NURS 6630 psychopharmacologic treatments Assignment

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NURS 6630 psychopharmacologic treatments Assignment

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SHORT ANSWER ASSESSMENT NURS 6630 WEEK 8

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.
Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
1. 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?
2. List 4 predictors of late onset generalized anxiety disorder.
3. List 4 potential neurobiology causes of psychotic major depression.
4. 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.
5. 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 information
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1. To submit your completed assignment, save your Assignment as WK8Assgn1_LastName_Firstinitial
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3. Next, click on Upload File and select Submit Assignment for review.

Rubric
NURS_6630_Week8_Assignment1_Rubric
NURS_6630_Week8_Assignment1_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome 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 it is the timeframe that the patient should see resolution of symptoms? 13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly explains in detail the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse…. The response accurately and clearly details which drugs are contraindicated with specific examples…. The response accurately and clearly explains in detail the timeframe that the patient should see resolution of symptoms. 11 to >10.0 pts
Good Point range: 80–89
The response accurately explains the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse…. The response accurately identifies which drugs are contraindicated with specific examples…. The response accurately explains the timeframe that the patient should see resolution of symptoms. 10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely explains the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse…. The response inaccurately or vaguely identifies which drugs are contraindicated with inaccurate or vague examples…. The response inaccurately or vaguely explains the timeframe that the patient should see resolution of symptoms. 9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely explains the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse, or is missing…. The response inaccurately and vaguely identifies which drugs are contraindicated with inaccurate examples, or is missing…. The response inaccurately and vaguely explains the timeframe that the patient should see resolution of symptoms, or is missing.
13 pts
This criterion is linked to a Learning Outcome List four predictors of late onset generalized anxiety disorder. 13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly lists in detail four predictors of late-onset generalized anxiety disorder. 11 to >10.0 pts
Good Point range: 80–89
The response accurately lists four predictors of late-onset generalized anxiety disorder. 10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely lists four predictors of late-onset generalized anxiety disorder. 9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely lists four predictors of late-onset generalized anxiety disorder, or is missing.
13 pts
This criterion is linked to a Learning Outcome List four potential neurobiology causes of psychotic major depression. 13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly lists in detail four potential neurobiology causes of psychotic major depression. 11 to >10.0 pts
Good Point range: 80–89
The response accurately lists four potential neurobiology causes of psychotic major depression. 10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely lists four potential neurobiology causes of psychotic major depression. 9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely lists four potential neurobiology causes of psychotic major depression.
13 pts
This criterion is linked to a Learning Outcome An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least five symptoms required for the episode to occur. Be specific. 13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly explains in detail at least five symptoms for the episode of major depression to occur…. Specific examples provided fully support the response. 11 to >10.0 pts
Good Point range: 80–89
The response accurately explains at least five symptoms for the episode of major depression to occur…. Specific examples provided support the response. 10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely explains at least five symptoms for the episode of major depression to occur…. Specific examples provided inaccurately or vaguely support the response. 9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely explains at least five symptoms for the episode of major depression to occur, or is missing…. Specific examples provided do not support the response, or is missing.
13 pts
This criterion is linked to a Learning Outcome List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. 13 to >11.0 pts
Excellent Point range: 90–100
The response accurately and clearly lists in detail 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia…. Examples provided fully support the response provided. 11 to >10.0 pts
Good Point range: 80–89
The response accurately lists 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia…. Examples provided support the response provided. 10 to >9.0 pts
Fair Point range: 70–79
The response inaccurately or vaguely lists 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia…. Examples provided inaccurately or vaguely support the response provided. 9 to >0 pts
Poor Point range: 0–69
The response inaccurately and vaguely lists 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia, or is missing…. Examples provided do not support the response provided, or is missing.
13 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 >2.0 pts
Fair Point range: 70–79
Contains several (3 or 4) grammar, spelling, and punctuation errors. 2 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 >2.0 pts
Fair Point range: 70–79
Contains several (3 or 4) APA format errors. 2 to >0 pts
Poor Point range: 0–69
Contains many (≥ 5) APA format errors.
5 pts
Total Points: 75

