TREATMENT FOR A PATIENT WITH A COMMON CONDITION NURS 6630
Sample Answer for TREATMENT FOR A PATIENT WITH A COMMON CONDITION NURS 6630 Included After Question
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.
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.
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!
NURS_6630_Week7_Discussion_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. |
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44 pts | ||||
| This criterion is linked to a Learning Outcome Main Posting:Writing |
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6 pts | ||||
| This criterion is linked to a Learning Outcome Main Posting:Timely and full participation |
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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. |
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9 pts | ||||
| This criterion is linked to a Learning Outcome First Response:Writing |
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6 pts | ||||
| This criterion is linked to a Learning Outcome First Response:Timely and full participation |
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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. |
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9 pts | ||||
| This criterion is linked to a Learning Outcome Second Response:Writing |
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6 pts | ||||
| This criterion is linked to a Learning Outcome Second Response:Timely and full participation |
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5 pts | ||||
| Total Points: 100 | ||||||
A Sample Answer For the Assignment: TREATMENT FOR A PATIENT WITH A COMMON CONDITION NURS 6630
Title: TREATMENT FOR A PATIENT WITH A COMMON CONDITION NURS 6630
WK 7 discussion
The first question I would ask is: Does the patient have any cardiovascular disorders- the reasoning behind this is that TCAs can produce life threatening arrhythmias and EKG changes.
Second question: Do you take any herbal medications- some herbal medications like St Johns warts can interact with psychotropic meds.
Third question: Does she has any central nervous systems disorders like Myasthenia gravis due to the fact that antipsychotic are contraindicated with Myasthenia gravis.
I would like to speak with any of her children or close friends to get feedback to further assess the patient. I would ask them has the patient been angry or have they felt like the patient has been pushing them away and this means she is in the anger stage of the death and dying stages. I would also ask about the patient support system, who does she live with, does she visit or have visits from close friends and family and is she involved in any community programs
For this patient I would perform a mini cog exam, PHQ-9 and drawn hypothyroid labs. I would do the mini cog and ph-9 to rule out any dementias or pseudodementia. I would determine if the patient has any cognitive difficulty that might be causes by depression. The thyroid panel would help to rule out thyroid disorders which could cause depression and sleep disturbances.
Differential diagnoses for this patient are situation depression, hypothyroid, bereavement.
I think the patient has Bereavement due to the loss of her husband and the patient has no previous history of depression before the loss of her husband.
Two med options for this pt
Nortriptyline 10mg at bedtime
Trazadone 25 mg at bedtime
Nortriptyline is a TCA and inhibits reuptake of norepinephrine more than serotonin. This option taken at bedtime will help the patient with insomnia, but the side effects are less favorable for this patient, due to her age. TCAs should be avoided in elderly due to the anticholinergic effects which could cause falls and TCAs should be avoided in patient with diabetes.
“Low-dose trazadone (25 to 100mg at bedtime) is commonly used in the treatment of insomnia secondary to antidepressant use a strategy that may also result in an improvement in depressive symptoms” (Stern MD, Theodore A. et al., 2015, p. 37).
This is the best option for the patient it will decrease both her depression and insomnia with minimal side effects at the lowest dose possible.
When starting meds in elderly you should start low and titrate slow due to their decreased action in almost everything; decreased plasma volume, decreased GI absorption and decreased lean muscle
The contraindication of taking trazadone is that it increases serotonin and can cause the patient to have serotonin syndrome since she is taking sertraline 100mg. “Since trazodone is also a week inhibitor of serotonin re-uptake as well, the overall effects of trazadone appears to be an increase in extracellular levels of serotonin in the brain. This effect explains the fact that trazodone treatment has been associated with the occurrence of serotonin syndrome” (Stern MD, Theodore A. et al., 2015, p. 29).
At about 4 weeks I would ask the patient if she is experiencing any symptoms of serotonin syndrome, if yes I would discontinue Trazadone and possibly add cyproheptadine, propranolol or muscle relaxer depending on the patient symptoms.
References
Stern MD, Theodore A., Maurizio, F. M., Wilens MD, Timothy E., & Rosenbaum MD, Jerrold F. (2015). Massachusetts general hospital psychopharmacology and neurotherapeutics (1st ed.). Elsevier.
A Sample Answer 2 For the Assignment: TREATMENT FOR A PATIENT WITH A COMMON CONDITION NURS 6630
Title: TREATMENT FOR A PATIENT WITH A COMMON CONDITION NURS 6630
Hello Tinesha, thank you for your insightful discussion post this week. In your post, you have proposed great suggestions to help treat the patient which I agree with. Just to add on, I feel it is essential to question the patient about medication adherence as the response will help in informing us whether there is need for change in medication. Moreover, I also feel it is good to question about stress, anxiety and depression considering the patient is grieving.
