NURS 6630 ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS ASSIGNMENT

NURS 6630 ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS ASSIGNMENT

Sample Answer for NURS 6630 ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS ASSIGNMENT Included After Question

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

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

Medication Resources

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

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  • alprazolam
  • amitriptyline
  • amoxapine
  • amphetamine
  • desipramine
  • diazepam
  • doxepin
  • eszopiclone
  • flunitrazepam
  • flurazepam
  • hydroxyzine
  •  imipramine
  • lemborexant
  • lorazepam
  • melatonin
  • methylphenedate
  • modafinil
  • armodafinil
  • carnitine
  • clomipramine
  • clonazepam
  • nortriptyline
  • pitolisant
  • ramelteon
  • sodium oxybate
  • solriamfetol
  • SSRI’s
  • temazepam
  • trazodone
  • triazolam
  • trimipramine
  • wellbutrin
  • zaleplon
  • zolpidem

Required Media

Links to an external site.

Note: This case study will serve as the foundation for this week’s Assignment.

 

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)

ASSESSING AND TREATING PATIENTS WITH SLEEP WAKE DISORDERS
ASSESSING AND TREATING PATIENTS WITH SLEEP WAKE DISORDERS
  • 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.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting

Links to an external site..

By Day 7

Submit your Assignment.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK8Assgn2_LastName_Firstinitial
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

A Sample Answer For the Assignment: NURS 6630 ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS ASSIGNMENT

Title: NURS 6630 ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS ASSIGNMENT

The patient, in this case, is a 31-year-old man with insomnia. The condition began six months ago after the sudden death of his wife. He is employed as a forklift operator at a local chemical company, but his health condition has affected his ability to perform his work. The patient claims that he has utilized diphenhydramine for sleeping in the past, but he does not like how he feels the next morning after using the medication. According to the patient’s prior physician’s medical record, he was abusing opiates after injuring his ankle in a skiing accident. The patient’s previous physician prescribed him hydrocodone/APAP (acetaminophen) for acute pain management after the accident. For four years, the individual has not received a prescription for an opiate analgesic. He points out that he has recently consumed approximately four beers to help him fall asleep. The patient is attentive and aware of the person talking to him, location, time, and incident. He maintains eye contact and is dressed appropriately for the season. All aspects of judgment, insight, and reality contact remain intact. The man also denies any suicidal ideas and is focused on the future.

Decision One

The treatment should start with Trazodone 10 mg daily at bedtime. Trazodone has been approved as an effective treatment for insomnia. The medicine is effective in lower doses in treating primary and secondary insomnia. Due to its generic availability, the medication is less expensive than newer insomnia medications. Trazodone can also be an effective sleep aid when taken in lower doses. The other reason for selecting the medication is that it is not addictive compared to other insomnia medications such as benzodiazepine class medication such as Valium and Xanax (Yi et al, 2018). The medication can also help the patient improve slow wave sleep, and the medication also has fewer side effects than most of the other medications used in treating insomnia.

There are various reasons why Zolpidem was not selected. The medication can result in severe allergic reactions in some patients. The various signs of allergic reaction due to the medication include swelling of the face and difficulty in breathing. The other reason is that the sedative effect of the medication is stronger than the other available options. The medication can also make a patient experience severe dizziness and drowsiness, resulting in falls, accidents, and severe injuries. Considering the nature of the patient’s work, the medication is not a good option because it can result in daytime drowsiness and dizziness, making the patient not conduct his job effectively. The medication can also result in a high level of aggressiveness and extroversion that is abnormal compared to the patient’s usual behavior (Jung, 2018). Considering that the patient has confirmed that he takes alcohol, Zolpidem cannot be used in the treatment process because the patient can experience auditory and visual hallucinations associated with strange behavior due to alcohol toxicity. Hydroxyzine 50mg was also not selected due to various. One of the main reasons is that the medication has a high side effects profile compared to Trazodone. The medication can also lead to daytime sedation, affecting how the patient will perform at work. Hydroxyzine can also result in various side effects such as skin rash, fast heartbeat, difficulty in swallowing, and chest discomfort (Silvestro, 2021).

