NURS 6630 Therapy for Patients With Sleep or Wake Disorders

Sample Answer for NURS 6630 Therapy for Patients With Sleep or Wake Disorders Included After Question

NURS 6630 Therapy for Patients With Sleep or Wake Disorders

 

From negative changes in mood to problems concentrating, sleep/wake disorders can have a tremendous impact on patients’ lives. When patients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. However, many of the medications used to treat sleep/wake disorders may be addictive, making thorough patient assessments and close follow-up care essential. To prescribe appropriate therapies with patient safety in mind, you must understand not only the pathophysiology of these disorders but also the pharmacologic agents used to treat them.

This week, as you study therapies for individuals with sleep/wake disorders, you examine the assessment and treatment of patients with these disorders. You also explore ethical and legal implications of these therapies.

Learning Objectives

Students will:

NURS 6630 Therapy for Patients With Sleep or Wake Disorders
NURS 6630 Therapy for Patients With Sleep or Wake Disorders
  • Synthesize concepts related to the psychopharmacologic treatment of patients
  • Assess patient factors and history to develop personalized therapy plans for patients with sleep/wake disorders
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for sleep/wake disorders
  • Synthesize knowledge of providing care to patients presenting for sleep/wake disorders
  • Analyze ethical and legal implications related to prescribing therapy for patients with sleep/wake disorders

Learning Resources

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: NURS 6630 Therapy for Patients With Sleep or Wake Disorders

 

Required Readings (click to expand/reduce)

 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (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 Reports, 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. Chest, 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. SLEEP, 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. SLEEP, 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 Medicine, 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 Medicine, 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740

 

Medication Resources (click to expand/reduce)

 

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

 

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.

  • 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

Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource

A Sample Answer For the Assignment: NURS 6630 Therapy for Patients With Sleep or Wake Disorders

Title: NURS 6630 Therapy for Patients With Sleep or Wake Disorders

Assessing and Treating Patients with Sleep/Wake Disorders  

Insomnia is a mental disorder that affects significantly the health, wellbeing, and functioning of the patients. Therefore, this paper examines a case study of a 31-year-old male that presents with chief complaint of insomnia. The patient reported that the insomnia has worsened progressively over the last six months. The problem started about six months ago after his fiancé passed on. Insomnia has affected his ability to perform at his job as a forklift operator. The patient has a history of using diphenhydramine to enhance sleep but did not like what he felt the morning after, as he fallen asleep because of lack of sleep the night before. The patient’s history also shows that he has opiate abuse after breaking his ankle where he was prescribed acetaminophen for pain management. However, he has not received an opiate prescription for the last four years.   

The patient also has a history of alcohol use to induce sleep. He drinks about four beers before bed. Mental status exam performed on the patient showed that he was oriented to place, time, person, and event. He made eye contact, dressed appropriately for the occasion, denied hallucinations, with judgement, insight, and reality being intact. He also denied suicidal ideation and future oriented. Therefore, the patient factors that will affect the selected treatment include his age, experience with diphenhydramine, opiate abuse, and alcohol use. The selected treatments should not predispose him to unwanted outcomes such as poor performance at workplace, dependence, or increased use of alcohol to manage insomnia symptoms.  

Decision 1 

Selected Decision  

Zolpidem: 10 mg daily at bedtime  

Why I Selected the Decision  

I selected Zolpidem for the patient because of its high level of tolerance and efficacy in managing insomnia and minimal residual effects. According to Xiang et al., (2021), Zolpidem is highly effective in increasing the total sleep time, reducing sleep latency, and enhancing sleep quality in patients suffering from insomnia disorder. Clinical trials have also demonstrated that Zolpidem has a high efficacy level in improving wake after sleep onset, which enhances the performance and productivity of the patients affected by insomnia disorder (Inoue et al., 2022). In another study, zolpidem was found to increase patients’ ability to sleep within 30 minutes, eliminate troubles they experience staying awake during daytime, and remaining motivated to get things done (Asok et al., 2019). The effectiveness was high as compared to placebo and use of other agents to enhance sleep.  

Why the Other Two were not Selected? 

I did not select the decision to initiate the patient on Trazodone 50 mg PO at bedtime because it is not the first-line drug of choice for insomnia. Instead, it is recommended for patients treated with selective serotonin reuptake inhibitors (SSRIs) to manage their associated insomnia (Cuomo et al., 2019). I did not select the decision to start the patient with Hydroxyzine 50 mg daily at bedtime. This is because it is a histamine H1 blocker, which the patient reported having a negative experience with it (Sharma et al., 2019). Its administration is likely to affect treatment adherence, hence, the lack of realization of the desired outcomes.  