NURS 6630 psychopharmacologic treatments Assignment
NURS 6630 psychopharmacologic treatments Assignment

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NURS 6630 psychopharmacologic treatments 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 Discussion Foundational Neuroscience  

 

As we begin this session, I would like to take this opportunity to clarify my expectations for this course:

Please note that GCU Online weeks run from Thursday (Day 1) through Wednesday (Day 7).

 

Course Room Etiquette:

  • It is my expectation that all learners will respect the thoughts and ideas presented in the discussions.
  • All postings should be presented in a respectful, professional manner. Remember – different points of view add richness and depth to the course!

 

Office Hours:

  • My office hours vary so feel free to shoot me an email at [email protected] or my office phone is 602.639.6517 and I will get back to you within one business day or as soon as possible.
  • Phone appointments can be scheduled as well. Send me an email and the best time to call you, along with your phone number to make an appointment.
  • I welcome all inquiries and questions as we spend this term together. My preference is that everyone utilizes the Questions to Instructor forum. In the event your question is of a personal nature, please feel free to post in the Individual Questions for Instructor forumI will respond to all posts or emails within 24 or sooner.

 

Late Policy and Grading Policy

Discussion questions:

  • I do not mark off for late DQ’s.
  • I would rather you take the time to read the materials and respond to the DQ’s in a scholarly way, demonstrating your understanding of the materials.
  • I will not accept any DQ submissions after day 7, 11:59 PM (AZ Time) of the week.
  • Individual written assignments – due by 11:59 PM AZ Time Zone on the due dates indicated for each class deliverable.

Assignments:

  • Assignments turned in after their specified due dates are subject to a late penalty of -10%, each day late, of the available credit. Please refer to the student academic handbook and GCU policy.
  • Any activity or assignment submitted after the due date will be subject to GCU’s late policy
  • Extenuating circumstances may justify exceptions, which are at my sole discretion. If an extenuating circumstance should arise, please contact me privately as soon as possible.
  • No assignments can be accepted for grading after midnight on the final day of class.
  • All assignments will be graded in accordance with the Assignment Grading Rubrics

Participation

  • Participation in each week’s Discussion Board forum accounts for a large percentage of your final grade in this course.
  • Please review the Course Syllabus for a comprehensive overview of course deliverables and the value associated with each.
  • It is my expectation that each of you will substantially contribute to the course discussion forums and respond to the posts of at least three other learners.
  • substantive post should be at least 200 words. Responses such as “great posts” or “I agree” do notmeet the active engagement expectation.
  • Please feel free to draw on personal examples as you develop your responses to the Discussion Questions but you do need to demonstrate your understanding of the materials.
  • I do expect outside sources as well as class materials to formulate your post.
  • APA format is not necessary for DQ responses, but I do expect a proper citation for references.
  • Please use peer-related journals found through the GCU library and/or class materials to formulate your answers. Do not try to “Google” DQ’s as I am looking for class materials and examples from the weekly materials.
  • will not accept responses that are from Wikipedia, Business com, or other popular business websites. You will not receive credit for generic web searches – this does not demonstrate graduate-level research.
  • Stay away from the use of personal pronouns when writing.As a graduate student, you are expected to write based on research and gathering of facts. Demonstrating your understanding of the materials is what you will be graded on. You will be marked down for lack of evidence to support your ideas.

Plagiarism

  • Plagiarism is the act of claiming credit for another’s work, accomplishments, or ideas without appropriate acknowledgment of the source of the information by including in-text citations and references.
  • This course requires the utilization of APA format for all course deliverables as noted in the course syllabus.
  • Whether this happens deliberately or inadvertently, whenever plagiarism has occurred, you have committed a Code of Conduct violation.
  • Please review your LopesWrite report prior to final submission.
  • Every act of plagiarism, no matter the severity, must be reported to the GCU administration (this includes your DQ’s, posts to your peers, and your papers).

