Treatment for Patient With Common Condition Essay.

Discussion: Treatment for a Patient With a Common Condition
Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Treatment for Patient With Common Condition Essay.

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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 PNP, 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.Treatment for Patient With Common Condition Essay.
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:Treatment for Patient With Common Condition Essay.

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.Treatment for Patient With Common Condition Essay.
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 the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
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 Patient With Common Condition Essay.

Treatment for Patient with Common Condition

Insomnia disorder is distinguished by discontent with the amount or consistency of sleep, combined with difficulties feeling tired, repeated wakefulness at nights with trouble going back to sleep, and/or waking sooner than expected (Levenson, 2015). Insomnia can develop in 60 percent-80 percent of people with depression (AbdulRahmanman, 2018). For the last 10 months after her husband died, the client who presented to the clinic has suffered from depression and insomnia. She has been given 100 mg of sertraline orally each day to manage her depression and experiences sleep issues.Treatment for Patient With Common Condition Essay.

List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

I would ask the patient the following questions:

Do you adhere to your medicine?

Are you drinking caffeinated beverages? How frequently?

Have you been feeling down, sad, or discouraged for the previous two weeks? Have you had no excitement or satisfaction in doing stuff during the past 2 weeks?

It is essential to inquire about medication compliance. The chief concern from the patient is insomnia. Medications provided for hypertension can induce insomnia in certain individuals. In addition, I would ask the client about her consumption of caffeinated beverages, which may be the source of insomnia. Once you doubt depression, the third series of questions is the productive screening questions for office work. It is necessary for this client to progress to a psychiatric evaluation.Treatment for Patient With Common Condition Essay.

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.

Inquire for the perceptions of the children who live with the client or the caregiver that may be useful for the diagnosis. Ask if she is consistent with her drugs and if they notice any shifts of mindfulness, mood, or voice, shifts in thinking, recollection or orientation, phobias, paranoia, repetitive behavior, and panic, dementia, or delirium. These queries are structured to clarify typical and specific conditions that need to be addressed by the caregiver and can also be specifically experienced by the client.Treatment for Patient With Common Condition Essay.

Explain what, if any, physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

Depression screening tools are helpful, and the Patient Health Questionnaire-9 is the most commonly used. Nevertheless, it is necessary to remember that the results found by the utilization of either rating scales or screening tools for depression do not really detect depression and can be unreliable in any demographic, specifically geriatric persons (Manea, Gilbody& McMillan, 2015).

List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

Central nervous system conditions such as neoplastic lesions, multiple sclerosis, dementia, and Parkinson’s disease – Since the client is 75 years of age, this is the highly probable diagnosis.Treatment for Patient With Common Condition Essay.

Sleep-related disorders

Endocrine disorders such as hypothyroidism and hyperthyroidism

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 depressive disorder, the dose for sertraline would be as follows: initial 50 mg by mouth daily; can raise to 200 mg by 25 to 50 mg daily at periods of not less than a week’ (Sweetman, 2021). I would raise her dose of sertraline to 150 mg a day, oral route.Treatment for Patient With Common Condition Essay.

Probably I would even introduce Trazadone to manage insomnia, beginning with 25 mg at bedtime. Trazadone is authorized for depression management; however, the off-label utilization of it to treat insomnia has overshadowed its use to treat depression (Jaffer, 2017). At the low 25 mg dosage, Trazadone causes, and enhances sleep without inducing sleepiness or irritation during the day (Jaffer, 2017).Treatment for Patient With Common Condition Essay.

For the drug therapy, you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

The client’s ethnicity is not mentioned in the case scenario; however certain ethnic groups are more likely to be CYP2D6/CYP2C19 carriers (Fabbri, 2020). This could lead to complications with antidepressant absorption, which might trigger toxicity to accumulate in the neurological system.Treatment for Patient With Common Condition Essay.

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.

In four weeks I would want the client to return to my clinic; however, I will maintain contact with her weekly through a phone call or telehealth. I would like this client to have a sleep log so that she can record the number of hours she sleeps as well as the sleep quality she gets every night. Additionally, I would track symptom advancement and potential adverse effects of this client to the prescription medications. Treatment for Patient With Common Condition Essay.