Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses, 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’s 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.
Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/
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’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the 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
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 patient’s life you would need to speak to or get feedback from to further assess the patient’s 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 patient’s 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.
Week 7 Discussion
Treatment for a Patient with a Common Condition
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
a).On the occasions when you experience anxiety, do you manage to control your situation?
This is perhaps one of the important questions to ask the client to understand her current situation. The client has to get in terms with what they can manage, and hence there is a need to acknowledge the situation. The answers to this question could be a starting point for developing clues that could help them deal with the situation.
b). Based on your criteria, what could be the causes of your anxiety? Can you identify a single event that triggers the anxiety?
This question is crucial in evaluating the client’s subjective opinion regarding the cause of their depressive symptoms. It would be easier to manage the depressive symptoms if the causes of these experiences are already known. I would use the client’s perspectives to formulate some strategies to help manage the identified triggers.
c). Based on your current experiences, how would you rate your overall quality of life?
Does the extended feeling of anxiety make you feel as if your life is falling apart?
It is crucial to get updated on the client’s feedback on the level of quality of life they perceive to have. The response would allow me to evaluate whether the client spends the majority of life worrying about unnecessary events and encounters of their day-to-day life. I would become aware of the client has any held regrets on things that they wish should have been done differently. It is also necessary to know if anxiety has changed the patient’s perspectives on life or whether it has hindered the achievement of specific goals. Considering the patient’s insightsinto their current life events would help to assess the damage that has been caused by her current condition.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
I would wish to contact the husband of the patient. However, he is already deceased by the time the patients present to the office. Therefore, I would make further attempts to contact her caregiver or close members of the family. I would also ask for her consent to contact any of her previous employers or colleagues.
For the caregiver or a close family member, I would ask when the patient demonstrates anxious symptoms and how long they do last? Have you ever witnessed the patient at her worst experience? Do you recall a time when the patient received proper treatment that improved the situation? Have you seen the patient struggling to keep awake during the day and in public places?
I would request a family member to answer questions such as: Could you give a brief overview of the patient during the years before the diagnosis of this condition? Are there any instances that would contribute to the client’s change in behaviors or not? Has the client attempted to commit suicide before?
For the former boss or colleague, the most suitable questions would be: Did you ever witnessed the client showing any signs of anxiety, or aggressiveness in the workplace? Was she a team player, sad, isolated, outgoing, talkative, or withdrawn? Did she ever report anything that would make you think they had some depressive experiences?…….Please click the icon below to purchase full answer at only $10