that the plan matches the set out expectations from the patient. When making the decision on the dynamics of the treatment plan, one of the key areas to consider is the needs projected by the patient. In this case, the ability to include these needs as part of the treatment plan acts as a key determinant of ethical outcomes. In communication with the patient, ethical considerations would seek to build an avenue from which it would be expected that the patient must be accorded all information regarding the treatment plan. Thus, this means that the inclusion of ethical considerations will go a long way towards ensuring that the patient receives all information regarding the services offered.
Factors Influencing Pharmacokinetic and Pharmacodynamics Processes
In clients, some of the key factors that may influence pharmacokinetic and pharmacodynamic processes include haemodynamics, metabolism, pH, temperature, and gastrointestinal function. These factors play a critical role towards determining the overall capacity for the body to achieve overall effectiveness depending on the drugs that a patient would take for purpose of dealing with a specific health issue. From that view, it is important to consider such factors when making decisions, as have been presented above, as this would act as a key determinant of the expected success levels.
References
Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., ... & Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: a qualitative review. BioMed research international , 2014 .
Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., & Nordberg, S. S. (2008). An open trial of integrative therapy for generalized anxiety disorder. Psychotherapy: Theory, Research, Practice, Training , 45 (2), 135-146.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M., & Grady, M. (2010). Stahl’s illustrated anxiety, stress, and PTSD . New York, NY: Cambridge University Press.
Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depression and Anxiety , 29 (4), 328-339.
