NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

Sample Answer for NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment Included After Question

Insomnia is one of the most common medical conditions you will encounter as a PMHNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PMHNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being. 

Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29 

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.   

Case: An elderly widow who just lost her spouse.  

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:  

• Metformin 500mg BID  
• Januvia 100mg daily  
• Losartan 100mg daily  
• HCTZ 25mg daily  
• Sertraline 100mg daily  

 Current weight: 88 kg 

Current height: 64 inches 

Temp: 98.6 degrees F 

BP: 132/86  

By Day 3 of Week 7 

Post a response to each of the following: 

• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.  
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.  
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.  

• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.  
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.  
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making? 
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.  

Read a selection of your colleagues’ responses. 

By Day 6 of Week 7 

Respond to at least two of your colleagues on two different days in one of the following ways: 

• If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained. 
• If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days and 

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! 

A Sample Answer For the Assignment: NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

Title:  NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

    According to Stern, et al., (2016), insomnia is difficulty in falling or staying asleep for a reasonable period, 5 to 8 hours of sleep. This may vary from person to person. Sleep disorder is observed at least three times per week and for at least one month. Many mental sicknesses are as a result of insomnia, but not limited to depression, anxiety, and schizophrenia (Roth, 2007).   

Many authors have found the coloration between mental illness and insomnia. Fifty percent of adults with insomnia have a mental health problem, and up to 90% of the adults with depression experience sleep problems (Roth, 2007).  

. Many cases of insomnia have been noted in Americans. Some patients, 30 to 35% have brief symptoms of insomnia, 15 to 20% have a short-term insomnia disorder, which lasts less than three months, 10% have a chronic insomnia disorder, which occurs at least three times per week for at least three months. Riemann et al. (2015) highlighted that persistent insomnia had a 58% higher risk of premature death ( Denollet,et al., 2009).   

Three questions to ask a patient with anxiety disorder. Provide a rationale for why you might ask these questions.   

Question 1: You said that your depression has gotten worse, tell me more about it. To data more data that will assist in diagnosis.  

How long do you fall asleep? How often do you wake up at night, and how long does it take you to fall back asleep? Do you wake up tired and how tired are you during the day? These questions can be asked to get insight into the current complaint, which will aid for proper diagnosis purpose.   

Atkeson and Jelic (2008) point out that gene contributes to sleep disorder,    

An adult daughter or any adult who is involved and takes care of the patient should be a source for detailed information.  

Question 2: Do you think that patients are stressed out? Can you point out things stressing patient out?  

According to Lucassen et al., (2008). Stress has long been known to be linked with sleep problems. Most people have experienced this connection at some point in their life when difficult circumstances may have made it hard to get to sleep or fall back asleep after waking up in the night.  

Some authors have found that stress, anxiety, and depression could result from chronic insomnia. Some patients who have trouble falling asleep may experience worsening symptoms of anxiety, stress, and depression. Insomnia may have other psychological or emotional causes such as worry, anger, trauma, grief, and bipolar disorder.  

Question 3: Does a patient have a quiet environment to sleep without interruption?  

Stern, et al., (2016), highlighted that a quiet environment establishes the right conditions that may promote sleep. Make it cool, quiet, dark, comfortable, and free of interruptions. Check for and remove distractions light, heat, noise, or other things that may cause stress. Consider adding ear plugs, blackout curtains, or white noise to your bedroom.  

Physical exams, and diagnostic tests would be appropriate for the patient, family members, or care givers how the results would be used for diagnosis purposes.   

• History taking 
  Diagnosis of insomnia is based on good history taking from the patient (and/or family member or car giver) about the sleep pattern.  
• a detailed history should be carried out to  
• sleep pattern, pre sleep conditions  
• If any impact   
• Physical exam. No precise exam, but a blood test may be done to check for thyroid problems or other conditions that may be associated with poor sleep.  
• Sleep habits review. In addition to asking you sleep-related questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks.  
• Sleep study. This is done to monitor and record a variety of body activities while the patient is sleeping, including brain waves, breathing, heartbeat, eye movements and body movements.  
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.   

