Feb 23, 2024 NURS 6630 Discussion Treatment for Patient With Common Condition
NURS 6630 Discussion Treatment for Patient With Common Condition A Sample Answer For the Assignment: NURS 6630 Discussion Treatment for Patient With Common Condition Three Questions to Ask the Patient and the Rationale How much caffeine/alcohol do you consume? Insomnia complaints are sometimes due to dietary choices. Caffeine taken late in the day can interfere with sleep. This causes a person to consume more the following day, creating a vicious cycle of being addicted to caffeine. Do you snore? The patient is obese, with a BMI of 34.37. Hargens et al. (2013) state that persons with obesity may report insomnia. Besides, snoring is often associated with obstructive sleep apnea (OSA). OSA is also strongly associated with obesity. Do you have leg cramps at bedtime? The questions help screen for restless legs syndrome (RLS). RLS can lead to delayed onset of sleep, reduced sleep time, and difficulty maintaining sleep. RLS is also associated with obesity, as those with a high BMI tend to have RLS compared to those with a low BMI (Hargens et al., 2013). People in the Patient’s life to Speak to, Questions to Ask and the Rationale If the patient has children and other relatives, such as siblings, they can help determine insomnia’s familial or biological cause. I can ask the family members if they have a similar problem. This will help to identify if any first-degree relative has a sleep problem (Beaulieu-Bonneau et al., 2007). Another question is about which type of sleep problem the family members experience, such as sleep apnea, restless leg syndrome, or daytime sleepiness. Struggling to Meet Your Deadline? Get your assignment on NURS 6630 Discussion Treatment for Patient With Common Condition done on time by medical experts. Don’t wait – ORDER NOW! Meet my deadline Any Useful Physical Exams and Diagnostic Tests and How to Use the Results First, the patient is taking antidepressants which can cause insomnia. The patient is also taking diabetics medications such as metformin which can lead to sleep disturbance. Losartan may also lead to sleep difficulties. Currently, the patient’s insomnia is highly likely due to medications. It is first important to treat insomnia due to medication effects. Besides, I can assess insomnia further using sleep diaries and questionnaires that the patient can present during the follow-up visits. One tool is the insomnia rating scale which will aid in recording the symptoms and treatment response. Wrist actigraphy will also help monitor and store movement data to assist in monitoring treatment response and other circadian issues that may lead to insomnia (Patel et al., 2018). Differential Diagnosis and the most Likely One Insomnia due to drugs Insomnia due to a medical condition The most likely differential diagnosis is insomnia due to drugs. The patient is taking medications to manage moods, hypertension, and diabetes. Khandelwal et al. (2017) assert that sleep disturbances are common in people with diabetes. People with diabetes report higher rates of poor sleep quality, excessive daytime sleepiness, and insomnia. Sleep disturbances may be due to rapid changes in blood glucose levels during the night due to medications. Insomnia may also be due to hypertension drugs. The patient is taking HCTZ to manage hypertension, and the restlessness associated with the drug may lead to sleep disturbances. Sertraline, an antidepressant, may also be contributing to insomnia. Pharmacologic Agents, Dosing and the Most Preferred Doxepin 3mg once a day Eszopiclone 1mg once a day at bedtime At low doses, doxepin blocks the wake-promoting impacts of histamine. Adults aged 65 and older report high sleep onset with 3mg/day doxepin when taken 30 minutes before bedtime (Patel, 2018). It has a peak time of 3.5 hours (Almasi & Meza, 2019). It is highly distributed to other body tissue compartments. It is excreted through urine. It also has a high plasma protein binding rate. Eszopiclone is rapidly absorbed and binds with plasma proteins at a rate of 52% to 59% taking about one hour. It is metabolized in the liver following oral administration. Elimination occurs after 6 hours, and about 10% or less of the dose is excreted in the urine (Brielmaier, 2006). When taken with a high-fat meal, it may lead to a one-hour delay in achieving peak concentration. The most preferred drug is Eszopiclone 1mg/day at bedtime as there are evidence-based studies on its use among the eldrly above 65 years old. It has a peak time of one hour compared to 3.5 hours of doxepin. Fundamentally, although doxepin is highly effective, it should be avoided for patients above 65 years old (Almasi & Meza, 2019). Contraindications of the Drug Eszopiclone has no known contraindications. However, because the patient has depression, the drug should be cautiously administered. It is important to start with the smallest dose (Brielmaier, 2006). Long-term use of the drug may lead to physical and psychological dependence. Check Points and Therapeutic Changes After four weeks of 1mg eszopiclone daily, I expect improvements in total sleep time, quality, and depth of sleep, including the number of awakenings without side effects (Kirkwood & Breden, 2010). I will increase the dosage to 2mg/day. In the eighth week, I expect significant improvements in total sleep time, quality and sleep depth, daytime alertness, and a higher sense of physical well-being. The patient will continue with 2 mg/day dosage for four more weeks. After 12 weeks of 2mg treatment, I expect a significant improvement in sleep, social life, and daily responsibilities. I will also encourage the patient to practice sleep hygiene and engage in physical activity due to her weight and to improve her sleep. References Almasi, A., & Meza, C. E. (2019). Doxepin. NIH National Library of Medicine, National center for biotechnology information. Statpearls. January 2022. Beaulieu-Bonneau, S., LeBlanc, M., Mérette, C., Dauvilliers, Y., & Morin, C. M. (2007). Family history of insomnia in a population-based sample. Sleep, 30(12), 1739-1745. Brielmaier, B. D. (2006, January). Eszopiclone (Lunesta): a new nonbenzodiazepine hypnotic agent. In Baylor University Medical Center Proceedings (Vol. 19, No. 1, pp. 54-59). Taylor & Francis. Hargens, T. A., Kaleth, A. S., Edwards, E. S., & Butner, K. L. (2013). Association between sleep disorders, obesity, and exercise: a review. Nature and Science of Sleep, 27-35. Khandelwal, D., Dutta, D., Chittawar, S., & Kalra, S. (2017). Sleep disorders in type 2 diabetes. Indian Journal of Endocrinology and Metabolism, 21(5), 758. Kirkwood, C., & Breden, E. (2010). Management of insomnia in elderly patients using eszopiclone. Nature and Science of Sleep, 151-158. Patel, D., Steinberg, J., & Patel, P. (2018). Insomnia in the elderly: a review. Journal of Clinical Sleep Medicine, 14(6), 1017-1024. Insomnia is one of the most common medical conditions you will encounter as a PNP. 