NURS 6630 Week 11 Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders

NURS 6630 Week 11 Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders

NURS 6630 Week 11 Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders

Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.

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Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018
To prepare for this Assignment:

Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. 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 (1 page)

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 (1 page)

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 (1 page)

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 #3 (1 page)

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 (1 page)

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.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

LINK; https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_11/index.html

A Sample Of This Assignment Written By One Of Our Top-rated Writers

Treating Sleep-Wake Disorders for a 31 Year-Old Male: Decision Tree

            Sleep-wake disorders are a diagnostic category in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5 and include insomnia, hypersomnolence, and narcolepsy amongst other similar conditions (APA, 2013; Sadock et al., 2015). This is the case study of a 31 year-old male who presents with insomnia. Three decisions are to be made about his pharmacotherapeutic treatment.

Decision Point #1

            At this point, three medication options are given: zolpidem (Ambien), trazodone (Desyrel), or hydroxyzine (Atarax). The choice is made to commence the patient on trazodone (Desyrel) 50 mg at bedtime. The choice was made because scholarly evidence shows that the drug is effective in treating insomnia. Jaffer et al. (2017) reviewed 45 studies systematically and found that 95.5% of them showed that trazodone was effective in the treatment of insomnia. Zolpidem is FDA-approved for insomnia but was not chosen because of debilitating side effects. Hydroxyzine (Atarax) was also not chosen because of the side effects of xerophthalmia (dryness of the conjunctiva) and xerostomia (dryness of the mouth) (Stahl, 2017). What was hoped to be achieved was a remission of symptoms by a correction in the disturbance of sleep patterns for the patient. The ethical considerations were beneficence and nonmaleficence (Haswell, 2019). The best drug that would help the patient was chosen (beneficence), and those that would harm the patient with serious side effects not chosen (nonmaleficence).

Decision Point #2

            After two weeks of being on the trazodone (Desyrel) 50 mg at bedtime, the patient returned with both good and bad news. The good news was that the medication was already producing a therapeutic effect and he was sleeping better now. However, he had also started experiencing the side effect of priapism every morning and it was making him delay for work. He reported no hallucinations which are also side effects. At this decision point, the decision taken is to decrease the dose of the trazodone to 25 mg at bedtime. This decision was taken because trazodone was already showing therapeutic effect and stopping it altogether would have been clinically unsound. Reducing the dose by half would control the priapism as a side effect (Stahl, 2017). It would also honor beneficence as an ethical principle. 

            To leave the dose of trazodone at 50 mg at bedtime would have encouraged the side effect of priapism to continue and violated the ethical principle of nonmaleficence. To discontinue trazodone would also have been unwise since it was already producing results. What was hoped to be achieved by reducing the dose of trazodone but continuing with the medication was that the priapism would relent but the therapeutic effect would augment.

Decision Point #3

            In another two weeks the patient comes back again for review and assessment of treatment efficacy. He reports this time that the trazodone (Desyrel) is making him sleep very well. The medication is actually so effective that he wishes the dose could be increased from the 25 mg being taken at the moment. At this juncture also, he denies having any hallucinations of a visual or auditory nature. At this decision point also, three options are provided for a decision to be made. Two of them involved discontinuing trazodone while one involved continuing with the 25 mg trazodone dose at bedtime but also encouraging sleep hygiene. The option taken at this stage is that of continuing the patient on trazodone at the reduced dose of 25 mg. However, the patient is also to be educated on sleep hygiene that will help him sleep better. The patient is to try this (trazodone and sleep hygiene) for four weeks and then come back for another assessment of treatment progress.

            The reason for selecting the option taken above is that the trazodone was working quite well with the patient stating that he is nowadays sleeping very well. As a matter of fact, after the reduction of the dose his priapism was not reported again. Sleep hygiene is very important in determining how fast one falls asleep and how well he or she also sleeps. This patient was now tolerating the trazodone (Desyrel) very well and there would be no reason to stop it or change to something else. This is why the other two options have not been selected because they involve stopping trazodone (Desyrel). The hope in making the above decision is that sleep disturbance is completely eradicated and the patient’s functionality is restored. As has been seen, hydroxyzine (Atarax) would cause xerostomia and xerophthalmia and so would violate the bioethical principle of nonmaleficence.

Conclusion

            The decision as to which pharmacotherapeutic agent to use by the psychiatric-mental health nurse practitioner (PMHNP) is usually based on a number of factors. The most important of these is evidence of efficacy and a relatively good safety profile. A medication that can be well tolerated and that at the same time produces the desired therapeutic effect is to be preferred to one that is somewhat effective but has many serious side effects. This case of a 31 year-old male with insomnia was instructive. Throughout the three decision points, it has been seen that evidence of efficacy informed the choice of trazodone (Desyrel) and consideration of safety informed the reduction of the dose to 25 mg at bedtime from the initial 50 mg at bedtime.    

 References

American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Jaffer, K.Y., Chang, T., Vanle, B., Dang, J., Steiner, A.J., Loera, N., Abdelmesseh, M., Danovitch, I., & Ishak, W.W. (2017). Trazodone for insomnia: A systematic review. Innovations in Clinical Neuroscience, 14(7-8), 24-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842888/#:~:text=The%20majority%20of%20these%20studies,in%20the%20treatment%20of%20insomnia

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11^th ed. Wolters Kluwer.

Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6^th ed. Cambridge University Press.