Feb 23, 2024 Discussion: Treatment for a Patient With a Common Condition NURS 6630
Discussion: Treatment for a Patient With a Common Condition NURS 6630 A Sample Answer For the Assignment: Discussion: Treatment for a Patient With a Common Condition NURS 6630 Treatment for a Patient with Insomnia Three questions for the patient Do you have trouble falling asleep, and how often do you wake up at night after managing to sleep? Inquiring about the frequency will help determine the severity of the condition and the right intervention. Do you snore loudly and have trouble breathing when you wake up at night? This will help determine if there could be other underlying issues causing insomnia besides grief and depression. Are there distractions like noise, light, and noise around your place? This will help determine if the environment is contributing to insomnia. People to speak to and why I will speak with the people close to the patient, particularly her friends and family members. The family members will help explain her sleep habits, while the friends will help establish how insomnia affects her daily activities Struggling to Meet Your Deadline? Get your assignment on Discussion: Treatment for a Patient With a Common Condition NURS 6630 done on time by medical experts. Don’t wait – ORDER NOW! Meet my deadline Physical exams and diagnostic tests I would physically assess the nasal septum and the tonsils. According to Krystal et al. (2019), this examination will help determine if insomnia could be aggravated by obstructive sleep apnea. I will also use actigraphy to monitor the patient’s movement after falling asleep. Actigraphy will help determine the severity of the condition. Most likely differential diagnosis and why The differential diagnosis for insomnia includes mental illness, medical conditions, drug or substance use, obstructive sleep apnea, or inadequate sleep hygiene. The most likely differential diagnosis for this case is mental illness. The patient suffered a loss; thus, she is likely to be experiencing sleep disturbance due to bereavement and depression. Two pharmacologic agents and their dosing Benzodiazepines and Agomelatine are highly suitable for treating patients with insomnia resulting from depression. The patient should take 15 to 30 mg of Benzodiazepines daily and 25 to 50 mg of Agomelatine daily (Morera-Fumero et al., 2020). The two present a combination of sedative and non-sedative antidepressants; hence, they’ll suit the patient. The combination also offers both long-term and short-term solutions. Contradictions or alteration in the dosing drug and why Agomelatine dosage can be increased to 50mg daily if the condition does not improve. However, Norman and Olver (2019) warn that the drug should not be used for more than 24 weeks as extended use can result in dementia in patients above 75 years. The drug also has side effects like active liver disease and liver cirrhosis. Benzodiazepines should not be used for long-term solutions as they may lead to addiction. Morera-Fumero et al. (2020) explain that the other side effects of Benzodiazepines include drowsiness, headache, and respiratory arrest. Checkpoints and any therapeutic changes I will monitor for improvement after three, six, twelve, and 24 weeks of treatment to determine the effectiveness of the Agomelatine drug. Norman and Olver (2019) explain that monitoring any side effects of liver disease, like dark urine, yellow skin, eyes, and fatigue, is crucial. Regarding the Benzodiazepines, I will evaluate changes after three days, one week, and four days. The treatment will not last for more than two weeks, and in each period, I will monitor headaches and breathing challenges. References Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World Psychiatry, 18(3), 337-352. Morera-Fumero, A. L., Fernandez-Lopez, L., & Abreu-Gonzalez, P. (2020). Melatonin and melatonin agonists as treatments for benzodiazepines and hypnotics withdrawal in patients with primary insomnia. A systematic review. Drug and Alcohol Dependence, 212, 107994. Norman, T. R., & Olver, J. S. (2019). Agomelatine for depression: expanding the horizons?. Expert opinion on pharmacotherapy, 20(6), 647-656. List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions. Have you ever been hospitalized or undergone any surgical procedure? Are you allergic to any medication? Do you smoke, drink alcohol, or take any other recreational drugs? Rationale: Asking the patient about her surgical and hospitalization history is crucial as it gives insight into whether the patient may be having underlying conditions which were not properly resolved and contributing to her current symptoms. Finding out about her allergies is also necessary as this helps prevent prescribing medications that might lead to allergic reactions hence undermining the patient’s health (Khaledi et al., 2019). Finding out about the patient history of substance use is also crucial to promote lifestyle modifications such as smoking cessation, or quitting alcohol which are the main risk factors for DM and HTN. Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. Close family members such as the patient’s children: How does the patient behave at home? How has the patient been grieving? Rationale: The patient’s children or close family members with whom they reside are great historians who will provide more information regarding the patient’s behavior at home, for further understanding of her symptoms (Zaki et al., 2020). The grieving process is also crucial to promoting positive mental health. This information will also help in determining the best psychotherapeutic approach to help with the patient’s depression. Close friends: Has the patient been reaching out ever since her husband passed on? Has the patient’s behaviour in social places changed ever since her husband passed on? Rationale: The patient’s close friends are great historians to provide further information regarding the patient’s behavior in social settings. Asking them whether the patient has been reaching out helps determine whether she is withdrawn (Khaledi et al., 2019). Her friends will also be able to notice whether there is a change in her behavior ever since she lost her husband. This information