From the treatment process, I expect that Trazodone will effectively treat the patient’s condition, and he will be able to sleep well. The patient experience an erection, which will last for approximately 15 minutes as a side effect of the medication. Ethical consideration will positively impact the treatment plan and when communicating with the patient. For instance, every decision and action that I will take will be for the fulfillment of the obligation to provide optimal care to the patient.

Decision Two

Explaining to the patient that an erection that lasts for approximately 15 minutes that he is experiencing is not priapism and should end over time, and he should continue taking the current dose. I choose this decision because the medication effectively treats insomnia, and the patient has enough sleep at night. Continuing with the current dose is also important because the patient is not experiencing any severe side effects apart from the prolonged erections and priapism due to its adrenergic blocking activity.

I did not select the decision to discontinue Trazodone and initiate treatment with suvorexant 1o mg at bedtime daily because of various reasons. Trazodone effectively treated the patient’s condition, and the patient did not experience any side effects; hence, changing the medication will negatively impact the treatment process. Initiating treatment with suvorexant is not a good decision. The medication is associated with various side effects such as next-day drowsiness and agitation. There is also limited evidence supporting the safety of using suvorexant in treating insomnia. The medication can cause the patient to become less alert during the day and feel drowsiness, headache, and dizziness. The medication can also result in memory problems or confusion. The patient can experience disturbed sleep as a side effect and have various experiences such as abnormal dreams, nightmares, and hallucinations. The medication can also cause the patient to experience sleep paralysis or even walk in their sleep.

Decreasing the current trazodone dose to 25 mg daily at bedtime is also not a good decision because the current dose of the medication was effective in treating the patient’s condition. Dose reduction can only be implemented when the patient is experiencing severe side effects due to the medication or it is too expensive for the patient to purchase the current dose of the medication (Yi et al, 2018). Considering the effectiveness of the current dose of Trazodone, reducing the dose can reduce the medication’s efficiency in treating insomnia or slow down the treatment process. I expect the patient to experience a further decrease in priapism from the treatment approach, and insomnia will also decrease. In this case, ethical consideration will ensure that I avoid causing harm to the patient.

Decision Three

The patient should continue with the current dose, and he may split the 50mg tablet into two. Decreasing the dose will help in reducing next-day drowsiness. In order to reduce the side effects of the medication, it is crucial to reduce the current dose to a lower dose considering that the medication is effective and the patient is getting better. Taking a lower dose of Trazodone is proven to be similarly effective than a higher dose, with appreciably fewer adverse effects such as decreased drowsiness and potentially improved quality of life.

The decision to discontinue Trazodone and initiate treatment with sonata 10 mg administered during bedtime is not good. This is because Trazadone has been effective in managing the patient’s condition. Initiating therapy with sonata 10 mg will is not a good decision considering the patient operates a vehicle in the chemical industry. This is because one of the major side effects of the sonata is lack of coordination which can lead to an accident, especially when an individual is driving. Other side effects of the medication that can reduce the patient’s quality of life include dizziness, drowsiness, and short-term memory loss. Another reason why treatment with sonata should not be initiated is that the medication is habit forming and can lead to dependency and can also be abused (Reeve & Bailes, 2010). Due to its habit-forming characteristics, it is not advisable to use the medication in long-term treatment, and it has not been proven to be effective in treating patients with long-term insomnia. Considering the patient has a history of alcohol consumption, the medication is not the best option and can result in various withdrawal symptoms if the patient suddenly stops using it.

The decision to discontinue Trazadone and start treatment with hydroxyzine 50 mg at bedtime is also not advisable. Hydroxyzine cannot be clinically significant to the patient considering the medication has a comparatively long half-life of approximately 20 hours (Schiffman et al, 2011). This will result in daytime sedation after sleeping at night. The medication also has a high side effect profile compared to the low side effect profile of Trazodone. Introducing hydroxyzine can also result in other adverse side effects such as Xerostomia and Xerophthalmia.

From the treatment approach, I expect the patient condition to become better after another four weeks of using the medication. Priapism will also diminish completely, and the level of drowsiness will decrease because the patient will be using a lower dose than the initial dose. Ethical consideration will be crucial in the treatment process and communication with the patient because it will allow me to minimize the medication’s harm to the patient and focus on promoting good health (Haddad, 2018).

References NURS 6630 ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS ASSIGNMENT

Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations.

Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., … & Ishak, W. W. (2017). Trazodone for insomnia: a systematic review. Innovations in clinical neuroscience14(7-8), 24.

Jung, M. (2018). Zolpidem overdose: a dilemma in mental health. The Health Care Manager37(1), 86-89.

Reeve, K., & Bailes, B. (2010). Insomnia in adults: Etiology and management. The journal for nurse practitioners6(1), 53-60.

Schiffman, J., Davis, M., Pierre, J., & Saunders, C. S. (2011). Hydroxyzine: rational choice for inpatients with insomnia. Current Psychiatry10(3), 88-89.

Silvestro, S. (2021). Hydroxyzine (Vistaril): dosage, uses, side effects. Drugs.

NURS_6630_Week8_Assignment2_Rubric

NURS_6630_Week8_Assignment2_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome 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.
10 to >8.0 pts

Excellent Point range: 90–100

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 to >7.0 pts

Good Point range: 80–89

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 to >6.0 pts

Fair Point range: 70–79

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.

6 to >0 pts

Poor Point range: 0–69

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.

10 pts
This criterion is linked to a Learning Outcome 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.
20 to >17.0 pts

Excellent Point range: 90–100

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.

17 to >15.0 pts

Good Point range: 80–89

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.

15 to >13.0 pts

Fair Point range: 70–79

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.

13 to >0 pts

Poor Point range: 0–69

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.

20 pts
This criterion is linked to a Learning Outcome 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.
20 to >17.0 pts

Excellent Point range: 90–100

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.

17 to >15.0 pts

Good Point range: 80–89

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.

15 to >13.0 pts

Fair Point range: 70–79

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.

13 to >0 pts

Poor Point range: 0–69

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.

20 pts
This criterion is linked to a Learning Outcome 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.
20 to >17.0 pts

Excellent Point range: 90–100

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.

17 to >15.0 pts

Good Point range: 80–89

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.

15 to >13.0 pts

Fair Point range: 70–79

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.

13 to >0 pts

Poor Point range: 0–69

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.

20 pts
This criterion is linked to a Learning Outcome 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.
15 to >13.0 pts

Excellent Point range: 90–100

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.

13 to >11.0 pts

Good Point range: 80–89

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 to >10.0 pts

Fair Point range: 70–79

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.

10 to >0 pts

Poor Point range: 0–69

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.

15 pts
This criterion is linked to a Learning Outcome 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 to >4.0 pts

Excellent Point range: 90–100

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 to >3.5 pts

Good Point range: 80–89

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 to >3.0 pts

Fair Point range: 70–79

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.

3 to >0 pts

Poor Point range: 0–69

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.

5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 pts

Excellent Point range: 90–100

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.5 pts

Good Point range: 80–89

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.5 to >3.0 pts

Fair Point range: 70–79

Contains several (3 or 4) grammar, spelling, and punctuation errors.

3 to >0 pts

Poor Point range: 0–69

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts
This criterion is linked to a Learning Outcome 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 to >4.0 pts

Excellent Point range: 90–100

Uses correct APA format with no errors.

4 to >3.5 pts

Good Point range: 80–89

Contains a few (1 or 2) APA format errors.

3.5 to >3.0 pts

Fair Point range: 70–79

Contains several (3 or 4) APA format errors.

3 to >0 pts

Poor Point range: 0–69

Contains many (≥ 5) APA format errors.

5 pts
Total Points: 100

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NURS 6630 ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS ASSIGNMENT Grading Rubric

Performance Category 100% or highest level of performance

100%

16 points

Very good or high level of performance

88%

14 points

Acceptable level of performance

81%

13 points

Inadequate demonstration of expectations

68%

11 points

Deficient level of performance

56%

9 points

 

Failing level

of performance

55% or less

0 points

 Total Points Possible= 50           16 Points    14 Points 13 Points        11 Points           9 Points          0 Points
Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic topics.

Presentation of information was exceptional and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was minimally demonstrated in all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
 

Presentation of information is unsatisfactory in one of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
 

Presentation of information is unsatisfactory in two of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information is unsatisfactory in three or more of the following elements

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information
 16 Points  14 Points  13 Points 11 Points 9 Points  0 Points
Application of Course Knowledge

Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations

Presentation of information was exceptional and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was minimally demonstrated in the all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in one of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from and scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in two of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in three of the following elements

  • Applies principles, knowledge and information and scholarly resources to the required topic.
  • Applies facts, principles or concepts learned scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
   10 Points 9 Points  6 Points  0 Points
Interactive Dialogue

Initial post should be a minimum of 300 words (references do not count toward word count)

The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count)

Responses are substantive and relate to the topic.

