Unit 12 Assignment – Clinical: Journal Reflection

Reflective Journal Instructions

You will create 7 entries for your Reflective Journal about a patient encounter. In the 7th entry, you will review the previous 6 entries and evaluate your progress in reflective practice over the course of the term.  Each journal should be a minimum of 250 words. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

The purpose of this reflective journal is self-reflection regarding the role in the process of self-reflection as a PMHNP provider. Through reflective practice, the student will evaluate their own emotional health and recognize one’s own feelings as well as one’s ability to monitor and manage those feelings. The point of the exercise is to learn yourself, your triggers, the types of cases you end up getting overly involved with, and those you’d rather refer to someone else. The idea is to be able to personally reflect on your behaviors/thoughts/decisions and how those impact you in the role of PMHNP.  (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

Address the following items: 

• For the following side effects, what are the options you can provide patients with?
  • Think about the risk/benefit of stopping, switching, or adding medication.
  • Explain the rationale for your decision: (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)
• • Akathisia/Tremors
  • EPS/TD
  • Weight gain
  • Metabolic Syndrome
  • Sexual Dysfunction
  • Blunted affect
  • Agranulocytosis

Use the appropriate APA formatting with a minimum of 2 references to support your work.

Note: Grades of Incomplete on this assignment will result in a clinical failure.

Rubric

NU675 Unit 12 Assignment – Clinical: Journal Reflection

NU675 Unit 12 Assignment – Clinical: Journal Reflection

CriteriaRatingsPts

This criterion is linked to a Learning OutcomeContent Reflection

8 pts

Level 5

Reflection demonstrates a high degree of critical thinking in applying, analyzing, and evaluating key course concepts and theories from readings, lectures, media, discussions activities, and/or assignments. Insightful and relevant connections made through contextual explanations, inferences, and examples. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

5.6 pts

Level 3

Reflection demonstrates some degree of critical thinking in applying, analyzing, and/or evaluating key course concepts and theories from readings, lectures, media, discussions activities, and/or assignments. Connections made through explanations, inferences, and/or examples. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

3.2 pts

Level 1

Reflection demonstrates limited critical thinking in applying, analyzing, and/or evaluating key course concepts and theories from readings, lectures, media, discussions, activities, and/or assignments Minimal connections made through explanations, inferences, and/or examples. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

0 pts

Level 0

Reflection lacks critical thinking. Superficial connections are made with key course concepts and course materials, activities, and/or assignments.

8 pts

This criterion is linked to a Learning OutcomePersonal Growth

8 pts

Level 5

Conveys strong evidence of reflection on own work with a personal response to the self-assessment questions posed. Demonstrates significant personal growth and awareness of deeper meaning through inferences made, examples, well developed insights, and substantial depth in perceptions and challenges. Synthesizes current experience into future implications. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

5.6 pts

Level 3

Conveys evidence of reflection on own work with a personal response to the self-assessment questions posed. Demonstrates satisfactory personal growth and awareness through some inferences made, examples, insights, and challenges. Some thought of the future implications of current experience. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

3.2 pts

Level 1

Conveys limited evidence of reflection on own work in response to the self-assessment questions posed. Demonstrates less than adequate personal growth and awareness through few or simplistic inferences made, examples, insights, and/or challenges that are not well developed. Minimal thought of the future implications of current experience. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

0 pts

Level 0

Conveys inadequate evidence of reflection on own work in response to the self-assessment questions posed. Personal growth and awareness are not evident and/or demonstrates a neutral experience with negligible personal impact. Lacks enough inferences, examples, personal insights and challenges, and/or future implications are overlooked. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

8 pts

This criterion is linked to a Learning OutcomeTimliness

4 pts

Level 5

Journal reflection is submitted on or before deadline.

2.8 pts

Level 3

Journal reflection is submitted within 1 day (24 hours) after the deadline.

1.6 pts

Leve 1

Journal reflection is submitted 1-2 days (25-48 hours) after the deadline.

0 pts

Level 0

Journal reflection is submitted 2-3 days (49-72 hours) after the deadline.

