Comparison of Collaborative Care – Bipolar Disorder Vs Addison’s Disease Patient

This paper addresses the comparison of collaborative care for a patient with mental health disorder (bipolar disorder) versus a patient with a medical disorder (Addison’s disease) in the acute care setting. Also referred to as manic-depressive disorder by Cooke and Horne (2012), bipolar disorder is a mental disorder, which influences an individual to have abnormal or unusual activity, energy and mood levels as well as increased ability to perform daily tasks. It is essential to note that bipolar symptoms can be severe. In fact, they differ from the usual high and low moments that every person undergoes every other time. The resulting consequences from bipolar disorder symptoms can include, but not limited to poor school or job performance, damaged relationships and suicide. It is, however, significant to note that bipolar disorder is treatable and victims of this condition can resume their normal, productive lives after treatment. Research shows that late teenage hood or early adulthood is the time when bipolar disorder begins appearing. Generally, half of the recorded cases of bipolar disorder have been reported to have started before the age of 25 years.

Addison’s disease, on the other hand, is a medical disorder, which occurs when a person’s body begins producing inadequate amounts or levels of particular hormones that the adrenal glands produces. The adrenal glands have two main parts: the outer shell (cortex), which surrounds the inner core (medulla) (Abdel-Motleb, 2012). Even though absence of the inner core (medulla) cannot cause any disorder, it is critical that the cortex is always present for production of steroid hormones. Addison’s disease is characterized by the adrenal glands producing too little aldosterone as well as cortisol. These two are steroid hormones that are vital for supporting life. Aldosterone is essential for controlling water and salt levels that influence blood volume and blood pressure. Cortisol, on the other, hand is essential for performing a number of activities such as triggering liver stimulation to start producing blood sugars, the body to fight inflammation, mobilizing nutrients, and, also, helping to control water levels in the body. Under normal circumstances, the adrenal cortex has a huge functional reserve that is signaled by the body, particularly during moments of intense stress such as trauma, surgery or any other serious infection. Therefore, it is essential to note that the body’s inability to adapt to stresses such as these comprise the most critical consequences that are influenced by Addison’s disease. In the event that there is insufficient steroid cover, an Addisonian crisis, which is a state of shock may result leading to a serious medical emergency.

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The underlying similarity between bipolar disorder and Addison’s disease is that both conditions are treatable, and patients can recover fully and resume their normal lives. In the case of bipolar disorder, treatment usually involves administration of psychotherapy and mood stabilizing drug. The primary treatment for this mental condition involves drug treatment; however, continuing psychotherapy is essential for enabling patients to handle the condition (Cooke & Horne, 2012). It is; however, essential to consider that bipolar disorder patients may remain on medication throughout their lives. Treatment of Addison’s disease, on the other hand, entails replacement of aldosterone and/or cortisol that the patient’s body secretes inadequately or is unable to produce. Upon conducting tests and physical examination, the treating doctor or endocrinologist will be able to determine whether the patient requires replacement of one or both hormones.

There are several differences that exist between bipolar disease and Addison’s disease. First, bipolar disorder is a mental health condition while Addison’s disease is medical condition. Bipolar disorder appears during early adulthood, mostly before an individual reaches 25 years while Addison’s disease affects any age. Diagnosis of bipolar hinges on the patient having moments of unusual irritability or elevation in the mood, which are, also, coupled with fast thinking, sleeplessness, and elevation in energy levels (Cooke & Horne, 2012). During diagnosis, the doctor asks detailed questions regarding the bipolar symptoms of the patient. Some of the questions may seek to evaluate the patient’s memory, reasoning, ability to maintain relationships, and self-expression ability. Diagnosis for Addison’s disease involves the doctor asking the patient questions regarding cases of autoimmune disorder in the family. Physical examination entails examining the patient’s skin to check if there is any brownish discoloration, especially in areas such as gums and lips and elbow crease. Performance of blood test may, also, be necessary in order to measure cortisol, potassium, and sodium levels in the body of the patient (Abdel-Motleb, 2012).

It should, also, be clear that bipolar disorder differs from Addison’s disease in terms of causes.  Bipolar disorder; for instance, is caused by a number of factors that include inherited traits, neurotransmitters, and biological difference. Addison’s disease, on the other hand, is caused by several factors that include autoimmune destruction of adrenal glands, tuberculosis, bilateral adrenal hemorrhage, and many other medications that prevent biosynthesis of cortisol thereby influencing adrenal insufficiency. The two conditions, also, differ from each other in terms of their symptoms. In bipolar disorder, the symptoms include being unusually distracted, talking very fast, sleeplessness, being overly restless, increasing activities, behaving impulsively and unrealistic belief in once capabilities. Addison’s disease, on the other hand, is expressed through the following symptoms: muscle weakness and chronic fatigue, blood sugar abnormalities, dark tanning of the skin, low blood pressure, craving of salt, and intolerance to cold or heat.

