NURS 6630 Treatment for a Patient With a Common Condition Paper

NURS 6630 Treatment for a Patient With a Common Condition Paper

NURS 6630 Treatment for a Patient With a Common Condition Paper

Treatment for a Patient with a Common Condition

This paper is an examination of a case study involving a 75-year-old patient. The patient comes to the primary care office today with complaint of insomnia. The patient reports that her husband of 41 years passed away 10 months ago. She has experienced worsening depression since then as well as her sleep habits. She has no previous history of depression before her husband’s death. The essay focuses on questions that would be asked, people in her life to contact, physical examinations and diagnostic tests, differential diagnosis, treatment, and checkpoints.

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Three Questions

 One of the questions that I would ask the patient is what brings her today to the office. This is the first question in any encounter with a patient. The question gives the patient an opportunity to explain her problem and experience with it. It provides the subjective data that will guide the diagnosis of her health problem. The second question I would ask her is what effect the problem has on her health, wellbeing and functioning. This question will enable determine the impact of the health problem on her normal functioning, health and wellbeing. Mental health problems lower quality of life and functioning of patients and that of their significant others. The third question I would ask is if the patient consumes any alcohol, smokes, or abuses drugs. Mental health problems such as depression increase the risk of drug and substance abuse, hence, the need for the question(Javed et al., 2021; Rehm & Shield, 2019; Wiegand-Grefe et al., 2022).

People in the Patient’s Life

The people in the patient’s life that I would need to speak to or get feedback concerning her health include her children, caretakers and friends. These people would provide accurate information about her health, including changes in her behaviors. They would also provide information about her adherence to the prescribed treatment. These people will also provide information that the patient may be hiding from the healthcare provider. Therefore, their information will guide the development of an accurate diagnosis and treatment for the patient.

Physical Exams and Diagnostic Tests

The physical examinations that may be needed for the patient include weighing the patient and comparing with previous findings. Major depression may result in unintentional weight loss or gain because of changes in the appetite of the patient. Thyroid function tests should also be performed to rule out other causes such as hypothyroidism(Dopheide, 2020). Hypothyroidism is associated with symptoms that align with those of major depression.

Differential Diagnosis

 Insomnia is the client’s differential diagnosis. Insomnia is a condition characterized by decline in the sleep quality and quantity. Patients report difficulties in falling asleep and maintaining sleep. The DSMV also identifies that patients complain of night awakening and finding it difficult to fall asleep. The changes in the quality of sleep often results in next day sleepiness, which affect social and occupational functioning. Patients deny any history of substance abuse, medical conditions, or medications use. The patient in the case study is experience insomnia, which could be precipitated by the use of antidepressants(Dopheide, 2020; Van Someren, 2021). The secondary diagnoses that should be considered for the patient include major depression and post-traumatic stress disorder. The patient has a history of being diagnosed with major depression. She is also currently on treatment for the disorder. However, she does not report other symptoms associated with major depression such as changes in weight, suicidal thoughts, or appetite. Post-traumatic stress disorder may be considered since she lost her husband 10 months ago. She may be experiencing traumatic memories related to her husband’s death.

Pharmacologic Agents and Dosing

 The two appropriate drugs for treating insomnia are Trazodone and Triazolam. Trazodone is an antidepressant that is largely used in treating insomnia. It has sedating properties that induce hypnosis among patients with the disorder. Trazodone works by inhibiting 5-HTA receptors in the brain. The recommended dosage for initiating the patient with Trazodone is 25-50 mg. Triazolam is a benzodiazepine that has also been approved for treating insomnia. Triazolam has been shown to be highly effective in reducing sleep latency and increasing total sleep duration(Chiu et al., 2021; Wichniak et al., 2021). The recommended dosage for Triazolam is 0.125-0.25 mg at bedtime.

