Assignment: Assessing and Treating Patients With Sleep/Wake Disorders Paper
Assignment: Assessing and Treating Patients With Sleep/Wake Disorders Paper
Assignment: Assessing and Treating Patients With Sleep/Wake Disorders Paper
Assessing and Treating Patients With Sleep/Wake Disorders Paper Sample
Assessing and Treating Patients With Sleep/Wake Disorders
Insomnia is one of the most common disorders where an individual may show various symptoms, such as having trouble getting quality or good sleep, problems staying asleep, or trouble falling asleep. It is important to note that such symptoms would appear even though the environment or condition is right for sleep. It is known that insomnia can negatively impact a person’s normal and daily activities (Berkley et al.,2019). As such, it is important to use appropriate treatment approaches to help patients with such symptoms. Treatment can entail pharmacological approaches. Therefore, the purpose of this assignment is to explore a case study of a patient presenting with insomnia.
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The Introduction to the Case
The case is about a thirty-one-year-old male patient presenting to the facility with insomnia. The patient’s condition began about six months ago, immediately after the death of her fiancée, and the condition has since gotten worse. The patient reports that the condition has negatively impacted his performance at work, and he can perform well as he, at times, falls asleep while working. The patient has been trice using diphenhydramine to help him sleep, but he dislikes the feeling he gets after taking the medication. The patient has a history of opiate abuse, which he developed after using acetaminophen for pain, sometimes back. He also reports consuming around four beers before bed to make him fall asleep. The mental exam revealed that the patient is future-oriented; he denies homicidal or suicidal ideation. He also denies hallucinations.
Decision 1
Trazodone 50 mg PO at bedtime
The Decision Selected
As indicated, the first decision was to start the patient with Trazodone 50 mg PO at bedtime. This decision was taken since the medication is an SSRI that can safely be taken with alcohol, as the patient has confessed to consuming alcohol every night before he sleeps (Zheng et al.,2022). Even though trazadone is approved for the treatment of depression, it is also used as an off-label medication for insomnia.
Why the Other Two Options Were Not Selected
There are reasons why the other two choices were not taken. Zolpidem was not chosen since it is a schedule IV medication and is known for a high frequency of dependency and abuse. The patient already has a history of addiction hence prescribing Zolpidem is a risk since he may end up becoming dependent on it. In addition, Zolpidem acts on GABA, similar to benzodiazepines. As such, it affects neurological functions and sleep and hence has similar CNS depression symptoms. The patient is already consuming alcohol hence using this medication can have a negative impact due to the dual effect (Grzegorzewska et al.,2020). Hydroxyzine 50 mg was also ignored as it is an antihistamine. The patient indicated that he had taken diphenhydramine and did not like how he felt the following morning. In addition, Hydroxyzine is known to be a strong sedative medication; therefore, taking it with alcohol which the patient is already consuming, may be dangerous (Kawauchi et al.,2019).
What I Was Hoping to Achieve By Making the Decision
By giving Trazodone 50 mg, I was expecting that the patient’s symptoms would significantly reduce. In need when the patient returned to the facility, he reported improvements. He indicated that the medication worked well except for priapism each morning, making it complicated to be ready for work.
How Ethical Consideration May Impact the Treatment Plan and Communication With Patients
It is important to consider the ethical aspects that may impact treatment options. One of them is autonomy. There is a need to involve the patient in the medication choice and why the medication is the best. It is also important to consider the principle of beneficence and ensure that the decision made promotes the well-being of the patient. In addition, nonmaleficence should also be considered to ensure that the medication decision made does not harm or injure the patient.
Decision 2
Explain that an erection lasting 15 minutes is not considered a priapism and should diminish over time, continue with the current dose.
The Decision Selected
The next decision is to continue with the current dose and explain to the patient that an erection lasting 15 minutes is not considered priapism. The decision to continue with the current dose was taken since this dose was associated with positive results. As such, the goal is to continue experiencing positive results of good sleep. Therefore, it is important to continue with the current dose and educate him regarding the erections and how long they will last, as in most cases, this problem resolves on its own.
Why the Other Two Options Were Not Selected
The other two options were also not chosen due to various reasons. Suvorexant can help regulate the wake-sleep cycle well. However, the medication is also a class IV controlled substance due to the potential for abuse (Huhn et al.,2022). As earlier indicated, the patient has a history of addiction; hence this medication may not be suitable for him. In addition, Suvorexant has various side effects, such as making those who take it fatigued and drowsy the patient has reported such effects; hence this medication is not the best for him. The other option of decreasing the dose of Trazodone was also ignored since it may negative the positive effects of better sleep observed with the higher dose. In addition, there is no guarantee that a reduced dose would lead to decreased erections.
