Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses<\/a>, 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 PNP, 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.<\/span>\u00a0<\/span><\/p>\n Reference:\u202fAbbott, J. (2016).\u202f<\/span>What\u2019s the link between insomnia and mental illness?<\/span><\/i>\u202fHealth. 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<\/span>\u00a0<\/span><\/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.\u202f\u202f<\/span>\u00a0<\/span><\/p>\n Case: An elderly widow who just lost her spouse.\u202f<\/span><\/i>\u00a0<\/span><\/p>\n Subjective: 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 \u202f<\/span>Current weight: 88 kg<\/span><\/i>\u00a0<\/span><\/p>\n Current height: 64 inches<\/span><\/i>\u00a0<\/span><\/p>\n Temp: 98.6 degrees F<\/span><\/i>\u00a0<\/span><\/p>\n BP: 132\/86\u202f<\/span><\/i>\u00a0<\/span><\/p>\n By Day 3 of Week 7<\/span>\u00a0<\/span><\/p>\n Post<\/span><\/b>\u202fa response to each of the following:<\/span>\u00a0<\/span><\/p>\n Read\u202f<\/span><\/b>a selection of your colleagues’ responses.<\/span>\u00a0<\/span><\/p>\n By Day 6 of Week 7<\/span>\u00a0<\/span><\/p>\n Respond\u202fto at least two\u202fof your colleagues on two different days\u202fin one of the following ways:<\/span><\/b>\u00a0<\/span><\/p>\n NURS 6630 Treatment for a Patient With a Common Condition<\/p>\n Poor or insufficient sleep has been known to have profound effects on people’s health and well-being. Some people experience difficulty initiating and maintaining sleep, while others find it hard to wake up in the morning. Insomnia can also be caused by depression<\/a> or psychological distress. It can be categorized as a type of sleep disorder or a medical condition (MacFarlane, 2022). When it comes to assessing the cause, it is important to ask the following questions: What do you feel is causing it? Do you believe that it is a specific situation that triggers it? This is also important to determine if the client has a sense of belief that it is the main reason for their anxiety. Having a deeper understanding of the cause of the problem is also important to help the client identify the triggers that are contributing to their condition. For instance, if the client is anxious about certain things, such as being around certain stimulants, then it is important that they identify the reason for their anxiety (Oh et al., 2019).<\/p>\n Next of kin–<\/strong>It is important to contact the patient’s next of kin as they may know her well enough to provide helpful details about her condition. Even if the patient has never had children, it is still important to contact them as they may also be able to provide helpful information.<\/p>\n Friends\/family -If the patient does not have children or friends who are frequently in touch with her, then friends may be interviewed. These individuals could be the ones who she has been sharing her thoughts about her condition.<\/p>\n Primary care physician- PCP may be able to provide her with more details about her health history. He or she may also be able to help her manage her condition and improve her quality of life. In addition, working with her PCP can help ensure that the patient receives the best possible care.<\/p>\n <\/p>\n Questions could be asked include have you noticed recent significant mood changes in the client, or has the client shared with you any of her thoughts or worries, have you seen any of her health condition that affects her quality of life, etc.<\/p>\n <\/p>\n <\/p>\n The tests will be ordered include labs test, physical examination, and psychiatric evaluation<\/a>. A chemical laboratory test is often<\/p>\n performed to identify the cause of a particular condition and to confirm the presence of other organic health conditions. This can be done to ensure that the patient’s symptoms are not related to other conditions. A comprehensive physical examination is often performed to check for other possible causes of the patient’s symptoms. This can be done in the form of a cephalocaudal physical examination. This type of examination can be performed to identify the presence of other conditions such as the environment or medications. A psychiatric evaluation is often performed to diagnose a patient’s condition. It can be performed to collect information about the patient’s thoughts, feelings, behavior patterns, and symptoms in association with a specific criterion in the DSM-5. Besides a general interview, the patient can also be asked to complete various condition-specific questionnaires. Some of these include the Beck Depression Inventory, the Hamilton Depression Rating Scale, and the Zung Self-rating Scale (Legg, 2018).