What I was Hoping to Achieve 

I was hoping to achieve improvements in sleep quality, latency, after night performance, and functioning in the patient. This is largely attributed to the effects of zolpidem on sleep. I was also hoping to see the patient tolerating the selected treatment (Xiang et al., 2021).   

Ethical Considerations  

The ethical consideration that informed the adopted decision is the principle of beneficence and non-maleficence. Psychiatric mental health nurses should adopt treatments associated with minimal harm and optimum patient benefits. As a result, zolpidem has more benefits than harm as compared to the given options (Xiang et al., 2021).  

Decision 2 

Selected Decision  

Discontinue zolpidem and initiate therapy with Trazodone 50-100 mg daily at bedtime.  

Why I Selected the Decision  

The decision to discontinue zolpidem and initiate therapy with trazodone 50-100 mg daily at bedtime was adopted. This is because the patient returned to the clinic with complains that suggested that he developed adverse effects associated with zolpidem. Accordingly, he reports that he felt knocked out, waking up in the middle of the night and cooking breakfast and having no recollection of the occurrence, and taking the medication with beer right before bedtime to get sleep. As shown by Asok et al., (2019), these are some of the unwanted side effects of zolpidem. Trazodone would be the best drug of choice at this time. According to Pochiero et al., (2022), Trazodone is an off-label drug that is used in treating acute cases of insomnia because of its high affinity for alpha 1 and serotonin 2A receptors that regulate sleep. The long-term use of trazodone is associated with improved sleep complaints and enhanced cognitive and functional scores among patients suffering from insomnia (La et al., 2019). Therefore, it makes it an effective drug to manage insomnia symptoms for the patient.  

Why the Other Two were not Selected? 

I did not select the decision to decrease zolpidem to 5 mg daily at bedtime because the client demonstrated symptoms of adverse reaction to the drug. Its continued administration is associated with the increased risk of worsening symptoms and poor treatment adherence. I did not select the decision to discontinue zolpidem and initiate eszopiclone 1 mg daily at bedtime because it has a high risk of symptom relapse as well as studies demonstrating high efficacy when used in elderly patients (Liang et al., 2019).  

What I was Hoping to Achieve  

I was hoping to eliminate the adverse effects the patient developed towards zolpidem. I was also hoping to improve his sleep quality, eliminate night awakening, and improve his daily functioning. I was also hoping to improve his overall tolerance to the treatment (Cuomo et al., 2019).  

Ethical Considerations  

The ethical consideration that informed the above decision is utilizing evidence-based data to ensure safety and efficiency in treating mental health disorders. Psychiatric mental health nurses should adopt evidence-based decisions to minimize potentials of patient harm. As a result, the decision to change the treatment aimed at eliminating further risks associated with zolpidem in insomnia treatment (Xiang et al., 2021).  

Decision 3 

Selected Decision  

Continue dose. Explain to patient he may split the 50 mg table in half. The decreased dose should minimize next day drowsiness. Follow up in 4 weeks.  

Why I Selected the Decision  

The client returned to the clinic in 2 weeks. He reported that trazodone is effective at 50 mg dose. However, he wakes up sometimes the following day with next-day drowsiness. He denies any auditory or visual hallucinations and is future oriented. These findings demonstrate the Trazodone has been effective in managing symptoms associated with insomnia. The patient denies night awakening and failing to recollect his experiences. He also does not take the drug with beer to enhance sleep quality. The next-day drowsiness is an expected finding because of the effect of the current dosage of trazodone (Cuomo et al., 2019). As a result, an effective solution would be to split the 50 mg tablet in half to minimize the next day drowsiness.  

Why the Other Two were not Selected? 

The decision to discontinue trazodone, initiate therapy with sonata 10 mg nightly at bedtime and following up in 4 weeks was not selected because trazodone had demonstrated the desired treatment outcomes. There was improvement in symptoms translating into no need to initiate the patient on a new drug. Similarly, the decision to discontinue trazodone and initiate therapy with hydroxyzine 50 mg at bedtime and following up in 4 weeks was not selected since trazodone had shown its effectiveness and efficacy. In addition, the patient has negative experience with diphenhydramine, which translate into a similar effect with hydroxyzine (Inoue et al., 2022).  

What I was Hoping to Achieve  

I was hoping to see sustained improvement in insomnia symptoms. I was also hoping that the patient will report minimal side effects associated with trazodone. Splitting the tablet into half was also expected to address the issue of next-day sleepiness (Cuomo et al., 2019).  

Ethical Considerations  

Ethical considerations such as justice, beneficence, and non-maleficence could have affected the adopted treatments. Accordingly, psychiatric mental health nurses demonstrate justice in their practice by ensuring confidentiality and privacy of the patient’s data. In addition, they ensure the adopted treatments are not harmful and aim at doing for their patients. Therefore, a violation of any of these principles would affect treatment outcomes.  

