\u202f\u202f\u202f 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.\u202fMany mental sicknesses are\u202fas a result of\u202finsomnia, but not limited to depression, anxiety, and schizophrenia (<\/span>Roth, 2007).<\/span>\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

Many authors\u202fhave found the coloration\u202fbetween mental illness and insomnia. Fifty percent of adults with insomnia have a mental health problem, and\u202fup to 90% of\u202fthe adults\u202fwith depression experience sleep\u202fproblems\u202f(<\/span>Roth, 2007).<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

.\u202fMany 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 (\u202fDenollet,et\u202fal., 2009).\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

Three questions to ask a patient with anxiety disorder. Provide a rationale for why you might ask these questions.\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

Question 1: You said that your depression has gotten worse, tell me more about it. To data more data that will assist\u202fin diagnosis.<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

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\u202ffor proper diagnosis purpose.\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

Atkeson and Jelic (2008)\u202fpoint out that gene contributes to sleep disorder,\u202f\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

An adult daughter or any adult who is involved and takes care of the patient should be a source for detailed information.<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

Question 2: Do you think that patients are stressed out? Can you point out things stressing patient out?<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

According to Lucassen et al., (2008).\u202fStress 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.<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

Some authors have found that stress, anxiety,\u202fand 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\u202fpsychological or emotional causes such as worry,\u202fanger,\u202ftrauma,\u202fgrief, and bipolar disorder.<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

Question 3: Does a patient have\u202fa quiet environment to sleep without interruption?<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

Stern, et al., (2016), highlighted that a quiet environment\u202festablishes\u202fthe 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.<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

Physical exams, and diagnostic tests would be\u202fappropriate for\u202fthe patient, family members, or care givers\u202fhow the results would be used for diagnosis purposes.\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

\n
• History taking<\/span><\/i>\u202f<\/span>
  \nDiagnosis of insomnia is based on good history taking from the patient (and\/or family member or car giver) about the sleep pattern.<\/span><\/i>\u202f<\/span>\u00a0<\/span><\/li>\n
• a detailed history should be carried out to<\/span>\u202f<\/span>\u00a0<\/span><\/li>\n
• sleep pattern, pre sleep conditions<\/span>\u202f<\/span>\u00a0<\/span><\/li>\n
• If any impact\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/li>\n
• 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.<\/span>\u202f<\/span>\u00a0<\/span><\/li>\n
• 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.<\/span>\u202f<\/span>\u00a0<\/span><\/li>\n
• 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.<\/span>\u202f<\/span>\u00a0<\/span><\/li>\n
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

  -Insomnia<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

  -Anxiety Disorder\/Depression<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

  -Sleep Apnea<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

  Insomnia Treatment<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

  List two pharmacologic agents and their dosing that would be appropriate for the patient\u2019s 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.\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

  \n
  1. Eszopiclone (Lunesta)<\/span>\u202f<\/span><\/li>\n
  2. Zaleplon (Sonata)<\/span>\u202f<\/span><\/li>\n
  3. Eszopiclone (Lunesta)<\/span>\u202f<\/span><\/li>\n<\/ol>\n

     INDICATION<\/span>\u202f<\/span>\u00a0<\/span><\/h2>\n

     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\u20138 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\u20134 h) and can be dosed during the night of sleep.\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

     PHARMACOLOGY<\/span>\u202f<\/span>\u00a0<\/span><\/h2>\n

     How eszopiclone works is not\u202fhypnotically\u202funknown, but its effect is\u202fbelieved\u202fto come\u202ffrom its interaction with GABA receptor complexes at binding domains\u202flocated\u202fclose to or allosterically coupled to benzodiazepine receptors. \u201cEszopiclone is a nonbenzodiazepine hypnotic that is structurally unrelated to pyrazolopyrimidines, imidazopyridines, benzodiazepines, barbiturates, or other drugs with known hypnotic properties (Brielmaier<\/span>, 2006)\u201d<\/span>.<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

     PHARMACOKINETICS<\/span>\u202f<\/span>\u00a0<\/span><\/h2>\n

     Onset of action<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

     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.<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

     Absorption and distribution<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

     \u202fNajib,\u202f(2006) highlight that eszopiclone is absorbed fast following oral administration. The peak plasma concentrations\u202fare\u202freached within\u202f1 hour after oral consumption. It is weakly bound to plasma proteins (52%\u201359%).<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

