Assignment 2 Assessing and Treating Patients With Sleep/Wake Disorders

A Sample Answer For the Assignment: Assignment 2 Assessing and Treating Patients With Sleep/Wake Disorders

The patient is a male patient who is 31 years old and has insomnia. Since he lost his fiancé, the sleeplessness has been worse over the past six months. The patient claimed that although he hasn’t always been a “great sleeper,” he now has trouble going to sleep or staying asleep at night. The patient claims that his inability to sleep is now impairing his performance at work as a forklift operator at a chemical plant, where he is dozing off in the course of his duties. He usually takes diphenhydramine to fall asleep, but the morning after is unpleasant.

Review of the patient’s medical file reveals that he has a history of opiate usage dating back more than 4 years, when he was prescribed hydrocodone for an ankle fracture sustained in a skiing accident. Prior to going to bed, the patient has been consuming about 4 beers and using diphenhydramine to put him to sleep. The patient is awake, alert, and aware of place, time, people, and events. The patient denies experiencing auditory or visual hallucinations and is adequately dressed. He is future-focused, denies SI or HI, and has sound insight and judgment.

Decision one

The patient was first given 50 mg of trazodone PO at bedtime. Trazodone is a drug that belongs to the category of a serotonin reuptake inhibitor and antagonist. Trazodone is an off-label treatment for insomnia and has FDA approval as an antidepressant. For those with chronic alcohol use like the patient in question, trazodone is a secure pharmaceutical option. Alcohol consumption may not interact with hydroxyzine or zolpidem to provide an additional sedative effect.

Since the patient has been taking diphenhydramine as a supplement, hydroxyzine may not be as beneficial because it works on comparable receptors. Zolpidem may cause sleepwalking and other unusual sleep habits, which are undesirable side effects. The option with less negative effects was trazodone. Trazodone may be able to address two issues since the patient also sounds like he may be having difficulties adjusting to the death of his fiancé.

Alcohol and substance abuse can be a bad coping mechanism for depressive disorders, and depression and sleeplessness are frequently co-occurring disorders. As the other two do not have antidepressant characteristics and can cause further sedations when combined with alcohol, trazodone would be the better option. Zolpidem in combination with alcohol can lead to further respiratory depression and death (Jaffer et al., 2017).

Decision two

When the patient comes back two weeks later, he says the drug works great but gives him a 15-minute erection when he wakes up. The patient additionally claims that this makes it challenging to prepare for work. He rejects auditory and visual hallucinations and is future oriented. The decision was made to reduce the dosage of trazodone to 25 mg once a day at bedtime.

An erection that lasts longer than four hours is known as priapism and is a side effect of the drug trazodone. Since the patient is still developing, lowering the dose may reduce that side effect and be a safer alternative than using the other two drugs (Settimo et al., 2018).

When the patient comes back two weeks later, he says the drug works great but gives him a 15-minute erection when he wakes up. The patient additionally claims that this makes it challenging to prepare for work. He rejects auditory and visual hallucinations and is future oriented. The decision was made to reduce the dosage of trazodone to 25 mg once a day at bedtime.

An erection that lasts longer than four hours is known as priapism and is a side effect of the drug trazodone. Since the patient is still developing, lowering the dose may reduce that side effect and be a safer alternative than using the other two drugs (Schifano et al., 2022).

Decision three

The patient returns to the clinic two weeks after the trazodone dosage is reduced and notes that while the trazodone is good for promoting sleep, the 25mg dose is occasionally insufficient for a full night’s rest. He rejects auditory or visual hallucinations and is future oriented. The choices were to keep taking the medication, encourage good sleeping habits, or return in four weeks. Stop taking trazodone and replace it with remolten 8 mg at bedtime.

Follow up in four weeks. Trazodone should be stopped, and hydroxyzine 50 mg should be prescribed at bedtime, with a follow-up after 4 weeks. The decision was made to advocate good sleeping habits and then reevaluate in four weeks. Because the trazodone was effective and he had only sometimes complained of not being able to sleep through the night, it was decided to continue using it.

If the medicine is changed, the patient may become irritated and less likely to follow instructions because it may be necessary to try several different medications and doses and run into options that don’t work (Krzystanek et al., 2020).

Because hydroxyzine has CNS depressive and sedative effects that may intensify with alcohol, causing dizziness and stumbling and a hangover effect the next morning, it is not a viable alternative to diphenhydramine. Ramelteon is a highly selective melatonin receptor agonist for MTI and MT2.This medicine may help with insomnia and enhance several aspects of sleep.

