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

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

NURS 6630 Assignment 2 Assessing and Treating Patients With Sleep Wake Disorder

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 

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 

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 
• Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry ReportsLinks to an external site., 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8 
• Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. ChestLinks to an external site., 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/ 
• Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEPLinks to an external site., 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf 
• Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEPLinks to an external site., 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf 
• 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 MedicineLinks to an external site., 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470 
• Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of MedicineLinks to an external site., 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740 

Medication Resources 

• U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugsLinks to an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
  Links to an external site. 

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. 

Required Media 

• Case study: Pharmacologic approaches to the treatment of insomnia in a younger adultLinks 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) 

• 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 formattingLinks 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 

1. Then, click on Start Assignment near the top of the page. 

1. Next, click on Upload File and select Submit Assignment for review. 

Rubric 

NURS_6630_Week8_Assignment2_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

Introduction to the case

The case scenario represents a 31-year-old guy who suffers from insomnia as a primary symptom, which has gotten worse in the six months since he lost his fiancé. The client admits that he is not a natural sleeper, but has been having difficulty falling asleep and staying asleep throughout the night. He states that insomnia has a negative effect on his occupational performance because he naps at work due to his inability to sleep at night. The customer has previously used diphenhydramine to induce sleep, but he dislikes its morning consequences. His medical history suggests a history of opiate abuse that began when he was prescribed hydrocodone/apap for acute pain following an ankle fracture. He had not, however, been prescribed an opiate analgesic in four years. The client admits to having around four beers to assist with sleep initiation. His mental status examination reveals a patient who is attentive and focused, maintains good eye contact, and clothes appropriately for the weather. The client denies hearing/seeing hallucinations or having suicidal/homicidal thoughts. Additionally, he retains his judgment, reality contact, and intelligence, and he is future-oriented.

This patient’s treatment approach should focus on improving sleep quality and alleviating associated daytime deficits. However, methods for achieving these objectives differ according to the underlying etiology and patient characteristics (Krystal, Prather & Ashbrook, 2019). For example, if the client has an underlying neurologic, medical, or sleep condition, the treatment should be directed toward that disorder. Additionally, the patient’s history of opiate abuse should lead the PMHNP in prescribing an anti-abuse medication (Krystal et al., 2019). The purpose of this article is to detail the client’s treatment plan and to discuss the ethical concerns that may affect the treatment plan and communication with the client.

Decision Point One: Prescribe Trazodone: 50–100 mg daily at bedtime.

Why did you select this decision?

I initiated the client on Trazodone because its efficacy in treating insomnia has been established. Trazodone blocks the receptors for neurotransmitters that promote wakes, such as alpha-1-adrenergic and histamine receptors (Neubauer et al., 2018). It also inhibits serotonin reuptake resulting in sleep-enhancing effects. Sateia et al. (2017) conducted a study that showed that Trazodone increases sleep duration, reduces sleep latency, reduces onset of wake after sleep, moderately improved quality of sleep, and lessens the frequency of nighttime awakenings. NURS 6630 Assignment 2 Assessing and Treating Patients With Sleep/Wake Disorder

Why I Did Not Select the Other Two Options Provided

The other two options provided were Zolpidem and Hydroxyzine. I did not select Zolpidem because of its associated adverse effects, including psychomotor impairment and dose‐dependent sedation, which can impair functioning and lower the quality of life (Krystal et al., 2019). Zolpidem has a documented risk of abuse and complex sleep behaviors, making it a less ideal drug due to the client’s history of opiate abuse. I did not select Hydroxyzine due to its strong sedative properties. Krystal (2019) explains that Hydroxyzine sedative properties contribute to increased daytime sleepiness following nighttime use. NURS 6630 Assignment 2 Assessing and Treating Patients With Sleep/Wake Disorder

What I Was Hoping To Achieve By Making This Decision

I was hoping that starting the client on Trazodone would improve sleep quality and duration and help initiate and maintain sleep. I also hoped that the client would report reduced daytime speediness and improved daytime functioning. Jaffer et al. (2017) explain that Trazodone enhances subjective and objective sleep and awakening in persons with primary insomnia. The drug also enhances subjective sleep, duration, and quality in individuals with primary insomnia.

