NURS 6630 Assignment 2: Assessing and Treating Patients with Sleep/Wake Disorders
Sample Answer for NURS 6630 Assignment 2: Assessing and Treating Patients with Sleep/Wake Disorders Included After Question
Week 8: Therapy for Patients With Sleep/Wake Disorders
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
Learning Resources
Required Readings (click to expand/reduce)
Medication Resources (click to expand/reduce)
Required Media (click to expand/reduce)
Assignment 1: 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.
Photo Credit: Getty Images/Collection Mix: Sub
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.
- 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?
- List 4 predictors of late onset generalized anxiety disorder.
- List 4 potential neurobiology causes of psychotic major depression.
- 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.
- List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.
By Day 7
This Assignment is due.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK8Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 8 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 8 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 8 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 8 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 7 of Week 8
To participate in this Assignment:
Week 8 Assignment 1
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.
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.
The Assignment: 5 pages
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.
By Day 7
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK8Assgn2+last name+first initial.(extension)” as the name.
- Click the Week 8 Assignment 2 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 8 Assignment 2 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Assgn2+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 8 Assignment 2 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 8 Assignment 2 draft and review the originality report.
Submit Your Assignment by Day 7 of Week 8
To participate in this Assignment:
Week 8 Assignment 2
What’s Coming Up in Week 9?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will continue to build on your assessment and treatment skills as you examine patients presenting with signs and symptoms consistent with ADHD/ODD.
Next Week
Rubric Detail
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Name: NURS_6630_Week9_Assignment_Rubric
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Excellent
Point range: 90–100 Good
Point range: 80–89 Fair
Point range: 70–79 Poor
Point range: 0–69
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.
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.
The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.
8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.
The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.
7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.
The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.
The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
Decision #1 (1–2 pages)
- 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.
The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.
The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.
The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.
The response accurately explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.
The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.
The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.
The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.
The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.
Examples provided do not support the decisions and responses provided, or is missing.
Decision #2 (1–2 pages)
- 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.
The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.
The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.
The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.
The response accurately explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.
The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.
The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.
The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.
The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.
Examples provided do not support the decisions and responses provided, or is missing.
Decision #3 (1–2 pages)
- 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.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.
The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.
The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.
Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.
The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.
The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.
The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.
The response accurately explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.
The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.
The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.
The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.
Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected.
The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.
The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.
The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.
Examples provided do not support the decisions and responses provided, or is missing.
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.
14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.
The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.
12 (12%) – 13 (13%)
The response accurately summarizes the recommendations on the treatment options selected for this patient.
The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided.
11 (11%) – 11 (11%)
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient.
The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided.
0 (0%) – 10 (10%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.
The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
Purpose, introduction, and conclusion of the assignment is vague or off topic.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.
No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written 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 (5%) – 5 (5%)
Uses correct APA format with no errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100
Name: NURS_6630_Week9_Assignment_Rubric
A Sample Answer For the Assignment: NURS 6630 Assignment 2: Assessing and Treating Patients with Sleep/Wake Disorders
Title: NURS 6630 Assignment 2: Assessing and Treating Patients with Sleep/Wake Disorders
Insomnia is the most prevalent sleep disorder affecting a substantive amount of the population. It is characterized by the inability to initiate, and maintain sleep or simply a poor sleep quality. Insomnia affects 10-15% of the population (Kaur et al., 2020). Insomnia can be graded based on the duration and the frequency of symptoms. This week’s case study focuses on a 31-year-old male who presented with a chief complaint of insomnia which has progressively gotten worse over the past six months. The symptomatology includes difficulty in falling asleep and staying asleep at night. The problem began after the loss of his fiancé. The problem affects his work. He has used diphenhydramine in the past to sleep but stopped due to the side effect of marked morning drowsiness. He has a history of opiate abuse which started with the prescription medication hydrocodone when he broke his ankle. He has not had any other prescription for the opiate for four years. The patient currently uses alcohol to help him fall asleep. The Mental Status Exam is normal. He denies any auditory or visual hallucinations. His judgment and insight are intact. The patient denies any suicidal ideations and is future-oriented. There are no features of depression or any other mental or physical illness.
