NURS 6630 Week 10 Assignment 2: Special Considerations for Patient Populations Paper Example Comprehensive Treatment Plan for Schizophrenia: Optimizing Medication Adherence and Symptom Management

The case of a 27-year-old male schizophrenic patient underscores the complexities involved in managing the disease, particularly in relation to medication adherence. Despite the proven effectiveness of paliperidone, the patient finds it challenging to maintain a regular medication schedule, leading to relapses and multiple hospital readmissions. Schizophrenia poses unique challenges in medication adherence due to a variety of factors, including cognitive deficits, a lack of insight into the illness, and the occurrence of psychotic symptoms such as delusions and hallucinations, which can hinder the patient’s ability to acknowledge the necessity for medication (Guo et al., 2023).

One of the primary pharmacological approaches to improve medication adherence in patients with schizophrenia is the utilization of long-acting injectable (LAI) antipsychotics, with paliperidone, highlighted in the case study, being an example. The aim of this paper is to formulate a comprehensive treatment approach for the patient, which encompasses the choice of medication, dosing determination, patient education, required laboratory tests or diagnostics, monitoring of side effects and drug efficacy, clarification on the unsuitability of other medications, and any further collaboration or education that might be needed.

Selected Medication, Dosing, and Patient Education

Paliperidone, an atypical antipsychotic, is selected due to its established efficacy in controlling schizophrenia symptoms. Considering the patient’s history of medication non-adherence, an LAI drug, paliperidone palmitate, is recommended to maintain steady blood concentrations and enhance adherence. The medication has the benefit of guaranteeing consistent medication delivery, eliminating the requirement for daily pill intake, and minimizing the likelihood of non-compliance (Minwalla et al., 2021).

For the patient in this case study, Invega Trinza, a three-month injectable variant of paliperidone, offers a practical solution with fewer dosing intervals, which could potentially boost adherence. The recommended maintenance dose for Invega Trinza is 117 mg IM on a monthly basis, with some patients requiring a lower or higher dosage within a monthly dosage range of 39-234 mg (Minwalla et al., 2021; Riboldi et al., 2022).

However, before starting Invega Trinza, patients must have been treated with the monthly paliperidone injection for a minimum of four months. When transitioning from the monthly injection to Invega Trinza, it is crucial to adjust the dose carefully based on the previous monthly dose. While Invega Trinza provides the benefit of less frequent dosing, it is crucial to closely monitor the patient due to delayed response to dose adjustments.

Patient education is vital for treatment adherence and efficacy. The patient and their family must comprehend the significance of taking medication consistently. They should also receive information about paliperidone’s mechanism of action, potential side effects such as sedation and weight gain, as well as methods for addressing any adverse effects. Furthermore, it is crucial to address crisis management strategies to assist the patient and their family in effectively managing symptomatic episodes. Crisis management education should underscore the crucial need for building a robust support network, involving both healthcare professionals and close relations, to offer steadfast guidance and aid throughout demanding phases.

Necessary Labs, Diagnostics and Monitoring

Before initiating treatment with paliperidone, a series of lab tests and diagnostic procedures are performed to safeguard patient health and enhance the effectiveness of the treatment. Key metabolic parameters, such as fasting blood glucose levels and lipid profile, are established at the outset to evaluate metabolic status and identify any risk factors for metabolic syndrome, a side effect associated with antipsychotic medications (DeJongh, 2021). Tests to assess liver function are vital to monitor hepatic health and identify any potential liver irregularities.

In contrast, tests for renal function are necessary to ensure uninterrupted renal clearance of the medication. An electrocardiogram (ECG) is recommended to evaluate heart function and identify any existing heart abnormalities or risk factors, particularly given the possibility of QT interval prolongation linked to the use of paliperidone (