Demonstrated all of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 3 of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 2 of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 1 or less of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
  8 Points 7 Points  6 Points         5 Points          4 Points  0 Points
Grammar, Syntax, APA

Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition

Error is defined to be a unique APA error. Same type of error is only counted as one error.

The following was present:

  • 0-3 errors in APA format

AND

  • Responses have 0-3 grammatical, spelling or punctuation errors

AND

  • Writing style is generally clear, focused on topic,and facilitates communication.
The following was present:

  • 4-6 errors in APA format.

AND/OR

  • Responses have 4-5 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is somewhat focused on topic.
The following was present:

  • 7-9 errors in APA format.

AND/OR

  • Responses have 6-7 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is slightly focused on topic making discussion difficult to understand.
 

The following was present:

  • 10- 12 errors in APA format

AND/OR

  • Responses have 8-9 grammatical, spelling and punctuation errors

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand.
 

The following was present:

  • 13 – 15 errors in APA format

AND/OR

  • Responses have 8-10 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand.

AND/OR

  • The student continues to make repeated mistakes in any of the above areas after written correction by the instructor.
The following was present:

  • 16 to greater errors in APA format.

AND/OR

  • Responses have more than 10 grammatical, spelling or punctuation errors.

AND/OR

  • Writing style does not facilitate communication
  0 Points Deducted 5 Points Lost
Participation

Requirements

Demonstrated the following:

  • Initial, peer, and faculty postings were made on 3 separate days
Failed to demonstrate the following:

  • Initial, peer, and faculty postings were made on 3 separate days
  0 Points Lost 5 Points Lost
Due Date Requirements Demonstrated all of the following:

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.

Demonstrates one or less of the following.

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.

Read Also:  NURS 6630 ASSESSING AND TREATING PATIENTS WITH IMPULSIVITY, COMPULSIVITY, AND ADDICTION ASSIGNMENT 

 

A Sample Answer 2 For the Assignment: NURS 6630 ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS ASSIGNMENT

Title: NURS 6630 ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS ASSIGNMENT

To promote a comprehensive understanding of the treatment of a patient with insomnia, this discussion examines the case of a 31-year-old male patient diagnosed with insomnia. The patient reports being used to getting inadequate sleep most of his life. However, ever since he lost his fiancé about 6 months ago, he has been finding it hard to fall and stay asleep. Previously, the patient was using diphenhydramine to manage his insomnia but stopped due to the side effects experienced upon waking up. His work requires very high concentration levels which are greatly impacted by his inability to get enough sleep at night. The patient even reports that he has been falling asleep at work recently. As reported by the patient’s previous physician, he has a history of opiate abuse, which was developed when he was prescribed hydrocodone/APAP (acetaminophen) for managing pain associated with his broken ankle from skiing. The patient however denies use of opioid analgesics for the past 4 years. He however reports drinking alcohol every night to help him sleep. Mental status examination reveals no possibilities of comorbidities. 

Several medications have been proven to be effective in the management of insomnia among adults. However, the choice of which medication to prescribe depends on several patient factors. For the patient in this discussion, such factors include his age, gender, and insomnia diagnosis. His previous use of diphenhydramine but with undesirable side effects will also be considered. His social history of losing his fiancé, history of opiate abuse, and use of alcohol will also play a significant role in determining the most effective drug choice. The purpose of this paper is to illustrate the decisions made in prescribing medication for the treatment of young adult patients with insomnia, in addition to the ethical consideration at each decision point.  