Alcohol and ramalteon both intensify each other’s effects. Ramelteon was not chosen due to the increased side effects of the drug and alcohol as well as the fact that trazodone is effective and only rarely causes interrupted sleep, making it unwise to start a new treatment (Uchiyama et al., 2019).

Conclusion

Insomnia can accompany depression or cause it, as well as result in poor work performance, anxiety, and substance abuse. The guy has been grieving the loss of his fiancé for six months and has trouble sleeping. Trazodone is an effective sedative antidepressant that affects serotonin neurotransmitters and can help with depression and sleep-related issues. The histamine class of drugs includes hydroxyzine, and the patient has been using diphenhydramine with minimal effects and lingering effects of lethargy the next day.

Since trazodone had some negative effects, reducing the dose could lessen them while maintaining the medication’s current level of effectiveness. Poor sleep hygiene can reduce most people’s capacity to sleep, making it a crucial factor to consider. Changing a patient’s drug regimen on a regular basis can result in noncompliance and frustration if the patient continues to experience unwanted side effects (Riemann et al., 2017).

References

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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842888/

Krzystanek, M., Krysta, K., & Pałasz, A. (2020). First generation antihistaminic drugs used in      the treatment of insomnia–superstitions and evidence. Pharmacotherapy in      Psychiatry and Neurology/Farmakoterapia w Psychiatrii i Neurologii, 36(1), 33-   40.       Doi:10.33450/fpn.2020.04.003

Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., … &             Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of    insomnia. Journal of Sleep Research, 26(6), 675-700. Doi: 10.1111/jsr.12594.

Schifano, N., Capogrosso, P., Boeri, L., Fallara, G., Cakir, O. O., Castiglione, F., … & Salonia,    A. (2022). Medications mostly associated with priapism events: Assessment of the     2015–2020 Food and Drug Administration (FDA) pharmacovigilance database entries. International Journal of Impotence Research, 1-5. Doi: 10.1038/s41443-022-  00583-3

Settimo, L., & Taylor, D. (2018). Evaluating the dose-dependent mechanism of action of trazodone by             estimation of occupancies for different brain neurotransmitter         targets. Journal of Psychopharmacology, 32(1), 96-104. Doi:    10.1177/0269881117742101

Uchiyama, M., Sakamoto, S., & Miyata, K. (2019). Effect of ramelteon on insomnia severity:      evaluation of         patient characteristics affecting treatment response. Sleep and Biological   Rhythms, 17(4), 379-388. https://link.springer.com/article/10.1007/s41105-019-00224-1

Assignment 2 Assessing and Treating Patients With Sleep/Wake Disorders

Sleep disorders are conditions that affect an individual’s sleep pattern (Mayo Clinic, 2020).
As might be expected, a sleep disorder can have a detrimental effect on an individual’s overall health, safety, and quality of life. Psychopharmacologic treatments can be used by psychiatric nurse practitioners to treat sleep disorders; however, many of these medications can have adverse effects on other aspects of a patient’s health and well-being.

Additionally, while psychopharmacologic treatments may be effective at addressing sleep problems, they may also interfere with waking patterns. Thus, it is critical for the psychiatric nurse practitioner to conduct an in-depth evaluation of the most effective psychopharmacologic treatments for patients presenting with sleep/wake disorders.

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_Reference: 

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

To prepare for this Assignment:

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.

The Assignment: 5 pages

Consider the following case study: Pharmacologic Approaches to the Treatment of Insomnia in a Young Adult. You will be given three options for prescribing medication to this patient.
Take into account any potential influences on the patient’s pharmacokinetic and pharmacodynamic processes.

Assessment and Treatment of Patients With Sleep/Awake Disorders. At each decision point, you should weigh all available options before making a choice and continuing with the exercise.
Prior to making a choice, ensure that you have thoroughly researched each option and have evaluated the one you have chosen. Make certain to conduct primary research on each option.

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.

Assessing and Treating Patients with Sleep/Wake Disorders

Sleep is a crucial part of human existence, much like regular exercise and a healthy diet. Adults need between 6 and 8 hours of sleep per night on average, although individual needs may vary. No matter what the underlying cause of sleep loss is, insomnia may have negative effects on both a person’s physical and mental health.

Insomnia is characterized by sleeplessness, frequent awakenings, and trouble falling asleep. As a result, patients may experience anxiety, fatigue, sleepiness, mood disturbances, and reduced cognitive performance.