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How Ethical Considerations May Impact the Treatment Plan and Communication

Ethical considerations may influence the treatment plan since the PMHPN ensures the prescribed treatment is safe and will promote

the best possible outcomes. For instance, I evaluated the treatment options and selected the drug with strong evidence supporting its efficacy and safety. I did not select drugs with adverse effects to avoid causing harm to the client and improve his quality of life. According to Milliken (2018), communication may be impacted since the PMHMNP has to obtain consent from the client before initiating treatment or sharing his information with other providers.

Decision Point Two: Explain to the client that priapism is a side effect of Trazodone that should diminish over time and continue the dose.

Why I Selected This Decision

I selected this decision because the patient expressed concerns about prolonged erection for about 15 minutes after waking within two weeks of therapy. A client has a right to information about their medication, including potential side effects (Milliken, 2018). Consequently, I explained to the patient about Trazodone’s side effect of priapism and informed him about its duration for reassurance and to promote medication adherence.

Why I Did Not Select the Other Two Options Provided

Other options provided were to discontinue Trazodone and initiate therapy with suvorexant or decrease trazodone dose to 25 mg daily. The PMHNP did not stop Trazodone and start suvorexant because the latter causes psychomotor hyperactivity, has a sedative effect that causes somnolence, and probable abuse potential (Krystal et al., 2019). Furthermore, I did not reduce the dose since it may decrease the drug’s impact and effectiveness in reducing insomnia. Besides, the client did not experience other adverse effects that affected his quality of life.

What I Was Hoping to Achieve By Making This Decision

I hoped that enlightening the client on the side effect of priapism and its duration would reassure him and promote compliance to treatment. I also hoped that educating the client on the priapism side effect would make him adhere to treatment.  According to Jaffer et al. (2017), low doses of Trazodone induce and maintain sleep without daytime drowsiness or tolerance, primarily because of its short half-life of 3–6 hours.

How Ethical Considerations May Impact the Treatment Plan and Communication

Ethical considerations may influence the treatment plan since the PMHNP has to uphold nonmaleficence, requiring that the practitioner do not harm a patient. Consequently, the PMHNP has to modify the treatment plan to prevent harm to the patient and promote good health outcomes (Milliken, 2018). In this case, the PMHNP analyzed the reported side effect and educated the client about priapism and its duration to promote compliance. If other adverse effects were reported, they would warrant a change of medication. NURS 6630 Assignment 2 Assessing and Treating Patients With Sleep/Wake Disorder

Decision Point Three: Continue Trazodone dose and explain that he may split the 50 mg tablet in half. Follow up in four weeks.

Why I Selected This Decision

I continued treatment with Trazodone because it effectively ameliorates insomnia, and the primary concern of priapism has abated. I advised the client to divide the Trazodone tablet in half because low doses of Trazodone reduce side effects such as next-day drowsiness (Wang et al., 2020). I scheduled a follow-up in four weeks to monitor the patient’s response and severity of drowsiness after dividing the tablet.

Why I Did Not Select the Other Two Options Provided

Other options were to stop Trazodone and initiate treatment with Sonata 10 mg or initiate Hydroxyzine. I did not start Sonata because its elimination half-life approximately correlates with the duration of action, which increases the potential risk for following-day residual sedation and impairment (Neubauer et al., 2018). Hydroxyzine has anticholinergic and sedative properties that cause involuntary motor activity, drowsiness, and dry mouth, affecting compliance.

What I Was Hoping To Achieve By Making This Decision

I hoped that dividing Trazodone tablet by half would reduce next-day drowsiness and improve daytime functioning. I hoped that the client would report diminished drowsiness and improved daytime functioning within four weeks after dividing the dose. A study by Wang et al. (2020) showed that a low dose of Trazodone 25 mg effectively reduces the severity of insomnia and improves concentration.

How Ethical Considerations May Impact the Treatment Plan and Communication

The PMHNP has an ethical duty to promote better health outcomes while preventing any damage to the client (Milliken, 2018). In the case study, the PMHNP advised the client to divide the dose to reduce drowsiness and improve his daytime functioning. This ensures better patient outcomes and prevents harm to the client. NURS 6630 Assignment 2 Assessing and Treating Patients With Sleep/Wake Disorder

NURS 6630 Assignment 2 Assessing and Treating Patients With Sleep Wake Disorder Conclusion

The client in the case scenario had insomnia manifested with difficulties initiating and maintaining sleep and daytime negative effects of daytime sleepiness. I started the client on Trazodone 50 mg, an antidepressant used as an off-label drug to treat insomnia (Neubauer et al., 2018). The therapeutic efficacy of Trazodone in insomnia patients has been established as well as its safety. At low doses, it induces and maintains sleep without side effects of daytime drowsiness or tolerance (Jaffer et al., 2017). The drug was effective in attaining the goal of alleviating insomnia but had a side effect of priapism. However, the client expressed concerns about the priapism since it lasted 15 minutes.

