NURS 6630 Week8 Assignment 2: Evaluation and Treatment of Patients With Sleep/Wake Disorders

NURS 6630 Week8 Assignment 2: Evaluation and Treatment of Patients With Sleep/Wake Disorders

Sleep disorders are medical conditions that disrupt an individual’s sleep patterns, potentially impacting their overall health, safety, and quality of life (Mayo Clinic, 2020). Psychiatric nurse practitioners have the ability to address sleep disorders using psychopharmacologic interventions, but it is crucial to consider the potential impact on patients’ overall well-being. This includes evaluating how these medications might affect both sleep and wake patterns. Therefore, careful assessment and selection of the most appropriate psychopharmacologic treatments are essential when treating patients with sleep/wake disorders.

Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018

To prepare for this Assignment:

1. Review this week’s Learning Resources, including the Medication Resources provided for this week.
2. Reflect on the psychopharmacologic treatments that you would recommend for assessing and treating patients with sleep/wake disorders.

The Assignment: 5 pages

Introduction (1 page)

Provide a brief overview and summary of the case study, “Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult.” Include specific patient factors that may influence your decision-making process when prescribing medication for this patient.

Decision #1 (1 page)

– Explain the decision you have chosen.
– Provide a detailed rationale for your decision, citing clinically relevant and patient-specific resources, including primary literature.
– Explain why you did not select the other two options presented in the exercise, offering specific reasons supported by clinically relevant and patient-specific resources, including primary literature.
– Describe the expected outcomes you anticipated by making this decision, providing evidence and references from the Learning Resources, including primary literature.
– Discuss how ethical considerations may impact your treatment plan and communication with the patient, giving specific examples.

Decision #2 (1 page)

– Explain the decision you have selected.
– Offer a comprehensive rationale for your decision, supported by clinically relevant and patient-specific resources, including primary literature.
– Discuss why you did not choose the other two options provided in the exercise, providing specific justifications backed by clinically relevant and patient-specific resources, including primary literature.
– Describe the expected outcomes you expected by making this decision, providing evidence and references from the Learning Resources, including primary literature.
– Explore how ethical considerations may influence your treatment plan and interactions with the patient, providing specific instances.

Noah Caputo Dermatology School Age Sick Visit Shadow Health Care Plan

Decision #3 (1 page)

– Explain the decision you have opted for.
– Provide a thorough rationale for your decision, citing clinically relevant and patient-specific resources, including primary literature.
– Explain why you did not opt for the other two options presented in the exercise, offering specific reasons supported by clinically relevant and patient-specific resources, including primary literature.
– Describe the expected outcomes you envisioned by making this decision, providing evidence and references from the Learning Resources, including primary literature.
– Discuss how ethical considerations may impact your treatment plan and communication with the patient, giving specific examples.

Conclusion (1 page)

Summarize your recommendations regarding the selected treatment options for this patient. Justify your recommendations and support your responses with clinically relevant and patient-specific resources, including primary literature.

Note: Ensure that your rationale is supported by at least five academic resources. While the course text may be used to support your rationale, it will not count toward the resource requirement. Utilize primary and secondary literature.

Reminder: The College of Nursing requires all submitted papers to include a title page, introduction, summary, and references. The Sample Paper available at the Walden Writing Center provides an example of the required elements (accessible at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). Ensure that your paper adheres to this formatting.

NURS_6630_Week8_Assignment2_Rubric

Title: Evaluation and Management of Sleep/Wake Disorders – Pharmacologic Approaches to Insomnia Treatment in a Young Adult

Introduction:

This case involves a 31-year-old male suffering from insomnia, which began six months ago after the unexpected death of his wife. The patient is employed as a forklift operator in a chemical company, and his insomnia has significantly impacted his job performance. He mentions that he has previously used diphenhydramine for sleep but dislikes the residual effects the next morning. Notably, his medical records indicate a history of opiate abuse following an ankle injury sustained during a skiing accident, for which he was prescribed hydrocodone/APAP. However, he hasn’t received an opiate prescription for the past four years. He admits to recently consuming alcohol to aid in sleep but is attentive and aware during interactions, exhibiting intact judgment, insight, and reality contact. The patient denies suicidal ideation and focuses on the future.