Plagiarism includes:

  • Representing the ideas, expressions, or materials of another without due credit.
  • Paraphrasing or condensing ideas from another person’s work without proper citation and referencing.
  • Failing to document direct quotations without proper citation and referencing.
  • Depending upon the amount, severity, and frequency of the plagiarism that is committed, students may receive in-class penalties that range from coaching (for a minor omission), -20% grade penalties for resubmission, or zero credit for a specific assignment. University-level penalties may also occur, including suspension or even expulsion from the University.
  • If you are at all uncertain about what constitutes plagiarism, you should review the resources available in the Student Success Center. Also, please review the University’s policies about plagiarism which are covered in more detail in the GCU Catalog and the Student Handbook.
  • We will be utilizing the GCU APA Style Guide 7th edition located in the Student Success Center > The Writing Center for all course deliverables.

LopesWrite

  • All course assignments must be uploaded to the specific Module Assignment Drop Box, and also submitted to LopesWrite every week.
  • Please ensure that your assignment is uploaded to both locations under the Assignments DropBox. Detailed instructions for using LopesWrite are located in the Student Success Center.

Assignment Submissions

  • Please note that Microsoft Office is the software requirement at GCU.
  • I can open Word files or any file that is saved with a .rtf (Rich Text Format) extension. I am unable to open .wps files.
  • If you are using a “.wps” word processor, please save your files using the .rtf extension that is available from the drop-down box before uploading your files to the Assignment Drop Box.

Grade of Incomplete

  • The final grade of Incomplete is granted at the discretion of the instructor; however, students must meet certain specific criteria before this grade accommodation is even possible to consider.
  • The grade of Incomplete is reserved for times when students experience a serious extenuating circumstance or a crisis during the last week of class which prevents the completion of course requirements before the close of the grading period. Students also must pass the course at the time the request is made.
  • Please contact me personally if you are having difficulties in meeting course requirements or class deadlines during our time together. In addition, if you are experiencing personal challenges or difficulties, it is best to contact the Academic Counselor so that you can discuss the options that might be available to you, as well as each option’s academic and financial repercussions.

Grade Disputes

  • If you have any questions about a grade you have earned on an individual assignment or activity, please get in touch with mepersonally for further clarification.
  • While I have made every attempt to grade you fairly, on occasion a misunderstanding may occur, so please allow me the opportunity to learn your perspective if you believe this has occurred. Together, we should be able to resolve grading issues on individual assignments.
  • However, after we have discussed individual assignments’ point scores, if you still believe that the final grade you have earned at the end of the course is not commensurate with the quality of work you produced for this class, there is a formal Grade Grievance procedurewhich is outlined in the GCU Catalog and Student Handbook.

A Sample Answer For the Assignment: NURS 6630 psychopharmacologic treatments Assignment

Title: NURS 6630 psychopharmacologic treatments Assignment

Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult 

Insomnia is one of the critical predictors of mental health problems including depression. Diurnal and nocturnal symptoms characterize insomnia disorder. Patients with the disorder complain of being dissatisfied with the quality or duration of their sleep alongside prolonged or frequent awakenings. Difficulties to return to sleep follow the awakenings. The consequence of insomnia disorder in patients include reduction in energy, fatigue, mood disturbances and impaired cognitive functions such as attention and decision-making. As a result, patients suffer from significant inabilities to perform in their social as well as occupational roles.  