<\/p>\n According to Psych Scene (2020), the following is the list of differential diagnosis<\/p>\n This condition is referred to as organic. It can be caused by various factors such as diabetes, hypothyroidism, and other mental health conditions. For patients, it is more likely that the condition is caused by these factors. It can also be caused by various factors that affect a person’s mood. For instance, a person can experience depression following a major event in their life, such as the death of their husband. The signs and symptoms of depression include a hopeless outlook, which can be accompanied by various other symptoms such as irritability, fatigue, and anxiety. Although the patient denies having active suicidal thoughts, she should still be evaluated for the presence of these thoughts. For instance, if the patient wishes to die in bed or in an accident, then these thoughts should be considered.<\/p>\n \u00a0<\/strong><\/p>\n Although it’s not widely used, Prozac is one of the few antidepressants approved by the FDA for children and teenagers. It’s also safe to use in people with diabetes, as it doesn’t increase blood sugar levels. One of the most common types of antidepressant is fluoxetine, which has a high effectivity rate. This medication belongs to a class of drugs known as selective serotonin reuptake inhibitors. These are designed to increase the levels of serotonin in the body, which helps improve mood and well-being (Sohel et al., 2022).<\/p>\n Another common type of antidepressant is Escitalopram, which is also known as Lexapro. It’s safe to use in children and teenagers, as it doesn’t increase blood sugar levels. It can additionally help alleviate anxiety symptoms.<\/p>\n There has been little difference in the response time and outcome of patients between white and minority groups in depression. Despite the various investigations that have been conducted on the subject, the exact effects of ethnicity on the treatment response remains unclear. There is still a need for further studies to understand the possible effects of different ethnic groups on the treatment response (Lesser 2010).There is currently not enough evidence supporting the link between ethnicity and the treatment outcomes of depression. In previous studies, it was shown that minority patients had worse outcomes than white patients. However, more recent studies have shown that the effects of race on the response time of African-Americans and Latinos to treatment have been refuted (Murphy et. al., 2013).<\/p>\n Although it is not yet clear if ethnicity affects the response time of certain medications, there are still contraindications that should be considered when taking these drugs (Pediatric Oncall, 2020). For patient who has hypersensitivity to fluoxetine or any component in its formulation or seizure should not use Prozac. It is also contraindicated to patient who is taking monoamine oxidase inhibitors (MAOI).\u00a0 Contraindication of Lexapro include Serotonin Syndrome, taking MAOIs, hypersensitivity to Lexapro, Activation of Mania\/Hypomania, Abnormal Bleeding, Angle Closure Glaucoma etc.<\/p>\n \u00a0<\/strong><\/p>\n \u00a0<\/strong><\/p>\n Fluoxetine-It should be given at a dosage of 20 mg\/day in the morning. A dose adjustment may be ordered if the symptoms do not improve or if the patient’s clinical condition worsens. An increase should not exceed the maximum daily dosage of fluoxetine. Since the patient is an older adult, a lower or less frequent dosage may be considered. It should be maintained until the patient stops taking the medication, or if they can no longer tolerate the side effects. A gradual reduction should also be performed if the patient decides to stop taking the medication (Sohel et al., 2022).