Decision One:

The initial treatment choice is to prescribe Trazodone at a 10 mg dose taken daily at bedtime. Trazodone has been recognized as an effective remedy for insomnia, particularly in lower doses for primary and secondary insomnia. Its affordability, owing to generic availability, makes it a cost-effective option compared to newer insomnia medications. Trazodone’s non-addictive nature distinguishes it from other insomnia medications like benzodiazepines (e.g., Valium and Xanax). Additionally, it has fewer side effects and can enhance slow-wave sleep (Yi et al., 2018).

Zolpidem was not chosen due to potential severe allergic reactions, excessive sedation, dizziness, and the risk of daytime drowsiness, which could adversely affect the patient’s job performance. Furthermore, Zolpidem may induce aggressive behavior, which is not aligned with the patient’s usual demeanor. Given the patient’s alcohol use, Zolpidem may lead to auditory and visual hallucinations. Hydroxyzine 50mg was also excluded due to its higher side effects profile compared to Trazodone. Potential side effects include skin rash, fast heartbeat, difficulty swallowing, and chest discomfort (Silvestro, 2021).

The anticipated outcome of this decision is effective insomnia treatment with the possibility of an erection lasting approximately 15 minutes as a side effect. Ethical considerations play a role in ensuring optimal patient care.

Decision Two:

The decision here is to educate the patient that the 15-minute erection is not priapism and is expected to resolve over time, allowing him to continue with the current dose of Trazodone. This choice is based on the medication’s effectiveness in treating insomnia, as well as the absence of severe side effects, aside from the prolonged erections due to its adrenergic blocking activity.

Choosing not to discontinue Trazodone and start suvorexant 10 mg at bedtime is due to the patient’s positive response to Trazodone without experiencing significant side effects. Initiating suvorexant could result in next-day drowsiness and agitation, raising concerns about its safety and efficacy. Discontinuing Trazodone and initiating treatment with sonata 10 mg at bedtime is also not advisable due to the risk of accidents associated with sonata, especially when operating machinery. Sonata’s potential side effects, such as dizziness, drowsiness, short-term memory loss, and sleep disturbances, make it a less suitable option. Sonata’s habit-forming nature and limited evidence supporting its use in long-term insomnia treatment further discourage its prescription, especially considering the patient’s history of alcohol consumption (Reeve & Bailes, 2010).

The expected outcome of this decision is the resolution of priapism and a decrease in insomnia. Ethical considerations remain paramount to minimize harm to the patient.

Decision Three:

The patient should continue with the current dose of Trazodone, with the option to split the 50mg tablet into two to reduce next-day drowsiness. Lowering the dose is intended to mitigate side effects while maintaining effectiveness in treating insomnia. Lower doses of Trazodone have demonstrated similar efficacy with fewer adverse effects (Yi et al., 2018).

Opting against discontinuing Trazodone and initiating hydroxyzine 50 mg at bedtime is due to hydroxyzine’s extended half-life of approximately 20 hours, which can result in daytime sedation. Hydroxyzine also presents a higher side effect profile compared to Trazodone, including Xerostomia and Xerophthalmia (Silvestro, 2021).

The expected outcome of this decision is an improvement in the patient’s condition, reduced priapism, and decreased daytime drowsiness. Ethical considerations continue to guide treatment to promote the patient’s well-being (Haddad & Geiger, 2018).

References:

Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations.

Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., … & Ishak, W. W. (2017). Trazodone for insomnia: a systematic review. Innovations in clinical neuroscience, 14(7-8), 24.

Jung, M. (2018). Zolpidem overdose: a dilemma in mental health. The Health Care Manager, 37(1), 86-89.

Reeve, K., & Bailes, B. (2010). Insomnia in adults: Etiology and management. The journal for nurse practitioners, 6(1), 53-60.

Silvestro, S. (2021). Hydroxyzine (Vistaril): dosage, uses, side effects. Drugs.