will help determine the progress of her depression, and additional symptoms such as agitation or irritability. Explain what, if any, physical exams and diagnostic tests would be appropriate for the patient and how the results would be used. Physical Exams: It is important to check the patient’s blood pressure to determine whether her HTN is well controlled. Blood test for lipids will also be done as healthy triglycerides and cholesterol level reduces the risks of stroke or heart attack. A blood sugar test is necessary to determine whether the patient’s DM is well managed (Zaki et al., 2020). Additional routine physical examinations for the patient include a colorectal cancer exam, vaccinations, periodontal exam, eye exam, hearing test, thyroid stimulation hormone screening, vitamin D test, bone density scan, skin check, and prostate cancer screening. Discussion: Treatment for a Patient With a Common Condition NURS 6630 Diagnostic tests: There are no specific diagnostic tests for the patient’s chief complaint of insomnia. However, given her advanced age and history of HTN and DM, routine tests for the patient will include complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, vitamin b12 test, Hemoglobin A1C, brain natriuretic peptide (BNP) test, pap smear, ECG, and mammogram (Zaki et al., 2020). The test results will be used to find out whether the patients presenting illnesses are well managed, and whether any other underlying conditions are contributing to her current symptoms. Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Discussion: Treatment for a Patient With a Common Condition NURS 6630 List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why. Insomnia: According to the DSM-V insomnia has been defined as dissatisfaction with the quantity or quality of sleep associated with one or more symptoms such as difficulty starting to sleep or maintaining sleep characterized by being awakened frequently or failing to return to sleep after being awakened (Bei et al., 2018). This is the most possible diagnosis given that the patient had already been diagnosed with MDD but presented with a chief complaint of insomnia. Major Depressive Disorder (MDD): The patient was previously diagnosed with MDD, which was precipitated by the loss of her husband. MDD is also associated with a lack of sleep which might be contributing to the patient’s insomnia (Franzen & Buysse, 2022). Prolonged grief disorder: This disorder was recently added to the DSM-V for a patient who has lost a loved one and presents with a feeling of intense grief which persists just like the patient in the provided case study (Ahrenholz & Baernstein, 2020). List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. Sertraline 150 mg PO once daily Bupropion ER 150mg PO once daily Rationale: Sertraline is a selective serotonin reuptake inhibitor that is considered the first line for the management of the major depressive disorder. The drug has also been proven to suppress REM sleep in addition to delaying REM latency. Studies show that sertraline minimally reduces nocturnal wakefulness time and increases sleep efficiency which is beneficial for depressive patients with insomnia (Hassinger et al., 2020). Since the patient was already taking the drug with no reported side effects, it was necessary to increase the dose to 150mg once daily for more effectiveness in the management of the patient’s insomnia. Bupropion on the other hand is a good antidepressant that has also been associated with increasing REM sleep time among depressive patients with insomnia. However, the drug is considered a second-line therapy after SSRIs have failed to work due to increased risks of side effects. The drugs have also been reported to increase blood pressure hence not recommended for hypertensive patients like the one in the provided case study. For the drug therapy, you select and identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making? Sertraline is contraindicated in patients with increased risks of bleeding, syndrome of inappropriate antidiuretic hormone, manic depression, seizures, suicidal thoughts, low sodium levels in the blood, and liver problems among others (Bei et al., 2018). These contraindications are mainly due to the potential side effects of the drug, which might compromise the health of the patients with the above conditions. Such side effects include increased suicidality, easily bruising, fainting, tremors, and serotonin syndrome among others. Include any “checkpoints” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen. Close monitoring of patients on sertraline is necessary to promote positive treatment outcomes. For patients with mild symptoms, with improving health outcomes, follow-up is scheduled in 4 to 6 weeks. During follow-up visits, the physician will check for suicidal thoughts, mood, appetite, sleep habits, energy levels, ability to feel pleasure, and concentration levels (Ahrenholz & Baernstein, 2020). Dose adjustments may be necessary based on these outcomes. References Ahrenholz, N. C., & Baernstein, A. (2020). Management of Pharmacotherapy for Depression. In Chalk Talks in Internal Medicine (pp. 333-338). Springer, Cham. https://doi.org/10.1007/978-3-030-34814-4_51 Bei, B., Asarnow, L. D., Krystal, A., Edinger, J. D., Buysse, D. J., & Manber, R. (2018). Treating insomnia in depression: Insomnia-related factors predict long-term depression trajectories. Journal of consulting and clinical psychology, 86(3), 282. https://doi.org/10.1037/ccp0000282 Franzen, P. L., & Buysse, D. J. (2022). Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues in clinical neuroscience. https://doi.org/10.31887/DCNS.2008.10.4/plfranzen Hassinger, A. B., Bletnisky, N., Dudekula, R., & El-Solh, A. A. (2020). Selecting a pharmacotherapy regimen for patients with chronic insomnia. Expert opinion on pharmacotherapy, 21(9), 1035-1043. https://doi.org/10.1080/14656566.2020.1743265 Khaledi, M., Haghighatdoost, F., Feizi, A., & Aminorroaya, A. (2019). The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta diabetologica, 56(6), 631-650. https://doi.org/10.1007/s00592-019-01295-9 Zaki, N., Alashwal, H., & Ibrahim, S. (2020). Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: A systematic review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(5), 1133-1142. https://doi.org/10.1016/j.dsx.2020.07.005 Discussion: Treatment for a Patient With a Common Condition Insomnia is one of the most common medical conditions you will encounter as a PMHNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PMHNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being. Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29 For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs. Case: An elderly widow who just lost her spouse. Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: Metformin 500mg BID Januvia 100mg daily Losartan 100mg daily HCTZ 25mg daily Sertraline 100mg daily Current weight: 88 kg Current height: 64 inches Temp: 98.6 degrees F BP: 132/86 By Day 3 of Week 7 Post a response to each of the following: List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions. Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used. List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why. List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making? Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen. Read a selection of your colleagues’ responses. By Day 6 of Week 7 Respond to at least two of your colleagues on two different days in one of the following ways: If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained. If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days and Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions. Based on the case scenario, I will ask the following questions to collect more information. When do you go to bed, and how long does it take to fall asleep? How long do you spending in bed each night? What do you think is causing the insomnia problem? Poor or insufficient sleep has been known to have profound effects on people’s health and well-being. Some people experience difficulty initiating and maintaining sleep, while others find it hard to wake up in the morning. Insomnia can also be caused by depression or psychological distress. It can be categorized as a type of sleep disorder or a medical condition (MacFarlane, 2022). When it comes to assessing the cause, it is important to ask the following questions: What do you feel is causing it? Do you believe that it is a specific situation that triggers it? This is also important to determine if the client has a sense of belief that it is the main reason for their anxiety. Having a deeper understanding of the cause of the problem is also important to help the client identify the triggers that are contributing to their condition. For instance, if the client is anxious about certain things, such as being around certain stimulants, then it is important that they identify the reason for their anxiety (Oh et al., 2019). Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. Next of kin–It is important to contact the patient’s next of kin as they may know her well enough to provide helpful details about her condition. Even if the patient has never had children, it is still important to contact them as they may also be able to provide helpful information. Friends/family -If the patient does not have children or friends who are frequently in touch with her, then friends may be interviewed. These individuals could be the ones who she has been sharing her thoughts about her condition. Primary care physician- PCP may be able to provide her with more details about her health history. He or she may also be able to help her manage her condition and improve her quality of life. In addition, working with her PCP can help ensure that the patient receives the best possible care. Questions could be asked include have you noticed recent significant mood changes in the client, or has the client shared with you any of her thoughts or worries, have you seen any of her health condition that affects her quality of life, etc. Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used. The tests will be ordered include labs test, physical examination, and psychiatric evaluation. A chemical laboratory test is often performed to identify the cause of a particular condition and to confirm the presence of other organic health conditions. This can be done to ensure that the patient’s symptoms are not related to other conditions. A comprehensive physical examination is often performed to check for other possible causes of the patient’s symptoms. This can be done in the form of a cephalocaudal physical examination. This type of examination can be performed to identify the presence of other conditions such as the environment or medications. A psychiatric evaluation is often performed to diagnose a patient’s condition. It can be performed to collect information about the patient’s thoughts, feelings, behavior patterns, and symptoms in association with a specific criterion in the DSM-5. Besides a general interview, the patient can also be asked to complete various condition-specific questionnaires. Some of these include the Beck Depression Inventory, the Hamilton Depression Rating Scale, and the Zung Self-rating Scale (Legg, 2018). List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why. According toPsych Scene (2020), the following is the list of differential diagnosis Depression- is a type of mood disorder that lingers in one’s mind for a prolonged period of time. It can manifest in feelings of hopelessness, sadness, and loss of interest. This condition is referred to as organic. It can be caused by various factors such as diabetes, hypothyroidism, and other mental health conditions. For patients, it is more likely that the condition is caused by these factors. It can also be caused by various factors that affect a person’s mood. For instance, a person can experience depression following a major event in their life, such as the death of their husband. The signs and symptoms of depression include a hopeless outlook, which can be accompanied by various other symptoms such as irritability, fatigue, and anxiety. Although the patient denies having active suicidal thoughts, she should still be evaluated for the presence of these thoughts. For instance, if the patient wishes to die in bed or in an accident, then these thoughts sho
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