     Metabolism<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

     Eszopiclone is metabolized in the liver after oral\u202fconsumption\u202fby 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).<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

     Elimination<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

     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\u202fdrug.<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n

     \n
     1. Zaleplon (Sonata)<\/span>\u202f<\/span><\/li>\n<\/ol>\n

        Zaleplon,\u202fa nonbenzodiazepine sedative hypnotic\u202ffrom the pyrazolopyrimidine class, which is used in the\u202ftreatment of insomnia.\u202f<\/span>\u00a0<\/span><\/p>\n

        A Sample Answer 2 For the Assignment: NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment<\/strong><\/h2>\n

        Title: <\/strong>\u00a0<\/strong>NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment<\/h2>\n

        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.\u00a0<\/span>\u00a0<\/span><\/p>\n

        References<\/span>\u00a0<\/span><\/h2>\n

        Bollu, P. C., & Kaur, H. (2019). Sleep medicine: insomnia and sleep. <\/span>Missouri medicine<\/span><\/i>, <\/span>116<\/span><\/i>(1), 68. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6390785\/<\/a><\/span>\u00a0<\/span><\/p>\n

        Ng, L., & Cunnington, D. (2021). Management of insomnia in primary care. <\/span>Australian Prescriber<\/span><\/i>, <\/span>44<\/span><\/i>(4), 124.<\/span> doi:\u202f10.18773\/austprescr.2021.027<\/span>\u00a0<\/span><\/p>\n

        A Sample Answer 3 For the Assignment: NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment<\/strong><\/h2>\n

        Title: <\/strong>\u00a0<\/strong>NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment<\/h2>\n

        List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.<\/span><\/b>\u00a0<\/span><\/h3>\n

        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.<\/span>\u00a0<\/span><\/p>\n

        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 (<\/span>Abraham et al., 2018<\/span>).<\/span>\u00a0<\/span><\/p>\n

        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.<\/span><\/b>\u00a0<\/span><\/h2>\n

        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 (<\/span>Krystal et al., 2019).<\/span>\u202fOther relevant questions are those related to the patient’s daytime activities and functional level (<\/span>Krystal et al., 2019).<\/span>\u00a0<\/span><\/p>\n

        Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.<\/span><\/b>\u00a0<\/span><\/h2>\n

        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 \u202f<\/span>Wennberg<\/span>\u202fet al. (2017), 60 to 70 percent of older adults with cognitive impairments suffer from sleep disturbances.<\/span>\u00a0<\/span><\/p>\n

        List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.<\/span><\/b>\u00a0<\/span><\/h2>\n

        \n
        • Major Depressive Disorder<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
          \n
          • Generalized Anxiety Disorder<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

            Mental health conditions such as anxiety and depression are common causes of sleep disturbances (<\/span>Levenson et al., 2015<\/span>). 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.<\/span>\u00a0<\/span><\/p>\n

            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.<\/span><\/b>\u00a0<\/span><\/h2>\n

            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).<\/span>\u00a0<\/span><\/p>\n

            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?<\/span><\/b>\u00a0<\/span><\/h2>\n

            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.<\/span>\u00a0<\/span><\/p>\n

            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.<\/span><\/b>\u00a0<\/span><\/h2>\n

            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).<\/span>\u00a0<\/span><\/p>\n

            References<\/span><\/b>\u00a0<\/span><\/h2>\n

            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\u2013817. https:\/\/doi.org\/10.1007\/s11096-017-0467-x<\/a><\/span>\u00a0<\/span><\/p>\n

            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\u2013352. https:\/\/doi.org\/10.1002\/wps.20674<\/a><\/span>\u00a0<\/span><\/p>\n

            Levenson, J. C., Kay, D. B., &Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179\u20131192. https:\/\/doi.org\/10.1378\/chest.14-1617<\/a><\/span>\u00a0<\/span><\/p>\n

            Stahl, S. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. (5th ed.). Cambridge University Press. DOI: 10.1017\/9781108975292<\/span>\u00a0<\/span><\/p>\n

            Wennberg, A., Wu, M. N., Rosenberg, P. B., &Spira, A. P. (2017). Sleep Disturbance, Cognitive Decline, and Dementia: A Review.\u202f<\/span>Seminars in neurology<\/span><\/i>,\u202f<\/span>37<\/span><\/i>(4), 395\u2013406. https:\/\/doi.org\/10.1055\/s-0037-1604351<\/a><\/span>\u00a0<\/span><\/p>\n