This assignment is develops the treatment decisions that would be used in treating a patient with insomnia disorder. The patient in the case study is a 31-year old male who presents to the office with the primary complaint of insomnia. The history taken from the client shows that the symptoms of insomnia have progressively worsened over the last six months. The patient complaints that he is having difficulties both in sleeping and staying asleep at night. The onset of the problem was about six months ago after the sudden loss of his fiancé. The patient reports that his problem has affected his ability to perform his job in a local chemical company as a forklift operator. The mental status examination showed that the patient is alert and oriented to place, time, person and event. He also makes good eye contact, dressed appropriately, and denies any visual or auditory hallucinations.  

Patient factors will influence the decisions that will be made in this case study. The factors include his past medical record that shows that he has a history of opiate abuse. The patient has also been using alcohol to help him fall asleep. The patient also has used diphenhydramine in the past and did not like the way it made him fell afterwards. Therefore, the above factors will be considered in the decision-making.  

Decision Point One 

The first decision that will be made for the patient in the case study is the administration of Trazodone 50-100 mg daily at bedtime. Trazodone is a drug approved for treating depression but also an off-label medication for insomnia. Trazodone produces its effects in insomnia by antagonizing serotonin, histamine and alpha adrenergic receptors. The inhibition of the above receptors cause hypnosis, hence, its effectiveness in insomnia. The use of Trazodone at low disease induces alongside maintain sleep without predisposing patients to daytime drowsiness and tolerance because of its short half-life (Jaffer et al., 2017). The use of Zolpidem 10 mg daily at bedtime was not selected as the first option of treatment because it is associated with the adverse effects of the patient feeling drugged, dizziness and drowsiness. As a result, Zolpidem is not selected as the first line drug for insomnia (Wong et al., 2020). The use of hydroxyzine 50 mg daily at bedtime was not selected because it is associated with side effects that include strong sedation, xeropthalmia and xerostomia (Bruni et al., 2018). The side effects might result in worsening in the symptoms of insomnia in the patient.  

The selection in the first decision was made with the expectation that the symptoms of insomnia in the patient will improve. The administration of low dose of Trazodone is effective in improving the symptoms of insomnia and daytime drowsiness. The improvement in symptoms was expected to lead to enhanced functioning in the workplace by the client (Morin et al., 2020). The client came to the clinic after 2 weeks. He reports that medication works well but gives hum the unpleasant side effect of prolonged erection of the penis, approximately 15 minutes after waking. The patient states that prolonged erection makes it difficult for him to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning. He also denies visual or auditor hallucinations and is future oriented. The outcomes were expected because Traodone has the side effect of priapism (Jaffer et al., 2017). The improvement in symptoms was expected because of the therapeutic effectiveness of Trazodone.  

Decision Point Two 

The decision that is selected for the patient at the second step is explaining to the patient that priapism is a side effect of trazodone that should diminish over time. As a result, the current dose of trazodone should be continued. The use of trazodone in decision point one led to a significant improvement in the symptoms of insomnia that the client experienced initially. The improvement in symptoms is evidenced by the fact that the client reports the medication to work well (Wong et al., 2020). The side effect of priapism was expected. The side effects of trazodone are expected to improve over time, as the patient tolerates the medication. Based on the above outcomes, the best option for the patient would be to maintain the current dosage of trazodone. Maintaining the dosage will ensure that the therapeutic effects of the medication are sustained. In addition, maintaining the current dose will ensure that the risk of symptom relapse is eliminated (Wang et al., 2020). Educating the patient is therefore important to raise his level of awareness, enable him to make informed decisions and promote adherence to medications. The decision to discontinue trazodone and initiate therapy with suvorexant 10 mg daily bedtime was not considered at this stage because there is no indication for changing the therapy. The decision to decrease the dosage of trazodone to 25 mg daily at bedtime was not considered at this step because the client did not experience any severe side effects with the initial dose of trazodone. Decreasing the dose to 25 mg at bedtime was also associated with the risk of symptom relapse, hence, the decision not to select this decision (Jaffer et al., 2017).  