-Insomnia  

-Anxiety Disorder/Depression  

-Sleep Apnea  

Insomnia Treatment  

List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.   

1. Eszopiclone (Lunesta) 
2. Zaleplon (Sonata) 
3. Eszopiclone (Lunesta) 

INDICATION  

Eszopiclone is indicated for the treatment of insomnia in patients 18 years of age or older. Unlike other nonbenzodiazepine agents, there is no restriction on their duration of use. Besides, eszopiclone has a 6–8 h half-life, evidenced has proved that there is no reported rapid eye movement (REM) sleep rebound on discontinuation, and has been used for long term without any adverse consequences on clinical trials. Zaleplon is shorter acting (3–4 h) and can be dosed during the night of sleep.   

PHARMACOLOGY  

How eszopiclone works is not hypnotically unknown, but its effect is believed to come from its interaction with GABA receptor complexes at binding domains located close to or allosterically coupled to benzodiazepine receptors. “Eszopiclone is a nonbenzodiazepine hypnotic that is structurally unrelated to pyrazolopyrimidines, imidazopyridines, benzodiazepines, barbiturates, or other drugs with known hypnotic properties (Brielmaier, 2006)”.  

PHARMACOKINETICS  

Onset of action  

In a study conducted by Zammit et al. (2007) in adults with chronic insomnia, the average onset of sleep (measured by sleep latency) was 10.4 minutes faster in the eszopiclone 2 mg group than in the placebo group.  

Absorption and distribution  

 Najib, (2006) highlight that eszopiclone is absorbed fast following oral administration. The peak plasma concentrations are reached within 1 hour after oral consumption. It is weakly bound to plasma proteins (52%–59%).  

Metabolism  

Eszopiclone is metabolized in the liver after oral consumption by oxidation and demethylation. The primary plasma metabolites have little to no binding potency to GABA receptors. A vitro study shows that CYP3A4 and CYP2E1 enzymes are involved in the metabolism of eszopiclone (Huq, 2007).  

Elimination  

The mean elimination half-life (t1/2) of eszopiclone is approximately 6 hours. Less than 10% of an oral dose is excreted in the urine as parent drug.  

2. Zaleplon (Sonata) 

Zaleplon, a nonbenzodiazepine sedative hypnotic from the pyrazolopyrimidine class, which is used in the treatment of insomnia.  

A Sample Answer 2 For the Assignment: NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

Title:  NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

Hello Cherechi! This is an outstanding and insightful post about insomnia, which is the underlying condition of the patient in the case scenario. Ideally, these questions you selected are appropriate and critical in detecting the conditions that the patient may have and help in successful treatment. Asking the patient about the condition also help in improving the confidence of patient in medical care. The other important aspect is patient education. The patient should be educated about good sleep hygiene (Ng & Cunnington, 2021). Sleep hygiene are activities and tendencies that facilitate maintenance of quality sleep and entire daytime alertness. In particular, the patient should be taught to create regular sleep tendencies by ensuring a usual sleeping and waking time, having enough sleep to help her feel refreshed in the next day, and avoiding spending unnecessary time in bed. The patient should also ensure that her bedroom is relaxing, quiet, dark, and at a favorable temperature (Bollu & Kaur, 2019). Moreover, dietary changes such as avoiding caffeine, heavy meals, and alcohol before bedtime is also essential. The patient should also be advised to engage in exercise during the day to help her fall asleep easily at night.  

References 

Bollu, P. C., & Kaur, H. (2019). Sleep medicine: insomnia and sleep. Missouri medicine, 116(1), 68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390785/ 

Ng, L., & Cunnington, D. (2021). Management of insomnia in primary care. Australian Prescriber, 44(4), 124. doi: 10.18773/austprescr.2021.027 

A Sample Answer 3 For the Assignment: NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

Title:  NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions. 