Selected Drug Therapy

The selected drug for the patient is Triazolam. Benzodiazepines are the most appropriate for this patient since she is currently on an antidepressant. Adding another antidepressant such as Trazodone will increase the risk of side and adverse effects because of drug interractions. Triazolam is likely to produce optimum benefits with minimal risk of harm to the patient. The contraindications of Triazolam that should be considered include patients with myasthenia gravis, chronic obstructive pulmonary disease, bronchitis, and sleep apnea. It is also contraindicated in patients with allergic reaction to it. Triazolam relaxes the smooth muscles, hence, increased likelihood of respiratory system depression in patients with conditions such as COPD and bronchitis(Chiu et al., 2021). The follow-up should be done after four weeks to determine the response of the patient to the treatment. The patient should be informed to report to the primary care provider should she develop psychomotor retardation or abnormal movements.

Conclusion

In summary, appropriate questions should be asked to guide the development of an accurate diagnosis. Insomnia is the patient’s primary diagnosis. The most appropriate people to seek further information include her children, caretakers, and friends. Triazolam is the appropriate drug for treating insomnia in this case study.

References

Chiu, H.-Y., Lee, H.-C., Liu, J.-W., Hua, S.-J., Chen, P.-Y., Tsai, P.-S., & Tu, Y.-K. (2021). Comparative efficacy and safety of hypnotics for insomnia in older adults: A systematic review and network meta-analysis. Sleep, 44(5), zsaa260. https://doi.org/10.1093/sleep/zsaa260

Dopheide, J. A. (2020). Insomnia overview: Epidemiology, pathophysiology, diagnosis and monitoring, and nonpharmacologic therapy. The American Journal of Managed Care, 26(4 Suppl), S76–S84. https://doi.org/10.37765/ajmc.2020.42769

Javed, A., Lee, C., Zakaria, H., Buenaventura, R. D., Cetkovich-Bakmas, M., Duailibi, K., Ng, B., Ramy, H., Saha, G., Arifeen, S., Elorza, P. M., Ratnasingham, P., & Azeem, M. W. (2021). Reducing the stigma of mental health disorders with a focus on low- and middle-income countries. Asian Journal of Psychiatry, 58, 102601. https://doi.org/10.1016/j.ajp.2021.102601

Rehm, J., & Shield, K. D. (2019). Global Burden of Disease and the Impact of Mental and Addictive Disorders. Current Psychiatry Reports, 21(2), 10. https://doi.org/10.1007/s11920-019-0997-0

Van Someren, E. J. W. (2021). Brain mechanisms of insomnia: New perspectives on causes and consequences. Physiological Reviews, 101(3), 995–1046. https://doi.org/10.1152/physrev.00046.2019

Wichniak, A., Wierzbicka, A. E., & Jarema, M. (2021). Treatment of insomnia—Effect of trazodone and hypnotics on sleep. Psychiatria Polska, 55(4), 743–755. https://doi.org/10.12740/pp/125650

Wiegand-Grefe, S., Liedtke, A., Morgenstern, L., Hoff, A., Csengoe-Norris, A., Johannsen, J., Denecke, J., Barkmann, C., Grolle, B., Daubmann, A., Wegscheider, K., & Boettcher, J. (2022). Health-Related Quality of Life and mental health of families with children and adolescents affected by rare diseases and high disease burden: The perspective of affected children and their siblings. BMC Pediatrics, 22(1), 596. https://doi.org/10.1186/s12887-022-03663-x

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Treatment for a Patient With a Common Condition

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

Chapter 4, “Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate” (pp. 77-158)

Chapter 5, “Targeting Dopamine and Serotonin Receptors for Psychosis, Mood, and Beyond: So-Called “Antipsychotics” (pp. 159-243)

American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia

Links to an external site.. 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

Links to an external site.. 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

Links to an external site.. 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

Links to an external site., 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

Links to an external site., 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

Links to an external site., 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

Links to an external site., 23(8), 649–659. https://doi.org/10.2165/00023210-200923080-00002

Utah State University. (n.d.). Creating study guides

Links to an external site.. https://www.usu.edu/academic-support/test/creating_study_guides

Medication Resources

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs

Links to an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Links to an external site.

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

Optional Resources

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

Links to an external site., 5(3), 124–134. https://doi.org/10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy

Links to an external site., 71(9), 728–738. https://doi.org/10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly

Links to an external site., 86(1), 107–121. https://doi.org/10.1007/s11126-014-9326-2

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.

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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!