NURS 6630 Week 8 Therapy for Patients with Sleep/Wake Disorders Paper
NURS 6630 Week 8 Therapy for Patients with Sleep/Wake Disorders Paper
NURS 6630 Week 8 Therapy for Patients with Sleep/Wake Disorders Paper
NURS 6630 Week 8 Therapy for Patients with Sleep/Wake Disorders
Advanced practice registered nurses are equipped with advanced knowledge of management interventions to help assist patients with these conditions. The management of some problems can be affected by comorbid conditions such as substance abuse. APRNs must understand the implications of comorbid conditions on treating mental health illness, especially mood disorders such as depression and anxiety. This paper addresses questions directed toward managing patients with sleep/wake disorders.
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- In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see the resolution of symptoms?
The appropriate therapy for a patient with major depressive disorder and alcohol abuse entails pharmacologic and behavioral interventions. Selective serotonin reuptake inhibitors such as fluoxetine and citalopram are used alongside other interventions such as cognitive behavioral therapy, and medications for naltrexone for alcohol dependence are the standard therapy for these patients (McHugh & Weiss, 2019). Monoamine oxidase inhibitors such as phenelzine can be potentially fatal and are thus contraindicated in these patients (Carey, 2019). Depression and anhedonia symptoms are last to disappear and can take 4-6 weeks, but changes are noted in the first 1-2 weeks. However, alcohol abuse makes patients treatment-resistant, and individuals can take up to ten weeks for symptoms to fully improve compliant patients.
- List 4 predictors of late-onset generalized anxiety disorder.
Late-onset GAD is GAD that occurs in later years of life (not adolescence or childhood). Some late-onset generalized anxiety disorder predictors are female gender, recent adverse events in an individual’s life, chronic physical illnesses such as cognitive impairment, and mental health disorders (DeMartnini et al., 2019).
- List 4 potential neurobiology causes of psychotic major depression.
The potential neurobiology causes of psychotic major depression are abnormal dopamine, serotonin, and norepinephrine neurotransmitter levels in the blood. 2) Another potential cause is structural changes in the brain affecting the production of the neurotransmitters or their receptors, such as hippocampus shrinkage. 3) Decreased hypothalamic-pituitary-adrenal (HPA) axis hence imbalance in hormones released in response to stress (Cherian et al., 2019). 4) Genetic predisposition due to inheriting genes that expose individuals to depression or psychosis or both (Dubovsky et al., 2021).
- An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.
The symptoms required for a major depressive episode can include a depressed mood, anhedonia or loss of interest in activities one previously treasured, irritability, weight loss or gain, insomnia, hypersomnia, psychomotor agitation or retardation, fatigue, guilt, feeling worthlessness, decreased concentration, and suicidal thoughts/ ideations (Kennedy, 2022).
- List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.
Insomnia refers to patients’ inability to initiate sleep, night awakening, and waking up early (Dopheide, 2022). Beta-blockers are medications that slow the heart rate, which is vital for blood pressure management. Examples of beta blockers include atenolol, metoprolol, and propranolol. These medications can cause insomnia, among other side effects. Medications implicated in precipitating insomnia are associated with their mechanism of action on serotonin (Lee & Choo, 2019). Selective serotonin reuptake inhibitors such as fluoxetine and serotonin can also cause drowsiness and insomnia. Dopamine agonists can also cause daytime sleepiness and accelerate falling into sleep. They include aripiprazole, phencyclidine, and Quinpirole. The medications a patient is on are significant to
References
Carey, T. L. (2019). Use of antidepressants in patients with co-occurring depression and substance use disorders. Antidepressants: From Biogenic Amines to New Mechanisms of Action, 359–370. https://doi.org/10.1007/164_2018_162
Cherian, K., Schatzberg, A. F., & Keller, J. (2019). HPA axis in psychotic major depression and schizophrenia spectrum disorders: Cortisol, clinical symptomatology, and cognition. Schizophrenia Research, 213, 72-79. https://doi.org/10.1016/j.schres.2019.07.003
DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized anxiety disorder. Annals of Internal Medicine, 170(7), ITC49-ITC64. https://doi.org/10.7326/AITC201904020
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
Dubovsky, S. L., Ghosh, B. M., Serotte, J. C., & Cranwell, V. (2021). Psychotic depression: diagnosis, differential diagnosis, and treatment. Psychotherapy and Psychosomatics, 90(3), 160–177. https://doi.org/10.1159/000511348
Kennedy, S. H. (2022). Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues in Clinical Neuroscience. https://doi.org/10.31887/DCNS.2008.10.3/shkennedy
Lee, J., & Choo, H. (2019). Serotonin Receptors for Treatment of Insomnia. Chronobiology in Medicine, 1(1), 14-20. https://doi.org/10.33069/cim.2018.0005
McHugh, R. K., & Weiss, R. D. (2019). Alcohol use disorder and depressive disorders. Alcohol Research: Current Reviews, 40(1). https://doi.org/10.35946/arcr.v40.1.01
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NURS 6630 Week 8: Therapy for Patients With Sleep/Wake Disorders
WEEK 8: AT A GLANCE
THERAPY FOR PATIENTS WITH SLEEP/WAKE DISORDERS
INTRODUCTION
From negative changes in mood to problems concentrating, sleep/wake disorders can have a tremendous impact on patients’ lives. When patients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. However, many of the medications used to treat sleep/wake disorders may be addictive, making thorough patient assessments and close follow-up care essential. To prescribe appropriate therapies with patient safety in mind, you must understand not only the pathophysiology of these disorders but also the pharmacologic agents used to treat them.
