17 Oct Discussion: Treatmentfor a Patient With a Common Condition Insomnia is one of the most common medicalconditions you will e
Discussion: Treatmentfor a Patient With a Common Condition
Insomnia is one of the most common medicalconditions you will encounter as a PNP. Insomnia is a common symptom of manymental illnesses, including anxiety, depression, schizophrenia, and ADHD(Abbott, 2016). Various studies have demonstrated the bidirectionalrelationship between insomnia and mental illness. In fact, about 50% of adultswith insomnia have a mental health problem, while up to 90% of adults withdepression experience sleep problems (Abbott, 2016). Due to the interconnectedpsychopathology, it is important that you, as the PNP, understand theimportance of the effects some psychopharmacologic treatments may have on apatients mental health illness and their sleep patterns. Therefore, it isimportant that you understand and reflect on the evidence-based research indeveloping treatment plans to recommend proper sleep practices to your patientsas well as recommend appropriate psychopharmacologic treatments for optimalhealth and well-being.
Reference: Abbott, J.(2016). Whats the link between insomnia and mental illness? Health.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
For this Discussion, review the case LearningResources and the case study excerpt presented. Reflect on the case studyexcerpt and consider the therapy approaches you might take to assess, diagnose,and treat the patients health needs.
Case: An elderly widow who just lost herspouse.
Subjective: A patient presents to your primarycare office today with chief complaint of insomnia. Patient is 75 YO withPMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 monthsago. Since then, she states her depression has gotten worse as well as hersleep habits. The patient has no previous history of depression prior toher husbands death. She is awake, alert, and oriented x3. Patientnormally sees PCP once or twice a year. Patient denies any suicidal ideations. Patientarrived at the office today by private vehicle. Patient currently takesthe following medications:
- Metformin 500mg BID
- Januvia 100mg daily
- Losartan 100mg daily
- HCTZ 25mg daily
- Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post a response to each of the following:
- List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
- Identify people in the patients life you would need to speak to or get feedback from to further assess the patients situation. Include specific questions you might ask these people and why.
- Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
- List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
- List two pharmacologic agents and their dosing that would be appropriate for the patients 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.
- 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?
- Include any check points (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.
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