The patient in the provided case study is a 31-year-old male who suffers from insomnia. The patient has trouble falling asleep, and the symptoms progressively worsen. The symptoms were brought on by the emotional pain due to the death of his fiancée. The patient’s symptoms have significantly impacted his capacity to do his duties as a forklift operator.

Insomnia was treated with diphenhydramine in his medical history. The patient began taking opiates four years ago after using hydrocodone for pain treatment. The patient consumes four beers before bed to help him sleep. The patient refuted any claims of experiencing hallucinations or harboring violent ideations.

The selection of the appropriate medication for prescription is contingent upon various patient-related factors. The patient under consideration is influenced by various factors, including his age, gender, and diagnosis of insomnia. The individual’s prior utilization of diphenhydramine, which resulted in unfavorable adverse reactions, will also be taken into account.

The individual’s social history, which includes the experience of losing his fiancé, a history of opiate abuse, and the consumption of alcohol, will also exert a substantial influence on the selection of the most appropriate pharmaceutical intervention. The purpose of this paper is to elucidate the decision-making process involved in prescribing medication for the management of insomnia in young adult individuals, while also exploring the ethical considerations associated with each decision juncture.

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 primaryliterature.
• 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.

Assessing and Treating Patients with Sleep/Wake Disorders

Getting enough sleep is crucial for overall well-being, like maintaining a regular exercise routine and eating a balanced diet. According to Madari et al. (2021), adults are generally advised to aim for six to eight hours of sleep per night, but individual needs may vary. Insomnia can adversely affect a person’s overall physical and mental health, regardless of the reasons behind it. Insomnia is characterized by the inability to sleep, frequent awakenings, and trouble falling asleep. As a result, individuals may experience symptoms including but not limited to anxiety, fatigue, drowsiness, mood disturbances, and compromised cognitive abilities.

This case study focuses on a 31-year-old male patient who is experiencing insomnia. The patient has sleeplessness, with worsening symptoms over time. The symptoms were a direct consequence of the emotional distress experienced due to the loss of his fiancée. Symptoms have significantly impacted the patient’s forklift operation. In his medical records, diphenhydramine was given as a remedy for insomnia. Four years ago, the patient started using opiates after being prescribed hydrocodone for pain relief. The individual also uses four alcoholic beverages before going to bed to promote sleep. The patient reported no hallucinations or violent thoughts.

Various patient-related factors influence the selection of medication for prescription. The patient’s age, gender, and insomnia diagnosis are all critical considerations. Previous diphenhydramine usage by the person and any adverse effects will be considered. The social background of the person—including the death of his fiancé, opiate addiction, and alcoholism—will have a significant influence on whether medicinal intervention is best. This paper explores the decision-making process and legal and ethical considerations involved in prescribing medication for the management of insomnia in the above patient.

Decision Point One

Selected Decision and Rationale

            The first intervention was giving a 50 mg dosage of trazodone just before bed. Trazodone was selected for its strong effectiveness in promoting and maintaining sleep. Trazodone has received FDA approval for the medical management of insomnia, as stated by Pelayo et al. (2023). Trazodone inhibits the production of neurotransmitters linked to arousal, including histamine, serotonin, noradrenaline, dopamine, and acetylcholine (Madari et al., 2021). Trazodone is often given to people with primary and secondary sleeplessness to help them sleep. Furthermore, studies indicate that low doses of trazodone to treat and manage insomnia are linked to a positive safety record (Vgontzas et al., 2020). Trazodone allows patients to manage sleep disturbances while remaining focused on their work.

Numerous adverse effects, including decreased inhibitory control, hallucinations, sleeplessness, and gastrointestinal discomfort, including nausea and abdominal pain, have been related to zolpidem (Madari et al., 2021). In addition, Hydroxyzine was not selected because it closely resembles the client’s diphenhydramine. In addition, the medication has sedative effects and may lead to urination retention (Wang et al., 2020).

Expected Outcome

After starting trazodone, the patient is anticipated to get more and better quality sleep over the following four weeks. It is projected that there is going to be an improvement in his general well-being and work-related focus throughout this period (Hassinger et al., 2020).

Ethical Considerations

Beneficence and nonmaleficence are ethical concepts that govern treatment options and patient-provider communication. Considering the moral concept of beneficence, it was essential to dedicate sufficient efforts to provide aid and safeguard the patient’s welfare, reducing the likelihood of potential harm (Hassinger et al., 2020). The pharmacological drug with the lowest occurrence of adverse effects was administered in the scenario without any malicious intentions.

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.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

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

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