Some questions I believe must be asked include whether the patient is having difficulties falling or staying asleep, how many nights in a week she experiences sleep disturbances, and whether she is taking any over-the-counter medication to help herself sleep. In my opinion, it is important to determine whether the patient is having difficulties falling or staying asleep to help the provider determine which kind of medication to order. For instance, if the patient has problems falling asleep but not staying asleep, Melatonin could be a good option. According to Zisapel (2018), melatonin levels decrease with age, disrupting sleep patterns and increasing sleep disturbances. 

On the other hand, knowing the frequency the patient experiences insomnia may help the provider determine whether the patient requires a scheduled or as-needed medication. In addition, knowing whether the patient is taking over-the-counter sleeping aids prevents the provider from ordering a medication that could interact with whatever the patient may be taking. Furthermore, due to the patient’s age, knowing if she is taking an over-the-counter sleeping aid is crucial as many of these products contain diphenhydramine, which is potentially harmful to elderly patients (Abraham et al., 2018). 

Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. 

The provider should refrain from reaching out to anyone unless the patient provides explicit authorization to talk to a third party. If the patient gives authorization to speak to third parties, speaking with people living with the patient may expose information such as the patient sleep habits, including daytime napping, the time at which the patient goes to bed, and whether she experiences nighttime awakening. This information is crucial for the clinical assessment of insomnia (Krystal et al., 2019). Other relevant questions are those related to the patient’s daytime activities and functional level (Krystal et al., 2019). 

Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used. 

Based on the information provided, the patient is most likely suffering from sleep insomnia related to her depression; however, I believe it is imperative to perform a cognitive evaluation. By doing so, cognitive decline can be ruled out as causation. Although the patient presents alert and oriented to person, place, and time that does not rule out early stages of cognitive decline, which could be associated with her insomnia. According to  Wennberg et al. (2017), 60 to 70 percent of older adults with cognitive impairments suffer from sleep disturbances. 

List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why. 

• Major Depressive Disorder 

• Generalized Anxiety Disorder 

Mental health conditions such as anxiety and depression are common causes of sleep disturbances (Levenson et al., 2015). In this patient’s case, not only has the patient recently lost her husband, but she also reported she was already suffering from depression even before he passed away. Based on this information, one can conclude that the loss of her spouse caused her depression to worsen. 

List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. 

In this case, to augment the effects of Sertraline and to improve the patient’s sleep, I would start the patient on Trazodone. According to Stahl (2021), medications used to augment the effect of Sertraline include Trazodone, Wellbutrin, Mirtazapine, and Atomoxetine. Trazodone is FDA-approved for the treatment of insomnia, and while it is not the first line of treatment, in this case, it will potentially solve the two complaints, increased depression and insomnia. Wellbutrin, on the other hand, is the preferred medication to augment Sertraline (Stahl, 2021), is a norepinephrine and dopamine reuptake inhibitor and insomnia is among the potential side effects of this medication (Stahl, 2021). 

For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making? 

Caution must be observed when using Trazodone if the patient is elderly, suffers cardiac disease, electrolyte abnormalities, long QT syndrome, QT prolongation, ventricular arrhythmias, CHF, bradycardia, and a recent MI, among others. The medication may also cause depression in the central nervous system and should be used with caution. The medication should be started at a low dose to prevent side effects (Stahl, 2021). The patient should be educated on the possible side effects and health risks associated with the medication, so she can make an informed decision, thus exercising autonomy. 

Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen. 

Trazodone may take two to four weeks to yield results (Stahl, 2021). The patient should be re-evaluated after six to eight weeks to determine whether the medication is effective; if no positive results are reported, the dose should be increased and re-evaluated after four weeks (Stahl, 2021). 