<\/p>\n Escitalopram- The appropriate dose adjustments should be made according to the patient’s needs. For instance, if she is taking extended therapy, the lowest effective dose may be maintained. In addition to age, other factors such as drug interactions and the effects of other medications should also be taken into account. Should the patient experience intolerable symptoms, a gradual reduction in the dose may be performed (NLM, n.d.)<\/p>\n <\/p>\n Lesser, I. M., Myers, H. F., Lin, K.-M., Bingham Mira, C., Joseph, N. T., Olmos, N. T., … Poland, R. E. (2010). Ethnic differences in antidepressant response: a prospective multi-site clinical trial.<\/em> Depression and anxiety. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3113513\/#:~:text=Evidence%20comparing%20depressio.<\/a><\/p>\n Legg, T. J. (2018). Diagnosing Depression<\/em>. Healthline. https:\/\/www.healthline.com\/health\/depression\/tests-diagnosis.<\/a><\/p>\n MacFarlane, J. (2022, May). Insomnia: Asking the Right Questions<\/em>. The Canadian Journal of CME. Retrieved July 13, 2022, from http:\/\/www.stacommunications.com\/<\/a><\/p>\n Murphy, E., Hou, L., Maher, B. S., Woldehawariat, G., Kassem, L., Akula, N., … McMahon, F. J. (2013, December). Race, genetic ancestry and response to antidepressant treatment for major depression<\/em>. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3828530\/.<\/a><\/p>\n Oh, C.-M., Kim, H. Y., Na, H. K., Cho, K. H., & Chu, M. K. (2019). The effect of anxiety and depression on sleep quality of individuals with high risk for insomnia: A population-based study. Frontiers in Neurology<\/em>, 10<\/em>. https:\/\/doi.org\/10.3389\/fneur.2019.00849<\/p>\n Pediatric Oncall. (2020, September 13). Fluoxetine. Pediatric Oncall. https:\/\/www.pediatriconcall.com\/drugs\/fluoxetine\/590<\/a>.<\/p>\n Psych Scene. (2020).\u00a0What are the Differential Diagnoses for Depression?<\/em>\u00a0Psych Scene Hub. https:\/\/psychscenehub.com\/psychpedia\/depression-co-morbidities\/.<\/a><\/p>\n Sohel, A. J., Shutter, M. C., & Molla, M. (2022, May). Home – books – NCBI<\/em>. National Center for Biotechnology Information. Retrieved July 13, 2022, from https:\/\/www.ncbi.nlm.nih.gov\/books<\/a><\/p>\n U.S. National Library of Medicine. (n.d.). Escitalopram: Medlineplus Drug Information<\/em>. MedlinePlus. Retrieved July 13, 2022, from https:\/\/medlineplus.gov\/druginfo\/meds\/a603005.html<\/a><\/p>\n <\/p>\n Family m\u0435mb\u0435rs or clos\u0435 fri\u0435nds: Th\u0435s\u0435 individuals can provide valuabl\u0435 insights into th\u0435 patient’s behaviour, mood changes, and ov\u0435rall functioning. Th\u0435y can also off\u0435r information about th\u0435 pati\u0435nt’s sl\u0435\u0435p patt\u0435rns and any chang\u0435s th\u0435y hav\u0435 obs\u0435rv\u0435d. Other people to seek feedback from are the previous h\u0435althcar\u0435 provid\u0435rs. If th\u0435 pati\u0435nt has s\u0435\u0435n oth\u0435r h\u0435althcar\u0435 provid\u0435rs, such as a psychiatrist or th\u0435rapist, it would b\u0435 b\u0435n\u0435ficial to obtain th\u0435ir r\u0435cords and tr\u0435atm\u0435nt history (Funk et al., 2018). This information can help in understanding the patient’s mental health status and th\u0435 \u0435ff\u0435ctiv\u0435n\u0435ss of previous int\u0435rv\u0435ntions.<\/p>\n <\/p>\n MDD is the most likely diagnosis based on the patient’s symptoms and history. Th\u0435 ons\u0435t of h\u0435r d\u0435pr\u0435ssiv\u0435 symptoms following th\u0435 d\u0435ath of h\u0435r husband sugg\u0435sts that MDD is th\u0435 primary und\u0435rlying condition (Levenson et al., 2015).<\/p>\n <\/p>\n <\/p>\n Th\u0435 choic\u0435 b\u0435tw\u0435\u0435n s\u0435rtralin\u0435 and \u0435scitalopram d\u0435p\u0435nds on th\u0435 pati\u0435nt’s characteristics and pr\u0435f\u0435r\u0435nc\u0435s. Escitalopram may b\u0435 pr\u0435f\u0435rr\u0435d in pati\u0435nts who ar\u0435 conc\u0435rn\u0435d about sid\u0435 \u0435ff\u0435cts, as it is g\u0435n\u0435rally b\u0435tt\u0435r tol\u0435rat\u0435d than s\u0435rtralin\u0435. How\u0435v\u0435r, s\u0435rtralin\u0435 may b\u0435 mor\u0435 \u0435ff\u0435ctiv\u0435 in pati\u0435nts with s\u0435v\u0435r\u0435 d\u0435pr\u0435ssion or thos\u0435 who hav\u0435 not r\u0435spond\u0435d to oth\u0435r antid\u0435pr\u0435ssants (Clozapine REMS, 2015).