In managing bipolar disorder, the most critical beginning point entails administration of appropriate treatment in terms of medication and therapy. It is essential that patients receive the right information that relates to healthy lifestyle tips. Essential resources that are needed in the management of bipolar disorder include mood stabilizers and the right medications as well as efforts that entail considering proper diet, proper sleeping schedule, and healthy habits. Regarding medication, it is advisable for bipolar disorder patients observe and stick to the medication prescription given by the doctor. Carbamazepine and lithium are some of the most common mood-stabilizers available for bipolar patients (Cooke & Horne, 2012). Besides, more resources are, also, needed to support psychotherapy for bipolar disorder patients. Medications assist in stabilizing moods, but they cannot alter thinking patterns. Through psychotherapy, a patient may learn to develop the correct perspective, which, in turn, may prevent episodes of depression.

Managing a patient with Addison’s disease, also, requires substantial amount of resources just like in the case of bipolar disorder. According to Abdel-Motleb (2012), management of an acute adrenal crisis requires urgent establishment of VI access. In an acute care setting, a patient with Addison’s disease patient should be infused with an isotonic chloride solution to help in restoring the deficit. This is because, an Addisonian crisis being a life-threatening condition may result in high levels of potassium in blood, low blood sugar levels, and low blood pressure. More resources may be required because some patients may require glucose supplementation. In situations of stress, adrenal glands produces 250-300 mg of cortisol in every 24 hours (Abdel-Motleb, 2012).

Therefore, during a crisis, continuous infusion of isotonic chloride solution should be a preferable option. Except for crisis situations, treating Addison’s disease entails replacement therapies that help in normalizing steroid hormone levels that the body may not be producing adequately. In most cases, oral corticosteroids: cortisone acetate, prednisone, hydrocortisone may be preferred for replacing cortisol. Corticosteroid injections may be preferable for vomiting patients who are unable to retain oral medications. In addition, prescription of dehydroepiandrosterone is an appropriate androgen replacement therapy for treating the deficiency of androgen in women. Given both conditions: bipolar disorder and Addison’s disease, more resources are needed in caring for a patient with bipolar disorder than in caring for a patient with Addison’s disease.

The burden that a patient with bipolar disorder endures is not comparable to the burden endured by a patient with Addison’s disease. Severe cases of bipolar disorder exposes a patient to severe manic condition or depression, inability to look after self or inability to function, high risk of committing suicide and other unpleasant consequences (Cooke & Horne, 2012). The burden is severe because bipolar disorder patients have a high likelihood of committing suicide and the fact that become unable to take care of themselves can leave everything in a mess. Marriage relationships are, also, adversely affected during severe cases of bipolar disorder. During an Addisonian crisis, on the other hand, a patient experiences mental confusion, extreme weakness, pronounced dizziness, extreme drowsiness, severe headache, abdominal tenderness, and abnormal low  blood pressure. However, these conditions can be corrected in an acute care setting through infusion with an isotonic chloride solution.

While administering care to a bipolar disorder patient, there are a number of issues that may arise for both the family and the patient. First, family members are likely to encounter a considerable change in the patient’s personality. To their surprise, the family will note the extreme violent and abusive nature of the patient that sometimes, social workers and the police may be called in to provide assistance to the doctors and nurses (Cooke & Horne, 2012). At this point, there are noticeable incidences of strained relationship between family and the bipolar disorder patient. The second issue that, especially a patient is likely to encounter is infliction of harm upon self. This happens, particularly during episodic illness, when a patient’s mental confusion becomes extreme. Similarly, there are, also, a number of issues that the family may encounter while caring for a patient with Addison’s disease. First, the family the will notice that the patients faints from time to time, especially when he/she tries to stand. This incident is attributed to low blood pressure that leaves the patient feeling dizzy most of the time. The second issue that may arise, especially for the patient is muscle weakness and chronic fatigue.

There are several ethical and legal implications that Registered Nurses (RN) should consider while administering care to patients with bipolar disorder and Addison’s disease. In the case of bipolar disorder, ethical and legal implications that may arise. It is essential for RNs to embrace ethical decision making that is vital to compassionate and astute clinical care. Registered Nurses should note that patients are equally protected by the federal and state laws just like the case is for other normal citizens. It is essential for an RN to note that involuntary commitment of a bipolar disorder patient to care can easily be contested by the patient when he/she recovers. Therefore, a registered nurse requires applying for a writ of habeas corpus to enable him or her challenge any claims of unlawful detention (Pozgar, 2012). The RN should, also, ensure voluntary admission of all patients suffering from bipolar disorder. Ethical considerations require the RN to always observe confidentiality, and only disclose patient information to authorized persons. The RN should, also, not be reported in any cases of harassment, abuse or discrimination. Similarly, the RN requires observing confidentiality while attending to patients with Addison’s disease. Revealing information to unauthorized persons may instill fear in patients, which reduce their confidence in seeking for medical assistance from particular settings of care. The RN should, also, consider that patients with Addison’s disease are fundamentally protected by federal and state laws and, therefore, their rights access medication should not be compromised. The only difference in ethical and legal implications for the RN while caring for patients in both conditions is that there is no application of writ of habeas corpus in the case of Addison’s disease.

