Treatment for a Patient with a Common Condition Discussion

Questions you would ask the patient

Inquire about her surrounding environment. Environmental factors such as excessive light, extreme temperatures and noise often interfere with the sleeping habits (Krystal et al., 2019). Ask about the patients support system; family, friends, social and church groups. Has her financial status changed after her husband’s death? Clinical studies have shown that insomnia is prevalent in people with greater social and financial stressors. Is the patient responsible for taking your own medications or do you require assistance when taking your medications? Polypharmacy is commonly seen in the elderly population due to the need to treat different diseases that develop with age (Bates, 2019). Adherence to medications may be affected thus resulting to worsening symptoms. Treatment for a Patient with a Common Condition Discussion

ORDER HERE A PLAGIARISM-FREE PAPER 

People in the patient’s life

The people I would consult about the patient’s life include; family members, care giver, friends and church members. Ask if there are any social or financial stressors which are major causes of insomnia. Ask how long they have noted her mental health deterioration as about any behavioral or mood changes they have noticed.

Physical and diagnostic tests

A sleep diary is an assessment tool that is recorded by the patient for at least two successive  weeks. It is necessary when a patient reports an irregular sleeping pattern and is used to characterize the specific sleeping problem, describe maladaptive behaviors and provide an indicatory of treatment outcome (Krystal et al., 2019). Thyroid function tests to rule out hyperthyroidism as it presents with sleep disturbances. An airway examination and neck circumference is required to rule obstructive sleep apnea. The Davidson trauma scale is administered to help assess patients for PTSD and determine if they meet the DSM IV criteria. The Hamilton depression rating scale is used to assess the severity of depressive symptoms in order to determine whether dose adjustment is necessary. Treatment for a Patient with a Common Condition Discussion

Differential diagnosis

Post-traumatic stress disorder (F43.1): a mental disorder that is often triggered by a terrifying event such as trauma or loss of a loved one. The onset of symptoms is usually after one month of occurrence but in other cases it may occur years late after the incident (Bryant, 2019). People with underlying mental disorders such as anxiety, depression and others are at increased risk of getting PTSD.

Pharmacological agents

• PO Eszopiclone 1mg 24hourly (nocte): it is a sedative that acts on GABA that results in relaxation that helps one to fall and stay asleep (Rösner et al., 2018). However, this drug should be used with caution.
• PO fluraxepam 15mg 24hourly (nocte): it is a benzodiazepine that induces sleep through their positive allosteric modulation of GABA type A receptor(Flurazepam, 2017).

The most preferable drug Eszopiclone because it is not associated with toxicity with the patients current medications. Fluraxepam is not used in the elderly due to its long-acting metabolites that increase the rates of falls.

Contraindications

Not to be used in patients with gait problems and at risk of accidental falls.

Follow up after 2 weeks to monitor the progress of symptoms. Treatment for a Patient with a Common Condition Discussion

References

Bates, A. (2019, July 18). Polypharmacy and Drug Adherence in Elderly Patients. Uspharmacist.com. https://www.uspharmacist.com/article/polypharmacy-and-drug-adherence-in-elderly-patients

‌Bryant, R. A. (2019). Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges. World Psychiatry, 18(3), 259–269. https://doi.org/10.1002/wps.20656

Flurazepam. (2017, January 24). Nih.gov; National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/books/NBK548683/

Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World Psychiatry, 18(3), 337–352. https://doi.org/10.1002/wps.20674

Rösner, S., Englbrecht, C., Wehrle, R., Hajak, G., & Soyka, M. (2018). Eszopiclone for insomnia. Cochrane Database of Systematic Reviews, 2018(10). https://doi.org/10.1002/14651858.cd010703.pub2

‌

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. Treatment for a Patient with a Common Condition Discussion

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. Treatment for a Patient with a Common Condition Discussion

ORDER HERE 

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.

Treatment for a Patient with a Common Condition Discussion