 

Decision #1 

Selected Decision and Rationale 

Out of the provided alternatives, starting the patient on trazodone 50mg once daily at bedtime seems to be the most appropriate decision. Trazodone is an antidepressant with a complex mode of action primarily associated with the inhibition of the serotonin pathway (Martsenkovskyi & Napryeyenko, 2019). The drug is frequently prescribed off-label for the management of chronic insomnia high tolerance levels and effectiveness in initiating and maintaining sleep (Winkelman, 2015; Grandner & Perlis, 2019). The initial dose of the drug for adults with insomnia usually ranges from 25 to 50mg once daily, but the dose may range to up to 150mg once daily depending on the treatment outcome (Sateia et al., 2017). The drug is administered orally with a rapid absorption rate that promotes a short onset of action with peak plasma concentration being attained within 30 minutes to 1 hour. It is metabolized primarily via the CYP2D6 and CYP3A4 pathways with reduced risks of toxicity and adverse events. 

Zolpidem can be used in the management of insomnia but is associated with increased risks of life-threatening sleep behaviors hence should only be recommended in case there is no other safer alternative (Sateia et al., 2017). On the other hand, it was not appropriate to prescribe hydroxyzine, given it belongs to a similar class of drugs to diphenhydramine (antihistamines) which already displayed undesirable side effects which made the patient discontinue using the drug (Martsenkovskyi & Napryeyenko, 2019; Yi et al., 2018).  

Expected Outcome 

In about four weeks, the patient is expected to report to the hospital with significantly improved sleeping patterns (Sateia et al., 2017). He should be able to sleep adequately through the night, and exhibit improved concentration and energy levels the following morning (Grandner & Perlis, 2019). 

Ethical Considerations 

When treating adult patients, the PMHNP needs to uphold the patient’s privacy and confidentiality. Consequently, the patient’s decision must be respected to uphold his autonomy. 

Decision #2 

Selected Decision and Rationale 

Looking at the reported treatment outcome after four weeks, it was necessary to reduce the trazodone dose to 25 mg orally at bedtime. The decision was mainly based on the reported side effect of prolonged erection the following morning (Madari et al., 2021). The patient displayed a positive outcome of the drug in managing his insomnia which is an indication of potential effectiveness (Sateia et al., 2017; Akinnusi & El Solh, 2019). Studies show that when used at low doses, the risks of potential side effects of trazodone such as priapism are normally reduced (Winkelman, 2015; Martsenkovskyi & Napryeyenko, 2019). Additionally, it has been reported that in case of self-limiting side effects like prolonged erection, reducing the dose will promote the side effect disappearing within a shorter time, hence promoting the patient’s tolerance to the medication (Yi et al., 2018).  

Explaining to the patient that the reported side effect is not priapism and will resolve with time, without altering the dose was not necessary as this would promote worsening of the side effect (Grandner & Perlis, 2019; Yi et al., 2018). Consequently, stopping trazodone and starting suvorexant was also inappropriate given that the patient’s response within the two weeks displayed great adherence to the medication with only one self-limiting side effect, which does not qualify termination of the treatment therapy (Martsenkovskyi & Napryeyenko, 2019). 

Expected Outcome 

The reported side effects of prolonged erection in the morning are expected to diminish within the next 4 weeks upon reducing the dose to 25mg once daily (Sateia et al., 2017). The patient’s sleeping pattern is also expected to improve even further within this time (Yi et al., 2018).  

Ethical Considerations 

With the obligation of preventing harm to the patient and respecting their autonomy, the PMHNP needed to consider the patient’s discomfort with the reported side effects of the drug (Grandner & Perlis, 2019). As such, it was necessary to observe ethical principles such as justice and nonmaleficence in promoting clinical decision which promotes using a lower dose of the drug, which is still effective to elicit desired effects (Madari et al., 2021). 

Decision #3 

Selected Decision and Rationale 

Looking at the available options in line with the reported outcome from the initial intervention, the last decision was to continue using the same drug, at the same frequency and dose and encourage sleep hygiene. The patient has displayed great adherence and tolerance to trazodone, as the previously reported side effect diminished (Winkelman, 2015). However, the dose was quite low, hence sometimes failing to help the patient sleep through the night. Studies show that at low doses, trazodone can take up to 8 to 12 weeks to completely help patients sleep through the night (Grandner & Perlis, 2019). Consequently, to avoid side effects associated with the use of several pharmacological agents, evidence supports the use of nonpharmacological interventions such as appropriate sleep hygiene to promote treatment outcomes (Sateia et al., 2017; Yi et al., 2018).  