At this point, it is significant to consider that interprofessional team members are critical in providing collaborative and continuous care in an acute setting. Interprofessional team members implies a team of specialists from various disciplines who come together to collaborate in order to provide enhanced care to patients in acute care settings. The team works together, but each member delivers on areas of specialty. In the course of working together the members share vital information in order to support one another (Dossey, 2015). Through coordinating interventions and processes, the team is able to enhance provision of different services and programs. Family members and patients become included by the interprofessional team, especially at advanced levels of care. The collaboration between community health teams, family health teams and integrated health teams is an appropriate example where these teams collaborate to provide care for patients with various disorders.

There are various roles that a professional nurse can play within the team. A professional is critical for influencing delivery of care so that there can be overall minimization of errors, quality enhancement, and improved outcomes for patients (Dossey, 2015). The first example of a professional nurse’s role is coordination of patient care. Successful administration of treatment is the ultimate desire of all patients who commit to acute care settings. Therefore, ensuring that patients receive appropriate and timely care is one of the major roles played by a professional nurse. The second example of a professional nurse’s role is pain management. Lack of proper pain management approaches can spoil the patient’s quality of life. The third example of a professional nurse’s role is prevention and elimination of infections that may arise within the acute care settings. Some of these infections may occur in bloodstream.

It is essential for patients to adhere to medication regimen and follow-up visits in order to achieve positive or desirable outcomes. Failure by the patients to adhere to medication regimen and follow-up visits can result into a serious problem can negatively affect the patients and the entire health care system (Dossey, 2015). The first example of ensuring adherence is providing trust by way of communication. Proper communication regimes should exist between the physician and the patient in order to ensure adherence to medication regimen. Proper communication boost’s the patient’s trust in the instructions of the physician thereby enhancing adherence to medication regimen. The second example of ensuring adherence to medication regimen is imparting knowledge in the proper way. Knowledge helps the patient to appreciate the necessity of the treatment process and, this way, they get encouraged to adhere to medical regimen. The third example of ensuring adherence to medication regimen is simplifying the regimen so that the dosage, timing, frequency and amount fits in the schedule of the patient. There should be reduced mismatch between the patient’s daily activities and the medication regimen.

There are various measures that require consideration during evaluation of the efficiency of the interprofessional plan of care. During evaluation, the measures used should entail the three key perspective: the family, the team and the patient (Dossey, 2015). The strengths and resources that a patient owns comprise a critical measure for consideration, particularly where there can be need of mobilizing them so that each of the patient’s problems can be addressed. Other significant measures for evaluating effectiveness of interprofessional plan of care include the patient’s emotional, social, environmental and medical problems. An appropriately designed plan of care should be able to meet a number of objectives: first, it should improve the safety and quality of care; second, it should enhance patients’ accessibility to care; third, it should have the capacity to minimize exhaustion within health professionals and, at the same time, boost the morale of the provider; and fourth, it should enhance efficiency and coordination of care to patients. Through utilization of certain tools such as E-walk, implicit evaluation test, knowledge test, and zaption video assessment, the RN can be able to evaluate the interprofessional team efforts and thereby identify essential medications (Dossey, 2015).

In conclusion, this paper addressed the comparison of collaborative care for a patient with mental health disorder (bipolar disorder) versus a patient with a medical disorder (Addison’s disease) in the acute care setting. Bipolar disorder is a mental disorder, which influences an individual to have abnormal or unusual activity, energy and mood levels as well as increased ability to perform daily tasks. Addison’s disease, on the other hand, is a medical disorder, which occurs when a person’s body begins producing inadequate amounts or levels of particular hormones that the adrenal glands produces.

The underlying similarity between bipolar disorder and Addison’s disease is that both conditions are treatable, and patients can recover fully and resume their normal lives. Bipolar disorder is caused by a number of factors that include inherited traits, neurotransmitters, and biological difference. Addison’s disease, on the other hand, is caused by several factors that include autoimmune destruction of adrenal glands, tuberculosis, bilateral adrenal hemorrhage, and many other medications that prevent biosynthesis of cortisol thereby influencing adrenal insufficiency. In managing bipolar disorder, essential resources that are needed in the management of bipolar disorder include mood stabilizers and the right medications as well as efforts that entail considering proper diet, proper sleeping schedule, and healthy habits. In regard to ethical implications for both conditions, the RN should observe confidentiality and only share patient information with authorized persons. It is essential for patients to adhere to medication regimen and follow-up visits in order to achieve positive or desirable outcomes.


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