The symptomatology of increased sleep latency, difficulty maintaining sleep, and daytime symptoms confirm the diagnosis of insomnia. The co-morbidities like alcohol use disorder, history of opiate abuse, previous pharmacotherapy for insomnia using diphenhydramine, and the maladaptive disorder of alcohol abuse to induce sleep will all greatly influence medication decisions. The selected drug must confer low toxicity, high efficacy for reduction of sleep latency and maintaining sleep, tolerability to minimize drug non-compliance, and minimal side effects especially drowsiness that may affect the subsequent day’s work. Cognitive Behavioral Therapy in conjunction with drug therapy is highly efficacious in insomnia management. The treatment is aimed at providing the best-indicated medication to the patient to provide remission of symptomatology. The treatment also aims at preventing the development of complications like depression, diabetes, and other cardiovascular diseases. Standard individualized care is indicated for a full recovery. The purpose of this paper is to describe the decision points taken to treat this patient regarding medication choice, the expectation with each decision, and ethical considerations
Decision 1
Trazodone 50mg at bedtime.
Reason for Selection
For this particular case, trazodone is the drug for use in the management. From Randomized Clinical Trials on Trazodone use in the treatment of Insomnia, it was highly efficacious in maintaining sleep by reducing the number of awakenings during sleep, it remarkably improved the quality of sleep, and was well tolerated by a majority of patients in short-term treatment (Wichniak et al., 2021). In primary Insomnia, a combination of CBT and Trazodone was found to have the highest efficacy in reducing sleep latency. Trazodone has a half-life of 12 hours with a peak plasma concentration of four hours. When trazodone is taken 1-2 hours before bedtime, it can reduce sleep latency. Trazodone reduces the risk of relapse in alcohol-dependent patients. Hypnotics like Zolpidem reduce the quality and depth of sleep and has a higher risk of drug dependence. As a result, Zolpidem is not effective in the treatment of patients with poor quality sleep insomnia (Wichniak et al., 2021). Zolpidem is also associated with adverse effects such as anterograde amnesia and an increased risk of falls. Concerning Hydroxyzine, it is only indicated for the treatment of accidental insomnia (Krysta, 2020). It is also associated with marked sedation and increased morning drowsiness. The use of hydroxyzine in the management of insomnia is highly unpopular due to hyperacute tolerance and increased daytime somnolence (Albrecht et al., 2019). There is no further literature that justifies its use.
Expectations
From the treatment with Trazodone, there is an expected reduction in sleep latency, increased duration of sleep, reduced number of awakenings during sleep, and a general increase in sleep quality. As the patient is currently dependent on alcohol for sleep, trazodone will work to reduce the relapse. There is also an expected clearing of the depressive symptoms that are set in.
Ethical Considerations
Ethical considerations of beneficence, justice, non-maleficence, and confidentiality go a long way in the management of the patient. These are achieved through explaining the illness to the patient. Psychosocial therapy like CBT requires the help of family members. Through this, the patient needs to understand there is a need for breach in confidentiality (Barber, 2017). Providing the patient with the best pharmacotherapy for the illness based on research and current studies. The need to employ a clinical innovation poses an ethical risk as these are auxiliary to the main course of treatment and have not been adequately researched though they possess an advantage such as sleep restriction therapy in insomnia. Proper communication between the caregiver and the patient provides an enabling environment for the treatment of both somatic and psychological disorders.
Decision 2
Explain to the patient that an erection lasting fifteen minutes is not considered priapism and should diminish over time and the patient to continue with the current dosage of Trazodone.
Reason for Selection
Priapism affects less than 1% of low-dose trazodone users (Shah et al., 2021). Priapism is a prolonged painful erection ideally lasting more than four hours. The 15-minute early morning erection does not qualify as priapism. It vital to watch out for these adverse effects among others to ensure early management. Suvorexant is rejected as it is associated with an increased number of awakenings and abnormal dreams. These greatly impair the quality and duration of sleep (Xue et al., 2022). The dual orexin receptor agonists have not been adequately compared to trazodone. Suvorexant has a higher efficacy in associated motor insomnia (Janto et al., 2018). Trazodone brought a huge improvement in the patient and there would not be any need to change the medication. Reducing the dosage of trazodone to 25mg at bedtime was rejected as the unpleasant side effect could not be attributed to trazodone. Moreover decreasing the dose just after a short course may lead to rebound insomnia (Jaffer et al., 2017). This makes this decision unsuitable.