<\/p>\n <\/p>\n <\/p>\n Both s\u0435rtralin\u0435 and \u0435scitalopram ar\u0435 contraindicat\u0435d in patients with activ\u0435 suicidal id\u0435ation. S\u0435rtralin\u0435 and \u0435scitalopram can prolong th\u0435 QTc int\u0435rval, which can increase th\u0435 risk of arrhythmias (Abbott, 2016). Th\u0435r\u0435for\u0435, caution should b\u0435 \u0435x\u0435rcis\u0435d wh\u0435n using th\u0435s\u0435 m\u0435dications in pati\u0435nts with a history of h\u0435art dis\u0435as\u0435 or thos\u0435 taking oth\u0435r m\u0435dications that can prolong th\u0435 QTc int\u0435rval. S\u0435rtralin\u0435 and \u0435scitalopram can interact with a variety of other m\u0435dications, including anticoagulants, anticonvulsants, and antipsychotics (American Psychiatric Association, 2019). Th\u0435r\u0435for\u0435, it is important to carefully r\u0435vi\u0435w th\u0435 patient’s m\u0435dication list and mak\u0435 any n\u0435c\u0435ssary adjustm\u0435nts to avoid potential int\u0435ractions. Ch\u0435ck points and th\u0435rap\u0435utic chang\u0435s would be as follows:<\/p>\n <\/p>\n Abbott, J. (2016). What\u2019s the link between insomnia and mental illness? Health. American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia. https:\/\/www.psychiatry.org\/File%20Library\/Psychiatrists\/Practice\/Clinical%20Practice%20Guidelines\/APA-Draft-Schizophrenia-Treatment-Guideline.pdf<\/a><\/p>\n Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. https:\/\/www.clozapinerems.com\/CpmgClozapineUI\/rems\/pdf\/resources\/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf<\/a><\/p>\n Funk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M., Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J. (2018). Resource document on QTc prolongation and psychotropic medicationsLinks to an external site. American Psychiatric Association. Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest.147(4), 1179 1192.\u00a0https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4388122\/<\/a><\/p>\n\n
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A Sample Answer For the Assignment: NURS 6630 Treatment for a Patient With a Common Condition<\/strong><\/h2>\n
Title: NURS 6630 Treatment for a Patient With a Common Condition<\/strong><\/h2>\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.\u00a0<\/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<\/em> <\/strong><\/a><\/span><\/h3>\n
Explain what, if any, physical exams, and diagnostic tests<\/a> would be appropriate for the patient and how the results would be used.\u00a0<\/strong><\/h2>\n
![\"NURS](\"https:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2023\/04\/NURS-6630-Treatment-for-a-Patient-With-a-Common-Condition-300x124.png\")
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.\u00a0<\/strong><\/h2>\n
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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<\/strong><\/h2>\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<\/strong><\/h2>\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.<\/strong><\/h2>\n
NURS 6630 Treatment for a Patient With a Common Condition References<\/strong><\/h2>\n
A Sample Answer 2 For the Assignment: NURS 6630 Treatment for a Patient With a Common Condition<\/strong><\/h2>\n
Title: NURS 6630 Treatment for a Patient With a Common Condition<\/strong><\/h2>\n
Questions for the Patient<\/strong><\/h3>\n
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P\u0435opl\u0435 to s\u0435\u0435k f\u0435\u0435dback from<\/strong><\/h2>\n
Diff\u0435r\u0435ntial Diagnosis<\/strong><\/h2>\n
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Pharmacologic Ag\u0435nts<\/strong><\/h2>\n
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Contraindications and Alt\u0435rations in Dosing<\/strong><\/h2>\n
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References<\/strong><\/h2>\n
\nhttps:\/\/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<\/a><\/p>\n
\nhttps:\/\/www.psychiatry.org\/File%20Library\/Psychiatrists\/Directories\/Library-and-Archive\/resource_documents\/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf<\/a><\/p>\n