\u00a0<\/span><\/p>\nFor 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.\u202f\u202f<\/span>\u00a0<\/span><\/p>\nCase: An elderly widow who just lost her spouse.\u202f<\/span><\/i>\u00a0<\/span><\/p>\nSubjective: A patient presents to your primary care office today with chief complaint of insomnia.\u202fPatient is 75 YO with PMH of DM, HTN, and MDD.\u202fHer husband of 41 years passed away 10 months ago.\u202fSince then, she states her depression has gotten worse as well as her sleep habits.\u202fThe patient has no previous history of depression prior to her husband\u2019s death.\u202fShe is awake, alert, and oriented x3.\u202fPatient normally sees PCP once or twice a year.\u202fPatient denies any suicidal ideations.\u202fPatient arrived at the office today by private vehicle.\u202fPatient currently takes the following medications:\u202f<\/span><\/i>\u00a0<\/span><\/p>\n\n- Metformin 500mg BID\u202f<\/span><\/i>\u00a0<\/span><\/li>\n
- Januvia 100mg daily\u202f<\/span><\/i>\u00a0<\/span><\/li>\n
- Losartan 100mg daily\u202f<\/span><\/i>\u00a0<\/span><\/li>\n
- HCTZ 25mg daily\u202f<\/span><\/i>\u00a0<\/span><\/li>\n
- Sertraline 100mg daily\u202f<\/span><\/i>\u00a0<\/span><\/li>\n<\/ul>\n
\u202f<\/span>Current weight: 88 kg<\/span><\/i>\u00a0<\/span><\/p>\nCurrent height: 64 inches<\/span><\/i>\u00a0<\/span><\/p>\nTemp: 98.6 degrees F<\/span><\/i>\u00a0<\/span><\/p>\nBP: 132\/86\u202f<\/span><\/i>\u00a0<\/span><\/p>\nBy Day 3 of Week 7<\/span>\u00a0<\/span><\/h2>\nPost<\/span><\/b>\u202fa response to each of the following:<\/span>\u00a0<\/span><\/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.\u202f<\/span>\u00a0<\/span><\/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.\u202f<\/span>\u00a0<\/span><\/li>\n
- Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.\u202f<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
\n- List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.\u202f<\/span>\u00a0<\/span><\/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.\u202f<\/span>\u00a0<\/span><\/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?<\/span>\u00a0<\/span><\/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.\u202f<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
Read\u202f<\/span><\/b>a selection of your colleagues’ responses.<\/span>\u00a0<\/span><\/p>\nBy Day 6 of Week 7<\/span>\u00a0<\/span><\/h2>\nRespond\u202fto at least two\u202fof your colleagues on two different days\u202fin one of the following ways:<\/span><\/b>\u00a0<\/span><\/p>\n\n- If your colleagues\u2019 posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.<\/span>\u00a0<\/span><\/li>\n
- 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<\/span><\/b>\u202fa selection of your colleagues\u2019 responses and respond to\u202f<\/span>at least two<\/span><\/b>\u202fof your colleagues on\u202f<\/span>two different days\u202f<\/span><\/b>and<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
Note:<\/span><\/i><\/b>\u202fFor this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues\u2019 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\u202f<\/span><\/i>Submit<\/span><\/i><\/b>, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on\u202f<\/span><\/i>Submit!<\/span><\/i><\/b>\u00a0<\/span><\/p>\nA Sample Answer For the Assignment: NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment<\/strong><\/h2>\nTitle: <\/strong>\u00a0<\/strong>NURS 6630 TREATMENT FOR A PATIENT WITH A COMMON CONDITION Assignment<\/h2>\n\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>\nMany 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>\nThree 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>\nQuestion 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>\nHow 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>\nAtkeson and Jelic (2008)\u202fpoint out that gene contributes to sleep disorder,\u202f\u202f<\/span>\u202f<\/span>\u00a0<\/span><\/p>\nAn 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>\nQuestion 2: Do you think that patients are stressed out? Can you point out things stressing patient out?<\/span>\u202f<\/span>\u00a0<\/span><\/p>\nAccording 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>\nSome 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>\nQuestion 3: Does a patient have\u202fa quiet environment to sleep without interruption?<\/span>\u202f<\/span>\u00a0<\/span><\/p>\nStern, 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>\nPhysical 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>\nInsomnia Treatment<\/span>\u202f<\/span>\u00a0<\/span><\/p>\nList 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>