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 PNP, 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 NURS 6630 Discussion Treatment for Patient With Common Condition 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! Hey Aileen! I thoroughly enjoyed reading your discussion post this week on the patient with insomnia. I personally did not choose sertraline due to the patient being on this medication and her having depressive symptoms. According to Stahl (2021), sertraline is generally tolerated in lower doses in elderly patients, so increasing the dose may not be the best method of pharmacological intervention, and may require switching agents to find one that works best for her depressive symptoms (Stahl, 2021). Additionally, escitalopram may not be an appropriate choice for this patient due to the side effect of insomnia (Stahl, 2021). For this patient, I would choose a medication such as Trazodone that has the FDA approval for the treatment of depression as well as the FDA off label indication for insomnia (Stahl, 2021). Trazodone, according to Jaffer et. Al (2017) is a medication that is used for the primary or secondary treatment of insomnia as well as depression (Jaffer et. Al, 2017). It is also described that this medication is a very good choice in regards to patients with depression who also suffer with insomnia due to it being well tolerated and having effects on both of these symptoms (Jaffer et. Al, 2017). Next, I appreciated the questions you would ask the patient for the initial interview of the patient. I fund these questions to encompass much of the problem at hand. One of the other questions that can be asked of the patient is their behavioral habits before they go to sleep at night with such inquiries as if they watch television at night before bed, or what they do before they lay down at night (Pacheco & Rehman, 2023). Another question that can be asked is about caffeine intake. These questions can indicate whether medic action is not the first line treatment for this patient, or if this insomnia is related to behavioral changes instead. Thank you for your post! References Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., Abdelmesseh, M., Danovitch, I., & Ishak, W. W. (2017). Trazodone for Insomnia: A Systematic Review. Innovations in clinical neuroscience, 14(7-8), 24–34. Pacheco, D., & Rehman, A. (2023, December 22). Diagnosing insomnia. Sleepfoundation.org. Retrieved January 11, 2024, from Diagnosing Insomnia”> Stahl, S. M. (2021). Stahl’s essential psychopharmacology prescriber’s guide (7th ed.). Cambridge University Press. Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6630 Discussion Treatment for Patient With Common Condition Submission and Grading Information Grading Criteria To access your rubric: Week 7 Discussion Rubric Post by Day 3 of Week 7 and Respond by Day 6 of Week 7 To Participate in this Discussion: Week 7 Discussion Week 7: Therapy for Patients With Schizophrenia According to the Schizophrenia and Related Disorders Alliance of America, approximately 3.5 million NURS 6630 Discussion Treatment for Patient With Common Condition people in the United States are diagnosed with schizophrenia (n.d.), and it is one of the leading causes of disability. In practice, patients may present with delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior, as well as other negative symptoms that can be disabling for these individuals. Not only are these symptoms one of the most challenging symptom clusters you will encounter, many are associated with other disorders, such as depression, bipolar disorder, and disorders on the schizophrenia spectrum. As a psychiatric nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for patients. This week, as you examine antipsychotic therapies, you explore the assessment and treatment of patients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies. Reference: Schizophrenia and Related Disorders Alliance of America. (n.d.). About schizophrenia. https://sardaa.org/resources/about-schizophrenia/#:~:text=Quick%20Facts%20About%20Schizophrenia.%20Schizophrenia%20can%20be%20found,is%20one%20of%20the%20leading%20causes%20of%20disability Learning Objectives Students will: Assess client factors and history to develop personalized therapy plans for patients with insomnia Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for insomnia Assess patient factors and history to develop personalized plans of antipsychotic therapy for patients Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring antipsychotic therapy Synthesize knowledge of providing care to patients presenting for antipsychotic therapy Analyze ethical and legal implications related to prescribing antipsychotic therapy to patients across the lifespan Learning Resources Required Readings (click to expand/reduce) Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier. American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf Funk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M., Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J. (2018). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. https://doi.org/10.1093/schbul/13.2.261 Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/ McClellan, J. & Stock. S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9), 976–990. https://www.jaacap.org/article/S0890-8567(09)62600-9/pdf Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649–659. https://doi.org/10.2165/00023210-200923080-00002 Medication Resources (click to expand/reduce) U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments. amisulpride aripiprazole asenapine brexpiprazole cariprazine chlorpromazine clozapine flupenthixol fluphenazine haloperidol iloperidone loxapine lumateperone lurasidone olanzapine paliperidone perphenazine pimavanserin quetiapine risperidone sulpiride thioridazine thiothixene trifluoperazine ziprasidone Required Media (click to expand/reduce) Case study: Pakistani woman with delusional thought processesNote: This case study will serve as the foundation for this week’s Assignment. Optional Resources (click to expand/reduce) Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., Miller, A. L., & Miller, D. D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 12
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