I thought increasing Sertraline dosage would be a better option, however, from your submission, I am convinced that administering low- dose trazadone at bedtime would offer better results to the patient. This is because trazadone is used in the treatment of insomnia secondary to antidepressant use a strategy that may also result in an improvement in depressive symptoms (Stern et al., 2015). Therefore, this will help the patient’s insomnia and depression.
Reference
Stern, T. A., Fava, M., Wilens, T. E., & Rosenbaum, J. F. (2015). Massachusetts general hospital psychopharmacology and neurotherapeutics. Elsevier Health Sciences.
A Sample Answer 3 For the Assignment: TREATMENT FOR A PATIENT WITH A COMMON CONDITION NURS 6630
Title: TREATMENT FOR A PATIENT WITH A COMMON CONDITION NURS 6630
Thank you for the informative post this week Tinesha. In addition to the three questions you’ve asked, I would also love to ask about the patient’s sleeping patterns and caffeine consumption. Caffeine has adverse sleep-related consequences, especially when consumed on subsequent nights, resulting in subjective insomnia symptoms, such as decreased total sleep time, difficulty falling asleep, and increased nocturnal awakenings (O’Callaghan et al., 2018). I would also love to know about her sleeping patterns because insomnia may result from her behavior of undertaking hyper arousal activities instead of relaxation techniques before bed. Heller acknowledges that indulging in healthy sleep hygiene habits such as meditating can have a positive effect on an individual’s sleep and fight insomnia (2019).
References
Heller, E. L. (2019). Effect of Relaxation Technique to Improve Insomnia (Doctoral dissertation, Brandman University).
O’Callaghan, F., Muurlink, O., & Reid, N. (2018). Effects of caffeine on sleep quality and daytime functioning. Risk management and healthcare policy, 11, 263.
Shin, J. J., & Saadabadi, A. (2017). Trazodone. In StatPearls [Internet]. StatPearls Publishing.
A Sample Answer 4 For the Assignment: TREATMENT FOR A PATIENT WITH A COMMON CONDITION NURS 6630
Title: TREATMENT FOR A PATIENT WITH A COMMON CONDITION NURS 6630
I, too, was looking at taking Trazodone for sleep in addition to increasing the Sertraline to 150mg. However, I chose to hold off and start with Melatonin first while increasing the Sertraline as the combination of Trazodone and Sertraline may cause a serotonin sydrome when used together. Serotonin is a neurotransmitter produced by the nerve cells in your brain. Most people can take sertonergic medications without problems if the dosage is appropriate and under the prescribed, monitored guidance of the healthcare provider. However, sometimes serotonin syndrome happens most often when adding in a new SSRI or increasing the dose which causes an increased level of serotonin in the body (Cleveland Clinic, n.d.). “Serotonin syndrome is a potentially life-threatening syndrome that is precipitated by the use of serotonergic drugs and overactivation of both the peripheral and central postsynaptic 5HT-1A and, most notably, 5HT-2A receptors”. (Volpi-Abadie, et.al. 2013). Symptoms of serotonin syndrom are altered mental status ( anxiety, disorientation, confusion, restlessness), neuromuscular abnormalities (tremors, muscle rigidity, akithesia, and autonomic hyperactivity (diaphoresis, tachycardia, shivering, vomiting, hyperthermia). Sertonin syndrome may be rare, but I would always use cautiously as I have seen it first hand with my husband and he honestly looked as if he was ready to go in to cardiac arrest. I have witnessed it twice with him, and the symptoms I mentioned are the exact ones he had. The first time we just thought it was a bad reaction to his chemo, but he had been on the same regimin for years. The second time it happened again after chemo and he had to be taken out by squad. This time I researched for any medication changes he may have had during his chemo treatements. I found that his meds had recently been changed and he was receiving Aloxi for nausea as premedication before the chemo infusion. It turns out this causes serotonin syndrome and he is maxed out on Sertraline 200mg daiy. I talked to him and his physician on what I felt was causing the reaction. At his next chemo appt we refused the Aloxi and he has not had the reaction since.
Serotonin syndrome: What it is, causes, symptoms & treatment. Cleveland Clinic. (n.d.). Retrieved January 12, 2023, from https://my.clevelandclinic.org/health/diseases/17687-serotonin-syndrome
Jacqueline Volpi-Abadie,, J., Kaye PharmD, FASCP, FCPhA, A. M., & Kaye MD, PhD, A. D. (2013). Serotonin syndrome. The Ochsner journal. Retrieved January 11, 2023, from https://pubmed.ncbi.nlm.nih.gov/24358002/