In the second decision, I educated the client that priapism is an expected side effect of the medication, but it diminishes over time. I also maintained the dose because it had positive outcomes. As expected, the priapism decreased over time, but the client later reported having occasional next-day drowsiness with Trazodone 50 mg.  In the third decision, I advised the client to halve the Trazodone tablet in half to minimize drowsiness since low doses have minimal side effects (Wang et al., 2020). Ethical considerations that may influence the treatment plan include the principle of beneficence and nonmaleficence, which require the PMHNP to implement interventions that promote the best possible outcomes and do not harm the patient (Milliken, 2018). The selected medication was evaluated for its efficacy and safety, which upholds the two principles. Communication may also be impacted since the PMHNP has to seek the patient’s consent before initiating treatment or sharing information with colleagues.

NURS 6630 Assignment 2 Assessing and Treating Patients With Sleep Wake Disorder References

Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., Abdelmesseh, M., Danovitch, I., & Ishak, W. W. (2017). Trazodone for Insomnia: A Systematic Review. Innovations in clinical neuroscience, 14(7-8), 24–34.

Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World psychiatry: official journal of the World Psychiatric Association (WPA), 18(3), 337–352. https://doi.org/10.1002/wps.20674

Milliken, A. (2018). Ethical awareness: what it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1). https://doi.org/10.3912/OJIN.Vol23No01Man01

Neubauer, D. N., Pandi-Perumal, S. R., Spence, D. W., Buttoo, K., & Monti, J. M. (2018). Pharmacotherapy of Insomnia. Journal of central nervous system disease, 10, 1179573518770672. https://doi.org/10.1177/1179573518770672

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: JCSM: official publication of the American Academy of Sleep Medicine, 13(2), 307–349. https://doi.org/10.5664/jcsm.6470

Wang, J., Liu, S., Zhao, C., Han, H., Chen, X., Tao, J., & Lu, Z. (2020). Effects of Trazodone on Sleep Quality and Cognitive Function in Arteriosclerotic Cerebral Small Vessel Disease Comorbid with Chronic Insomnia. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00620

Decision Point One

Selected Decision

            Administration of Trazodone 50 mg before bedtime.

Rationale

Trazodone was selected as the treatment since it is one of the most effective drugs for inducing and maintaining sleep. The FDA has approved the use of trazodone to treat insomnia (Pan et al., 2023). Trazodone inhibits the serotonin 5-HT2A receptor as a SARI (Muehlan et al., 2020). Trazodone has traditionally been used to treat the patient’s potential primary and secondary insomnia. Furthermore, studies indicate that utilizing low doses of trazodone to treat and manage insomnia has a high safety profile (Bragg et al., 2019; Zheng et al., 2020). Trazodone would thus allow the patient to manage sleep interruptions while focusing on his work.

The decision to not select zolpidem was influenced by its association with a sleep-related eating disorder (Pan et al., 2023). Zolpidem is associated with various adverse effects, including cognitive decline, hallucinations, diminished inhibitory control, somnolence, as well as gastrointestinal discomfort such as nausea and abdominal pain. Moreover, due to the resemblance of Hydroxyzine to the client’s diphenhydramine, it was not selected (Muehlan et al., 2020). In addition, the medication possesses sedative characteristics and induces urinary retention.

Expected Outcome

Within the next four weeks, the patient’s sleep quality and quantity are anticipated to improve with the administration of trazodone (Yue et al., 2023). Within this period, his ability to focus at work and his general quality of life should both increase (Begum et al., 2021).

Ethical Considerations

The moral considerations of beneficence and nonmaleficence have had an impact on the treatment approach and communication with the patient (Pan et al., 2023). Due to the ethical principle of beneficence, it was imperative to exert sufficient endeavors to assist, safeguard, and safeguard the patient from any potential harm. The prescription of the drug with the least number of adverse effects was made in a situation where malice was not present (Bragg et al., 2019).

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