Assessing And Treating Patients With Sleep/wake Disorders paper
Assessing And Treating Patients With Sleep/wake Disorders paper
Sleep-Awake Disorders
Insomnia is difficulties in falling asleep, maintaining sleep, and having a restful slumber. It is the most common sleep disorder affecting the quality of life, precipitates health conditions, and weight gain. Assessing And Treating Patients With Sleep/wake Disorders paper The presenting symptoms of insomnia are daytime fatigue, difficulties in falling asleep, waking up at night, irritability or depressed mood, poor concentration, and difficulties in returning to sleep. Assessing And Treating Patients With Sleep Awake Disorders paper Insomnia may last a few days to weeks due to stress. Chronic insomnia occurs at least three times a week for over three months. Causes of insomnia are life stressors like financial difficulties, work, and relationship issues, unhealthy lifestyle and sleep habits, anxiety disorders, chronic diseases like cancer, chronic pain due to arthritis, gastrointestinal disorders like gastritis, hormonal fluctuations, medication and substance use, neurological diseases, and other sleep diseases like restless leg syndrome (Hertenstein, et al, 2019). However, the care provider should do a complete sleep study, keep a sleep diary, and rule out health conditions when making a diagnosis of insomnia. Medication and cognitive behavioral therapy help improve the patient’s symptoms. The patient has had difficulties in falling asleep and staying asleep for over six months. The onset of the symptoms was after the sudden loss of his fiancé which has greatly affected his work performance. he has a positive history of opioid use after he had an ankle fracture. He takes at least four bottles of beer before bedtime. The patient has no other associated symptoms and other comorbidities. The essay describes three decisions when treating insomnia and how the ethical considerations impact treatment and communication. Assessing And Treating Patients With Sleep Awake Disorders paper
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Decision #1
Which decision did you select?
Trazodone 50mg PO at bedtime
Why did you select this decision?
Trazodone is a selective serotonin reuptake inhibitor that has a weak affinity to cholinergic and histaminic receptors. It is FDA approved for depression and an off-lave drug for insomnia and anxiety disorders.Assessing And Treating Patients With Sleep Awake Disorders paper Trazodone reduces the neurotransmitters associated with sleep like dopamine, serotonin, and noradrenaline thus initiating sedative effects. It is taken 1-3 hours before bedtime and after meals to reduce the morning side effects. It has a quick mode of action and achieves its maximum effects in 21 days (Vgontzas, et al, 2020). The initial dose should be low to avoid anticholinergic effects. This is the best medication for the patient because it is effective in treating insomnia. Additionally, it is tolerable with no side effects compared to other hypnotics. Assessing And Treating Patients With Sleep or Wake Disorders paper
Why did you not select the other two options provided in the exercise?
Zolpidem is a sedative-hypnotic that modulates omega-1 type GABA receptor via selective antagonism resulting in to increase in chloride conductance, neuronal hyperpolarization inhibition of action potential, and reduction in neuronal excitability that produces sedative and hypnotic effects (Xiang, et al, 2021). It is FDA approved for treating insomnia in patients with difficulties in falling asleep. However, the drug may cause loss of memory and wake up in the middle of the night. I did not select this medicine because of its side effects of sleepwalking, taking, loss of memory, and change of behavior. Additionally, the drug has a short half-life that makes the patient wake up in the middle of the night.
Hydroxyzine is a first-class antihistamine used for treating itchiness, nausea, anxiety, and tension. Its common side effects are sedation, impairment of motor function, dizziness, blurring of vision, dry mouth, palpitations, and tachycardia. Therefore, its sedative effect makes it effective in treating insomnia (Krzystanek, et al, 2021). However, I did not select this drug because of its unpleasant effects in the morning; drowsiness, fatigue, and headache. Moreover, it is in the same class as diphenhydramine which causes unpleasant effects in the morning.
What were you hoping to achieve by making this decision?
The expectations of prescribing trazodone 50mg at bedtime are to improve the ability to fall asleep, have quality rest, and maintain sleep until the desired wake-up time. Trazodone is fast-acting because its peak serum time is about 30mins and has a half-life of about 10hours. This enables the patient to fall asleep soon after taking the medication and maintain quality sleep for up to 10hours. Assessing And Treating Patients With Sleep or Wake Disorders paper
How ethical considerations impact treatment plan and communication with patients
Ethical principles are the moral values that benefit the patient, minimize harm and respect the patient’s preferences. The ethical principles, in this case, are justice and fairness. Justice is the equitable and appropriate treatment of persons. Justice will enable the care provider to communicate with the patient with respect despite their ethnicity, occupation, and social habits. Additionally, the care provider prescribes the appropriate drugs to ensure the well-being of the patient. Justice enables the care provider to schedule a follow-up clinic to monitor the patient’s progress in treatment.