What I Was Hoping to Achieve By Making the Decision
The decision taken was to maintain the current dosage. I was hoping that the patient would show sustained positive effects of improved sleep. Besides, I was hoping that the patient would have reduced erection due to the education points offered. Indeed, when the patient returned after a period of two weeks, he reported that the priapism had disappeared and the Trazodone was still effective even though he woke up drowsy in the mornings.
How Ethical Consideration May Impact the Treatment Plan and Communication With Patients
As part of the ethical considerations, it will be important to continue making the patient better using the current dose. I would also avoid harm by not prescribing medication, which may lead to side effects that the patient doesn’t want. Therefore, the decision is to ensure that the patient benefits.
Decision 3
Continue dose. Explain to the patient he may split the 50 mg tablet in half. The decreased dose should minimize next-day drowsiness. Follow up in 4 weeks.
The Decision Selected
The decision is to continue with the current medication but split the tablet in half. It is important that the goal of improving sleep has been achieved; hence there is a need to eliminate the drowsiness that the patient is facing (Zheng et al.,2022). Therefore, this decision will reduce the dose in half hence helping reduce the drowsiness that the patient has been experiencing. In addition, a reduced dose would help fight the fatigue experienced the following morning.
Why the Other Two Options Were Not Selected
The decision to initiate Sonata was ignored since it has serious interactions with alcohol, even though it can help with insomnia. The adverse effects of the interaction can lead to death and even respiratory failure. The other decision of discontinuing Trazodone and initiating Hydroxyzine was also ignored since the medication is an antihistamine (Kawauchi et al.,2019), hence would have the same effects which the patient did not like. As such, it is important to continue with the current medication and evaluate the patient after a period of four weeks.
What I Was Hoping to Achieve By Making the Decision
I was hoping that the patient would continue having improved sleep. The medication dosage was reduced to half. Hence, I was also hoping that the patient’s experience of drowsiness would reduce. The patient’s overall condition was also expected to improve.
How Ethical Consideration May Impact the Treatment Plan and Communication With Patients
It is important to prevent any kind of harm in making the decision regarding the medication regimen. Hence medications such as Sonata have to be avoided as they can lead to death when they interact with alcohol. The patient’s autonomy should also be upheld, and respect his decision of not wanting antihistamines due to their effects on him.
Conclusion
Insomnia is known to have various negative impacts on patients, hence a need to appropriately manage it. The implication is that healthcare professionals should consider the patient individual case and commence an appropriate medication treatment strategy that can help improve the patient’s symptoms. It is also important to explore the potential root cause of the problem for better management. The first decision for treatment was to start 50 mg of Trazodone. This is a medication that has been shown to be effective in treating insomnia (Zheng et al.,2022). The patient developed these symptoms after losing a fiancée; hence he could have been depressed. The medication was best for him as it acted on his serotonin levels to help him with his mood and sleep. The patient needed education points such as the need to reduce alcohol use of consumption. As part of decision two, the 50 mg dosage was maintained as the patient showed improvement. Finally, the patient was asked to reduce the dosage by half as this would help reduce the effects, such as drowsiness. It was also important to make a follow-up after a period of four weeks to find out if the patient is tolerating the medication well and if the positive effects are still sustainable. Such a follow-up is also key to finding out if there is a need to consider changes in the medication regimen.
References
Berkley, A. S., Carter, P. A., Yoder, L. H., Acton, G., & Holahan, C. K. (2020). The effects of insomnia on older adults’ quality of life and daily functioning: A mixed-methods study. Geriatric Nursing, 41(6), 832–838. https://doi.org/10.1016/j.gerinurse.2020.05.008
Grzegorzewska, A., Landowski, J., & Cubała, W. J. (2020). Clinical considerations of sleep-related amnestic behaviours associated with Zolpidem. Pharmacotherapy in Psychiatry and Neurology/Farmakoterapia w Psychiatric Neurology, 36(1), 23-31. https://doi.org/10.33450/fpn.2020.04.001
Huhn, A. S., Finan, P. H., Gamaldo, C. E., Hammond, A. S., Umbricht, A., Bergeria, C. L., … & Dunn, K. E. (2022). Suvorexant ameliorated sleep disturbance, opioid withdrawal, and craving during a buprenorphine taper. Science translational medicine, 14(650), eabn8238. https://doi.org/10.1126/scitranslmed.abn8238
Kawauchi, H., Yanai, K., Wang, D. Y., Itahashi, K., & Okubo, K. (2019). Antihistamines for allergic rhinitis treatment from the viewpoint of nonsedative properties. International Journal of Molecular Sciences, 20(1), 213. https://doi.org/10.3390/ijms20010213
Zheng, Y., Lv, T., Wu, J., & Lyu, Y. (2022). Trazodone changed the polysomnographic sleep architecture in insomnia disorder: a systematic review and meta-analysis. Scientific reports, 12(1), 14453. https://doi.org/10.1038/s41598-022-18776-7
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Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult.
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_11/index.html
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
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
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
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
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
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.
