Case Study:
• Your patient is a 36-year-old woman with bipolar disorder and anxiety. She has been stable on a combination of fluoxetine and olanzapine for two years. She is morbidly obese at 340 pounds at 5’5” in height, has type II diabetes, hypertension, and hyperlipidemia. She has concerns about her weight and has tried numerous ‘fad diets’ to no avail. She explains she has lost, at most, 15 pounds and has been able to keep it off for three months.
• She has three children, one of which is severely disabled, and a husband who has a terminal diagnosis. She expresses worry that her weight will impact her ability to care for her disabled child when her husband dies. She reports she eats out frequently due to her children’s busy schedules. She is a stay-at-home mother but gets little exercise and performs no regular physical activity.
• She reports feelings of shame that she can no longer orgasm on the rare occasions her husband has the energy and desire to be intimate.
Questions:
• What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence.
• What would be our approach to the sexual side effects she is experiencing?
• If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended?
• Please include the subjective and objective information in this post.
All responses must by supported by correct APA 7th edition formatted citations and references.
- What would be your approach to managing this patient's weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence.
- Non-pharmacological Approach
- Pharmacological Approach
- What would be our approach to the sexual side effects she is experiencing?
• Lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support.
Full Answer Section
**2. Referral to a registered dietitian (RD)
A referral to a registered dietitian (RD) can be very helpful for patients who are struggling to lose weight on their own. An RD can create a personalized meal plan for the patient based on their individual needs and preferences. They can also provide support and guidance as the patient works to change their eating habits.
Research-based evidence
A systematic review of 39 studies found that lifestyle interventions, such as diet and exercise, are effective in promoting weight loss in patients with obesity. The review also found that lifestyle interventions can lead to improvements in other health conditions, such as blood pressure, cholesterol levels, and blood sugar control.
Approach to managing the patient's sexual side effects
The first step in managing the patient's sexual side effects is to determine if the olanzapine is causing the problem. Olanzapine is a known side effect of antipsychotic medications, but it is not as common as some other medications, such as risperidone. If it is determined that the olanzapine is causing the problem, there are a few things that can be done.
One option is to switch to a different antipsychotic medication. There are a number of antipsychotic medications that are less likely to cause sexual side effects. Another option is to reduce the dose of olanzapine. However, it is important to note that reducing the dose may also reduce the effectiveness of the medication.
If the patient is not able to switch to a different medication or reduce the dose of olanzapine, there are a few other things that can be done to manage the sexual side effects. One option is to use lubricants or vaginal moisturizers. Another option is to use vibrators or other sex toys. The patient may also want to talk to a therapist about ways to cope with the sexual side effects.
Research-based evidence
A study of 100 patients with schizophrenia found that switching from olanzapine to aripiprazole was effective in reducing sexual side effects without compromising the effectiveness of treatment.
Prescribing laws
In the state of Washington, PMHNPs are able to prescribe all antipsychotic medications, including olanzapine and aripiprazole.
Conclusion
The patient's weight and sexual side effects are complex issues that will require a multifaceted approach. It is important to involve the patient in decision-making and to provide her with the support and resources she needs to succeed.
Sample Answer
Approach to managing the patient's weight concern
**1. Patient education
The first step in managing the patient's weight concern is to provide her with education on healthy eating and exercise habits. This includes teaching her about the importance of a balanced diet, portion control, and regular physical activity. It is also important to discuss the risks associated with her current weight, such as heart disease, stroke, and type 2 diabetes.