Decision #2
Which decision did you select?
Explain that an erection lasting 15minutes is not priapism and should diminish over time, continue with the current dose
Why did you select this decision?
I chose to continue with this treatment because the patient reports that he sleeps well until morning. However, the drug causes arousal effects in the morning. Priapism is a prolonged erection of the penis for over four hours without sexual arousal. However, the arousal effects disappear with time as the patient continues with the treatment. to reduce the morning effects of trazodone, I will administer it two hours before bedtime.
Why did you not select the other two options provided in the exercise? Assessing And Treating Patients With Sleep Awake Disorders paper
Suvorexant is hypnotic with an orexin receptor antagonist. Orexin is a neurotransmitter that regulates arousal, wakefulness, and appetite. It is FDA approved for treating insomnia. Its plasma peak time is within two hours after drug administration and has a half-life of 12hours. I did not select suvorexant for this patient because it has a higher probability of abuse (Tampi, et al, 2018). Additionally, it has unpleasant effects like sleep paralysis, hypnagogic hallucinations, obstructive sleep apnea, and suicidal ideation. Decreasing trazodone to 25mg will not improve the patient’s symptoms because the recommended dose by the FDA is 50mg once a day up to a maximum of 200mg.
What were you hoping to achieve by making this decision?
The expectations of maintaining the current dose are to improve the quality of sleep and reduce a prolonged erection. The expected side effects are drowsiness, dry mouth, and fatigue.
How ethical considerations impact treatment plan and communication with patients
Non-maleficence is the principle that obligates the PNP not to cause pain or suffering to a patient (Rainer, et al, 2018). The PNP weighs the benefits and the burdens of all the treatment options, particularly when relieving suffering. This principle enabled the PNP to continue with the current treatment because it is effective and has no side effects on the patient. Changing the patient to suvorexant is life-threatening because it has suicidal ideation and sleeps paralysis. Assessing And Treating Patients With Sleep Awake Disorders paper
Decision #3
Which decision did you select?
Continue the dose. Explain to the patient that he may split the 50mg tablet in half. The decreased dose should help minimize next-day drowsiness. Follow-up the patient in four weeks
Why did you select this decision?
Trazodone is an effective drug with no severe side effects. The patient reports occasional drowsiness the following morning after taking trazodone 50mg. splitting the 50mg tablet in half will help the patient reduce the morning symptoms like fatigue and drowsiness.
Why did you not select the other two options provided in the exercise?
Sonata is a non-benzodiazepine barbiturate hypnotic that inhibits the GABA receptors thus reducing the hyper-arousal effects (McElroy, et al, 2021). It has a plasma peak time of one hour and a shorter half-life. It improves the ability to fall asleep and maintain sleep. However, I did not select this medicine. After all, it decreases its sleep latency within four weeks because its plasma half-life is one hour. Additionally, it has undesirable effects such as hallucination, suicidal ideation, and memory loss. Hydroxyzine is an antihistamine with sedative side effects. However, I did not initiate this therapy at this point because of its undesirable effects. Assessing And Treating Patients With Sleep Awake Disorders paper
What were you hoping to achieve by making this decision?
Splitting the 50mg tablet into half will help reduce the side effects of drowsiness. The 25mg dosage will be effective for the patient because the patient has achieved the therapeutic goal.
How ethical considerations impact treatment plan and communication with patients
Beneficence is the principle that enables the PNP to act for the benefit of a patient. In this case, the PNP acts for the benefit of a patient by relieving the symptoms and avoiding the adverse effects. Additionally, the care provider refers the patient to a psychotherapist for cognitive behavioral therapy to improve the sleep-wake pattern. This helps the patient to recover and improve his quality of life.
Conclusion
Insomnia is difficulties in falling asleep, maintaining sleep, and having a restful slumber. It is the most common sleep disorder affecting the quality of life, precipitates health conditions, and weight gain. Medication and cognitive behavioral therapy help improve the patient’s symptoms. Hypnotics and antidepressants are commonly prescribed medicine for the patient. However, the side effects and therapeutic goals determine the best between the two. SSRIs antidepressants are the best because of their therapeutic effectiveness with no side effects. Assessing And Treating Patients With Sleep or Wake Disorders paper
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Link to case study: https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_11/index.html Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Assessing And Treating Patients With Sleep Awake Disorders paper Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) Which decision did you select? Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision?Assessing And Treating Patients With Sleep or Wake Disorders paper Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #3 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Conclusion (1 page) Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. case study- https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_11/index.html. Assessing And Treating Patients With Sleep Awake Disorders paper