References 

Abraham, O., Schleiden, L., & Albert, S. M. (2017). Over-the-counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep. International journal of clinical pharmacy, 39(4), 808–817. https://doi.org/10.1007/s11096-017-0467-x 

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 

Levenson, J. C., Kay, D. B., &Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://doi.org/10.1378/chest.14-1617 

Stahl, S. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. (5th ed.). Cambridge University Press. DOI: 10.1017/9781108975292 

Wennberg, A., Wu, M. N., Rosenberg, P. B., &Spira, A. P. (2017). Sleep Disturbance, Cognitive Decline, and Dementia: A Review. Seminars in neurology, 37(4), 395–406. https://doi.org/10.1055/s-0037-1604351 

Zisapel N. (2018). New perspectives on the role of Melatonin in human sleep, circadian rhythms and their regulation. British journal of pharmacology, 175(16), 3190–3199. https://doi.org/10.1111/bph.14116 

A Sample Answer 4 For the Assignment: NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

Title:  NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

Hello Krisnamor! Your post about the case scenario is detailed and interesting. Indeed, the patient is suffering from insomnia, which is a serious public health concern that is associated with considerable impact on functional, physical, and psychological welfare of a patient. Essentially, managing this patient requires input of various specialists to help in further assessment of her situation (Condon et al., 2021). One of the specialists whose input is crucial is pharmacist. They play a crucial role in helping the patient to understand their condition, detect any drug in the patient’s regimen that is likely to cause adverse outcome on sleep, and propose nonpharmacologic treatment choices that may enhance the quality of sleep (Basheti et al., 2021). Pharmacists are also in better place to foster the effectiveness of CBT interventions to the patient and the clinicians. When the CBT interventions and lifestyle changes fail to improve symptoms, pharmacists can help in determining the best pharmacologic treatment techniques.  

References 

Basheti, M. M., Tran, M., Wong, K., Gordon, C., Grunstein, R., & Saini, B. (2021). Australian Consultant Pharmacists’ Potential Roles in Sleep Health Care: Exploring a New Avenue for Improving the Management of Insomnia. Behavioral Sleep Medicine, 1-16. https://doi.org/10.1080/15402002.2021.1975718 

Condon, H. E., Maurer, L. F., & Kyle, S. D. (2021). Reporting of adverse events in cognitive behavioural therapy for insomnia: A systematic examination of randomised controlled trials. Sleep Medicine Reviews, 56, 101412. https://doi.org/10.1016/j.smrv.2020.101412 

 

Resources

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

WEEKLY RESOURCES

Insomnia is one of the most common medical conditions you will encounter as a PMHNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PMHNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.

_{NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment Reference:}

_{Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29}

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.

Case: An elderly widow who just lost her spouse. 

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: 

• Metformin 500mg BID 
• Januvia 100mg daily 
• Losartan 100mg daily 
• HCTZ 25mg daily 
• Sertraline 100mg daily 

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86 

By Day 3 of Week 7

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

Post a response to each of the following:

• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

Read a selection of your colleagues’ responses.

By Day 6 of Week 7

Respond to at least two of your colleagues on two different days in one of the following ways:

• If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
• If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective. Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

A Sample Answer 5 For the Assignment: NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

Title:  NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment

You provided a comprehensive assessment of the patients’ condition, possible differential diagnosis, and treatment options.  I agree with many of your recommendations and have been able to obtain a deeper understanding of a comprehensive assessment after reading your post.  I would like to offer some things that I researched after reading your post below.

Insomnia has a significant impact on the quality of life of many adults.  Prolonged depression can affect sleep patterns, while lack of sleep can exacerbate depression.  This can lead to a cycle of problematic issues, warranting assessment, diagnosis, and treatment of the primary condition.  Criteria for diagnosis of insomnia includes difficulty falling or maintaining sleep and impairment in daily functioning (Krystal et al., 2019).  I agree that it is important to assess the specific factors that the patient is experiencing and for how long she has been experiencing them.  I also agree that speaking to those that regularly interact with the patient may be able to provide important information regarding changes or impacts on daily functioning that the patient herself may not notice.