Replacing trazodone with ramelteon, which is a hypnotic was not necessary as the already displayed great tolerance and adherence to trazodone, and the latter is also associated with undesired cardiovascular side effects which might compromise the patient’s health (Martsenkovskyi & Napryeyenko, 2019). As stated earlier, replacing trazodone with hydroxyzine was also inappropriate as hydroxyzine being an antihistamine would only lead to undesired side effects which might affect the patient’s compliance with the medication (Grandner & Perlis, 2019). 

Expected Outcome 

At this point, the patient is expected to attain an adequate amount of sleep every night with the adoption of appropriate sleep hygiene (Winkelman, 2015). No side effects are expected. Patient productivity at work is expected to improve due to improved quality of sleep (Yi et al., 2018). 

Ethical Considerations 

Adult patients have the legal right of making sound decisions concerning their health. As such, the PMHNP must ensure that the patient is adequately acknowledged of the available treatment options, and the benefits and limitations of each choice (Grandner & Perlis, 2019). Respecting patient autonomy is also crucial in promoting trust and a positive care outcome (Martsenkovskyi & Napryeyenko, 2019). 

Conclusion 

Several drugs have been recommended for the management of insomnia among adults. However, the decision on which medication to prescribe greatly depends on several patient-specific factors. The provided case demonstrates a young adult male patient with worsening insomnia. The patient was initially taking phenylhydrazine for the management of his insomnia but did not like the way it made him feel the following morning. Out of the available options, the first decision was to start the patient on trazodone 50mg orally every night. The drug has been approved by the FDA for the management of depression, but due to its tolerance and great effectiveness in the management of chronic insomnia, it is frequently prescribed doff label (Winkelman, 2015). Zolpidem and hydroxyzine were thus neglected due to their increased risks of toxicity (Martsenkovskyi & Napryeyenko, 2019). After two weeks, the patient came back to the hospital complaining of prolonged erection the following morning, but with well-managed insomnia (Akinnusi & El Solh, 2019). This outcome led to the second decision which was to reduce the dose of the drug to 25 mg every night (Yi et al., 2018). Discontinuing the drug and initiating suvorexant instead was not appropriate due to associated safety risks (Madari et al., 2021). 

The patient reported that the side effect diminished after 2 weeks, but the dose was quite low to keep him asleep through the night. As such, the final decision was to continue using the same drug at the same dose and consider sleep hygiene to promote the treatment outcome (Sateia et al., 2017). In each decision process, the PMHNP was forced to observe several ethical principles including justice, autonomy, nonmaleficence, and observing the patient’s privacy and confidentiality (Grandner & Perlis, 2019). The patient was also adequately informed about each decision process, in terms of all the available options with their benefits and limitations.  

 

References 

Akinnusi, M., & El Solh, A. A. (2019). Drug treatment strategies for insomnia in patients with post-traumatic stress disorder. Expert Opinion on Pharmacotherapy, 20(6), 691–699. https://doi.org/10.1080/14656566.2019.1574745 

Grandner, M. A., & Perlis, M. L. (2019). Pharmacotherapy for Insomnia Disorder in Older Adults. JAMA Network Open, 2(12), e1918214. https://doi.org/10.1001/jamanetworkopen.2019.18214 

Madari, S., Golebiowski, R., Mansukhani, M. P., & Kolla, B. P. (2021). Pharmacological Management of Insomnia. Neurotherapeutics. https://doi.org/10.1007/s13311-021-01010-z 

Martsenkovskyi, D., & Napryeyenko, O. (2019). P.818 Adjunctive therapy with trazodone for insomnia in adolescents with post-traumatic stress disorder and depression. European Neuropsychopharmacology, 29, S543–S544. https://doi.org/10.1016/j.euroneuro.2019.09.682 

Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13(02), 307–349. https://doi.org/10.5664/jcsm.6470 

Winkelman, J. W. (2015). Insomnia Disorder. New England Journal of Medicine, 373(15), 1437–1444. https://doi.org/10.1056/nejmcp1412740 

Yi, X., Ni, S., Ghadami, M. R., Meng, H., Chen, M., Kuang, L., Zhang, Y., Zhang, L., & Zhou, X. (2018). Trazodone for the treatment of insomnia: a meta-analysis of randomized placebo-controlled trials. Sleep Medicine, 45, 25–32. https://doi.org/10.1016/j.sleep.2018.01.010