NURS 6630 Assignment: Treatment for a Patient With a Common Condition

NURS 6630 Assignment: Treatment for a Patient With a Common Condition

NURS 6630 Assignment: Treatment for a Patient With a Common Condition

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

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.

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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.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check. Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

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!

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

Treatment for a Patient with a Common Condition

 A 75-year-old woman with depression presents with insomnia. She reports that her depression and insomnia have worsened ten months after her husband of 41 years passed away. She has a history of depression, hypertension, and depression and is currently on metformin, javunia, losartan, hydrochlorothiazide, and sertraline. The purpose of the paper is to describe any questions one may ask the patient, identify people one may need feedback from, and list physical exams, diagnostic tests, differential diagnosis, and drug therapy.

Additional Questions I Might Ask the Patient

1. Did the passing of your husband trigger the insomnia?
2. Have you tried any sleeping medications and remedies?
3. What other additional symptoms are you experiencing alongside the insomnia?

The questions seek to inquire whether grief could have triggered the onset of insomnia. They also seek to inquire about other symptoms affecting the patient besides insomnia and the patient’s actions to alleviate her symptoms (Shah, 2023).

Questions I Would need to ask the People in the Patient’s Life

1. Her relatives or caregivers
2. Does the patient take any caffeinated or alcoholic drinks close to her bedtime?
3. Have you noticed any changes in the patient’s sleep schedule?

The questions seek to inquire whether the patient takes any drinks that may affect her sleep schedule (Shah, 2023). In addition, they may give more information on the number of hours the patient has been sleeping during the period.

2. The primary physician
3. Have you prescribed any other medications other than the ones listed?
4. Has the patient ever complained to you that she has been experiencing insomnia?

The question may be used to rule out any other medications contributing to insomnia and whether the patient had previously sought help to relieve the symptoms (Shah, 2023).

Physical Examinations and Diagnostic Tests for the Patient

Liver and renal function tests are vital for this patient as they help guide pharmacological dosing (Aggestrup et al., 2023). Additionally, thyroid function tests are essential to rule out thyroid abnormalities as a cause of hypertension and depression. Glycosylated hemoglobin (Hb1C) can be used to follow up diabetes.

The Likely Differential Diagnosis and Why

Major depressive disorder is the most likely diagnosis. The symptoms of a depressive episode often include a depressed mood, altered sleep patterns, and weight changes, which have lasted more than two weeks (Aggestrup et al., 2023).

Appropriate Medications and Their Dosing, and Rationale for Use

1. Sertraline 100mg daily
2. Desvenlafaxine 50mg once daily

I would prefer sertraline to venlafaxine. Sertraline is a selective serotonin receptor inhibitor (SSRI) to desvenlafaxine, a serotonin-noradrenaline receptor inhibitor (Boyce et al., 2023). Sertraline is a medication that does not require renal dosing when given to patients. Additionally, sertraline does not interact with noradrenaline receptors and can worsen pre-existing hypertension, making it safe for the patient compared to desvenlafaxine. Desvenlafaxine has also been associated with an increased risk of panic attacks that may worsen the patient’s health.

            Hepatic dosing is required for patients with hepatic impairment by lowering the dose by half. The medication has been contraindicated in pregnant women due to a risk of cardiovascular congenital abnormalities and respiratory failure (Adjei et al., 2023). Additionally, sertraline has been contraindicated when used together with monoamine oxidase and tricyclic antidepressants, disulfiram, and in pediatric and young adults.

Check Points

Week 4: I would evaluate the patient’s response to sertraline by assessing changes in mood and energy levels. If the patient is responsive, I would maintain the current medication and increase the dose to 125g daily if the response is suboptimal (Aggestrup et al., 2023).

Week 8: I would continue monitoring to check for improvement in symptom relief and assess for side effects. I will maintain the dosage if the patient improves and increase the dose to 150mg if the response is suboptimal (Aggestrup et al., 2023).

Week 12: I would evaluate whether the medication suits maintenance therapy. If the response is suboptimal, I would increase the dose to 200mg per day and consider other treatment options, such as venlafaxine or other serotonin-noradrenaline receptor inhibitors (Aggestrup et al., 2023).

Conclusion

Patients suffering from depression often experience insomnia. It is essential to rule out any differential diagnosis that may contribute to insomnia. The patient picture often influences medications to be used and follow-up needed to check on improvement.

References

Adjei, K., Adunlin, G., & Ali, A. A. (2023). Impact of Sertraline, Fluoxetine, and Escitalopram on Psychological Distress among United States Adult Outpatients with a Major Depressive Disorder. Healthcare (Basel, Switzerland), 11(5), 740. https://doi.org/10.3390/healthcare11050740

Aggestrup, A. S., Martiny, F., Faurholt-Jepsen, M., Hvenegaard, M., Christensen, R., Davidsen, A. S., & Martiny, K. (2023). Interventions promoting recovery from depression for patients transitioning from outpatient mental health services to primary care: Protocol for a scoping review. PloS one, 18(9), e0291559. https://doi.org/10.1371/journal.pone.0291559

Boyce, P., & Ma, C. (2021). Choosing an antidepressant. Australian prescriber, 44(1), 12–15. https://doi.org/10.18773/austprescr.2020.064

Shaha, D. P. (2023). Insomnia Management: A Review and Update. The Journal of family practice, 72(6 Suppl), S31–S36. https://doi.org/10.12788/jfp.0620