The decision above was made with the aim of maintaining the current therapeutic effects of Trazodone. It was also expected that the patient would tolerate the dose, as evidenced by the lessening of the side effects of trazodone (Lavigne et al., 2019). The client was assessed after 2 weeks. He reported that priapism has diminished over time. The patient also denied auditory or visual hallucinations and is future oriented. The client also stated that trazodone is effective at 50 mg dose but sometimes wakes up following day with drowsiness. The outcomes of the decision were achieved because of the enhanced therapeutic effectiveness of trazodone. The complaint of waking up the following day with drowsiness was expected due to the prolonged hypnotic effects of trazodone (Jaffer et al., 2017). Therefore, reducing the dosage might be an appropriate decision.  

Decision Point Three 

The decision that is selected at this step is continuing the dose and explaining to the patient he may split the 50 mg table in half. The decreased dose should minimize next day drowsiness. Follow-up should be done after 4 weeks. Reducing the dose was expected to lower the extended hypnotic and sedation effect of trazodone 50 mg (Wang et al., 2020). The decision to discontinue trazodone and initiate therapy with sonata was not selected because trazodone had produced the desired therapeutic effect in managing insomnia. Similar basis was considered in not selecting the decision to discontinue trazodone and initiate therapy with hydroxyzine 50 mg at bedtime. The decision to use sonata was also not considered because of the increased risk of complex sleep behaviors. The decision not to use hydroxyzine was also not selected because of its strong sedation effects, which could have led to extended drowsiness after waking up (Narang et al., 2020). The decision at this step was made with the aim of minimizing next day drowsiness experienced by the patient. Reducing the dose would have minimized the sedative effect of trazodone (Morin et al., 2020). The outcomes of this decision were not given in the case study. 

Conclusion  

The decisions that the PMHNP made in treating the patient in this case study were effective and informed by evidence-based data. The decisions made showed that trazodone was an effective treatment for insomnia over the other options of treatment. Evidence-based data support the outcomes of using trazodone in this case study. Sources of evidence-based data show that trazodone is the first line of drug utilized in insomnia. Trazodone is highly tolerated and is associated with minimal side effects to the patients. Trazodone has demonstrated effectiveness in use in both short and long-term basis in the management of insomnia. Ethics influenced the decisions that the PMHNP made in relation to the management of insomnia. The PMHNP prioritized the safety of the drugs that were selected for use in the treatment process. The PMHNP also ensured that the patient was informed about the side effects that he was experiencing and reassured him that the symptoms will resolve over time. Therefore, I hope to demonstrate similar competency in solving case studies involving patients with mental health illnesses in the future.  

 

References 

Bruni, O., Angriman, M., Calisti, F., Comandini, A., Esposito, G., Cortese, S., & Ferri, R. (2018). Practitioner Review: Treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities. Journal of Child Psychology and Psychiatry, 59(5), 489–508. https://doi.org/10.1111/jcpp.12812 

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. 

Lavigne, J. E., Hur, K., Kane, C., Au, A., Bishop, T. M., & Pigeon, W. R. (2019). Prescription Medications for the Treatment of Insomnia and Risk of Suicide Attempt: A Comparative Safety Study. Journal of General Internal Medicine, 34(8), 1554–1563. https://doi.org/10.1007/s11606-019-05030-6 

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Narang, P., Held, J., & Lippmann, S. (2020). Pharmacotherapy for Insomnia. In K. Sedky, R. Nazir, & D. Bennett (Eds.), Sleep Medicine and Mental Health: A Guide for Psychiatrists and Other Healthcare Professionals (pp. 101–128). Springer International Publishing. https://doi.org/10.1007/978-3-030-44447-1_6 

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 

Wong, J., Murray Horwitz, M., Bertisch, S. M., Herzig, S. J., Buysse, D. J., & Toh, S. (2020). Trends in Dispensing of Zolpidem and Low-Dose Trazodone Among Commercially Insured Adults in the United States, 2011-2018. JAMA, 324(21), 2211–2213. https://doi.org/10.1001/jama.2020.19224