            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\u20133199. https:\/\/doi.org\/10.1111\/bph.14116<\/a><\/span>\u00a0<\/span><\/p>\n

            A Sample Answer 4 For the Assignment: NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment<\/strong><\/h2>\n

            Title: <\/strong>\u00a0<\/strong>NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment<\/h2>\n

            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\u2019s 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.\u00a0<\/span>\u00a0<\/span><\/p>\n

            References<\/span>\u00a0<\/span><\/h2>\n

            Basheti, M. M., Tran, M., Wong, K., Gordon, C., Grunstein, R., & Saini, B. (2021). Australian Consultant Pharmacists\u2019 Potential Roles in Sleep Health Care: Exploring a New Avenue for Improving the Management of Insomnia. <\/span>Behavioral Sleep Medicine<\/span><\/i>, 1-16. https:\/\/doi.org\/10.1080\/15402002.2021.1975718<\/a><\/span>\u00a0<\/span><\/p>\n

            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. <\/span>Sleep Medicine Reviews<\/span><\/i>, <\/span>56<\/span><\/i>, 101412. https:\/\/doi.org\/10.1016\/j.smrv.2020.101412<\/a><\/span>\u00a0<\/span><\/p>\n

             <\/p>\n

            Resources<\/strong><\/h2>\n

            Be sure to review the Learning Resources before completing this activity.
            \nClick the weekly resources link to access the resources.<\/p>\n

            WEEKLY RESOURCES<\/strong><\/a><\/h2>\n

            Insomnia is one of the most common medical conditions<\/a> you will encounter as a PMHNP.\u00a0Insomnia is a common symptom of many mental illnesses, including anxiety, depression<\/a>, 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\u2019s 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<\/a>.<\/p>\n

            _{NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment Reference: <\/sub><\/h2>\n}

            _{Abbott, J. (2016). What\u2019s the link between insomnia and mental illness?<\/em>\u00a0Health.} https:\/\/www.sciencealert.com\/what-exactly-is-the-link-between-insomnia-and-mental-<\/a>illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29<\/sub><\/p>\n

            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\u2019s health needs.<\/p>\n

            Case: An elderly widow who just lost her spouse.\u00a0<\/em><\/h2>\n

            Subjective: A patient presents to your primary care office today with chief complaint of insomnia.\u00a0Patient is 75 YO with PMH of DM, HTN, and MDD.\u00a0Her husband of 41 years passed away 10 months ago.\u00a0Since then, she states her depression has gotten worse as well as her sleep habits.\u00a0The patient has no previous history of depression prior to her husband\u2019s death.\u00a0She is awake, alert, and oriented x3.\u00a0Patient normally sees PCP once or twice a year.\u00a0Patient denies any suicidal ideations.\u00a0Patient arrived at the office today by private vehicle.\u00a0Patient currently takes the following medications:\u00a0<\/em><\/p>\n

            \n
            • Metformin 500mg BID\u00a0<\/em><\/li>\n
            • Januvia 100mg daily\u00a0<\/em><\/li>\n
            • Losartan 100mg daily\u00a0<\/em><\/li>\n
            • HCTZ 25mg daily\u00a0<\/em><\/li>\n
            • Sertraline 100mg daily\u00a0<\/em><\/li>\n<\/ul>\n

              Current weight: 88 kg<\/em><\/p>\n

              Current height: 64 inches<\/em><\/p>\n

              Temp: 98.6 degrees F<\/em><\/p>\n

              BP: 132\/86\u00a0<\/em><\/p>\n

              By Day 3 of Week 7<\/strong><\/h2>\n

              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<\/strong><\/a><\/span><\/p>\n

              Post<\/strong>\u00a0a response to each of the following:<\/p>\n

              \n
              • List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.<\/li>\n
              • Identify people in the patient\u2019s life you would need to speak to or get feedback from to further assess the patient\u2019s situation. Include specific questions you might ask these people and why.<\/li>\n
              • Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.<\/li>\n
              • List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.<\/li>\n
              • List two pharmacologic agents and their dosing that would be appropriate for the patient\u2019s 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.<\/li>\n
              • 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?<\/li>\n
              • Include any \u201ccheck points\u201d (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.<\/li>\n<\/ul>\n

                Read\u00a0<\/strong>a selection of your colleagues’ responses.<\/p>\n