Performing a thorough physical assessment will contribute important information regarding overall health.  I agree that assessment of current hemoglobin A1c is essential because uncontrolled hyperglycemia can contribute to many serious illnesses and can exacerbate symptoms of insomnia.  I would examine diet to determine whether the patient is compliant with recommendations and that she demonstrates understanding of her specific diet.  Metformin and Januvia are both associated with insomnia, so if they are not providing effective treatment for her diabetes, I would consider use of insulin.  (Wiwanitkit & Wiwanitkit, 2012).  Lack of sleep contributes to poor glycemic control and poor glycemic control contributes to insomnia, so it is necessary to treat both conditions concurrently.  Along with obtaining a sleep log or diary I would also recommend starting a glucose log.

Considering the age of this patient and the fact that she has a history of depression, I would assess her ability to care for herself.  It may be necessary to obtain a home care nurse for the management of diabetes, and blood pressure.  Assessing the level of understanding in diabetes management may reveal the need of a diabetes educator (Ernawati et al., 2021).  Evaluation of ability to complete ADLs would also be helpful, as the patient recently lost her husband and may not have sufficient help.  Use of HCTZ can also increase blood sugar levels, I would consider changing the medication to Chlorthalidone, which is effective at lowering blood pressure, lowering cholesterol (commonly a problem in diabetics), providing cardioprotective effects, and less likely to increase blood sugar.  If labs show a decrease in kidney function, use of an ACE inhibitor may also be warranted (Khalil & Zeltser, 2022).

NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment References

Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of public health research, 10(2), 2240. https://doi.org/10.4081/jphr.2021.2240

Khalil H, Zeltser R. Antihypertensive Medications. [Updated 2022 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554579/

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

Wiwanitkit, S., & Wiwanitkit, V. (2012). Metformin and sleep disorders. Indian journal of endocrinology and metabolism, 16 Suppl 1(Suppl1), S63–S64. https://doi.org/10.4103/2230-8210.94262

