Answer

Kootu Bulambo Case Study

1. What diagnosis would you consider for Kootu?

Kootu is suffering from Schizophrenia. Schizophrenia is a chronic and at the same time severe well known mental disorder, which is currently rated to be affecting approximately 20 million people in the worldwide population (Atkinson et al., 2014). This disorder is usually characterized by several symptoms which are distortion in perception, language, thinking, emotions and self-sense, and behavior (Atkinson et al., 2014).

 An individual with Schizophrenia usually shows commons signs of hallucinations which entails hearing or seeing voices or things that are not there, and delusions which are false or even fixed believes. The disorder is also associated with a kind of disability that usually in most cases affects the person’s occupational and educational performance (Atkinson et al., 2014). In the case study, Kootu portrayed high negative symptoms of the disorder with poor functional outcomes and also poor life quality or lifestyle.

 Increased negative symptoms of the disability tend to lead to a huge burden to the caregivers which was the case of Kootu. The patient had lost her house due to lack of rent after she lost her job in her first admission which landed her in the shelter. The patient also experienced hallucinations and delusions which are evident in her first brief admission where she believed male and female officers were having sex with her frequently and she was also being recorded on cameras. From the positive Negative Syndrome Scale, the results showed a high scale of the negative symptoms.

1.  You decide to start a long-acting injection. What are the pros and
   cons of starting a long-acting injection? What barriers are you going
   to run into with her being homeless?

According to the case study “the patient had already been given two doses of the aripiprazole short-acting intramuscular injection without showing any adverse effects”. Since the patient had refused to take any oral medication of the aripiprazole, a long-acting injection should be commenced excluding the two-week oral drug recommended period.

Advantages of long-acting injection of antipsychotics medication include;

1. Increased adherence to medication
2. Decreased need for daily oral doses
3. The clinic visits for the patient’s injections creates a good opportunity for monitoring by the clinician and for building consistent relationship with the patient (Chung et al., 2012).

Disadvantages of long-acting injections of antipsychotics medication are;

1. Slow titration periods- the dose has to be started slow and increased gradually.
2. Pain during injection
3. Long lasting side effects of the injection
4. A must clinic visits for the injection.
5. Stigma associated with the long-acting injection for psychotic medication (Chung et al., 2012).

Barriers due to homeless state of the patient

The major barrier that will be encountered during this treatment is the patient may miss the clinic injection appointments eventually causing disengagement from the treatment (Parellada & Bioque, 2016).

Additionally, the medication is linked to some adverse effects which can cause serious medical effects hence affecting the attitude of the patient concerning the treatment (Parellada & Bioque, 2016). In the state of being homeless, it would be difficult for Kootu to deal will the side effects without close monitoring by any close family or caregivers. 

1. Pick an appropriate long-acting injection and explain the mechanism of
   action, starting dose, patient education, baseline labs that need to
   be done, and possible food/drug interactions that you must be aware of
   while you have her on this injection

Aripiprazole is an antipsychotic medication in the second generation which is licensed to treat schizophrenia disorder. The use of aripiprazole long-acting injection to the Schizophrenia adverse negative effects has proved to be effective (Miyamoto & Fleischhacker, 2017). Aripiprazole has a unique mechanism of action following the “partial agonism at dopamine D2 receptors when compared to all other second-generation antipsychotics medication”. Aripiprazole usually rebalances dopamine and serotonin in a Schizophrenia patient to improve their thinking, behavior, and also mood. The efficiency of the drug has been well established (Miyamoto & Fleischhacker, 2017). 

Approved by the US Food and Drug administration aripiprazole long-acting injection should be administered 40mg dose once a month intramuscularly for treatment initiating and maintenance Schizophrenia treatment (Miyamoto & Fleischhacker, 2017). The dose should be administered concurrently with oral aripiprazole during the medication first fourteen dosage days. The nurse practitioner is supposed to discuss with the patient first the side effects of the injection which may be very severe as well as the benefits and the mode of administration. 

Caution must be taken before administering the injection like checking if the patient may have an allergy to the drug ingredients, any ongoing medication, or self-prescribed drugs, to avoid alcohol or any illegal drugs (Atkinson et al., 2014). Concerning the diet, the medication calls for a normal diet but ensure they are feeding properly to deal with the strong effects of the medication.

1.  What additional challenges will you face with Kootu due to her being
   homeless and without an income or financial support? Call a local lab
   and ask about what it costs for the blood tests you want her to have.
   Call a local pharmacy and ask how much the medication would be out of
   pocket.

It will be difficult for Kootu to get the needed medication due to her financial constraints. Secondly being homeless and living at the shelter she cannot get proper care especially in terms of feeding properly or where to get support for the medication in terms of finance.

WHO’s Mental Health Gap Action Programme (mhGAP), which was launched back in 2008 makes use of tools and also training packages in expanding mental services across the world in poor-settings like the case of Kootu (Thornicroft et al., 2018).

WHO Quality Rights project helps to improve the quality of patient care and the conditions of human rights in social care and mental health facilities (Thornicroft et al., 2018). The program recommends healthcare providers shift the mental services from the institutions and carry them down to the community where they are most needed like in the case of Kootu who is unable to afford medication. Kootu can benefit from WHO Mental Health Gap Action Programme (mhGAP).