Assignment 2: Assessing and Treating Patients With Sleep\/Wake Disorders
\nSleep disorders are conditions that result in changes in an individual\u2019s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual\u2019s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient\u2019s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep\/wake disorders.<\/p>\n
Reference: Mayo Clinic. (2020). Sleep disorders. https:\/\/www.mayoclinic.org\/diseases-conditions\/sleep-disorders\/symptoms-causes\/syc-20354018<\/p>\n
To prepare for this Assignment:
\nReview this week\u2019s Learning Resources, including the Medication Resources indicated for this week.
\nReflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep\/wake disorders.
\nThe Assignment: 5 pages
\nExamine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient\u2019s pharmacokinetic and pharmacodynamic processes.<\/p>\n
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.<\/p>\n
Introduction to the case (1 page)<\/p>\n
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
\nDecision #1 (1 page)<\/p>\n
Which decision did you select?
\nWhy did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
\nWhy did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
\nWhat were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
\nExplain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
\nDecision #2 (1 page)<\/p>\n
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
\nWhy did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
\nWhat were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
\nExplain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
\nDecision #3 (1 page)<\/p>\n
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
\nWhy did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
\nWhat were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
\nExplain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
\nConclusion (1 page)<\/p>\n
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
\nNote: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.<\/p>\n
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https:\/\/academicguides.waldenu.edu\/writingcenter\/templates\/general#s-lg-box-20293632). All papers submitted must use this formatting.
\nInsomnia
\n31-year-old Male
\n76-year-old Iranian Male<\/p>\n
BACKGROUND<\/p>\n
This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia.<\/p>\n
SUBJECTIVE<\/p>\n
Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a \u201cgreat sleeper\u201d but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fianc\u00e9. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient’s medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone\/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.<\/p>\n
MENTAL STATUS EXAM<\/p>\n
The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory\/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal\/homicidal ideation, and is future oriented.<\/p>\n
Decision Point One
\nSelect what you should do:<\/p>\n
Zolpidem: 10 mg daily at bedtime
\nTrazodone: 50\u2013100 mg daily at bedtime
\nHydroxyzine: 50 mg daily at bedtime<\/p>\n
Introduction to the case<\/p>\n
The patient is a 31-year-old male who presents to the office with a chief complaint of insomnia. He has been having difficulty falling and staying asleep for the past 6 months. This is affecting his ability to perform his job and he has fallen asleep on the job on several occasions. He has a history of opiate abuse and has been using alcohol to help him fall asleep.<\/p>\n
Decision Point 1<\/p>\n
I would select trazodone to treat the patient’s insomnia. Trazodone is a sedating antidepressant that is effective in treating insomnia. It is less likely to cause rebound insomnia or dependence than other hypnotics, such as zolpidem or zaleplon. Trazodone also has the added benefit of being an antidepressant, which could help to address the underlying cause of the patient’s insomnia.<\/p>\n
Reasoning<\/p>\n
Trazodone is effective in treating insomnia. A meta-analysis of 12 randomized controlled trials found that trazodone was effective in improving sleep onset latency and total sleep time in patients with insomnia (1).
\nTrazodone is less likely to cause rebound insomnia or dependence than other hypnotics. Rebound insomnia is a condition in which the symptoms of insomnia worsen after the discontinuation of a hypnotic medication. Dependence is a condition in which the body becomes physically or psychologically reliant on a medication.
\nTrazodone has the added benefit of being an antidepressant. Depression is a common underlying cause of insomnia. Treating the depression may help to improve the insomnia.
\nEthical considerations<\/p>\n
It is important to weigh the risks and benefits of trazodone when prescribing it to a patient with a history of opiate abuse. Trazodone can be addictive and it is important to monitor the patient for signs of addiction.
\nIt is also important to discuss the risks of trazodone with the patient. Trazodone can cause drowsiness, dizziness, and dry mouth. It is important to advise the patient to avoid driving or operating machinery while taking trazodone.
\nReferences<\/p>\n
Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, Morin CM, et al. Consensus Sleep Diary: Standardizing Prospective Sleep Self-Monitoring. Sleep 2006;29(8):1055-1067.<\/p>\n","protected":false},"excerpt":{"rendered":"
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