Expectations
The expectations are that the prolonged erection will abate over time and the action of trazodone of reducing sleep latency and maintaining sleep will continue due to the low tolerance of the body to these effects. The patient should tolerate the drug with minimal side effects as only the low doses are used.
Ethical considerations
Constant continuous counseling on adherence is prime. Counseling the patient on the features of side effects such as priapism and hallucinations and the need for an immediate clinic visit when any of the adverse effects occur (Barber, 2017). Continue the perfect doctor-patient relationship to allow for ease of communication of the patient’s concerns
Decision 3
Continue dose. Explain to the patient that he may split the 50mg in half
Reason for selection
One of the main side effects of trazodone is morning drowsiness. This is due to its long half-life which is 12 hours. To reduce the symptoms, a reduction in the dosage is employed. The effective dose for insomnia ranges from 25mg to 200mg per day. A titration of the dosage to the lowest effective dose confers a reduction in the side effects (Jaffer et al., 2017). Monitoring and follow-up are important in appropriately managing any other side effects. Sonata is suitable for induction of sleep. It reduces sleep latency. It has a short half-life, and this leads to an increased number of awakenings in its use from randomized clinical trials. This makes it poor at the maintenance of sleep. The use of Hydroxyzine an H1 receptor antagonist is widely shunned due to its hyperacute tolerance and increased daytime somnolence. The use of hydroxyzine is likely to worsen morning drowsiness (Albrecht et al., 2019). Sedation is the main feature of this drug. Discontinuation of trazodone needs to be in a step-wise fashion, not abrupt.
Expectations
With a reduction in the dosage of trazodone, there is an expected reduction in the side effect of morning drowsiness. The reduced dose is still expected to be effective in the management of insomnia. With this duration of treatment, it is expected that the features of insomnia would have mostly abated and treatment could be done by other mechanisms like sleep deprivation and following a fixed timetable.
Ethical Considerations
At this point of management, a professional and cordial relationship between the doctor and the patient is still essential. Proper communication between the doctor and the patient on the reduction of dosage must be discussed (Barber, 2017). There is a need to stick to a single therapy for better outcomes.
Conclusion
Insomnia is one of the most common sleep disorders affecting people of all races and ages. It is a major predisposing factor to many diseases including Alcohol use disorder, diabetes, and hypertension among others. This case study provides a perfect example of a 31-year-old male with a six-month history of initiation and maintenance of sleep. The precipitating factor was the loss of his fiancé. He has currently tipped into alcohol use disorder. Zolpidem reduces the quality and depth of sleep and has a higher risk of drug dependence. As a result, Zolpidem is not effective in the treatment of patients with poor quality sleep insomnia (Wichniak et al., 2021). Hydroxyzine is also rejected as it is only indicated for the treatment of accidental insomnia (Krysta, 2020). The use of hydroxyzine in the management of insomnia is highly unpopular due to hyperacute tolerance, marked morning drowsiness, and increased daytime somnolence (Albrecht et al., 2019). There is no further literature that justifies its use. Randomized Clinical Trials show Trazodone use in the treatment of Insomnia as highly efficacious in maintaining sleep by reducing the number of awakenings during sleep, it remarkably improved the quality of sleep and was well tolerated by a majority of patients in short-term treatment (Wichniak et al., 2021). In primary Insomnia, a combination of CBT and Trazodone was found to have the highest efficacy in reducing sleep latency. Trazodone also reduces the risk of relapse in alcohol-dependent patients. In the management of different disorders, the importance of monotherapy is stressed. This prevents unnecessary changes in regimen and encourages adherence. In the management of insomnia, drug choice is based on the pharmacokinetics, pharmacodynamics of the drug, and the individual patient characteristics which may include the type of insomnia an individual has. All these help determine the right regimen. Ethical consideration at all steps of the treatment is based on the patient-caregiver interaction, informed consent, adherence to treatment, and provision of the best form of treatment to benefit the patient.
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