4 pts

Total Points: 20

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 Reflective Journal as a PMHNP provider Essay Example for Nursing Students

Akathisia/Tremors

The patient with Akathisia can be helped by stopping, switching, or adding other medications. Increasing medicine dosages relative to the side effects, like propranolol (beta blockers), can help reduce the symptoms (Citrome et al., 2021). Consequently, a PMHNP should switch medications in cases where the current medications are ineffective, such as prescribing high doses of vitamin B6 where antidepressants are failing. Besides, they can also discontinue a medication when it is not relieving the symptoms (Citrome et al., 2021). Discontinuing medications is associated with less harm. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

EPS/TD

Patients with Extrapyramidal Symptoms can be treated by discontinuing their medications or adding or switching to a different medication. Kahn et al. (2018) observe that it is adequate to discontinue the prescription of first-generation antipsychotics like haloperidol if the patient’s condition worsens, especially when they have other health conditions. Besides, they can switch medications, such as using loxapine instead of clozapine (Kahn et al., 2018). Clozapine has increases EPS. A practitioner can also prescribe other drugs alongside the antipsychotics, like haloperidol alongside clozapine, when the patient responds poorly to clozapine alone. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

Weight gain

Antipsychotic drugs increase hunger resulting in increased food consumption and weight gain. Such patients can be helped by stopping the medication increasing their hunger, such as stopping olanzapine medications, which have a high risk of weight gain (Corrigan, Ballentine & American Psychiatric Association, 2021). The patient may suffer withdrawal symptoms if the medication is spontaneously stopped. Practitioners can also switch patients’ medications when the rate of weight gain is high, such as prescribing low-risk medications like aripiprazole in place of olanzapine. They can also prescribe anti-obesity medications alongside psychotics to help the patient lose weight.  (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

Metabolic Syndrome

The side effects of metabolic syndrome can be treated by adding the patient’s medication, such as prescribing high blood pressure medications like ACE inhibitors (Capoten) alongside cholesterol medications like niacin (nicolar) (Melmed et al., 2020). The change helps increase the effectiveness of a single medication. Also, physicians can switch medications if the current ones are failing, such as prescribing niacin when statin therapy fails. This can help reduce elevated triglycerides. Additionally, Melmed et al. (2020) observe that physicians can discontinue prescribing antipsychotic medications like olanzapine to help ease the side effects of metabolic syndrome. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

Sexual Dysfunction

Sexual dysfunction may result from the side effects of various medications. It can be treated by examining its underlying cause (Basson & Gilks, 2018). For instance, physicians can discontinue antidepressants like amoxapine if they are the leading cause. However, the antidepressant must be replaced by another antidepressant-like mirtazapine (Remeron), to prevent worsening the patient’s psychological functioning. Consequently, Basson and Gilks (2018) observe that they can reduce its side effects by administering mirtazapine with estrogen therapy (tablet) to increase female patients’ sexual functioning. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

Blunted affect

Blunted affect treatment depends on the severity and underlying cause of the condition. Physicians can discontinue antidepressants like selective serotonin reuptake inhibitors (SSRIs) when they increase blunted effect in patients (Springer International, 2018). In this case, they can replace them with medications like venlafaxine to prevent worsening the patient’s psychological functioning. Also, Physicians can prescribe additional medications when the patient’s condition is not improving, such as duloxetine alongside the SSRIs to increase their efficiency.  (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

Agranulocytosis

Patients with agranulocytosis can be helped by discontinuing antidepressants like clozapine. They can also reduce it by using immunosuppressants like prednisone alongside other medications to suppress the immune system and increase white blood cell production (Sedhai, Lamichhane & Gupta, 2021). Also, they can prescribe filgrastim to ease the symptoms of agranulocytosis. (Reflective Journal as a PMHNP provider Essay Example for Nursing Students)

References

Basson, R., & Gilks, T. (2018). Women’s sexual dysfunction associated with psychiatric disorders and their treatment. Women’s health, 14, 1745506518762664.

Citrome, L., Yatham, L. N., Patel, M. D., Barabássy, Á., Hankinson, A., & Earley, W. R. (2021). Cariprazine and Akathisia, restlessness, and extrapyramidal symptoms in patients with bipolar depression. Journal of Affective Disorders, 288, 191–198.

Corrigan, P. W. Ballentine, S. L. & American Psychiatric Association. (2021). Health and wellness in people living with serious mental illness). American Psychiatric Association Publishing.

Kahn, R. S., van Rossum, I. W., Leucht, S., McGuire, P., Lewis, S. W., Leboyer, M., … & Wilson, D. (2018). Amisulpride and olanzapine followed by open-label treatment with clozapine in first-episode schizophrenia and schizophreniform disorder (OPTIMISE): a three-phase switching study. The Lancet Psychiatry, 5(10), 797-807.

Melmed S. Auchus R. J. Goldfine A. B. Koenig R. Rosen C. J. & Williams R. H. (2020). Williams textbook of endocrinology (14th ed..). Philadelphia: Elsevier.https://www.clinicalkey.com.au/dura/browse/bookChapter/3-s2.0-C20160054128.

Sedhai, Y. R., Lamichhane, A., & Gupta, V. (2021). Agranulocytosis. In StatPearls [Internet]. StatPearls Publishing.

Springer International. (2018). Neuroimaging of schizophrenia and other primary psychotic disorders. Springer. ISBN: 9783319973074