 Assignment Rubric

NURS_6630_Week7_Discussion_Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning Outcome Main Posting:Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.	44 to >39.0 pts Excellent Point range: 90–100 Thoroughly responds to the Discussion question(s)…. Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources…. No less than 75% of post has exceptional depth and breadth…. Supported by at least three current credible sources. 39 to >34.0 pts Good Point range: 80–89 Responds to most of the Discussion question(s)…. Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module…. 50% of the post has exceptional depth and breadth…. Supported by at least three credible references. 34 to >30.0 pts Fair Point range: 70–79 Responds to some of the Discussion question(s)…. One to two criteria are not addressed or are superficially addressed…. Is somewhat lacking reflection and critical analysis and synthesis…. Somewhat represents knowledge gained from the course readings for the module…. Post is cited with fewer than two credible references. 30 to >0 pts Poor Point range: 0–69 Does not respond to the Discussion question(s)…. Lacks depth or superficially addresses criteria…. Lacks reflection and critical analysis and synthesis…. Does not represent knowledge gained from the course readings for the module…. Contains only one or no credible references.	44 pts
This criterion is linked to a Learning Outcome Main Posting:Writing	6 to >5.0 pts Excellent Point range: 90–100 Written clearly and concisely…. Contains no grammatical or spelling errors…. Adheres to current APA manual writing rules and style. 5 to >4.0 pts Good Point range: 80–89 Written concisely…. May contain one to two grammatical or spelling errors…. Adheres to current APA manual writing rules and style. 4 to >3.0 pts Fair Point range: 70–79 Written somewhat concisely…. May contain more than two spelling or grammatical errors…. Contains some APA formatting errors. 3 to >0 pts Poor Point range: 0–69 Not written clearly or concisely…. Contains more than two spelling or grammatical errors…. Does not adhere to current APA manual writing rules and style.	6 pts
This criterion is linked to a Learning Outcome Main Posting:Timely and full participation	10 to >8.0 pts Excellent Point range: 90–100 Meets requirements for timely, full, and active participation…. Posts main Discussion by due date. 8 to >7.0 pts Good Point range: 80–89 Posts main Discussion by due date…. Meets requirements for full participation. 7 to >6.0 pts Fair Point range: 70–79 Posts main Discussion by due date. 6 to >0 pts Poor Point range: 0–69 Does not meet requirements for full participation…. Does not post main Discussion by due date.	10 pts
This criterion is linked to a Learning Outcome First Response:Post to colleague’s main post that is reflective and justified with credible sources.	9 to >8.0 pts Excellent Point range: 90–100 Response exhibits critical thinking and application to practice settings…. Responds to questions posed by faculty…. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 to >7.0 pts Good Point range: 80–89 Response has some depth and may exhibit critical thinking or application to practice setting. 7 to >6.0 pts Fair Point range: 70–79 Response is on topic, may have some depth. 6 to >0 pts Poor Point range: 0–69 Response may not be on topic, lacks depth.	9 pts
This criterion is linked to a Learning Outcome First Response:Writing	6 to >5.0 pts Excellent Point range: 90–100 Communication is professional and respectful to colleagues…. Response to faculty questions are fully answered, if posed…. Provides clear, concise opinions and ideas that are supported by two or more credible sources…. Response is effectively written in Standard, Edited English. 5 to >4.0 pts Good Point range: 80–89 Communication is mostly professional and respectful to colleagues…. Response to faculty questions are mostly answered, if posed…. Provides opinions and ideas that are supported by few credible sources…. Response is written in Standard, Edited English. 4 to >3.0 pts Fair Point range: 70–79 Response posed in the Discussion may lack effective professional communication…. Response to faculty questions are somewhat answered, if posed…. Few or no credible sources are cited. 3 to >0 pts Poor Point range: 0–69 Responses posted in the Discussion lack effective communication…. Response to faculty questions are missing…. No credible sources are cited.	6 pts
This criterion is linked to a Learning Outcome First Response:Timely and full participation	5 to >4.0 pts Excellent Point range: 90–100 Meets requirements for timely, full, and active participation…. Posts by due date. 4 to >3.0 pts Good Point range: 80–89 Meets requirements for full participation…. Posts by due date. 3 to >2.0 pts Fair Point range: 70–79 Posts by due date. 2 to >0 pts Poor Point range: 0–69 Does not meet requirements for full participation…. Does not post by due date.	5 pts
This criterion is linked to a Learning Outcome Second Response:Post to colleague’s main post that is reflective and justified with credible sources.	9 to >8.0 pts Excellent Point range: 90–100 Response exhibits critical thinking and application to practice settings…. Responds to questions posed by faculty…. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 to >7.0 pts Good Point range: 80–89 Response has some depth and may exhibit critical thinking or application to practice setting. 7 to >6.0 pts Fair Point range: 70–79 Response is on topic, may have some depth. 6 to >0 pts Poor Point range: 0–69 Response may not be on topic, lacks depth.	9 pts
This criterion is linked to a Learning Outcome Second Response:Writing	6 to >5.0 pts Excellent Point range: 90–100 Communication is professional and respectful to colleagues…. Response to faculty questions are fully answered, if posed…. Provides clear, concise opinions and ideas that are supported by two or more credible sources…. Response is effectively written in Standard, Edited English. 5 to >4.0 pts Good Point range: 80–89 Communication is mostly professional and respectful to colleagues…. Response to faculty questions are mostly answered, if posed…. Provides opinions and ideas that are supported by few credible sources…. Response is written in Standard, Edited English. 4 to >3.0 pts Fair Point range: 70–79 Response posed in the Discussion may lack effective professional communication…. Response to faculty questions are somewhat answered, if posed…. Few or no credible sources are cited. 3 to >0 pts Poor Point range: 0–69 Responses posted in the Discussion lack effective communication…. Response to faculty questions are missing…. No credible sources are cited.	6 pts
This criterion is linked to a Learning Outcome Second Response:Timely and full participation	5 to >4.0 pts Excellent Point range: 90–100 Meets requirements for timely, full, and active participation…. Posts by due date. 4 to >3.0 pts Good Point range: 80–89 Meets requirements for full participation…. Posts by due date. 3 to >2.0 pts Fair Point range: 70–79 Posts by due date. 2 to >0 pts Poor Point range: 0–69 Does not meet requirements for full participation…. Does not post by due date.	5 pts
Total Points: 100

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NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION 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.

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