This week, as you study therapies for individuals with sleep/wake disorders, you examine the assessment and treatment of patients with these disorders. You also explore ethical and legal implications of these therapies.
LEARNING OBJECTIVES
Students will:
Synthesize concepts related to the psychopharmacologic treatment of patients
Assess patient factors and history to develop personalized therapy plans for patients with sleep/wake disorders
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for sleep/wake disorders
Synthesize knowledge of providing care to patients presenting for sleep/wake disorders
Analyze ethical and legal implications related to prescribing therapy for patients with sleep/wake disorders
SHORT ANSWER ASSESSMENT
As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being. The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders.
TO PREPARE
• Review the Learning Resources for this week.
• Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders.
• Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.
TO COMPLETE:
Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.
1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?
2. List 4 predictors of late onset generalized anxiety disorder.
3. List 4 potential neurobiology causes of psychotic major depression.
4. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.
5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.
NURS_6630_Week8_Assignment1_Rubric
NURS_6630_Week8_Assignment1_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeIn 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why. Be specific. What it is the timeframe that the patient should see resolution of symptoms? 13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly explains in detail the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse…. The response accurately and clearly details which drugs are contraindicated with specific examples…. The response accurately and clearly explains in detail the timeframe that the patient should see resolution of symptoms. 11 to >10.0 pts
Good Point range: 80–89
The response accurately explains the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse…. The response accurately identifies which drugs are contraindicated with specific examples…. The response accurately explains the timeframe that the patient should see resolution of symptoms. 10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely explains the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse…. The response inaccurately or vaguely identifies which drugs are contraindicated with inaccurate or vague examples…. The response inaccurately or vaguely explains the timeframe that the patient should see resolution of symptoms. 9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely explains the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse, or is missing…. The response inaccurately and vaguely identifies which drugs are contraindicated with inaccurate examples, or is missing…. The response inaccurately and vaguely explains the timeframe that the patient should see resolution of symptoms, or is missing.
13 pts
This criterion is linked to a Learning OutcomeList four predictors of late onset generalized anxiety disorder. 13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly lists in detail four predictors of late-onset generalized anxiety disorder. 11 to >10.0 pts
Good Point range: 80–89
The response accurately lists four predictors of late-onset generalized anxiety disorder. 10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely lists four predictors of late-onset generalized anxiety disorder. 9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely lists four predictors of late-onset generalized anxiety disorder, or is missing.
13 pts
This criterion is linked to a Learning OutcomeList four potential neurobiology causes of psychotic major depression. 13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly lists in detail four potential neurobiology causes of psychotic major depression. 11 to >10.0 pts
Good Point range: 80–89
The response accurately lists four potential neurobiology causes of psychotic major depression. 10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely lists four potential neurobiology causes of psychotic major depression. 9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely lists four potential neurobiology causes of psychotic major depression.
13 pts
This criterion is linked to a Learning OutcomeAn episode of major depression is defined as a period of time lasting at least 2 weeks. List at least five symptoms required for the episode to occur. Be specific. 13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly explains in detail at least five symptoms for the episode of major depression to occur…. Specific examples provided fully support the response. 11 to >10.0 pts
Good Point range: 80–89
The response accurately explains at least five symptoms for the episode of major depression to occur…. Specific examples provided support the response. 10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely explains at least five symptoms for the episode of major depression to occur…. Specific examples provided inaccurately or vaguely support the response. 9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely explains at least five symptoms for the episode of major depression to occur, or is missing…. Specific examples provided do not support the response, or is missing.
13 pts
This criterion is linked to a Learning OutcomeList 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. 13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly lists in detail 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia…. Examples provided fully support the response provided. 11 to >10.0 pts
Good Point range: 80–89
The response accurately lists 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia…. Examples provided support the response provided. 10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely lists 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia…. Examples provided inaccurately or vaguely support the response provided. 9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely lists 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia, or is missing…. Examples provided do not support the response provided, or is missing.
13 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts
Excellent Point range: 90–100
Uses correct grammar, spelling, and punctuation with no errors. 4 to >3.5 pts
Good Point range: 80–89
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3.5 to >2.0 pts
Fair Point range: 70–79
Contains several (3 or 4) grammar, spelling, and punctuation errors. 2 to >0 pts
Poor Point range: 0–69
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 to >4.0 pts
Excellent Point range: 90–100
Uses correct APA format with no errors. 4 to >3.5 pts
Good Point range: 80–89
Contains a few (1 or 2) APA format errors. 3.5 to >2.0 pts
Fair Point range: 70–79
Contains several (3 or 4) APA format errors. 2 to >0 pts
Poor Point range: 0–69
Contains many (≥ 5) APA format errors.
5 pts
Total Points: 75
