Insomnia is a Critical Problem in the Popular Press
Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders
Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s 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’s 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.
Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018
To prepare for this Assignment:
- Review this week’s Learning Resources, including the Medication Resources indicated for this week.
- Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.
The Assignment: 5 pages
Examine 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’s pharmacokinetic and pharmacodynamic processes.
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.
Introduction to the case (1 page)
- 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.
Decision #1 (1 page)
- Which decision did you select?
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why 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.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why 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.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why 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.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
- 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.
Note: 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.
By Day 7
Insomnia is a critical problem in the popular press and medical literature. It is a condition that makes patients have sleeping problems. In the medical literature, the condition insomnia is accompanied by polysomnographic sleep disturbance (Mayo Clinic, 2020). Thus, insomnia constitutes transient arousals, prolonged awakenings and long sleep latency. Insomnia qualifies to be a sleep disorder due to its adverse consequences and pathological responses. The prevalence of the condition relies on the criteria used for its definition and description. For instance, in the case study, insomnia is described as nonrestorative sleep and difficulty in initiating and maintaining sleep. With the critical impacts of insomnia and its prevalence, it is included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (Mayo Clinic, 2020). DSM-IV indicates key symptoms of insomnia such as anxiety, depression, irritability, and attention problems. Accurate and timely management of insomnia is necessary to reduce the secondary effects on the patient's physical and mental health.
The case study shows a typical patient with insomnia symptoms from the subjective data and mental examination in the last six months. It constitutes a 31-year-old patient with the listed symptoms of insomnia, such as sleeping difficulty. However, before making the decision tree, the key factors that would determine the treatments are age and historical factors. The patient has specific histories which need analysis, such as opiate abuse and extreme effects of diphenhydramine. The critical condition also has effects on his occupation, such as inactivity during daytime activities. Regarding mental examinations, the patient does not have homicidal ideation or hallucinations, and he is very alert. The paper generates a reliable and justifiable decision tree based on the patient factors and treatment options.
Decision One: Zolpidem: 10 mg daily at bedtime
Justification of the Decision
A 10 mg of Zolpidem daily at bedtime is the first decision for the treatment due to its efficiency. It is also among the class of drugs that have minimal side effects and would counter the issues the patient raised, such as diphenhydramine effects. Zolpidem is effective, and its actions are felt within 30 minutes of consumption (Zolpidem, 2022). It improves the sleeping condition between 7 and 10 days with minimal secondary consequences. It also allows the patient to be actively engaged in the next day's activities by limiting drowsiness. Therefore, it would be beneficial to the patient and restore his occupational difficulties, such as sleeping at his job.
Reasons for Ignoring other Alternatives
Regardless of choosing Zolpidem as the key treatment option, ignoring other alternatives are also valid. For instance, Trazodone is an effective option but not considered in the patient's situation. The patient has suffered insomnia for the last six months, indicating it is chronic. Trazodone is mainly efficient for patients who do not have chronic insomnia symptoms. Trazodone also has adverse side effects, such as constant erections whenever the patient walks for long distances (Yi et al., 2018). Therefore, the medication is not necessary for the first weeks of treatments. The reason for ignoring 50 mg of Hydroxyzine is due to its anxiety and mood problems which affect the mental stability of the patient (Smith et al., 2016). It also leads to Xerophthalmia and Xerostomia. Therefore, it is necessary to avoid the two decisions and choose Zolpidem for high-quality sleep.
Expected Outcome and Ethical Considerations
The patient should indicate improvement in sleeping conditions within the first week. Zolpidem improves the sleeping condition between 7 and 10 days, meaning the patient should show some changes during the provided period (Zolpidem, 2022). The second expectation is to ensure the patient does not experience side effects as indicated in the primary information, including diphenhydramine issues. The ethical consideration impacted the treatment option by considering patient autonomy and avoiding ethical issues of Zolpidem, such as constant erection.
Decision Two: Decrease Zolpidem to 5mg daily at bedtime
Justification of the Decision
The second decision relies on the outcome of the first decision. For instance, it is necessary to decrease the dose of Zolpidem due to its adverse side effects on the patient. A higher dose of 10 mg knocked the patient out, which imposes critical concern. Secondly, a higher dose of Zolpidem in the second phase would have side effects such as drowsiness during the day (Zolpidem, 2022). Drowsiness would adversely impact the client's occupation, which is a primary concern. Lastly, decreasing the dose is also necessary for the patient body system to adjust and recove...
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