Conclusion 

In conclusion, the initially adopted treatment to begin the patient with zolpidem was ineffective. The patient demonstrated signs and symptoms of adverse reactions to zolpidem. This increased the need for the adoption trazodone to minimize the adverse and side effects while improving the symptoms of insomnia. The decision to begin the patient with zolpidem and not trazodone is that trazodone is largely used in patients with insomnia associated with other disorders. The selection of trazodone proved effective for the patient. There was the elimination of night awakening, feeling knocked out, and having to add beer to enhance his sleep quality. The patient reported feeling sleepy the following day, which necessitated the splitting of the Trazodone 50 mg table into half to address it (Cuomo et al., 2019). This decision led to further improvement in insomnia symptoms and drug tolerance, hence, the effectiveness of the decision. 

Ethical considerations informed the patient’s treatment. Accordingly, the decisions made aimed at ensuring the promotion of safety, efficiency, and quality in the treatment process. The psychiatric mental health nurse practitioner made the decisions with the aim of optimizing benefits while minimizing the potential harm the selected drugs had on the patient. In addition, the principles of justice, autonomy, and beneficence, and non-maleficence informed the decisions made in the case study. For example, by minimizing harm, the nurse ensured the principle of non-maleficence. The use of evidence-based interventions in decision-making aimed at doing good for the patients (Xiang et al., 2021). Therefore, ethics guided the selected decisions in the patient’s treatment.  

 

References 

Asok, A., Sreekumar, S., TK, R., CC, A., P, U. D., & K, P. (2019). Effectiveness of zolpidem and sleep hygiene counseling in the treatment of insomnia in solid tumor patients. Journal of Oncology Pharmacy Practice, 25(7), 1608–1612. https://doi.org/10.1177/1078155218801062 

Cuomo, A., Ballerini, A., Bruni, A. C., Decina, P., Sciascio, G. D., Fiorentini, A., Scaglione, F., Vampini, C., & Fagiolini, A. (2019). Clinical guidance for the use of trazodone in major depressive disorder and concomitant conditions: Pharmacology and clinical practice. Rivista di Psichiatria, 54(4), 137–149. 

Inoue, Y., Nishida, M., Kubota, N., Koebis, M., Taninaga, T., Muramoto, K., Ishikawa, K., & Moline, M. (2022). Comparison of the treatment effectiveness between lemborexant and zolpidem tartrate extended release for insomnia disorder subtypes defined based on polysomnographic findings. Journal of Clinical Sleep Medicine. https://doi.org/10.5664/jcsm.10378 

La, A. L., Walsh, C. M., Neylan, T. C., Vossel, K. A., Yaffe, K., Krystal, A. D., Miller, B. L., & Karageorgiou, E. (2019). Long-Term Trazodone Use and Cognition: A Potential Therapeutic Role for Slow-Wave Sleep Enhancers. Journal of Alzheimer’s Disease, 67(3), 911–921. https://doi.org/10.3233/JAD-181145 

Liang, L., Huang, Y., Xu, R., Wei, Y., Xiao, L., & Wang, G. (2019). Eszopiclone for the treatment of primary insomnia: A systematic review and meta-analysis of double-blind, randomized, placebo-controlled trials. Sleep Medicine, 62, 6–13. https://doi.org/10.1016/j.sleep.2019.03.016 

Pochiero, I., Gorini, M., Comandini, A., Calisti, F., Loreto, G. D., Cattaneo, A., Knight, T., Anastassopoulos, K. P., Patel, R., Baik, R., & Bruni, O. (2022). Real-World Characteristics and Treatment Patterns of Patients With Insomnia Prescribed Trazodone in the United States. Clinical Therapeutics, 44(8), 1093–1105. https://doi.org/10.1016/j.clinthera.2022.07.004 

Sharma, M. K., Kainth, S., Kumar, S., Bhardwaj, A., Agarwal, H. K., Maiwall, R., Jamwal, K. D., Shasthry, S. M., Jindal, A., Choudhary, A., Anand, L., Dhamija, R. M., Kumar, G., Sharma, B. C., & Sarin, S. K. (2019). Effects of zolpidem on sleep parameters in patients with cirrhosis and sleep disturbances: A randomized, placebo-controlled trial. Clinical and Molecular Hepatology, 25(2), 199–209. https://doi.org/10.3350/cmh.2018.0084 

Xiang, T., Cai, Y., Hong, Z., & Pan, J. (2021). Efficacy and safety of Zolpidem in the treatment of insomnia disorder for one month: A meta-analysis of a randomized controlled trial. Sleep Medicine, 87, 250–256. https://doi.org/10.1016/j.sleep.2021.09.005